Friday, March 20, 2009


A 25 year old man with obesity presents with the skin finding above. He notes the lesions in his axillae, inguinal area, inner thighs, and perianal and perineal skin. He said it started at puberty with solitary, painful nodules lasting several weeks or months. He was diagnosed with "boils" and "furunculosis" at the time. Since then, he's always had a few active lesions; they are intensely painful; he can barely walk or sit without pain. A few of these skin lesions have become infected over the years, developed into abscesses, and ruptured externally, draining pus. That relieves the pain. Healing of these lesions has lead to dense fibrotic bands and indurated thick-scarred plaques.

Challenge: This disease is actually more common in women (3:1) but this was the best picture I found. What's the diagnosis?

Image shown under Fair Use.


deardoc said...

Inversa Acne..(hidradenitis suppurativa) is a chronic relapsing inflammatory skin disease characterized by recurrent draining sinuses and abscesses, predominantly in skin folds that carry terminal hairs and apocrine glands..Journal of Investigative Dermatology (2006) 126, 1302–1306

From the photo,could not deduce what it could be, had to depend entirely on the internet this time. i'd read about it somewhere but never saw a picture, so couldn't connect the case to the photo. my compliments to you on finding on such rare cases and photos...keep it up! I only wish you could post cases more frequently.

Craig Chen said...

Nice job! That was a hard one - I've only seen it once, and I had no idea what it was.

Hidradenitis suppurativa (also known as acne inversa) is a chronic follicular occlusive disease involving the intertriginous skin of the axillary, groin, perianal, perineal, and inframammary regions. It has a variable clinical course.

Sources: UpToDate;