University of Kansas School of Medicine-Wichita, Wichita, KS, USA.
Am Fam Physician. 2019 Nov 1;100(9):562-569.
Hidradenitis suppurativa is a chronic folliculitis affecting intertriginous areas. Onset generally occurs in young adulthood to middle adulthood (18 to 39 years of age). Females and blacks are more than twice as likely to be affected. Additional risk factors include family history, smoking, and obesity. Hidradenitis suppurativa is associated with several comorbidities, including diabetes mellitus and Crohn disease. The clinical presentation of hidradenitis suppurativa ranges from rare, mild inflammatory nodules to widespread abscesses, sinus tracts, and scarring. Quality of life is often affected, and patients should be screened for depression. Treatment includes wearing loose-fitting clothes, losing weight if overweight, and smoking cessation. Topical clindamycin alone can be effective for patients with mild disease. Patients with moderate disease can be treated with oral antibiotics, such as tetracyclines, in addition to topical clindamycin. Adalimumab, a tumor necrosis factor alpha inhibitor, is effective for patients with moderate to severe hidradenitis suppurativa. Surgical procedures are often necessary for definitive treatment and include local procedures, such as punch debridement and unroofing/deroofing. Wide excision is indicated for patients with severe, extensive disease and scarring.
化脓性汗腺炎是一种影响皱褶部位的慢性毛囊炎。发病通常发生在青年期到中年期（18 岁至 39 岁）。女性和黑人的发病率是男性和白人的两倍以上。其他危险因素包括家族史、吸烟和肥胖。化脓性汗腺炎与多种合并症有关，包括糖尿病和克罗恩病。化脓性汗腺炎的临床表现从罕见的轻度炎症性结节到广泛的脓肿、窦道和瘢痕形成不等。生活质量通常受到影响，患者应接受抑郁筛查。治疗包括穿着宽松的衣服、超重者减肥和戒烟。对于轻度疾病的患者，单独使用局部克林霉素可能有效。对于中度疾病的患者，可以在局部使用克林霉素的基础上使用口服抗生素，如四环素。对于中重度化脓性汗腺炎患者，肿瘤坏死因子-α抑制剂阿达木单抗有效。手术通常是必要的，包括局部手术，如打孔清创术和切开引流术。对于严重、广泛病变和瘢痕形成的患者，建议进行广泛切除术。
