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What Caused These Boils?

What Caused These Boils?

HS

A 59-year-old African-American male presented to the dermatology clinic complaining of pus-producing “boils” in the axilla and groin for 40 years as well as new pus-producing “bumps” on the scalp, face, and buttocks over the last year. Upon physical examination, the patient had multiple non-fluctuant, soft nodules and cysts with sinus tracts located in the bilateral axilla and groin with significant secondary scarring. Also, his scalp had scattered keloidal, red papulo-pustules with underlying alopecia. In addition, his buttocks had multiple non-fluctuant papulonodules with a midline scar over the sacrum from previous surgical excision of a “cyst.” His past medical history is significant for a 40-year history of palmar-plantar psoriasis and mild psoriatic arthritis. The relevant family history was a sister with psoriasis.

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