LHidradnite Phlegmoneuse Verneuils Disease Primary Observations

Two French surgeons fathered the description of hidrosadenitis. In 1833, Velpeau (1795-1867) described a phlegmon tubériforme [4] of the axilla, "frequently induced by rubbings and irritations of the sebaceous follicles, by the absence of cleanliness (...) this kind of inflammation which evolution is usually slow can be sometimes quite painful. Its usual ending is suppuration; healing is exceptional." Velpeau described a different clinical aspect named phlegmon érysipélateux, similar to the previous one but always quite painful. "Patients are sometimes afflicted with indurations and tumors that may remain the whole life through."

Velpeau regretted "the ignorance of the authors regarding the awful consequences of these inflammations of the axillae which frequency is probably underestimated, while nothing is more common."

Then, from 1854 until 1865 Aristide Verneuil published a series of articles on skin tumors [5]. Observing the absence of any study on this topic, Verneuil indicated he would deal with those sudoral tumors that may have a surgical interest. Although Velpeau mentioned the origin of the abscesses in the sebaceous follicles, Verneuil taught that Velpeau's tumors had their origin in the sweat glands.

Verneuil admitted he had never observed any patient with such an acute inflammation of the sudoral glands. In fact, the only occasion he had to observe it was on the cadaver of a young patient who died from cachexia. In this observation entitled "inflammations de la région sacrée et fessière, abcès multiples circonscrits et sous cutanés siégeant probablement dans les glandes sudoripares," Verneuil indicated in an extremely precise way that "the buttocks area was scattered with a great number of little escarrs separated from the others (. ) moreover a great number of pustules, the size of a pinhead, without any sign of inflammation were disseminated; these pustules were filled by a liquid lifting the epidermis without breaking it. After removing the epidermis, the cleaning of the pustule made perceptible a tiny red hole in which one could introduce a bristle of a boar or a very thin stylet; then one entered a channel of one fifth to one third millimeter crossing the dermis and leading to a subdermal cavity larger than the subepidermal one and filled with the same liquid."

Observing these cavities both linked by a thin channel across the dermis, Verneuil as

sumed necrosis of the sudoral glands, the pus being excreted by the sudoral duct and accumulating under the epidermis.

Verneuil localized the abscesses in the sweat gland through clinical and micro anatomical observations only. Therefore, he added prudently "I make this observation with reservation for it is chiefly the curious distribution of these collections that made me adopt the interpretation which I give here. It is therefore a point to be restudied and to be demonstrated in a more satisfactory manner." However he indicated "to have no more doubt on the existence of a new variety of skin tumors consisting of the hypertrophy of sweat glands." Nevertheless, he added, "I have nothing to say on the aetiology of this disease: the causes of these glandular cysts, the symptoms, the evolution cannot be inferred from such a small number of observations."

In 1864 Verneuil named this disease "hidro-sadenite phlegmoneuse" [6]. A few decades later when complementary cases were published, Dubreuilh (Bordeaux, France) considered the word hidradenitis as improper and hydrosade-nitis as barbarism [7].

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