Painful Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronically relapsing skin disorder characterized by recurring inflammatory lesion in hair and apocrine gland-bearing skin creases in the axilla; groin or perineum, buttocks, and/or breast. HS may lead to painful eruptions and malodorous discharge significantly detracting from quality of life. HS causes a high degree of morbidity with the highest scores obtained for the level of pain caused by the disease. The majority of patients rated their pain on a Numerical Rating Scale-11 ranging from 4/10 to 10/10 and described it at various times as hot, burning, pressure, stretching, cutting, sharp, taut, splitting, gnawing, pressing, sore, throbbing, and aching. Despite the severe pain associated with this disease, HS has been essentially ignored in the pain medicine literature. It is hoped that greater understanding of the diagnosis, pathophysiology, and potential treatment options available for patients with HS, may help put pain specialists in a better position to contribute to the overall care of patients with significantly painful HS. This article reviews HS and pain. Potential mechanisms of modulating nociceptive processes in the skin are presented. A greater understanding of the diagnosis, pathophysiology, and potential treatment options for HS patients may help providers to be better able to contribute to care of patients with painful hidradenitis suppurativa.