Hidradenitis suppurativa of the nape: Description of an atypical phenotype related to severe early‐onset disease in men

Abstract

Some patients with hidradenitis suppurativa (HS) develop severe inflammatory lesions of the nape. Through a single‐center, cross‐sectional study with a total of 377 patients, we sought to compare patients with and without nape involvement, to determine whether disease severity is greater in these patients and to describe their clinical characteristics. Thirty patients (90% male) were identified as having nape involvement. Patients with versus without nape involvement had greater disease severity, earlier disease onset, a family history of HS, lower body mass, and higher Dermatological Life Quality Index and pain scores. Amongst them, involvement of the trunk and gluteal regions predominated. A significant univariate relationship existed between patients with nape involvement and male sex, early disease onset, family history, scalp and gluteal involvement, Canoui‐Poitrine phenotypes II and III, and Dowling–Degos disease. A significant multivariate relationship existed with early disease onset, Dowling–Degos disease, and phenotypes II and III.

Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life

“…Commonly affected anatomic locations include the axillary, infra‐ and intermammary, inguinal, perineal, perianal and gluteal regions 39 . The lower abdomen, suprapubic, retroauricular, nape, eyelids and scalp are less frequently reported sites 40–42 . Patients may experience pain, itching, malodour, burning sensation and local warmth.…”

Vulvar hidradenitis suppurativa: Clinical cross‐sectional study of 25 patients

“…In analogy with HS involving the vulva, nape involvement is also associated with lower BMI patients, although mostly male, who fit into atypical LC2 and LC3 phenotypes. 15 Ultrasonographic study of the lesions demonstrated that most of them were fistulas with high Doppler signal suggestive of a high inflammatory load. Notably, most lesions of this type could have been mistakenly regarded as nodules or pustules, in accordance with previous publications that have demonstrated that ultrasonographic exam in HS patients can detect fistulas and abscesses more efficiently.…”

“…Those results point at VHS as a manifestation of the so‐called atypical HS as described by Naasan and Affleck 14 and posteriorly by Frew et al 13 Some other atypical sites of HS involvement include the nape. In analogy with HS involving the vulva, nape involvement is also associated with lower BMI patients, although mostly male, who fit into atypical LC2 and LC3 phenotypes 15 …”

The role of biologic treatment in special scenarios in hidradenitis suppurativa: Facial and nape phenotype, dissecting cellulitis of the scalp, and lymphedema

“…4,5,8,9 • DCS and Nape HS: Pustules, nodules, abscesses, scars, and fistulas on the scalp or posterior cervical area. 3,10 • HS lymphedema: Persistent edema in patients with a history of HS in the same location after ruling out other etiologies. 11 3 | RESULTS…”

“…These characteristics were used as diagnostic criteria in the differential diagnosis with acne conglobate (AC), as it is described in the bibliography 4,5,8,9 DCS and Nape HS : Pustules, nodules, abscesses, scars, and fistulas on the scalp or posterior cervical area 3,10 HS lymphedema : Persistent edema in patients with a history of HS in the same location after ruling out other etiologies 11 …”