Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glands

Introduction: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. Case reports: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.

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Verneuil’s Disease or Hidradenitis Suppurativa Complicated by Verrucous Carcinoma: Description of a Case with Extremely Extended Pathology in Pregnancy

Journal of Surgical Oncology ◽

10.31487/j.jso.2020.06.01 ◽

2020 ◽

pp. 1-4

Author(s):

Domenico Parmeggiani ◽

Roberto Ruggiero ◽

Giuseppe Chiacchio ◽

Franco Faccenda ◽

...

Keyword(s):

Hidradenitis Suppurativa ◽

Verrucous Carcinoma ◽

Maximum Diameter ◽

Excision Biopsy ◽

Milk Analysis ◽

Hormonal Activity ◽

Sinus Pilonidalis ◽

Apocrine Glands ◽

Verneuil’S Disease ◽

In Pregnancy

Background: Verneuil’s disease is a rare suppurative pathology of apocrine glands and pilosebaceous system of the inguinal-pelvis and perianal region with a multifactorial aetiology. The disease produces skin fistulas, draining a serum-purulent material on the skin, and finally with spontaneous healing. Verneuil’s disease can be complicated by recurrence, and unfortunately, by squamous carcinoma. We have found in literature, just 2 cases of Hidradenitis Suppurativa, complicated by Verrucous Carcinoma. Main Observation: we describe a patient F, 34-year-old, comes to our observation at 4th gestational month, with suppurative sinus pilonidalis diagnosis and with the absolute indication of the gynaecologist to the abortion. We decided to continue the pregnancy. The patient gives birth with C. to 9 months; the new-born baby was perfectly healthy and after the maternal milk analysis, the baby also nursed for about 2 months. Finally, we decided to perform a wide excision biopsy and after a controversial histology (first Warty Carcinoma, then after a “second view” Suppurative Hidradenitis), we started a series of medical treatments, including biological therapy with Infliximab, but unfortunately with fleeting results. The patient did not answer substantially. Therefore, the last chance appears a combined demolitive and plastic surgical treatment. The histology described a Verrucous squamous cell carcinoma maximum diameter of 38 x 26 cm, with lateral deep margins free of neoplastic involvement. Conclusion: This very advanced clinical behaviour of the Hidradenitis Suppurativa can present in pregnancy, therefore, motivating the interruption of the same one. Our experience contributes to underlining the possibility to bring to term the pregnancy. This case report shows how the hormonal activity can anyway influence the development of the hidradenitis and an interesting hypothesis could consider the hormonal activity of the pregnancy and the HPV promoting gene regulation (RB) from inflammatory pathology to neoplastic pathology in VC like a model to study.

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P15: RELAPSING EROSIVE POLYARTHRITIS ASSOCIATED WITH HIDRADENITIS SUPPURATIVA

Journal of Investigative Medicine ◽

10.1136/jim-2016-000080.55 ◽

2016 ◽

Vol 64 (3) ◽

pp. 823.1-823

Author(s):

AG Adiga ◽

JS Pixley

Keyword(s):

Hidradenitis Suppurativa ◽

Skin Lesions ◽

Laboratory Evaluation ◽

Inflammatory Back Pain ◽

Apocrine Glands ◽

Chronic Disorder ◽

Multicenter Analysis ◽

Distal Interphalangeal ◽

Polymerase Chain ◽

Joint Examination

Purpose of StudyHidradenitis Suppurativa (HS) is a chronic disorder involving apocrine glands characterized by comedo like follicular occlusion and a chronic relapsing inflammation; sinus tracts and scarring. We observed a case of HS in a young African American (AA) male with relapsing polyarthritis.Methods UsedThe patient first developed HS as a teenager and then arthritis 10 years later. On this presentation he had multiple nodular skin lesions, predominately in intertriginous areas in the axilla and inguinal area; few of them presenting as draining pustules which had increased in size and number as well as generalized arthritis. This occurs 1–2 times yearly subsiding in association with antibiotic treatment. Physical examination was notable for generalized suppurate nodules chronic scars and sinuses. Joint examination revealed generalized polyarthritis with effusions in ankles, knees and elbows. Laboratory evaluation revealed marked inflammation. Autoantibody studies were negative. Radiographs revealed demineralization, erosions including the distal interphalangeal joints with suggestion of pencil/cup deformity in an asymmetric manner. All cultures were negative. Urine Chlamydia and Neisseria polymerase chain reaction testing was also negative.Summary of ResultsMusculoskeletal association with HS has been reported. Most note an association of skin flares and that it tends to occur years after the onset of skin disease. Most reports are anecdotal. We identified one multicenter analysis. The pattern of disease described resembles the spondyloarthropathy manifestations including sacroiliitis, dactylitis, inflammatory back pain and entesthitis. Our patient's findings were consistent with the limited literature available.ConclusionsIn conclusion, we propose that inflammatory spondyloarthropathy may be a complication of HS.

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Surgical treatment of chronic hidradenitis suppurativa in the gluteal and perianal regions

Acta chirurgica iugoslavica ◽

10.2298/aci1202091b ◽

2012 ◽

Vol 59 (2) ◽

pp. 91-95 ◽

Cited By ~ 5

Author(s):

Sokol Bilali ◽

Vangjel Todi ◽

Ali Lila ◽

Valbona Bilali ◽

Julian Habibaj

Keyword(s):

Wound Healing ◽

Successful Treatment ◽

Hidradenitis Suppurativa ◽

Surgical Excision ◽

Healing Time ◽

Complete Healing ◽

Sweat Glands ◽

Apocrine Glands ◽

Treatment Methods ◽

Complete Wound Healing

Introduction: Verneuil disease, or perianal hidradenitis suppurativa (HS), is a chronic suppurative disease with a tendency to develop sinus formation, fibrosis, and sclerosis, having a great impact on quality of life. HS affect the apocrine sweat glands or sebaceous glands and may arise in each of the regions where the apocrine glands are prominent: the axilla, breast aureole, umbilicus, perineum, groin, and buttocks. We present here moderate and extensive HS cases, with their respective treatment methods and outcomes. Methods: A retrospective re-view of 6 patients? medical records from January 2001 to December 2010. Results: The 6 patients underwent treatment for HS in the gluteal and perianal regions with surgical excision. Five of the patients were male (83%). The median age was 42.5 years. We performed a total of 8 operations on these patients. In 3 patients, the wound was left open for secondary healing, and the mean time for complete wound healing was 11.3 weeks (range: 9.5-19 weeks). Delayed skin grafting was used for 2 patients in whom the wounds had been left open after the first operation. In this group, complete wound healing took 2 months in total. One patient underwent primary wound closure using rotation flaps, with a complete healing time of 2 weeks. Successful treatment without recurrence was accomplished in 5 (83.3%) of the patients. Conclusion: The conservative treatment methods had little effect, particularly on gluteal and perianal/perineal HS. The only successful treatment was wide surgical excision. Management of the wound after wide excision should be tailored to the individual patient.

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Demographic and Clinical Features of Hidradenitis Suppurativa in Turkey

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419887732 ◽

2019 ◽

Vol 24 (1) ◽

pp. 55-59 ◽

Cited By ~ 4

Author(s):

Mavişe Yüksel ◽

Pelin Basım

Keyword(s):

Odds Ratio ◽

Hidradenitis Suppurativa ◽

Severe Disease ◽

High Body Mass Index ◽

Education Level ◽

Disease Stage ◽

Apocrine Glands ◽

Male Predominance ◽

Low Education ◽

Disease Stages

Background The literature contains conflicting reports on the epidemiology and frequency of hidradenitis suppurativa (HS), a chronic, recurrent inflammatory disease of the apocrine glands. Objective To evaluate the clinical and demographic characteristics of HS cases in Turkey and investigate the similarities with world epidemiology. Method The records of 208 patients that presented to our polyclinics and were diagnosed with HS between June 2012 and July 2017 were retrospectively evaluated. Results Of the cases, 68.3% were male and 31.7% were female. Of the patients, 75.5% had no family history of HS, 60.6% were smokers, 39.4% were aged 20-29 years, and 36.1% were aged 30-39 years. The most commonly involved regions were the axilla (62%), groin (50.5%), and gluteus (15.9%). According to univariate analyses, male patients had higher disease stages than females (odds ratio=1.67). The patients with groin involvement, high body mass index (BMI), and low education level (0-8 years) had higher risk of severe disease stage (odds ratio=1.63, 8.91, and 1.51, respectively). The most commonly used treatment was oral antibiotics in Hurley stages I and II, and surgical intervention in Hurley III. In all 3 Hurley stages, clavulanic acid–amoxicillin combination was the mostly used systemic antibiotic (41.8%, 43.2%, and 47.8%, respectively). Conclusions This is the first epidemiological study on HS in the Turkish population, where HS shows male predominance. Male gender, low education level, absence of acne, high BMI, and groin involvement were associated with severe disease stages. Determining associated comorbidities and possible risk factors is important in progression and prevention of the disease.

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Reconstructive options in severe cases of Hidradenitis suppurativa

Open Medicine ◽

10.2478/s11536-009-0126-2 ◽

2010 ◽

Vol 5 (6) ◽

pp. 674-678 ◽

Cited By ~ 2

Author(s):

Birol Civelek ◽

Kadir Aksoy ◽

Esra Bilgen ◽

Ibrahim İnal ◽

Unal. Sahin ◽

...

Keyword(s):

Hidradenitis Suppurativa ◽

Skin Grafting ◽

Surgical Removal ◽

Apocrine Glands ◽

Reconstruction Methods ◽

Thickness Skin ◽

Split Thickness Skin Grafting ◽

Topical Antibacterial ◽

Systemic Antibiotics

AbstractHidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodular lesions. The treatment of Hidradenitis suppurativa consists of topical antibacterial or antiseptic solutions, systemic antibiotics, steroids, hormonal therapy, anti-tumor necrosis factor, and various surgical procedures. In this report, we present a series of 14 cases with severe Hidradenitis suppurativa. Surgical options are reviewed to show the best outcomes in the long term. A total of 14 patients (9 female, 5 male) were treated for advanced cases of Hidradenitis suppurativa. They underwent excision of the affected regions followed by reconstruction. The reconstruction methods consisted of split-thickness skin grafting and various cutaneous and myocutaneous flaps. There was no flap necrosis or dehiscence. One patient developed contracture in the axilla, for which he underwent release surgery. There were recurrences in 4 cases. There was no limitation of the arm movements in cases with flap reconstruction. In the long-term, they were satisfied with the results. In conclusion, incision and drainage should be avoided because it is of limited value. Surgical removal of the involved tissue should be the first treatment of choice. Depending on the defect following excision, local flaps should be preferred over the grafts for recurrence prevention.

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Sebaceous and sweat gland disorders

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.2311 ◽

2010 ◽

pp. 4676-4682 ◽

Cited By ~ 2

Author(s):

Alison Layton

Keyword(s):

Sweat Gland ◽

Hidradenitis Suppurativa ◽

Sweat Glands ◽

Ear Canal ◽

Sebaceous Glands ◽

Apocrine Glands

Cutaneous glands in humans include holocrine or sebaceous glands and merocrine or sweat glands. Merocrine glands are subdivided into apocrine, eccrine, and apoeccrine glands. Disorders of each of these cutaneous glands have been associated with disease. Apocrine glands in adults are found predominantly in the axillae and anogenital regions, with a few located in the ear canal (ceruminous glands) and eyelids (Moll’s glands). Associated disorders include hidradenitis suppurativa, Fox–Fordyce disease, bromhidrosis, trimethylaminuria, and chromhidrosis....

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Three Fatal Cases of Squamous Cell Carcinoma Arising in Chronic Perineal Hidradenitis Suppurativa

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x209392 ◽

2007 ◽

Vol 89 (7) ◽

pp. 709-712 ◽

Cited By ~ 53

Author(s):

Gael M Maclean ◽

David J Coleman

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Hidradenitis Suppurativa ◽

Squamous Carcinoma ◽

Apocrine Glands ◽

Medline Search ◽

The Past ◽

History Of ◽

Malignant Condition

INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory and suppurative disorder of skin bearing apocrine glands. The most severe complication is squamous cell carcinoma (SCC) and we here present three cases, all of which proved fatal, and review the past 40 years of published cases. PATIENTS AND METHODS Three advanced cases of SCC arising in chronic HS have been referred for reconstructive surgery over the past 8 years. Another 28 cases published over the past 40 years were identified using a Medline search (search items in combination: hidradenitis, squamous, carcinoma). RESULTS The male:female ratio was 4:1, most (61%) were perineal or buttock. We found no reports of SCC arising in axillary disease. The symptomatic history of HS prior to SCC diagnosis ranged from 3–50 years with a mean of 25 years. Age at diagnosis of SCC ranged from 27–71 years, and 15 patients (48%) died within 2 years of SCC diagnosis. CONCLUSIONS We advocate that hidradenitis suppurativa arising in extra-axillary sites is a pre-malignant condition, and should not be treated conservatively; curative resection is the mainstay of management.

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Hidradenitis suppurativa: infection, autoimmunity, or both?

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x19895488 ◽

2019 ◽

Vol 11 ◽

pp. 1759720X1989548 ◽

Cited By ~ 4

Author(s):

Costas A Constantinou ◽

George E Fragoulis ◽

Elena Nikiphorou

Keyword(s):

Rheumatic Diseases ◽

Hidradenitis Suppurativa ◽

Metabolic Diseases ◽

Strong Association ◽

Fistula Formation ◽

Current Evidence ◽

Skin Microbiome ◽

Biologic Drugs ◽

Apocrine Glands ◽

Autoimmune Rheumatic Diseases

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease mainly affecting areas rich in apocrine glands. Clinically, is characterized by painful subcutaneous nodules and if left untreated to pus secretion, abscess and fistula formation. Its frequency is estimated to be 0.5–4% of the general population, affecting women more often. Pathogenesis of HS is still not clearly defined. It seems to be a combination of genetic factors with alterations in the skin microbiome. Furthermore, at tissue (i.e. skin) as well as at serum level, several inflammatory cytokines are upregulated. The most important of the latter are tumor necrosis factor (TNF), interleukin (IL)-1, IL-17, and IL-23. Adding another level of complexity, it has been suggested that keratinocytes might be intrinsically activated, contributing also to the observed inflammation. Interestingly, it has been noted that frequency of HS is increased in some autoimmune rheumatic diseases, such as spondyloarthropathies (SpA). Of note, both HS and SpA have relatively strong association with metabolic diseases and obesity implying that there are indeed some common underlying pathophysiological pathways. Although no specific microbe has been identified, alterations in the microbiome of the skin of these patients have been reported. Of note, microbes with a capability for biofilm formation are abundant. Treatment of HS among others, include antibiotics as well as biologic drugs targeting TNF and other cytokines and used for autoimmune rheumatic diseases. Herein, we review the current evidence on links between HS and autoimmune diseases and infectious diseases with a focus on epidemiology and pathophysiology.

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Hidradenitis Suppurativa and the Association With Hematological Malignancies

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475416668161 ◽

2016 ◽

Vol 21 (2) ◽

pp. 158-161

Author(s):

Bahman Sotoodian ◽

Mariam Abbas ◽

Alain Brassard

Keyword(s):

Risk Factor ◽

Male Patient ◽

Hidradenitis Suppurativa ◽

Late Onset ◽

Chronic Inflammatory Disease ◽

Epidemiologic Studies ◽

Lymphocytic Leukemia ◽

Apocrine Glands ◽

History Of ◽

Underlying Risk

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting skin sites with a high density of apocrine glands. HS commonly presents after puberty, with most patients diagnosed in the second decade of their life. Several studies have investigated smoking, obesity, hypertension, diabetes, and dyslipidemia as possible underlying risk factors for HS. However, we encountered 2 patients with a long-standing history of untreated leukemia who developed late-onset HS. Objective: To investigate the presence of malignancy as an underlying risk factor for development of HS. Method: The PubMed and Scopus databases were searched for keywords such as hidradenitis suppurativa, malignancy, cancer, and epidemiology. Observation: Only 1 retrospective Swedish study with 2119 patients investigated the prevalence of cancer, including 6 hematopoietic malignancies, in HS patients. However, the study did not assess the timeline of developing HS in relation to the cancer diagnosis. We report 2 patients with a long-standing history of hematopoietic cancers who received no continuous treatments for their malignancies and developed late-onset HS: a 60-year-old male patient with hairy cell leukemia and a 68-year-old male patient with chronic lymphocytic leukemia who developed HS later in life. Conclusion: Multiple epidemiologic studies found the average age of HS diagnosis to be well prior to the fourth decade of life. The latency of the HS diagnosis as well as the presence of long-standing leukemia in both of our patients raises the necessity for assessing the possibility of malignancy, especially hematopoietic cancer, as a risk factor for HS. Limitation: This is a small retrospective analysis including only 2 patients. Larger studies would better assess the role of malignancy, leukemia in particular, as a possible risk factor for development of HS.

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