Extensive Hidradenitis Suppurativa Research Articles

Commentary on "Staged Regional Deroofing for the Treatment of Extensive Hidradenitis Suppurativa".

Commentary on "Staged Regional Deroofing for the Treatment of Extensive Hidradenitis Suppurativa".

Staged Regional Deroofing for the Treatment of Extensive Hidradenitis Suppurativa.

Staged Regional Deroofing for the Treatment of Extensive Hidradenitis Suppurativa.

Extensive hidradenitis suppurativa treatment with wide radical excision and skin grafting: a case report

Acne inversa, also referred to as purulent apocrine gland inflammation (hidradenitis suppurativa – HS), is a chronic inflammation of the skin, causing painful and purulent lesions that usually appear in the areas with a large number of apocrine glands, such as axillae, inguinal regions and inframammary folds. This study involves the case of a 46-year-old woman suffering from the treatment resistant Hurley Stage III HS. The patient underwent a series of surgeries using wide radical excision of the entire involved tissue, as well as graft procedures to treat extensive HS lesions in various body areas. Numerous treatment modalities regarding HS have been established, although their effects are not permanent enough to prevent recurrence. Therefore, surgery is regarded as the most effective, or even the only effective treatment of severe HS. Nevertheless, following the standard pharmacological and surgical treatment, it is crucial to ensure optimization of the nutritional parameters, reduction of friction and pressure in the affected area, appropriate wound care, weight loss and smoking cessation.

Two-stage Treatment Using Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d) for Extensive Hidradenitis Suppurativa of the Buttocks

Two-stage Treatment Using Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d) for Extensive Hidradenitis Suppurativa of the Buttocks

Spontaneous rupture of a parastomal hernia with evisceration of small bowel: a case report

BackgroundLong standing ostomy related complications such as parastomal hernia and stoma prolapse may be at a higher risk of developing spontaneous rupture and evisceration, especially in patients suffering from chronic cough. Such patients may need early refashioning of the stoma to prevent this serious complication. Parastomal evisceration is a very rare complication of stomas and to date, only few cases have been reported in the literature.Case presentationA 51 year old patient with chronic obstructive pulmonary disease (COPD) and extensive hidradenitis suppurativa of the perineum underwent a temporary defunctioning loop sigmoid colostomy and subsequent perineal skin excision and skin grafting. The ostomy was complicated by a parastomal hernia and stoma prolapse 6 weeks post operatively. Five months later he developed spontaneous rupture of parastomal hernia and evisceration of small bowel. Urgent surgery was done and reduction of small bowel loops and re-siting of the sigmoid colostomy was done.Discussion and conclusionsParastomal evisceration is an extremely rare life threatening stoma-related complication which requires urgent treatment.

Split-Thickness Skin Graft for Repeated Extensive Hidradenitis Suppurativa of Axilla: Case Report and Literature Review

Hidradenitis suppurativa (HS) is a chronic relapsing disease that frequently causes disabling pain, diminished range of motion, and social isolation. In advanced cases of HS, aggressive excision of the involved apocrine tissue with subsequent reconstruction is the definitive treatment. Here, we present our recent experience of using split-thickness skin graft (STSG) for managing an extensive defect following wide surgical excision of axillary HS lesions. Adequate wide excision of the infected tissue ensures complete skin-graft take while allowing full shoulder mobility, thereby minimizing undesirable outcomes. No limitation of shoulder joint or disease recurrence was observed during one year of follow-up. This method has satisfactory aesthetic and functional results as well as low donor site morbidity for treatment of repeated extensive HS of axilla.

Extensive hidradenitis suppurativa (HS) Hurly stage III disease treated with intravenous (IV) linezolid and meropenem with rapid remission

A 57-year-old woman with Hurley Stage 3 hidradenitis suppurativa (HS) and multiple co-morbidities is presented. She had failed multiple antibiotic therapies and etanercept. She had end stage renal disease and was on dialysis. Her HS was put into remission with one month of daily IV treatment with 1.2 grams linezolid and 1 gram of meropenem, administered daily through her dialysis shunt. Unfortunately, her disease flared again two weeks after the cessation of the IV treatment. Nevertheless, more conventional therapy was then able to maintain her disease at a level that was significantly improved over baseline prior to the IV treatment. This case highlights above all a primary etiology of HS is stimulus of immune system's over-reaction in HS to the bacterial microbiome. If antibiotics are administered to a patient with stage 3 HS powerful enough to wipe out the bacterial biome, the immune system having no target retreats, permanent scarring in its wake and retreats to a certain but hardly permanent normalcy.

Surgical Approach to Extensive Hidradenitis Suppurativa

BACKGROUND Hidradenitis suppurativa (HS) is a chronic suppurative disease of skin with high recurrence. OBJECTIVE To determine factors affecting complications and recurrence of HS in patients who underwent surgery. MATERIALS AND METHODS We operated on 15 patients with HS at 36 sites between 1999 and 2009. The affected areas were classified as groin, axilla, buttocks, nuchae, perianal, and perineal. All patients were treated using wide surgical excision under general anesthesia. The methods of reconstruction varied depending on the size and location of the defect. RESULTS The female:male ratio of patients was 4:11. Mean age was 41.8±10.6. Twenty-eight (77%) of the lesions were Stage III according to Hurley's staging system. Mean follow-up was 42 months. Radical excision was performed on all lesions; 20 were reconstructed with primary closure, nine with fasciocutaneous flaps, and five with split-thickness skin grafts. The overall complication rate was 25% (9/36) and complications occurred mostly in perineal, perianal, and buttocks sites. Two (5.5%) recurrences were seen only in buttocks site. CONCLUSION To prevent complication, avoid recurrence of HS, and improve patients' quality of life, early and wide surgical excision is important and effective. The recurrence and complications are mostly related to the location of the disease. The authors have indicated no significant interest with commercial supporters.

Surgical Approach to Extensive Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic suppurative disease of skin with high recurrence. To determine factors affecting complications and recurrence of HS in patients who underwent surgery. We operated on 15 patients with HS at 36 sites between 1999 and 2009. The affected areas were classified as groin, axilla, buttocks, nuchae, perianal, and perineal. All patients were treated using wide surgical excision under general anesthesia. The methods of reconstruction varied depending on the size and location of the defect. The female:male ratio of patients was 4:11. Mean age was 41.8 ± 10.6. Twenty-eight (77%) of the lesions were Stage III according to Hurley's staging system. Mean follow-up was 42 months. Radical excision was performed on all lesions; 20 were reconstructed with primary closure, nine with fasciocutaneous flaps, and five with split-thickness skin grafts. The overall complication rate was 25% (9/36) and complications occurred mostly in perineal, perianal, and buttocks sites. Two (5.5%) recurrences were seen only in buttocks site. To prevent complication, avoid recurrence of HS, and improve patients' quality of life, early and wide surgical excision is important and effective. The recurrence and complications are mostly related to the location of the disease. The authors have indicated no significant interest with commercial supporters.

Hyperbaric Oxygen Therapy as an Adjunct to Surgical Treatment of Extensive Hidradenitis Suppurativa

We appreciate the comments by Uzun et al. [1]. In our series, we did not consider the option of hyperbaric oxygen therapy (HBOT) because we did not experience any serious wound complications. This was due to the meticulous wound care carried out in our clinic. We also did not experience any recurrences [2]. In cases of serious woundsite infections, however, HBOT may be an alternative treatment, although it should always be accompanied by surgery and intensive surgical wound care [1]. Apart from wound-site infections, this modality can be considered for the purpose of shortening the wound-healing period for patients whose wounds are left open for secondary intention. In our study, despite the 2-week mean healing period for the rotation flap group, the mean healing times of the patients who were treated with skin grafts and secondary intention were 8.0 and 12.2 weeks, respectively (almost 2 and 3 months, respectively) [2]. This prolonged healing period might have been avoided had the enhanced wound-healing effects of HBOT mentioned by Uzun et al. [1] been applied. We can see that there is a lack of data in the literature concerning the use of HBOT as an adjunct to surgery in such cases and agree that the role of HBOT in hidradenitis suppurativa cases should be researched in a randomized controlled trial.

Hyperbaric Oxygen Therapy as an Adjunct to Surgical Treatment of Extensive Hidradenitis Suppurativa

We appreciate the comments by Uzun et al. [1]. In our series, we did not consider the option of hyperbaric oxygen therapy (HBOT) because we did not experience any serious wound complications. This was due to the meticulous wound care carried out in our clinic. We also did not experience any recurrences [2]. In cases of serious woundsite infections, however, HBOT may be an alternative treatment, although it should always be accompanied by surgery and intensive surgical wound care [1]. Apart from wound-site infections, this modality can be considered for the purpose of shortening the wound-healing period for patients whose wounds are left open for secondary intention. In our study, despite the 2-week mean healing period for the rotation flap group, the mean healing times of the patients who were treated with skin grafts and secondary intention were 8.0 and 12.2 weeks, respectively (almost 2 and 3 months, respectively) [2]. This prolonged healing period might have been avoided had the enhanced wound-healing effects of HBOT mentioned by Uzun et al. [1] been applied. We can see that there is a lack of data in the literature concerning the use of HBOT as an adjunct to surgery in such cases and agree that the role of HBOT in hidradenitis suppurativa cases should be researched in a randomized controlled trial.

Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Peri‐Anal and Gluteal Regions

Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Peri‐Anal and Gluteal Regions

Surgical Approach to Extensive Hidradenitis Suppurativa in the Perineal/Perianal and Gluteal Regions

Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes. A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed. Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks. Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic spread of the malignancy. At the end of a 5-year mean follow-up period, all remaining patients had no evidence of disease. Conservative treatment methods have little or no effect on extensive perineal/perianal hidradenitis suppurativa. Therefore, total surgical excision must be considered for these patients to prevent further complications, such as abscess, sinus tract formation, fistulization, and scarring. A temporary stoma may be needed in some cases. Because wound management after total excision is performed via different methods according to each individual patient, multidisciplinary team work is necessary and the patients often require a long hospital stay. If the treatment is not performed in an appropriate manner or if the patients are not followed closely until definitive healing, recurrence is almost inevitable. Despite the low incidence of accompanying squamous cell carcinoma, it is the most serious complication. We evaluated 15 patients to present our experience with extensive perineal/perianal and gluteal hidradenitis suppurativa.

Squamous cell carcinoma complicating hidradenitis suppurativa

SUMMARY We describe a patient who suffered over 40 years from persistent, extensive hidradenitis suppurativa (HS) and who developed squamous cell carcinomas at two different sites.

Gluteal and perianal hidradenitis suppurativa: surgical treatment by wide excision.

Hidradenitis suppurativa is a chronic inflammatory disease of the skin and subcutaneous tissue. Extensive gluteal and perianal disease represents a challenge presentation. The aim of this study was to present results of management of extensive hidradenitis suppurativa in gluteal, perineal, and inguinal areas. From January 1980 to May 2000, 56 patients underwent treatment of hidradenitis suppurativa in gluteal, perineal, and inguinal areas through wide excision; 52 (93 percent) were male and 36 (64 percent) were white. Mean age was 40 years. We evaluated distribution of disease, associated conditions, use of diverting colostomy, management of operative wounds, time to complete healing, complications, and recurrence. Twenty-one (37.6 percent) and 17 (30.6 percent) patients had gluteal and perineal disease, respectively. Squamous-cell carcinoma and Crohn's disease were observed in one patient each. Wide surgical excision was performed in all. Healing by second intention was the choice in 32 (57.1 percent) patients, and 24 (42.9 percent) patients underwent delayed skin-grafting. Diverting colostomy was used in 23 (41 percent) patients. Mean time for complete healing in the nongrafted group was 10 (range, 7-17) weeks and in the skin graft group was 6 (range, 3-9) weeks. New resection was performed in five (8.9 percent) patients. Partial graft loss rate was 37.5 percent and recurrence was observed in only one (1.8 percent) patient. Significant morbidity derives from extensive gluteal and perineal hidradenitis suppurativa caused by the disease extension and large wounds that result from surgical treatment. Wide surgical excision is the treatment of choice and leads to cure. Skin-grafting and healing by second intention lead to effective wound healing.

Letter: Facial involvement with hidradenitis suppurativa.

To the Editor.— Hidradenitis suppurativa is a chronic, progressive disease with substantial morbidity that occurs chiefly in young adults and is topographically limited to the apocrine gland-bearing areas of the body. The usual sites of involvement are the axillae, perineum, buttocks, breasts, and umbilicus. However, it occasionally occurs in areas where apocrine glands are considered ectopic, such as the face and the eyelids (Arch Ophthalmol77:635,1967). There have been few reports in the literature concerning hidradenitis suppurativa in ectopic or unusual sites. In the following case, the patient had extensive hidradenitis suppurativa of the axillae, groin, and buttocks, as well as involvement of the right temporal and periorbital areas. Report of a Case A 57-year-old white man was institutionalized in a state mental hospital at the age of 22 with a diagnosis of chronic schizophrenia, simple type. He has remained in the institution for the past 35 years. He apparently