Introduction

Hidradenitis suppurativa (HS) is an inflammatory skin disease. The clinical presentation and historical concept of the disease have traditionally been interpreted to indicate that bacteria have a pathogenic role, but specific microbiological investigations have suggested that the role of bacteria is generally not that of a simple infection. Routine cultures are more often than not found to be sterile, and recognized pathogens such as Staphylococcus aureus can be found mainly in rapidly evolving lesions [1, 2]. Heavy bacterial overgrowth of known pathogens is therefore not a main feature of the disease, and the pathogenic role of bacteria may be an im-munological one. Bacteria may only be the antigen that starts an immunological disease. Similar mechanisms have been described in guttate psoriasis and atopic dermatitis. In acne, bacterial antigens have also been shown to elicit an immunological response, suggesting a similar mechanism.

Similarly scarring is a prominent feature of more advanced disease [3]. Whereas scarring is currently not amenable to medical therapy, preventive medical therapy may be of clinical interest. Since the primary pathogenic event in HS is not known, treatment directed at minimizing scar formation is of independent interest to all involved. Immunosuppressive therapy has a potential in reducing the inflammatory phase of the disease, which may result in subsequent scar formation. Accepting the possibility of such a mechanism, a different range of therapeutic options becomes available to the dermatologist.

Table 18.1. Immunosupressive treatment of HS

Table 18.1. Immunosupressive treatment of HS

Ciclosporin Gupta et al. [8] 1 (male,

60 years)

Moderate response Good response

Ciclosporin Gupta et al. [8] 1 (male,

60 years)

Buckley 1

and Rogers [9]

Dapson

Hofer and Itin [11]

Methotrexate Jemec [12]

a. Groin a. Female b. Axillae 38 yearsa and groin b. Male

31 years

Axillae and groin

Axillae and groin

6 mg/kg for 6 weeks 4.5 mg/kg a. 4 mg/kg (3 months) then tapered to 2 mg/kg for continuous therapy b. 3 mg/kg for 3 months

25-100 mg/day

Moderate response Good response a. Continuous therapy with good effect b. Remission for 4 months after 3 months of treatment

Effect within 2-4 weeks, described as very good by 2 and good by 3 patients

12.5-15 mg per week No effect on primary for 6 weeks lesions or recurrence rates, to 6 months but slight weakening of flare intensity aPatients previously treated with corticosteroids.

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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