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Basic dermatology in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Kalyani Marathe, Kathleen Ellison
Treatment of hidradenitis should be based on individual symptoms. Lifestyle modifications including weight loss and smoking cessation are recommended for HS patients who are overweight or current smokers. Topical antibacterial washes such as benzoyl peroxide and chlorhexidine are often recommended. Topical antibiotics such as clindamycin 1% lotion or solution are also used. Oral antibiotics, especially tetracyclines, are used to reduce inflammation. It has also been suggested that oral zinc gluconate can induce clinical improvement or remission in patients with mild to moderate HS.24 Biologic medications are now being used for the treatment of HS. Adalimumab is approved for use for moderate to severe HS in adults. Anakinra and ustekinumab are also being studied for the treatment of HS. Carbon dioxide laser treatment has also been effective. For acute, limited flares of hidradenitis or for persistent nodules, intralesional triamcinolone (5–10 mg/mL) is often used for short-term relief of symptoms. However, if infection is suspected, intralesional steroids are contraindicated.25 While incision and drainage of nodules can provide pain relief, this treatment is associated with recurrence of the lesions.26 For persistent cases, deroofing of sinus tracts or surgical excision may be necessary.22
Pilonidal Sinus
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Hidradenitis is often associated with pilonidal disease, and when this condition affects the gluteal region, there will almost inevitably be some degree of pilonidal disease. Patients may present with chronic sepsis in the subcutaneous tissue of both buttocks that often has been present for many years. When pilonidal disease is associated with bilateral sinuses, this is nearly always due to hidradenitis rather than pure pilonidal disease. The management is somewhat different, as the sepsis on both sides of the buttocks needs to be dealt with, making the usual techniques more difficult.
Clindamycin and Lincomycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Hidradenitis suppurativa (HS) is a chronic and recurring inflammatory disease of hair follicles, most commonly affecting the axillae and the inguinal and anogenital areas (Zouboulis et al., 2015). The pathogenesis of HS is not fully understood, although the literature increasingly implicates a dysfunction of the immune system; the role of bacteria remains controversial (Deckers and Prens, 2016; Ring and Emtestam, 2016). In-depth guidelines for the medical and surgical treatment of HS are available (Zouboulis et al., 2015).
Double trouble: a case of bilateral multiple epidermal inclusion cysts after reduction mammaplasty
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Khairun Izlinda Abdul Jalil, David Herlihy, Edward Jason Kelly
Previous history of trauma or surgery to the breast (such as needle biopsy, excision, reduction mammaplasty and breast reconstruction with latissimus dorsi) has been reported to be associated with this benign tumor [4–6,10,11]. It is postulated to be caused by epidermis, either that has been left when de-epithelializing the skin, or implanted within the breast tissue, which was then buried. In a mammaplasty procedure, the nipple areolar complex is repositioned along with a vascularized tissue pedicle, requiring in folding of the tissue. Small fragments of epidermis may possibly remain and later result in the development of epidermal inclusion cysts on the medial or lateral skin flaps along the inframammary incision line [3,10,11]. Although breast EIC after mammaplasty have been described, nonetheless, all cases have been unilateral [3,6,11,12]. This is the first case report where EIC presented bilaterally. The patient had a diagnosis of mild hidradenitis suppurativa and it is not clear if this contributed to her presentation [18]. She has no other history of epidermal inclusion cyst in any other location, dental anomalies, gastrointestinal symptoms or family history of colon cancer, making association with Gardner’s Syndrome unlikely [19].
Intense pulsed light treatment for patients with hidradenitis suppurativa: beware treatment with resorcinol
Published in Journal of Dermatological Treatment, 2018
P. Theut Riis, D. M. Saunte, V. Sigsgaard, C. Wilken, G. B. E. Jemec
Hidradenitis suppurativa (HS) develops in the hair follicle. Histological studies suggest that hyperkeratosis is an early event in the pathogenesis of HS (1). Intense pulsed light therapy (IPL) has been applied for HS in a few trials, and the results suggest that it may provide an effective alternative to other treatments in mild-to-moderate disease (2,3). The mechanism of action for IPL treatment in HS is thought to be the removal of the obstruction in the hair follicle, that is, the hair, or the entire hair follicle itself (2). IPL is a broad spectrum pulsed light source, employing a range of wavelengths to deposit heat in chromophore-containing tissue, that is, the melanin of the hair (4). To the best of our knowledge, no follow-up data from routinely treated patients are available.
Skin diseases of the vulva: inflammatory, erosive-ulcerating and apocrine gland diseases, zinc and vitamin deficiency, vulvodynia and vestibulodynia
Published in Journal of Obstetrics and Gynaecology, 2018
Freja Lærke Sand, Simon Francis Thomsen
Hidradenitis suppurativa is a chronic inflammatory disease of apocrine gland hair follicles caused by occlusion and rupture of follicular units (Alikhan et al. 2009). Many apocrine glands open into the upper portions of the pilosebaceous duct and comedonal keratin occlusion of the outflow of the corresponding hair follicle is believed to be the initiating event in hidradenitis suppurativa. Secondary bacterial infection with Staphylococcus aureus, anaerobic streptococci and Bacterioides spp. perpetuates the chronic inflammatory and scarring nature of the disease. Women may present with isolated vulvar hidradenitis suppurativa or it may be distributed to flexural areas, especially the axillae and groynes. Tender, deep, painful erythematous furuncle-like nodules develop after puberty, especially in young obese women who smoke. The nodules may slowly enlarge to become indurated plaques in the pubic and inguinal area, buttocks and upper thighs and may eventually perforate the overlying skin, draining thick purulent material (Figure 10). Individual lesions may resolve, but more commonly they spread with formation of multiple abscesses, draining sinuses and progressive scarring (Figure 11). The severity of hidradenitis suppurativa can be graded according to Hurley’s three stages (Table 2). The quality of life in women with hidradenitis suppurativa is significantly reduced (Gerard et al. 2015).