Conglobata Controversial Views

In the twentieth century the French School of Dermatology centered the nosological discussion on the connections between acne conglo-bata (described in 1901 by Spitzer under the name of dermatitis folliculitis et perifolliculitis conglobata) [24] and hidrosadenitis.

In 1904, Audry (Toulouse), authoring the chapter on sweat glands in the prestigious Pratique Dermatologique, pointed out the fact that "reading the authors who dealt with this question gave an impression of a complete darkness, distinct diseases being described under a common name." Audry indicated he had never found any convincing evidence of the initial origin in the sweat glands [25].

Thirty-five years later in the subsequent masterpiece of the French School of Dermatology (Nouvelle Pratique Dermatologique) Audry could not still "envision to file perianal and perimamelonal abcesses among the idrosadeni-tis [sic]" [26]. However, for him more consistent probabilities existed for the sudoral origin of the axillary abscesses, despite the absence of any histopathological evidence. In fact he regarded tuberous abscesses of the axillaries as a subcutaneous boil (furuncle).

In 1949, Degos et al. (Paris) presented a case of acne conglobata abnormally localized to the axillaries, perianal area, and inter- and sub-mammary region, sparing the scalp and the back of the neck [27, 28]. For the authors, the observation gave credence to the follicular origin of the so-called hidradenitis.

In fact, Degos insisted on the difficulty or impossibility of establishing a definite distinction between acne conglobata and Verneuil disease. In this respect, Moline (Paris) underlined the fact that "the close relations between sweat glands and pilosebaceous follicles and the consequences of the infectious process made a rigorous distinction between acne conglobata and hidrosadenitis quite difficult. A common understanding of both diseases may be considered" [29].

Confirming the French point of view, Debay (Paris) [30], concluding his work on perineal suppurations, considered that "the same clinical feature can result from three distinct processes: acne conglobata, Verneuil's disease [aetiology adopted by the Anglo-Saxon authors; no valid differential criterion exists between Verneuil's disease and heterotypical forms of acne conglobata) (...)] and the dysembryoplasia whose clinical features are almost identical to those of acne conglobata and Verneuil's disease."

Mouly (Paris) [31] tried to reconcile the French and American views, drawing attention to the fact that French authors essentially knew the axillary features of the disease, whereas the Anglo-Saxon authors described the perineal features extensively. He insisted also on the fact that hidrosadenitis was commonly designated under the name of Verneuil in the English-speaking medical literature. He incited his French colleagues to acknowledge Verneuil's primary work and to definitively coin the disease maladie de Verneuil.

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