Hidradenitis suppurativa in primary care: From early recognition to modern management

Abstract

Hidradenitis suppurativa (HS), also known as acne inversa, is a heterogeneous, chronic, relapsing inflammatory disease of the pilo-sebaceous unit, primarily affecting intertriginous areas such as the axillae, groin and anogenital region. Despite its relatively low global prevalence, HS remains underdiagnosed, especially in primary care settings, where it is often mistaken for recurrent boils. The pathogenesis is multifactorial, involving follicular occlusion, immune dysregulation, genetic susceptibility, microbiome imbalance, hormonal influences and lifestyle factors. Hidradenitis suppurativa typically presents after puberty with a peak incidence during the second and third decades of life. The condition is characterised by painful nodules, abscesses and in advanced stages of the disease, forms sinus tracts and scars that greatly impair quality of life. Early recognition and a multidisciplinary management approach, including lifestyle modification, long-term medical therapy and surgical intervention when indicated, are essential to prevent disease progression and complications. This article provides an evidence-based overview of HS and practical guidance for family practitioners on its recognition, classification and management within the South African context.