Dorsal perforation of prepuce: a common end point of severe ulcerative genital diseases?
Severe ulcerative genital diseases can cause destruction of the prepuce, glans, or sometimes of the whole penis (phagedena). We observed a characteristic pattern of partial destruction of the prepuce as a result of a wide variety of ulcerative genital diseases. Five patients, two with severe genital herpes, one with hidradenitis suppurativa, and two with donovanosis presented with perforation on the dorsal surface of the prepuce. In four of them, the glans protruded through the defect and in one, the defect was not large enough to allow protrusion of the glans. In two patients, the preputial sac was obliterated. The relatively decreased blood supply of the prepuce is the probable explanation for perforation at this selective site. (+info)
Hidradenitis suppurativa: a treatment challenge.
Hidradenitis suppurativa is a chronic, recurrent, debilitating disease that presents with painful, inflamed lesions in the apocrine-gland-bearing areas of the body, most commonly the axillary, inguinal, and anogenital areas. Etiology traditionally has been attributed to occlusion of the apocrine duct by a keratinous plug; however, defects of the follicular epithelium also have been noted. Contributing factors include friction from axillary adiposity, sweat, heat, stress, tight clothing, and genetic and hormonal components. Multiple treatment regimens are available, including antibiotics, retinoids, corticosteroids, incision and drainage, local wound care, local excision, radiation, and laser therapy. However, no single treatment has proved effective for all patients. Radical excision of the defective tissue is the most definitive treatment. The psychological impact on the patient can be great, encompassing social, personal, and occupational challenges. This impact should be addressed in all patients with significant disease. (+info)
Inversa acne (hidradenitis suppurativa): a case report and identification of the locus at chromosome 1p21.1-1q25.3.
Acne inversa (hidradenitis suppurativa) is a chronic relapsing inflammatory skin disease characterized by recurrent draining sinuses and abscesses, predominantly in skin folds that carry terminal hairs and apocrine glands. The genetic basis for this disease is unknown. In this study, we performed a genome-wide scan in a four-generation Chinese family to map the chromosome location of the responsible gene. We first identified a locus at chromosome 1p21.1-1q25.3 with the maximum logarithm of odds (LOD) score of 3.26 at the marker D1S2624 (at recombination fraction=0.00). The other two-point LOD scores >/=3 were observed at markers D1S2695, D1S2726, D1S252, and D1S2777. Haplotype analysis localized this locus to a 76 Mb region flanked by D1S248 and D1S2711. This is the first locus for the inversa acne and will be a starting point towards understanding the molecular mechanisms of this disease. (+info)
A life-threatening multilocalized hidradenitis suppurativa case.
The patient was a 38-year-old man. He had been suffering from hidradenitis suppurativa (HS) for approximately 20 years. He had active lesions at both axillas, hip, scrotum, and perineum, and inactive lesions located behind the ears, lower abdomen, and posterior neck. He was monitored and treated at different branches; he continuously used antibiotics and was given steroids at times. Antibiotic resistance developed subsequently. His general situation was bad; vital signs were poor; and he was in a state of sepsis and preshock, so this case was regarded as life-threatening. Total excision was performed first on the lesion at the right axilla, then on the lesion at the left axilla, and the parascapular fasciocutaneous flap was reversed. A skin graft was applied to the triangular defect on the scapula. No relapse occurred. Then the lesions at the hip were managed. Broad excision was used twice with the patient under general anesthesia; because the lesions spread to the retrococcygeal and gluteal muscles, coccyx resection and partial gluteal muscle resection were implemented. The defect was eliminated with a progressive flap. At the intergluteal sulcus, small lesions emerging at the median line were debrided with the patient under local anesthesia, and together with secondary recovery, the disease was completely managed. Lesions at the perineum and scrotum and at both inguinal areas were broadly excised and grafted. No lesion has relapsed so far. One year later, Hodgkin's lymphoma was diagnosed, and the patient was treated with chemoradiotherapy easily, because there was no infective focus. The disease is in remission now. The patient weighs 110 kg, is healthy, and is working again. (+info)
Three fatal cases of squamous cell carcinoma arising in chronic perineal hidradenitis suppurativa.
INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic, inflammatory and suppurative disorder of skin bearing apocrine glands. The most severe complication is squamous cell carcinoma (SCC) and we here present three cases, all of which proved fatal, and review the past 40 years of published cases. PATIENTS AND METHODS: Three advanced cases of SCC arising in chronic HS have been referred for reconstructive surgery over the past 8 years. Another 28 cases published over the past 40 years were identified using a Medline search (search items in combination: hidradenitis, squamous, carcinoma). RESULTS: The male:female ratio was 4:1, most (61%) were perineal or buttock. We found no reports of SCC arising in axillary disease. The symptomatic history of HS prior to SCC diagnosis ranged from 3-50 years with a mean of 25 years. Age at diagnosis of SCC ranged from 27-71 years, and 15 patients (48%) died within 2 years of SCC diagnosis. CONCLUSIONS: We advocate that hidradenitis suppurativa arising in extra-axillary sites is a pre-malignant condition, and should not be treated conservatively; curative resection is the mainstay of management. (+info)
Clinical immunology review series: an approach to the patient with recurrent superficial abscesses.
Squamous cell carcinoma arising in Verneuil's disease.
BACKGROUND: Verneuil's disease or hidradenitis suppurativa is a chronic suppurative, and cicatricial inflammatory disease, mainly affecting apocrine-bearing area of the skin. Squamous cell carcinoma is an uncommon but a frightening complication of hidradenitis suppurativa. AIM: To report a new case of squamous cell carcinoma arising in Verneuil's disease. CASE REPORT: We reported a case of 60 year old man with a 30 years history of hidradenitis suppurativa in which squamous cell carcinoma arise. A wide surgical excision removing the tumour and leaving a large defect was performed. The patient had a well recovery, wounds healed well by primary intention. No recurrence observed at 18 months of follow up. CONCLUSION: Squamous cell carcinoma is an uncommon complication of hidradenitis suppurativa. Surgical excision represents also the treatment of choice. (+info)
A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa.