Author Topic: Hidradenitis Suppurativa Articles  (Read 141994 times)

0 Members and 1 Guest are viewing this topic.

Celery Peach

  • Guest
Hidradenitis Suppurativa Articles
« on: Monday March 08, 2004, 12:32:08 PM »
 :hi: Guys.

I have started this thread, after conflabs with Nick, so I can just post articles of interest to HS sufferers. Its good for me to have all these in one place. HS, being a 'so called' orphan illness, means that these articles are tucked in here & there all over the web.

I hope Jo (missmash) & others will join me in posting HS info here, but I would ask, can we keep it to articles rather than chit chat (no offence to anyone) I would just like to keep it strictly info.  
« Last Edit: Thursday February 03, 2005, 12:49:08 PM by Celery Peach »

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #1 on: Monday March 08, 2004, 12:36:44 PM »
Hidradenitis suppurativa. An update
A. J. Papadopoulos, G. Kihiczak and R. A. Schwartz
   

   Summary
Hidradenitis suppurativa is a chronic and often disabling disease characterized by intermittent periods of inflammation and abscess formation in apocrine sweat gland-containing skin. Various therapies have been implemented in its treatment with variable results. Pathogenesis, histopathology and therapy of this disease are reviewed.
   
  Introduction
Hidradenitis suppurativa (HS) is a chronic disease of unknown etiology that mainly affects the genitofemoral, perianal and axillary regions (1-4). The disease is believed to be follicular in origin (1). HS has a higher prevalence in women than men and is estimated to affect 4 percent of women in the general population (5).  

Etiology
HS often occurs in multiple members within families, suggesting a genetic predisposition (5). Various etiological agents have been associated. The increased incidence of HS in obese women with acne led to the theory of HS being associated with an hyperandrogenic endocrine disorder (6,7). One study did not find evidence for biochemical hyperandrogenism in women affected with HS (8). Thus, the role of androgens in HS is still not clear. Smoking (9), lithium (10) and oral contraceptives (11) may also be associated with HS, possibly as triggering factors. Nonetheless, the etiology of the disease is unknown.  

Pathogenesis
Historically, apocrinitis was believed to be the defining histologic feature and pathogenetic mechanism of HS (12,13). Characteristic lobular abscesses in the apocrine gland, demonstrated histologically, seemed to further implicate apocrine gland involvement in the manifestation of disease (12-14). Recently, histological evidence points to HS being a follicular disease (1,15-19). Histological examination in the majority of specimens reveals follicular involvement, including poral occlusion and folliculitis (1). Apocrinitis as the dominant histological feature is found in only a small number of specimens (1,17). Furthermore, a paucity of apocrine glands was demonstrated in the genitofemoral region, one area commonly affected by HS (1). This finding supports the theory that apocrine gland inflammation is not the etiological and pathogenetic mechanism of HS, but rather a secondary manifestation of follicular involvement (1).  

Clinical features
HS may arise singularly or multifocally in the genitofemoral, perianal and axillary areas (1-4). The lesions are painful and have a foul odor attributed to bacterial colonization. Erythematous dermal abscesses form that measure up to 2 cm in diameter. Untreated abscesses will gradually increase in size and may drain to the surface. The course of HS is chronic and remitting, with new abscesses arising in previously unaffected areas or in regions of past involvement. Scarring, fibrosis and sinus tract formations are manifestations of late disease. Strictures can occur secondary to sinus tracts; fistulas may also complicate HS. Squamous cell carcinoma is a rare sequella of longstanding HS (20-24). These cancers may be locally aggressive with distant metastases and a high mortality rate (25).

Clinical associations
The follicular occlusion triad consists of HS, acne conglobata and perifolliculitis capitis abscedens et suffodiens (26-28). Arthritis of peripheral joints and the axial skeletion may rarely be associated with HS (29-32). HS has also been linked to Crohn's disease (33-35). One study reported 24 out of 61 patients with HS were also diagnosed with Crohn's disease, which predated the HS by an average of 3.5 years (35). Acanthosis nigricans and Fox-Fordyce disease may predispose to HS (36). Pyoderma gangrenosum (37,38) and pyoderma vegetans (27) have also been associated with hidradenitis suppurativa.

Therapy
Treatment of hidradenitis suppurativa is challenging. Late stage disease, evidenced by the formation of sinus tracts, fibrosis and scarring, usually necessitates surgical intervention. Early HS is often best treated with antibiotics in our experience, although few clinical trials are available (39). Three months' of treatment with topical clindamycin decreased the number of abscesses, inflammatory nodules and pustules in twenty-seven patients with chronic HS (40). Systemic tetracycline therapy has shown similar clinical effectiveness (39). Others and also we often recommend intrealesional corticosteroids in early stage disease (41). The use of cyproterone acetate and ethinyl estradiol achieved successful clinical results in four women with chronic HS (42); clinical improvement with cyproterone acetate and ethinyl estradiol was also described in another study (43). Isotretinoin is only slightly effective in controlling the disease; clinical improvement is seen in patients with mild HS (44). The clearing of chronic, refractory perianal HS was seen after treatment with cyclosporin for concomitant pyoderma gangrenosum (38).
Medical therapy is of limited value once HS has progressed past its early stage (2). The surgical option of choice for late stage HS is wide local excision with healing by secondary intention (41). One study examined patients with chronic HS who had undergone surgery between the years of 1976 and 1997 (4). An estimated 72-month follow-up revealed that 45% of the patients had recurrence of local HP (4). A 100% recurrence rate was reported after drainage procedures, while limited and wide local excision techniques had a recurrence rate of 42.8% and 27%, respectively (4). More recently, carbon dioxide laser excision has been proposed as a better alternative to conventional surgery (2,45). Carbon dioxide laser excision offers better hemostasis and visualization of abscessed tissue than conventional surgical techniques, allowing more accurate excision (2).
 

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #2 on: Monday March 08, 2004, 12:41:22 PM »
Acne inversa in Crohn's disease]

[Article in German]

Goischke HK, Ochsendorf FR.

Hartwald-Rehabilitationsklinik der BfA, Bad Bruckenau.

We report 2 patients with the association of Crohn's disease and acne inversa (= hidradenitis suppurativa). A 50-year-old woman with a 10-year-history of Crohn's disease developed suppurative nodules and abscesses in the genitoanal region. Over several years these lesions were hidden from everybody including the family physician. In a 42-year-old female patient abscesses appeared in the axilla 4 years after the diagnosis of Crohn's disease. During the next years these draining lesions also developed in both groins and the perineum. The differential diagnosis included cutaneous manifestations of Crohn's disease in both cases. The clinical picture with draining abscesses and sinuses with communicating channels, cystic nodules, hypertrophic scars and foul-smelling discharge were typical findings of acne inversa. In the last years this entity was reported several times in patients with Crohn's disease. Acne inversa starts with a compact hyperkeratosis of the infundibulum in terminal hair follicles, followed by a segmental rupture of the follicular epithelium and a spreading inflammatory reaction. As pathogenic factors genetic disposition and smoking were discussed. The only curative therapy is excision of the affected area. The reported association should be known in order to recognize the disease and institute the right therapy.

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #3 on: Monday March 08, 2004, 12:42:04 PM »
[Acne inversa. Pathogenesis and genetics]

[Article in German]

Kuster W, Rodder-Wehrmann O, Plewig G.

Hautklinik, Heinrich-Heine-Universitat Dusseldorf.

Acne inversa is a chronic inflammatory disorder of sebaceous follicles and terminal hair follicles and is one type of acne diseases. The pathogenesis of acne inversa is identical with that of the other types: Hyperkeratosis of the follicular infundibulum leads to a comedo. Bacterial infections result in a rupture of the follicular canal followed by a granulomatous inflammatory reaction with abscesses, panniculitis and draining sinuses. Acne inversa has so far only occasionally been observed in two or more members of the same family. The familial presentations of acne inversa published in the literature and two observations of familial occurrence among the authors' own patients reveal an autosomal dominant inheritance with high penetrance.

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #4 on: Monday March 08, 2004, 12:43:01 PM »
Acne inversa (alias hidradenitis suppurativa).

Jansen I, Altmeyer P, Piewig G.

Department of Dermatology, Ruhr-University Bochum, Germany.

Acne inversa is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. Once considered to be a disease of the apocrine glands, it is actually a defect of follicular epithelium. Thus, the term hidradenitis suppurativa is a misnomer and should be abandoned. In cases of familial acne inversa, the pattern of transmission and number of affected individuals are consistent with autosomal dominant inheritance. Aetiological factors such as hyperandrogenism, obesity, smoking and chemical irritants are not consistently associated with the affection. Bacterial involvement is not a primary event in acne inversa, but is secondary to the disease process. Potential complications include dermal contraction, local or systemic infection due to the spread of microorganisms, systemic amyloidosis, arthropathy, and squamous cell carcinoma. As spontaneous resolution is rare and progressive disability is the rule, early definitive surgical intervention is advisable. The surgical procedure of choice in most cases is wide local excision and healing by secondary intention. Pharmacotherapeutic drugs, including synthetic retinoids and antiandrogens, do not prevent progression of the disease

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #5 on: Monday March 08, 2004, 12:47:10 PM »
[Acne inversa (hidradenitis suppurativa): early deetection and curative surgery]

[Article in German]

Herrmann A, Preusser KP, Marsch WC.

Universitatsklinik und Poliklinik fur Dermatologie und Venerologie, Martin-Luther-Universitat Halle-Wittenberg.

Acne inversa (synonyms are hidradenitis suppurativa, pyodermia fistulans sinifica) is a chronic inflammatory disorder of the terminal hair follicles of the intertrigines. Abscesses and fistules develop mostly in both axillae, in the anogenital region, and under the breasts. The disease is common, but the right diagnosis is often missed. Local incision gives only a short relief of pain. The therapy of choice is wide local excision. We report on 12 patients with acne inversa who were surgically treated from 1991-1999 in our department. Surgical results and patient satisfaction were assessed on an average of 4.2 years. In all, 20 excisions in the axillae and 5 excisions anogenital were done. Seven patients were treated preoperatively with isotretinoin over at least 2 months. All patients could move their limbs without trouble. The cosmetic result was good in nine patients and three expressed dissatisfaction. Nine patients did not develop new lesions in the treated area. Three patients had new inflammations in both treated and previously uninvolved and therefore not resected regions. Wide local excision gives very good functional and cosmetic results. It usually heate long-lasting disease for nearly disabled patients. Isotretinoin reduces the disease activity and allows radical surgical treatment.

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #6 on: Monday March 08, 2004, 12:48:23 PM »
[Reticular pigmented anomaly of the flexures. Dowling-Degos disease of the intertrigo type in association with acne inversa]

[Article in German]

Kleeman D, Trueb RM, Schmid-Grendelmeier P.

Dermatologische Klinik, Universitatsspital Zurich, Gloriastrasse 31, CH-8091 Zurich.

Reticulated pigmented anomaly of the flexures (Dowling-Degos disease) is a rare autosomal-dominant genodermatosis with variable penetrance that is characterized by reticulated hyperpigmentation of the flexures. Acne inversa has been previously described in the literature under several synonyms, such as acne triad, acne tetrad and hidradenitis suppurativa. Acne inversa is an inflammation affecting the pilosebaceous units of the flexures. We report a case of Dowling-Degos disease in association with acne inversa. The association of these diseases has been described several times and it appears not to be coincidental. Pathogenetic mechanisms leading to this coincidence are discussed.

Celery Peach

  • Guest
Re:Hidradenitis Suppurativa Articles
« Reply #7 on: Monday March 08, 2004, 12:49:23 PM »
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.

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

Offline Nick

  • SkinCell