1. Follicular Pathophysiology
Hidradenitis Suppurativa (HS) is a chronic inflammatory cicatricial disease of terminal hair follicles in intertriginous skin (axillae, groin, perineum, submammary). It begins with follicular infundibular hyperkeratosis, occlusion, rupture, and intense foreign-body immune responses resulting in painful subcutaneous nodules, abscesses, and draining sinus tracts.
2. Hurley Clinical Staging System
- Hurley Stage I: Solitary or multiple isolated abscesses without sinus tract formation or cicatrization.
- Hurley Stage II: Recurrent abscesses with sinus tract formation and early scarring, widely separated lesions.
- Hurley Stage III: Diffuse or broad involvement across entire anatomical regions with interconnecting sinus tracts and extensive fibrotic scar sheets.
3. Modern Treatment Landscape
Combines oral rifampin/clindamycin, anti-TNF biologics (Adalimumab, Secukinumab), and surgical deroofing or wide local excision.