Reflex sympathetic dystrophy with hidradenitis suppurativa exacerbation: a case report

Hidradenitis suppurrativa (acne inversa) as a systemic disease

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic follicular occlusive skin disorder characterized by recurrent abscesses, draining sinuses, and scarring, with a multifactorial pathogenesis. The answer to the question whether HS may be considered a systemic disease relies on the presence of accompanying systemic manifestations, on the proof of association with other diseases or conditions, and on the occurrence of systemic implications. We address these questions based on a systemic review of the existing literature. There are several reports in the literature of the coexistence of HS with other diseases, including pyoderma gangrenosum, PASH syndrome, Adamantiades-Behcet's disease, spondylarthropathy, Crohn's disease, SAPHO, pachyonychia congenita, Dowling-Degos disease, and the keratitis-ichthyosis-deafness (KID) syndrome. Case series exist only for Crohn's disease, while most other reports are anecdotal, thus, not providing high-quality scientific evidence. Based on well-designed studies, HS has been associated with the metabolic syndrome and with excess body weight or obesity. The link between HS and systemic associations may be attributed to common genetic or environmental factors or shared inflammatory pathways.

Hidradenitis suppurativa: a comprehensive review

Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor-alfa inhibitors have given clinicians more options against this difficult disease.

Report of a focus group survey of current practice in the therapeutic treatment of Complex Regional Pain Syndrome in the United Kingdom

Complex Regional Pain Syndrome (CRPS) typically affects the hand following trauma. It is characterised by pain, altered sensation, motor disturbance, oedema, functional limitation and psychological disturbance. There is no definitive curative treatment for CRPS and controversy exists regarding the most effective combination of interventions for the treatment of this syndrome (Siddiqui et al 2001).

A study was commissioned in 2006 to explore the therapeutic interventions being implemented with patients with CRPS in the UK. Sixty therapists at the British Association of Hand Therapists annual conference consented to participate in focus group discussions. Categories were established to identify all therapeutic modalities currently used by participants. Therapists utilised the following therapeutic techniques: functional activity, exercise, education, support, sensory re-education, desensitisation, stress loading, pressure garments, mirror visual feedback, splints and psychological strategies, amongst others.

The identified interventions were then reviewed against evidence in the recent literature. There is insufficient evidence to support the use of a single set of multidisciplinary interventions (Stanton-Hicks et al 2002) to address the primary long-term goals of functional restoration and pain relief. This study has, however, highlighted that this is achieved through the treatment of individual symptoms, using multiple therapeutic interventions and algorithms in a multidisciplinary approach.