Peer Reviewed

Photo Quiz

A 28-Year-Old Man With Draining Nodules and Cysts in His Axilla

Allison Robbins, MD
Oliver J. Wisco, DO, FAAD, FACMS
Isabelle Moseley, BA
Volume 63 - Issue 4 - April 2023

  • AFFILIATIONS:
    1Warren Alpert Medical School of Brown University, Providence, Rhode Island
    2Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
    3Director, Department of Cutaneous Oncology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
    4Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island

    CITATION:
    Moseley I, Robbins A, Wisco OJ. A 28-year-old man with draining nodules and cysts in his axilla. Consultant. 2023;63(4):e3. doi:10.25270/con.2022.07.000018

    Received January 24, 2022. Accepted February 28, 2022. Published online July 29, 2022.

    DISCLOSURES:
    The authors report no relevant financial relationships.

    DISCLAIMER:
    The authors report that informed patient consent was obtained for publication of the images used herein.

    CORRESPONDENCE:
    Isabelle Moseley, BA, Brown University, 339 Eddy Street, Providence, RI 02903 (isabelle_moseley@brown.edu)

     

    A 28-year-old man with a medical history significant for mild hypertension and pre-obesity presents with bilateral draining nodules and cysts with sinus tract formation in the axillae (Figure). He has minimal involvement of the inguinal folds.

    Hidradenitis suppurativa

    Figure. Axillary nodules and draining cysts

    A full-body examination of the skin reveals no other similar lesions, and there is notable sparing of the oral mucosa and nails. No lymphadenopathy was observed. The lesions have been present since his early teenage years and seem to wax and wane but never fully resolve. They can be very sore and periodically have a foul odor.

    Answer and discussion on next page.

References

1. Micali G. Hidradenitis Suppurativa: A Diagnostic Atlas. John Wiley & Sons; 2017.

2. Collier EK, Parvataneni RK, Lowes MA, et al. Diagnosis and management of hidradenitis suppurativa in women. Am J Obstet Gynecol. 2021;224(1):54-61. doi:0.1016/j.ajog.2020.09.036

3. Ibler KS, Kromann CB. Recurrent furunculosis – challenges and management: a review. Clin Cosmet Investig Dermatol. 2014;7:59-64. doi:10.2147/CCID.S35302

4. Alavi A, Shah M, Kang NC. Inflamed, purulent axillary nodules. Am Fam Physician. 2020;102(2):111-112.

5. Pekarek B, Buck S, Osher L. A comprehensive review on Marjolin's ulcers: diagnosis and treatment. J Amer Col Certif Wound Spec. 2011;3(3):60-64. doi:10.1016/j.jcws.2012.04.001

6. Kalra MG, Higgins KE, Kinney BS. Intertrigo and secondary skin infections. Am Fam Physician. 2014;89(7):569-573.

7. Zouboulis CC, Del Marmol V, Mrowietz U, Prens EP, Tzellos T, Jemec GBE. Hidradenitis suppurativa/acne inversa: criteria for diagnosis, severity assessment, classification and disease evaluation. Dermatology. 2015;231(2):184-190. doi:10.1159/000431175

8. Garg A, Lavian J, Lin G, Strunk A, Alloo A. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;77(1):118-122. doi:10.1016/j.jaad.2017.02.005

9. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Amer Acad Dermatol. 2009;60(4):539-561. doi:10.1016/j.jaad.2008.11.911

10. Vasanth V, Chandrashekar BS. Follicular occlusion tetrad. Indian Dermatol Online J. 2014;5(4):491-493. doi:10.4103/2229-5178.142517

11. Vossen ARJV, van der Zee HH, Prens EP. Hidradenitis suppurativa: a systematic review integrating inflammatory pathways into a cohesive pathogenic model. Front Immunol. 2018;9:2965. doi:10.3389/fimmu.2018.02965

12. Sayed CJ, Hsiao JL, Okun MM, Hidradenitis Suppurativa Foundation Women's Health Subcommittee. Clinical epidemiology and management of hidradenitis suppurativa. Obstet Gynecol. 2021;137(4):731-746. doi:10.1097/AOG.0000000000004321

13. Dauden E, Lazaro P, Aguilar MD, et al. Recommendations for the management of comorbidity in hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2018;32(1):129-144. doi:10.1111/jdv.14517

14. Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol. 1983;22(5):325-328.

15. Jemec, G.B. and P. Wendelboe, Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39(6):971-974.

16. Saunte DML, Jemec GBE. Hidradenitis suppurativa: advances in diagnosis and treatment. JAMA. 2017;318(20):2019-2032. doi:10.1001/jama.2017.16691

17. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101. doi:10.1016/j.jaad.2019.02.068

18. Włodarek K, Ponikowska M, Matusiak Ł, Szepietowski JC. Biologics for hidradenitis suppurativa: an update. Immunotherapy. 2019;11(1):45-59. doi: 10.2217/imt-2018-0090