Penile and scrotal lymphedema associated with hidradenitis suppurativa: Case report and review of surgical options

Abstract

Lymphedema is the result of an alteration of the lymphatic drainage, and its most common worldwide cause is filariasis. In our practice usually is associated to neoplasic, inflammatory and granulomatous processes, radiotherapy, hydroelectrolytic disbalances, and idiopathic. It can affect any part of the body, including the penis and scrotum. The genital lymphedema is a rare presentation, it corresponds to 0.6% of lymphedema. However, causes serious functional, social and emotional limitations for the patient. Too often have pain, recurrent infections, sexual dysfunction, cosmetic deformity, sometimes it limits mobility and ambulation. Although there are several treatment options, both medical and surgical, it has not been found ideal for this disease. We present a 43 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa, it limits his normal activity. The patient was referred to our center after unsuccessful medical treatment (doxycycline and clindamycin cycles). Surgical treatment consisted of total excision of the skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. The result was satisfactory both functionally and aesthetically.

Genital Lymphedema and How to Deal with It: Pearls and Pitfalls from over 38 Years of Experience with Unusual Lymphatic System Impairment

“…Usually, lymphedema involves upper or lower limbs, and Wuscheria banrofti infection represents the most common cause worldwide [3]. Filariasis is the most frequent cause even of GL, but the involvement of external genitalia represents an uncommon lymphedema presentation, accounting for 0.6% of lymphedema cases worldwide [12]. Due to the rarity of GL, diagnostic criteria and modality and timing of therapies were debated without reaching a consensus to date [15].…”

“…Lymphedema management becomes even more difficult and obscure when dealing with unusual presentations, such as genital lymphedema (GL). The involvement of external genitalia represents an uncommon form, accounting for 0.6% of lymphedema cases worldwide [12]. Lymphatic obstruction secondary to filariasis is the most common cause, but other clinical conditions such as cancer therapies, hidradenitis suppurative, primary presentations or heart, liver and kidney dysfunctions are more common causes in the developed countries.…”

Hidradenitis suppurativa: Current understanding, diagnostic and surgical challenges, and developments in ultrasound application

“…Musculoskeletal conditions such as back pain and axial spondyloarthropathy have been also linked to HS . Lymphedema, another disabling and difficult to treat complication of HS, usually affects the anogenital region and has been noted in several cases …”

The role of biologic treatment in special scenarios in hidradenitis suppurativa: Facial and nape phenotype, dissecting cellulitis of the scalp, and lymphedema

“…Its management is generally complex, showing variable response to therapies, with the need for biologic treatments in a high percentage of cases. [3][4][5][6] The aim of this study is to identify those patients with atypical HS who have an inadequate response to first-line antibiotics within a cohort of patients with HS, and to describe the efficacy of the biologic therapy and adjuvant therapeutic interventions used.…”