Hidradenitis suppurativa is infection of sebaceous glands It is actually due to keratin blockage of apocrine glands but the inflammation extends to involve the eccrine and the sebaceous glands Hidradenitis suppurativaisalso called Acne inversa or ectopic acne It is a chronic recurrent follicular disease presenting after pubey in the apocrine gland-bearing areas such as axilla, groin, perineal and perianal regions, buttocks and infra and inter-mammary folds It has an association with obesity and smoking Hidradenitis suppurativa (HS), also known as acne inversa, is a long term skin disease characterized by the occurrence of inflamed and swollen lumps. These are typically painful and break open, releasing fluid or pus. The areas most commonly affected are the underarms, under the breasts, and groin. Scar tissue remains after healing Self-consciousness or depression may result. *The cause of HS remains unknown, and expes disagree over proposed causes. The condition probably results from a combination of genetic and environmental factors. *Lesions occur in any body areas with hair follicles, although areas such as the axilla, groin, and perianal region are more commonly involved. This theory includes most of the following potential indicators: Postpubescent individuals are more likely to exhibit HS.[ Plugged apocrine (sweat) gland or hair follicle Excessive sweating Androgen dysfunction Genetic disorders that alter cell structure Patients with more advanced cases may find exercise intolerably painful, which may increase the rate of obesity among sufferers. The historical understanding of the disease suggests dysfunctional apocrine glands[or dysfunctional hair follicles, possibly triggered by a blocked gland, create inflammation, pain, and a swollen lesion Treatment Medication: Antibiotics: taken by mouth, these are used for their anti-inflammatory propeies rather than to treat infection. Most effective is a combination of rifampicin and clindamycin given concurrently for 2-3 months. A few popular antibiotics include tetracycline, minocycline, and clindamycin.Topical clindamycin has been shown to have an effect in double-blind placebo controlled studies. Coicosteroid injections. Also known as intralesional steroids: can be paicularly useful for localized disease, if the drug can be prevented from escaping the sinuses. Antiandrogen therapy: hormonal therapy with antiandrogenic medications such as spironolactone, flutamide, cyproterone acetate, ethinylestradiol, finasteride, dutasteride, and metformin have been found to be effective in clinical studies.However, the quality of available evidence is low and does not presently allow for robust evidence-based recommendation Intravenous or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab, and etanercept. This use of these drugs is not currently Food and Drug Administration approved and is somewhat controversial, so may not be covered by insurance. TNF inhibitor: Studies have suppoed that various TNF inhibitors have a positive effect on hidradenitis suppurativa lesions. Specifically adalimumab at weekly intervals is useful. Topical isotretinoin is usually ineffective in people with HS and is more commonly known as a medication for the treatment of acne vulgaris. Individuals affected by HS who responded to isotretinoin treatment tended to have milder cases of the condition Ref Harrison 20th edition pg 1234