Recurrent Axillary Nodules in a Young Adult Female: Suspected Hidradenitis Suppurativa

Case at a Glance

A 20-year-old female presents with a 1.5-2 month history of recurrent painful nodules in bilateral axillae, with seven episodes total. The lesions follow a characteristic pattern of development from pea-sized subcutaneous nodules to marble-sized inflammatory masses that spontaneously drain.

Patient's Story

The patient reports the onset of symptoms approximately 1.5-2 months ago, beginning shortly after axillary shaving. Initially attributed to ingrown hairs, the lesions have continued to appear cyclically despite cessation of hair removal and wearing loose-fitting clothing. Each lesion follows an identical progression: starting as a pea-sized, firm subcutaneous nodule, enlarging to marble-size over 2 days, developing central fluctuance, then spontaneously draining. The patient experiences significant pain with each lesion. She has a background in pharmacy and became concerned about hidradenitis suppurativa after learning about the condition through her work.

Initial Assessment

Primary care physician initially dismissed symptoms as ingrown hairs despite patient's cessation of hair removal practices. Physical examination revealed characteristic inflammatory nodules in bilateral axillae. Patient's concern about hidradenitis suppurativa prompted referral to dermatology for specialist evaluation.

The Diagnostic Journey

The patient's recognition of the condition through her pharmaceutical background led to self-advocacy for appropriate specialist referral. Clinical presentation includes recurrent inflammatory nodules in apocrine gland-bearing areas (axillae), following a predictable course of development and spontaneous drainage. No family history of similar conditions reported.

Final Diagnosis

Clinical suspicion for Hidradenitis Suppurativa (HS) based on characteristic presentation of recurrent inflammatory nodules in apocrine areas, typical lesion morphology and progression, and absence of other predisposing factors.

Treatment Plan

Dermatology referral initiated for definitive diagnosis and management. Pending specialist evaluation for confirmation of HS diagnosis and appropriate therapeutic intervention including potential antibiotics, anti-inflammatory treatments, and lifestyle modifications.

Outcome and Follow-up

Patient awaiting dermatology consultation. Current management focuses on symptom monitoring and avoidance of mechanical irritation to affected areas. Long-term prognosis dependent on specialist evaluation and implementation of appropriate HS management protocols.