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General Category => Skin Complaints and Skin Disorders => Hidradenitis Suppurativa Board => Topic started by: Celery Peach on Monday March 08, 2004, 12:32:08 PM

Title: Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.  
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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).
 
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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
Title: Re:Hidradenitis Suppurativa Articles
Post by: Nick on Monday March 08, 2004, 12:51:40 PM
I have taken the liberty of making this thread "sticky" as I think it will be a continuing project for the forum :up:
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 12:51:43 PM
[Acne inversa: a dapsone-sensitive dermatosis]

[Article in German]

Hofer T, Itin PH.

Abteilung fur Dermatologie, Kantonsspital Aarau.

Acne inversa is a chronic disease with a major impact on the quality of life. Therapeutic options were long restricted to local disinfectants and systemic antibiotics, as well as repeated incision and drainage which produce only short term benefits. Retinoids, antiandrogens and radiation therapy are only partially successful. The best approach appears to be surgical removal of the entire apocrine sweat gland apparatus. Dapsone is used in dermatology to treat inflammatory dermatoses such as dermatitis herpetiformis and pyoderma gangrenosum, and was formerly the treatment of choice for acne conglobata. We report its successful use in acne inversa. Five female patients aged 23-40 years with acne inversa for a mean of 9.6 years were included. All patients showed an almost complete resolution of their symptoms within 2-4 weeks. All patients rated the treatment results with dapsone as good or very good. The treatment was well tolerated and no important side effects occurred. Because of its lack of teratogenicity, dapsone may be the most favorable treatment option in young women with acne inversa.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 12:58:27 PM
Nodulocystic acne and hidradenitis suppurativa treated with acitretin: a case report.

Scheman AJ.

North Shore Center for Medical Aesthetics, Northbrook, Illinois 60062, USA.

Nodulocystic acne is a dermatologic disease that can result in significant damage to the skin of the face, chest, and back. Hidradenitis suppurativa is a scarring disease of the skin that causes deep cysts and abscesses on the axillae and anogenital areas. We review a case of a patient with severe nodulocystic facial acne and hidradenitis suppurativa that was treated with 2 full courses of isotretinoin. Although the patient's condition improved, some draining cysts persisted on the face and groin. Because of the inability of isotretinoin to achieve long-term remission of the patient's condition, acitretin was considered as a possible maintenance drug. The patient was almost completely improved after 5 months' therapy with acitretin, which also was effectively used for ongoing maintenance. Acitretin may be a promising treatment for severe nodulocystic acne and hidradenitis suppurativa, which require long-term suppression when isotretinoin fails to give long-term remission.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 01:04:14 PM
Hidradenitis suppurativa polyposa.

Wrone DA, Landeck A, Dibbell DG, Xie H, Warner TF.

Department of Medicine, University of Wisconsin Hospital and Clinics, Madison 53792, USA.

A case of severe chronic hidradenitis suppurativa of the perineum complicated by disfiguring fibrous, polypoid lesions is presented. The patient, a 41-year-old woman, had a long history of axillary hidradenitis which subsequently involved the perineum. Draining sinuses, scars and large pendulous masses of the vulva developed over 10 years. Cutaneous scars, ridges, papules and large fibrous polyps were present. Deep clefts, sinuses, dense fibrous scars and foci of chronic inflammation were seen. Rarely, large fibrous polyps may develop in chronic hidradenitis suppurativa and may be due to chronic local lymphedema. Careful pathologic examination is necessary to exclude squamous cell carcinoma.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 01:05:59 PM
Immunohistochemical study of cytokeratins in hidradenitis suppurativa (acne inversa).

Kurokawa I, Nishijima S, Kusumoto K, Senzaki H, Shikata N, Tsubura A.

Department of Dermatology, Hyogo Prefectural Tsukaguchi Hospital, Hyogo, Japan. ikuro@alles.or.jp

In 14 cases of hidradenitis suppurativa, cytokeratin (CK) expression was studied immunohistochemically, using six antikeratin antibodies against CK1, CK10, CK14, CK16, CK17 and CK19, respectively. The draining sinus tract epithelium of hidradenitis suppurativa lesions was divided into three components: infundibular-like keratinized epithelium (type A), non-infundibular keratinized epithelium (type B), and non-keratinized epithelium (type C). In type A samples, CK17 (which is found in normal infundibulum) was not detected, suggesting fragility of this epithelial type. Keratin expression in types B and C epithelia was similar to that observed in the outer root sheath in normal hair follicles. Our results suggest that the draining sinus epithelium may possess characteristics of fragility, undifferentiation and hyperproliferation, as shown with CK expression.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 01:10:09 PM
Perineal hidradenitis suppurativa: presentation of two unusual complications and a review.

Williams ST, Busby RC, DeMuth RJ, Nelson H.

Department of General Surgery, Oregon Health Services University, Portland.

Two patients with advanced perineal hidradenitis suppurativa, complicated by fecal incontinence and squamous cell carcinoma, are presented. The first patient was a 58-year-old man who had a 30-year history of chronic recurring perianal abscesses and perineal sinuses. At the time of presentation, he had extensive perineal suppurative disease, and scarring and fixation of the anal sphincters with resultant fecal incontinence. He was treated with wide excision and skin graft closure. The second patient was a 27-year-old man with an 11-year history of recurrent gluteal abscesses and perineal sinuses. At the time of presentation, his inflammatory disease was only mildly active, but he had a nonhealing gluteal lesion. The nonhealing lesion was diagnosed as a squamous cell carcinoma and was managed with wide excision and primary closure. The inflammatory disease was excised and grafted. Complications of advanced hidradenitis suppurativa can be debilitating and life threatening. We review the etiology, pathophysiology, complications, and treatment options of hidradenitis suppurativa, including a literature review of the association with malignancy. We propose that the incidence of disabilities and complications may be reduced by early diagnosis and treatment, by emphasis on prevention of recurrence, and by more aggressive surgical intervention for recurrent and extensive disease.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 01:13:34 PM
Skin disease tied to greater squamous cell cancer risk. (Hidradenitis Suppurativa).
OB/GYN News, Dec 15, 2001, by Bruce Jancin

MUNICH -- Hidradenitis suppurativa is associated with a markedly increased risk of squamous cell carcinoma, Dr. JeanPaul Ortonne said at the 10th Congress of the European Academy of Dermatology and Venereology.

This chronic inflammatory skin disease may also be associated with increased risks of buccal and primary liver cancer, although this possibility needs to be interpreted with caution, said Dr. Ortonne of the National Institute of Health and Medical Research, Nice.

He cited a retrospective study by Dr. Jan Lapins and associates at Stockholm's Karolinska Institute. This was the first large-scale follow-up study of patients with hidradenitis suppurativa.

The investigators identified all 2,119 patients discharged with a diagnosis of hidradenitis suppurativa from any Swedish hospital during 1965-1997 and linked those records to the Swedish National Cancer Registry After excluding all cancers diagnosed within 1 year after hospitalization on the grounds that the malignancy might have predated the hidradenitis suppurativa, the Swedish investigators determined that patients with hidradenitis suppurativa were at 4.6-fold increased risk of subsequently developing squamous cell carcinoma. Women faced an 8.2-fold increase; for men, the increase was 1.7 fold (Arch. Dermatol. 137[6]:730-34, 2001).

This study validates prior anecdotal reports suggesting a possible association between hidradenitis suppurativa and nonmelanoma skin cancer, Dr. Ortonne said. The suspicion is that the chronic inflammatory bacterial infections and foreign body reactions that figure so prominently in hidradenitis suppurativa can trigger epidermal proliferative changes, including malignancy The higher skin cancer risk in women than men with hidradenitis suppurativa could be related to hormonal influences, or to the fact that women tend to get the inflammatory skin disease at an earlier age than men and hence have lengthier exposure to the disease's effects.

The Swedish study also demonstrated that patients with hidradenitis suppurativa were at 5.5-fold increased risk of buccal cancer and 10-fold elevated risk of primary liver cancer.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 03:30:41 PM
Hidradenitis Suppurativa
Surgery

Hidradenitis suppurativa refers to a chronic relapsing cutaneous inflammation of the apocrine glands of the body. Chronic hidradenitis suppurativa can affect, in order of preference, the axilla, perineum, scrotum, inguinal, scalp, palms of the hand, soles of thefeet and the submammary region. Hidradenitis suppurativa usually manifests itself afterpuberty (androgen-dependent disorder). Females are more commonly affected than males.The inflammatory process begins as a local occluding spongiform infundibulo-folliculitis of a sweat gland with subsequent rupture and secondary bacterial infection. Symptomsinclude pain, swelling, purulent discharge, and pruritus of the affected region. Associated medical conditions include diabetes and obesity. Initial management consists of general hygienic measures with antibiotics, antiandrogens and estrogens. Surgery is needed when the condition is at an advanced stage with cellulitis and scarring. Non operative treatment is disappointing. Total excision of all apocrine-bearing axillary tissue with primary closure is the treatment of choice. Operative treatment can be safely accomplished even when draining sinuses are present. Recurrence results from inadequate excision or an unusually wide distribution of apocrine glands, but physical factors such as obesity, local pressure,and skin maceration play a role. Radical surgery gives good symptomatic control of severe hidradenitis suppurativa of the axilla, inguino perineal, and perianal regions but is less satisfactory for submammary disease
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 03:45:51 PM
 :up: I thought this one was very informative

Hidradenitis Suppurativa
JoergPeter Ritz MD and Heinz J Buhr MD FACS
Department of Visceral Vascular and Thoracic Surgery, Hindenburgdamm 30, University Hospital Benjamin Franklin Free University of Berlin, Berlin, 12200, Germany

Current Treatment Options in Infectious Diseases 2001, 3:379-385

--------------------------------------------------------------------------------
   
Outline   Opinion statement  

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. This article reports on the information in the literature regarding epidemiology, pathogenesis, clinical manifestations, and treatment options of HS. HS occurs mainly in the third to fourth decade of life and seems to be associated with obesity, smoking, chemical irritants, and hyperandrogenism; bacterial involvement is secondary. Although acute intermittent lesions of early HS often respond to conservative therapy, such treatment most likely does not alter the clinical course of the disease. Patients may occasionally derive symptomatic benefit from long-term antibiotics, but relapse is almost inevitable when treatment is withdrawn. Therefore, surgery is the only effective therapy for severe HS, especially in view of possible complications after long-standing disease. Incision and drainage of each lesion and abscess may temporarily improve symptoms but do not cure the underlying sinuses and infected apocrine glands. Drainage procedures and limited resections lead to an unacceptable rate of recurrence with an unnecessary risk of life-threatening complications such as squamous cell carcinoma. Recurrence is mostly due to limited resection and inadequate eradication of sweat glands. Radical wide excision of the HS-affected cutis is associated with the lowest recurrence rate. In general, HS recurs the earlier the less infected and abscess- containing skin is resected. Obesity, local pressure, and skin maceration are important promoting factors. Approximately 20 to 25% of HS progresses to a previously unaffected area, which cannot be influenced by therapy options. Patients with HS need to be followed up and treated over a long period of time to exclude late- developing recurrences and to detect a malignant degeneration in an early stage by histopathologic examination of suspicious areas.

Outline   Introduction    

Hidradenitis suppurativa (HS) was first described as a clinical entity by Velpeau in 1839 as a peculiar inflammatory process with superficial abscess formation, affecting tissues of the axillary, mammary, and perianal regions. In 1864, the French surgeon Verneuil was the first to associate HS with the sweat glands [1-3]. In 1922, Schiefferdecker classified sweat glands in eccrine or apocrine and subsequently localized HS to the apocrine glands because those areas rich in these glands (such as axillary, inguinal, genital, perianal, and perineal regions) are affected by the disease [4¢¢,5].

The prevalence of HS is unknown. Jemec [6]reported a point prevalence of 4.1% based on objective findings in a younger adult population. The disease develops mainly in men in the third and fourth decades of life, which coincides with postpubertal increases in androgen levels [1,4¢¢,7]. Onset before puberty is rare. In women, HS sometimes persists into the climacteric; onset after menopause is rare. HS in the perianal region is 10 times more common in men than in women, whereas axillary disease is more prevalent in women [2,4¢¢,6-8]. Some authors believe that HS is more common in the black population, but some report no racial predilection [6-8].

Although its exact etiology is unknown, HS seems to be associated with obesity, proneness to acne, excessive sweating, endocrine disorders such as Cushing's syndrome or diabetes, poor personal hygiene, and smoking [4¢¢,8,9]. Many authors consider chemical irritants such as deodorants, mechanical irritation, depilation, and shaving to be factors. Morgan and Leicester [10] retrospectively compared 40 patients who had HS with 40 age-matched controls and found no significant difference in the use of these items. Since Schiefferdecker, the disease has been considered a disorder of apocrine glands. This theory was supported by an experimental model that induced poral occlusion by manual skin depilation and application of atropine-impregnated tape. This resulted in dilation, inflammation, and bacterial invasion of the apocrine duct. However, the lesions did not progress to the characteristically chronic condition of HS [11]. More recent studies have identified HS as a disorder of follicular rather than apocrine occlusion. Attanoos et al. [5] studied the skin biopsies of patients with HS and reported a consistent finding of follicular occlusion in all specimens when compared with controls. They discussed that inflammation of the apocrine glands did not occur in the absence of an adjacent folliculitis. Thus, apocrine gland involvement seems to be secondary to the primary involvement of the terminal hair follicle [12]. In addition, several reports in the literature link HS to a single gene transmission. Fitzsimmons et al. [13,14¢] reported a pattern of autosomal dominant transmission in their study of three families with 21 affected members.

The disease onset is insidious, with early symptoms of pruritus, erythema, and local hyperhidrosis. Later, a firm pea-sized nodule appears and may rupture spontaneously, yielding a purulent discharge. Gland rupture spreads the infection to surrounding tissues. The cycle is repeated in the adjacent tissue, leading to localized abscesses, chronic draining sinuses, and finally scarring and fibrosis. The disease course is characterized by exacerbations and remissions, with the extent of affected skin gradually increasing [4¢¢,5,7,12]. There are numerous reports of severe complications in chronic HS, including anemia, intestinal keratitis, osteomyelitis, fistulous communications to pelvic organs, and even death [15¢,16]. It remains unclear whether radical excision can prevent some of these complications. Squamous cell carcinoma (SCC) is a dreaded but rare complication with only 26 reported cases since the first description by Anderson in 1958 [16,17]. SCC tends to occur in patients with peri-anal and gluteal disease and is less frequent in axillary cases. In a review of all the published cases by Perez-Diaz et al. in 1995 [18], the average age at diagnosis was 47 years with a male predominance. The mean duration from the onset of HS to SCC was 20 years. Only four patients had a history of fewer than 10 years. Treatment varies from wide local excision to abdominoperineal resection, sometimes combined with radiotherapy or chemotherapy. According to follow-up data, 30% of the patients were alive and recurrence free at 1 year and 41% developed recurrent cancer [16-18].

   
Outline   Treatment  
 
Controversy exists regarding the appropriate treatment for HS. Consequently, there is no standard treatment and most studies lack a long-term follow-up after initial therapy. However, the care and observation of patients with HS remains an important factor because the disease can recur even years after initial therapy [16,19]. Conservative management ranges from antiseptic cleaning or topical steroid creams to systemic anti-biotic therapy [1-3,4¢¢,19,20¢,21¢]. Combined anti-androgen and estrogen therapy in women has been reported to control HS. Acute intermittent lesions of early HS often respond to conservative therapy, but it is unlikely that such treatment alters the long-term clinical course of the disease [19,20¢,21¢,22-23]. Patients may occasionally derive symptomatic benefit from long-term antibiotics, but relapse is almost inevitable when treatment is withdrawn. Therefore, surgery is the only effective therapy for severe HS, especially considering the possible complications after long-standing disease [24¢¢,25]. Selection of a treatment approach is facilitated by preliminary clinical staging (1). All patients, irrespective of the stage or extent of their HS, require proper maintenance care of the involved areas with emphasis on avoidance of local frictional trauma to prevent new outbreaks or recurrences. Thus, continued medical surveillance is usually necessary, even in most patients with definitive surgery for stage III disease.

Pharmacologic treatment

Because of the required extensive nature of surgical treatment, patients are often first administered medical treatment. Patients may have symptomatic relief with a long-term course of antibiotics. Antibiotics are not curative but may diminish unpleasant odor and discomfort in the patient. Conservative medical treatment is applied mainly in stage I disease (1). In general, after withdrawal of conservative treatment, relapse of HS is almost inevitable. The topical use of clindamycin has been favored in the literature. Hormonal therapy is of no value in HS. Isotretinoin or 13-cis-retinoid acid administered in 1 mg/kg daily doses is helpful in some patients with stage II or III disease but is not as beneficial as it is in acne vulgaris [12,19,27]. Anti-androgenes such as spironolacton and cyproterone acetate have been recommended to help prevent recurrent HS but are not routinely helpful.

Systemic antibiotics

Standard dosage

Tetracycline (1-1.5 g/day), minocycline (100-200 mg/day), or ciprofloxacin (250-500 mg/day) should be administered only in patients with early lesions with signs of local inflammation. The treatment should be maintained until all signs of the inflammation are gone, usually for 7 to 10 days.

Contraindications

None.

Special points

Bacterial culture with antibiotic sensitivity testing should be performed on available drainage material. Alternative antibiotic therapy should be based on the results of these studies [20¢]. Tetracycline and ciprofloxacin can be administered orally for 7 to 10 days in patients with early stages of the disease and does not require surgical incision or drainage. Treatment should be adapted according to antibiotic sensitivity testing.

Complications

High recurrence rate after withdrawal of therapy, complications of antibiotic treatment (ie, diarrhea).

Local treatment

Standard procedure

Gentle daily cleaning with a germicidal soap such as chlorhexidine gluconate is advised, as is daily application of a topical antibiotic (2% clindamycin).

Contraindications

None.

Special points

Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin in patients with HS.

Complications

None.

Surgery

Surgery is the basis for successful treatment of HS, especially in cases of chronic or recurrent disease (stages II and III). Radical surgery is considered the only curative therapy for HS, although the particular area excised can be cured. HS can recur in patients in remote or untreated regions because it may affect any apocrine gland-bearing area. Patients should be appropriately cautioned [16,21¢,24¢¢,25,28]. Currettage and electrofulguration can be used in the base of the exteriorization wounds to destroy residual disease epithelial elements or for hemostasis but are not routinely necessary. Because of the thick fibrotic scarring in these areas, satisfactory anesthesia may be difficult or impossible to achieve with local anesthetics. The surgical strategy can be subdivided into drainage procedures, limited regional exision, and radical wide excision.

Incision and drainage

Defined as simple abscess incisions or drainage of the affected area, this procedure can temporarily improve symptoms and offers a transient benefit. However, it does not cure the underlying sinuses and infected area. It is a simple surgical method with a low complication rate, but acute infection recurs within 1 to 3 months in nearly all patients (1 and 2) [16,24¢¢,29].

Contraindications

This procedure can be performed easily under local anesthesia on an outpatient basis in almost every patient without contraindications. The patient needs to be informed about the partial and temporary improvements of this procedure.

Complications

High recurrence rate.

Limited excision

Defined as resection of the infected abscess and fistula containing cutis in the affected region. This procedure carries a high risk of local recurrence in 40% to 50% of patients, occurring after a median of 9 to 11 months [16,24¢¢,25]. We found no advantage to limited regional excision of the affected skin (1 and 2).

Contraindications

None.

Complications

High recurrence rate.

Radical wide excision

Radical wide excision includes all hair-bearing skin (with or without signs of HS) of the affected region down to soft normal tissue with margins well beyond the clinical borders of activity (1 cm). This procedure is considered to be most effective in treating HS, with a recurrence rate of 20% to 30%. Most authors agree that radical wide excision of the affected skin minimizes recurrence. In a series of 82 patients with wide excision and a mean follow-up of 47 months, Harrison et al. [30] found a 26% recurrence rate in all cases, which is comparable to the 27% recurrence rate in our series of radical wide excision [16].

Standard procedure

Excision of the involved areas down to soft, normal tissue with clear margins of at least 1 cm in the clinically unaffected skin under general anesthesia.

Contraindications

Patient must tolerate general anesthesia, postoperative immobilization, and long-term follow-up.

Complications

Acceptable recurrence rate. Contracture (1%-2%), bleeding, long-term wound healing, vascular/nerve injury.

Skin closure

Controversy exists regarding closure of the skin defect. Primary closure and rotation flaps are rarely used because of the extensive nature of the excisions. The method of wound management may influence the course of the disease. In a surgical series, reoperation was necessary in 54% of the cases with primary wound closure, in 19% after flap repair, and in 13% after grafting [29]. This confirms our experience, which indicated that primary skin closure may inadvertently compromise the excision margin and increase the risk of recurrence. Immediate or delayed split-skin grafting offers the advantage of rapid healing with complete wound closure in 2 to 4 weeks. Grafting is most successful in axillary disease. Healing by granulation is associated with a predictable result that is as good as or superior to that obtained by skin grafting. However, complete wound closure may take up to 2 to 3 months [31].

Standard procedure

Open wound healing by granulation in affected areas. Delayed skin grafting in selected patients with axillary HS 1 to 2 weeks after excision to avoid missing infected skin not completely excised.

Contraindication

Grafting in perianal, anal, or perineal affection of HS.

Complications

Unsightly cosmetic results and poor cosmesis at the donor site. Immobilization of the affected limb for 5 to 7 days. High failure rate in the perianal and perineal area. Grafts in the anal area may contract and lead to anal stenosis.

Radiotherapy

X-irradiation in doses sufficient to produce temporary epilation (single doses of 0.5 to 1.5 Gy up to total doses of 3.0 to 8.0 Gy) appears to be less effective than the approaches cited previously [32].

Lifestyle factors and prevention

An essential part of treatment includes avoidance of tight garments such as T-shirts, body-shirts, snug-fitting blouses, blue jeans, panty hose, and the straps and seams of undergarments and athletic equipment, all of which produce frictional trauma and exacerbate the disease. Whenever possible, women may have to forego wearing a brassiere in favor of a cotton undershirt. The patients must maintain this approach throughout their lives to sustain a quiescent state.

Generally, the local application of adhesive tape, which can promote poral occlusion and is irritative, should be avoided in these patients or used for a limited time. Shaving of regional hair, as in the axillae, is permissible but must be done gently and carefully with a clean sharp razor with prior cleansing of the area. Antiperspirant-deodorant formulations, preferably the liquid or spray varieties (not the roll-on, mat applicators, or stick types) may be used in the axillae. Several reports found a clear correlation between HS and nicotine intake, thus patients should quit smoking
 
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday March 08, 2004, 04:10:32 PM
Combination treatment using Clindamycin & Rifampicin

E.A.O Hindle, B.Kirby & C.E.M. Griffiths
Hope Hospital, Salford, UK - Published in the British Journal of Dermatology 2002

Combination treatment with clindamycin 300 mg twice daily and rifampicin 300 mg twice daily for 10 weeks has previously been reported as successful in folliculitis decalvans.

We report our experience with this regimen in seven patients with HS and three patients with acne keloidalis nuchae. A 10 week course of both agents was initiated in all patients, with liver function monitoring at baseline and during therapy. Four patients with HS tolerated the combination, and three of these responded well: one patient remained clear for 12 months, one reprted a 70% improvement and the third patient has not attended for further review following a good initial response.

Three Patients with HS were unable to tolerate the combination due to diarrhoea, nausea & vomiting. Clindamycin was discontinued in the two patients who experienced diarrhoea due to the association with Clostridium difficile, and minocycline was substituted. One of these patients subsequently developed raised liver aminotransferases, and rifampicilin was discontinued.

All three patients with acne keloidailis nuchae responded completely and this has been maintained for up to 26 months without relapse.

We conclude that this treatment appears effective in these shronic and usually difficult to treat conditions and thus represents a significant theraputic advance.

Title: Re:Hidradenitis Suppurativa Articles
Post by: missmash on Tuesday March 30, 2004, 02:11:54 PM
Lapins, Jan
Hidradenitis suppurativa: With special reference to carbon dioxide laser surgery

Fredagen den 4 maj 2001, kl. 10.00.
Föreläsningssal I 42, Huddinge Universitetssjukhus.
 
ISBN: 91-628-4722-8     Diss: 01:227  


Abstract:

Hidradenitis suppurativa (HS) is a chronic inflammatory disease with recurrent abscesses. In most cases, it involves the axillar and anogenital regions. In industrialised countries, the prevalence is of 0.3% to 4%, and the disease is over-represented in young adult females. Various medical treatments have been used but they are seldom effective. Surgical treatment is recommended as soon as the condition is diagnosed, but wide excisions very well outside the clinical borders of activity, are mandatory. A simple local incision is of no value. According to Hurley's clinical classification, stage I consists of one or more abscesses with no sinus tract and cicatrisation and stage II consists of one or more widely separated recurrent abscesses, with a tract and cicatrisation. The severest cases (stage III) have multiple interconnected tracts and abscesses throughout an entire area.

    In this thesis we report a method in which horisontal vaporisation with carbon dioxide laser is used to remove the inflamed infiltrating abscesses with precision. Patients classified as Hurley stage H were selected consecutively, in 1989 and by the year 2000 that had undergone this treatment. Most patients were females, in their twenties and thirties and had had the disease for a mean of more than ten years. By using a radical but selective, tissue-sparing technique, we removed the inflamed, foreign body-like tissues of HS, including its squamous epitheliumlined and keratin- containing sinuses. Initially, we used a free hand and more surgeondependent technique that was later abandoned for a scanner assisted technique providing better accuracy, safety and faster ablation. The use of these carbon dioxide laser, rapid beam, optomechanical scanner systems in a continuous mode gives a fast and even ablation with better visualisation of the macro- pathology during surgery. The surgical results were satisfactory cosmetically, functionally and as regards quality of life. We believe that this technique offers a safe and efficient strategy for many colleagues who treat HS.

    Squamous cell carcinoma is a rare but serious complication of HS. To investigate this association and the risk of other malignancies, we performed a population-based retrospective cohort study on 2119 HS patients selected from a computerised database of hospital discharge diagnoses in Sweden during 1965-1997. We found a significantly increased risk of non- melanoma skin cancer in patients with HS. The risks of buccal cancer and primary liver cancer were also higher.

    Aerobic and anaerobic cultures from superficial and deep levels were taken during laser surgery in 24 patients. In all cases, bacterial cultures were positive for one or more specimens from at least one level and from deep levels in all but three cases. Sixteen species or subspecies were found. Staphylococcus OBS aureus OBS and coagulase-negative OBS staphylococci OBS (CNS) were the most frequently found species which suggests that CNS is a true pathogen.

    In our comparison of forty-two unrelated Swedish patients with HS and 250 controls we found no association with HLA-A, -B or -DRB1 alleles using the genetic tissue typing technique. Genetic factors associated with the HLA class I or II regions do not seem to contribute significantly to the possible genetic susceptibility of HS.

    We also compared the release of oxygen radicals and of primary granula from in vitro activated peripheral neutrophils from HS patients with inactive disease to that from a group of healthy controls. Our findings suggest that dysfunctional neutrophils may be involved in the pathogenesis of hidradenitis suppurativa.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Tuesday March 30, 2004, 06:13:59 PM
HS Article written March 2004 by Prof Jean Revuz

Needs adobe reader:

http://www.orpha.net/data/patho/GB/uk-hidradenitis-suppurativa.pdf (http://www.orpha.net/data/patho/GB/uk-hidradenitis-suppurativa.pdf)

Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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 (http://livingnature.com/ourproducts/products/rawmaterials/manukahoney.html)
Title: Re:Hidradenitis Suppurativa Articles
Post by: missmash 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)

Title: Re:Hidradenitis Suppurativa Articles
Post by: missmash 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.




Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach 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.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:49:10 PM
Nodulocystic acne and hidradenitis suppurativa treated with acitretin: a case report.

Scheman AJ.

North Shore Center for Medical Aesthetics, Northbrook, Illinois 60062, USA.

Nodulocystic acne is a dermatologic disease that can result in significant damage to the skin of the face, chest, and back. Hidradenitis suppurativa is a scarring disease of the skin that causes deep cysts and abscesses on the axillae and anogenital areas. We review a case of a patient with severe nodulocystic facial acne and hidradenitis suppurativa that was treated with 2 full courses of isotretinoin. Although the patient's condition improved, some draining cysts persisted on the face and groin. Because of the inability of isotretinoin to achieve long-term remission of the patient's condition, acitretin was considered as a possible maintenance drug. The patient was almost completely improved after 5 months' therapy with acitretin, which also was effectively used for ongoing maintenance. Acitretin may be a promising treatment for severe nodulocystic acne and hidradenitis suppurativa, which require long-term suppression when isotretinoin fails to give long-term remission.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:51:22 PM
Perforator-based fasciocutaneous island flaps for the reconstruction of axillary defects following excision of hidradenitis suppurativa.

Geh JL, Niranjan NS.

St Andrew's Centre for Burns and Plastic Surgery, Broomfield Hospital, Chelmsford, UK.

Hidradenitis suppurativa is a chronic socially debilitating disorder of unknown aetiology. Treatments include simple incision and drainage, excision and healing by secondary intention, spilt-skin grafting, and local-flap reconstructions. All of these methods can leave unsightly scars. Recurrence of the disease can be significantly reduced only by wide local excision of all the hair-bearing skin. Most methods involve repeated hospital admission, and leave contour defects in the upper arm and axilla. We describe a new method using double opposing V-Y perforator-based flaps to recreate the axillary contour after wide excision of the hair-bearing skin of the axilla. This method allows both axillae to be treated in a single stage, and represents a new alternative in the treatment of axillary hidradenitis suppurativa. Four patients are described: three underwent bilateral excision and reconstruction, while the fourth had a unilateral procedure. All patients had a single surgical procedure with no flap loss. The result following known reconstructive procedures is far from satisfactory: skin grafting leaves a divot deformity, and when a local flap, such as the posterior arm or thoracodorsal flap, is used it leaves a large bulky flap in the axilla. In our technique the flaps maintain the diamond shape of the axilla. Copyright 2002 The British Association of Plastic Surgeons.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:52:34 PM
[Prevalence of hidradenitis suppurativa in Denmark]

[Article in Danish]

Jemec GB, Heidenheim M, Nielsen NH.

H:S Bispebjerg Hospital, dermatologisk afdeling D.

The morbidity of hidradenitis suppurativa can be considerable, but little is known about its epidemiology. Our purpose was to describe the one-year and point prevalences of hidradenitis suppurative and its potential precursor lesions. We obtained the histories and examined an unselected sample (599 persons) of the general population (one-year prevalence), and we performed physical examination for a consecutive sample of 507 persons undergoing screening for sexually transmitted diseases (point prevalence). The point prevalence was 4.1% (95% confidence interval [CI] = 3.0-6.0) on the basis of objective findings. The one-year prevalence of hidradenitis was 1.0% (CI = 0.4-2.2) on the basis of subject recollection only. The patients in the sample on which the point prevalence is based were younger than those in the unselected sample of the general population (p < 0.001). Hidradenitis was significantly more common in women (p = 0.037), which may result from a female preponderance of genitofemoral lesions (odds ratio [OR] = 5.4; CI = 1.5-19.3). No sex difference was found in the prevalence of axillary lesions. Hidradenitis suppurativa is significantly more common than hitherto estimated. A female preponderance of patients is confirmed, except for patients with axillary lesions. Additional longitudinal studies are necessary to assess the importance of potential precursor lesions such as non-inflamed nodules or comedones.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:54:08 PM
Radiation therapy for benign diseases: patterns of care study in Germany.

Seegenschmiedt MH, Katalinic A, Makoski H, Haase W, Gademann G, Hassenstein E.

Klinik fur Radioonkologie, Strahlentherapie und Nuklearmedizin, Alfried Krupp Krankenhaus, Essen, Germany.

BACKGROUND: Radiotherapy of benign diseases is controversial and rarely applied in Anglo-American countries, whereas in other parts of the world it is commonly practiced for several benign disorders. Similar to a European survey, a patterns of care study was conducted in Germany. METHOD: Using a mailed questionnaire, radiation equipment, treatment indication, number of patients, and treatment concepts were assessed in 1994, 1995, and 1996 in 134 of 152 German institutions (88%): 22 in East and 112 in West Germany; 30 in university hospitals and 104 in community hospitals. Average numbers of each institution and of all institutions were analyzed for frequencies and ratios between regions and among institutions. Radiation treatment concepts were analyzed. RESULTS: A mean of 2 (range 1-7) megavoltage and 1.4 (range 0-4) orthovoltage units were available per institution; 32 institutions (24%) had no orthovoltage equipment. A mean of 20,082 patients were treated annually: 456 (2%) for inflammatory diseases (221 hidradenitis, 78 local infection, 23 parotitis; 134 not specified) 12,600 (63%) for degenerative diseases (2711 peritendinitis humeroscapularis, 1555 epicondylitis humeri; 1382 plantar/dorsal heel spur; 2434 degenerative osteoarthritis; 4518 not specified); 927 (5%) for hyperproliferative diseases (146 Dupuytren's contracture, 382 keloids; 155 Peyronie's disease; 244 not specified); 1210 (6%) for functional disorders (853 Graves' orbitopathy; 357 not specified); and 4889 (24%) for other disorders (e.g., 3680 heterotopic ossification prophylaxis). In univariate analysis, there were geographic (West vs. East Germany) differences in using radiation therapy (RT) for inflammatory and degenerative disorders, and institutional differences (university versus community hospitals) in using RT for hyperproliferative and functional disorders (p < 0.05). The prescribed dose concepts were mostly in the low dose range, <10 Gy but varied widely and inconsistently within geographic regions and institutions. CONCLUSION: Radiation therapy is a well-accepted and frequently practiced treatment for several benign diseases in Germany; however, there are significant geographic and institutional differences. As the number of orthovoltage units decreases, an increasing patient load will demand more megavoltage units, which may compromise the cost-effectiveness of this treatment. Only 4% of all clinical institutions have been involved in controlled clinical trials. To maintain a high level of RT service to other disciplines, RT treatment guidelines, quality control, and continuing medical education are required.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:55:40 PM
[Radiotherapy of hidradenitis suppurativa--still valid today?]

[Article in German]

Frohlich D, Baaske D, Glatzel M.

Klinik fur Strahlentherapie, Zentralklinikum, Suhl.

PURPOSE: In a retrospective analysis the efficacy of radiotherapy in the treatment of hidradenitis suppurativa was assessed. PATIENTS AND METHODS: Data from 231 patients undergoing radiotherapy for hidradenitis suppurativa in the last years in 2 hospitals were analyzed. The patients were treated with an orthovoltage therapy unit with 175 kV, 0.5 mm copper-filtering. The single doses reached from 0.5 Gy to 1.5 Gy up to total doses between 3.0 Gy and 8.0 Gy in one series. In chronic recurrent disease 2 or more series with a total dose of more than 10.0 Gy were given. RESULTS: Complete relief of symptoms at the end of radiotherapy was achieved in 89 patients (38%). In 92 patients (40%) there was clear improvement of symptoms. Only 2 patients did not react to radiotherapy. No side effects of radiotherapy occurred. CONCLUSION: Radiotherapy should be given more consideration as a treatment option for hidradenitis suppurativa.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:57:39 PM
Sebum excretion in hidradenitis suppurativa.

Jemec GB, Gniadecka M.

Department of Dermatology D, Bispebjerg Hospital, University of Copenhagen, Denmark.

BACKGROUND: Clinical and histological similarities between hidradenitis suppurativa and acne have been pointed out. The possible role of sebaceous glands in hidradenitis has not previously been investigated. Acne treatment, in particular is however not effective in hidradenitis. No previous information was found on regional sebum excretion in hidradenitis. OBJECTIVE: Investigate the sebum excretion (SE) and markers of cutaneous virilization in hidradenitis patients. METHODS: Sebutapes and scores of acne, hirsutes and alopecia in 16 women with hidradenitis suppurativa were compared with 16 healthy controls. RESULTS: The SE and the number of active glands followed a similar pattern in both groups (face > axillae/genitofemoral fold, p < 0.0001) but no significant differences were seen between the two groups. No differences were seen in the median Body Mass Index, number of obese persons in either group or any of the clinical markers of virilization studied. CONCLUSION: No significant axillary, genitofemoral or facial seborrhea was found in hidradenitis. It is suggested that SE 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. The results further suggest that general cutaneous virilization is not a feature of hidradenitis.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 05:58:30 PM
Squamous cell carcinoma in perineal inflammatory disease.

Gur E, Neligan PC, Shafir R, Reznick R, Cohen M, Shpitzer T.

Division of Plastic Surgery, Toronto Hospital, University of Toronto, Ontario, Canada.

Four patients with squamous cell carcinoma of the perineal region were diagnosed and treated during the last 4 years in our institutions. The underlying diagnoses consisted of recurrent pilonidal disease, Crohn's disease, and hidradenitis suppurativa. In all patients, a pattern of a long-term inflammatory process was evident. Current concepts regarding the pathophysiology of a chronic inflammatory state and malignant transformation are reviewed. We conclude that regardless of the original pathology, all chronic inflammatory processes in the perineal region should be evaluated for malignant degeneration. A high index of suspicion may potentiate an early diagnosis, possibly improving the chance of cure.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday July 30, 2004, 06:01:03 PM
Subcutaneous fistulectomy in bridging hidradenitis suppurativa.

Golcman R, Golcman B, Tamura BM, Nogueira MA, Zoo CM, Germano JA.

Department of Dermatology, University of Sao Paulo Medical School, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil.

BACKGROUND: The treatment of chronic lesions in hidradenitis suppurativa remains a challenge. For some clinical types surgical management is an excellent alternative. OBJECTIVE: This study evaluates an alternative surgical approach for the treatment of hidradenitis suppurativa of specific bridging lesions by subcutaneous resection of the tubular fibrotic tissue. METHODS: Periorificial fusiform skin incisions were made around the orifices parallel to the axillary or inguinal folds and the subcutaneous tubular fibrotic tissue was removed en bloc before skin suturing. RESULTS: The outcome was evaluated as satisfactory due to lower morbidity, minimizing the excised skin areas, prevention of bridles or adherences, shorter incisions, no healing difficulties, and less dehiscence or wound exposure. CONCLUSION: The subcutaneous fistulectomy is a surgical option in bridging hidradenitis suppurativa.
Title: Re:Hidradenitis Suppurativa Articles
Post by: Fortuna on Wednesday September 08, 2004, 07:31:10 PM
I didn't see this one yet:
http://www.sma.org/smj1998/decsmj98/brown.pdf  (http://www.sma.org/smj1998/decsmj98/brown.pdf)
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Thursday September 09, 2004, 02:49:43 PM
Cellulitis Info a side effect sometimes found with HS

Symptoms and Signs

Infection is most common in the lower extremities. A cutaneous abnormality (eg, skin trauma, ulceration, tinea pedis, dermatitis) often precedes the infection; areas of lymphedema or other edema seem especially susceptible. Scars from saphenous vein removal for cardiac or vascular surgery are common sites for recurrent cellulitis, especially if tinea pedis is present. Frequently, however, no predisposing condition or site of entry is evident. The major findings are local erythema and tenderness, frequently with lymphangitis and regional lymphadenopathy. The skin is hot, red, and edematous, often with an infiltrated surface resembling the skin of an orange (peau d'orange) (see Plate 112-1). The borders are usually indistinct, except in erysipelas (see below), a type of cellulitis in which the raised margins are sharply demarcated. Petechiae are common; large areas of ecchymosis, rare. Vesicles and bullae may develop and rupture, occasionally with necrosis of the involved skin. Systemic manifestations (fever, chills, tachycardia, headache, hypotension, delirium) may precede the cutaneous findings by several hours, but many patients do not appear ill. Leukocytosis is common but not constant.

Diagnosis

The diagnosis usually depends on the clinical findings. Unless pus has formed or an open wound is present, the responsible organism often is difficult to isolate, even on aspiration or skin biopsy. Blood cultures are occasionally positive. Serologic tests, especially measurement of rising titers of anti-DNase B, confirm a streptococcal cause but are usually unnecessary.

Although cellulitis and deep vein thrombosis usually are easily differentiated clinically (see Table 112-1), many physicians confuse these entities when edema occurs in the lower extremities.

Course and Prognosis

Local abscesses form occasionally, requiring incision and drainage. Serious but rare complications include severe necrotizing subcutaneous infection (see below) and bacteremia with metastatic foci of infection. Even without antibiotics, most cases of superficial cellulitis resolve spontaneously; however, recurrences in the same area are common, sometimes causing serious damage to the lymphatics, chronic lymphatic obstruction, marked edema, and, rarely, elephantiasis. With antibiotics, such complications are uncommon. Symptoms and signs of superficial cellulitis usually resolve after a few days of antibiotic therapy.

Treatment

For streptococcal cellulitis, penicillin is the drug of choice: For mild outpatient cases, penicillin V 250 to 500 mg po qid or a single dose of benzathine penicillin 1.2 million U IM is adequate. For severe infections, which require hospitalization, aqueous penicillin G 400,000 U IV q 6 h is indicated. In penicillin-allergic patients, erythromycin 250 mg po qid is effective for mild infections, and parenteral clindamycin 150 to 300 mg IV q 6 h for severe infections. Although S. aureus rarely causes typical cellulitis, many clinicians prefer using antibiotics also active against this organism: dicloxacillin 250 mg po qid for mild infections, or oxacillin or nafcillin 1 g IV q 6 h for severe infections. For penicillin-allergic patients or those with suspected methicillin-resistant S. aureus infection, vancomycin 1 g IV q 12 h is the drug of choice. When pus or an open wound is present, results of a Gram stain should dictate antibiotic choice. Immobilization and elevation of the affected area help reduce edema, and cool, wet dressings relieve local discomfort.

Cellulitis in a neutropenic patient requires antibiotics effective against aerobic gram-negative bacilli (eg, tobramycin 1.5 mg/kg IV q 8 h and piperacillin 3 g IV q 4 h) until culture results are available. Penicillin is the drug of choice for P. multocida, an aminoglycoside (eg, gentamicin) is effective against A. hydrophila, and tetracycline is the preferred antibiotic for V. vulnificus.

Recurrent leg cellulitis is prevented by treating concomitant tinea pedis, which often eliminates the source of bacteria residing in the inflamed, macerated tissue. If such therapy is unsuccessful or not indicated, recurrent cellulitis sometimes can be prevented by benzathine penicillin 1.2 million U IM monthly, or penicillin V or erythromycin 250 mg po qid for 1 wk/mo
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Thursday September 09, 2004, 02:52:45 PM
I think I may have posted this allready, but it has been updated this August, so here it is again :

http://www.emedicine.com/derm/topic892.htm (http://www.emedicine.com/derm/topic892.htm)
Title: Re:Hidradenitis Suppurativa Articles
Post by: Celery Peach on Thursday September 09, 2004, 03:04:38 PM
J Am Acad Dermatol 1998 Dec;39(6):971-4 Abstract quote

BACKGROUND: Antibiotics are often used to treat hidradenitis, but only topical clindamycin has been shown to be effective in a randomized controlled trial. The paucity of these trials may be the result of difficulties in disease assessment.

OBJECTIVE: We compare topical clindamycin with systemic tetracycline in the treatment of hidradenitis suppurativa, and study clinical disease assessment.
 
METHODS: A total of 46 patients with stage 1 or 2 hidradenitis suppurativa were treated in a double-blind, double dummy controlled trial.

RESULTS: No significant difference was found between the two types of treatment. Patients' global assessment of disease was significantly worse than physician's assessment in 3 of 5 evaluations (P = .0096 to .015), but the correlation between patients' and physicians' assessments was satisfactory after only one visit (rs = .761 to .895). Soreness was the key factor in patients' overall assessment of the disease.

CONCLUSION: Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin. Subjective factors, particularly soreness, appear to be a key factor in patients' assessment of the disease and should, therefore, be included as an outcome variable in future therapy studies
Title: Re: Hidradenitis Suppurativa Articles
Post by: missmash on Wednesday September 22, 2004, 10:27:42 PM
updated emedicine article declaring HS to be very common in the USA..

http://www.emedicine.com/emerg/topic259.htm
Title: Re: Hidradenitis Suppurativa Articles
Post by: symsharon on Tuesday October 12, 2004, 11:44:24 PM
PLEASE HELP ,MY GRANDAUGHTHER HAS BEEN DIAGNOSED WITH THIS DISEASE ! IS IT CURABLE ??IS IT HEREDITARY ????I HAVE HAD BOILS ,CYSTS, LYMPH NODES REMOVED ,SKIN CANCER ,THYROID PROBLEMS ,ETC... FEEL GUILTY!!!!
Title: Re: Hidradenitis Suppurativa Articles
Post by: froggy on Wednesday December 01, 2004, 02:58:55 AM
Dear Ice Queen,
     This is so sad...what a great life we all have to look forward to.  I just met the man that accepts all this cr--. :-\
     Froggy
Title: Re: Hidradenitis Suppurativa Articles
Post by: timnray03 on Wednesday December 15, 2004, 05:02:22 PM
Hi, I have some info that I`d like to pass along. There is nothing published yet but HS suffers are about to get a new name for our medical condition or thats the rumors in PUBMED. With the new laser stuff, surgury type, they have found a host of new things about our condition many they did not know before. Myself, I`am not real happy with my HS being assocated with everything from a nose bleed to an in-grown toe nail, if you get my drift. Take care, timnray
Title: Re: Hidradenitis Suppurativa Articles
Post by: timnray03 on Thursday December 16, 2004, 10:06:05 PM
 ;D Hi Gales and Guys, Wanted to pass on what Tim & I use our our HS outbreaks. The product we is called Hydrogen Peroxide-3%. It has been very effective for us and its very easy an cheap to use. This is not snake oil nor am I a snake oil sale salemans! Tim had an outbreak a few months age and it was one of the bad ones. It healed completely in about 17 days to a smooth round scar about the size of a dime. My disclamer, It works for us. Take care, timnray
Title: Re: Hidradenitis Suppurativa Articles
Post by: timnray03 on Tuesday December 21, 2004, 09:02:22 PM
Hi Ice Woman ;), Thank you very much for all the info that you worked so hard on in this section.  You are a credit to the Forum and to all those that suffer from HS. Best Regards, Ray  -------- Merry Christmas and Merry New Year for you ;D
Title: Re: Hidradenitis Suppurativa Articles
Post by: timnray03 on Tuesday December 21, 2004, 09:04:47 PM
Hi, OPS, Ice Queen, sorry bout` that. Ray
Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Tuesday December 21, 2004, 10:27:22 PM
 :-* aww shucks Ray  :-[ thanks  ;D

Seasons greetings to you and yours !  ;D
Title: Re: Hidradenitis Suppurativa Articles
Post by: timnray03 on Tuesday December 21, 2004, 11:34:12 PM
Hi Ice Queen, No problem, right back at you on the X`mas stuff, Take care, Ray
Title: Re: Hidradenitis Suppurativa Articles
Post by: erol1234 on Wednesday February 02, 2005, 11:19:38 AM
hi guys i am 25 and i think i v been suffering this since i am 17 i am not sure about exact date because i didnt know this name untill i had a surgery in the army becasuse of this, i usually ha ve it under( or you can call it inner shoulder) my left shoulder , in first times i usually tried to fix it by myself ( such an idiot) then i had this small operation while i was in university and the bigger one in army ( in turkey every male spend arauond half a year in the army after you graduate from university so i am not a army member now) last time i had this in august this time it hurt really bad and now after 4 months time it striked again my doc advised me to make cold ice compress several times a day and use anti biotic stuff untill friday if it wnt get smaller he will have to cut me again :o what ever it takes i want to learn if we can stop tihs with changing our lifestyles like quit smoking drinking leaving fatty food or anything else and i am curious about sth else i am using methotrexate for my psoriasis and it fixes good but somehow my dermotologist told me that methotraxate slows down the imule system so maybe hydra... sup...  strikes back because of this usage of metho... ??? anyway dont feel depressed about it there are lots of worst disases araound this is only gives little pain and no danger of death  ;)
Title: Re: Hidradenitis Suppurativa Articles
Post by: peterb on Wednesday February 02, 2005, 03:27:13 PM
Hi erol1234

Welcome to the forum.
 
 
Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Wednesday March 30, 2005, 11:06:22 AM
 :) A great article here, found by our Rock

Hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a suppurative folliculitis of apocrine sweat gland-bearing skin of the perianal, periumbilical, axillary, and genital areas, producing abscesses, sinuses, or mucopurulent discharge. The condition occurs when apocrine gland follicular epithelium becomes blocked by perspiration and cannot drain normally because of incomplete gland development. Perspiration and bacteria extrude into surrounding tissue, causing subcutaneous comedo-like follicular occlusion, inflammation, and infection. Apocrine glands occlude with periodic acid Schiff-positive extracellular polysaccharide substance, which may originate from Staphylococcus epidermidis. Many bacteria have been associated with infected HS.

In the United States, the prevalence of HS appears to be 1% to 2% in the general population. HS does not present until apocrine glands are triggered by a surge in sex hormones at puberty. There is a familial HS with an autosomal dominant inheritance. There is an increased incidence in females, in African American patients, and individuals with HLA-A1 and HLA-B8. Hirsutism and obesity also predisposing factors. Flare-ups have been associated with menstruation, which may be explained by the effects of androgens and estrogen on apocrine sweat glands. A hot, humid environment creates a milieu favorable the development of HS. Hidradenitis may be observed in association with arthritis, Crohn's disease, Down syndrome, Graves' disease or Hashimoto's myroiditis, herpes simplex virus, irritable bowel syndrome, and Sjgren's syndrome. Arthropathy associated with HS may present with asymmetric pauciarticular arthritis to a symmetric polyarthritis or polyarthralgia syndrome.

Patients present with painful, firm, and nodular lesions in areas where apocrine glands are found. The nodules may drain spontaneously. Regional lymphadenopathy is characteristically absent. Nodules often heal within a month, but may recur several times a year. Perianal HS may be difficult to distinguish from cutaneous manifestations of Crohn's disease, which may coexist with perianal HS in 39% of patients. Anal fistula formation is common in perineal HS. In severe cases, the patient may have new lesions form as the older condition heals. Excessive heat, perspiration, and obesity seem to aggravate the condition. Remissions may last months or years [18].

First-line treatment consists of enhanced hygiene measures, instructions to wear loose-fitting clothes, and stop smoking, and lose weight for obese patients [19]. When infection occurs, drainage aids the resolution of the acute inflammation. The drainage incisions should parallel the skin folds. Injections of povidone- iodine into the draining fistula may enhance the recognition of the subcutaneous fibrotic tissue and its complete removal. Cellulitis, fever, or toxicity mandates short-course antibiotic use. Topical clindamycin and systemic tetracycline have been used with success [20]. Other adjunctive therapies to decrease inflammation in HS include the use of retinoids (acetretin) [21], intralesional injection of triamcinolone acetonide suspension [19], and antiandrogen cyproterone acetate combined with ethinyloestradiol [22\]. Patients should be warned of the potential existence of metachronous disease.

Operative excision, with wide margins and excision of the subcutaneous tissue down to the deep fascia is the preferred treatment for chronic or recurrent disease [18]. Coverage of the wound may be achieved by secondary intention, split thickness skin grafts, or by musculocutaneous flaps. The carbon dioxide (CO2) laser procedure has been described patients with severe perianal HS to ablate lesions in layers until all macroscopically abnormal tissue is removed. Musculocutaneous flaps are used for procedures to reconstruct areas of large resection. Skin grafting is not recommended for closure of inguinoperineal disease. There is a recurrence rate of 2.5% after wide surgical excision. Up to 90% of patients with HS may continue to have symptomatic disease years after initial presentation. There is a 3% prevalence of squamous cell carcinoma among patients with long-standing perianal HS [23].

http://66.102.9.104/search?q=cache:SXBzkNaLy2cJ:www.rednova.com/news/display/%3Fid%3D129840+acetretin+sex&hl=en
Title: Re: Hidradenitis Suppurativa Articles
Post by: Frances on Wednesday March 30, 2005, 09:07:25 PM
I am Frances, I am a female from the UK and I suffer from HS. I have had it for 23 years.
Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Thursday March 31, 2005, 09:25:33 AM
 :hi: Frances

Welcome to Skincell  :)
Title: Re: Hidradenitis Suppurativa Articles
Post by: electric_ian on Saturday April 09, 2005, 12:54:26 PM
Hi Frances welcome to skincell :)
Ian
Title: Re: Hidradenitis Suppurativa Articles
Post by: Gobe on Saturday April 09, 2005, 02:27:35 PM
 :hi:

Welcome to Skincell Frances!

 :)
Title: Re: Hidradenitis Suppurativa Articles
Post by: Frances on Saturday April 09, 2005, 09:03:44 PM
I find alcohol and chocolate (my two favourites) irritate my absesses and make them worse. It must be the sugar in them. Does anyone else find this.
Sometimes I get a flare up after a drinking binge..

Frances
Title: Re: Hidradenitis Suppurativa Articles
Post by: wickanwitchin on Thursday April 14, 2005, 12:22:35 AM
 ;D OMG somebody has the same thing as me...a flare up after a drinking binge??? Or chocolate??? Wow..Im happy now.Sorry if that sounds rude.You must know where Im comming from!  ::) Its just great to hear someone else has the same thing.I love having a drink and miss getting a bit  :slosh: sloshed..and I know I crave chocolate and its before a breakout. Im sorry you have this nasty thing too Frances...Welcome to the forum  :hi:
Title: Re: Hidradenitis Suppurativa Articles
Post by: Ellen ON VACATION on Friday May 13, 2005, 03:40:47 AM
You know what, a lot of people say that food doesn't cause flares but I really think that it does.

If I eat a lot of garbage food I can see it in my skin big time.

I'm right there with ya girls!
Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday September 26, 2005, 07:02:20 PM
Journal of Dermatological Treatment 
   Publisher:   Taylor & Francis 
   Issue:   Volume 16, Number 2 / April 2005 
   Pages:   75 - 78 
   URL:   Linking Options 
   DOI:   10.1080/09546630510031403 

Hidradenitis suppurativa treated with finasteride


M. A. Joseph , E. Jayaseelan , B. Ganapathi , John Stephen

A1 Department of Dermatology, St John's Medical College Hospital, Bangalore, India


Abstract:


Background: Hidradenitis suppurativa (HS) is a distressing condition for which no satisfactory treatment is available. Studies on hormonal mechanisms responsible for HS point towards altered end-organ sensitivity, probably related to the enzyme 5a reductase that converts testosterone to dihydrotestosterone. Finasteride, an inhibitor of type II 5a reductase, has been reported to be effective in recalcitrant HS. Aim: To study the effectiveness and tolerability of finasteride in patients with HS in a preliminary trial . Methods: Seven patients (five women and two men) with HS that was not responding well to antibiotics were treated with finasteride at a dose of 5 mg/day as monotherapy. Clinical response was assessed at regular intervals. Patients were followed up for periods varying from 8 months to 2 years. Results: Six patients improved significantly and three of them had complete healing of lesions. Two patients who were followed up for more than 1 year experienced remissions lasting 8“18 months. The drug was generally well tolerated; however, two women complained of breast enlargement. Conclusion: The results of this preliminary study suggest that finasteride is an effective therapeutic option in HS.

 

Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday September 26, 2005, 07:05:03 PM
More about Finasteride :


Women of childbearing potential should not use or handle crushed finasteride tablets. Finasteride can cause birth defects in male fetuses.
Finasteride (fin-AS-tur-ide) belongs to the group of medicines called enzyme inhibitors. It is used to treat urinary problems caused by enlargement of the prostate (benign prostatic hyperplasia or BPH). In men with very enlarged prostates and mild to moderate symptoms (difficulty urinating, decreased flow of urination, hesitation at the beginning of urination, getting up at night to urinate), finasteride may decrease the severity of symptoms. Finasteride may also reduce the chance that surgery on the prostate will be needed.

Finasteride blocks an enzyme called 5-alpha-reductase, which is necessary to change testosterone to another hormone that causes the prostate to grow. As a result, the size of the prostate is decreased. The effect of finasteride on the prostate lasts only as long as the medicine is taken. If it is stopped, the prostate begins to grow again.

Finasteride also is used by some balding men to stimulate hair growth. If hair growth is going to occur with the use of finasteride, it usually occurs after the medicine has been used for about 3 months and lasts only as long as the medicine continues to be used. The new hair will be lost within 1 year after finasteride treatment is stopped.

Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday September 26, 2005, 07:25:58 PM
interesting fly-on-the-wall kind of chat from derms about HS ?

http://dermatology.cdlib.org/rxderm-archives/hidradenitis
Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Monday October 03, 2005, 06:49:34 AM
Enbrel trials for HS - one to watch I reckon !

Purpose

This study is being done to test a drug called etanercept (Enbrel®). Etanercept has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of chronic moderate to severe plaque psoriasis (PsO), for use in reducing the signs and symptoms of moderately to severely active rheumatoid arthritis (RA) in adults and children, and psoriatic arthritis (PsA) and ankylosing spondylitis (AS) in adults. It is available by prescription for the treatment of PsO, RA, PsA, and AS. Etanercept is approved for injection under the skin at a dose of 50 mg per week in patients with psoriasis.

The purpose of this study is to determine whether etanercept is safe and effective for the treatment of hidradenitis. Another purpose of this study is to determine the impact of etanercept treatment of hidradenitis on skin related to quality of life.

The skin lesions typically associated with hidradenitis are thought to be partly due to a blockage that occurs in sweat glands, called apocrine ducts, which become inflamed and eventually destroyed. A protein found in the body called tumor necrosis factor alpha, or TNF- α, is a hormone that causes this inflammation or swelling. The study drug, etanercept, blocks the action of TNF- α. By blocking the action of TNF-α, etanercept may provide a reduction in the signs and symptoms of hidradenitis.

This study will take place at the University of Pennsylvania and will involve up to 21 participants ages 18 and up. Approximately 21 subjects will participate at the University of Pennsylvania.

Each patient will participate in this study for a maximum of 6 months. The study consists of a screening visit, baseline assessment visit (Day 1), a treatment period (Week 2 “ Week 14), and a one month follow-up visit (Week 18 visit). The total duration of the study will be approximately 2 years.

Condition  Intervention Phase
Hidradenitis Suppurativa
  Drug: etanercept
 Phase II
 

MedlinePlus related topics:  Bacterial Infections;   Skin Conditions


Study Type: Interventional
Study Design: Treatment, Non-Randomized, Open Label, Uncontrolled, Single Group Assignment, Safety/Efficacy Study

Official Title: A Phase II Open Label Clinical Trial of Etanercept for the Treatment of Hidradenitis Suppurativa

Further Study Details:
Primary Outcomes: The primary objective of this study is to determine the safety and estimate the efficacy of etanercept for the treatment of hidradenitis suppurativa
Secondary Outcomes: The secondary objective of this study is to determine the impact of etanercept treatment of hidradenitis suppurativa on skin related quality of life
Expected Total Enrollment:  21
Study start: April 2005;  Expected completion: April 2007
Last follow-up: August 2006;  Data entry closure: October 2006

Purpose: The primary objective of this study is to determine the safety and estimate the efficacy of etanercept for the treatment of hidradenitis suppurativa. The secondary objective of this study is to determine the impact of etanercept treatment of hidradenitis suppurativa on skin related quality of life.

Duration:

Each patient will participate in this study for a maximum of 6 months. The study consists of a screening visit, baseline assessment visit (Day 1), a treatment period (Week 2 “ Week 14), and a one month follow-up visit (Week 18 visit). The total duration of the study will be approximately 2 years.

Subject Recruitment and Selection:

It is planned that enrollment will be 12-21 patients.

Background:

Hidradenitis suppurativa is a physically, psychologically, and socially disabling disease characterized by inflammatory, cystic papules and nodules affecting the underarms, groin, perineum, and breasts. Lesions can become erosive and often develop deep abscesses and sinus tracts and drain foul smelling pus. Left untreated, hidradenitis can result in permanent scarring. In the most severe cases, characterized by chronic ulceration and granulation, there may be an increased risk of aggressive squamous cell carcinoma.

Current treatment of hidradenitis consists of intra-lesional injections of steroids, topical and/or systemic antibiotics, hormonal therapy, and isotretinoin. For many patients with severe hidradenitis (stage II and III), these therapies are often ineffective. Patients with stage II and III hidradenitis often require surgical excision of the affected area (a highly morbid procedure) to control the disease. Unfortunately, for most patients with hidradenitis, existing therapies are ineffective and there is an unmet medical need for therapies that control this disabling and destructive disease.

The pathophysiology of hidradenitis is unknown. The leading hypothesis is that occlusion of apocrine ducts leads to severe dilatation, apocrine gland inflammation, with ensuing bacterial growth and neutrophilic infiltration and destruction of the duct. The importance of the immune dysregulation in hidradenitis is further demonstrated by its association in many individuals with inflammatory bowel disease.

The pathologic immune reaction to follicular occlusion in hidradenitis suggests a strong rationale for the use of treatments that may neutralize this inflammatory reaction. In fact, the existing standard treatment of hidradenitis is intra-lesional injections of steroids, in the effort to minimize the destructive nature of the immune response. Medications that are broadly immuno-suppressive, such as cyclosporine, have also been used to successfully treat hidradenitis, but are limited by organ toxicity. This rationale is further supported by case reports of dramatic and rapid (e.g. within days) improvement in hidradenitis treated with infliximab, a monoclonal antibody that blocks TNF-alpha.

Etanercept is a TNF-alpha inhibitor currently FDA approved to treat various inflammatory disorders including rheumatoid arthritis, psoriatic arthritis and psoriasis. By inhibiting TNF-alpha, etanercept stops the inflammatory cascade by binding directly to circulating TNF-alpha and inhibiting its binding to cell surface receptors.

Etanercept has been used in over 200,000 patients world wide for more than 5 years and has a well established safety record. The most common adverse effect of etanercept is injection site reaction which is typically mild and self-limited. Currently, laboratory monitoring for patients being treated with etanercept is not recommended according to its label since the drug has not been associated with a significant incidence of laboratory abnormalities.

The well established safety profile of etanercept and its potent role in suppressing pathologic immune responses through TNF-inhibition make it a promising agent for the treatment of hidradenitis suppurativa. In this phase II clinical trial, we will determine preliminary evidence of safety and estimate the efficacy of etanercept in the treatment of hidradenitis. This study will provide critical preliminary data for planning larger pivotal trials.

Research Design:

This is a phase II, open label, two-stage clinical trial of etanercept for the treatment of hidradenitis. This design is a widely accepted method for early investigations of safety and efficacy of medications for new indications. Etanercept 50 mg will be administered subcutaneously once a week for 12 weeks in an open label manner. At week 12, the etanercept dose will be tapered to 25 mg subcutaneously once a week for 2 weeks.

This is an 18 week study. Subjects will be screened to determine eligibility. Day -95 to -3 will be a screening period which will allow washout of concurrent therapies if necessary.

Potential Risks:

Etanercept was generally well tolerated in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Adverse events that were reported in at least 3% of all patients with higher incidence in patients treated with etanercept than placebo are:

Injection site reaction;
Infection;
Headache;
Nausea;
Rhinitis;
Dizziness;
Pharyngitis;
Cough;
Asthenia;
Abdominal pain;
Rash;
Peripheral edema;
Respiratory disorder;
Dyspepsia;
Sinusitis;
Vomiting;
Mouth ulcer;
Alopecia
Potential Benefits:

No direct benefits from participation in the study can be guaranteed. The study medication will be provided by the Financial Sponsor at no charge.

 Eligibility

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both
Criteria
Inclusion Criteria:

Subjects must be able to give informed consent.
Severe hidradenitis suppurativa clinically confirmed by the investigator and defined as recurrent abscesses, with 4 or more lesions (e.g. nodules or abscesses) with sinus track and scar formation (e.g. Stage II or III disease) that has not responded to previous standard therapies such as topical or oral antibiotics, or intralesional injections of steroids.
Age 18 or older.
Willingness to use at least one form of effective contraception during the study period and for one month after discontinuation of etanercept if female and of child bearing capacity or if male. If the patient elects to use a hormonal form of contraception then the patient must be on the same form of hormonal contraception for 90 days prior to the start of Etanercept and must plan to continue using the same form of hormonal contraception for the duration of the study (e.g. until week 18).
Exclusion Criteria:

Use of oral or topical antibiotics, isotretinoin, or intralesional steroids within 30 days prior to day 0 or at any time during the study treatment period.
Use of systemic immunosuppressants within 90 days prior to day 0 of this study.
Use of an investigational medication 90 days prior to day 0 of this study.
Use of a live vaccine 90 days prior to day 0 of this study.
Any previous use of TNF- α inhibitors.
If using a hormonal form of contraception, the patient will be excluded if they have not used the same form of hormonal contraception for 90 days prior to the start of the etanercept (e.g. day 0) or are not willing to continue the use of the same form of hormonal contraception for the duration of the study.
Active infection within 30 days of day 0 of the study that is moderate (discomfort sufficient to reduce or affect normal daily activity) or severe (incapacitating with inability to work or perform normal daily activities) or requires treatment with antibiotics.
History of tuberculosis or other mycobacterial disease or positive screening visit PPD (≥ 5 mm).
Known history of an immuno-suppressing disease (e.g. HIV)
Clinically significant abnormality in liver function, renal function, chemistry panel or CBC (AST or ALT ≥ 2 times the laboratory's upper limit of normal, hemoglobin < 10.0 g/dL, platelet count <125,000/cm3, white blood count <3,500 cells/cm3 or > 15,000 cells/cm3, or serum creatinine ≥ 2.0 mg/dL) or severe co-morbidities defined as diabetes mellitus requiring insulin, congestive heart failure, history of myocardial infarction, unstable angina, uncontrolled hypertension (systolic blood pressure > 180 mmHg or diastolic blood pressure >110 mmHg), severe pulmonary disease (requiring oxygen therapy), history of cancer within 5 years (other than resected basal cell or squamous cell carcinoma and in situ cervical cancer), known history of active hepatitis B or C or HIV infection, history of demyelinating diseases or lupus.
Pregnancy or lactation
History of alcohol or drug abuse within 12 months of screening visit

Info from : http://www.clinicaltrials.gov/ct/gui/show/NCT00107991
Title: Re: Hidradenitis Suppurativa Articles
Post by: ATMOSPHERE on Monday October 03, 2005, 07:41:59 AM
Fingers crossed then  :cf: ! Very intresting article,if only gp's were so up on the knowladge about the research going on/or as not as the case  has been,i would have far more faith in the gp's and derms.Keep up the good work CP,getting information like this gives us some hope that somthing is being done.  :praise:
Title: Re: Hidradenitis Suppurativa Articles
Post by: spiky on Friday November 04, 2005, 07:52:12 PM
 :) Thanks for the Enbrel info. CP - it sounds really hopeful! :hugs:
Title: Re: Hidradenitis Suppurativa Articles
Post by: wildflower77 on Tuesday November 08, 2005, 06:56:02 AM
All this info is great...thanks a million babe :-*(Cel).....Your a Gem!!!
Im lovin hearing about these drugs..........brings hope...and a tiny little sparkle to me again!!!!
Title: Re: Hidradenitis Suppurativa Articles
Post by: alanr1 on Tuesday November 22, 2005, 09:18:14 PM
hello everyone,
Thanks for getting information regarding the infections .Antibiotics are playing very good role in this .But problem occurs when we have to choose some good medications for that.Like for blood infections (septicemia and blood poisoning) the Gentamicin injection link removed is very great working .There are lots of infections also with this .So just want to get more about these .
Title: Re: Hidradenitis Suppurativa Articles
Post by: wildflower77 on Tuesday November 22, 2005, 09:24:54 PM
Hey Alanr  :)
I have had the Gentamycin Injection for months..(by IV actually) and It is a good anti...but I dont know in regaurds to HS..I had a very serious infection...and the genta..still didnt help me as the infection had worked its way into my bone.They use Genta for MSRA strains of staph..and it :) usually has a very good outcome...I was just one unlucky egg  :-\
I know that it its not used here for HS..otherwise I'd be first in line!!
~Cheers~
WF ;)
Title: Re: Hidradenitis Suppurativa Articles
Post by: csharp on Wednesday February 01, 2006, 08:44:53 PM
I have suffered from HS FOR 20 YEARS ON AND OFF.
I COULD NOT GO A WEEK WITHOUT A NEW BUMP FORMING.
BUT IN NOVEMBER OF 2005 NOV1ST TO BE EXACT. MY DOCTOR
PESCRIBED A DRUG NOT AN ANTIBOTIC AND I HAVE HAD NO NEW ONES FORM.
WHAT A THRILL. I FEEL LIKE I GOT MY LIFE BACK. AND I HOPE IT KEEPS WORKING.
CSHARP
Title: Re: Hidradenitis Suppurativa Articles
Post by: Celery Peach on Friday February 03, 2006, 09:43:09 AM
 ??? I seem to keep losing this article, and its one of my favourites, I highly rate Dr Von der Werth :

http://www.hs-usa.org/pub/articles/2001_HS_VDW.pdf
Title: Re: Hidradenitis Suppurativa Articles
Post by: darrens_angel on Sunday April 16, 2006, 07:34:02 AM
MY DOCTOR PESCRIBED A DRUG NOT AN ANTIBOTIC AND I HAVE HAD NO NEW ONES FORM.
CSHARP

CSHARP,
You've probably answered this before, but I was wondering what drug you were referring to? ( By the way, congrats on the success!)

Thanks  :)


Title: Re: Hidradenitis Suppurativa Articles
Post by: Rusty on Monday June 12, 2006, 07:06:48 AM
Hi Celery Peach, it's Rusty!!    You helped me out a few years ago with all the info on HS that you sent me. I have continued trying different remedies, but have only had short term relief. At one point my condition got worse, leaving me with large scars on my neck, arms, and butt. As soon as one healed, another formed, old scars formed sinus tracts, and drained continuously. Tracts kept forming on existing areas and extended outward. I could never go outside during warm weather, except in long sleeve shirts. I also spent a fortune on bandages to soak up the fluid. I was embarressed to death. I never thought it would end. But over the past year I have found a new therapy. And it works for me! I now go out in short sleeve shirts and have not spent a dime on bandages. I came to the conclusion that skin disorders don't make enough money for doctors to research. If it did, there would be cures, and not opinions. Research seems very limited. Anyway, I felt compelled to contact you and let you know what has been working for me. This may sound crazy, but I now drink 4 beers every night. I never miss a night. And it works! The constant alcohol flow somehow suppresses the outbreaks. After 6 months of this I stopped for 2 weeks, I broke out immediately, as soon as I started the 4 beer rule, it stopped again. Please don't think I'm an old drunk, just a victim tired  of HS. I got this idea from reading about IV drips of pure grain alcohol that has cured many disorders. Althouth, this is not a cure, it does allow me to lead a normal life again. I did read about the others who have flare ups after a drinking binge, I did notice that also, but decided to do a constant flow rather than a sugar overload. I think allowing your system to adjust is the key, it will take a few weeks to notice improvement. Once again, thank you for leading the fight against HS. Celery you really are a peach.  Love Rusty
Title: Re: Hidradenitis Suppurativa Articles
Post by: cemeterybride666 on Friday October 20, 2006, 12:05:56 AM
4 beers a day ? As if living with hs wasn't enough of a reason already. I am 34 in stage 3 and ready to try anything...I do not drink but for relief...hope the liquor store is still open...I'll get back to you on any results.  :beer:
Title: Re: Hidradenitis Suppurativa Articles
Post by: ket on Sunday November 12, 2006, 12:46:37 PM
hi all

havent been on for a while, had some dark times just lately! :(
have just been told on wed 7 nov that i have to have anova operation in january so been down, they done listen and just nod when u tell them u want ur life back, hate that they dont understand wot we go thro

anyway got to keep smilin, hope everyone is doing ok! been thinking of u guys

xx
Title: Re: Hidradenitis Suppurativa Articles
Post by: cemeterybride666 on Tuesday November 14, 2006, 03:04:13 AM
hi ket
try to keep your chin up. think about nov. & dec. for now. jan. will be here too soon i know. i hope it goes well for you.
Title: Re: Hidradenitis Suppurativa Articles
Post by: MIGHTY on Wednesday November 15, 2006, 10:44:34 PM
I have suffered from HS FOR 20 YEARS ON AND OFF.
I COULD NOT GO A WEEK WITHOUT A NEW BUMP FORMING.
BUT IN NOVEMBER OF 2005 NOV1ST TO BE EXACT. MY DOCTOR
PESCRIBED A DRUG NOT AN ANTIBOTIC AND I HAVE HAD NO NEW ONES FORM.
WHAT A THRILL. I FEEL LIKE I GOT MY LIFE BACK. AND I HOPE IT KEEPS WORKING.
CSHARP

What drug is it?
Title: Re: Hidradenitis Suppurativa Articles
Post by: cemeterybride666 on Thursday November 16, 2006, 12:07:57 AM
we all want to know what csharp is taking but she isn't telling...? :-\
Title: Re: Hidradenitis Suppurativa Articles
Post by: 9055 on Thursday May 17, 2007, 02:21:10 AM
what is the drug please tell us  :'(
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Thursday July 31, 2008, 09:23:00 PM
Yes..Please DO tell us the name of the med.. ???

Also is there other more recent Hidradenitis Suppurativa articles/threads in here? I have HS and Crohn's disease.
Doctors seem very hesitant  to accept that may even be a correlation between the two. :-X :(
Title: Re: Hidradenitis Suppurativa Articles
Post by: janeybug63 on Friday August 01, 2008, 12:51:46 AM
I have been trying to find out what is wrong w/ me for 25 or so years Finally in 2006 I was diagnosed w/ HS
I just deal with the outbreaks when they occur.A surgeon years ago created a "hole" for this to drain when neccessary
and i think that actually helped keep it isolated to my underarm. I believe they are correct in that it can be inherited
becasue i believe my younger brother has it and he wont see a doctor about his condition.
I did not know this website existed until i finally decided to do some research. I have no home remadies, i just
drain it w/ a hot cloth and i use quartizone to help keep it "soft" I can't believe i am typing out all this stuff, it is such a
deep dark secret for me(except family and my husband) I have a new surgeon and she thinks i should get my underarm reconstructed
i am not ready for that yet.Has anybody been through surgery for this ? Thanks everybody for listening.
janeybug63  :-[
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Sunday August 03, 2008, 05:58:27 PM
Janie..hi there, just saw your post. I have had several lesions incised,
but never the surgery. I also found out about the same time you did
what this is..I am 60 years old..I HOPE that it does not get worse with
age. (the only reason I have handled it so well, is I have taken steps
to avoid the associated problems). I wonder if there is other post on
here regarding this problem, as the post are very outdated. I have
searched and have not found any.
Janie..I seem to do well with EXTREME cleanliness (just makes me feel
better) and I take antibiotics regularly. I am large but not huge in weight,
but I find when I gain too much weight, they are MUCH worse. I also find
that proper diet, activity, and exercise, as well as a positive attitude
seem to help me, a bit anyway.
I (like you) am very embarrassed about this disease. When I was diagnosed
with Crohn's disease (I believe the two to be related, as they relate to
flares in the IBD and the outbreaks of HS) anyway no one even talked
about Crohn's (IBD) then!
Just wanted to know, I am here from time to time if you want to talk and
you are in my prayers.
Blessings,
Lana

Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Sunday August 03, 2008, 07:35:24 PM
hi janie, nice to tk to you. Have had hs for over 20 years and have had over 20 surgeries. My hs affects my underarms, anal and groin areas. For years had incision and drainage surgeries and then 8 years ago i had major surgery on my right arm. Unfortunately after 3 months the hs returned but had the surgery repeated and have had no trouble since. It is quite drastic surgery with quite a long recovery but in my eyes well worth it. I've had similar surgerys in both my groins but unfortunately have had no success, my hs has progressed to stage 3 now but i will keep going until i can get my life back. Everyone has different experiences with surgery and i think it is an individual choice. I hope whatever decision you make is the right one for you and if you want to ask any questions or just chat i will be more than happy to. take care     annmarie
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Sunday August 03, 2008, 09:26:30 PM
Hi Anniemarie..I ALSO would be glad to have people to talk with about this
thanks.
Lana  ;)
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Sunday August 03, 2008, 10:04:13 PM
Hi Lana welcome! just to answer this lana...
Quote
Doctors seem very hesitant  to accept that may even be a correlation between the two
The correlation only applies to people who have crohns disease. Not everyone with HS or any other autoimmune disease has crohns. HS is an autoimmune disease. Crohns is also an autoimmune disease. People who carry the genetic predisposition to having an abnormal immune response targeting *self * tissues or organs , blood etc. can have more than one autoimmune condition (there are over 80 different conditions) manifesting at the same time but in a different way, as is evident in you.
This genetic predisposition may trigger an abnormal response in some people to the normal bacterium in the gut.The pathogenic result of which, is Crohns Disease
Quote
Currently, most investigators believe that some people with the disease develop it because of an abnormal immune response to bacteria that normally live in the intestine.
This abnormal response to the bacterium in the gut, could then trigger off other mutated genes you may have, resulting in another abnormal immune response , the pathogenic result of this abnormal immune response (autoimmune response ) in you being HS. Crohns is the pathogenic result of predisposing genes, triggering an abnormal immune response to the normal bacterium in the gut.
That in italics is the correlation and the way crohns is linked, but it doesn't apply to everyone with HS or any other autoimmune conditions. The abnormal immune response which occurs from having mutated genes carrying the predisposition, occurs to different factors in each individual, although the pathogenic result of their abnormal immune response may be also HS.
Some autoimmune conditions also carry a mutated hereditary gene predisposing to a specific disease itself, like psoriasis, diabetes, and Crohns.
Quote
Heredity. About 20 percent of people with Crohn's disease have a parent, sibling or child who also has the disease. Mutations in a gene called NOD2/CARD15 tend to occur frequently in people with Crohn's disease and seem to be associated with an early onset of symptoms as well as a high risk of relapse after surgery for the disease. Scientists continue to search for other genetic mutations that might play a role in Crohn's.

Very best wishes, and again a warm welcome. (I'm just a bit older than you Lana)
Bunnie
PS just to add some treatments...
For people with mild cases, a doctor injects corticosteroids into the area and prescribes antibiotics, such as tetracycline
or doxycycline...to be taken by mouth.
Some Trade Names
ACHROMYCIN V
TETRACYN
SUMYCIN
or erythromycin Some Trade Names
E-MYCIN
ERYTHROCIN
ILOSONE
 For severe cases, isotretinoin  Trade Name  ACCUTANE  an anti-inflammatory drug, may be given by mouth.
Clindamycin applied topically is also effective.
Trade Name CLEOCIN
In some cases, a doctor cuts open the abscesses to drain the pus.
Laser treatment has also been used. In severe cases, cutting out the involved area followed by skin grafting may be necessary.
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Sunday August 03, 2008, 11:29:20 PM
 :)Thank you so much for all the wonderful info..for many years..(like the Crohn's) I just
sorta KNEW I had something and did not really want to know. (isn't that stupid?)  ;D

We have many MANY auto immune type diseases (in our family)and I also have asthma and
who knows what all else. Many of the stories related to this disease are dreadful, and I at
times hate to even read about it. :P

Bunnie and everyone..one question if I may. I have a HUGE lesion in my groan at this time,
that started our like normal..itch, swell, pain, bleeding and you know. :-X.it seemed to 'explode'
and felt better..The location has a painless swelling now, that has turned almost rock hard.
I have not had one like this before. Does anyone have any info?

Many thanks to you all and blessings of health.

Lana

Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Monday August 04, 2008, 08:29:54 AM
Hi Lana, there are many types of cysts lana, but from what you have said you MAY have a sebaceous cyst or an Apocrine hidrocystoma I did a search for both sebaceous cysts and Apocrine hidrocystoma, and found these links.... and from them , I quote...
Quote
A sebaceous cyst is a closed sac found under the skin, usually on the trunk, neck, or face. It usually is a slow-growing lump that can move easily under the skin. Sebaceous cysts are filled with a oily or cheese-like matter and usually are painless. In some cases, however, cysts can get inflamed and become tender to the touch. Sebaceous cysts also are called epidermal cysts, keratin cysts, or epidermoid cysts
http://my.clevelandclinic.org/disorders/cysts/sebaceous_cysts.aspx
Apocrine hidrocystomas
Quote
are benign cystic proliferations of the apocrine secretory glands. (The target sites of HS )These cysts most commonly appear as solitary, soft, dome-shaped, translucent papules or nodules and most frequently are located on the eyelids, especially the inner canthus. Apocrine hidrocystomas grow slowly and usually persist indefinitely.
The exact stimulus for the development of an apocrine hidrocystoma is unknown. Plausible causes of the closely related eccrine hidrocystoma include occlusion or blockage of the sweat duct apparatus, which results in the retention of sweat and a dilated cystic structure.Tumors also have been reported to occur in the axillae, and in the anal region.
I understand too that one can have a dermatofibroma-stroma type cyst which can be found in apocrocine glands , which are more solid. I'm not sure, but I think these build up due do to scar tissue in that area. A dermatofibroma cyst is basically scar tissue and  stroma- like tissue is connective type tissue.

Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Monday August 04, 2008, 02:54:13 PM
hi lana, would be very happy to talk to you. Was reading what bunnie replied and would tend to agree. This "lump" does sound very much like scar tissue. I fully agree with you on the positive thinking. When i joined the forum (quite recently), i was feeling very down. I had recent major surgery in my left groin and had spent a month in hospital with infection. Unfortunately the surgery was unsuccessful and the hs is back with a vengence, but am trying to remain positive. Bunny, cazangel just to name a few are fantastic support to anyone joining the forum and take time to welcome everyone so i have to say i do feel much better. Everyone who suffers hs does so in different ways and have different things that work for them. I went to a friends party last night, first social outing in over a year and had such a good night. Obviously wasn't up for dancing but spent the night downing beer with my friends. Needless to say am paying for it today but it was worth it!! Take care lana and hope to chat soon x     annmarie
Title: Re: Hidradenitis Suppurativa Articles
Post by: CazAngel on Monday August 04, 2008, 04:14:55 PM
Hi, I just wanted to pop in and say I'm here if Lana or Annmarie or anyone wants to talk, I know HS can cause loneliness or feeling alone. I don't know that I have much to share with this thread.... I noticed when I stopped eating processed food and became a vegetarian, I didn't have has many or as bad flare ups, but I'm also losing weight, I am over weight. Take care all. :bighug:
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Monday August 04, 2008, 04:51:06 PM
Thanks caz, all support is very welcome. x annmarie
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Monday August 04, 2008, 05:42:56 PM
Hi girls have you met FD with HS here?
http://www.skincell.org/community/index.php/topic,23952.msg298684/topicseen.html#msg298684
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Monday August 04, 2008, 10:05:29 PM
Hi bunny, just left a post for fd there. You gave him some good advice. Wish i'd met someone like you 20 years ago! Take care x annmarie
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Monday August 04, 2008, 11:01:50 PM
Hi anniemary, my niece has  recently been diagnosed with this, and I feel for those of you who have it. I get dreadful 3rd degree burn like wounds in those delicate places too, the blisters burst and I have blisters on the dermis sometimes. It is SO painful! I'm most comfortable in a cotton nightie, especially in the warm weather we are having in the UK. The heat is miserable for me. It is so difficult for men though, unless they wear a kaftan! (and why not if one is just at home?) FD if you see this what do you wear to be comfortable?
Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Monday August 04, 2008, 11:13:19 PM
 :)Funny thing is I joined in here in 2005..and I have now found more threads..(on HS)
a big DOH Lana!!  :laugh:
I was in several HS groups other than skin cell and maybe it is me..one of them
depresses me to the point that I can hardly go there.
Have any of you ever been treated snooty in regard to this disease by a Doctor?
I have and also have been told that he/she did not even what to SEE it..see a
specialist..!
Thank you all for your help and Bunnie for all the research and info.

Just got in from work and working on supper.
Hope to talk more with you all.
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Tuesday August 05, 2008, 05:17:46 PM
Hi lana, wanted to answer your question regarding snooty doctors.  I was admitted to hospital about 10 years ago with a really nasty abcess(size of a melon) on my left inner thigh/groin. Was in agony. They took me to theatre for incision and drainage. Outside the theatre, they asked me would i mind waiting until they did a small procedure on another patient as mine was a "dirty job"! I was mortified! Unfortunately i was so embarrassed about my condition already that i agreed. I felt then that i was "dirty" and hated myself. Hindsight is a wonderful thing but i am so much stronger now and would never let anyone speak to me like that again. There is a horrible stigma attached to hs (maybe it comes from within) but we all know that our personel hygiene is probably better than most peoples. We have an illness that we can do nothing about and there are times when i feel insecure and embarrassed with it and i SHOULDN'T. (my husband goes mad when i say i am embarrassed.He says he loves ME,lumps and all,) :-* :-* bless him. I hope you have similar support.   Take care,   annmarie x

















Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Tuesday August 05, 2008, 07:14:39 PM
 :-*   God bless 'im..I have that kind of husband as well Anne Marie.
He is severely disabled (and retired late 60's now).
The last Dr. I went to went out of his way to allay my embarrassment
and hurt..(he touched my underarm area without gloves & he had JUST
Scrubbed his hands!)  :laugh:
But he also told me that I am scrubbing my skin too often and too hard!
LOL, I can't win!!  :laugh:
When I was very young, I guess late 20s (not even sure) I had 3 small
daughters and I used to think I had some sort of horrible STD, and I was
very faithfully married for quite a few years..(I knew I had done nothing to
have one). I guess this is one way that ignorance (mine) is NOT good and
could possibly be dangerous.
I am so thankful you all are here to talk to.

Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Tuesday August 05, 2008, 07:23:03 PM
 :)AnneM..I forgot to tell you also, that the last reg. specialist I
went to see was very pleasant and kind to me and assured me that
he sees the condition 'all the time', but his (assistant) kept giving
me the nastiest looks,,NO not paranoia..she really did..that made me
so sad.  ???
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Tuesday August 05, 2008, 08:03:50 PM
Hi lana, glad to hear your husband is supporting you but very sorry that he is disabled. Must be very difficult for you both.  I was diagnosed with hs in my teens and never knew anyone else with hs until i entered this forum. I live in a small town in n.ireland. I know what you mean when you said about the lack of information being dangerous. I have the disease very badly in the groin and very personal areas' When it first spread to these areas, i was convinced i had cancer of the vulva. I have had recent extensive surgeryand  have been assured it is the hs. I nearly had a breakdown at the time.   Reports would suggest that stress plays a contributing factor in the onset of hs. I had my first daughter very young. She had a very serious immune deficiency and tragically passed away when she was a year old. It was during this time that i had my first major flare, so maybe there is some truth in it, What do you think....  ANNMARIE xx
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Tuesday August 05, 2008, 08:19:28 PM
Hi ladies can I just draw attention to two or three things that you ladies have said, because it affects all people with skin conditions.
 
Quote
waiting until they did a small procedure on another patient as mine was a "dirty job"!
I would say many of us on here have had similiar things said to us or in front of us. There was a thread concerning just that some time ago on here, I wonder if I can find it?
A "specialist" once said to me in front of my husband , after returning from the examination room into his office, that I had scabies and I should "go home and consider as to with whom I had been sleeping with!" I just walked out, and then burst into tears! My husband never let it drop after that. I was livid! I wish now I had reported him, but you know what its like when you have something going on and nobody seems to know what it is? I was scared to do anything because I wasn't sure if I would get treatment. Needless to say I never went back to him.
Quote
but i am so much stronger now and would never let anyone speak to me like that
Absolutely! I am not rude , but choosing my words carefully, they are told in no uncertain terms and without any shadow of doubt, what I think. They are just people! nobody needs to be afraid of asking as many questions as they like, and to be sure of all that is said. Take a dictophone with you if necessary.
Quote
I guess this is one way that ignorance is NOT good and could possibly be dangerous.

No truer words were spoken! That is my main worry and why I try to explain things, because ignorance can kill you! believe me!
Quote
but his (assistant) kept giving me the nastiest looks,,NO not paranoia..she really did
I would politely ask directly to the person, "Is there something wrong? you are looking at me as if in disgust". I wouldn't be able to stop myself! The words would be out of my mouth before I could catch them! I HATE that! It goes against all good medical practice and principals, in either doctors or nurses, and I would definately draw attention to it there and then. Two hours later is too late!
Quote
but we all know that our personel hygiene is probably better than most peoples.
I have heard loads of derms say that, the reason being because they bathe more regulary for soothing comfort and ease alone!
Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Tuesday August 05, 2008, 08:24:59 PM
hi bunny. so sorry to hear about your niece. I have to admit that i have been a bit selfish of late and have only been thinking of myself. Today i read up on your illness bunny... oh  pet it is terrible. You are such a pillar of support to everyone and are always giving out great advice. from me to you :hug: :clap: take care annmarie xx
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Tuesday August 05, 2008, 08:30:37 PM
Oh Anniemary! how absolutely dreadful for you. :hug: I'm so very sorry.
Stress exascerbates an already manifesting condition; however in some cases severe stress can incite these genes due to the imbalance of stress hormones, but don't forget you must already have the genetic predisposition to start with. Only people who carry genes with a predisposition to having an abnormal immune response can ever actually have one, these conditions do not occur in people who do not have these faulty genes. Big hug for you.
Bunnie
(http://www.inspirationline.com/images/PB11a.jpg)
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Tuesday August 05, 2008, 08:35:16 PM
 :)  I thought it funny that my last GP told me to quit washing SO often
and SO hard!!  ;D
I mentioned to my hubby on the way home from that specialist office how
that PA kept looking at me unkindly and really rudely..he said "awww baby she
probably didn't mean to" Yeah right!!

Bunnie, I went and studied a bit on what you have..and I want you to know my
kindest thought and wishes of health are with you as well. Are all these things
related ? :o
Bunnie, If I may I need to send you a very short PM..it is just a site related
question. Is that OK?

I will be in and out this afternoon and evening and I just thank you all so very
much for your kindness and for being here. :-*

Bunny the Lords blessing and care to your sweet neice as well.

Anne Marie..I am so glad I 'met' you here! :)


Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Tuesday August 05, 2008, 08:41:14 PM
Anne Marie.. Backtrackin' on me self a bit here..LOL, I cannot understand
how ANYONE could use the word 'dirty' even within ear shoot of a patient.
I think I would have (wanted) to say..'well please don't bring any nasty in
here with me!!'  :'(
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Tuesday August 05, 2008, 08:48:43 PM
 :) Anne Marie..I think that definitely could have contributed to the
flare. I am so deeply sorry that occurred for you.
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Tuesday August 05, 2008, 09:06:05 PM
ah thanks you guys. I have 2 beautiful children now a boy and a girl.
 
lana with ref to "dirty". At the time i wanted to curl up and die. If it was now, i'd probably be arrested for what i would say :lol:
'm glad i met you too girl.... :hug:

Bunny thanks for the picture, soooo cute. you girls are way to clever for me. Had to get my son to show me where the capital letters button was!! lol
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Tuesday August 05, 2008, 09:22:29 PM
Oh hell! I just lost my post!
Are all these things related ? If you mean autoimmune diseases Lana, they are in the sense that the underlying cause is the same. Mutated genes predisposing you to ever having an autoimmune response.
Not everyone carrying the predisposition will have one, but they are more likely to. People who do not have these mutated genes cannot have these abnormal immune responses targeting "self antigens". I have done many posts on it, and it applies to all autoimmune diseases. If you click on my blog and scroll down to "Autoimmunity" its all there. Anything you don't understand I can explain.
Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Tuesday August 05, 2008, 10:19:15 PM
You both can prolly teach me a great deal..I think MOST
people do not understand these serious skin diseases. LOL,
I even studied some medicine,,NOW I really feel dumb..perhaps
it was that ole' avoidance thing in me again!!  ;D
Bunnie, did you get a PM from me? I sent it while ago.
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Wednesday August 06, 2008, 09:59:29 AM
Yes lana, I replied straightaway. Look in your inbox on the messages tab.
Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Wednesday August 06, 2008, 10:08:41 AM
Hi ladies,
Quote
Had to get my son to show me where the capital letters button was!! lol

Don't worry anniemary, the more you use the computer the more adept you will get at it. I knew NOTHING, about this game. I got my computer 2004 , the chap set it up for me from pcworld, and left me to it! I remember him being in bits, when just as he was leaving, I asked him to show me how to switch it on and off!
I must say too, that Nick and some of the guys on here are brilliant at explaining things. Take a look on the forum page at the Bits and Bytes thread.http://www.skincell.org/community/index.php/board,12.0.html
Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Friday August 08, 2008, 03:04:05 PM
Hi bunnie would like some advice if you can. Have been on augmenten for 5 days for a nasty abcess in a very personal area. They took swabs and the surgery rang me today to say the antibiotic i am on is not the right one. They have left me a script for penicillan and metrodonizole. The abcess has settled quite a bit and am a bit reluctant to take any more. Have had about 20 courses of antibiotics this year. Also a week in hospital on i.v for cellulitis. This could not be good for me. What do you think? thanks annmarie x
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Friday August 08, 2008, 03:33:51 PM
 :hugs: ANNIE, Hi again..
I know you wanted help from Bunnie..I just wanted to offer prayers
and sincere big  :hugs:
Lord's blessings,
Lana
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Friday August 08, 2008, 05:12:29 PM
Hi lana, how's things girl. Thanks pet, just having a bad day. annmarie x
Title: Re: Hidradenitis Suppurativa Articles
Post by: Lana-84 on Friday August 08, 2008, 07:02:18 PM
 :) Pretty good my friend..I had a slight embarrassing situation
with my Crohn's disease at work the other day.. :faint: but lol, I have
learned to handle it...somewhat.. :P
Keep your chin up my friend..I am sure sweet Bunny will be in
to help soon.
Blessings.
Lana  :peck:
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Friday August 08, 2008, 07:15:06 PM
Sometimes in an embarrassing situation laughing is the only way to handle it... good on you pet. Am grand lana, just one of them days when you get fed up and just wish things were different you know. But then you realise that your being selfish and there are so many people so much worse off. Will be fine again tomorrow. Hope all is well with you girl, thanks for being here to listen to me moan, i'm a big wuss today, i really appreciate it so much... annmarie xx
Title: Re: Hidradenitis Suppurativa Articles
Post by: bunnie on Friday August 08, 2008, 08:06:58 PM
Hi Anniemary, I think you must go back to the docs about the antibiotic, because if the one you were taking was not sensitive to the sample then it will only flare again. Pick up the script, but ask if they still want you to take it. I think they very well might to be honest. Don't worry about how many courses of AB's you have had, the important thing is you have had breaks inbetween. I was on AB'S every day for many many months as indeed a lot of people on here are are or have been too.
Bunnie
Title: Re: Hidradenitis Suppurativa Articles
Post by: anniemary40 on Friday August 08, 2008, 08:23:37 PM
Will do.   Thanks pet  annmarie xx
Title: Re: Hidradenitis Suppurativa Articles
Post by: CazAngel on Wednesday December 10, 2008, 11:17:16 AM
I noticed this bit of info, I noticed all of this info pages are slightly different. *sigh*

Will have to add a link, this goes very much over the max length.


http://emedicine.medscape.com/article/1073117-overview
Title: Re: Hidradenitis Suppurativa Articles
Post by: tonyswalkabout on Tuesday January 13, 2009, 04:01:56 PM
Bit slow in adding to the comment about snooty doctors. In my experience i've found that lot of the doc's i've seen have acted that way because they have no idea about the illness!!! When first diagnosed and having loads of ops i was told by incapacity review board that HS doesn't exist!! (i think we can all testify that it does!! :)). And the first doc i was under tred a drain which meant it tracked all the way down my arm, so i think he was funny with me cos he knew he'd made it worse cos he had no knowledge of HS either.
I've now had 12 excisions and skin grafts (and various x-y plasties etc) and the 2 plastic surgeons i've been under (Mr Cooper in Morriston, Swansea & Mr Daly in Nottingham City Hosp) have been really good.
At moment just finished 3 month course of 2 antibiotics which held it at bay but its starting to come back, problem i've got is i need op on torn cartiledge in my knee and that surgeon won't do it (or even put me on waiting list) wile i'm having any other treatment.
oh and on the clothing front, when my HS was at its worst (especially in genitoanal area)i just wanted to sit it a bath all day!!! :) Not really practical for day to day living.

Tony