Lumps and Bumps
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh in 300 Essentials SBAs in Surgery, 2017
Hidradenitis suppurativa classically presents as swollen, painful, erythematous lesions; the skin may be thickened following recurrent infections, and the presence of sinus tracts is diagnostic. Hidradenitis suppurativa typically occurs in the axillae and groin, but it can occur in any part of the body that contains apocrine glands. It is thought to be caused by occlusion of the hair follicles, which subsequently leads to occlusion of the apocrine glands and causes a perifolliculitis. The incidence is greater in females, and it does not present before puberty. It is associated with perspiration, obesity, cigarette smoking and stress. Nodules will heal slowly, with or without drainage. Erysipelas is a skin infection typically caused by group A β-haemolytic streptococci; features include erythema and induration, and lesions have a well-demarcated border, which sets it apart. Sebaceous cysts are typically solitary. Lymphadenitis (inflammation and/or enlargement of a lymph node) more often occurs in children due to infection (mostly viral); a single node or a localised group of lymph nodes may be enlarged, and lumps are typically well circumscribed and rubbery. Cystic hygromas are congenital lesions that present at birth/early infancy within the head and neck, not axillae.
Hidradenitis Suppurativa
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 in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Follicular hyperkeratosis and perifolliculitis are the key histological features of HS.8,21 Histopathology from affected skin in patents with HS has been shown to be homogenous, with early follicular inflammation preceding follicular rupture.21 Rupture of affected follicles then triggers a mixed inflammatory response (neutrophils, histiocytes, lymphocytes).5,10 Continued inflammation leads to granuloma formation and, over time, the formation of deep-seated nodules.10 Importantly, apocrine glands have been shown to be involved in a minority of cases under histopathological examination.7,8,21Figure 12.1 displays the histopathological characteristics of HS development.
Principles of Clinical Diagnosis
Susan Bayliss Mallory, Alanna Bree, Peggy Chern in Illustrated Manual of Pediatric Dermatology, 2005
PathogenesisDisrupted keratinization with follicular hyperkeratosis and plugging of the apocrine duct leading to dilatation of the duct with perifolliculitis, abscess formation, destruction of the pilosebaceous unit ending in fibrosisSecondary bacterial infection can occur with staphylococci, streptococci and Gram-negative organisms
Majocchi granuloma presenting as a verrucous nodule of the lip
Published in Baylor University Medical Center Proceedings, 2018
Ritu Swali, Elmira Ramos-Rojas, Stephen Tyring
There are two forms of Majocchi granulomas: follicular and nodular. They can be distinguished based on their clinical appearance and the immune status of the host. The follicular type is usually found in healthy individuals, most often due to trauma such as shaving in women or topical corticosteroid use, especially in children. The lesions are characterized by superficial papulopustular perifolliculitis. The nodular form is most often noted in immunocompromised hosts, presenting with chronic erythema, indurated plaques, and subcutaneous nodules.3 Both types advance from suppurative to granulomatous infiltration in situ.5 Histopathologically, the dermatophytes are located in the stratum corneum, using keratin as a substrate.6 Moreover, the fungal hyphae can be confused with Mucor and Rhizopus species due to their shorter, thicker appearance than common hyphae found in more superficial dermatophytoses.4
Approach to treatment of refractory dissecting cellulitis of the scalp: a systematic review
Published in Journal of Dermatological Treatment, 2021
On November 1st, 2018, we searched on the Embase, Pubmed, and Scopus databases with combinations of the terms ‘dissecting cellulitis,’ ‘perifolliculitis capitis abscedens,’ and ‘dissecting folliculitis’ for all articles published prior to that date. We concentrated primarily on papers that focused on patients who had failed standard treatments. Conference abstracts and articles not published in English were excluded. A total of 57 articles that included treatment responses of 90 patients with DCS were included in our review, as summarized in Table 1. The majority of articles (53/57) were case reports or series. No randomized control trials comparing treatments were identified.
Idiopathic facial aseptic granuloma: case series and review of histological findings
Published in Baylor University Medical Center Proceedings, 2023
Sydney A. Weir, Sima Amin, Alyssa Higgins, David Kelly, Amy Theos
The clinical differential diagnosis includes a host of other neoplasms and infectious and inflammatory conditions, including pilomatrixomas, dermoid or epidermoid cysts, infantile nodular acne, infections, nevi, xanthogranulomas, and vascular malformations. The histologic presentation of IFG is nonspecific and shares features with other inflammatory conditions such as granulomatous rosacea or perifolliculitis, which makes this diagnosis challenging. As such, the diagnosis of IFG should be made using a combination of historical, clinical, and histologic findings.