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Surgical treatment options for hidradenitis suppurativa and critical review of own experience
Author(s) -
Marsch Wolfgang Christian
Publication year - 2006
Publication title -
experimental dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.108
H-Index - 96
eISSN - 1600-0625
pISSN - 0906-6705
DOI - 10.1111/j.0906-6705.2006.0436k.x
Subject(s) - medicine , hidradenitis suppurativa , acne , axilla , dermatology , skin grafting , perineum , apocrine , abscess , lamellar ichthyosis , erythema , isotretinoin , hyperkeratosis , surgery , disease , pathology , breast cancer , cancer , ichthyosis
HS (acne inversa) is a chronic, progressive, initially inflammatory, ultimately a fistulating and scarring disease affecting apocrine gland‐bearing skin areas. Late phases afford a broad surgical removal of affected skin areas including subcutaneous fatty tissue, with secondary mesh grafting after a period of granulation tissue formation. Fifty‐three patients have been treated surgically at our Dermatology Department. Long‐term results are excellent concerning satisfaction of the patients and functional objectives. Local recurrences or development of new lesions in formerly unaffected areas were noticed only in some patients who did not stop smoking. Patient details were as follows: gender distribution: male (M) 20 (38%), female (F) 33 (62%), age: M 19–62 (average 40.7), F 15–56 (average 35.4), onset: M 16–57 (32.2), F 8–50 (25.5), duration: 3 months to 37 years (8.0), F 6 months to 37 years (9.9). Sites mainly affected: axillary and perigenital. Specific regions for men: perineum and rima ani, for women: inguinal, submammary and abdominal. Multiple anatomical regions involved: men 40%, women 91%. Familiarity 0.4%. Associated acne papulo‐pustulosa or nodulo‐cystica (=conglobata): 19%. Cigarette smokers: men 100%, women 67%. Excised material from each operation was carefully examined histologically. The results endorse the concept of ‘acne inversa’ by recognizing a perifollicular accumulation of lymphocytes simultaneously at different infrainfundibula of terminal hair follicles. However, a follicular hyperkeratosis seems secondary to this, follicular perforation, and a combination of sinus, abscess and scar formation are most obviously tertiary events. Therefore, HS seems to be an inflammatory, probably an immunological disease with an initially strictly dermal target, even followed by an intradermal horizontal propagation. Laser flux imaging could visualize the subclinical peripheral extension of the basically dermal perifollicular inflammation. Biologics may have a beneficial effect on these early or perpetuating inflammatory events; however, thus far surgery remains the first‐line therapy in late phases of the disease.