Chronic hidradenitis suppurativa of the anal canal

Abstract

Obstruction of the outlet of the apocrine duct adjacent to the skin surface, with subsequent rupture into the intradermal plane, initiates the inflammatory condition termed "hidradenitis suppurativa." The chronic manifestations of the process, indicated by recurrent abscess formation, draining sinuses, skin fistulas, and an intense cicatricial response, usually affect the distal two thirds of the anatomic anal canal because the proximal portion is devoid of hair follicles and accessory glands. An anal fistula that lacks continuity with the cryptoglandular units of the dentate margin or intersphincteric space (or both) is suggestive of the presence of hidradenitis. The fistula of chronic hidradenitis suppurativa can be diagnosed by a track that originates in a pitlike scar, usually epithelialized, within the skin of the distal anal canal, which then progresses beyond the anal verge superficial to the internal sphincter muscle. A group of 30 patients have been followed up from one to seven years and are without evidence of recurrent symptoms in the anal canal.

Deroofing: A tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions

“…Systematic comparison of studies is hampered by variable definitions of recurrence. The deroofing technique, as used in this study, was first described in 1959 by Mullins et al 9 In 1983 Culp 15 reported on deroofing in a group of 30 patients with HS of the anal region. Unfortunately recurrences and follow-up were not studied and the diagnosis of HS was questionable.…”

Hidradenitis suppurativa: A comprehensive review

“…2 Patients with anogenital HS may also have disease in the anal canal (30 of 132 patients in one study). 26 HS in the anal canal lies superficial to the internal sphincter and begins in the lower two-thirds of the canal, distal to the dentate line (the transition zone from columnar epithelium to squamous epithelium). 26 This corresponds with the distribution of apocrine glands and hair follicles in the anal canal.…”

“…26 HS in the anal canal lies superficial to the internal sphincter and begins in the lower two-thirds of the canal, distal to the dentate line (the transition zone from columnar epithelium to squamous epithelium). 26 This corresponds with the distribution of apocrine glands and hair follicles in the anal canal. 26 If lesions are seen proximal to this area, disorders such as Crohn disease (CD) or a fistulous abscess should be considered.…”

“…26 If lesions are seen proximal to this area, disorders such as Crohn disease (CD) or a fistulous abscess should be considered. 26 CLINICAL STAGING Key points d Hurley's staging system is simple and relies on the subjective extent of diseased tissue d The Sartorius system is more sophisticated then Hurley's and is likely to supplant it as a means for conducting clinical trials…”

“…HS researchers generally accept this, but many authors have argued that certain locations appear to have sexual predilection. 2,7,8,11,13,15,17,[24][25][26][27][28] Perianal HS, for instance, seems to affect males more than females. 3 Some authors have suggested a higher prevalence of HS among African Americans.…”