We are used to seeing hidradenitis suppurativa involving the
axillae and groins but sometimes it becomes more extensive and sinuses and
draining abscesses form extensively on the trunk as in this case. Hidradenitis
suppurativa is considered a disease of apocrine glands usually affecting young
people or obese diabetics. Bacterial cultures can sometimes be negative but
always ask for anaerobic culture as well. Patients with this condition may have
other inflammatory diseases such as
cystic acne and dissecting cellulitis of the scalp. Treatment with antibiotics
and surgical drainage of abscesses was often unsuccessful and long term
scarring and depression were commonly seen in these patients. A major recent
development has been the availability on the PBS of the biologic adalimumab, a
cytokine TNF alpha inhibitor given by subcutaneous injection every two weeks.
This shuts off the inflammation in this disease and the abscesses and sinuses
dry up. Therapy has to be continued in the longer term but patients get their
life back!
