Background:
Hidradenitis suppurativa (HS) is an immune-mediated disorder affecting hair follicles mainly located in the apocrine gland-bearing area. It presents suppurative lesions consisting of nodules, abscesses, and fistulas that exhibit a variable degree of inflammatory activity.
Materials and Methods:
A prospective, single-center observational study was designed to correlate clinical and ultrasonographic parameters with the “lesions’ evolution” at the end of the study, the probability of flaring or undergoing a surgical/CO2-laser intervention.
Results:
Sixty-one patients (25 males and 36 females) with a mean age of 29.5±7.5 years who had a total baseline number of 127 inflammatory nodules, 43 abscesses, and 62 fistulas were recruited.
After a mean follow-up time of 77.9 weeks, 40%, 14%, 8% of nodules, abscesses, and fistulas respectively had healed, 5%, 30%, 29% were free of inflammation, 47%, 33%, 63% had an inflammatory status, and 8% and 23% of nodules and abscesses had evolved into fistulas. There were 137 flare episodes in the acute lesions (nodules + abscesses) and 54 in the chronic lesions (fistulas), while the number of procedural interventions was 59 and 50, respectively.
The predictive factors associated with an unfavorable evolution (inflammatory status or chronicity) for abscesses and nodules were: presence of hair tracts, high degree of Power Doppler (PD) and edema on ultrasonography, depth of localization and genital body area; for fistulas the predictors were: depth of localization, edema, and size.
The probability of an acute lesion going to procedural intervention correlated with: age, presence of hair tracts, high degree of PD, edema, and depth of localization; for fistulas the only independent predictor was size.
The predictors of flare for abscesses and nodules were: young age at disease onset, PD signal, hair tracts, depth of localization, and size; in the case of fistulas the predictors were: axillary localization, depth of localization, edema, and size.