Advancing Our Understanding of Hidradenitis Suppurativa: A Comprehensive Guide for Clinicians Designed to Improve Therapeutic Outcomes for Patients-Part 1.

Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that usually starts in the second or third decade of life and has a profound negative impact on quality of life of those who are affected. HS presents with both inflammatory and cicatricial lesions that are often markedly symptomatic, including pain and purulent discharge, and commonly affect areas that are intertriginous, resulting in additional frictional and mechanical discomfort. The pathophysiology is complex and incompletely understood and results in changes that are transcutaneous, involving the epidermis, superficial dermis, and deep dermis with inflammation, scarring, and sinus tract (tunnel) formation. Effective treatment warrants a timely, accurate diagnosis with early intervention with systemic therapy needed to prevent progression of disease in cases that do not remain as mild, well managed, and stable. The goal of this 4-part article series on HS is to be practical, reasonably comprehensive, and clinically useful as a "guidance tool" to assist clinicians in managing HS. This first article of the series includes a disease overview of HS, an overview of pathophysiology, important details of physical examination, suggested laboratory evaluations, and the significance and rational assessment of potential comorbidities.