Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by abscesses, fistulas, and scarring affecting the groin, anogenital area, and axillae. HS has an estimated prevalence of 1%, and moderate-to-severe forms have a high disease burden.1 The disease is a combination of homeostasis abnormalities of the pilosebaceous unit and dysregulation of the skin immune responses. Pathogenesis involves the interaction between a person’s genetic background (potentially heterozygous mutations of genes belonging to the gamma secretase complex) and environmental triggers, among which are the skin microbiome, cigarette smoking, and obesity.2 We report herein a case of radiation-induced HS and discuss its possible mechanisms.
A 57-year-old active smoker, normal-weight woman (body mass index 23 kg/m2) with no personal or family history of inflammatory skin or bowel disease was referred for painful inflammatory nodules and fluctuant abscesses located in her groin and inguinal folds. The infection appeared resistant to topical clindamycin 1%, oral zinc supplementation, oral corticosteroids at a dose of 1 mg/kg/day, and several cycles of oral antibiotics (amoxicilline, tetracycline, rifampicin, and metronidazole). One year before onset of her symptoms, she was treated for uterine adenocarcinoma with a total hysterectomy and bilateral annexectomy, along with external beam radiotherapy (25 treatment sessions over 4 weeks). No chemotherapy or hormonotherapy was given and regular follow-up did not show any sign of cancer relapse. The inflammatory and painful nodules developed a few weeks after the end of radiotherapy.Inflammatory