Vulvar hidradenitis suppurativa

Specialty: Gynecology and breast.

• Swallows in the vulva
• genital inverse acne
• recurrent painful vulvar nodules

Why it occurs

• Follicular occlusion of the epithelium of the apocrine areas of the vulvar labia majora with chronic perifollicular inflammation
• Dysfunction of the innate cutaneous immune system of genetic basis
• Environmental triggering or exacerbating factors (obesity, active smoking, mechanical friction due to tight clothing or repeated hair removal of the intimate area)

Initial workup

Clinical diagnosis using Hurley's classification (stages I, II and III according to the presence of isolated nodules, fistulas or confluent scar tracts). Culture of fistula exudate to rule out superinfections by specific germs (Staphylococcus aureus, Pseudomonas aeruginosa). High-resolution vulvar soft tissue ultrasound to delineate the depth of fistulas and collections.

Standard management

• Clindamycin 1% in topical solution applied twice a day in stage I lesions
• Doxycycline 100 mg orally every 12 hours for 10-12 weeks as anti-inflammatory treatment and systemic antibiotic of choice in moderate stages
• Combination of Clindamycin 300 mg every 12 hours and Rifampin 300 mg every 12 hours orally for 10 weeks in severe refractory cases
• Adalimumab (anti-TNF antibody) under the guidance and indication of a specialist in severe active hidradenitis (note: it is strongly recommended to stop smoking and use cotton underwear that does not put pressure on the area).