Hidradenitis suppurativa: a disease with male predominance in Tunisia.

Background: hidradenitis suppurativa (HS) is a chronic inflammatory, suppurating, fistulizing, and scar-producing disease of apocrine gland-bearing skin. The diagnosis is primarily clinical, based on the presence of both sinus tracts and abscesses with a characteristic distribution.
Objective: Review of epidemiological, clinical, and prognostic characteristics of HS and discussion of the etiopathogenic aspects of this chronic problem.
Patients and Methods: We retrospectively report all cases of HS followed at the Department of Dermatology between January 1985 and December 2008.
Results: Eleven patients (10 male and 1 female), with a mean age of 35.2 years (range 21 dash, vertical53 years) at HS diagnosis were followed for HS. The average age of disease onset was 23.9 years. The median delay between onset of symptoms and diagnosis was 144 months (range 1 dash, vertical408 months). Clinical features showed inflamed discharging papules or nodules, painful tender erythematous nodules, and double-ended comedones. The disease mainly affected the axillary, anal, perineal, and genital areas. Histologically, dermal features showed active folliculitis or abscess, sinus tract formation, fibrosis, and granuloma formation. Pathological associations (Darier's disease and Down syndrome) were noted in two patients. Treatment consisted of antibiotics in eight patients, retinoids (1 mg/kg/ day) in three patients, and surgery in three patients. The mean follow-up was 13 months (range 2 dash, vertical30 months). Recurrence of lesions was observed in all patients approximately 1 month after treatment withdrawal. The Down syndrome patient developed vaginal hydrocele of the testis as a complication of his staphylococcic ulcers. In all cases healing occurred with substantial scarring.
Discussion: An obvious male predominance was noted in our patients as well as a delay in the diagnosis of HS, which could be explained by non-recognition of the disease by non-specialists that see the patients at the primary-care level.