Surgical treatment of hidradenitis suppurativa

Banerjee, Arundhati

doi:10.1002/bjs.1800790905

Cited by 95 publications

(72 citation statements)

References 65 publications

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“…It represents a therapeutic challenge for surgeons, dermatologists and general practitioners. A well-established treatment of severe cases consists of wide local excision and healing by secondary intention [5]. …”

Section: Introductionmentioning

confidence: 99%

Cigarette Smoking as a Triggering Factor of Hidradenitis suppurativa

et al. 1999

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Background: Hidradenitis suppurativa is a chronic inflammatory skin disease involving the axillary, inguinal and anogenital regions and sometimes, in addition, the submammary or sacral areas. The etiology of this condition is unknown. Objective: A matched-pair case-control study was performed to evaluate the influence of smoking habits on the manifestation of this disease. Methods: Patients who had received surgical treatment for hidradenitis suppurativa in two dermatological centers completed a questionnaire dealing with family history, course of the disease and smoking habits. To form a randomized matched-pair control group, an equal number of patients admitted for various other skin diseases such as atopic dermatitis, varicose veins, skin tattoos, alopecia areata or melanoma was matched for sex and age and evaluated for smoking habits. Statistical analysis was performed by use of several χ² tests in a cross-table setting. Moreover, a comparison to the expected smoking prevalence in Germany based on national statistics was performed. Results: Out of 84 patients treated for hidradenitis suppurativa, 63 subjects (27 men, 36 women) completed the questionnaire. The rate of active cigarette smokers was 88.9% (56 patients), whereas 4 subjects (6.4%) had never smoked. 3 patients (4.8%) stated to be ex-smokers, but 2 of these had quit smoking only recently and after onset of the disease. The rate of smokers in the matched-pair control group was 46%. The significantly higher proportion of active smokers among patients with hidradenitis suppurativa can be expressed by an odds ratio of 9.4, the calculated 95% confidence interval was 3.7–23.7 (p < 0.001). The expected smoking prevalence in Germany was 26.7% according to national statistics. 73% of our patients had no family history of hidradenitis suppurativa whereas 27% reported at least one affected first-degree relative. Conclusion: From the exceedingly high rate of smokers among patients with this condition we conclude that cigarette smoking is a major triggering factor of hidradenitis suppurativa. Remarkably, the disease can be categorized as a smoking sequel that is neither of vascular nor neoplastic nature. Because familial occurrence was rather rarely reported, and because an environmental factor in the form of cigarette smoking appears to be of crucial importance to trigger the disease, we assume that the genetic basis of hidradenitis suppurativa is polygenic rather than mendelian. Smoking cessation should be encouraged particularly in patients with hidradenitis suppurativa although it is unknown whether this improves the course of the disease.

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Section: Introductionmentioning

confidence: 99%

Cigarette Smoking as a Triggering Factor of Hidradenitis suppurativa

et al. 1999

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“…There is a need for a radical debridement that plays a major role in avoiding recurrence and chronicity of the disease [3,[19][20][21][22][23]. Therefore, a radical excision of the affected areas should be the primary concern.…”

Section: Discussionmentioning

confidence: 99%

Reconstructive options in severe cases of Hidradenitis suppurativa

et al. 2010

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AbstractHidradenitis suppurativa is a chronic, debilitating inflammatory disease of apocrine glands characterized with abscesses and nodular lesions. The treatment of Hidradenitis suppurativa consists of topical antibacterial or antiseptic solutions, systemic antibiotics, steroids, hormonal therapy, anti-tumor necrosis factor, and various surgical procedures. In this report, we present a series of 14 cases with severe Hidradenitis suppurativa. Surgical options are reviewed to show the best outcomes in the long term. A total of 14 patients (9 female, 5 male) were treated for advanced cases of Hidradenitis suppurativa. They underwent excision of the affected regions followed by reconstruction. The reconstruction methods consisted of split-thickness skin grafting and various cutaneous and myocutaneous flaps. There was no flap necrosis or dehiscence. One patient developed contracture in the axilla, for which he underwent release surgery. There were recurrences in 4 cases. There was no limitation of the arm movements in cases with flap reconstruction. In the long-term, they were satisfied with the results. In conclusion, incision and drainage should be avoided because it is of limited value. Surgical removal of the involved tissue should be the first treatment of choice. Depending on the defect following excision, local flaps should be preferred over the grafts for recurrence prevention.

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“…A sebek szabadon hagyása és másodlagos sebgyógyulása csak a 140 cm 2 -nél kisebb sebek esetében javasolt. Hátránya a hosszú gyógyulási idő (6-12 hét), a tervezettnél nagyobb mértékű hegesedés és a kontraktúrák kialakulása (53)(54)(55)(56). A hidradenitises csomók akut gyulladása esetén szükség lehet a feszülő, fluktuáló csomók bemetszésére és kitisztítására elsősorban palliatív céllal, a fáj-dalom rapid csökkentésére.…”

Section: Sebészi Kezelésunclassified

Hidradenitis suppurativa: why isn’t it a form of acne?

Törőcsik¹,

Kinyó²,

Kovács³

et al. 2016

BVSZ

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ÖSSZEFOGLALÁSKey words: acne inversa, acne vulgaris, hidradenitis suppurativa 1. Patogenezis Acne inversa: miért nem acne és nem is hidradenitis?A betegség korábbi nevével, az acne inversával joggal leszámolva, hisz nem ott, nem akkor és nem úgy jelenik meg, mint a serdülőkori acne, sokak számára a jellegzetes lokalizációból adódóan egyértelmű patogenetikai tényező-ként az apokrin mirigyek foglalták el a központi helyet. A tünetek típusos intertriginózus megjelenése kétséget kizá-róan rámutat az adott terület jellegzetességeinek szerepére, melyek nagyban hozzájárulhatnak a betegség kialakulásá-hoz. Számos elmélet született már, részleges magyarázatot adva a hidradenitis suppurativa (HS) patogenezisére, mint például a fokozott mechanikai irritáció szerepe, vagy a terület eltérő higiénés jellemzői, immunológiai sajátossá-gai, melyben a fokozott nedvesség kaphat központi szerepet. Ugyanakkor a szövettani vizsgálatok alapján az apokrin mirigyek csak az előrehaladott formákban voltak érint-ve és akkor is sokkal inkább a végpontjai mint sem aktív szereplői voltak a patológiai folyamatoknak (1).Az utóbbi évek kutatásai a faggyúmirigyek szerepére is ráirányították a figyelmet, melyhez nagyban hozzájárultak azok a szövettani leletek, melyek a faggyúmirigyek elpusztulását már a HS kezdeti stádiumában leírták (2). A szövet-tani minták elemzésének másik szembetűnő lelete az acné-ből jól ismert follicularis hiperkeratinizáció/okklúzió volt, mely a folliculusok kitágulásához majd roncsolódásához vezet, így a baktériumokban gazdag törmelék a dermist infiltrálva annak gyulladását eredményezi felvetve, hogy a baktériumok és a különböző gyulladásos útvonalak éppúgy fontosak lehetnek ebben a betegségben is (1. ábra). A gyulladásban szerepet játszó sejteken az acnéban ismerthez hasonlóan, szintén fokozottan vannak jelen a Toll-like 129

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Surgical treatment of hidradenitis suppurativa

Cited by 95 publications

References 65 publications

Cigarette Smoking as a Triggering Factor of Hidradenitis suppurativa

Cigarette Smoking as a Triggering Factor of Hidradenitis suppurativa

Reconstructive options in severe cases of Hidradenitis suppurativa

Hidradenitis suppurativa: why isn’t it a form of acne?

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