Measure of Quality of Life Quantitative Approach

A quantitative approach for measuring QoL in HS was performed 2 . Questionnaires widely used in other skin diseases such as the Dermatology Life Quality Index (DLQI) questionnaire, Skindex and VQ-Dermato 1, 4, 5 were chosen. This approach allows a direct comparison of the results with those from previous studies on other skin diseases. We will discuss two studies, one already published and our unpublished data 2 . In both studies, in addition to this questionnaire, basic demographic data and...

Clinical Experience

With this more modern-view pathophysiology, it may seem rational to view antibiotic therapy as useful when pathogens are recovered from furunculoid lesions or draining purulent material, provided that the sampling and bacteriological methods allow the recovery of significant, i.e., deep-seated, material and the growth of relevant species, i.e., aerobic and anaerobic bacteria. Distinguishing between a non-infected, highly inflammatory process associated with nodular abscess-type lesions and a...

Bacteria Found in HS Lesions

Although the HS etiology is unknown, a large variety of microorganisms can be isolated from the lesions. The clinical picture of the disease resembles an infectious process and various Table 11.2. Studies describing the diversity of bacteria found in various HS lesions Table 11.2. Studies describing the diversity of bacteria found in various HS lesions Staphylococcus aureus, anaerobic bacteria Staphylococcus aureus, Staphylococcus epidermidis Bacteroides fragilis, Bacteroides melaninogenicus...

Children and Adolescents

What should I tell my child's teachers Your child may have trouble remaining seated for long periods, may need physical attention, and may be absent from school. This is a delicate problem, as it may be unacceptable to the child, especially if an adolescent, if all the teachers are aware of the health problem. The best solution may be to ask for a meeting with the school doctor or nurse. They can be informed in confidence about the problem, and they can provide teachers with information that...

Mira

I do realize that this disease is a painful and very embarrassing one, as it has been that way for me also for many years. I am a 41 year old woman and have been suffering with this for 19 years. I first noticed this disease (although I didn't have any idea it was a chronic disease or that it had a name) when I was pregnant with my first child in 1977. I started getting what looked like boils that would come up and then go down on my buttocks. When one got big enough or painful enough to make...

General Questions

Depending on the severity of the disease it could be a dermatologist, a plastic surgeon or a proctologist. What is important is that the doctor knows about hidradenitis suppurativa (HS). No, it affects an estimated 1 of the population. It is therefore a relatively frequent disease, but it is often not diagnosed. Many patients do not know what they have and are only told of their correct diagnosis after many years. 3. How do I distinguish between a simple boil and HS The location (groin and...

Antibiotics

The significance of bacterial findings in HS is controversial. While bacteria are likely to be involved in the pathogenesis to some extent, it is probably in a role similar to that in acne in early lesions. In later stages of the disease bacterial infection seems to be a risk factor for the destructive scarring and progression of HS lesions. Coagulase-negative staphylococci are the most common bacteria found in cultures from the deep portions of HS lesions, as seen following carbon dioxide...

References

Dictionnaire de Medicine, un Repertoire General des Sciences Medicales Sous La Rapport Theorique et Pratique. Aiselle, Bechet, 1839 2. Verneuil A. Etudes sur les tumours de la peau et quelques maladies des glandes sudoripares. Arch Gen Med 1854 4 447-468 3. Schiefferdecker B. Die Hautdrusen des Menschen, und der Saugetierre, ihre Histologische und rassenanatomische Bedeutung Sowie die Muscularis Sexu-alis. Schweizerbart, Stuttgart, 1922 4. Brunsting HA. Hidradenitis suppurativa...

Social Security

Is the disease recognized as chronic It is not on the list of illnesses deemed long and costly, but see Question 2. 2. Can the patient receive 100 cover by social security Yes, in certain cases and in some countries when a very detailed medical certificate is provided and a discussion is held with the relevant social security official and when the illness really is expensive. 3. Can the patient be recognized as disabled Yes. This chapter of this remarkable book does not take the form of a...

Anatomy

Hidradenitis Suppurativa The Head

Hidradenitis suppurativa (HS) was originally classified according to location, and this remains a hallmark of the disease. Shortly after the diagnosis was established, an erroneous association with apocrine glands was made and the name created. A classification according to topography alone obviously does not improve the understanding of pathogenesis and hence is of little help. The erroneous classification according to an incorrect deduction based only on simple co-localization obviously...

Perspectives

HS is a relatively common skin disease affecting about 1 of the general population. Both genetic and environmental factors have been identified as potential causative factors but assessment of their importance is hampered by the lack of systematic analyses considering potential confounding effects and interactions. For the future a larger collaborative research network promoting more systematic research activity would be desirable. Relatively simple measures, such as prevalence rates, are of...

Potential Contribution of the VIP Gene to HS

TIZ emerged as one of the genes with real potential as a candidate for HS. TIZ inhibits TRAF6, a tumour-necrosis-factor- (TNF-) associated factor that is a signal transducer in the TNF receptor superfamily pathway, and also mediates nuclear factor kappa B (NF-kB) and JNK activation in the interleukin-1 receptor Toll-like receptor (IL-1R TLR) signalling pathway. NF-kB together with activator protein 1 are activated in acne lesions with consequent elevated expression of their target gene...

End Organ Androgen Sensitivity

All the above data suggest that the main mechanism for the possible role of sex hormones in HS lies in end-organ sensitivity rather than in the plasma levels. Women can develop HS while taking oral contraceptives especially when an-drogenic progestins are used, and this also suggests, as in acne, a possible androgen dependence of the disease 19 . In acne, not only sebocytes but also other epithelial cells are involved in the skin hyperandrogenism that is responsible for the formation of the...

Other Lesions

Butt Folliculitis

A number of other lesions may be seen in patients with HS. Some of these lesions are clearly follicular and may therefore obscure HS lesions and cause a delay in the diagnosis. Common small follicular papules and pustules are frequent in area in both early and late HS (see Fig. 3.11) and may occur isolated in a region not involved by HS 1, 2 . The general prevalence of minor pustular follicular lesions of the skin in not known, but such transient lesions are estimated to be very common. In HS...

BS1 Intermittent Benign Course of the Disease

In more severe cases there are no days off for the patient pain and suppuration are permanent features of their lives and the disease is relentlessly progressive in one or several areas. Inflammatory nodules rupture externally giving rise to chronic sinuses with intermittent or permanent discharge of a mixture of blood, serous exudate and pus. Who among the patients progresses to this stage of the disease cannot currently be predicted with any certainty. Neither clinical examination nor other...

Lack of Association between HS and Endocrinopathies

Although HS has been reported in two men with acromegaly 4 , which is very likely due to a direct effect not of androgens but of growth hormone on apocrine glands, HS was not found to be associated with endocrine disorders. In women HS has not been reported in association with ovarian or adrenal tumours, Cush-ing' syndrome, PCOS or NCAH, all known causes of hyperandrogenism with increased or abnormal androgen production. In fact, a possible association of HS with functional hyperan-drogenism...

Antiandrogenic Progestins

Other progestins with antiandrogen properties 11, 14 (antagonists at the AR levels) include chlormadinone acetate (CMA), drospirenone and dienogest. They may be used either in combination with EE 5, 8, 16 as a contraceptive OC (similarly the combination of CPA 2mg + 30 g EE) or as antiandrogenic progestin alone (CMA for instance) according to countries where the drugs have been approved. In fact no evaluation of the effects of these progestins exists in women with hirsutism, severe acne or...

Modulation of the Proliferation and Differentiation of Keratinocytes and Cell Apoptosis

19.2 Zinc Salts 141 19.2.1 Mechanisms of Action Modulation of the Proliferation and Differentiation ofKeratinocytes and Cell Apoptosis 141 19.2.2 Anti-Inflammatory Activity 142 19.2.3 Activity Against 5a-Reductase 142 19.3 Zinc Salts in Verneuil's Disease 142 19.4 Other Experimental Drugs 143 References 144

Pro Inflammatory Chemokines

Pma Activate Cells

Chemokines, a superfamily of chemotactic proteins induced by contact with pathogens, regulate the recruitment of various classes of phago-cytic cells, T cells and eosinophils into sites of infection. Keratinocyte-derived chemokines regulate the migration of leukocytes and neu-trophils from peripheral blood vessels into inflamed skin, in a sequence of tightly controlled events involving the activation of vessel endo-thelium, transendothelial migration and che-motaxis 31, 32 . Skin-pathogenic...

Kevin

I have been searching the web for nearly a year now for HS information and every now and again I do another search in the hope I may find something new. Today I was delighted to find your pages and especially the visitor's book with remarks from fellow sufferers which made me feel so much better about the way I feel. I have been a chronic HS victim for a few years now and despite much sympathy from 27 those in the medical profession - no ACTION. I visited a Naturapath nearly 2 months ago who...

Acne Conglobata

Acne conglobata (AC) is a disease attributed to an occlusion of sebaceous glands by a process of keratinization. This occlusion can be responsible for secondary sebaceous inflammation. Clinically, the patient presents with comedones, cysts, abscesses and draining sinus tracts, mainly located on the trunk and buttocks, but the face, neck and extremities may also be involved. In the literature, several cases of so-called AC may very well in fact be HS, such as in Whipp's two familial cases of...

The Last Metamorphosis of Verneuils Disease

In 1956, Pillsbury, Shelley, and Kligman brought together acne conglobata, hidradenitis suppura-tiva, and dissecting cellulitis of the scalp 32 under the name follicular occlusion triad 33 , whose common feature was a tendency to fol-licular hyperkeratinization leading to the retention of keratin products with secondary bacterial infection. In 1975, Plewig and Kligman 34 added pilo-nidal sinus to the triad and proposed the term acne tetrad, pointing out the absence of apo-crine involvement in...

Conclusion for Physicians

Chren MM, Lasek RJ, Flocke SA, Zyzanski SJ 1997 Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases. Arch Dermatol 133 1433-1440 2. der Werth JM, Jemec GB 2001 Morbidity in patients with hidradenitis suppurativa. Br J Dermatol 144 809-813 3. der Werth JM, Williams HC 2000 The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 14 389-392 4. Finlay AY 1997 Quality of life measurement...

And the Commensal Microbiota of the Skin

The human skin is densely populated with resident microbiota, composed of commensal microorganisms such as S. epidermidis, P. acnes, Micrococcus luteus and or Malassezia furfur. These microorganisms compete for nutrients and space, limiting each other's population size and also competing out pathogens that may attempt to colonize the skin. Despite the density of the microbiota, epidermal keratinocytes do not activate pro-inflammatory signaling cascades in response to commensal microorganisms,...

Intralesional Therapy

In contrast to topical therapy the use of intralesional anti-inflammatory therapy has been used more extensively. This therapy represents an intermediate form of treatment between pharmacological therapy and surgery. The intralesional injection of corticosteroids is aimed at reducing inflammation rapidly, and may even be suggested to have an atrophogenic effect on formed sinus tracts, which is desirable from a theoretical point of view. There is a long tradition of using this modality in acne...

Mechanism of Action

There is a broad base of clinical experience with etretinate and acitretin in the treatment of chronic keratinizing disorders 33 . If ductal hy-perkeratinization is crucial in the pathogenesis of HS, etretinate and acitretin could be good alternatives to isotretinoin, because these drugs have a clearly greater effect on hyperkeratiniza-tion 3 . In addition, etretinate and acitretin show considerable immunomodulatory and anti-inflammatory effects 33 . Acitretin, the active retinoid metabolite,...

Azelaic Acid

Ever, the use of local anti-inflammatory treatment is in good accordance with the use of systemic anti-inflammatory therapies see Chap. 18 , and the low prevalence of recognized pathogenic bacteria. In practice this is particularly useful for patients with few intermediate lesions, and may often be combined with topical therapy to keep the disease under control. If there is clinical suspicion of suprainfection with, for example, Staphylococcus aureus this treatment is not recommended. Patients...

IL1 Receptors in the Skin

IL-1 receptor type 1 IL-1R1 can bind both IL-1a and IL-1p resulting in the initialization of MyD88-dependent signaling see below and Fig. 13.1 . The receptor, expressed on the surface of a variety of cells, mediates all known biologic activities of IL-1 by initializing a cascade of events leading to the recruitment and activation of macrophages and neutrophils, vascular dilation, fever and a proinflammatory immune response. The central role of the IL-1 system is protection against microbial...

Hidradenitis Surgery Before And After

Hidradenitis Suppurativa Pictures

Hidradenitis suppurativa HS, synonym acne inversa is a cicatrizing and frequently persistent inflammatory disorder of the sebaceous follicles and terminal hair follicles of apocrine-gland-bearing areas in the adult 12, 31 . The condition may remain relatively mild but nevertheless distressing 32 , ranging from a few but recalcitrant suppurating lesions to an advanced widespread and disabling disease lasting for years or decades. Possible consequences of longstanding, recurrent disease are...

Innate and Acquired Immunity

Innate immunity is the most ancient and common system for defense against microbial infections. It evolved a detection system, a limited set of receptors e.g., Toll-like receptors TLRs against microbial signatures that remain invariant inside a class of microbes 33 . Given that epithelial cells lie at the interface between the host and the environment, the expression of TLRs on these cells provides the first line of defense against invading pathogens through the recognition of microbial motifs....

Methods of Closure

Several different techniques have been described, and the techniques employed include excision and primary closure, excision followed by secondary healing, excision and split thickness skin grafting, excision and delayed grafting, and skin excision and plastic reconstruction using rotation flaps and pedicle flaps. Controversy exists about closure of the skin defect. Adequate excision will usually result in a defect that precludes primary closure, and various techniques are described to obtain...

Normal Microflora of the Skin

Normal human skin is colonized by a large variety of organisms that live as commensals on its surface. There are quantitative differences among different regions of the skin, related to temperature difference, moisture content, and the presence of various amounts of skin lipids that may be inhibitory or lethal for some microorganisms. These differences characterize three main regions of the skin 1 axilla, perineum, and toe webs 2 hands, face, and trunk and 3 arms and legs 20 . The skin...

Postoperative Wound Care

The diseased area resulting from recurrent relapses of abscesses and chronic inflammation is delineated with ink. Following cleansing with 0.05 mg ml chlorhexidine solution the area is anesthetized with injections of lidocaine 0.51.0 mg ml and epinephrine Xylocaine adrenalin, Astra, Sodertalje, Sweden with sufficient margins. Richly innervated areas, such as the groin, are pretreated with a lidocaine prilocaine cream EMLA , Astra prior to the injections. The solution is injected and infiltrates...

And Other Corticosteroids

Early studies of adrenocorticotrophic hormone ACTH and corticosteroids suggested that general immunosuppression was beneficial to the well-being of HS patients 4 . These studies however do not conform to current requirements for evidence as they are anecdotal rather than randomized and controlled. Relief is however regularly offered to patients with flares of HS by treating with prednisolone, either as monotherapy or in combination with other therapies. In this manner systemic corticoste-roids...

Oestrogen receptora and HS

Gen receptor BCR in mature or activated B-cells leads to inhibition of a number of cellular responses such as cell proliferation, antibody production and activation, and instead promotes apoptosis, whereas co-aggregation of FcyRIIB with FceRIIB receptor in mast cells leads to an inhibition of antigen-induced degranulation and cytokine production 45 . ZNF91 is highly expressed in T lymphocytes and acts to repress FcyRIIB expression in these cells. Deficiency of FcyRIIB in mice leads mainly to...

And the Pilosebaceous Unit

Pilosebaceous Unit

The sebaceous glands are an integral part of the pilosebaceous unit and are found over the entire body surface with the exception of the palms and soles. The gland itself is made up of several lobules, which are separated by vascular connective tissue. These lobules all empty into a short duct which then empties into the upper part of a hair follicle at the level of the infun-dibulum. More than one sebaceous duct may drain into the upper part of the hair follicle. Fig. 4.2. Diagrammatic...

Early Lesions Fig 43ad

What Vomeronasal Lesion

Follicular hyperkeratosis with plugging and dilatation of the hair follicle is seen as an early event in HS. The follicular epithelium may proliferate or may be destroyed. Inflammation is frequently not apparent in early lesions but peri-folliculitis will ensue and the inflammatory infiltrate embraces neutrophils, lymphocytes and histiocytes. Early lesions may show acute inflammation involving the apocrine gland and duct but this is not always apparent and would appear to be a rare primary...

Clinical Presentation of Cutaneous Lesions

The primary lesions of CD are confined largely to the endoanal skin, the transitional epithelium of the anal canal, and the contiguous 1-2 cm of rectal mucosa. The primary lesion is a painless, midline fissure of the anal canal, which usually remains symptomless and benign. Edematous skin tags arise from the distal margin of superficial fissures. They may be voluminous, with no tendency to decrease. A second and more destructive lesion is a penetrating ulcer which gives rise to fistulas 18 ....

Identification of a Second HS Locus to Chromosome

A genome-wide scan was performed on DNA from 13 members of Family 13 9 with HS and 7 unaffected. A cluster of markers on chromosome 19 co-segregated with the disease giving a highest two-point LOD score of 3.66 at recombination fraction with D19S414 Table 2.18 . Higher density markers were then taken from data on the Human Genome Browser and were run on the samples from Family 13 in order to define the limits of the candidate region. Recombination events narrowed the region to a 16.8-cM region...

Distribution of Lesions

The frequency of each localization is different in men and women 1, 4 . Axillary involvement has no gender predilection whereas genitofemoral lesions are significantly more common in women. In contrast perianal and perineal as well as buttock lesions are significantly more common in men see Figs. 3.19, 3.20 Table 3.1 . One or several sites may be involved in the same patient, and activity in the sites may vary as well. New regions may be involved at the same time as the disease burns out in...

Atypical Localizations Other Zones May Be Involved

Apocrine Glands The Buttocks

The buttocks are one of the most frequent of these atypical localizations especially in men. The clinical aspect is sometimes very peculiar the deep-seated abscesses and sinus are closely associated in a unique lesion slowly extending at the periphery over a period of years see Fig. 3.18 . The lesions may be very large, solitary and very deep. Such single macro lesions may be mistaken for regular abscesses of the muscle or even bone-derived lesions. Lesions of the buttock therefore are easily...

The Two Less Frequently Involved Zones

The breast may be involved in women, particularly the sub-mammary folds, sometimes the inter-mammary fold see Fig. 3.16 and the are- Fig. 3.17. Perianal and buttock involvement Fig. 3.17. Perianal and buttock involvement ola. These lesions have the same characteristics as HS lesions elsewhere and are, as a rule, easily differentiated from acne lesions. It is a clinical diagnostic aid that comedones are not present in HS. In contrast, the perineal and perianal zones are mainly involved in male...

Age at Onset and Resolution

Hidradenitis Suppurativa Pictures Women

HS develops after puberty, usually in the second or third decade. In a personal series of 164 patients mean age at onset was 22.8 years with extremes of 10 and 57 years see Fig. 3.21 . This finding was similar to those of other series 4, 12 . Genetic factors may affect the onset of disease. Patients with a familial history of HS tend to experience an earlier onset mean age 20 versus 23 years , although positive bias through over-reporting may occur in families where HS is a communal rather than...

Analytic Epidemiology

The main purpose of analytic studies, including cohort and case-control studies, is to identify factors that may influence the disease frequency and to precisely estimate their contribution to disease occurrence. The results of analytic studies are best expressed in terms of relative risk. The relative risk is the ratio of the disease incidence among those exposed to a purported causal factor risk factor , to the incidence among the unexposed. When derived from case-control studies, odds ratios...

Natural History and Prognosis

There are limited data concerning the natural history and prognosis of HS. Ideally, a prognostic study should be based on a representative sample of affected individuals followed-up for a sufficiently long period of time. Loss to follow-up should be reduced to a minimum, outcome measures should be clearly defined at the beginning of the study, and adequate analytic methods should employed e.g., survival analysis . A number of studies evaluating the impact of HS have been based on a...

Introduction

The ultimate aim of epidemiologic research is to find means to prevent disease onset primary prevention and to restore health once a disease has been developed secondary prevention . Additional purposes are to evaluate and optimize healthcare. It is not surprising that the main clinical areas covered by epidemiologic research are those associated with a high mortality rate in the population as a whole, such as tumors, and those involving a major disability problem, for example chronic...

LHidradnite Phlegmoneuse Verneuils Disease Primary Observations

Two French surgeons fathered the description of hidrosadenitis. In 1833, Velpeau 1795-1867 described a phlegmon tub riforme 4 of the axilla, frequently induced by rubbings and irritations of the sebaceous follicles, by the absence of cleanliness this kind of inflammation which evolution is usually slow can be sometimes quite painful. Its usual ending is suppuration healing is exceptional. Velpeau described a different clinical aspect named phlegmon rysip lateux, similar to the previous one but...

Hidradenitis Suppurativa Introduction

References 3 At long last, hidradenitis suppurativa, a disease first described a century and a half ago and one of the most devastating among the thousands of dermatologic entities, has finally received recognition by a text dedicated solely to this horrible disorder. This publication reminds us that this disease, neglected for most of its history, would merit classification by taxonomists as a nomen dubi-um et confusum, about which there has been no consensus regarding etiology, pathogenesis,...

Tertiary Lesions

Hidradenitis Suppurativa

The final stage of the disease Hurley stage III, see below is characteristic and most often recognized. The chronic inflammation and pain are accompanied by a very peculiar and specific 3 form of hypertrophic fibrous scarring leading to indurated plaques in which the inflammatory nodules and sinus remains active see Figs. 3.6, 3.7a, b . This process may involve the entire zone of apocrine-gland-bearing skin to form a subcutaneous honeycomb-like structure on clinical examination. In more lax,...

Clinical Experience Etretinate and Acitretin for HS

Etretinate and acitretin were of great benefit in all ten patients with HS, as described in five case reports 33-38 . In 1984 Stewart 34 was the first to report on HS treatment with etretinate in a study of six patients four other case reports followed in the period from 1988 until 2002 35-38 . The data are summarized in Table 17.3. Overall, eight patients were treated with 17 etretinate at a dose of 0.35-1.0 mg kg per day 34, 36, 37 and two patients with acitretin at a dose of 0.5-1.0 mg kg...

Pathophysiology

Recent advances in the pathogenesis of CD involve interactions of three elements genetic factors, enteric microflora and immune-mediated tissue injury. Furthermore cigarette smoking has been described as the main risk factor for relapse and poor evolution of the disease 1 . CD appears to have a genetic tendency, with multiple susceptibility genes. The first susceptibility locus for CD, which was found in replica-tive studies worldwide 2, 3 , is on the...

Fox Fordyce Disease

Fox-Fordyce disease has the same anatomical distribution, as well as age and sex incidence as HS. This condition is more convincingly associated with an inflammatory process of the apocrine duct. Of interest there have been descriptions of some cases of Fox-Fordyce disease progressing to HS. The pathogenesis of acne embraces increased sebum production, follicular hyperkeratosis, colonization with propionibacteria and inflammatory changes. The sebaceous duct hyperkera-tinization is mediated by...

Causes of Hyperandrogenism

As far as hyperandrogenisms due to an excess of androgen production are concerned, tumoral causes and Cushing's syndrome are rare. The most common endocrine disorders are polycys-tic ovary syndrome PCOS and non-classic adrenal hyperplasia NCAH with 21-hydroxylase deficiency. Hyperandrogenism is associated with high levels of circulating androgens and decreased SHBG levels. PCOS also requires morphological and ultrasound criteria an increased number of subcapsular follicles and stromal...

Androgen Metabolism

The causes of hyperandrogenism are multiple Table 12.1 . Skin androgenization in women may be due to abnormal production of andro-gens by the ovaries and or the adrenal glands, and or to an excessive response of target cells in the pilosebaceous unit peripheral androgen-ism 6 . Androgens testosterone and the less potent androgens in women A4-androstenedione A4A and dehydroepiandrosterone DHEA are synthesized by the adrenals mostly DHEA and its sulfate - SDHEA and the ovaries mostly A4A and may...

Clinical Features

The clinical characteristics of HS, i.e., deep-seated lesions and topography, are very specific and the hallmark of the disease however, they are not explained by the histological pictures which form the main evidence for establishing a connection with acne and the so-called follicular obstruction diseases. Exceptional case reports of an association of HS with dissecting folliculitis of the scalp, acne conglobata, large epithelial cysts and pilonidal cysts have focused attention on a possible...

Topical Treatment

Karin Sartorius, Jurr Boer, Gregor B.E. Jemec 21.2.1 Topical Clindamycin 152 21.3 Keratolytics 152 21.3.1 Resorcinol as a Keratolytic Agent in Hidradenitis Suppurativa . . . . 152 21.3.1.2 Mechanism of Action 154 21.3.1.3 Side-Effects of Resorcinol 155 21.3.1.5 Clinical Experience 156 21.4 Topical Anti-Inflammatory Therapy 157 21.5 Intralesional Therapy 157 21.6 The Use of Local Therapy 158 21.7 Publication Bias 158 22.1 I ntroduction 161 22.2 Methods of Closure 164 22.3 Anatomical Regions...

Dissecting Folliculitis of the Scalp

A synonym for this entity is perifolliculitis capitis abscedens et suffodiens. This disease shows considerable geographical variation and most often appears to affect Afro-Caribbean male patients. It usually starts during early adulthood. It has been described in women and girls 20 as well, and familial occurrence has also been documented 21 . An association with acne is reported in 30 of cases 22 . The disease is however uncommon and only a few cases have been reported in the literature making...

Sartorius [9

The need for uniform outcome variables when reporting treatment effects has led to a proposition of a score by Sartorius and co-workers. This classification allows for better dynamic monitoring of disease severity in individual patients, and therefore forms a complimentary system to the Hurley classification. 1. Anatomical region involved axilla, groin, gluteal or other region or infra-mammary region left or right 3 points per region involved . 2. Number and scores of lesions abscesses,...

Follicular Occlusion Diseases

Follicular occlusion diseases or perifolliculitis capitis abscedens et suffodiens The term follicular occlusion disease refers to a possible common pathogenic mechanism of occlusion of sebaceous or apocrine glands, and diseases included in this term are listed in Table 6.1. An association of these disorders has been described in several patients, suggesting that a causal relationship may be found rather than mere co-occurrence. It has therefore been suggested that the association of...

Immunohistochemistry of Hidradenitis Suppurativa

Immunohistochemical evaluation of apocrine and eccrine involvement in HS has been performed retrospectively on sections of HS from vulval skin. Markers of apocrine differentiation GCDFP-15, CD15, lysozyme and eccrine differentiation GCDFP-15, S-100, CA-19.9, HMB45 were used. In total 13 cases were examined the majority of glands identified in the samples from vulval skin were eccrine. Apocrine glands were either not seen or were present away from the area of active inflammation in 10 of the 13...

Biographical Landmarks of a Surgeon Venereologist

Aristide Verneuil 1823 1895

Aristide Auguste Stanislas Verneuil Fig. 2.1 was born in Paris on 29 November, 1823. He was appointed Interne des H pitaux de Paris in 1843, graduated as a Doctor in Medicine in 1852 thesis the movements of the heart and became Professeur Agr g at the Paris Faculty of Medicine in 1853 thesis the anatomy and physiology of the venous system . As Surgeon of the Paris Hospitals from 1856, he was officially in charge of the teaching of venereal diseases from 1863. Non syphilitic venereal diseases...

Established Hidradenitis Suppurativa Fig 44ae

Inflammation Apocrine Glands

Biopsy samples from established HS lesions show sinus tracts with marked suppuration and frank abscess formation. The sinuses are lined by stratified epithelium and are surrounded by fibrosis and inflammation. The squamous epithelium extends from the associated follicular epithelium. The inflamed sinus tracts frequently contain desquamated keratin and hair shafts within the dense fibrosis 6 . Within the adjacent connective tissue there is frequently a dense chronic inflammatory infiltrate,...

Comedones

Closed comedones white heads are never present in areas of HS. Open comedones black heads are also absent in early disease but may appear in long-lasting HS, usually as double-ended comedones. These may be taken to reflect the distortion and degradation of the dermal architecture caused by the extensive inflammation and scarring of the disease. They are particularly conspicuous in burnt out lesions, presumably when no longer obscured by the active disease see Fig. 3.10 . As in acne conglobata...

Genetics of Hidradenitis Suppurativa

Irvine, W.H. Irwin McLean 10.4 Genetic Markers 75 10.5 Positional Cloning of Dominantly Inherited Disease Genes 75 10.6 Genome-Wide Linkage Analysis 10.7 Linkage of Hidradenitis Suppurativa 10.8 Identification of a Second HS Locus 10.9.1 Oestrogen receptor-a and HS . . . .79 10.9.2 ZNF91 and HS 79 10.9.3 TIZ Association with HS 80 10.10 Additional Candidate Gene-Protein Systems in HS 81 10.10.1 Interleukin 1-a 81 10.10.2 TNF Signalling and HS 81