Hidradenitis suppurativa of the perineum, scrotum, and gluteal area: presentation, complications, and treatment

Hidradenitis suppurativa is an infrequent inflammatory process that begins as an infection in the apocrine sweat glands. From an initial focus, the infection spreads to involve other tissues of the skin and adjacent structures. When inadequately treated or neglected, the disease becomes chronic with suppuration, sinus formation, invasion of adjacent organs, and occasional malignant degeneration. Social and occupational dislocations are the rule. The peak incidence of the disease is in the third and fourth decades. Blacks and women are most often affected.Our clinical experience with hidradenitis of the scrotum, perineum, and gluteal area is presented. One patient had an associated adenocarcinoma and another had osteomyelitis. All but one had neglected the disease. Emphasis is placed on early and appropriately wide excisional therapy for the disease in all its manifestations. Incision and drainage and antibiotics are of limited value and are best used as preliminaries to definitive excisional therapy.