From haircut to havoc: a teen’s battle with multisite inflammatory disease

A 15-year-old male presented with an atypical case of hidradenitis suppurativa that began with indurated nodules at the nape of his neck following a haircut. The condition progressively spread over 6 months to involve multiple body areas, including the chest, axillae, and perineal region. Initial treatments with conventional antibiotics proved ineffective, requiring surgical intervention for abscess drainage. The patient's condition continued to deteriorate despite postprocedural antibiotic therapy, ultimately necessitating escalation to combination therapy with high-dose prednisone and adalimumab, which led to clinical improvement. This case highlights an unusual presentation of hidradenitis suppurativa with widespread involvement while serving as a reminder to clinicians of the importance of early recognition and aggressive management in refractory cases.