 |
|
|
|
|
|
|
|
|
|
 |
 |
 |
 |
 |
 |
 |
 |
|
Background
This is a chronic and relapsing condition occurring within apocrine sweat glands, most commonly in women. Deep seated inflammatory nodules form in the axilla, groin, pubic region, and perineum. It is an androgen-dependent disorder and results from keratinous material occluding the sweat pores. There is an association with lithium therapy and Crohn's disease.
The skin shows a deep seated mixed inflammatory cell infiltrate with scarring, granulation tissue, and foreign body giant cells. Chronic abscesses and sinus tracts leading to the surface may develop. Early and new lesions show a suppurative folliculitis.
OUTLINE
EPIDEMIOLOGY CHARACTERIZATION SYNONYMS Verneuil's disease
Acne inversaINCIDENCE The prevalence of hidradenitis suppurativa and its potential precursor lesions.
Jemec GB, Heidenheim M, Nielsen NH.
Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, Denmark.
J Am Acad Dermatol 1996 Aug;35(2 Pt 1):191-4 Abstract quote
BACKGROUND: The morbidity of hidradenitis suppurativa can be considerable, but little is known about its epidemiology.
OBJECTIVE: Our purpose was to describe the 1-year and point prevalences of hidradenitis suppurativa and its potential precursor lesions.
METHODS: We obtained the histories and examined an unselected sample (599 persons) of the general population (1-year prevalence), and we performed physical examinations for a consecutive sample of 507 persons undergoing screening for sexually transmitted diseases (point prevalence).
RESULTS: The point prevalence was 4.1% (95% confidence interval [CI] = 3.0-6.0) on the basis of objective findings. The 1-year prevalence of hidradenitis was 1.0% (CI = 0.4-2.2) on the basis of subject recollection only. The patients in the sample on which point prevalence is based were younger than those in the unselected sample of the general population (p < 0.001). Hidradenitis was significantly more common in women (p = 0.037), which may result from a female preponderance of genitofemoral lesions (odds ratio [OR] = 5.4; CI = 1.5 - 19.3). No sex difference was found in the prevalence of axillary lesions.
CONCLUSION: Hidradenitis suppurativa is significantly more common than hitherto estimated. The female preponderance of patients is confirmed, except for patients with axillary lesions. Additional longitudinal studies are necessary to assess the importance of potential precursor lesions such as noninflamed nodules or comedones.
DISEASE ASSOCIATIONS CHARACTERIZATION CROHN'S DISEASE The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease.
Church JM, Fazio VW, Lavery IC, Oakley JR, Milsom JW.
Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio.
Int J Colorectal Dis 1993 Sep;8(3):117-9 Abstract quote
Over the last 8 years, 61 patients with hidradenitis suppurativa (HS) have been treated at this institution.
Twenty-four have also had a diagnosis of Crohn's disease (38%). This dual pathology is examined in detail in this retrospective review. There were 11 males and 13 females with a mean age of 39 years (range 18 to 75 years). The Crohn's disease was ileal in 1 patient, ileocolic in 4, and affected the large bowel only in 19. The diagnosis of Crohn's disease predated that of HS by an average of 3.5 years. At the time of review, 22 patients had a stoma, 23 had undergone laparotomy and 17 had lost their rectum. Hidradenitis suppurativa occurred in the perineal or perianal area in all patients but involved other sites in 20 cases. Skin grafting had been done in 9 and local procedures in 19 patients. Granulomas were found in excised skin in 6 cases but this finding was not associated with a poor outcome. At a mean follow-up of 3.2 years from the most recent surgery for HS (range 1 to 11 years) 11 were asymptomatic for HS, 11 had symptoms and no follow up was available in 2.
These data show that HS may coexist with Crohn's proctocolitis, complicating the diagnosis and management of patients in whom it occurs. An increased appreciation of the possibility is recommended.
Hidradenitis suppurativa and Crohn's disease: response to treatment with infliximab.
Martinez F, Nos P, Benlloch S, Ponce J.
Department of Gastroenterology and Hepatology, Hospital La Fe, Valencia, Spain.
Inflamm Bowel Dis 2001 Nov;7(4):323-6 Abstract quote
Cutaneous manifestations occur frequently in inflammatory bowel disease. The association between hidradenitis suppurativa (HS) and Crohn's disease (CD) has been reported.
We present a new case supporting this association. A dramatic improvement after treatment with infliximab was achieved for both refractory fistulizing CD and axillary HS.
ENDOCRINE STATUS Endocrine factors in pre- and postmenopausal women with hidradenitis suppurativa.
Barth JH, Layton AM, Cunliffe WJ.
Institute of Pathology, Leeds General Infirmary, U.K.
Br J Dermatol 1996 Jun;134(6):1057-9 Abstract quote
The relationship between hidradenitis suppurativa (HS) and hyperandrogenism is largely based on the finding of an increased free androgen index due to a low sex hormone binding globulin (SHBG). As SHBG is now believed to be regulated by factors that influence body weight, and previous studies were not controlled for body weight, we have re-evaluated the androgen status of female patients with HS.
We have studied the endocrine status of 66 women with HS. Twenty-three had acne, and 23 were significantly obese (body mass index: BMI > 30). There was no relationship between obesity and disease duration. Nineteen of 56 women were hirsute. A premenstrual flare in disease activity was reported by 32 women, but this was not related to menstrual disturbances. No consistent relationship was reported with pregnancy. Eight women with HS were menopausal at presentation, and one developed her disease 6 years after the menopause. Plasma androgens in women with HS were compared with controls matched for BMI and hirsuties. There was no difference between HS and controls. Testosterone and dehydroepiandrosterone sulphate were normal in all subjects with HS. In obese subjects, SHBG was reduced, consistent with BMI-matched controls.
We have found no supporting evidence for biochemical hyperandrogenism in women with HS when compared with age-, weight- and hirsuties-matched controls. We report the continuation and primary development of HS in postmenopausal women.
SPONDYLOARTHROPATHY Hidradenitis suppurativa and acne conglobata associated with spondyloarthropathy.
Leybishkis B, Fasseas P, Ryan KF, Roy R.
Department of Medicine, MCP Hahnemann University, Philadelphia, Pennsylvania 19102, USA.
Am J Med Sci 2001 Mar;321(3):195-7 Abstract quote
Hidradenitis suppurativa and acne conglobata are well-described chronic dermatologic diseases. Although the exact incidence of these disorders is unknown, both are relatively uncommon conditions. The incidence of spondyloarthropathy is less than 1% in the general population.
Therefore, a triad of hidradenitis suppurativa, acne conglobata and spondyloarthropathy is a rare syndrome described only in a few case reports in the literature.
We report a case of hidradenitis suppurativa and acne conglobata associated with spondyloarthropathy.
PATHOGENESIS CHARACTERIZATION APOCRINE GLANDS The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands.
Attanoos RL, Appleton MA, Douglas-Jones AG.
Department of Histopathology, University Hospital of Wales, Health Park, Cardiff, U.K.
Br J Dermatol 1995 Aug;133(2):254-8 Abstract quote
We undertook a retrospective pathological study of 118 skin resection specimens from 101 patients with hidradenitis suppurativa. Follicular occlusion was identified in all the specimens, regardless of disease duration (1 month to 18 years), but was not noted in the axillary and inguinal skin of controls.
We therefore regard follicular occlusion as an early and important feature in the pathogenesis of the disease. The presence of apoeccrine glands in axillary skin provided an in vivo model to directly observe the effects of follicular occlusion on follicle inflammation and apocrine gland destruction. In the majority of cases, active folliculitis was associated with apocrinitis and apocrine destruction, whereas apoeccrine glands, which drain directly on to the epidermal surface, appeared intact and non-inflamed.
These observations provide direct evidence in an in vivo model that follicular occlusion by keratinous material, with subsequent active folliculitis and secondary destruction of the skin adnexae and subcutis, occur as an integral step in the pathogenesis of hidradenitis suppurativa.
BACTERIA Coagulase-negative staphylococci are the most common bacteria found in cultures from the deep portions of hidradenitis suppurativa lesions, as obtained by carbon dioxide laser surgery.
Lapins J, Jarstrand C, Emtestam L.
Karolinska Institute, Departments of Dermatology and Venereology
Br J Dermatol 1999 Jan;140(1):90-5 Abstract quote
The significance of bacterial findings in hidradenitis suppurativa (HS) is controversial. Interpretation of the results of bacteriological examinations from the surface of HS lesions is obscured by the possible contamination of resident skin bacteria. Bacteriological analysis of aspirates from deeper parts of HS is liable to show low sensitivity.
We used a carbon dioxide (CO2) laser method to evaporate the diseased tissue level by level from the surface downwards, allowing concurrent sampling of bacteriological cultures from each level and thereby minimizing contamination with bacteria from the level above. In this study, 22 women and three men with a mean age of 35.3 years and a mean HS duration of 10.6 years were treated with this CO2 laser surgical method. Aerobic and anaerobic cultures from superficial and deep levels were taken during surgery. The regions treated were axillary in eight and perineal in 17 cases. Bacterial cultures were positive for one or more specimens from at least one level in all cases and from deep levels in all but three cases. Sixteen different species or sub-species were found. Staphylococcus aureus and coagulase-negative staphylococci (CNS) were the species most frequently found. Peptostreptococcus species and Propionibacterium acnes were not uncommon. S. aureus was detected in a total of 14 cases, six of which were from the deep levels. S. aureus was the sole bacterium isolated in two deep cultures. CNS were found in 21 patients and 16 of these isolates were from the deep levels. In nine of the 16 deep samples CNS were the only bacteria detected.
These findings motivate a re-evaluation of the significance of bacteria in the progress of HS and in particular they suggest that CNS are true pathogens. It is known that foreign bodies aggravate the virulence of the CNS in surgical implants, and an environment which resembles that produced by a foreign body, as found in chronic HS tissue, serves to intensify the pathogenic properties of CNS in HS.
HLA Hidradenitis suppurativa. Glucose tolerance, clinical, microbiologic, and immunologic features and HLA frequencies in 27 patients.
O'Loughlin S, Woods R, Kirke PN, Shanahan F, Byrne A, Drury MI.
Department of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland.
Arch Dermatol 1988 Jul;124(7):1043-6 Abstract quote
Glucose tolerance, lymphocyte populations, and HLA types were studied in 27 patients with untreated hidradenitis suppurativa; 18 of these patients had a negative history for acne vulgaris.
Six patients (22%) had an increased incidence of impaired glucose tolerance. We failed to confirm a previous report of high incidence of flat glucose tolerance curves. The frequency of HLA-A and HLA-B antigen loci and the median values of peripheral blood T lymphocytes were similar to the control population. However, seven patients with moderate or severe clinical disease had a marked reduction in T lymphocytes and these patients had an increased frequency of the HLA antigens, A1 and B8.
These results suggest that T lymphocytes may play a role in the pathogenesis of hidradenitis suppurativa and that HLA-A1 and HLA-B8 may predispose the patient to more severe disease, but further research is necessary to clarify this.
NEUTROPHIL DYSFUNCTION Neutrophil-related host response in hidradenitis suppurativa: a pilot study in patients with inactive disease.
Lapins J, Asman B, Gustafsson A, Bergstrom K, Emtestam L.
Department of Medicine, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden.
Acta Derm Venereol 2001 May;81(2):96-9 Abstract quote
Host-defence defects in hidradenitis suppurativa patients have been suspected, but not proven. Activated neutrophils can destroy the surrounding tissues by a release of reactive oxygen species and active proteases.
Peripheral neutrophils from 15 female patients (mean age 46, range 27-57 years) in an inactive state of their hidradenitis suppurativa, were studied and compared with 15 age-matched healthy female controls. There were no significant differences between patients and controls in the assessments of intracellular elastase activity, total content of antigenic elastase or release of elastase. Furthermore, no differences were found in total content and membrane expression of the receptors measured. The generation of free oxygen radicals, after stimulation with the protein kinase C activator phorbol myristate acetate, was significantly higher in the patients than in the controls, while there was no difference after Fc-receptor-mediated stimulation.
Dysfunctional neutrophils might be involved in the pathogenesis of hidradenitis suppurativa, but the findings should be interpreted with caution because of the small number of observed cases.
LABORATORY/RADIOLOGIC/
OTHER TESTSCHARACTERIZATION RADIOLOGIC Ultrasound examination of hair follicles in hidradenitis suppurativa.
Jemec GB, Gniadecka M.
Department of Dermatology D, Bispebierg Hospital, University of Copenhagen, Denmark.
Arch Dermatol 1997 Aug;133(8):967-70 Abstract quote
OBJECTIVE: To describe the in vivo skin echostructure, hair follicle shape, and dermal thickness in hidradenitis suppurativa.
DESIGN: Qualitative and quantitative assessment of high-frequency (20-MHz) B-mode ultrasound images of lesional and paralesional skin.
SETTING: University hospital.
PATIENTS: Age- and sex-matched outpatients with hidradenitis suppurativa (n = 15) and healthy control subjects (n = 13). Median age was 34 years (range, 31-38).
RESULTS: Clinically normal paralesional hair follicles in hidradenitis have an abnormal shape. The follicles appear to be wider in the deep dermis, the difference being statistically significant in the genitofemoral region (P = .007). Patients with hidradenitis have larger follicles in the axilla than controls (P = .002). Mature acne and hidradenitis lesions are indistinguishable, but both are different from epidermal cysts. Mean axillary and genitofemoral skin was significantly thicker in patients than in controls.
CONCLUSIONS: In vivo ultrasonography shows characteristic differences in the shape of hair follicles in hidradenitis. The general underlying abnormalities appear to occur in the deep part of the follicle. The mature lesions are indistinguishable from acne, but are clearly different from epidermal cysts. A thickened skin may play a pathogenic role in the development of hidradenitis.
LABORATORY MARKERS MICROBIOLOGY Aerobic and anaerobic microbiology of axillary hidradenitis suppurativa.
Brook I, Frazier EH.
Department of Pediatrics, Navy Hospital, Bethesda, MD, USA.
J Med Microbiol 1999 Jan;48(1):103-5 Abstract quote
A retrospective review of the microbiological and clinical data of 17 specimens obtained from axillary hidradenitis suppurativa (HS) over a period of 6 years was undertaken to study the aerobic and anaerobic microbiology of this condition.
A total of 42 bacterial isolates (2.5 per specimen) were obtained, 12 aerobic or facultative (0.7 per specimen) and 30 anaerobic or micro-aerophilic (1.8 per specimen). Aerobic and facultative bacteria only were isolated in six (35%) cases, anaerobic bacteria only in seven (41%) and mixed aerobic and anaerobic bacteria in four (24%). The predominant aerobic bacteria were Staphylococcus aureus (six isolates), Streptococcus pyogenes (three) and Pseudomonas aeruginosa (two). The most frequently isolated anaerobes were Peptostreptococcus spp. (10), Prevotella spp. (seven), micro-aerophilic streptococci (four), Fusobacterium spp. (three) and Bacteroides spp. sensu stricto (three).
This study highlights the polymicrobial nature and predominance of anaerobic bacteria in axillary HS and the need for antimicrobial thereby to reflect this.
GROSS APPEARANCE/
CLINICAL VARIANTSCHARACTERIZATION GENERAL VARIANTS FAMILIAL A family study of hidradenitis suppurativa.
Fitzsimmons JS, Guilbert PR.
J Med Genet 1985 Oct;22(5):367-73 Abstract quote
A family study of hidradenitis suppurativa was undertaken based on 26 subjects with the disease.
The probands were obtained from Hospital Activity Analysis (HAA) records for a three year period (1980 to 1983) and by direct referral from hospital specialists over a six month period (1983 to 1984). Family pedigree information was collected by home visits or hospital interviews and confirmation of the disease in relatives was obtained by examination where possible or by telephone contact and hospital/GP records. A total of 62 affected persons was eventually ascertained, 40 females and 22 males. In 11 families there was evidence in favour of a genetic aetiology with single gene transmission. In another three families there was historical evidence of familial occurrence and in nine families no family history was obtained at the time of enquiry.
Problems of ascertainment, including variability of age of onset and psychosocial factors, were noted and could be responsible for false negative family histories or underestimation of affected persons.
The clinical genetics of hidradenitis suppurativa revisited.
Von Der Werth JM, Williams HC, Raeburn JA.
Department of Dermatology, Queen's Medical Centre, Nottingham NG7 2UH, U.K.
Br J Dermatol 2000 May;142(5):947-53 Abstract quote
A familial form of hidradenitis suppurativa (HS) with autosomal dominant inheritance was described in a study conducted 15 years ago in Nottingham but has not been systematically confirmed elsewhere. Prior to commencing molecular genetic studies, we wanted to test the validity of the previous study by assessing its reproducibility on the basis of a strict, newly devised disease definition for HS. We were also interested whether new cases of the disease had arisen meantime in the study group as should be expected for an autosomal dominant disease.
We reviewed 14 surviving probands and their families. Seven of these probands had previously been noted to have a positive family history whereas the others had been classified as having a negative or possible family history. One hundred and thirty-two family members were assessed for their respective disease status. Participants were initially contacted by telephone or letter, and those who acknowledged a history of at least one previous boil were invited for a personal examination and interview. Only personally examined individuals were classified as a case. Twenty-eight relatives with HS were detected in total, and 27 of these were in the group previously labelled family history positive. Nine of these cases had not been detected in the previous study and in at least seven of these the disease had developed after the previous study had been conducted.
Only twice did our criteria fail to confirm cases that had been labelled as HS in the previous study. Both times we classified the patients as 'possibly affected'. A further 16 relatives were judged to be possibly affected. In the group with positive family history we found 10 affected and nine possibly affected individuals among 37 surviving first-degree relatives of HS sufferers.
Our findings support the concept of a familial form of HS with autosomal dominant inheritance. An insufficiently sensitive disease definition, a variable degree of gene penetrance and possibly a hormonal influence on gene expression may explain the reduced risk to first-degree relatives, which falls short of the expected 50% mark. Molecular genetic studies to clarify whether one or more gene(s) are involved in HS are now necessary and have been commenced.
FOLLICULAR OCCLUSION TRIAD Follicular occlusion triad: hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp.
Chicarilli ZN.
Ann Plast Surg 1987 Mar;18(3):230-7 Abstract quote
The pathophysiology and treatment of hidradenitis suppurativa, acne conglobata, and dissecting cellulitis of the scalp, which constitute the follicular occlusion triad, are reviewed.
The unusual occurrence of all three components in a single patient resistant to medical management is presented with a review of the literature. This patient's course was complicated by multiple synchronous squamous cell carcinomas developing in a localized area where his acne conglobata was most pronounced. Although one lesion was clinically obvious, the majority were less suspicious for cancer.
Occult cancer should be considered in recalcitrant cases of acne conglobata where isolated areas fail to respond to medical management, particularly when 13-cis-retinoic acid has been used.
POLYPS Hidradenitis suppurativa polyposa.
Wrone DA, Landeck A, Dibbell DG, Xie H, Warner TF.
Department of Medicine, University of Wisconsin Hospital and Clinics, Madison 53792, USA.
Pathol Res Pract 2000;196(8):589-592 Abstract quote
A case of severe chronic hidradenitis suppurativa of the perineum complicated by disfiguring fibrous, polypoid lesions is presented. The patient, a 41-year-old woman, had a long history of axillary hidradenitis which subsequently involved the perineum. Draining sinuses, scars and large pendulous masses of the vulva developed over 10 years. Cutaneous scars, ridges, papules and large fibrous polyps were present. Deep clefts, sinuses, dense fibrous scars and foci of chronic inflammation were seen.
Rarely, large fibrous polyps may develop in chronic hidradenitis suppurativa and may be due to chronic local lymphedema. Careful pathologic examination is necessary to exclude squamous cell carcinoma.
HISTOLOGICAL TYPES CHARACTERIZATION GENERAL Histology of hidradenitis suppurativa.
Jemec GB, Hansen U.
Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
J Am Acad Dermatol 1996 Jun;34(6):994-9 Abstract quote
BACKGROUND: Hidradenitis suppurativa is traditionally classified as a disease of the apocrine gland. However, different histologic descriptions exist.
OBJECTIVE: Our purpose was to describe prospectively the histopathologic characteristics of hidradenitis.
METHODS: We systematically described and classified 60 consecutive biopsy specimens from patients with hidradenitis and compared them with 33 specimens from clinically noninvolved regional controls.
RESULTS: A heterogeneous histologic picture was found. Apocrine glands were involved in a minority of the 60 specimens, 17 showed poral occlusion, 17 simple folliculitis without poral occlusion, 9 sinus tracts, 6 epithelial cyst, 5 abscess, 3 apocrinitis, 2 diffuse dermal inflammation, and 1 pyogenic granuloma and scarring. Secondary involvement of apocrine glands was found in 12% of all specimens, and secondary involvement of eccrine glands was found in 25%. Sinus tracts were found significantly more often in the presence of poral occlusion or epithelial cysts. Control specimens frequently revealed changes compatible with early stages of follicular involvement. Apocrine glands were observed significantly more often in the axillae than in the groin.
CONCLUSION: The clinical picture of hidradenitis suppurativa covers a broad histologic spectrum. This may help explain the therapeutic problems posed by this disease. The disease appears to be predominantly follicular, and apocrine glands appear to be primarily involved in only a minority of axillary lesions.
Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions.
Boer J, Weltevreden EF.
Department of Dermatology, Deventer Hospital, The Netherlands.
Br J Dermatol 1996 Nov;135(5):721-5 Abstract quote
The pathogenesis of hidradenitis suppurativa (HS) has given rise to controversy about whether the central pathogenetic feature is an apocrine follicular occlusion (with subsequent bacterial infection) or it is a folliculitis with secondary involvement of both apocrine and eccrine sweat glands. Most previous concepts have focused on apocrine gland involvement. A prospective study of 27 consecutive patients (39 biopsies) was performed to investigate the immune-histological findings in early, newly formed lesions. Most of them were examined within 3 days of clinical onset.
Histopathological findings showed that the initial lesion is an occluding spongiform infundibulo-folliculitis. Furthermore, it was found that T cells predominated in the lymphocytic cell population. A high percentage of HLA-DR positive lymphocytes was found in an inverse relationship with Leu-8 positive lymphocytes. Additionally, a sharp decline in the T-helper/suppressor ratio was observed after the initiation.
These results reveal that the primary event in HS is an infundibulofolliculitis with secondary involvement of apocrine glands. Acne inversa would be a more appropriate name.
The homogeneity of hidradenitis suppurativa lesions. A histological study of intra-individual variation.
Jemec GB, Thomsen BM, Hansen U.
Department of Dermatology, Bispebjerg Hospital, Denmark.
APMIS 1997 May;105(5):378-83 Abstract quote
Recent data suggest that hidradenitis suppurative is a disease of the follicle, but the histological homogeneity of findings over time and in different anatomical regions has not been verified. Its description may help towards a better classification of the follicular diseases.
Correct classification provides both knowledge by interference and a way of generalizing with respect to the significance of specific findings. The intra-individual variation of hidradenitis was described through classification of specimens taken from patients with multiple simultaneous or consecutive excisions. A total of 51 specimens from 11 patients were examined; of these 30 were from synchronous biopsies, and 21 from consecutive biopsies (range 2 months to 6 years). The majority of specimens (44/51) contained poral occlusion, sinus tracts or cysts. This pattern was present in 50-85% of the specimens from any given patient with hidradenitis. No primary apocrine involvement was seen. Fibrosis occurred often (33/51 specimens), and eccrine involvement was seen more often than apocrine involvement (10 vs 7 specimens). The homogeneous histology of hidradenitis supports its reclassification as a follicular disease.
The reproducibility of the findings further suggests that the changes are specific and that hidradenitis is therefore a definite disease entity within the spectrum of follicular diseases. Additional functional studies may help classify hidradenitis more precisely in relation to other follicular diseases.
VARIANTS GRANULOMATOUS Granulomatous hidradenitis suppurativa and cutaneous Crohn's disease.
Attanoos RL, Appleton MA, Hughes LE, Ansell ID, Douglas-Jones AG, Williams GT.
Department of Pathology, University of Wales, College of Medicine, Cardiff, UK.
Histopathology 1993 Aug;23(2):111-5 Abstract quote
Three patients with concurrent hidradenitis suppurativa and Crohn's disease are presented. The notable histological feature in each hidradenitis resection was the presence of numerous discrete epithelioid granulomas in areas of non-inflamed dermis.
The purpose of the study was to determine the incidence of epithelioid granulomas in 101 hidradenitis patients and their significance in relation to systemic granulomatous disease. Discrete epithelioid granulomas were identified in 8% of the resections (10 patients). One patient had Crohn's disease and one other pulmonary sarcoidosis. Seven patients with granulomatous hidradenitis neither had nor developed any other disease during the 3-year follow-up period. Clinical review identified a further two patients with Crohn's disease but associated with non-granulomatous changes in the skin resections. Foreign body type granulomas were identified in 25% of the resections adjacent to ruptured hair follicles, sinus tracts or nearby degenerate sweat glands.
The study shows that, although foreign body type granulomas are a common finding in hidradenitis, the presence of discrete epithelioid granulomas in the dermis away from the site of active inflammation is unusual and should alert the pathologist to the possibility of systemic granulomatous disease such as Crohn's disease or sarcoidosis.
SPECIAL STAINS/IMMUNOPEROXIDASE/
OTHERCHARACTERIZATION SPECIAL STAINS IMMUNOPEROXIDASE CYTOKERATIN Forms of epithelial differentiation of draining sinus in acne inversa (hidradenitis suppurativa).
Kurzen H, Jung EG, Hartschuh W, Moll I, Franke WW, Moll R.
Division of Cell Biology, German Cancer Research Centre, Heidelberg, Germany.
Br J Dermatol 1999 Aug;141(2):231-9 Abstract quote
The draining sinus is a late complication of several forms of severe acne, leading to extensive, periodically inflamed lesions that are undermined by a system of fistulas, supposed to be of follicular origin.
We investigated the expression of various cytokeratins (CKs) and desmosomal proteins in the draining sinus of acne inversa (hidradenitis suppurativa) using monoclonal antibodies in immunohistochemistry on paraffin-embedded sections. We were able to define three different phenotypes of stratified squamous epithelia covering the sinus tracts. Type I epithelium was cornifying and characterized by the presence of CK 10, desmogleins 1-3 and desmocollins 1-3 in an epidermis-like pattern. Type II epithelium was non-cornifying, negative for CK 10 and positive for CK 13. It was negative for desmocollin 1 but strongly immunopositive for desmoglein 1 suprabasally and for desmoglein 2 in the basal cells. Type III epithelium was non-cornifying and strongly inflamed. It was marked by the presence of CK 7, CK 19 and desmoglein 2 and the absence of CK 10, desmoglein 1 and desmocollin 1. In both type II and III epithelium, desmoglein 3, desmocollin 2 and desmocollin 3 showed an inverted staining pattern as compared with normal epidermis and type I epithelium. Desmoglein 2 and CK 5/14 always remained restricted to the basal cell layer. Antibodies against CK 6 and CK 13/15/16 were immunopositive in all three phenotypes and CK 17 was predominantly immunolocalized to suprabasal layers of type II and III epithelium.
The three phenotypes are characterized as pathological stratified squamous epithelia reflecting the dynamic process of inflammation, proliferation and stratification taking place in acne inversa.
DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES Crohn's disease See Disease Associations
PROGNOSIS AND TREATMENT CHARACTERIZATION PROGNOSTIC FACTORS GENERAL Extent of surgery and recurrence rate of hidradenitis suppurativa.
Ritz JP, Runkel N, Haier J, Buhr HJ.
Department of Surgery, University Hospital Benjamin Franklin, Free University of Berlin, Germany.
Int J Colorectal Dis 1998;13(4):164-8 Abstract quote
Hidradenitis suppurativa (HS) is a chronic fistula- and abscess-forming disease of the cutis and subcutis of unknown etiology. Disease recurrence is frequent and may cause severe complications.
We analyzed patients with HS who underwent surgery between 1976 and 1997. The operative procedures were divided into drainage procedures (n = 6), limited regional (n = 14), and radical wide excisions (n = 11). The extent of surgery was examined in terms of the clinical course and late postoperative sequelae of HS. At a mean follow-up of 72 months, we found developed locoregional recurrent HS in 45% of patients. There was 100% recurrence after drainage, 42.8% after limited, and 27% after radical excision (P < 0.05). HS recurred after a median interval of 3 months for drainage, 11 months for limited excision, and 20 months for radical excision (P < 0.05). The disease-free interval continued up to 35 months.
Long-term sequelae included penile amputation and a case of fatal squamous cell carcinoma. Although radical wide excision of the HS-affected cutis is associated with the lowest recurrence rate, it is still considerable and warrants long-term follow-up.
The natural history of hidradenitis suppurativa.
von der Werth JM, Williams HC.
Department of Dermatology, Queen's Medical Centre, Nottingham, UK.
J Eur Acad Dermatol Venereol 2000 Sep;14(5):389-92 Abstract quote
BACKGROUND: The natural history of hidradenitis suppurativa (HS) is not well known. There is incomplete published data on the average age of disease onset, progression of the disease, average monthly incidence and duration of boils, and factors that relieve or exacerbate disease symptoms.
STUDY DESIGN: Questionnaire-based survey among HS patients identified from hospital records of three hospitals in Nottinghamshire, UK.
RESULTS: One hundred and ten of 156 questionnaires (70.5%) were returned, 93 from females and 17 from males. The average patient's age was 40.1 years and the average reported age of disease onset was 21.8 years. At the time of the survey patients had suffered an average disease duration of 18.8 years. Most patients (98 of 110) still had experienced active disease within the past year. There was some evidence that in women the condition has a tendency to ease or subside after the menopause. Forty-four per cent of women felt that their condition was aggravated by menstruation. Thirty-eight per cent of patients gave a positive family history of the disorder. The average duration of painful boils was 6.9 days. In addition, 62% of patients acknowledged the presence of permanently painful boils that failed to subside. Patients developed a median of two boils per month. Factors that could aggravate the condition were primarily sweating or heat, stress or fatigue and tight clothing or friction. Factors that could improve the condition consisted largely of a variety of medical treatments and a number of life-style measures, such as swimming or baths. Twenty-four per cent of patients had failed to find anything at all to help their condition, despite an average disease duration of almost 19 years.
CONCLUSIONS: The study highlights several of the factors that make HS one of the most distressing dermatological diseases, such as the average monthly incidence of painful lesions, their average duration and the chronicity of the disease. It seems striking that the mean duration of an HS boil (6.9 days) roughly equals the duration of an average course of antibiotics. The postulated response of HS to oral antibiotics may thus simply have its explanation in the natural history of the condition itself.
Morbidity in patients with hidradenitis suppurativa.
von der Werth JM, Jemec GB.
Department of Dermatology, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Br J Dermatol 2001 Apr;144(4):809-13 Abstract quote
BACKGROUND: Although skin diseases are often immediately visible to both patients and society, the morbidity they cause is only poorly defined. It has been suggested that quality-of-life measures may be a relevant surrogate measure of skin disease. Hidradenitis suppurativa (HS) leads to painful eruptions and malodorous discharge and is assumed to cause a significant degree of morbidity. The resulting impairment of life quality has not previously been quantitatively assessed, although such an assessment may form a pertinent measure of disease severity in HS.
OBJECTIVES: To measure the impairment of life quality in patients with HS.
METHODS: In total, 160 patients suffering from HS were approached. The following data were gathered: quality-of-life data (Dermatology Life Quality Index, DLQI questionnaire), basic demographic data, age at onset of the condition and the average number of painful lesions per month.
RESULTS: One hundred and fourteen patients participated in the study. The mean +/- SD age of the patients was 40.9 +/- 11.7 years, the mean +/- SD age at onset 21.8 +/- 9.9 years and the mean +/- SD duration of the disease 18.8 +/- 11.4 years. Patients had a mean +/- SD DLQI score of 8.9 +/- 8.3 points. The highest mean score out of the 10 DLQI questions was recorded for question 1, which measures the level of pain, soreness, stinging or itching (mean 1.55 points, median 2 points). Patients experienced a mean of 5.1 lesions per month.
CONCLUSIONS: HS causes a high degree of morbidity, with the highest scores obtained for the level of pain caused by the disease. The mean DLQI score for HS was higher than for previously studied skin diseases, and correlated with disease intensity as expressed by lesions per month. This suggests that the DLQI may be a relevant outcome measure in future therapeutic trials in HS.
MALIGNANCIES Vulval squamous cell carcinoma arising in chronic hidradenitis suppurativa.
Manolitsas T, Biankin S, Jaworski R, Wain G.
Department of Gynecologic Oncology, Westmead Hospital, Westmead, New South Wales, 2145, Australia.
Gynecol Oncol 1999 Nov;75(2):285-8 Abstract quote
Hidradenitis suppurativa is a chronic inflammatory disease of the sweat glands and hair follicles which is rarely associated with squamous cell carcinoma (SCC). A case of vulval SCC complicating hidradenitis suppurativa is presented. In addition to being the first case to report the association of vulval SCC and hidradenitis suppurativa in the English language literature, it also illustrates the difficulty inherent in distinguishing between invasive SCC and pseudoepitheliomatous hyperplasia on histological examination.
The success of wide local excision of the vulval lesion and primary closure without recourse to skin grafts, rotational flaps, or healing by secondary intention is demonstrated.
Verrucous carcinoma arising in hidradenitis suppurativa.
Cosman BC, O'Grady TC, Pekarske S.
Surgical Service (112E), VA Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161-0002, USA.
Int J Colorectal Dis 2000 Nov;15(5-6):342-6 Abstract quote
There are many reported cases of squamous carcinoma complicating hidradenitis suppurativa, but only one previous mention of verrucous carcinoma in this setting.
We describe a case of verrucous carcinoma arising in hidradenitis suppurativa of the anal margin in a non-immunosuppressed man. This is the second report of verrucous carcinoma arising in a lesion of hidradenitis suppurativa. Although hidradenitis suppurativa can involve multiple intertriginous sites, malignant degeneration occurs mostly in the anogenital region. This suggests a role for a regional factor which, when combined with chronic inflammation, predisposes to malignant degeneration. A likely candidate for this factor is human papillomavirus; our case showed histologic evidence for this, but the specimen did not show viral DNA by polymerase chain reaction in situ hybridization.
The ability of anogenital hidradenitis suppurativa to form squamous and verrucous cancers reinforces the argument for early and complete resection.
Incidence of cancer among patients with hidradenitis suppurativa.
Lapins J, Ye W, Nyren O, Emtestam L.
Department of Medicine, Section of Dermatology and Venereology, I43, Karolinska Institutet at Huddinge University Hospital, SE-141 86 Stockholm, Sweden.
Arch Dermatol 2001 Jun;137(6):730-4 Abstract quote
BACKGROUND: On the basis of some case reports, a relationship has been suggested between hidradenitis suppurativa (HS) and the development of nonmelanoma skin cancer.
OBJECTIVES: To confirm this relationship and to explore the risk of other cancers among patients with HS.
PATIENTS: Patients with a discharge diagnosis of HS were obtained from the computerized database of hospital discharge diagnoses from January 1, 1965, through December 31, 1997. A total of 2119 patients with HS were identified.
SETTING: All hospitals in Sweden.
DESIGN: With record linkage to the Swedish National Cancer Registry, standardized incidence ratios (SIR [the ratio of the observed to expected incidence]) were calculated to estimate relative risk.
RESULTS: The risk of developing any cancer in the cohort with HS increased 50% (95% confidence interval of SIR, 1.1-1.8, based on 73 observed cases). Statistically significant risk elevations were observed for nonmelanoma skin cancer (5 cases; SIR, 4.6; 95% confidence interval, 1.5-10.7), buccal cancer (5 cases; SIR, 5.5; 95% confidence interval, 1.8-12.9), and primary liver cancer (3 cases; SIR, 10.0; 95% confidence interval, 2.1-29.2).
CONCLUSIONS: This study confirms an increased risk of nonmelanoma skin cancer among patients with HS. The risk for buccal cancer and primary liver cancer was also elevated among this cohort, but these associations should be interpreted cautiously because the combination of multiple significance testing and the few observed cases may have generated chance findings.
TREATMENT ANTIBIOTICS Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa.
Jemec GB, Wendelboe P.
Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark.
J Am Acad Dermatol 1998 Dec;39(6):971-4 Abstract quote
BACKGROUND: Antibiotics are often used to treat hidradenitis, but only topical clindamycin has been shown to be effective in a randomized controlled trial. The paucity of these trials may be the result of difficulties in disease assessment.
OBJECTIVE: We compare topical clindamycin with systemic tetracycline in the treatment of hidradenitis suppurativa, and study clinical disease assessment.
METHODS: A total of 46 patients with stage 1 or 2 hidradenitis suppurativa were treated in a double-blind, double dummy controlled trial.
RESULTS: No significant difference was found between the two types of treatment. Patients' global assessment of disease was significantly worse than physician's assessment in 3 of 5 evaluations (P = .0096 to .015), but the correlation between patients' and physicians' assessments was satisfactory after only one visit (rs = .761 to .895). Soreness was the key factor in patients' overall assessment of the disease.
CONCLUSION: Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin. Subjective factors, particularly soreness, appear to be a key factor in patients' assessment of the disease and should, therefore, be included as an outcome variable in future therapy studies.
DRESSINGS Negative-pressure dressings in the treatment of hidradenitis suppurativa.
Elwood ET, Bolitho DG.
Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Ann Plast Surg 2001 Jan;46(1):49-51 Abstract quote
Negative-pressure dressings have been used in the treatment of a variety of open wounds, and as a bolster for skin grafts. The benefits of these dressings include increased oxygen tension in the wound, decreased bacterial counts, increased granulation formation, and the prevention of shear force on wounds. Also, by virtue of the diminished need for daily dressing changes, there are the additional advantages of enhancing patient comfort, decreasing nursing work, and diminished cost of wound care. Hidradenitis suppurativa (HS) is a chronic infection of the apocrine sweat glands. Treatment options range from oral isotretinoin to radical excision. Wound closure may be achieved by secondary intention, skin grafting, or flap closure. Complications may still arise and include disease progression and squamous cell carcinoma. Radical excision yields the best results in terms of disease eradication.
The authors describe using the negative-pressure dressing in two cases of bilateral axillary HS to secure skin grafts firmly to the wound bed after radical excision of all involved tissues. Patient comfort and acceptance was high, and skin graft take was excellent. The dressings themselves are simple to apply and are highly effective.
INFLIXIMAB
Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial.
Grant A, Gonzalez T, Montgomery MO, Cardenas V, Kerdel FA.Florida Academic Dermatology Centers, Miami, Florida 33136, USA.
J Am Acad Dermatol. 2010 Feb;62(2):205-17. Abstract quote
BACKGROUND: Biologic therapies with anti-tumor necrosis factor agents are promising treatments for hidradenitis suppurativa (HS).
OBJECTIVE: We assessed the efficacy and safety of infliximab (IFX) for the treatment of moderate to severe HS.
METHODS: A prospective double-blind treatment phase of 8 weeks where patients received IFX or placebo was followed by an open-label phase where patients taking placebo were given the opportunity to cross over to IFX, and an observational phase. Primary treatment efficacy was based on HS Severity Index. Secondary end points included Dermatology Life Quality Index, visual analog scale, and Physician Global Assessment scores. Inflammatory markers erythrocyte sedimentation rate and C-reactive protein were also assessed.
RESULTS: More patients in the IFX than in the placebo group showed a 50% or greater decrease from baseline HS Severity Index score. In addition, statistically and clinically significant improvement from baseline was observed at week 8 in Dermatology Life Quality Index score, visual analog scale score, erythrocyte sedimentation rate, and C-reactive protein compared with placebo. Patients in the placebo group treated with IFX after week 8 (crossover) responded similarly to the original IFX group. Many patients withdrew during the observational phase to continue anti-tumor necrosis factor-alfa therapy. No unexpected serious adverse events were observed.
LIMITATIONS: Results are representative of a single center, patients were treated by a single physician, some patients did not return after their last infusion, and the HS Severity Index requires validation.
CONCLUSIONS: This clinical study represents the first formal assessment of IFX for treatment of moderate to severe HS. IFX was well tolerated, no unexpected safety issues were identified, and improvements in pain intensity, disease severity, and quality of life were demonstrated with concomitant reduction in clinical markers of inflammation.ISOTRETINOIN Long-term results of isotretinoin in the treatment of 68 patients with hidradenitis suppurativa.
Boer J, van Gemert MJ.
Department of Dermatology, Deventer Hospital, The Netherlands.
J Am Acad Dermatol 1999 Jan;40(1):73-6 Abstract quote
BACKGROUND: Oral isotretinoin has been used to treat mild to severe hidradenitis suppurativa (HS).
OBJECTIVE: We reviewed the results of low-dose isotretinoin for 4 to 6 months in the treatment of 68 patients with HS.
METHODS: This is a retrospective study. Data are presented in terms of response rate, long-term follow-up, and the relation between response rate and severity.
RESULTS: In 16 patients (23.5%), the condition completely cleared during initial therapy and 11 patients (16.2%) maintained their improvement during the follow-up period. Treatment was more successful in the milder forms of HS.
CONCLUSION: Monotherapy with isotretinoin for patients with HS usually has a limited therapeutic effect.
LASER Treatment of hidradenitis suppurativa with carbon dioxide laser excision and second-intention healing.
Finley EM, Ratz JL.
Department of Dermatology, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA 70121, USA.
J Am Acad Dermatol 1996 Mar;34(3):465-9 Abstract quote
BACKGROUND: Hidradenitis suppurativa is a disabling disease. Although medical management can at times control the disease, the treatment of choice is surgical excision. Surgical defects have been managed by second-intention healing, simple surgical closure, or complex surgical repairs.
OBJECTIVE: Our purpose was to determine the benefit of carbon dioxide laser excision with healing by second intention to treat lesions of hidradenitis suppurativa.
METHODS: We treated seven patients who had axillary and inguinoperineal hidradenitis suppurativa with carbon dioxide laser excision followed by second-intention healing. A total of 12 procedures were performed (five bilateral and two unilateral). Follow-up periods were 10 to 27 months.
RESULTS: After a healing time of 4 to 8 weeks, scars were flat and linear. Only one recurrence of hidradenitis suppurativa has been observed; this occurred along the margin of the surgical scar in a previously treated area. Some patients, however, had continued disease activity in untreated areas. All subjects were satisfied with the results of the procedure, and complications were minimal.
CONCLUSION: Carbon dioxide laser excision with second-intention healing is safe and effective for hidradenitis suppurativa.
SURGERY Perianal hidradenitis suppurativa: early surgical treatment gives good results in chronic or recurrent cases.
Endo Y, Tamura A, Ishikawa O, Miyachi Y.
Department of Dermatology, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
Br J Dermatol 1998 Nov;139(5):906-10 Abstract quote
Hidradenitis suppurativa (HS) represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses followed by the formation of sinus tracts and scarring. It is an uncommon disorder frequently involving the perianal region.
We review the clinical and pathological features of 12 patients (10 men and two women) with perianal HS (PHS). The mean age at presentation was 43 years (range 24-65), and the mean duration of illness was 14 years (range 2-30). Two patients exhibited multiple areas of involvement, including the axilla and the nape of the neck, in addition to the perianal region. Histological examinations showed epidermis-lined sinuses surrounded by dense plasma cell infiltration in four of nine specimens. The complications related with PHS included anal fistula (seven patients), diabetes mellitus (four), malignant tumour (two) and sepsis (one). Three patients died of the complications. Eight patients underwent wide local excision. The defects were managed with a meshed split-thickness skin graft in five patients, and open treatment in the remainder. New lesions developed in untreated skin of two patients. However, no patient relapsed in the surgically treated sites.
PHS is frequently complicated with anal fistula and is occasionally life-threatening as a result of the occurrence of malignant tumours or sepsis. Early surgical excision followed by meshed split-thickness skin graft can successfully cure the lesion without functional disturbance.
Subcutaneous fistulectomy in bridging hidradenitis suppurativa.
Golcman R, Golcman B, Tamura BM, Nogueira MA, Zoo CM, Germano JA.
Department of Dermatology, University of Sao Paulo Medical School, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
Dermatol Surg 1999 Oct;25(10):795-8 Abstract quote
BACKGROUND: The treatment of chronic lesions in hidradenitis suppurativa remains a challenge. For some clinical types surgical management is an excellent alternative.
OBJECTIVE: This study evaluates an alternative surgical approach for the treatment of hidradenitis suppurativa of specific bridging lesions by subcutaneous resection of the tubular fibrotic tissue.
METHODS: Periorificial fusiform skin incisions were made around the orifices parallel to the axillary or inguinal folds and the subcutaneous tubular fibrotic tissue was removed en bloc before skin suturing.
RESULTS: The outcome was evaluated as satisfactory due to lower morbidity, minimizing the excised skin areas, prevention of bridles or adherences, shorter incisions, no healing difficulties, and less dehiscence or wound exposure.
CONCLUSION: The subcutaneous fistulectomy is a surgical option in bridging hidradenitis suppurativa.
Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa.
Rompel R, Petres J.
Department of Dermatology, Klinikum Kassel, Kassel, Germany.
Dermatol Surg 2000 Jul;26(7):638-43 Abstract quote
BACKGROUND: Hidradenitis suppurativa (acne inversa) is a chronic recurrent disorder characterized by abscessing inflammation, fistulating sinus tracts, and scarring. Predilection sites are the intertriginal regions. The severe course of the disease demands an early and curative treatment.
OBJECTIVE: The aim of this study was to review the effect of radical surgical excision concerning cure rate and potential complications within a large group of patients.
METHODS: We analyzed data for 106 patients suffering from hidradenitis suppurativa treated during the period 1980-1998. The mean duration of the disease was 7 years. In about 90% of the cases, two or more sites were affected. Inguinal (70.8%) and axillary regions (61.3%) were most commonly involved. All patients were treated by radical wide excision using intraoperative marking of sinus tracts with methylviolet solution. The method of reconstruction depended on the size and location of the defect. Median postoperative follow-up time was 36 months.
RESULTS: The overall complication rate was 17.8%. Most of these were minor complications such as suture dehiscence, postoperative bleeding, and hematoma. Wound infection occurred in only 3.7% of patients. The rate of recurrence within the operated fields was 2.5%. There was no relation between the surgical method of reconstruction and the rate of recurrence. Recurrence was related to the severity of the disorder.
CONCLUSION: Our results confirm early radical excision as the treatment of choice for hidradenitis suppurativa. Using intraoperative color-marking of sinus tracts, the recurrence rate is minimal. The method of reconstruction has no influence on recurrence and should be chosen with respect to the size and location of the excised area.
LinkOut Surgical treatment of hidradenitis suppurativa.
Bohn J, Svensson H.
Department of Plastic and Reconstructive Surgery, Malmo University Hospital, Malmo, Sweden.
Scand J Plast Reconstr Surg Hand Surg 2001 Sep;35(3):305-9 Abstract quote
Hidradenitis suppurativa is a skin disease involving the apocrine sweat glands which often becomes chronic. The aetiology is not completely known, but the mainstays of medical treatment are antibiotics, which gives temporary relief but do not essentially alter the course of the disease.
We describe our results of treating 138 affected patients by radical excision of the diseased areas between 1978 and 1999. Postoperative follow-up ranges from 3 months to 21 years; we compiled data from the patients' casenotes and circulated a questionnaire, which 116 patients completed. Median age at onset of disease was 23 years and the interval before radical surgery was 10 years. Altogether 367 affected sites were excised; most cases required skin grafting. There were no serious surgical complications. In 38 patients (33%) the disease recurred to some degree, and 14 of them required further operation. Six patients had a subsequent operation to improve the aesthetic result. Ninety-six of the patients (83%) answered that they would recommend the procedure to other patients under similar circumstances.
In our opinion excision and skin grafting is a valuable treatment in cases of severe hidradenitis suppurativa.
Experience with surgical treatment of hidradenitis suppurativa.
Tanaka A, Hatoko M, Tada H, Kuwahara M, Mashiba K, Yurugi S.
Division of Plastic Surgery, Nara Medical University, Japan.
Ann Plast Surg 2001 Dec;47(6):636-42 Abstract quote
The authors report their experience with 23 sites of hidradenitis suppurativa, including cases with musculocutaneous flap repair, and discuss the surgical methods applied.
Twenty-three sites in 19 patients with chronic inflammatory skin lesions were reviewed. The lesions were divided into two groups: The limited group was comprised of mild lesions, which appear isolated and have limited abscesses without sinus tract formations. The severe group was compromised of severe lesions, which included diffuse, multiple abscesses with severe sinus tract formation and fibrosis. Nine sites were limited and 14 sites were severe. After resecting the lesion, the defect was covered with a split-thickness skin graft (four sites were limited, nine sites severe), a musculocutaneous flap (five sites severe), primary closure (four sites limited), and a local skin flap (one site limited). In six sites in 6 severe-group patients, local recurrence occurred. The local recurrence rate differed significantly between the limited and the severe groups. The reason for this may be because the lesions in the limited group could be resected completely, whereas the lesions in the severe group were diffuse and total resection was sometimes difficult for various reasons. The method of surgical repair did not affect the local recurrence rate. In recurrent cases, four sites treated with skin grafting required further surgical treatment, and two sites treated with musculocutaneous flaps were controlled with oral antibiotics. In conclusion, sufficient resection of the lesion is the most important issue in treating follicular occlusion triad disease.
In lesions that can be resected completely, the surgical procedure to cover the lesions should be selected to suit the size and site of the defect. However, in cases that cannot be resected completely, a musculocutaneous flap is recommended instead of a skin graft for enhanced postoperative management of the recurring wound, and its contribution to aesthetic and functional improvement.
Follicular occlusion triad-Hidradenitis suppurativa, dissecting cellulitis of the scalp, and acne conglobata.
Basic Principles of Disease
Learn the basic disease classifications of cancers, infections, and inflammation
Commonly Used Terms
This is a glossary of terms often found in a pathology report.Diagnostic Process
Learn how a pathologist makes a diagnosis using a microscopeSurgical Pathology Report
Examine an actual biopsy report to understand what each section meansSpecial Stains
Understand the tools the pathologist utilizes to aid in the diagnosisHow Accurate is My Report?
Pathologists actively oversee every area of the laboratory to ensure your report is accurate
Search for a Physician Specialist
Hidradenitis Suppurativa Foundation
Hidradentis Suppurativa USA
Last Updated February 17, 2010
Send
mail to The Doctor's Doctor with
questions or comments about this web site.
Read the Medical Disclaimer.
Copyright © The Doctor's Doctor