Atypical Localizations Other Zones May Be Involved

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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 differentiated from superficial follicular inflammation.

Numerous other localizations have been reported: the nape of neck, the waist (corresponding to the waist band), peri-umbilical lesions, the external auditory meatus, retro-auricular

Apocrine Glands The Buttocks
Fig. 3.18. A unique buttock lesion slowly extending peripherally over a period of years

folds and the eyelids. Some of these reports stem from the finding of inflamed apocrine glands, and therefore reflect the mistaken supposition that HS is an apocrine gland disease. These lesions are usually not typical of HS, and their relationship to HS is often at best tenuous. Fur-3 thermore, they are infrequent and there is always doubt about whether they are part of the general disease HS. From a disease management point of view it is often more fruitful if they are considered as being diseases possibly associated with HS, rather than as part of HS itself.

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