Vulvar hidradenitis suppurativa: Clinical cross-sectional study of 25 patients

Hidradenitis suppurativa (HS) involving the vulva is seldom reported in the gynecological or dermatological literature. The aim of this study was to describe the clinical characteristics of HS with vulvar affectation (VHS) and to compare it with patients without vulvar involvement. A cross-sectional study was conducted in a tertiary academic referral centre in Spain from May 1, 2015 to October 1, 2019. This study included 230 women with HS diagnosed in our hospital, 25 of them had vulvar involvement. In order to clinically characterize patients, demographic factors, comorbidities, clinical features, prescribed treatments and complications were recorded. The VHS group presented later median age of onset and lower body mass index (BMI) (P = 0.048), they mainly belonged to latent class 2 (LC2) and LC3 phenotypes involving groins, perineal and pubic area. A higher incidence of psychiatric disease was found in VHS (32% vs 10.7%). Significant positive association with fistula (P < 0.001), LC2 phenotype (P = 0.014), acne (P = 0.021) and thyroid disease (P = 0.006), and negative association with axillar lesions (P = 0.001) were noted. Ultrasonographical study of vulvar lesions demonstrated that most of them were fistulas with high Doppler signal suggestive of high inflammatory load. In conclusion, VHS is mostly seen in women with later onset and lower BMI and higher incidence of psychiatric disease compared to those without vulvar involvement. It is clinically characterized by the presence of fistulas and barely absent axillary involvement. Early diagnosis and treatment could be essential to prevent complications and quality of life impairment.