Cases Of Hidradenitis Suppurativa Research Articles

Prevalence of Hidradenitis Suppurativa: A Population-Based Study in Olmsted County, Minnesota

Background: Hidradenitis suppurativa (HS) is a follicular occlusion disorder occurring in apocrine-rich regions of the skin. Estimates of the prevalence of this disorder have not been population-based. Objective: We sought to provide population-based information on the prevalence of HS in Olmsted County, Minnesota, as of January 1, 2009. Methods: The Rochester Epidemiology Project, a unique infrastructure that combines and makes accessible all medical records in Olmsted County since the 1960s, was used to collect population-based data on the prevalence of HS. Results: We identified 178 confirmed cases of HS that included 135 females and 43 males, and estimated the total sex- and age-adjusted prevalence in Olmsted County to be 127.8 per 100,000 or 0.13%. The total prevalence was significantly higher among women than men. Conclusion: This study represents the first population-based investigation on the prevalence of HS. In this population-based cohort, HS was less prevalent than suggested by previous reports.

Successful Treatment of Severe Hidradenitis Suppurativa With Anakinra

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that is characterized by painful and suppurating lesions. Herein, we report a case of severe HS that was refractory to multiple treatments but responded rapidly to anakinra injections

Vulvar reconstruction using the “lotus petal” fascio-cutaneous flap

IntroductionVulvar reconstruction using the “lotus petal” fascio-cutaneous flap offers a relatively novel means to restore symmetry and functionality after extirpative gynecologic or oncologic procedures. We sought to assess the success rates and morbidity in a large series of consecutively treated patients. MethodsWe performed a retrospective review of 59 consecutive cases of lotus petal flaps performed at a single institution to more accurately assess success and complication rates. ResultsWe identified 80 flaps performed among the 59 patients between September 1, 2008 and March 30, 2013. The median (range) age was 59years (24–89) and the median (range) BMI was 27kg/m2 (19–34). The indications for vulvar/perineal excision were as follows: 39 (66.1%) vulvar carcinoma or melanoma, 12 (20.3%) vulvar dysplasia, 5 (8.5%) colorectal disease and 3 (5.1%) cases of hidradenitis suppurativa. The mean defect area, determined by post-fixation pathology specimen was 29cm2. Medical or surgical complications occurred in 36% of patients of which superficial wound separation was the most common (15%). There were no cases of complete flap loss, but partial loss occurred in 7 (8.8%) cases. 3 (5.1%) patients required re-operation prior to discharge with one case requiring skin grafting. Delayed surgical revision was required in 4 patients for partial flap loss (2) or stricture/stenosis (2). ConclusionThe lotus petal flap is safe for use in gynecologic reconstruction, with acceptable short- and long-term complication rates. Previous reports of smaller series likely underestimate the risk of complications through case selection.

Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis

Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Pyoderma fistulans sinifica (fox den disease) appears to be the same entity as Hurley Stage 2 of 3 HS. The rate of acne vulgaris in HS patients mirrors unaffected controls. The most common, albeit still uncommon, association is with seronegative, haplotype unlinked arthritis (most importantly B27), in particular spondolyarthritis. Crohn disease and HS occur together at a rate that varies from 0.6% to 38% in retrospective cases series. Ulcerative colitis occurred with HS in 14% of patients in one series. The next most common association is with pyoderma gangrenosum, but this association is likely under-reported. Synovitis-Acne-Pustulosis Hyperostosis-Osteitis (SAPHO) syndrome, which is rare, has more than 10 reports linking it to HS. Nine case reports have linked Dowling-Degos disease (DDD) to HS and two reports related HS to Fox-Fordyce disease (FF), but because both occur in the axilla this might be a mere coincidence. HS is rarely associated with ophthalmic pathology. Specifically, more than 5 reports link it to Keratitis-Ichthyosis-Deafness syndrome (KID); greater than10 cases link it to interstitial keratitis and 2 cases are linked to Behçet's disease. The presence of proteinuria and acute nephritis link HS to the kidney, especially since and reports have documented resolution of HS after renal transplant. Florid steatocystoma multiplex, Sjogren Syndrome, and HS have been linked and their reports likely underestimate their coincidence because all these entities involve occlusion (albeit by different mechanisms). Three reports link HS and amyloid, but both share some common genetic underpinnings and thus the coincidence of these diseases is likely underreported. Pyoderma vegetans has been noted in 2 cases of HS and 4 cases of Inflammatory Bowel Disease (IBD) and is likely a clue to the linkage of the pathology of IBD and HS. Pityriasis rubra pilaris, in particular Type VI related to HIV, has a relationship more commonly with acne conglobata, but with HS also. Single case reports of diseases associated with HS include systemic lupus erythematosus, acromegaly, Down syndrome, Bazex-Dupre´-Christol, and prurtis ani, but these might be coincidences. Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA Syndrome) and Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis (PASH Syndrome) are pyodermic-arthritic syndromes that are associated with HS. Erythema nodosum and granulomatous lobular mastitis have been reported with HS but the significance of these reports is uncertain. Because of scarring, HS can result in lymphedema including scrotal elephantiasis and verrucous lymphedema. HS is sometimes accompanied by obesity, hypertension, and anemia and can be considered a disease in the spectrum of metabolic syndrome, a skin disease with systemic consequences. HS, like other types of chronic inflammation when long standing in the perianal and perineal areas, can result in squamous cell cancer. A variety of drugs can induce HS. These include lithium, sirolimus, cyclosporine, vemurafenib, and oral contraceptives. Inverse psoriasis or psoriasis vulgaris as a side effect of infliximab therapy may be associated with HS. These associations aside, most cases of HS occur in isolation without coincident morbidity.

Disseminated Mycobacterium chelonae infection: Complicating a case of hidradenitis suppurativa

Mycobacteium chelonae is a rapidly growing atypical mycobacteria known to be pathogenic in humans. We report a case of Hidradenitis Suppurativa (HS) with diabetes complicated by infection of the lesions with Staphylococcus aureus and M. chelonae leading to non-healing and discharging lesions. HS is a rare, insidious and debilitating disease characterized by swollen, painful, inflamed lesions in the axillae, groin, and other parts of the body that contain apocrine glands. Discharge from HS lesions are often found to be sterile, however, polymicrobial bacterial colonization commonly occurs within sinus tracts which can lead to offensive smelling discharge, infection, cellulitis, and superinfection. The incidence of HS is very low and the association with M. chelonae makes it a rare and interesting case.

Utility of transperineal and anal ultrasonography in the diagnostics of hidradenitis suppurativa and its differentiation from a rectal fistula

The pathogenesis of hidradenitis suppurativa (HS) is not fully understood. There exist several theories, in which mechanical factors, genetic factors, as well as immunological dysfunction of lymphocytes are suspected. Clinically, this entity is frequently mistaken for anal fistula with consequently wrong treatment. We aim to determine the utility of transperineal ultrasound (TPUS) and anal ultrasound (AUS) in the diagnosis of HS and its differentiation from an anal fistula. Retrospective analysis was performed on 51 patients (5 females, 46 males) aged 20-71 years (mean age 47.5), who were operated on in the years 2006-2011 for HS in the area of the anus and perineum, and pre-operatively had been imaged with TPUS and AUS. Sixty-seven operations were analyzed, as 11 patients were operated on more than once due to HS recurrence. In 66 out of 67 cases (98.5%), the pre-operative TPUS and AUS were in accordance with the intraoperative findings. Only in 1 patient was a pilonidal cyst diagnosed intraoperatively. In all 67 patients, the TPUS showed typical fluid-solid changes localized in the subcutaneous adipose tissue. In 6 out of 67 cases of HS (8.9%) AUS showed an anal fistula coexisting with the HS. In 2 cases (2.9%) a skin malignancy coexisting with HS was found. TPUS is an accessible imaging method, which confirms the typical localization of changes of HS, and together with AUS it allows for the proper differentiation of HS from an anal fistula or an abscess.

Metformin for the treatment of hidradenitis suppurativa: a little help along the way

Despite recent insights into its aetiology, hidradenitis suppurativa (HS) remains an intractable and debilitating condition for its sufferers, affecting an estimated 2% of the population. It is characterized by chronic, relapsing abscesses, with accompanying fistula formation within the apocrine glandbearing skin, such as the axillae, ano-genital areas and breasts. Standard treatments remain ineffectual and the disease often runs a chronic relapsing course associated with significant psychosocial trauma for its sufferers. To evaluate the clinical efficacy of Metformin in treating cases of HS which have not responded to standard therapies. Twenty-five patients were treated with Metformin over a period of 24 weeks. Clinical severity of the disease was assessed at time 0, then after 12 weeks and finally after 24 weeks. Results were evaluated using Sartorius and DLQI scores. Eighteen patients clinically improved with a significant average reduction in their Sartorius score of 12.7 and number of monthly work days lost reduced from 1.5 to 0.4. Dermatology life quality index (DLQI) also showed a significant improvement in 16 cases, with a drop in DLQI score of 7.6. Metformin helps control HS with minimal side effects and good patient compliance and can represent a further agent in the spectrum of treatments available in the treatment of this disease.

Hidradenitis suppurativa: literature review and case report

Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating disease, affecting mainly women, especially in their second and third decades of life. Its most common incidence is in the axillary, inguinal, perianal and inframammary regions. Its complications include chronic fistulizing processes, with involvement of important adjacent structures, such as the sacrum and coccyx, the anal sphincter, urethra and great-caliber vessels, such as the groin vessels. The proportions of some cases of HS requiring extensive surgical procedures at several moments and the application of flaps and grafts, justify unusual cases reports, like this one. The authors present a case of extensive involvement of the perianal and gluteal regions, which required extended resection with flap in the first approach and fistulectomy in a second surgical moment, with good result for the patient.

Management of Recalcitrant Hidradenitis Suppurativa with Ustekinumab

Hidradenitis suppurativa (HS) is a chronic inflammatory disease resulting from occlusion of the pilosebaceous units within the intertriginous regions of the body. It is characterized by very tender papules, nodules, and neutrophilic abscesses. Sinus tracts with malodorous drainage and scarring can develop. Long-term complications include lymphoedema and fistulae formation. We present here a difficult case of HS that responded well to ustekinumab.

A case of hidradenitis suppurativa with multiple site involvements

A case of hidradenitis suppurativa with multiple site involvements

Prepubertal Hidradenitis Suppurativa Successfully Treated with Botulinum Toxin A

Hidradenitis suppurativa (HS) is a recurrent scarring suppurative disease of the apocrine gland-bearing areas of the body that usually affects the intertriginous areas. Prepubertal HS is a rare condition; fewer than 2% of patients have onset of the disease before the age of 11. Management of HS, in children and adults, may be difficult because of its chronic nature and lack of response to standard therapeutic options, and there is little evidence of the efficacy of the different treatments in randomized clinical trials or after long-term followup. Among all therapies, botulinum toxin A (BTX) has been regarded as effective for isolated case reports of adult-onset HS. Recently, we succeeded in treating a case of prepubertal HS with BTX, which to our knowledge has not previously been described.

Methyl aminolaevulinate photodynamic therapy for the treatment of hidradenitis suppurativa and pilonidal cysts

Hidradenitis suppurativa (HS) and pilonidal cysts are chronic, inflammatory skin conditions involving apocrine gland-bearing skin. Treatment is limited and unsatisfactory. Photodynamic therapy (PDT) has been reported to be safe and effective in the treatment of several off-label skin conditions. We report the case of a 29-year-old man affected by HS and pilonidal cysts since the age of 21. In the past, the patient was treated with antibiotics, corticosteroids and retinoids, without significant clinical improvement. Treatment with methyl aminolaevulinate (MAL)-PDT was started. A topical MAL cream (Metvix) was applied to the affected areas with an occlusive dressing for 3 h and irradiated with a red light source. Therapy was repeated every 15 days for a total of nine applications. The patient completed a 6-month follow-up and achieved an almost complete clinical remission of the skin lesions (80%) and complete resolution of the itching and discomfort. This is the first case of HS associated with pilonidal cysts treated with MAL-PDT. MAL-PDT was effective and well tolerated in our patient. The costs of this therapy represent an important limitation, taking into account the high number of sessions that were performed compared with non-melanoma skin cancers.

The thin circumflex scapular artery perforator flap

The development of microsurgery has most recently been focused upon the evolution of perforator flaps, with the aim of minimising donor site morbidity, and avoiding the transfer of functionally unnecessary tissues. The vascular basis of perforator flaps also facilitates radical primary thinning prior to flap transfer, when appropriate. Based upon initial clinical observations, cadaveric, and radiological studies, we describe a new, thin, perforator flap based upon the circumflex scapular artery (CSA). A perforator vessel was found to arise within 1.5cm of the CSA bifurcation (arising from the main trunk, or the descending branch). The perforator arborises into the sub-dermal vascular plexus of the dorsal scapular skin, permitting the elevation and primary thinning of a skin flap. This thin flap has been employed in a series of five clinical cases to reconstruct defects of the axilla (two cases of hidradenitis suppurativa; pedicled transfers), and upper limb (one sarcoma, one brachial to radial artery flowthrough revascularisation plus antecubital fossa reconstruction, and one hand reconstruction with a chimeric flap incorporating vascularised bone, fascia, and thin skin flaps; free tissue transfers). No intramuscular perforator dissection is required; pedicle length is 8-10cm and vessel diameter 2-4mm. There was no significant peri-operative complication or flap failure, all donor sites were closed primarily, patient satisfaction was high, and initial reconstructive aims were achieved in all cases. Surgical technique, and the vascular basis of the flap are described. The thin circumflex scapular artery perforator flap requires no intramuscular dissection yet provides high quality skin (whose characteristics can be varied by orientation of the skin paddle), and multiple chimeric options. The donor site is relatively hair-free, has favourable cosmesis and no known functional morbidity. This flap represents a promising addition to the existing range of perforator flaps.

HIDRADENITIS SUPPURATIVA OF THE BREAST AROLAE Case Report

A case of hidradenitis suppurativa of the areolae of the breasts is presented. The treatment was excision and split-skin grafting, and this was successful.

Surgical Treatment of Hyperhidrosis and Chronic Hidradenitis Suppurativa

Severe hyperhidrosis and chronic hidradenitis suppurativa both respond promptly to surgical treatment. In less clearly defined clinical situations the treatment of choice varies widely. When topical preparations and systemic therapy are ineffectual, surgery offers the best possibility for permanent cure. Sympathectomy eliminates severe sweating and is especially applicable in controlling pathologic sweating of the hands and feet. Excisional procedures are best for excessive sweating of the axilla. The areas of maximum sweating are excised and the defects closed primarily. Extensive involvement necessitates larger areas of excision and repairs with flaps and z-plasty or its modifications. Most cases of hidradenitis suppurativa can be cured by incision or incision and curettage, with or without fulgeration. In widespread, deeply penetrating cases, cures may require excision of the entire axillary organ. Reparative procedures include skin grafts, regional pedicle flaps, z-plasties, and modified z-plasties. Hidradenitis of various regions can be managed by similar surgical procedures. Cardinoma can develop in chronic hidradenitis suppurativa.

Treatment of Hidradenitis Suppurativa

To the Editor.— In a recent article advocating the treatment of hidradenitis suppurativa by excision and skin grafting, Shaughnessy et al (222:320, 1972) stated that all... therapy short of total excision of the apocrinegland-bearing tissue is temporizing. Several hundred cases of hidradenitis suppurativa seen at our institution during the past 20 years have been successfully treated by exteriorization, curettage, and electrocoagulation. The basic exteriorization procedure had been employed for some time, but its modification with curettage and electrocoagulation, as advocated by one of us has led to excellent results. 1 It is unfortunate that more surgeons do not learn and use this simple technique. The depth of perirectal lesions should be investigated preoperatively. Fissure-inano and processes that involve the deep subcutaneous tissues require more extensive surgery and are not treated by the method herein described. Adequate preoperative evaluation of perirectal lesions should include gentle probing of the sinus tracts, a

Fibrinolytic agents

Hidradenitis suppurativa (HS) generally appears after puberty, is infrequently seen in younger children, and early onset, which is associated with more widespread disease, is more common in children with a positive family history of HS. When compared with adults with HS, children with HS are more likely to have hormonal imbalances, making hormonal investigations integral to disease management in pediatric patients. HS affects intertriginous areas, presenting with double-ended comedones, tender subcutaneous nodules, purulent discharge, and the formation of sinus tracts, hypertrophic fibrotic scars, and dermal contractures. Treatment of HS in children has not been well studied. The goals of therapy in the pediatric setting are to alleviate pain, minimize inflammation and scarring, prevent disease progression, and postpone the need for surgery. Mild cases can be treated with topical antibiotics, while topical and oral antibiotics are the primary therapies for moderate forms of HS. Modalities like biologic agents, laser therapy, or surgery have been reserved for severe pediatric cases of HS. Early recognition and treatment are critical to minimize the effects of the disease on the life course. Given the significant impact of the condition on quality of life and self-esteem, there is a clear role for psychological support.

Norethindrone-Mestranol in Hidradenitis Suppurativa

To the Editor:— I would like to report an interesting case of hidradenitis suppurativa that responded to cyclic administration of a combination of norethindrone and mestranol. A 27-year-old white woman was seen at the Cleveland Clinic in June 1963 complaining of severe recurrent axillary hidradenitis suppurativa. The patient had had this disease, which recurred only between pregnancies for four years. She stated that at the onset of each of her four pregnancies (gravida-4, para-4, abort-0) she noticed the beginning of resolution of all lesions until the mid trimester of her pregnancy when the activity of the lesions appeared to be arrested. In the past she had been given sodium oxacillin, procaine penicillin injections, various tetracycline products by mouth, low doses of x-ray therapy, and injection of staphylococcus toxin. At no time during the course of her recurrences did there seem to be any relief from the condition. Routine urine analysis,