Now I want to talk about something much more pedestrian, that is hidradenitis suppurativa (HS), shown in the picture involving the axilla. The history of this is that it has been believed to be a disorder of the apocrine gland-bearing follicular skin. Clearly, as pediatricians, you are much more likely to see this in the ER than in the ICU. HS was described by Velpeau in 1839 in a patient with an inflammatory process involving the axilla, the inframammary zones and the perianal skin. In 1854, Veneul named the disease and ascribed it to the sweat glands. However, while it still carries that name, modern theory is that HS is a misnomer - it is NOT primarily suppurative, nor is it primarily an apocrine disorder. HS results from follicular plugging and rupture with secondary inflammation and infection and then secondary apocrine involvement.
It is part of a follicular occlusion tetrad that includes the following diseases, all of which stem from follicular occlusion as the initial event.