Case Report: Managing Hidradenitis Suppurativa in a 45-Year-Old Female with Chronic Axillary Flares
by: Dr. Caroline Vaughn
Introduction
At Village Dermatology, serving patients throughout Katy and Houston, Texas, we frequently see individuals struggling with hidradenitis suppurativa (HS)—a chronic inflammatory skin condition that can significantly impact quality of life. This case highlights the evaluation and management of a 45-year-old female with a one-year history of recurrent, painful lesions under both arms.
Case Presentation
A 45-year-old female presented as a new patient for evaluation of a persistent rash and painful swelling involving both axillae (underarms). The affected areas were red, swollen, tender, and draining fluid. The condition had persisted for about one year, and prior treatments with mupirocin ointment and ibuprofen (Motrin) offered minimal relief.
Her medical history included type 2 diabetes mellitus and hypertension, managed with metformin and lisinopril. She denied tobacco or alcohol use.
Clinical Examination
Examination of the right and left axilla revealed multiple inflammatory nodules, pustules, scarring, and sinus tracts, characteristic of advanced-stage hidradenitis suppurativa. The findings were consistent with a chronic, relapsing disease pattern.
Diagnosis
Hidradenitis Suppurativa (HS) – Stage II/III
ICD-10: L73.2
The presentation included weeping acneiform pustules and papules with scarring and sinus tract formation in both axillary vaults.
Treatment and Management
The patient was counseled on the chronic and recurrent nature of HS and educated on comprehensive treatment strategies, including:
Antibacterial cleansing with benzoyl peroxide wash
Topical antibiotic therapy with clindamycin 1% gel applied daily
Oral antibiotic therapy with doxycycline 100 mg twice daily for 3 months
Intralesional corticosteroid (Kenalog) injections administered to two inflamed nodules (5 mg/cc concentration, 1 cc total volume)
The risks of skin atrophy from steroid injections were discussed. She was also advised to practice gentle hygiene and wear breathable clothing to minimize irritation.
Long-Term Management Discussion
To reduce recurrence and disease progression, the patient was counseled on long-term options, including:
Spironolactone (for hormonal modulation)
Biologic therapy (such as adalimumab) for moderate to severe HS
Surgical excision for persistent or extensive sinus tracts
The patient was referred to Dr. Rodger Brown, Plastic Surgery (Houston, TX) for consultation regarding surgical management should she elect to pursue definitive treatment.
Follow-Up Plan
The patient will return in two months for reassessment of her response to oral and topical therapy. She was advised to contact the office sooner if she experiences worsening lesions or persistent drainage.
Discussion
Hidradenitis Suppurativa is a chronic inflammatory condition often mistaken for recurrent infections or acne. It typically affects areas with apocrine glands—such as the underarms, groin, or inframammary folds—and can lead to scarring, abscesses, and sinus tract formation over time. Early and consistent dermatologic care is essential for controlling inflammation, preventing complications, and improving quality of life.
At Village Dermatology, our team provides a comprehensive, individualized approach to HS management, combining medical, procedural, and lifestyle strategies tailored to each patient’s needs.
