Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa

Scanner-assisted carbon dioxide laser surgery: a retrospective follow-up study of patients with hidradenitis suppurativa

BACKGROUND

The chronic fistulating lesions of hidradenitis suppurativa spread by contiguous growth, and all affected tissue needs to be surgically removed.

OBJECTIVE

The aim of our study was to evaluate a surgical method for treatment of Hurley stage II hidradenitis suppurativa (HS), the carbon dioxide laser rapid-beam optomechanical scanner system in continuous mode.

METHODS

Thirty-four patients were evaluated after treatment; 31 patients were women, and the mean age was 33.9 years (range, 15-55 years). All patients had had HS for a mean of 13.4 years (range 1-35 years) and more than 3 recurrences of suppurating lesions in the year before inclusion in the study. All lesions had been classified as Hurley stage II. The mean follow-up time after carbon dioxide laser surgery was 34.5 months (range, 7-87 months), and patients were later contacted by telephone about recurrences and the end results.

RESULTS

The mean healing time was about 4 weeks (range, 3-5 weeks). During follow-up, 4 of the 34 patients had recurrences at the surgical site, that is, locoregional HS. Thirty had no recurrences in the treated area, but in 12 cases de novo suppurating lesions, separated from the initial surgical site by >5 cm, developed. Twenty-five patients had flares of HS lesion(s) in an area other than the treated site. Eight had no recurrences.

CONCLUSION

Macroscopically controlled tissue-selective carbon dioxide laser treatment of HS is a fast, efficient treatment and well accepted by the patients.

Acne inversa (alias hidradenitis suppurativa)

Acne inversa is a recurrent, suppurative disease manifested by abscesses, fistulas, and scarring. Once considered to be a disease of the apocrine glands, it is actually a defect of follicular epithelium. Thus, the term hidradenitis suppurativa is a misnomer and should be abandoned. In cases of familial acne inversa, the pattern of transmission and number of affected individuals are consistent with autosomal dominant inheritance. Aetiological factors such as hyperandrogenism, obesity, smoking and chemical irritants are not consistently associated with the affection. Bacterial involvement is not a primary event in acne inversa, but is secondary to the disease process. Potential complications include dermal contraction, local or systemic infection due to the spread of microorganisms, systemic amyloidosis, arthropathy, and squamous cell carcinoma. As spontaneous resolution is rare and progressive disability is the rule, early definitive surgical intervention is advisable. The surgical procedure of choice in most cases is wide local excision and healing by secondary intention. Pharmacotherapeutic drugs, including synthetic retinoids and antiandrogens, do not prevent progression of the disease.

Surgical treatment of hidradenitis suppurativa

Hidradenitis suppurativa is a skin disease involving the apocrine sweat glands which often becomes chronic. The aetiology is not completely known, but the mainstays of medical treatment are antibiotics, which gives temporary relief but do not essentially alter the course of the disease. We describe our results of treating 138 affected patients by radical excision of the diseased areas between 1978 and 1999. Postoperative follow-up ranges from 3 months to 21 years; we compiled data from the patients' casenotes and circulated a questionnaire, which 116 patients completed. Median age at onset of disease was 23 years and the interval before radical surgery was 10 years. Altogether 367 affected sites were excised; most cases required skin grafting. There were no serious surgical complications. In 38 patients (33%) the disease recurred to some degree, and 14 of them required further operation. Six patients had a subsequent operation to improve the aesthetic result. Ninety-six of the patients (83%) answered that they would recommend the procedure to other patients under similar circumstances. In our opinion excision and skin grafting is a valuable treatment in cases of severe hidradenitis suppurativa.

Morbidity in patients with hidradenitis suppurativa

BACKGROUND

Although skin diseases are often immediately visible to both patients and society, the morbidity they cause is only poorly defined. It has been suggested that quality-of-life measures may be a relevant surrogate measure of skin disease. Hidradenitis suppurativa (HS) leads to painful eruptions and malodorous discharge and is assumed to cause a significant degree of morbidity. The resulting impairment of life quality has not previously been quantitatively assessed, although such an assessment may form a pertinent measure of disease severity in HS.

OBJECTIVES

To measure the impairment of life quality in patients with HS.

METHODS

In total, 160 patients suffering from HS were approached. The following data were gathered: quality-of-life data (Dermatology Life Quality Index, DLQI questionnaire), basic demographic data, age at onset of the condition and the average number of painful lesions per month.

RESULTS

One hundred and fourteen patients participated in the study. The mean +/- SD age of the patients was 40.9 +/- 11.7 years, the mean +/- SD age at onset 21.8 +/- 9.9 years and the mean +/- SD duration of the disease 18.8 +/- 11.4 years. Patients had a mean +/- SD DLQI score of 8.9 +/- 8.3 points. The highest mean score out of the 10 DLQI questions was recorded for question 1, which measures the level of pain, soreness, stinging or itching (mean 1.55 points, median 2 points). Patients experienced a mean of 5.1 lesions per month.

CONCLUSIONS

HS causes a high degree of morbidity, with the highest scores obtained for the level of pain caused by the disease. The mean DLQI score for HS was higher than for previously studied skin diseases, and correlated with disease intensity as expressed by lesions per month. This suggests that the DLQI may be a relevant outcome measure in future therapeutic trials in HS.

Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa

BACKGROUND

Hidradenitis suppurativa (acne inversa) is a chronic recurrent disorder characterized by abscessing inflammation, fistulating sinus tracts, and scarring. Predilection sites are the intertriginal regions. The severe course of the disease demands an early and curative treatment.

OBJECTIVE

The aim of this study was to review the effect of radical surgical excision concerning cure rate and potential complications within a large group of patients.

METHODS

We analyzed data for 106 patients suffering from hidradenitis suppurativa treated during the period 1980-1998. The mean duration of the disease was 7 years. In about 90% of the cases, two or more sites were affected. Inguinal (70.8%) and axillary regions (61.3%) were most commonly involved. All patients were treated by radical wide excision using intraoperative marking of sinus tracts with methylviolet solution. The method of reconstruction depended on the size and location of the defect. Median postoperative follow-up time was 36 months.

RESULTS

The overall complication rate was 17.8%. Most of these were minor complications such as suture dehiscence, postoperative bleeding, and hematoma. Wound infection occurred in only 3.7% of patients. The rate of recurrence within the operated fields was 2.5%. There was no relation between the surgical method of reconstruction and the rate of recurrence. Recurrence was related to the severity of the disorder.

CONCLUSION

Our results confirm early radical excision as the treatment of choice for hidradenitis suppurativa. Using intraoperative color-marking of sinus tracts, the recurrence rate is minimal. The method of reconstruction has no influence on recurrence and should be chosen with respect to the size and location of the excised area.