Advances in surgical treatment of hidradenitis suppurative

Hidradenitis suppurative is a chronic, refractory and recurrent dermatological disease. The disease should be managed by targeted surgical intervention on the basis of medical treatment. Currently, the surgical treatment methods include local treatments like incision and drainage, unroofing, laser therapy, intense pulsed light therapy, photodynamic therapy, as well as complete lesion resection such as skin-tissue saving excision with electrosurgical peeling and extended excision. The clearance range, therapeutic effect, postoperative complications, and recurrence risk vary among the different treatment methods. Local treatments cause less damage, but have high recurrence rates, and are mainly for mild to moderate hidradenitis suppurative patients. Complete lesion resections have relatively low recurrence rates, but may bring more surgical injuries, and postoperative reconstructions are needed, which are mainly for moderate to severe hidradenitis suppurative patients. In this article, the surgical treatment principles and various surgical treatment methods of hidradenitis suppurative are reviewed, to provide a reference for the diagnosis and treatment of this disease in clinical practice.

Surgical management of acquired buried penis and scrotal lymphedema: A retrospective review

Acquired buried penis is a condition that can have detrimental physical and psychological consequences for patients. Factors such as elevated BMI, chronic scrotal lymphedema, hidradenitis suppurativa, and chronic inflammation can lead to the condition. Surgical intervention is the treatment of choice for advanced disease. Following IRB approval, a retrospective chart review was performed for patients with a diagnosis of acquired buried penis who required surgical intervention. Details of patient history, surgical management including intraoperative and post-operative photography, and complications were reviewed. Seven patient cases were reviewed. The average age at time of surgery was 44 with a mean weight of 344 pounds and an average BMI of 48. Severe scrotal lymphedema and hidradenitis were common concurrent comorbidities. Concurrent scrotoplasty and infraumbilical panniculectomy were standard parts of the operations. Native glans skin was salvageable in all but one case. Penile shaft skin was reconstructed with skin grafts or adjacent tissue transfer. 88% of the cases had some element of wound dehiscence post-operatively. Surgical management of an acquired buried penis can be challenging. The patient demographic with the disease is frequently complicated by morbid obesity, concurrent lymphedema, or hidradenitis. Post-operative complications are expected. The surgical techniques presented can aid in simplifying the management of this challenging surgical population.

Neutrophilic Eccrine Hidradenitis in an HIV-Infected Patient

A 35-year-old man presented with a 2-day history of a maculopapular pruritic eruption that had affected his general state of health and was accompanied by chills. The patient had been diagnosed with HIV in 2008, and was undergoing treatment with a combination of emcitrabine/tenofovir plus nevirapine. He had a current viral load of 1,558,160 copies/mL and a lymphocyte count CD4+ count of 230/mm3. Physical examination revealed an eruption involving the face, nape of the neck, chest, abdomen, extremities, palms, and soles. This was characterized by erythematous papules approximately 2 mm in diameter coalescing on the palms and soles, where they formed plaques (Figures 1 and 2).

Letter: Neutrophilic eccrine hidroadenitis with atypical findings

Neutrophilic eccrine hidradenitis (NEH) was originally described as a distinctive dermatosis occurring in patients undergoing chemotherapy, especially associated with the use of cytarabine in the treatment of acute myelogenous leukemia (AML). This disorder is characterized by a neutrophilic infiltrate around the eccrine glands and coils and is associated with necrosis. However, atypical findings in the histology have been reported. To the best of our knowledge, leukocytoclastic vasculitis has not been described in association with NEH. We hypothesize that a toxic effect of cytarabine may damage the vessel wall to some extent, causing a vasculitic phenomenon.

Neutrophilic eccrine hidradenitis in non-small cell lung cancer

A 75-year-old man was treated for non-small cell lung cancer (NSCLC) (stage IIIb) with three-cycle chemotherapy (cisplatin and paclitaxel) for 3 weeks. No skin lesions were observed during the first and second chemotherapy cycles. After the third chemotherapy cycle, he developed slightly pruritic skin eruptions on the anterior chest. He was treated for 1 month with topical steroid without improvement, and was referred to our dermatologic department. Skin examination revealed slightly elevated, dusky, erythematous, edematous patches on the anterior chest in a bilateral distribution (Fig. 1). Histologic examination of a biopsy specimen taken from the cutaneous lesions showed a neutrophilic infiltrate surrounding the secretory eccrine glands. The epithelial cells of the eccrine ducts and coils were not affected. There was a mild superficial perivascular infiltrate of mainly lymphocytes. These changes were consistent with a diagnosis of neutrophilic eccrine hidradenitis (Fig. 2). He was treated with dapsone, 50 mg/day, and methylprednisolone, 8 mg/day, for 2 weeks, and his skin lesions improved. Two months later the erythematous eruptions recurred on the chest, back, and extremities without the use of any chemotherapeutic agent, and were treated effectively with the same drugs.

Dégénérescence de maladie de Verneuil en carcinome épidermoïde : à propos de 2 cas et revue de la littérature

Verneuil's disease (hidradenitis suppurativa) is a chronic inflammatory, suppurating, fistulizing and scar-producing disease of apocrine gland-bearing skin. Its transformation into epidermoid carcimona has been reported 38 times in literature. We describe two new cases - two males aged 67 and 68-years-old. The first one is still alive with no recurrence after one year and the second patient died 2 months after surgery, showing generalised scattering. This rare complication is interesting for two reasons. It only concerns perianal location and it targets mainly men. Surgical treatment consists of wide excision. However, it is often too late. The outcomes are critical for it has been reported a 50% rate of deaths within 2 years after surgery. It is therefore imperative that both general practitioners and dermatologists follow patients with Verneuil's disease so that they can propose a preventive excision at the right time.

Neutrophilic eccrine hidradenitis heralding the onset of chronic myelogenous leukaemia

Neutrophilic eccrine hidradenitis was initially described in acute myelogenous leukaemic patients undergoing chemotherapy, suggesting a drug-induced mechanism. It has been reported in some with various neoplastic and non-neoplastic conditions as well as in healthy individuals. However, most the reported cases have been described in acute myelogenous leukaemic cases receiving chemotherapy. We describe a neutrophilic eccrine hidradenitis case unassociated with chemotherapy in a woman with chronic myelogenous leukaemia.

Neutrophilic eccrine hidradenitis in a patient with Behçet's disease

Patients with Behçet's disease may develop multiple mucocutaneous manifestations, several of which are mediated by neutrophils. These include aphthous ulcers, pseudofolliculitis, acneform lesions, and pathergy. We report another neutrophil-mediated disorder, neutrophilic eccrine hidradenitis (NEH), in a patient with Behçet's disease. NEH should be added to the list of mucocutaneous lesions that may be seen in patients with Behçet's disease.

Juvenile neutrophilic eccrine hidradenitis: a vasculitis-like plantar dermatosis

Neutrophilic eccrine hidradenitis is a variety of neutrophilic dermatosis described in patients with different neoplasms, most often leukaemia, and different chemotherapy regimens. It is characterised by neutrophilic infiltration of the eccrine coils of sweat glands. Recently it has been described in healthy juveniles, involving primarily the soles of the feet. We describe five new cases of juvenile neutrophilic eccrine hidradenitis all showing a good prognosis or a self-limiting course.

Neutrophilic eccrine hidradenitis in two neutropaenic patients

We describe two patients, who presented with erythematous facial plaques, in keeping with neutrophilic eccrine hidradenitis, during chemotherapy for acute myeloid leukaemia. Both patients were neutropaenic and febrile. Histology showed a dermal neutrophilic infiltrate around the eccrine glands with gland destruction. The importance of recognizing this disorder is to prevent the inappropriate use of antibiotics as it is self limiting.

[Eccrine neutrophilic hidradenitis: idiopathic plantar form in children]

In this study, two cases have been reported of idiopathic plantar hidradenitis, an uncommon dermatological pathology with a spontaneous favorable outcome.

OBSERVATIONS

Two children aged 12 and 14 years presented with a painful papulo-nodular plantar rash with major functional impairment. The diagnosis of idiopathic plantar hidradenitis was considered, and then confirmed in one case by plantar biopsy. Non-steroidal antiinflammatory drugs, associated with paracetamol in one case were administered. The symptoms disappeared spontaneously within a few days in both cases, without any recurrence.

CONCLUSION

A knowledge of the symptoms connected with plantar hidradenitis in the child allows a rapid diagnosis to be made without hospitalization or further medical examination. Analgesic treatment and rest seem to be the only useful approaches. Biopsy to investigate eccrine gland infiltration by neutrophils can only be proposed in the case of an abnormally prolonged duration or an atypical presentation of this pathology.

Recurrent neutrophilic eccrine hidradenitis in an HIV-1-infected patient

Most cases of neutrophilic eccrine hidradenitis (NEH) have been reported in patients receiving chemotherapy for acute myelogenous leukemia or other malignant diseases. We report the case of an HIV-1-infected patient who presented several and strikingly similar episodes of NEH without any medication as well as another one after the first course of chemotherapy for a B-cell non-Hodgkin's lymphoma. This case strengthens the hypothesis that NEH may occur in different situations, as reported for other neutrophilic dermatoses.

[Neutrophilic eccrine hidradenitis associated with relapse of acute myeloblastic leukemia]

BACKGROUND

Neutrophilic eccrine hidradentitis is a recently described clinical entity. Most reported cases have occurred in patients given chemotherapy for acute myelogenous leukemia, suggesting a drug induced mechanism. Some authors have considered however that neutrophilic eccrine hidradenitis belongs to the group of neutrophilic dermatoses.

CASE REPORT

We observed neutrophilic eccrine hidradentitis in a 48-year-old man which developed when he suffered a relapse of acute leukemia. He had not been given chemotherapy in the preceding months.

DISCUSSION

This case favors the hypothesis that neutrophilic eccrine hidradenitis is associated with myeloid hemotology disorders and not a complications secondary to treatment.

Neutrophilic dermatoses associated with myeloid malignancy

The neutrophilic dermatoses are significantly associated with myeloid malignancies. We now describe the clinical and histological features of 11 patients with these disorders, namely Sweet's syndrome in three cases, pyoderma gangrenosum in two, and neutrophilic eccrine hidradenitis in one; there were also five others which could not be categorised as recognised entities. Our observations, as well as those from a review of the literature, support the hypothesis that in the neutrophilic dermatoses associated with myeloid malignancy, a common mechanism may be involved.

Musculoskeletal features of acne, hidradenitis suppurativa, and dissecting cellulitis of the scalp

This article describes the various forms of acne and the clinical and radiographic features of the associated musculoskeletal manifestations. Occasionally, acne may occur together with hidradenitis suppurativa and dissecting cellulitis of the scalp, the so called "follicular occlusion triad." The current understanding of the etiology of these conditions and their treatment are also reviewed.

A case of pyoderma vegetans and the follicular occlusion triad

A case of pyoderma vegetans (PYV) and hidradenitis suppurativa (HS) is described. Our patient had a previous history of perifolliculitis capitis abscedens et suffodiens and acne conglobata. Direct immunofluorescence findings ruled out pemphigus vegetans and suggested a potential pathogenic mechanism.

Squamous cell carcinoma arising in hidradenitis suppurativa

The case reported concerns a 57-year-old man with a 35-year history of hidradenitis suppurativa lesions confined to his buttocks and recently complicated by a large, ulcerated, well-differentiated squamous cell carcinoma. Wide surgical excision and grafting, requiring temporary colostomy, were performed with no recurrence or metastasis during the following 12 months. The relevant literature is reviewed and discussed.

Perineal hidradenitis suppurativa: presentation of two unusual complications and a review

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.