Hidradenitis Suppurativa Perineal and Perianal

Hidradenitis suppurativa (HS) is a chronic inflammatory, recurrent, and a debilitating skin disorder that affects the follicular epithelium, specifically of apocrine-gland-bearing regions (such as axillae, inframammary folds, groin, perineal, and/or perigenital). HS prevalence is around 1–4%, and the perineal disease is more common in males. HS is initially characterized by perifollicular lymphocytic infiltrate, which causes glands’ duct occlusion, dilation, rupture of the follicle, and increased inflammation. The result is the formation of tunnels (fistulas) connecting the glands to the skin’s surface. Secondary bacterial infections may occur. The etiological factors are obesity, smoking, and hormones, with a genetic predisposition of up to 40% of patients. HS usually occurs in early adulthood, with inflamed skin nodules, abscesses, pus discharge tunnels, and scarring developed in axillary, inguinal, gluteal, and perineal body sites. The diagnosis is made clinically based on typical lesions, affected regions, and progression (chronicity, persistent lesions, and recurrence). The therapy for HS must be individualized and guided by severity. They range from topical and systemic antibiotics, retinoids, immunosuppressive drugs, local therapies such as laser, phototherapy, hyperbaric, and even regulated and extensive surgical resections, which may be associated with skin grafts