PMC10010119_01
Numerous isolated or confluent perivulvar and perianal pigmented macules of reticulated appearance with the presence of inguinal HS nodules and fistulas.
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The pigmentation is bilateral and symmetrical, located in the axillary, vulvar and perianal folds and does not affect the mucous membranes (Figures 1 and 2).  
Discrete isolated brownish macules of the axillae with HS cysts and fistulae.
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The pigmentation is bilateral and symmetrical, located in the axillary, vulvar and perianal folds and does not affect the mucous membranes (Figures 1 and 2).  
Pseudo-comedonal lesions and atrophic scars on the back.
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In addition to the classic HS lesions in the form of nodules, sometimes simple, sometimes fistulised, characterising the disease at stage 2 of Hurley's scale, we observe pseudo-comedonal lesions and atrophic scars on the back (Figure 3).
Elongation of epidermal buds, hyperpigmentation of basal keratinocytes without associated melanocytic hyperplasia (HES x 20).
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A skin biopsy of the reticular pigmentation shows discrete orthokeratotic hyperkeratosis with epidermal bud elongation and basal hyperpigmentation without associated melanocytic hyperplasia (Figure 4).