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 purulent discharge and true secondary infection is often not possible on clinical grounds alone. The presence of fever, cellulitis, and lymphadenopathy are helpful but are not common findings. Frequent cultures are essential for making rational decisions regarding the use of antibiotics. The need for antibiotic use driven by culture and sensitivity is even more important in view of the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired infections.

Over the years one of us (J.J.L.) has routinely cultured HS patients (Table 15.1). All of these patients are referred by other dermatologists and have had multiple courses of systemic antibiotics and in many cases have been on continuous antibiotic therapy. The latter is rational only if one believes that the non-antimicrobial, antiinflammatory properties of antibiotics are beneficial in HS.

The results of cultures in 150 patients with chronic disease indicate a low rate of recovery of pathogens. The most common pathogen isolated is S. aureus with MRSA seen in recent years. In the perineum, Gram-negative bacteria including Escherichia coli, Proteus and Pseudomonas species are found in a small percentage of patients. There results support the view that bacterial infection is not a primary event in HS. These findings are in agreement with Jemec et al. [6] and Lapins et al. [7]. The most frequently isolated pathogens are S. aureus and Gram-negative species. The studies of Jemec and Lapins circumvented the problem of collecting surface contaminants. If members of the resident cutaneous flora, e.g., coagulase-negative cocci, are recovered, they should not be considered pathogens unless the hypothesis of biofilm formation by this resident flora in a deep-seated sinus is verified (see Chap. 11). Several authors have recovered anaerobic bacteria from HS lesions [7-9]. See Chap. 11 for further information on bacterial isolates from HS lesions.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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