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Fig. 7.1. The elementary lesions of perianal Crohn's disease (CD, posterior fissure, skin tags, and fistulas)

Fig. 7.2. A CD fissure merging on the perianal skin

Fig. 7.4. HS lesions in a patient with operated perianal CD

Fig. 7.3. A suppurative form of perianal CD with multiple fistulas

Fig. 7.4. HS lesions in a patient with operated perianal CD

anal lesions may be absent or have healed. The aspect of the perianal lesions also differs. In CD the lesions are more ulcerative, scars are retractile, and the skin is involved only around the anus (Figs. 7.1-7.3), whereas in HS, there are cutaneous scarring, comedones, skin bridges and sinuses (Figs. 7.4, 7.5). From a pathological point of view, lesions may be very similar. Attanoos et al. [30] specifically looked at the granuloma in 101 HS patients. They found that although foreign-body-type granulomas are a common feature of HS (25%), the presence of discrete epithelioid granulomas in the dermis away from the site of active inflammation is unusual and should alert one to the possibility of granuloma-tous disease such as CD [30].

Fig. 7.5. HS lesions in a patient with CD
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