Vulvoperineal Hidradenitis Suppurativa: Diagnosis, Treatment, and Management of Deformities

Abstract

Importance: Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists.Objective: The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition.Evidence Acquisition: Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including "hidradenitis suppurativa," "pathogenesis," "prevalence," "management," "surgery," "perineal," and "vulva."Results: Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management.Conclusion: Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease.Relevance: Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.Target Audience: Obstetricians and gynecologists, family physicians.Learning Objectives: After completing this activity, the learner should be better able to describe the presentation and staging of hidradenitis suppurativa; explain possible medical and surgical treatments; and identify options for correction of vulvar deformities.Hidradenitis suppurativa (HS) is a chronic, inflammatory cutaneous disorder that occurs with a predilection for intertriginous locations such as the axilla, buttock, perineum, and groin. [1][2][3] It is a progressive disease characterized by the formation of abscesses, fistulas, and draining sinuses, as well as marked fibrosis leading to irregular, hypertrophic scarring. 1,2,4 Clinical staging is usually denoted using Hurley classification, although there are several additional verified schemata that can be used. Although historically considered rare, the overall prevalence of HS is likely anywhere between 0.1% and 4%. [5][6][7] Pathogenesis was originally felt to center on apocrine glands and follicular occlusion, but in recent years, it has been characterized as a chronic inflammatory disorder primarily centering on hair follicles. 8,9 In addition,

Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery—Pathogenesis, Comorbidities, and Current Treatments

“…This understanding enables them to facilitate early diagnosis, effective management, and appropriate referrals, all of which contribute to optimal outcomes for patients. Moreover, this knowledge equips gynecologists and primary care physicians to identify potential solutions for addressing vulvar deformities that might arise due to Hidradenitis suppurativa (HS) [ 47 ].…”