Author Topic: Hidradenitis Suppurativa Articles  (Read 139717 times)

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Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #20 on: Sunday April 04, 2004, 09:42:31 AM »
Article about Manuka Honey, with reference to a case involving a HS patient

http://livingnature.com/ourproducts/products/rawmaterials/manukahoney.html

Offline missmash

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Re:Hidradenitis Suppurativa Articles
« Reply #21 on: Wednesday June 16, 2004, 04:26:36 PM »
some useful info re: accutane and isotretinoin treatment and HS.

info taken from HS-USA .., references can be found on site at:-

http://www.hs-usa.org/accutane_is_no_cure.htm


"Isotretinoin administration (1mg/Kg*/24h) for three months, has not obtained distinct improvement of the clinical pattern while inflammatory reaction has imposed interruption of this treatment and administration of systemic antibiotics (in association with surgical incision and drainage of abscess lesions). However the clinical condition of the gluteal region was aggravated progressively while the risk of transformation in squamous cell carcinoma, existed as well. "  (1)

"Isotretinoin is only slightly effective in controlling the disease; clinical improvement is seen in patients with mild HS"  (2)

"Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy."  (3)

"Few patients with severe hidradenitis have been responsive to this synthetic vitamin A derivative. A review of the literature indicates that the results of treatment with isotretinoin for hidradenitis have been at best equivocal." (4)

"RESULTS: In 16 patients (23.5%), the condition completely cleared during initial therapy and 11 patients (16.2%) maintained their improvement during the follow-up period. Treatment was more successful in the milder forms of HS. CONCLUSION: Monotherapy with isotretinoin for patients with HS usually has a limited therapeutic effect."  (5)

"It is suggested that Sebum Excretion is not an important factor in the development of hidradenitis, and this may help explain the generally unsatisfactory therapeutic effect of retinoids in this disease." (6)

The greatest danger for most of us is not that our aim is too high and we miss it, but it is too low and we reach it...  michelangelo

Offline missmash

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Re:Hidradenitis Suppurativa Articles
« Reply #22 on: Tuesday July 13, 2004, 12:24:57 PM »
a "dear doc" reply from Chicago Tribune..  informative and accurate (for a change!!)

Chicago Tribune: Humble hair follicle can be a pain

Humble hair follicle can be a pain
By Allen Douma, M.D
Tribune Media Services

July 11, 2004

Q. One of our daughters has developed hidradenitis suppurativa, a relatively rare disease. We know that not much is known about the cause, or how to treat it well. We also know it to be debilitating.

--E.T., Salem, Ore.

A. It sounds like your knowledge of it being debilitating is from your experience with your daughter.

When someone has a severe case of this disease, it can cause a lot of psychological challenges on top of the physical ones. Hopefully the following will help guide better treatment.

Hidradenitis suppurativa is a poorly understood and frequently underreported chronic medical condition of inflammation in and around certain types of hair follicles. These hair follicles are located primarily in the groin, armpit and around the nipples.

Until recently it was thought that the primary problem was with the sweat (apocrine) glands. But a recent study has shown that the hair follicle itself is the primary problem, with the sweat gland being secondarily affected.

Another recent study also found that as many as 4 percent of people have hidradenitis to some degree, but it's usually not bad enough for them to undergo the cost and inconvenience of seeking medical attention.

Hidradenitis is more common in women. Although many women report that it flares up before menstruation, having hidradenitis is not related to levels of hormones. It occurs in many women after they reach menopause.

The most common symptoms are painful, tender, firm, nodular lesions under the arms. The nodules may open and drain pus spontaneously. Nodules will heal slowly, with or without drainage, over 10 to 30 days.

In typical cases, nodules recur several times yearly. In severe cases, the patient may suffer a continual recurrence of new lesions forming as soon as old lesions heal.

Many people think it is simply acne and treat it the same way. But the treatment for acne does not work for hidradenitis. Unfortunately, there is no great medical treatment for it.

There are some things your daughter can do that might help. Excessive heat, perspiration and obesity seem to aggravate the condition, so she should minimize heat exposure and sweating, and lose weight if overweight. A recent research study suggests that cigarette smoking could be a major triggering factor of hidradenitis suppurativa.

Oral antibiotics and steroids (both oral and injected) as well as rigorous skin cleaning and topical antibiotics may help some people. If nothing else, it may help prevent secondary bacterial infections.

Although it's commonly recommended that people with this condition not use deodorants or antiperspirants, studies have shown that they don't make much of a difference.

Topical products such as benzoyl peroxide may be helpful. Retin-A has helped some patients. Accutane can reduce the severity of attacks in some patients but is not a reliable cure for hidradenitis suppurativa.

Often people with severe cases are not adequately treated with medical management. For these people, surgical removal of the involved skin with skin grafting should be considered. Both surgical removal of skin flaps and "burning" each follicle with a laser have been shown to be safe and effective. The obvious downside of these treatments is that they do nothing for untreated areas.




The greatest danger for most of us is not that our aim is too high and we miss it, but it is too low and we reach it...  michelangelo

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #23 on: Friday July 30, 2004, 09:17:25 AM »
Aerobic and anaerobic microbiology of axillary hidradenitis suppurativa.

Brook I, Frazier EH.

Department of Pediatrics, Navy Hospital, Bethesda, MD, USA.

A retrospective review of the microbiological and clinical data of 17 specimens obtained from axillary hidradenitis suppurativa (HS) over a period of 6 years was undertaken to study the aerobic and anaerobic microbiology of this condition. A total of 42 bacterial isolates (2.5 per specimen) were obtained, 12 aerobic or facultative (0.7 per specimen) and 30 anaerobic or micro-aerophilic (1.8 per specimen). Aerobic and facultative bacteria only were isolated in six (35%) cases, anaerobic bacteria only in seven (41%) and mixed aerobic and anaerobic bacteria in four (24%). The predominant aerobic bacteria were Staphylococcus aureus (six isolates), Streptococcus pyogenes (three) and Pseudomonas aeruginosa (two). The most frequently isolated anaerobes were Peptostreptococcus spp. (10), Prevotella spp. (seven), micro-aerophilic streptococci (four), Fusobacterium spp. (three) and Bacteroides spp. sensu stricto (three). This study highlights the polymicrobial nature and predominance of anaerobic bacteria in axillary HS and the need for antimicrobial thereby to reflect this.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #24 on: Friday July 30, 2004, 09:19:39 AM »
ALA-PDT and blue light therapy for hidradenitis suppurativa.

Gold M, Bridges TM, Bradshaw VL, Boring M.

Gold Skin Care Center, 2000 Richard Jones Road, Suite 220, Nashville, TN 37215, USA. goldskin@goldskincare.com

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, often suppurative skin condition which affects primarily apocrine glands. A variety of therapies have been used to treat HS, often with unsatisfactory results. Photodynamic therapy (PDT), utilizing topical 20% 5-aminolevulinic acid (ALA) is being used to treat a variety of dermatologic skin concerns, including photorejuvenation and associated actinic keratoses, and acne vulgaris, and other skin tumors. OBJECTIVE: The purpose of these case reports is to evaluate the effectiveness of ALA-PDT in treating recalcitrant cases of HS. METHODS: Four patients, not responding to standard HS therapy, underwent short-contact ALA-PDT therapy utilizing a blue light for activation. One to two week intervals between therapies was utilized for 3-4 total treatments and follow-up was for 3 months following the last treatment. RESULTS: All four of the patients tolerated the therapies well. Clinical improvements from 75-100% were noted n 11 of the patients. No adverse effects were seen during the treatments. The treatments were pain free and there was no downtime associated with these ALA-PDT treatments. CONCLUSIONS: HS is a chronic disease which most dermatologists find difficult to treat. The use of ALA-PDT is finding an ever-expanding role in dermatology. These case studies support the use of ALA-PDT in cases of HS. Although all advertising material is expected to conform to ethical and medical standards, inclusion in this publication does not constitute a guarantee or endorsement by the Journal or its staff of the quality or value of such products or of the claims of any manufacturer.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #25 on: Friday July 30, 2004, 09:22:57 AM »
Arthritis associated with hidradenitis suppurativa.

Bhalla R, Sequeira W.

Division of Rheumatology, University of Illinois, Chicago.

OBJECTIVE--To review the presentation and clinical findings of arthritis associated with hidradenitis suppurativa. METHOD--Medical records from the rheumatology clinics of two major teaching hospitals were reviewed for arthritis and hidradenitis suppurativa. The nine patient records fulfilling these criteria were reviewed and compared with 20 previous reports. RESULTS AND CONCLUSION--The arthritis associated with hidradenitis suppurativa is rare and most commonly affects the peripheral joints. The axial skeleton is less frequently involved and is often asymptomatic.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #26 on: Friday July 30, 2004, 09:24:51 AM »
Axillary Hidradenitis Suppurativa: A Further Option for Surgical Treatment.

Altmann S, Fansa H, Schneider W.

Department of Plastic, Reconstructive and Handsurgery, University of Magdeburg, Magdeburg, Germany.

Background: Hidradenitis suppurativa is a chronic inflammatory disease of the cutis with furuncles, fistulas, and abscesses. The disease is mostly located in groin and axilla. As conservative treatment can usually not prevent recurrence, surgical treatment is the method of choice. Methods: We report on 20 patients with axillary hidradenitis suppurativa. The inflammatory region was excised in a rhomboid shape and immediately covered with a transposition flap according to Limberg. Postoperatively, all patients received antibiotic treatment and immobilization of the arm. Physiotherapy started after 2 weeks. Results: No flap complications occurred. The functional and aesthetic results were very satisfactory. Movement of shoulder showed no restrictions. A recurrence with single fistulas was seen in 3 patients. Conclusions: Conservative treatment of hidradenitis suppurativa is followed by a high rate of recurrence. Only radical debridement offers a cure. The therapy of choice is the radical excision of the affected region and immediate coverage with a flap. Open granulation or split skin grafting often results in a prolonged hospitalization, higher morbidity, and functional problems. Thus, open granulation is inferior to primary closure by a transposition flap. Using the Limberg flap, the donor site is allowed to be closed primarily.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #27 on: Friday July 30, 2004, 09:25:53 AM »
Coagulase-negative staphylococci are the most common bacteria found in cultures from the deep portions of hidradenitis suppurativa lesions, as obtained by carbon dioxide laser surgery.

Lapins J, Jarstrand C, Emtestam L.

Karolinska Institute, Departments of Dermatology and Venereology and. jan.lapins@dermat.hs.sll.se

The significance of bacterial findings in hidradenitis suppurativa (HS) is controversial. Interpretation of the results of bacteriological examinations from the surface of HS lesions is obscured by the possible contamination of resident skin bacteria. Bacteriological analysis of aspirates from deeper parts of HS is liable to show low sensitivity. We used a carbon dioxide (CO2) laser method to evaporate the diseased tissue level by level from the surface downwards, allowing concurrent sampling of bacteriological cultures from each level and thereby minimizing contamination with bacteria from the level above. In this study, 22 women and three men with a mean age of 35.3 years and a mean HS duration of 10.6 years were treated with this CO2 laser surgical method. Aerobic and anaerobic cultures from superficial and deep levels were taken during surgery. The regions treated were axillary in eight and perineal in 17 cases. Bacterial cultures were positive for one or more specimens from at least one level in all cases and from deep levels in all but three cases. Sixteen different species or sub-species were found. Staphylococcus aureus and coagulase-negative staphylococci (CNS) were the species most frequently found. Peptostreptococcus species and Propionibacterium acnes were not uncommon. S. aureus was detected in a total of 14 cases, six of which were from the deep levels. S. aureus was the sole bacterium isolated in two deep cultures. CNS were found in 21 patients and 16 of these isolates were from the deep levels. In nine of the 16 deep samples CNS were the only bacteria detected. These findings motivate a re-evaluation of the significance of bacteria in the progress of HS and in particular they suggest that CNS are true pathogens. It is known that foreign bodies aggravate the virulence of the CNS in surgical implants, and an environment which resembles that produced by a foreign body, as found in chronic HS tissue, serves to intensify the pathogenic properties of CNS in HS.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #28 on: Friday July 30, 2004, 09:27:33 AM »
Combined wide excision and mastopexy/reduction mammoplasty for inframammary hidradenitis: a novel and effective approach.

Williams EV, Drew PJ, Douglas-Jones AG, Mansel RE.

The Cardiff Breast Unit, Cardiff and Vale NHS Trust, Cardiff, UK.

Hidradenitis suppurativa is a rare chronic skin condition involving the apocrine glandular zones, which are found predominantly in the axilla and inguinoperineal regions, but have been described at other sites, including the inframammary fold. Treatment requires complex surgical intervention with wide excision of involved tissue. Inframammary hidradenitis tends to affect young women and can prove resistant even to this radical form of surgery, which often results in marked scarring and breast deformity. We therefore decided to adopt a novel approach by incorporating the wide excision of inframammary skin currently necessary in a reduction mastopexy procedure. This enables primary closure with ptosis correction and should improve cosmesis. The reduction in the depth of the inframammary fold also makes hygiene easier in the long term. During a 6-year period, five patients (mean age 27 years) have been treated by this method. All patients had long-standing hidradenitis (mean 12 years), and had been treated with several courses of antibiotics. A modified Wise pattern reduction incision was used with a minimum amount of breast tissue being removed. In each case histology was consistent with hidradenitis. All wounds healed well and to date there have been no inframammary recurrences. The success of this operation in curing inframammary hidradenitis has had a dramatic affect on the lives of these young women and underlines the need for this rare condition to be treated in a specialist centre.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #29 on: Friday July 30, 2004, 09:29:25 AM »
Early-onset hidradenitis suppurativa.

Palmer RA, Keefe M.

Department of Dermatology, Royal South Hants Hospital, Southampton, UK. roypalmer@totalize.co.uk

A 9-year-old girl developed hidradenitis suppurativa 3 months after the first signs of adrenarche. Such a close temporal relationship is consistent with the hypothesis that the disease is androgen dependent. Less than 2% of patients have onset of the disease before the age of 11 years. The exceptionally early age of onset in our patient may be partly explained by the fact that she had an early puberty.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #30 on: Friday July 30, 2004, 09:30:45 AM »
Experience with surgical treatment of hidradenitis suppurativa.

Tanaka A, Hatoko M, Tada H, Kuwahara M, Mashiba K, Yurugi S.

Division of Plastic Surgery, Nara Medical University, Japan.

The authors report their experience with 23 sites of hidradenitis suppurativa, including cases with musculocutaneous flap repair, and discuss the surgical methods applied. Twenty-three sites in 19 patients with chronic inflammatory skin lesions were reviewed. The lesions were divided into two groups: The limited group was comprised of mild lesions, which appear isolated and have limited abscesses without sinus tract formations. The severe group was compromised of severe lesions, which included diffuse, multiple abscesses with severe sinus tract formation and fibrosis. Nine sites were limited and 14 sites were severe. After resecting the lesion, the defect was covered with a split-thickness skin graft (four sites were limited, nine sites severe), a musculocutaneous flap (five sites severe), primary closure (four sites limited), and a local skin flap (one site limited). In six sites in 6 severe-group patients, local recurrence occurred. The local recurrence rate differed significantly between the limited and the severe groups. The reason for this may be because the lesions in the limited group could be resected completely, whereas the lesions in the severe group were diffuse and total resection was sometimes difficult for various reasons. The method of surgical repair did not affect the local recurrence rate. In recurrent cases, four sites treated with skin grafting required further surgical treatment, and two sites treated with musculocutaneous flaps were controlled with oral antibiotics. In conclusion, sufficient resection of the lesion is the most important issue in treating follicular occlusion triad disease. In lesions that can be resected completely, the surgical procedure to cover the lesions should be selected to suit the size and site of the defect. However, in cases that cannot be resected completely, a musculocutaneous flap is recommended instead of a skin graft for enhanced postoperative management of the recurring wound, and its contribution to aesthetic and functional improvement.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #31 on: Friday July 30, 2004, 09:32:10 AM »
Extent of surgery and recurrence rate of hidradenitis suppurativa.

Ritz JP, Runkel N, Haier J, Buhr HJ.

Department of Surgery, University Hospital Benjamin Franklin, Free University of Berlin, Germany.

Hidradenitis suppurativa (HS) is a chronic fistula- and abscess-forming disease of the cutis and subcutis of unknown etiology. Disease recurrence is frequent and may cause severe complications. We analyzed patients with HS who underwent surgery between 1976 and 1997. The operative procedures were divided into drainage procedures (n = 6), limited regional (n = 14), and radical wide excisions (n = 11). The extent of surgery was examined in terms of the clinical course and late postoperative sequelae of HS. At a mean follow-up of 72 months, we found developed locoregional recurrent HS in 45% of patients. There was 100% recurrence after drainage, 42.8% after limited, and 27% after radical excision (P < 0.05). HS recurred after a median interval of 3 months for drainage, 11 months for limited excision, and 20 months for radical excision (P < 0.05). The disease-free interval continued up to 35 months. Long-term sequelae included penile amputation and a case of fatal squamous cell carcinoma. Although radical wide excision of the HS-affected cutis is associated with the lowest recurrence rate, it is still considerable and warrants long-term follow-up.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #32 on: Friday July 30, 2004, 09:36:17 AM »
Forms of epithelial differentiation of draining sinus in acne inversa (hidradenitis suppurativa).

Kurzen H, Jung EG, Hartschuh W, Moll I, Franke WW, Moll R.

Division of Cell Biology, German Cancer Research Centre, Heidelberg, Germany. hjalmar_kurzen@med.uni-heidelberg.de

The draining sinus is a late complication of several forms of severe acne, leading to extensive, periodically inflamed lesions that are undermined by a system of fistulas, supposed to be of follicular origin. We investigated the expression of various cytokeratins (CKs) and desmosomal proteins in the draining sinus of acne inversa (hidradenitis suppurativa) using monoclonal antibodies in immunohistochemistry on paraffin-embedded sections. We were able to define three different phenotypes of stratified squamous epithelia covering the sinus tracts. Type I epithelium was cornifying and characterized by the presence of CK 10, desmogleins 1-3 and desmocollins 1-3 in an epidermis-like pattern. Type II epithelium was non-cornifying, negative for CK 10 and positive for CK 13. It was negative for desmocollin 1 but strongly immunopositive for desmoglein 1 suprabasally and for desmoglein 2 in the basal cells. Type III epithelium was non-cornifying and strongly inflamed. It was marked by the presence of CK 7, CK 19 and desmoglein 2 and the absence of CK 10, desmoglein 1 and desmocollin 1. In both type II and III epithelium, desmoglein 3, desmocollin 2 and desmocollin 3 showed an inverted staining pattern as compared with normal epidermis and type I epithelium. Desmoglein 2 and CK 5/14 always remained restricted to the basal cell layer. Antibodies against CK 6 and CK 13/15/16 were immunopositive in all three phenotypes and CK 17 was predominantly immunolocalized to suprabasal layers of type II and III epithelium. The three phenotypes are characterized as pathological stratified squamous epithelia reflecting the dynamic process of inflammation, proliferation and stratification taking place in acne inversa.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #33 on: Friday July 30, 2004, 09:44:56 AM »
Incidence of cancer among patients with hidradenitis suppurativa.

Lapins J, Ye W, Nyren O, Emtestam L.

Department of Medicine, Section of Dermatology and Venereology, I43, Karolinska Institutet at Huddinge University Hospital, SE-141 86 Stockholm, Sweden. Jan.Lapins@dermat.hs.sll.se

BACKGROUND: On the basis of some case reports, a relationship has been suggested between hidradenitis suppurativa (HS) and the development of nonmelanoma skin cancer. OBJECTIVES: To confirm this relationship and to explore the risk of other cancers among patients with HS. PATIENTS: Patients with a discharge diagnosis of HS were obtained from the computerized database of hospital discharge diagnoses from January 1, 1965, through December 31, 1997. A total of 2119 patients with HS were identified. SETTING: All hospitals in Sweden. DESIGN: With record linkage to the Swedish National Cancer Registry, standardized incidence ratios (SIR [the ratio of the observed to expected incidence]) were calculated to estimate relative risk. RESULTS: The risk of developing any cancer in the cohort with HS increased 50% (95% confidence interval of SIR, 1.1-1.8, based on 73 observed cases). Statistically significant risk elevations were observed for nonmelanoma skin cancer (5 cases; SIR, 4.6; 95% confidence interval, 1.5-10.7), buccal cancer (5 cases; SIR, 5.5; 95% confidence interval, 1.8-12.9), and primary liver cancer (3 cases; SIR, 10.0; 95% confidence interval, 2.1-29.2). CONCLUSIONS: This study confirms an increased risk of nonmelanoma skin cancer among patients with HS. The risk for buccal cancer and primary liver cancer was also elevated among this cohort, but these associations should be interpreted cautiously because the combination of multiple significance testing and the few observed cases may have generated chance findings.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #34 on: Friday July 30, 2004, 09:58:48 AM »
Lipid raft-enriched stem cell-like keratinocytes in the epidermis, hair follicles and sinus tracts in hidradenitis suppurativa.

Gniadecki R, Jemec GB.

Department of Dermatology, Bispebjerg Hospital, Copenhagen,Denmark.

Hidradenitis suppurativa (HS) is a disease, that causes considerable morbidity in patients. A histological hallmark of the disorder is the formation of sinus tracts in the dermis and the subcutis. Biologically, they represent a poorly understood phenomenon involving the infiltrative growth of proliferating non-malignant keratinocytes. Lipid domains in plasma membranes (lipid rafts) play a role in the function of growth factors and are suspected of having a pathogenic role in cell migration and invasive growth. Using HS as a model, the presence of lipid rafts was studied using cholera toxin conjugated with FITC (CTx-FITC) and antibeta1 integrin (CD29)-CyChrome conjugate fluorescence staining of unfixed and acetone-fixed cryostat sections of lesional and paralesional skin samples. The double-labeled skin samples were observed in the confocal laser-scanning fluorescence microscope. Samples were obtained from five patients with HS. The lesional epidermis of HS contained three populations of keratinocytes: CD29(bright)CTx(dim), CD29(dim)CTx(bright) and a third hitherto unseen population containing double-positive CD29(bright)CTx(bright) cells. The CD29(bright)CTx(dim) population resembles the earlier described epidermal stem-like cells, while the CD29(dim)CTx(bright) basal keratinocytes overlap with the transit-amplifying cell pool. The new population of double-positive CD29(bright)CTx(bright) cells was localized on the slopes of the papillas, focally in the suprabasal epidermal layers, in some hair follicles and in the majority of sinus tracts. Such double-positive cells have not previously been encountered by us in normal epidermis and hair follicles. Using HS as a model, it is suggested that the keratinocytes involved in sinus tract formation are CD29(bright)CTx(bright) cells. Owing to the physical proximity of the cells, it is hypothesised that the described CD29(bright)CTx(bright) cells result from an increased expression of CD29 on the CTx(bright) cells. It is likely that the double-positive CD29(bright)CTx(bright) cells emerge due to the influence of local inflammatory cytokines. Sinus tract formation may represent an aberrant epidermal repair response executed by the activated CD29(bright)CTx(bright) keratinocytes capable of non-malignant infiltrative growth in the dermis and subcutis.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #35 on: Friday July 30, 2004, 10:11:31 AM »
Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa.

Rompel R, Petres J.

Department of Dermatology, Klinikum Kassel, Kassel, Germany.

BACKGROUND: Hidradenitis suppurativa (acne inversa) is a chronic recurrent disorder characterized by abscessing inflammation, fistulating sinus tracts, and scarring. Predilection sites are the intertriginal regions. The severe course of the disease demands an early and curative treatment. OBJECTIVE: The aim of this study was to review the effect of radical surgical excision concerning cure rate and potential complications within a large group of patients. METHODS: We analyzed data for 106 patients suffering from hidradenitis suppurativa treated during the period 1980-1998. The mean duration of the disease was 7 years. In about 90% of the cases, two or more sites were affected. Inguinal (70.8%) and axillary regions (61.3%) were most commonly involved. All patients were treated by radical wide excision using intraoperative marking of sinus tracts with methylviolet solution. The method of reconstruction depended on the size and location of the defect. Median postoperative follow-up time was 36 months. RESULTS: The overall complication rate was 17.8%. Most of these were minor complications such as suture dehiscence, postoperative bleeding, and hematoma. Wound infection occurred in only 3.7% of patients. The rate of recurrence within the operated fields was 2.5%. There was no relation between the surgical method of reconstruction and the rate of recurrence. Recurrence was related to the severity of the disorder. CONCLUSION: Our results confirm early radical excision as the treatment of choice for hidradenitis suppurativa. Using intraoperative color-marking of sinus tracts, the recurrence rate is minimal. The method of reconstruction has no influence on recurrence and should be chosen with respect to the size and location of the excised area.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #36 on: Friday July 30, 2004, 10:19:39 AM »
Morbidity in patients with hidradenitis suppurativa.

von der Werth JM, Jemec GB.

Department of Dermatology, Queen's Medical Centre, Nottingham NG7 2UH, UK.

BACKGROUND: Although skin diseases are often immediately visible to both patients and society, the morbidity they cause is only poorly defined. It has been suggested that quality-of-life measures may be a relevant surrogate measure of skin disease. Hidradenitis suppurativa (HS) leads to painful eruptions and malodorous discharge and is assumed to cause a significant degree of morbidity. The resulting impairment of life quality has not previously been quantitatively assessed, although such an assessment may form a pertinent measure of disease severity in HS. OBJECTIVES: To measure the impairment of life quality in patients with HS. METHODS: In total, 160 patients suffering from HS were approached. The following data were gathered: quality-of-life data (Dermatology Life Quality Index, DLQI questionnaire), basic demographic data, age at onset of the condition and the average number of painful lesions per month. RESULTS: One hundred and fourteen patients participated in the study. The mean +/- SD age of the patients was 40.9 +/- 11.7 years, the mean +/- SD age at onset 21.8 +/- 9.9 years and the mean +/- SD duration of the disease 18.8 +/- 11.4 years. Patients had a mean +/- SD DLQI score of 8.9 +/- 8.3 points. The highest mean score out of the 10 DLQI questions was recorded for question 1, which measures the level of pain, soreness, stinging or itching (mean 1.55 points, median 2 points). Patients experienced a mean of 5.1 lesions per month. CONCLUSIONS: HS causes a high degree of morbidity, with the highest scores obtained for the level of pain caused by the disease. The mean DLQI score for HS was higher than for previously studied skin diseases, and correlated with disease intensity as expressed by lesions per month. This suggests that the DLQI may be a relevant outcome measure in future therapeutic trials in HS.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #37 on: Friday July 30, 2004, 05:44:58 PM »
Negative-pressure dressings in the treatment of hidradenitis suppurativa.

Elwood ET, Bolitho DG.

Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.

Negative-pressure dressings have been used in the treatment of a variety of open wounds, and as a bolster for skin grafts. The benefits of these dressings include increased oxygen tension in the wound, decreased bacterial counts, increased granulation formation, and the prevention of shear force on wounds. Also, by virtue of the diminished need for daily dressing changes, there are the additional advantages of enhancing patient comfort, decreasing nursing work, and diminished cost of wound care. Hidradenitis suppurativa (HS) is a chronic infection of the apocrine sweat glands. Treatment options range from oral isotretinoin to radical excision. Wound closure may be achieved by secondary intention, skin grafting, or flap closure. Complications may still arise and include disease progression and squamous cell carcinoma. Radical excision yields the best results in terms of disease eradication. The authors describe using the negative-pressure dressing in two cases of bilateral axillary HS to secure skin grafts firmly to the wound bed after radical excision of all involved tissues. Patient comfort and acceptance was high, and skin graft take was excellent. The dressings themselves are simple to apply and are highly effective

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #38 on: Friday July 30, 2004, 05:46:35 PM »
Neutrophil-related host response in hidradenitis suppurativa: a pilot study in patients with inactive disease.

Lapins J, Asman B, Gustafsson A, Bergstrom K, Emtestam L.

Department of Medicine, Karolinska Institutet at Huddinge University Hospital, Stockholm, Sweden. jan.lapins@dermat.hs.sll.se

Host-defence defects in hidradenitis suppurativa patients have been suspected, but not proven. Activated neutrophils can destroy the surrounding tissues by a release of reactive oxygen species and active proteases. Peripheral neutrophils from 15 female patients (mean age 46, range 27-57 years) in an inactive state of their hidradenitis suppurativa, were studied and compared with 15 age-matched healthy female controls. There were no significant differences between patients and controls in the assessments of intracellular elastase activity, total content of antigenic elastase or release of elastase. Furthermore, no differences were found in total content and membrane expression of the receptors measured. The generation of free oxygen radicals, after stimulation with the protein kinase C activator phorbol myristate acetate, was significantly higher in the patients than in the controls, while there was no difference after Fc-receptor-mediated stimulation. Dysfunctional neutrophils might be involved in the pathogenesis of hidradenitis suppurativa, but the findings should be interpreted with caution because of the small number of observed cases.

Celery Peach

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Re:Hidradenitis Suppurativa Articles
« Reply #39 on: Friday July 30, 2004, 05:48:08 PM »
No human leukocyte antigen-A, -B or -DR association in Swedish patients with hidradenitis suppurativa.

Lapins J, Olerup O, Emtestam L.

Department of Medicine, Karolinska Institutet, Huddinge University Hospital, Sweden. jan.lapins@dermat.hs.sll.se

Hidradenitis suppurativa (HS) is a cicatrizing, inflammatory and recurrent disease restricted to inverse skin, such as that of the axilla and groin of younger adults. In a previous study, using serological tissue-typing techniques, no significant increases in the human leukocyte antigen (HLA)-A and -B specificities were found in patients with HS. The aim of this study was to determine the frequencies of HLA-A, -B and, for the first time, HLA-DR alleles, using genomic tissue-typing methods in patients with HS. Forty-two unrelated Swedish patients with HS were included and compared with 250 controls. According to clinical staging adopted from Hurley all of the patients had stage II HS, i.e. recurrent abscesses with tract formation and cicatrization and single or multiple widely separated lesions. No association with HLA-A, -B or -DRB1 alleles was found in patients with HS. Genetic factors associated with the HLA class I or II regions do not appear to contribute significantly to the possible genetic susceptibility of HS.