![]() Number and scores of lesions for each region: Nodules = 1 fistulae = 6 ![]() Stage III-multiple interconnected sinus tracts and abscesses throughout an affected region more extensive scarringĪnatomical regions involved: Axilla (left and/or right), groin (left and/or right), gluteal (left and/or right), or other region (e.g., inframammary): 3 points per region involved Stage II-one or more widely separated recurrent abscesses, with sinus tract and scar formation Stage I-one or more abscesses with no sinus tract or scar formation 3.Ī gluteal HS subtype, representing 26% of cases, most often seen in smokers with lower body mass index (BMI) and with a morphology characterized by follicular papules, folliculitis, and gluteal involvement. 2.Ī follicular HS subtype, representing 26% of cases manifesting primarily in male smokers with a family history of HS and characterized by follicular lesions, including epidermal cysts, pilonidal sinus, comedones, and severe acne. Three clinical subtypes of HS have been recently proposed 1: 1.Ī classic axillary-mammary HS subtype, representing 48% of cases and characterized by breast and axillary involvement and hypertrophic scarring. The disease is often mistaken for a simple infection and a long delay in diagnosis is common. There is often a poor response to conventional antibiotics and no pathogens isolated from cultures of lesions. There is a strong tendency toward relapse and recurrence. Less common sites include the inguinal region, the breasts (more often in women), and the perineal or perianal skin (more often in men). The axilla is the most common site ( Fig. Stage III: Diffuse involvement of entire area with abscesses, sinus tracts, and scarring Stage II: Multiple abscesses plus sinus tracts and scarring 3. Stage I: Abscesses without sinus tracts or scarring 2. Ĭlassified into Hurley Stages ( Table E1): 1.Painful erythematous papules and nodules leading to painful abscesses with foul-smelling discharge 2.ĭermal contractures and ropelike elevation of the skin 3.Ĭomedones in the apocrine, gland-bearing skin Įarly symptoms include pain, itching, burning, erythema, and hyperhidrosis.The course of HS is prolonged and marked by intermittent periods of activity and remission. The diagnosis is primarily clinical, based on the development of typical lesions in a characteristic distribution, with a relapsing nature.
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