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

Acne inversa of the scrotum and penis - aggressive urological treatment

Acne inversa is a rare chronic and debilitating inflammatory skin disease.

The authors report a case of a 45-year old male who presented with acne inversa in the inguinal, perineal, and scrotal areas. After unsatisfactory pharmacological treatment a wide surgical excision of the affected skin was performed in stages. On follow-up the patient presented with a very good cosmetic and functional result. A review of the most recent literature is also presented.

Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin and early and chronic hidradenitis suppurativa lesions

BACKGROUND

Current insight into the histopathological course of events during disease progression in hidradenitis suppurativa (HS) is fragmentary.

OBJECTIVES

To identify histological alterations and leucocyte subsets in normal-appearing perilesional skin, and early and chronic HS lesions.

METHODS

In this observational study we examined eight perilesional skin samples, and six early and 10 chronic prototypic HS lesions, as well as skin samples from four healthy donors using in situ immunostaining.

RESULTS

Perilesional skin showed mild psoriasiform hyperplasia and follicular plugging as well as a low-grade influx of tryptase-positive mast cells, CD3+ T cells, CD138+ plasma cells and factor XIIIa+ dendritic cells. In early HS lesions, neutrophilic abscess formation and influx of mainly macrophages, monocytes and dendritic cells predominated. In chronic disease, the infiltrate expanded with markedly increased frequencies of CD20+ and CD79a+ B cells and CD138+ plasma cells. As in early lesions, free keratin fibres were detected in the dermis and within giant cells. Single detached keratinocytes and strands of follicular epithelium were observed in the dermis, the latter frequently expressing Ki67, indicative of active proliferation.

CONCLUSIONS

Psoriasiform hyperplasia, follicular plugging and low-grade leucocytic infiltration are already present in normal-appearing perilesional skin. Keratin fibres in the dermis are associated with clinical disease. Early lesions are characterized by neutrophilic abscess formation and influx of mainly histiocytes, and chronic lesions mainly by expansion of B cells and plasma cells in 'pseudo' follicles. Proliferating strands of follicular epithelium may initiate fistula formation. Mast cells are increased in all stages of HS including perilesional skin.

Comorbidities of hidradenitis suppurativa (acne inversa)

Comorbidities of hidradenitis suppurativa (acne inversa) were reviewed by extracting original and review publications included in MEDLINE, EMBASE and COCHRANE libraries using the terms "hidradenitis," "Verneuil" and "acne inversa." Follicular occlusion disorders, inflammatory bowel diseases, especially Crohn disease, spondylarthropathy, other hyperergic diseases, genetic keratin disorders associated with follicular occlusion and squamous cell carcinoma were the most common hidradenitis suppurativa comorbid diseases. A first classification of these major comorbidities and their possible genetic background reveals a list of chromosome loci and genes, which could be hidradenitis suppurativa candidates. Most of these diseases belong to the group of autoinflammatory disorders, where th17 cell cytokines seem to play a central role.

A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed.

OBJECTIVES

To test the efficacy of adalimumab in HS.

METHODS

This was a prospective, randomized, double-blinded, placebo-controlled, two-centre clinical trial conducted in Denmark. Inclusion criteria were age above 18 years and a clinical diagnosis of moderate to severe HS defined as Hurley stage II or III for at least 6 months. The patients were randomized 1:2 (placebo/active). Actively treated patients received adalimumab 80 mg subcutaneously (s.c.) at baseline followed by 40 mg s.c. every other week for 12 weeks. Placebo-treated patients received identical-looking injections with no active ingredient. The medicine was dispensed in sequentially numbered computer-randomized containers. Participants, care givers and those assessing the outcomes were blinded to group assignment. The primary efficacy endpoints were changes in the HS scores (Sartorius and Hurley scoring systems). Secondary efficacy endpoints included changes in pain (visual analogue scale), days with lesions and Dermatology Life Quality Index, and evaluation of scarring. Recruitment was terminated early due to expiry date of trial medication.

RESULTS

Twenty-one patients were included, of whom 15 received adalimumab and six received placebo. All participants were analysed according to the intention to treat principle. A significant reduction was seen in Sartorius score after 6 weeks and an almost significant reduction was seen after 12 weeks of active treatment (-10·7 vs. 7·5, P = 0·024 and -11·3 vs. 5·8, P = 0·07) when compared with the placebo group.

CONCLUSIONS

A significant reduction in HS severity was gained after 6 weeks. No long-term curative effect was uniformly seen.

Hidradenitis suppurativa: a review of cause and treatment

PURPOSE OF REVIEW

Hidradenitis suppurativa is a chronic or relapsing inflammatory cutaneous disorder manifested by recurrent formation of abscesses, fistulating sinus and scarring in the apocrine-gland-bearing skin. This review discusses the different aetiological theories and management opportunities.

RECENT FINDINGS

Current understanding of the pathogenesis suggests that hyperkeratosis of the infundibulum, leading to follicular occlusion of the pilosebaceous unit plays a role. Bacterial infection with staphylococci, Escherichia coli and streptococcus is considered as a secondary event in the pathogenesis. Smoking and obesity are both known as risk factors and are associated with more severe disease course. Recently, more attention has been put into the understanding of the immunopathology of the skin and the results indicate that hidradenitis suppurativa may be considered as an inflammatory disease of unknown cause based on a defect in the hair follicle immunity. The treatments are most appropriately chosen on the basis of disease severity and the existence of any associated risk factors or comorbidities. There are three levels in the management of hidradenitis suppurativa: topical options, systemic options and surgical methods including laser therapy. At each level several treatment principles have shown themselves to be efficient, and may therefore be used either alone or in combination. Therapies are generally effective against microorganisms, inflammation or infundibular hyperkeratosis. Where an antimicrobial therapy is used, the drugs used often have significant additional immunomodulatory effects.

SUMMARY

The recent studies give us a better insight into the pathogenesis of hidradenitis suppurativa and should translate into improved therapies.

A prospective open-label clinical trial of adalimumab for the treatment of hidradenitis suppurativa

OBJECTIVE

To evaluate the safety and efficacy of adalimumab for the management of hidradenitis suppurativa (HS).

METHODS

In a prospective open-label phase II study, adalimumab was administered subcutaneously in a dose of 160 mg induction regimen at week 0, followed by 80 mg at week 1, and 40 mg at alternate weeks for 12 weeks in 10 patients. The patients were followed up to 13 weeks and their disease activity was assessed using the HS Severity Index (HSSI) as well as with the numbers of daily dressing changes, the Visual Analogue Scale (VAS), Dermatologic Life Quality Index (DLQI), and Physician's Global Assessment of disease severity (PGA).

RESULTS

Ten patients were enrolled in this study. Of these, six patients completed the 12-week treatment period. A ≥ 50% decrease of HSSI score was not found in any of the patients at week 2, 4, 8, and 12. None of the 10 patients was classified as a responder at week 12 compared with baseline. Statistically significant difference in HSSI score was found between baseline and week 8 (P < 0.05) only but no significant differences were found between baseline and week 2, 4, and 12. Comparison of baseline with week 12 VAS and DLQI scores failed to show statistically significant improvement. Adalimumab was well tolerated and there were no serious adverse events reported.

CONCLUSIONS

Our study demonstrated statistically clinical improvement is not observed in the treatment of HS with adalimumab. Future studies using higher doses of adalimumab are warranted.

Hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory, scarring condition involving the intertriginous skin of the axillary, inguinal, inframammary, genital, and perineal areas of the body. It is also referred to as acne inversa and Verneuil disease. Follicular occlusion is the primary event in HS. It is now accepted that the first pathogenetic change is in the pilosebaceous follicular ducts, like acne, and so there has been a move to rename this disorder acne inversa. Despite the legitimate argument that hidradenitis suppurativa is a misnomer, the term has become generally accepted.

Hidradenitis suppurativa/acne inversa: bilocated epithelial hyperplasia with very different sequelae

BACKGROUND

Hidradenitis suppurativa/acne inversa is a chronic, inflammatory, scarring disease in the terminal hair follicle and apocrine gland-bearing areas (skin folds). There is considerable histological evidence that perifolliculitis and follicular hyperkeratosis precede the rupture of the follicle. The timing of the epithelial hyperplasia at the infundibula of inflamed terminal follicles has not yet been clarified.

OBJECTIVES

To clarify the early histopathological life of lesions ('chronology') in hidradenitis suppurativa/acne inversa, focusing on the terminal follicle structure and its surrounding tissue (hyperkeratosis, hyperplasia of follicular epithelium, perifolliculitis and rupture).

METHODS

In total, 485 operative specimens obtained from 128 patients with diagnosed hidradenitis suppurativa/acne inversa (all surgically treated by wide excision) were examined histologically. Two to five histological preparations (total 485) per operation area (total 196) were prepared by multiple slicing.

RESULTS

Hidradenitis suppurativa/acne inversa showed a heterogeneous histological pattern: hyperkeratosis of the terminal follicles (89%), hyperplasia of follicular epithelium (80%), pronounced perifolliculitis (68%) and follicle rupture (24%). Perifolliculitis, follicular hyperkeratosis and hyperplasia occurred prior to the rupture of the follicle. Other histological criteria were: subepidermal cellular inflammatory infiltrate (82%), epidermal psoriasiform hyperplasia (56%), pronounced acute dermal inflammation (28%), pronounced chronic dermal inflammation (49%), and involvement of apocrine glands (52%) and subcutis (31%).

CONCLUSIONS

Infundibular hyperkeratosis, hyperplasia of the follicular epithelium and perifolliculitis are major histopathological characteristics of hidradenitis suppurativa/acne inversa. These apparently precede rupture of the follicle. In particular, hyperplasia of the follicular epithelium probably marks the beginning of sinus formation, which usually spreads horizontally. Psoriasiform hyperplasia of the interfollicular epidermis with subepidermal inflammatory infiltrate might be interpreted as an inflammation-driven process basically identical to that which is evident at the terminal follicle. However, it does not lead to harmful and progressive sequelae like those (rupture, sinus tracts) seen at the terminal follicles.

[Acne inversa]

Acne inversa is a chronic inflammatory disease of the hair follicles. It can lead to severe functional and psychological impairment. It is characterized by inflamed painful nodules, abscesses, fistulas and scarring in late stages of the disease. The causes of acne inversa are still not fully understood. Conservative treatment options such as antibiotics may lead to clinical improvement; however they do not produce healing. Therapy of choice, especially in severe forms, is radical wide excision of all affected areas. Despite a variety of treatment options, acne inversa is still a therapeutic challenge.

Effects of ablative 10,600-nm carbon dioxide fractional laser therapy on suppurative diseases of the skin: a case series of 12 patients

BACKGROUND AND OBJECTIVES

We have used an ablative 10,600-nm carbon dioxide fractional laser system (CO(2) FS) for suppurative diseases in order to attempt improvement. The purpose of our study was to demonstrate the effect of CO(2) FS on the course of inflammatory reactions in suppurative diseases.

MATERIALS AND METHODS

We reviewed a total of 12 Korean patients with suppurative diseases of the skin who had a history of treatment failure with several therapeutic modalities as well as active and multiple inflammatory lesions at the time of CO(2) FS treatment.

RESULTS

Improvement scores considering the number of suppurative lesions revealed that 3 of the 12 patients demonstrated clinical improvement of grade 4. Seven had clinical improvement of grade 3 and two showed improvement of grade 2. Improvement scores in severity were also evaluated; 2 of the 12 patients showed clinical improvement of grade 4. Six demonstrated clinical improvement of grade 3 and four had clinical improvement of grade 2. No patient showed a worsening of suppurative lesions.

CONCLUSION

Our observations demonstrated that the use of CO(2) FS did not make active suppurative lesions worse, and might have a therapeutic effect on suppurative diseases and their related scars. Lasers Surg. Med. 41:550-554, 2009. (c) 2009 Wiley-Liss, Inc.

Hidradenitis suppurativa

Hidradenitis suppurativa is a chronic disease characterized by recurrent, painful, deep-seated, rounded nodules and abscesses of apocrine gland-bearing skin. Subsequent suppuration, sinus tracts and hypertrophic scarring are its main features. Onset is usually after puberty, although it is most common during the third decade and may persist in old age. The disease tends to be chronic and may develop to subcutaneous extension leading to indurations, sinus, and fistula having a profound impact on the quality of life. The prevalence is 1% in several studies. Axillary and inguinal involvement is more common in females; peri-anal and buttocks localizations are prevalent in males. The exact aetiology remains unknown. The primary event is a follicular occlusion with secondary inflammation, infection and destruction of the pilo-sebaceo-apocrine apparatus and extension to the adjacent sub-cutaneous tissue. Infection is common. Smoking may be a triggering factor. Obesity aggravates the discomfort. Differential diagnostic includes Crohn's disease, nodular acne and furonculosis. The main complications are arthropathy, carcinoma. Treatment depends upon the stage of the disease. Early nodular lesions may be treated by antibiotics for acute stage; long-term antibiotics, zinc salts may be useful as maintenance treatment; anti-TNF drugs have been used in severe cases; systemic steroids, estrogens, anti-androgens, retinoids have been used as options with limited success. Surgical treatment includes incision with or without drainage for limited abscesses; limited excisions are used for locally recurring draining sinuses. Total wide excision and healing with secondary intention or flaps and grafts is the only curative procedure in case of advanced disease.

Successful Treatment of Recalcitrant Hidradenitis Suppurativa with Adalimumab

Hidradenitis suppurativa is a chronic disease that affects the apocrine gland-bearing regions of the body. The etiology of this disorder is poorly understood, but most likely is a complex process involving follicular apocrine occlusion with subsequent perifolliculitis. Many treatment options have been reported with varying degrees of success, including topical and oral therapy and surgical procedures. Recently, TNF-alpha antagonists have been reported as effective therapy in a few patients. We report here a patient who initially responded to infliximab but developed an infusion reaction to this medication. After subsequent treatment with adalimumab, the patient's disease improved dramatically and has been maintained under excellent control for over 15 months. We propose that TNF-alpha inhibitors, particularly monoclonal antibody based agents, are a viable treatment option in patients with severe, recalcitrant HS and that a patient may be safely and successfully treated with the fully human monoclonal antibody adalimumab in cases in which the chimeric monoclonal antibody infliximab therapy is not tolerated.

Hidradenitis suppurativa treated with finasteride

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.

Hidradenitis suppurativa: a comprehensive review

Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor-alfa inhibitors have given clinicians more options against this difficult disease.

Hidradenitis suppurativa

Background

Hidradenitis suppurativa is a chronic, recurrent, suppurative cutaneous disease. Despite its incidence, optimal medical or surgical treatment remains unclear. This review describes the disease, ranging from pathogenesis to treatment and prognosis.

Methods

Articles were sourced from PubMed and Medline, using the MeSH terms ‘hidradenitis suppurativa’ and ‘acne inversa’. Selection of articles was based on peer review, journal, relevance and English language.

Results and conclusion

On the basis of histological findings, the disease is now considered inflammatory and originating from the hair follicle; therefore, the term ‘acne inversa’ is favoured by some experts. The exact aetiology remains obscure but smoking seems to be a major triggering factor. Treatment should be individualized according to the site and extent of the disease. Absolute cessation of smoking is essential in the treatment of hidradenitis. Management with antibiotics or other medications may relieve early symptoms, but radical surgery may be necessary for control and to prevent recurrence.

Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition.

OBJECTIVES

To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments.

METHODS

HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire.

RESULTS

Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement.

CONCLUSIONS

CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.

Acne inversa complicated by squamous cell carcinoma in association with diffuse malignant peritoneal mesothelioma arising in the absence of predisposing factors: a case report

Diffuse malignant peritoneal mesothelioma (DMPM) is a relatively rare neoplasm. Risk factors associated with its development include asbestos exposure, chronic irritation or inflammation of the peritoneum, abdominal radiotherapy, familial Mediterranean fever and simian virus 40. A familial segregation of this neoplasia has been reported in small villages of the Cappadocian region of Turkey, and it has been postulated that hereditary factors may predispose to mesothelioma, even with exposure to small amounts of asbestos. We report a case of DMPM, which apparently occurred in the absence of predisposing factors in a patient with a clinical history characterized by recurrent pre-sacral acne inversa of long duration. The association of this chronic inflammatory disease with DMPM has never been reported. The genetic locus for acne inversa has recently been identified within the 1p21.1-1q25.3 chromosomal region. Interestingly, frequent losses in chromosomal region 1p.21-22 have been found in mesothelioma as well. It is thus tempting to speculate that genetic mutations involving chromosome 1p.21-22 may account for the development of both diseases.

Hidradenitis suppurativa (acne inversa): management of a recalcitrant disease

Hidradenitis suppurativa is a chronic relapsing disorder of follicular occlusion that is often recalcitrant to therapy. Topical and systemic antibiotics, hormonal therapies, oral retinoids, immunosuppressant agents, and surgical treatment are some of the therapeutic alternatives used for this often recalcitrant and frequently troublesome disorder. This article reviews the pathophysiology of hidradenitis suppurativa, an evidence-based analysis of standard treatments, and recent advances in the therapy of this disorder.

Hidradenitis Suppurativa and Zinc: A New Therapeutic Approach

BACKGROUND

Hidradenitis suppurativa (Verneuil's disease) is a chronic suppurative dermatosis involving apocrine glands with a severe impact on the quality of life, which is enhanced by the fact that the drugs usually prescribed are poorly effective.

OBJECTIVE

We discuss a new therapeutic approach based on zinc salts.

METHODS

We performed a pilot study on 22 patients, mainly from grade I or II in Hurley's classification. All included patients had previously been prescribed a treatment (antibiotic, isotretinoin, surgery or anti-androgens), which was inefficient. They were then treated with 90 mg of zinc gluconate per day (15 mg zinc per Rubozinc capsule).

RESULTS

We observed a clinical response in all patients, with 8 complete remissions (CR) and 14 partial remissions (PR). When CR was obtained, the treatment was progressively decreased (average of 3.5 capsules/day); 4/22 patients experienced side-effects, mainly gastro-intestinal.

CONCLUSION

Zinc salts could provide a new therapeutic alternative for the treatment of hidradenitis suppurativa.

[Radical vulvectomy to treat severe vulvar acne inversa]

A rare case, when radical vulvectomy had to be done to treat a benign skin disorder is presented.

PATIENT AND METHOD

A 56-year-old white woman suffered from severe vulvar acne inversa. The systemic treatments, the incisions and drainages were not successful. The only solution was the radical excision of the seriously damaged vulva, with a satisfactory cosmetic and functional result. The pathology, the diagnosis and the treatment of the disease are also discussed.

CONCLUSION

The authors put emphasis on the importance of the interdisciplinary collaboration.

Infliximab for severe hidradenitis suppurativa: Transient clinical efficacy in 7 consecutive patients

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic and debilitating disorder. Despite its significant prevalence, few reports of therapeutic studies are available. Recent case studies have reported the efficacy of antitumor necrosis factor monoclonal antibodies in treating the condition. In the study presented here, we assessed the safety and efficacy of infliximab in a series of patients with severe HS.

METHODS

We reviewed all consecutive patients with severe HS and treated with infliximab between October 2004 and December 2005. They were evaluated using the Sartorius severity score, a physician and patient overall assessment, and the Skindex-29 quality-of-life index. A substantive response was defined as marked or moderate overall improvement assessed by both physician and patient.

RESULTS

Seven patients were reviewed. All received at least 3 infusions of infliximab (5 mg/kg) in weeks 0, 2, and 6, and 5 patients received a fourth infusion at week 10. At week 6, a substantive improvement was seen in 5 patients. With the other 2 patients, any improvement was minimal or nonexistent. At week 10, there was a substantive response in 2 of the 5 patients. Adverse events occurred in 3 patients: abdominal pain caused by colon cancer, a multifocal motor neuropathy with conduction block, and a severe allergic reaction.

LIMITATIONS

We have reported on only 7 patients. All had severe and chronic disease.

CONCLUSION

The efficacy of infliximab in patients with severe HS seems transient and is associated with significant toxicity. Prospective randomized studies are required to better assess the benefit-risk ratio of antitumor necrosis factor agents for this indication.

[Ten cases of Verneuil's disease]

INTRODUCTION

Verneuil's disease is a chronic inflammatory, suppurating and fistulizing disease. It is often misdiagnosed and taken for another pathology. The aim of this study was to describe the epidemiological, clinical, and therapeutic features of 10 patients presenting with this disease, in our dermatology unit.

PATIENTS AND METHODS

We retrospectively analyzed 10 observations of Verneuil's disease from 1994 to 2005. We studied the clinical, epidemiological, and therapeutic characteristics.

RESULTS

Nine male and one female patients were included. The mean age was 35 years. The mean delay between onset of symptoms and diagnosis was 6 years. All patients presented with a severe form of the disease. The localizations were the buttocks in 4 cases, the pubis in one case, and the axilla in another case. Four patients also presented with buttock and anoperineal lesions. The medical treatment was antiseptics, antibiotic therapy, or isotretinoin. All patients were treated surgically.

CONCLUSION

A suppurated and fistulized nodule on an anoperineal or axillary location must suggest this disease. Our series is characterized by the prevalence of men and the frequency of severe forms.

Aminolevulinic Acid Photodynamic Therapy for Hidradenitis Suppurativa

Hidradenitis suppurative (HS) is a chronic, often suppurative chronic dermatologic disorder that is often misdiagnosed. It has presented therapeutic challenges for decades since its first descriptions in the medical literature in 1854. HS is an apocrine disorder with high prevalence, which has a genetic predisposition. Numerous treatment options have been described, some to control the acute disease process and others to control its long-term consequences. The use of photodynamic therapy (PDT) recently has been described as a treatment option for intractable HS. The clinical trials that are associated with PDT and HS are reviewed, and thoughts about the probably mechanisms of actions of this therapy are given. PDT should be considered in patients who have severe HS.

Surgical treatment of hidradenitis suppurativa: case series and review of the literature

The chronic and relapsing nature of hidradenitis suppurativa leads to physical and psychological damage. The absence of a proven cure further worsens the scenario. Patient 1 was a 28-year-old woman with a 10-year history of abscesses and non healing sinuses with foul-smelling discharge from her axilla, submammary and groin areas. This led to an episode of self-harm due to severe depression. After failed medical therapy, she was referred for surgery with wide excision of the skin and healing by secondary intention. Her wounds were managed by our specialist wound clinic with the use of topical and systemic antibiotics and thus remained free from symptoms. Patient 2 was a 32-year-old woman with a similar history for 15 years. Patient 3 was a 41-year-old man with a 20-year history of discharging sinuses and abscesses. All the patients had endured a long period of medical treatment and subsequently required surgery for a long-term relief of symptoms. This has undoubtedly led to psychological symptoms and a decrease in quality of life.

Inversa acne (hidradenitis suppurativa): a case report and identification of the locus at chromosome 1p21.1-1q25.3

Acne inversa (hidradenitis suppurativa) is a chronic relapsing inflammatory skin disease characterized by recurrent draining sinuses and abscesses, predominantly in skin folds that carry terminal hairs and apocrine glands. The genetic basis for this disease is unknown. In this study, we performed a genome-wide scan in a four-generation Chinese family to map the chromosome location of the responsible gene. We first identified a locus at chromosome 1p21.1-1q25.3 with the maximum logarithm of odds (LOD) score of 3.26 at the marker D1S2624 (at recombination fraction=0.00). The other two-point LOD scores >/=3 were observed at markers D1S2695, D1S2726, D1S252, and D1S2777. Haplotype analysis localized this locus to a 76 Mb region flanked by D1S248 and D1S2711. This is the first locus for the inversa acne and will be a starting point towards understanding the molecular mechanisms of this disease.

"Hidradenitis suppurativa" is acne inversa! An appeal to (finally) abandon a misnomer

The term "hidradenitis suppurativa" is firmly entrenched in the dermatological literature although it refers to a false pathogenetic concept. The term was historically coined based merely on the characteristic distribution of the apocrine glands and the anatomical coincidence with the disease process. At center stage is not a suppurative inflammation of the apocrine sweat glands but an occlusion of the hair follicles, comparable to acne vulgaris. Reviewing the literature on this subject, we were astonished to find that even articles that concluded that the entity represents a form of follicular occlusion still referred to it as hidradenitis suppurativa. The disorder shares histopathological and clinical aspects with acne vulgaris modified under the special circumstances of anatomical regions rich in apocrine glands. It is acne inversa because, in contrast to acne vulgaris, the disease involves intertriginous localizations and not the regions classically affected by acne. We suggest that the term "hidradenitis suppurativa" for this disease should (finally) be abandoned in favour of "acne inversa".

Surgical Management of Hidradenitis Suppurativa of the Nipple–Areolar Complex

Involvement of the nipple-areolar complex is an infrequent area of distribution of hidradenitis suppurativa. The difficulty of this particular distribution has been encountered in the past and resulted in bilateral mastectomies. The authors describe successful treatment of a patient with hidradenitis suppurativa of the breasts and nipple-areolar complexes using breast-conserving measures. Normal breast contour was preserved and overall cosmetic result was good.

Hidradenitis suppurativa: a review

Hidradenitis suppurativa is a recurrent disease involving apocrine-bearing skin with a predilection for intertriginous areas, including genital skin. It has a highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to scarring, functional impairment, and rarely, squamous cell carcinoma. While genetic factors, patient characteristics, hormones and infection play a role in disease expression, a comprehensive understanding of the pathogenesis remains to be elicited. Additionally, effective treatment is largely unknown. While the mainstay of therapy had been surgery, and topical or systemic antimicrobial agents, other therapeutic modalities such as retinoids, hormonal therapy and immunosuppresive medications may also hold some promise.