A chronic inflammatory skin condition, often misdiagnosed for nearly a decade, is prompting calls for greater awareness among medical practitioners. Hidradenitis suppurativa (HS), also known as Verneuil’s disease, affects an estimated 1% of the population in France – over 670,000 people – yet diagnosis remains significantly delayed.
HS is a long-term autoimmune condition characterized by painful, recurring boils and abscesses in areas where skin rubs together, such as the armpits, groin, and under the breasts. The disease can manifest in less common areas like the face, back, or buttocks. While the exact cause remains unclear, research points to a combination of genetic predisposition, environmental factors like smoking and diet, and potentially hormonal influences, with a higher prevalence among women.
The diagnostic process is primarily clinical, relying on the observation of typical lesions: painful nodules and abscesses that develop into pus-filled sores, fistulas, and hypertrophic scarring. A key indicator is the recurrence of these lesions, with at least two flare-ups occurring within a six-month period. Importantly, no specific laboratory tests are required to confirm a diagnosis.
Despite the clear diagnostic criteria, the average delay in diagnosis remains between eight and ten years, according to medical professionals. This delay can significantly impact a patient’s quality of life, leading to chronic pain, social isolation, and psychological distress. Experts emphasize the necessitate for physicians to consider HS in any patient presenting with persistent nodules, cysts, or abscesses in the characteristic areas.
Treatment for HS is multifaceted and tailored to the severity of the condition, categorized using the Hurley score. Grade I involves single or multiple abscesses without fistulas or significant scarring. Grade II is characterized by recurring abscesses with fistula formation and hypertrophic scars. Grade III represents widespread and interconnected abscesses and fistulas, affecting a smaller proportion of patients.
Initial management of Grade I HS typically involves oral antibiotics for acute flare-ups, such as amoxicillin-clavulanate or pristinamycin, for a seven-day course. Prophylactic antibiotic therapy, using doxycycline or lymecycline, may be considered for patients experiencing four or more flare-ups annually. Topical antibiotics and antiseptics are generally not recommended due to the risk of antibiotic resistance and lack of proven efficacy.
For moderate to severe cases (Grades II and III), a multidisciplinary approach is crucial, often involving dermatologists, surgeons, and potentially other specialists. The advent of biologic therapies has significantly altered the treatment landscape, demonstrating efficacy in approximately half of patients. These systemic treatments are used in conjunction with surgical excision of affected areas, which can sometimes require extensive procedures and prolonged healing times.
The French Society of Dermatology recommends that treatment decisions be made in coordination with the patient’s primary care physician, ensuring a comprehensive and coordinated care plan. A specialized center for more severe cases is recommended for a multidisciplinary consultation.
