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Hidradenitis Suppurativa Articles

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Celery Peach:
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.

Celery Peach:
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.

Celery Peach:
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.

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.

Celery Peach:
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.

Celery Peach:
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.


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