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.

Management of severe hidradenitis suppurativa with biologic therapy and wide excision

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular occlusive disease that involves the intertriginous areas. Treatment methods include conventional topical and systemic medication, radiotherapy, biologic agents, and surgical excision. Of late, there has been an increased focus on the use of biologic agents in patients with moderate to severe HS. Here, we present the case of a 46-year-old man with Hurley stage III HS for whom wide excision was ultimately curative, after aggressive medical therapy with the use of infliximab and adalimumab had succeeded in limiting the body surface area affected by the disease. This case demonstrates the effective treatment of severe HS with a combination of biologic therapy and surgery.

Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities

Hidradenitis suppurativa is a chronic inflammatory skin condition associated with an increased prevalence of individual metabolic conditions such as insulin resistance, obesity, hyperlipidemia, hypertension, and with the metabolic syndrome, as a constellation of these risk factors. This places affected patients at an increased risk of early cardiovascular morbidity and mortality. Moreover, many of the therapeutic options, including the newer biologics, used in the treatment of hidradenitis suppurativa have both beneficial and adverse metabolic effects. Therefore, it is critical for physicians to consider the complex interactions between the disease process and the treatment options in the holistic management of these patients with an intrinsically higher risk of metabolic consequences. Other chronic systemic inflammatory diseases such as psoriasis and rheumatoid arthritis have been studied more extensively with regard to their associations and share an underlying link with the metabolic syndrome; we can draw upon the existing knowledge in our understanding and management of hidradenitis suppurativa.

Comentario a: “Hidrosadenitis supurativa: nuevas oportunidades para una enfermedad dermatológica huérfana” / Comment on “Hidradenitis Suppurativa: New Opportunities for an Orphan Skin Disease”

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[Expedience of application of a dietic therapy in treatment of purulent-septic diseases of soft tissues].

The results of investigation of the dietotherapy impact on the course of purulent-septic process in soft tissues were analyzed. There were operated 58 patients, to 38 of them a certain diet was prescribed. Immediate impact of the diet therapy on the wound process course was established, what was demonstrated by reduction of duration of the earning capacity loss in patients, who have followed a special diet, by 2.58 days.

Efectividad de la terapia fotodinámica con ácido 5-aminolevulínico en el tratamiento de la hidrosadenitis supurativa. Serie de 5 casos / Effectiveness of 5-Aminolevulinic Acid Photodynamic Therapy in the Treatment of Hidradenitis Suppurativa: A Report of 5 Cases

La hidrosadenitis supurativa (HAS) se ha definido como una enfermedad inflamatoria crónica, recurrente y debilitante, que compromete todo el folículo piloso. Varias alternativas terapéuticas, incluida la terapia fotodinámica, han sido utilizadas, con resultados variables y altas tasas de recurrencia. El presente trabajo muestra la evaluación de severidad, calidad de vida y seguridad de una serie prospectiva de 5 pacientes con HAS moderada o severa, sometidos a terapia fotodinámica, utilizando ácido 5-aminolevulínico (ALA) y luz 635 nm. Se evaluó la efectividad del tratamiento con el score de severidad de Sartorious, índice de calidad de vida (DLQI) y una escala visual analógica (EVA) para dolor y actividad de la enfermedad. Los pacientes mostraron una mejoría significativa en las 3 variables estudiadas, con efectos visibles que se mantenían a las 8 semanas, sugiriendo que esta terapia podría ser efectiva en HAS refractaria a terapias convencionales, disminuyendo la gravedad y mejorando la calidad de vida de los pacientes

Hidradenitis suppurativa has been described as a chronic, recurrent, and disabling inflammatory disease involving the entire hair follicle. Several treatments, including photodynamic therapy, have been used, but the results have been inconsistent and recurrence is high. In this prospective study, we evaluated disease severity, quality of life, and treatment tolerance in 5 patients with moderate to severe hidradenitis suppurativa treated with photodynamic therapy using 5-aminolevulinic acid and a 635-nm light source. Treatment effectiveness was evaluated using the Sartorius severity score, the Dermatology Life Quality Index, and a visual analog scale for pain and disease activity. Significant improvements were observed with all 3 instruments and the effects remained visible at 8 weeks. Our results suggest that photodynamic therapy with 5-aminolevulinic acid and a light wavelength of 635 nm could reduce disease severity and improve quality of life in patients with difficult-to-treat hidradenitis suppurativa

Carcinoma verrucoso sobre hidrosadenitis supurativa perianal. Presentación de un caso y revisión bibliográfica / Verrucous carcinoma complicating perianal hidradenitis suppurativa. Case report and literature review

La hidrosadenitis supurativa es una enfermedad inflamatoria crónica que afecta a las glándulas apocrinas. Al igual que en otras enfermedades inflamatorias crónicas de la piel pueden producirse cambios degenerativos. El carcinoma escamoso es la neoplasia maligna descrita con más frecuencia siendo excepcional el hallazgo de su variedad bien diferenciada denominado carcinoma verrucoso. Desde 1988, en nuestro hospital se han intervenido 44 pacientes diagnosticados de hidrosadenitis supurativa, de los cuales 15 presentaban una forma masiva de la enfermedad. Durante este periodo tan solo un paciente atendido en nuestra unidad de coloproctología por afectación perianal presentó degeneración maligna hacia un carcinoma verrucoso. Presentamos este caso y comentamos las peculiaridades clínicas y terapeúticas de esta situación tan poco frecuente (AU)

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