Introduction: Hidradenitis suppurativa (HS) is a potentially disabling chronic inflammatory disease. The intermammary location, not clearly specified in the usual phenotypic classifications, entails significant functional and cosmetic compromise. Case Presentation: Eleven cases of predominantly intermammary disease with multiple fistulization and disfiguring scarring were observed at our Department between January 2016 and March 2020. They were young (mean age = 22 years) obese or overweight women, in which the medical-surgical approach has led to variable results. Discussion/Conclusion: Intermammary HS possibly represents a unique phenotypic presentation, likely to be fistulizing and severe. We believe that anatomo-functional considerations, which can be paralleled to pilonidal sinus disease, contribute to its pathophysiology and striking appearance, and further emphasize the importance of multidisciplinary endeavor to reduce the morbidity associated with this seemingly overlooked location.

Keywords:
Hidradenitis suppurativa, Intermammary, Sinus pilonidal
1.
Van Der Zee
 
HH
,
Jemec
 
GB
.
New insights into the diagnosis of hidradenitis suppurativa: clinical presentations and phenotypes
.
J Am Acad Dermatol
.
2015
;
73
(
5 Suppl 1
):
S23
–
6
.
https://doi.org/10.1016/j.jaad.2015.07.047
.
Google Scholar
Crossref
Search ADS
PubMed
 
2.
Goldburg
 
SR
,
Strober
 
BE
,
Payette
 
MJ
.
Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis
.
J Am Acad Dermatol
.
2020
;
82
(
5
):
1045
–
58
.
https://doi.org/10.1016/j.jaad.2019.08.090
.
Google Scholar
Crossref
Search ADS
PubMed
 
3.
Goldburg
 
SR
,
Strober
 
BE
,
Payette
 
MJ
.
Hidradenitis suppurativa: current and emerging treatments
.
J Am Acad Dermatol
.
2020
;
82
(
5
):
1061
–
82
.
https://doi.org/10.1016/j.jaad.2019.08.089
.
Google Scholar
Crossref
Search ADS
PubMed
 
4.
Vasanth
 
V
,
Chandrashekar
 
BS
.
Follicular occlusion tetrad
.
Indian Dermatol Online J
.
2014
;
5
(
4
):
491
.
https://doi.org/10.4103/2229-5178.142517
.
Google Scholar
Crossref
Search ADS
PubMed
 
5.
Benhadou
 
F
,
Van der Zee
 
HH
,
Pascual
 
JC
,
Rigopoulos
 
D
,
Katoulis
 
A
,
Liakou
 
AI
, et al. 
Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients
.
Br J Dermatol
.
2019
;
181
(
6
):
1198
–
206
.
https://doi.org/10.1111/bjd.17927
.
Google Scholar
Crossref
Search ADS
PubMed
 
6.
Duman
 
K
,
Ozdemir
 
Y
,
Dandin
 
O
.
Pilonidal sinus disease - Etiological factors, pathogenesis and clinical features
.
Arch Clin Exp Surg
.
2016
;
5
(
4
):
228
.
https://doi.org/10.5455/aces.20151019114717
.
Google Scholar
Crossref
Search ADS
 
7.
Sinam
 
D
,
Daimei
 
D
,
Deven Singh
 
I
,
Damayanti Devi
 
N
.
Comparison of the upper and lower limbs-a phylogenetic concept
.
IOSR J Dent Med Sci Ver I
.
2015
;
14
(
8
):
2279
–
861
.
Google Scholar
 
8.
Diogo
 
R
,
Esteve-Altava
 
B
,
Smith
 
C
,
Boughner
 
JC
,
Rasskin-Gutman
 
D
.
Anatomical network comparison of human upper and lower, newborn and adult, and normal and abnormal limbs, with notes on development, pathology and limb serial homology vs. homoplasy
.
PLoS One
.
2015
;
10
(
10
):
e0140030
.
https://doi.org/10.1371/journal.pone.0140030
.
Google Scholar
Crossref
Search ADS
PubMed
 
9.
Elliot
 
D
,
Cory-Pearce
 
R
,
Rees
 
GM
.
The behaviour of presternal scars in a fair-skinned population
.
Ann R Coll Surg Engl
.
1985
;
67
(
4
):
238
.
Google Scholar
PubMed
 
10.
Papaspyros
 
S
,
Patel
 
R
,
Polyzois
 
K
,
Javagula
 
K
,
Jeffrey
 
R
.
Median sternotomy scars: formation and impact on patient quality of life
.
Br J Card Nurs
.
2011
;
6
(
11
):
531
–
40
.
https://doi.org/10.12968/bjca.2011.6.11.531
.
Google Scholar
Crossref
Search ADS
 
11.
Oliveira
 
M
,
Sayed
 
C
.
Surgical treatment of intermammary hidradenitis suppurativa with a 3-point advancement flap (Mercedes closure)
.
Dermatologic Surg
.
2019
;
46
(
11
):
1457
–
60
.
https://doi.org/10.1097/DSS.0000000000002102
.
Google Scholar
Crossref
Search ADS
 
© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.