Advances in surgical treatment of hidradenitis suppurative. / åŒ–è„“æ€§æ±—è ºç‚Žå¤–ç§‘æ²»ç–—ç ”ç©¶è¿›å±•.

Hidradenitis suppurative is a chronic, refractory and recurrent dermatological disease. The disease should be managed by targeted surgical intervention on the basis of medical treatment. Currently, the surgical treatment methods include local treatments like incision and drainage, unroofing, laser therapy, intense pulsed light therapy, photodynamic therapy, as well as complete lesion resection such as skin-tissue saving excision with electrosurgical peeling and extended excision. The clearance range, therapeutic effect, postoperative complications, and recurrence risk vary among the different treatment methods. Local treatments cause less damage, but have high recurrence rates, and are mainly for mild to moderate hidradenitis suppurative patients. Complete lesion resections have relatively low recurrence rates, but may bring more surgical injuries, and postoperative reconstructions are needed, which are mainly for moderate to severe hidradenitis suppurative patients. In this article, the surgical treatment principles and various surgical treatment methods of hidradenitis suppurative are reviewed, to provide a reference for the diagnosis and treatment of this disease in clinical practice.

[Painful nodules on the soles in a pediatric patient: A diagnostic challenge]. / Nodulos plantares dolorosos tras ejercicio intenso en paciente pediátrica: Un reto diagnóstico.

INTRODUCTION: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. OBJECTIVE: To present a case that shows the main clinical and histological characteristics of this entity. CLINICAL CASE: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. CONCLUSIONS: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.

Lymphocytic hidradenitis: A distinctive histopathological finding of annular erythema of Sjögren syndrome.

BACKGROUND/OBJECTIVES: Lymphocytic hidradenitis is a non-specific histopathological feature observed in many dermatoses such as lupus erythematosus, morphea or scleroderma. When it occurs it is usually accompanied by the other distinctive histological features of those conditions. Isolated lymphocytic hidradenitis is uncommon and its clinical features and associated underlying medical conditions are still undetermined. METHODS: We performed a retrospective review of patients who clinically presented with annular erythema between 2000 and 2016. Altogether, 30 patients with a histopathological presentation of isolated lymphocytic hidradenitis were identified. Their following characteristics were recorded: clinical features, number and localisation of lesions, serology and other associated medical conditions. RESULTS: Isolated lymphocytic hidradenitis was found most frequently in middle-aged women. Most patients (n = 28, 93%) presented with many annular erythematous patches and plaques with mild pruritus; 22 (73%) had the SS-A antibody and 17 (57%) met the diagnostic criteria of Sjögren syndrome. Among these patients, 11 had primary and six had secondary Sjögren syndrome associated with systemic lupus erythematosus. Altogether 15 (50%) patients tested positive for a high titre of the antinuclear autoantibody. Other underlying diseases identified during the follow-up period include cryoglobulinaemia, angioimmunoblastic T-cell lymphoma, autoimmune hepatitis, hepatitis C infection and toxic thyroid goitre. CONCLUSIONS: Lymphocytic hidradenitis is a microscopic finding associated with annular erythemas of Sjögren syndrome. Systemic survey for sicca symptoms and work up for autoimmune diseases, including antinuclear antibodies, SS-A, SS-B antibodies, cryoglobulin, lymphoma, viral and autoimmune hepatitis should be performed to facilitate the correct diagnosis.

Neutrophilic Eccrine Hidradenitis in an HIV-Infected Patient.

A 35-year-old man presented with a 2-day history of a maculopapular pruritic eruption that had affected his general state of health and was accompanied by chills. The patient had been diagnosed with HIV in 2008, and was undergoing treatment with a combination of emcitrabine/tenofovir plus nevirapine. He had a current viral load of 1,558,160 copies/mL and a lymphocyte count CD4+ count of 230/mm3. Physical examination revealed an eruption involving the face, nape of the neck, chest, abdomen, extremities, palms, and soles. This was characterized by erythematous papules approximately 2 mm in diameter coalescing on the palms and soles, where they formed plaques (Figures 1 and 2).

Acquired generalized anhidrosis: review of the literature and report of a case with lymphocytic hidradenitis and sialadenitis successfully treated with cyclosporine.

We report a case of acquired generalized anhidrosis successfully treated with cyclosporine. A skin biopsy showed T cell infiltration around the sweat glands and labial biopsy revealed lymphoplasmacytic infiltration around the minor salivary gland, suggesting an underlying autoimmune disease such as Sjögren's syndrome. Administration of cyclosporine markedly improved the patient's condition and sympathetic skin response; thus cyclosporine may be effective for treating anhidrosis in patients with autoimmune disorders.

Perineal reconstruction with local flaps: technique and results.

BACKGROUND: Wide excision of perineal lesions, often including the entire anal canal, may be necessary for benign and malignant conditions. Closure of these large defects is challenging, especially when continence is a goal. The aim of this study was to assess our experience with local flap closure of large perineal defects. METHODS: From 1994 to 2009, 20 patients underwent wide perineal and/or anal canal excisions and reconstruction using local flaps. Mean age was 45 years (range 20-65 years), 13 were male, and 8 (40 %) were immunocompromised. Primary indications included anal or perineal squamous cell carcinoma-(n = 12), Buschke-Lowenstein tumor (n = 3), and anal intraepithelial neoplasia (n = 3), hidradenitis, stenosis, ectropion, and traumatic cloaca repair (n = 1 each). Primary procedures included wide local excision of large neoplastic lesions-(n = 15) (mean size 10 cm, range 5-18 cm), abdominoperineal resection (APR) (n = 2), perineoplasty with sphincteroplasty-(n = 1), and others-(n = 2). All were reconstructed with bilateral local flaps (V-Y 18, S 2). Thirteen had complete excision of the anal canal to the anorectal ring preserving the sphincters. Six (30 %) had ostomies; 2 with APR and 4 temporary. RESULTS: There were no perioperative deaths. Mean hospital stay was 4.2 days. Follow-up averaged 35 months (range 3-87 months) in survivors. Five patients died during follow-up; 2 of complications of acquired immune deficiency syndrome (AIDS) and 3 of cancer (2 treated palliatively). Wound dehiscence occurred in 6 (30 %) patients: in 3 cases, this was minor dehiscence and healed quickly; in 3 cases, it was major dehiscence and occurred in the 2 radiation/APR patients and in one patient with advanced AIDS. Radiation was the only significant risk factor (P < .05). Twelve of 14 eligible patients with long-term follow-up and an intact anal canal are fully continent, and 2 are partially continent (1 traumatic cloaca; 1 the same as before surgery). CONCLUSION: Local flap reconstruction of the perineum and anal canal is an excellent method of managing large perineal defects. Most heal primarily, even in immunocompromised patients, and continence may be preserved. Local flaps should be avoided in irradiated patients.

Surgical management of acquired buried penis and scrotal lymphedema: A retrospective review.

Acquired buried penis is a condition that can have detrimental physical and psychological consequences for patients. Factors such as elevated BMI, chronic scrotal lymphedema, hidradenitis suppurativa, and chronic inflammation can lead to the condition. Surgical intervention is the treatment of choice for advanced disease. Following IRB approval, a retrospective chart review was performed for patients with a diagnosis of acquired buried penis who required surgical intervention. Details of patient history, surgical management including intraoperative and post-operative photography, and complications were reviewed. Seven patient cases were reviewed. The average age at time of surgery was 44 with a mean weight of 344 pounds and an average BMI of 48. Severe scrotal lymphedema and hidradenitis were common concurrent comorbidities. Concurrent scrotoplasty and infraumbilical panniculectomy were standard parts of the operations. Native glans skin was salvageable in all but one case. Penile shaft skin was reconstructed with skin grafts or adjacent tissue transfer. 88% of the cases had some element of wound dehiscence post-operatively. Surgical management of an acquired buried penis can be challenging. The patient demographic with the disease is frequently complicated by morbid obesity, concurrent lymphedema, or hidradenitis. Post-operative complications are expected. The surgical techniques presented can aid in simplifying the management of this challenging surgical population.

Letter: Neutrophilic eccrine hidroadenitis with atypical findings.

Neutrophilic eccrine hidradenitis (NEH) was originally described as a distinctive dermatosis occurring in patients undergoing chemotherapy, especially associated with the use of cytarabine in the treatment of acute myelogenous leukemia (AML). This disorder is characterized by a neutrophilic infiltrate around the eccrine glands and coils and is associated with necrosis. However, atypical findings in the histology have been reported. To the best of our knowledge, leukocytoclastic vasculitis has not been described in association with NEH. We hypothesize that a toxic effect of cytarabine may damage the vessel wall to some extent, causing a vasculitic phenomenon.

Marjolin ulcer arising within hidradenitis: a case report and literature review.

This is a report of a patient with squamous cell carcinoma discovered in a bed of longstanding (>20 years) hidradenitis suppurativa. A literature search demonstrates this to be an entity with potentially devastating sequelae if not expediently diagnosed and treated. In light of the possibility of malignant transformation, the hidradenitis specimen and any suspicious lesions in proximity should be sent to pathology for thorough assessment.

[An uncommon cause of delayed walking: idiopathic palmoplantar hidradenitis]. / Une cause inhabituelle de retard d'acquisition de la marche : l'hidradénite palmo-plantaire idiopathique.

INTRODUCTION: Idiopathic palmoplantar hidradenitis is an uncommon neutrophilic dermatosis, occurring in children and young adults. Its pathogenesis is incompletely understood. It is characterized by spontaneous resolution, but it can relapse in 50% of cases. We describe a case of a child with atypical idiopathic hidradenitis remarkable for its impact on his motor development. OBSERVATION: A 3-year-old boy was admitted to the pediatric unit for etiological assessment of delayed walking. Medullary MRI and TSH were normal. He was referred to a dermatologic consultation for recurrent and painful palmoplantar lesions, giving an equinus antalgic posture. Examination found erythematous tender plantar nodules. The palms were not affected. The exam was otherwise normal. Diagnosis of idiopathic plantar hidradenitis, pressure urticaria, and plantar erythema nodosum were discussed, leading to a skin biopsy. The histopathologic findings of nodular, neutrophilic infiltrates around the eccrine glands confirmed the diagnosis of idiopathic plantar hidradenitis. Anti-inflammatory treatment was given, followed by complete resolution of the lesions, but persistent equinus posture. COMMENTS: Idiopathic palmoplantar hidradenitis is an uncommon neutrophilic dermatosis, distinct from neutrophilic eccrine hidradenitis. It corresponds to neutrophilic infiltrates of the eccrine sweat glands. It is more frequently reported in children and young adults with no medical history. Its pathogenesis is not completely explained. The lesions are usually painful, hindering walking for a few days or even delaying it, as for our patient. These lesions typically involute, but they may recur in more than half of the cases. CONCLUSION: Through this observation, we highlight the atypical impact of idiopathic hidradenitis and the value of a dermatological examination in case of delayed walking.

Nodulos plantares dolorosos tras ejercicio intenso en paciente pediátrica: un reto diagnóstico / Painful nodules on the soles in a pediatric patient: a diagnostic challenge

Resumen: Introducción: La Hidradenitis palmoplantar ecrina idiopática (HPPI) es una dermatosis neutrofílica infrecuente, que cursa con nódulos eritematosos dolorosos de comienzo brusco en regiones plantares o palmoplantares, en niños que no tienen otra enfermedad subyacente. Objetivo: Presentar un caso que ilustra las principales características clínicas e histológicas de la HPPI. Caso Clínico: Niña de 11 años evaluada por nódulos eritematovioláceos dolorosos en planta de pie derecho de 48 horas de evo lución y fiebre de hasta 38,2 °C, sin antecedentes de interés salvo hiperhidrosis y práctica intensa de ejercicio en los días previos. Ante la sospecha clínica de HPPI se realizó biopsia cutánea, que mostró infiltrado inflamatorio neutrofílico alrededor de glándulas sudoríparas ecrinas y abscesos de neutrófilos, confirmando el diagnóstico. Se indicaron antiinflamatorios no esteroidales orales y reposo, con resolución de las lesiones en 7 días. Conclusiones: Este caso demuestra los aspectos más importantes de la HPPI. Esta entidad en muchos casos es infradiagnosticada, dado que puede confundirse con otras patologías que también cursan con nódulos acrales dolorosos, pero tienen distintas implicacio nes patogénicas y terapéuticas. Identificar apropiadamente la HPPI permite evitar la alarma innece saria, tanto en pacientes y sus padres, como en los propios dermatólogos y pediatras.

Abstract: Introduction: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. Objective: To present a case that shows the main clinical and histological characteristics of this entity. Clinical Case: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. Conclusions: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.

Musculoskeletal features of acne, hidradenitis suppurativa, and dissecting cellulitis of the scalp.

This article describes the various forms of acne and the clinical and radiographic features of the associated musculoskeletal manifestations. Occasionally, acne may occur together with hidradenitis suppurativa and dissecting cellulitis of the scalp, the so called "follicular occlusion triad." The current understanding of the etiology of these conditions and their treatment are also reviewed.

Juvenile neutrophilic eccrine hidradenitis: a vasculitis-like plantar dermatosis.

Neutrophilic eccrine hidradenitis is a variety of neutrophilic dermatosis described in patients with different neoplasms, most often leukaemia, and different chemotherapy regimens. It is characterised by neutrophilic infiltration of the eccrine coils of sweat glands. Recently it has been described in healthy juveniles, involving primarily the soles of the feet. We describe five new cases of juvenile neutrophilic eccrine hidradenitis all showing a good prognosis or a self-limiting course.

A case of pyoderma vegetans and the follicular occlusion triad.

A case of pyoderma vegetans (PYV) and hidradenitis suppurativa (HS) is described. Our patient had a previous history of perifolliculitis capitis abscedens et suffodiens and acne conglobata. Direct immunofluorescence findings ruled out pemphigus vegetans and suggested a potential pathogenic mechanism.

Neutrophilic eccrine hidradenitis in a patient with Behçet's disease.

Patients with Behçet's disease may develop multiple mucocutaneous manifestations, several of which are mediated by neutrophils. These include aphthous ulcers, pseudofolliculitis, acneform lesions, and pathergy. We report another neutrophil-mediated disorder, neutrophilic eccrine hidradenitis (NEH), in a patient with Behçet's disease. NEH should be added to the list of mucocutaneous lesions that may be seen in patients with Behçet's disease.

[Eccrine neutrophilic hidradenitis: idiopathic plantar form in children]. / Hidradénite eccrine neutrophilique: forme plantaire idiopathique de l'enfant.

UNLABELLED: In this study, two cases have been reported of idiopathic plantar hidradenitis, an uncommon dermatological pathology with a spontaneous favorable outcome. OBSERVATIONS: Two children aged 12 and 14 years presented with a painful papulo-nodular plantar rash with major functional impairment. The diagnosis of idiopathic plantar hidradenitis was considered, and then confirmed in one case by plantar biopsy. Non-steroidal antiinflammatory drugs, associated with paracetamol in one case were administered. The symptoms disappeared spontaneously within a few days in both cases, without any recurrence. CONCLUSION: A knowledge of the symptoms connected with plantar hidradenitis in the child allows a rapid diagnosis to be made without hospitalization or further medical examination. Analgesic treatment and rest seem to be the only useful approaches. Biopsy to investigate eccrine gland infiltration by neutrophils can only be proposed in the case of an abnormally prolonged duration or an atypical presentation of this pathology.

[Neutrophilic eccrine hidradenitis associated with relapse of acute myeloblastic leukemia]. / Hidradénite eccrine neutrophilique associée à une rechute de leucémie aiguë myéloblastique.

BACKGROUND: Neutrophilic eccrine hidradentitis is a recently described clinical entity. Most reported cases have occurred in patients given chemotherapy for acute myelogenous leukemia, suggesting a drug induced mechanism. Some authors have considered however that neutrophilic eccrine hidradenitis belongs to the group of neutrophilic dermatoses. CASE REPORT: We observed neutrophilic eccrine hidradentitis in a 48-year-old man which developed when he suffered a relapse of acute leukemia. He had not been given chemotherapy in the preceding months. DISCUSSION: This case favors the hypothesis that neutrophilic eccrine hidradenitis is associated with myeloid hemotology disorders and not a complications secondary to treatment.