Gluteal Area Research Articles

SYMMETRIC DRUG-RELATED INTERTRIGINOUS AND FLEXURAL EXANTHEMA (SDRIFE) INDUCED BY CIPROFLOXACIN

<h3>Introduction</h3> Symmetric Drug-Related Intertriginous and Flexural Exanthema (SDRIFE) describes a symmetrical erythematous rash seen on gluteal and intertriginous areas after first or repeated exposure to systemic drugs. Although beta-lactam antibiotics are the most common causative agents, fluoroquinolones and topical medications have only rarely been implicated in SDRIFE. Here we describe a case of SDRIFE to ciprofloxacin. <h3>Case Description</h3> A 19-year-old male with microtia was treated for otitis externa. He had no prior history of reactions to antibiotics. He received one week of ciprofloxacin otic drops followed by the addition of oral amoxicillin and ciprofloxacin. After one dose of oral ciprofloxacin, he developed pruritus on his neck, chest, and ear and was subsequently admitted for intravenous (IV) sulfamethoxazole-trimethoprim and ciprofloxacin along with otic ciprofloxacin due to worsening otitis. After 2 doses of IV antibiotics, he developed a maculopapular pruritic rash over the decolletage and back with symmetrical eczematous plaques to bilateral axillae, posterior auricular folds, and neck. Despite discontinuing IV antibiotics, the rash initially worsened but rapidly improved after stopping otic ciprofloxacin. <h3>Discussion</h3> We report one of the few cases of flouroquinolone induced SDRIFE previously described only in patients receiving systemic therapy. In this case, exposure to topical fluoroquinolones continued to drive the hypersensitivity reaction despite discontinuing all systemic fluoroquinolones. Although fluoroquinolones and topically administered drugs remain less recognized culprits of SDRIFE, this case highlights the importance of avoidance of all forms of a culprit drug in patients with drug hypersensitivity.

Trichofolliculoma on gluteal area: A unique case report

Trichofolliculoma on gluteal area: A unique case report

Perianal paget’s disease: A case report

The incidence of extramammary Paget’s disease (EMPD) is very low. It is very important to distinguish between primary Paget’s disease and secondary process. An 85-year-old man was consulted for the presence of an erythematous plaque located in the anal and gluteal area, confirming Paget cells in the biopsy.

Gluteal Reshaping Using a Simple Device for Collecting Fat

Introduction: Liposuction was popularized in the 80s of the previous century. Later, fat graft was widely used to augment different parts of the body especially the gluteal area. Fat collection is a part of the process of fat injection. Different methods have been described for fat collection. The objective is to address the outcome results of collecting large amount of fat using a chest tube canister for gluteal augmentation. Materials and Methods: A total of 20 females were operated for gluteal reshaping. Our choice was fat grafting for augmentation and correction of any depressed scars. The fat was collected using a canister of chest tube. Patients were assessed by measurement of hip circumference and by the usage of Likert scale with some modifications. Results: The mean amount of liposuction was about 4315 cm3 and the mean amount of fat injected was about 1250 cm3 per secession. After 6 months, hip circumference was increased by 4.045 cm. Actually, more than half of patients (65%) were strongly satisfied. One patient suffered from oily cyst that was excised surgically. Conclusion: The canister is safe, cheap, and effective method for collection and preparation of large volume of fat.

Immunomodulatory Drugs in the Treatment of Hidradenitis Suppurativa-Possibilities and Limitations.

Hidradenitis suppurativa, also known as acne inversa, is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. Treatment is rather difficult and typically requires the use of multiple modalities. Regardless of the presence of several therapeutic options, treatment often turns out to be ineffective or poorly selected concerning the clinical picture of the disease. Thus, the search for new biologics and other target treatments of hidradenitis suppurativa is ongoing. The safety and efficacy of adalimumab, still the only U.S. Food and Drug Administration approved biologic in the hidradenitis suppurativa treatment, paved the way for new drugs to be compared with it. Several more drugs with new immunological targets are currently under investigation for the treatment of acne inversa. The aim of the article was to present the current and future targets of acne inversa treatment, simultaneously providing insights into the molecular pathomechanisms of the disease.

Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.

Phytotherapeuthics Affecting the IL-1/IL-17/G-CSF Axis: A Complementary Treatment Option for Hidradenitis Suppurativa?

Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disease characterized by painful skin lesions that occur in the axillary, inguinal, gluteal and perianal areas of the body. These lesions contain recurring deep-seated, inflamed nodules and pus-discharging abscesses and fistulas. Affecting about 1% of the population, this common disease has gained appropriate clinical attention in the last years. Associated with numerous comorbidities including metabolic syndrome, HS is considered a systemic disease that severely impairs the quality of life and shortens life expectancy. Therapeutic options for HS are limited, comprising long-term antibiotic treatment, the surgical removal of affected skin areas, and neutralization of TNF-α, the only approved systemic treatment. Novel treatment options are needed to close the therapeutic gap. HS pathogenesis is increasingly better understood. In fact, neutrophilic granulocytes (neutrophils) seem to be decisive for the development of the purulent destructive skin inflammation in HS. Recent findings suggest a key role of the immune mediators IL-1β, IL-17A and G-CSF in the migration into and activation of neutrophils in the skin. Although phytomedical drugs display potent immunoregulatory properties and have been suggested as complementary therapy in several chronic disorders, their application in HS has not been considered so far. In this review, we describe the IL-1/IL-17/G-CSF axis and evaluate it as potential target for an integrated phytomedical treatment of HS.

First Report of Symmetrical Drug-related Intertriginous and Flexural Exanthema (SDRIFE or Baboon Syndrome) After Erenumab Application for Migraine Prevention.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), formerly also called baboon syndrome, is characterized by symmetrical erythematous rash with typical localization in the gluteal and intertriginous areas. A typeIV delayed hypersensitivity immune response is thought to be responsible for its development. CGRP monoclonal antibodies (CGRP mAbs) are a new class of drugs for the prevention of migraine. We present the first case of SDRIFE occurring in temporal relation to the use of erenumab for migraine prevention. A 48-year-old female patient with migraine received erenumab 140mg subcutaneously in the thigh area for the prevention of migraine in repetitive cycles, each 1month apart. Initially, the patient experienced no side effects. After the third cycle, a masseuse incidentally noticed a reddish, circular rash in the buttock area during a back massage. There were no other symptoms. The skin changes resolved spontaneously. Two years later, approximately 40h after reapplication of erenumab 140mg, the patient experienced a severe pain in the buttock area centered over the anal crease. The area of pain extended in a circular pattern with approximately 20cm in diameter. The pain started abruptly and reached a severe intensity within about 30min. Sitting on the buttocks was no longer possible for the patient. There was marked allodynia and hyperpathia in the entire buttocks region. A flat, broad-based blister-like skin swelling developed in this region. The blisters began opening up on the fourth day after the onset of the skin reaction. In addition, there was a pronounced redness in the entire buttock area. Here, the patient felt a strong burning pain, similar to a scald. The symptoms lasted for a period of 10days. From this point on, they fully subsided under concomitant therapy with prednisolone. SDRIFE as a rare dermatological side effect should be considered in the monitoring of skin lesions during migraine prophylaxis. In view of the high migraine prevalence, knowledge of this uncommon syndrome is important. It is crucial to recognize the relationship between the medication and the circumscribed exanthema occurring distant from the injection site.

Three cases of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) induced by proton-pump inhibitors.

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), previously termed drug-related baboon syndrome, is an uncommon drug eruption. It is characterized by symmetrical erythema involving the gluteal and/or inguinal area in association with one other intertriginous area in the absence of systemic involvement. It typically develops a few hours to days after drug exposure. The diagnosis is based on clinical presentation and drug history. The treatment consists mainly of withdrawal of the causative agent; corticosteroids (topical or systemic) are prescribed to accelerate the resolution. We present three cases that appeared after proton-pump inhibitors (PPIs) intake.

“Baboon” Syndrome

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), previously known as Baboon syndrome, is a symmetrical erythematous rash on the gluteal and intertriginous areas observed after exposure to systemic drugs. This was the case of a 35-year-old woman who presented to medicine OPD (outpatient department) of Assam Medical College and Hospital (AMCH), Dibrugarh with a history of a macular rash over the right and left armpit and right upper back, buttocks and inner aspect of the left thigh.

Caudal regression syndrome: A rare case report with review of the literature

Caudal regression syndrome is a very rare neural tube disorder, in which the caudal vertebral column and spinal cord develop abnormally, causing substantial sensory and motor deficits, primarily in the legs. An abnormality in the spinal cord and nerve roots interacts with a section of lumbar, lumbosacral, or coccygeal spinal dysgenesis or agenesis. Here, we present a rare case of caudal regression syndrome in a 3-year-old male child who was brought to the pediatrics department with a serious complaint of urine dribbling since infancy. The infant was discovered with spina bifida, lumbar scoliosis, and cavus deformity in both feet during a routine health check. For which, a neurological opinion was taken. Plain X-ray revealed a partial sacral agenesis, MRI revealed anterior and posterior nerve roots of cauda equina divided into two bundles of fibers due to abnormal path. The lower back and both gluteal areas were underdeveloped. On the basis of radiological findings, a diagnosis of the syndrome was confirmed.

Treatment of recurrent pilonidal sinus by flap technique(Limberg flap)

Background: pilonidal sinus (PNS) is a chronic disease that mostly affects young adults. describes a hair-filled cavity in the subcutaneous fat of the post sacral intergluteal region, known as the natal cleft , its name arises from the Latin terms “pilus” and “nidus” meaning a nest of hair PNS can be asymptomatic, or may be present as a recurrent abscess or as chronic inflamed cavity and local discharge from sinus or sinuses and local pain and discomfort . Materials and Methods: retrospective study was done from (November 2017 to November 2018) at surgical department in Kirkuk General Hospital in 50 patients with recurrent PNS all will be treated with Limberg flap then follow up for one year this surgery done by excision of PNS till we reach fascia overlying sacrum inferiorly and laterally till we reach gluteal fascia and dissection was performed with electro cautery and reconstruction done by flap (Limberg flap) from gluteal area. Results: in 50 patient with recurrent PNS we have 45 (90%) were male and 5 (10%) were female ,30 patient (60%) patients had a familial history of PNS and 42 patients(84%) with etiology-related risk factors to develop PNS then we divided them according first time surgery done either, by excision and primary closure 30 patient(60%) or excision and healing by granulation tissue and secondary intension 20patient (40%) Discussion: pilonidal sinus not classified as dangerous condition but any patients with PNS live in non-comfortable state and may have complications such as abscess formation or discharging sinus even severe pain therefore Limberg flap is commonly used method to treat recurrent PNS and this good result with healing in short period also satisfactory results in long duration but this method with Sacrococcygeal area disfigure mentation as one long duration complications but less recurrence rates and short stay in hospital and better patient tolerability in this way if we compare it to all other methods even with surgical challenge to create a flap but it less wound infection, hematoma ,edema , wound separation if we compare it to other surgical techniques but fluid accumulation in close space under flap is one of important complications in this method and we decrease it by using a drain and putted in site until fluid drainage in area decreased to be less than 50 ml/day . In this method recurrence rate in our study is 2% but reported recurrence rate for Limberg flap are from 0.8 to 2.7% if we compare to 12% recurrent rate in primary closure therefore we have very good recurrence rate Conclusions: the approach for recurrent PNS should be differ from primary PNS flap reconstruction methods in treatment for recurrent PNS is very good and efficient method even with surgical challenge procedure to create flap, personal hygiene are the keystones for preventing recurrence

Gluteal Region Reshaping of Massive Weight Loss Patients—A Decision-Making Strategy

Background Massive weight loss (MWL) is a very common presentation that you may face as a plastic surgeon. Each patient has his own individual criteria, so, you should work according to a well-organized plan, especially when such cases have concerns about their gluteal area contour that were neglected before by many surgeons. A decision-making strategy was used to give a personalized treatment for targeting gluteal region reshaping of MWL patients. Methods This study considered all patients with MWL subjected to buttock reshaping. There was no randomization in treatment; there was a case-by-case assessment. We analyzed the features of the buttocks, the type of surgery performed, the outcomes, and the complications. Results Fifty two patients were included (41 females and 11 males), ages ranged between 21 and 66 years. Demographic data, preoperative body mass index (BMI), duration of surgery, type of surgery, and postoperative complications were collected. Statistically significant improvements were observed in gluteal ptosis and patient satisfaction grades. Conclusion Aesthetic improvement of the buttocks involves either augmentation or contouring that may be obtained by liposculpture, surgical lifting, or combination. Patients with MWL have high expectations and are often treated with multiple procedures. Thus, an easy strategic approach personalized on each patient to treat multiple adjacent areas in one operation is necessary. Adipose tissue distribution, gluteal skin status, and BMI were the main factors that can forcefully affect our plan to guarantee reduction of unpleasant results and complications and improve patient satisfaction.

V06-05 OFFICE REMOVAL OF SACRAL NEUROMODULATION- WELL TOLERATED, SAFE AND EFFECTIVE

You have accessJournal of UrologyCME1 May 2022V06-05 OFFICE REMOVAL OF SACRAL NEUROMODULATION- WELL TOLERATED, SAFE AND EFFECTIVE Sarah Martin, Jacqueline Zillioux, Lauren Gleich, and Howard Goldman Sarah MartinSarah Martin More articles by this author , Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Lauren GleichLauren Gleich More articles by this author , and Howard GoldmanHoward Goldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacral neuromodulation (SNM) is successfully used for multiple indications. In some instances a trial lead or complete device needs to be removed. Traditionally, permanent lead and/or implantable pulse generator (IPG) removals are done in the operating room under sedation and local anesthesia. Increased age, obesity, frailty, airway, and cardiac disease have been linked to increased anesthetic complications in ambulatory surgery. Over the past 4 years, we have successfully removed 30 SNM devices in the office with pure local anesthesia up to 12 years after implantation; approximately half of these were lead removals after a failed stage I and the other half were SNM leads with IPGs removed for either decreased efficacy, need for MRI, pain or erosion after initial successful stage I and II. Our objective is to present our technique for office-based SNM removal. METHODS: We review our technique of SNM lead and IPG removal in the office using only local anesthesia. RESULTS: The patient is placed prone on the office table and the gluteal area prepped and draped in sterile fashion. Our mayo stand consists of a 15 blade, retractors, needle driver, Metzenbaum scissors, suture scissors, Adson pickups, curved hemostat, 4x4s, sterile water irrigation, a 2-0 and 4-0 Vicryl. Local anesthetic of 0.25% Marcaine and 2% Lidocaine plain is injected superficially and deep over the incisional site. If an IPG is being removed, anesthetic is injected down to the IPG to fill the capsule and aid in dissection. Local anesthetic is also infiltrated at the medial site where the lead was initially placed in case lead removal is difficult and this site needs to be opened. Using a 15 blade and Metzenbaum scissors, the dermal layers are sequentially opened until the lead connection or battery is identified. Either the extension wire or lead attached to the IPG is cut. With gentle traction on the tined lead, you can see the skin dimpling over its medial insertion site. This site is marked in case a medial incision is needed for lead removal. If we detect extensive stretching or tension on the lead, we make a medial incision for removal. We have been able to remove leads from the lateral incision up to 6.5 years after implantation. The incision is irrigated with sterile water. Deep tissue is closed with a 2-0 Vicryl and skin is closed with a 4-0 Vicryl. Steri-Strips and a Tegaderm are used for dressing. CONCLUSIONS: We have demonstrated our technique for removing SNM in the office using local anesthesia. All leads were removed completely intact, no additional pain medication was required and there were no complications. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e566 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Martin More articles by this author Jacqueline Zillioux More articles by this author Lauren Gleich More articles by this author Howard Goldman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Lumbar interlaminar epidural steroid injections for chronic low back- and lower extremity-pain in Sjogren's syndrome: A case report.

Introduction and importancePeripheral nervous system involvement is very common in Sjogren's syndrome (SS); however, polyradiculopathy has been reported rarely in association with SS, and predominantly chronic forms have been described. Here, we reported a case from our Neurosurgery Department in Intan Medika KIM Hospital, Bangka Island, Pangkalpinang, Indonesia; as Academic Health System of Universitas Padjadjaran.Case presentationA 32-year-old woman, diagnosed with Sjogren's syndrome that was characterized by anti-nuclear, anti-Ro, anti-La and anti dsDNA-antibodies positives since 3 years ago; consulted to our department for a chronic low back with a radicular pain in both lower limbs from the gluteal area to both feet together with numbness, hyperstesis and allodynia. The pain was evaluated by the visual analogue scale (VAS) score of 8; we then performed cervico-lumbal computed tomography (CT) scan that demonstrated multiple protruded discs of the cervical- and lumbar-spine.Clinical discussionPain was treated with lumbar interlaminar epidural steroid injections as a safe technique that allows relieving patient symptoms; after 10 min, the patient experienced an improvement in her pain with reduced scores to 0–1 in VAS, as well as a significant improvement on her quality of life later on.ConclusionThe use of lumbar interlaminar epidural steroid injections for an alternative therapeutic for neuropathic pain in SS gives a satisfactory result in terms of improvement of pain as well as a significant improvement on patients' quality of life.

Telerehabilitation of a Patient Post-buttockectomy and Internal Hemipelvectomy Secondary to Pelvic Round Cell Sarcoma during the COVID-19 Pandemic: A Case Report

Pelvic sarcomas are rare malignancies that can result in extensive surgeries involving bone and soft tissue resection, which can greatly improve with rehabilitation. However, due to the restrictions brought about by the COVID-19 pandemic, the rehabilitation of patients with pelvic sarcomas was affected. Limited information is also presented in the literature regarding the rehabilitation of patients with lower extremity surgeries undergoing telerehabilitation and during a pandemic. This study presents the rehabilitation process of a 43-year-old woman diagnosed with pelvic round cell sarcoma of the right gluteal area during the COVID-19 pandemic. The patient underwent wide excision, buttockectomy and internal hemipelvectomy, and we measured outcomes using the Tinetti assessment tool (TAT) and Lower Extremity Functional Scale (LEFS). A decreased risk of falls and improved functional performance were recorded using the TAT and LEFS respectively. Telerehabilitation was noted to have a good satisfaction rate among the patient and health workers.&#x0D; Telerehabilitation may be an effective alternative to face-to-face therapy during the COVID-19 pandemic. More studies are needed to look into the conduct of telerehabilitation intervention among patients with bone and soft tissue surgeries.

Abstract 149: Hyperphosphatemic familial tumoral calcinosis due to homozygous mutation at Leu366Arg: First case report

Background: Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare disabling autosomal recessive metabolic disorder characterized by hyperphosphatemia and manifestations ranging from progressive deposition of calcium phosphate crystals in the skin, soft tissues and bone, and hyperostosis. The most common cause of HFTC is related to loss-of-function mutations in GALNT3 (Polypeptide N-Acetylgalactosaminyl transferase 3) gene causing defective glycosylation of FGF23.Material and Methods: A 16 year boy presented with lump in the left gluteal area and hyperphosphatemia. Serum ionized calcium, alkaline phosphate, intact PTH, 25-OH vitamin D, serum creatinine and C terminal FGF 23, magnetic resonance imaging of hip, dental CBCT , bone mineral density at lumbar spine and hip by dual x-ray absorptiometry (DEXA) BMD, and 99Tc MDP bone scan, followed by next generation sequencing (NGS) and Sanger's sequencing.Results: A 16 year otherwise healthy boy presented with hard painless lump in the left gluteal area and hyperphosphatemia for last one year. His parents had third degree consanguinity with ancestral roots in Middle East. Father has small calcinosis in the right hand and mother was asymptomatic. Child had no associated bone pain, proximal muscle weakness, fracture or constitutional symptoms. S. phosphorus was 6.98mg/dl (normal: 3.5–5.5) with inappropriately increased TRP (95%) and TMP-GFR (7.2). Serum ionized calcium, alkaline phosphate, intact PTH, 25-OH vitamin D and serum creatinine were normal. MRI showed 5.7x3.7x3 cm lobulated heterogenous hypointensity near left greater trochanter. This mass was excised and showed tissue calcification. 99Tc-MDP bone scan and bone density parameters were normal. CBCT scan maxilla and mandible showed generalized hypercementosis with irregular root morphology. Serum C-terminal FGF 23 was 2401 RU/ml (normal: <150). NGS revealed normal FGF23 and Alpha Klotho genes. Exon 5 of GALNT3 gene showed homozygous mutation at Leu 366 Arg. GALNT3 Leu 366 Arg mutation causing HFTC has been described as compound heterozygous.Conclusion: This is the first case report of homozygous mutation at Leu366Arg causing HFTC.

A Single Superior Gluteal Artery Perforator Flap in Reconstruction of Large Midline Sacral Defects: A Method for Practical Harvest and Safe Closure.

Large midline sacral defects are reconstructive challenges. Superior gluteal artery perforator (SGAP) flap provides enough tissue and versatility to cover large defects; however, a single flap may be insufficient. We present a technique to cover large defects using single SGAP flaps. Large sacral defects (>100 cm2) reconstructed with single SGAP flaps were included. Angle of transposition (45°-60°) was determined based on the tissue laxity and mobility of gluteal area. Perforator identification, intramuscular dissection, or skeletonization was not performed. Outcomes were measured as achieving durable reconstruction, flap viability, and complications. There were 17 patients (12 male, 5 females; aged 25-72 years) with different etiologies. The mean flap surface area (136.1 ± 45.6 cm2, between 9 × 8 and 26 × 10 cm) was smaller than the mean defect surface area (211.1 ± 87.2 cm2, between 10 × 10 and 28 × 14 cm) (P < 0.001). All flaps survived with no partial or complete flap loss. Minor dehiscence in 4 patients (2 at donor site and 2 at recipient site) healed with dressing changes or using negative-pressure vacuum therapy. All patients had durable outcomes without any recurrence. Single unilateral SGAP flaps can be used to completely cover midline large sacral defects. It is important to design the flaps to have a joint side with the defect in the proximal part and use the intrinsic mobility of gluteal soft tissues for the closure. Flaps can be (1) planned to be smaller than the defects, (2) harvested with no intramuscular perforator dissection or pedicle skeletonization, and (3) transposed with an angle less than 60°.

Insights into hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. Acomplex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate invitro and animal models.

Hidradenitis suppurativa: a review of current treatment options.

Hidradenitis suppurativa (HS) is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. The pathogenesis of HS is still not completely understood; currently, it is considered to be an immune-mediated inflammatory illness (IMID). Due to the significant decrease in the patients' quality of life and a delayed beginning of a treatment, the selection of the appropriate therapy is extremely important in these patients. Regardless of the fact that there are multiple treatment options for HS, no uniformly effective therapy has been found. All the guidelines underline the need for a multidisciplinary approach to the disease, which enables providers to create the right management of HS. This article aims to provide updates on the current treatment options of acne inversa to raise awareness and improve the management of the disease.