The profile of a patient with HS is it occurs from sometime in puberty up to 40 years of age. There is a 4:1 female to male ratio and with that there appears to be some hormonal underpinning of this, as it appears to be worsened with menses or with the use of oral contraceptives. It is associated with obesity, hirsutism and, as described, acne. The primary sites of involvement are axillary, inguinal, perineal and the intra and inframammary zones.
Clinically, it presents as a painful subcutaneous nodule, usually in the axilla. This resolves and/or ruptures. Multiple nodules can form and coalesce, which results in abscess formation. They develop sinus tract drainage and cavitation of these coalescent nodules with fibrosis. These problems can be recurrent and relapsing.
The common areas of infection, in decreasing order of frequency, are:
- axillary
- inguinal-genital
- gluteal folds
- infraumbilical
- inter and inframammary
- perineal and perianal
- pubic
- scalp and neck
The disease is staged based on the severity of involvement. Stage III disease is what the surgeon usually sees.