Hidradenitis suppurativa (acne inversa) is a chronic, inflammatory, primary follicular disease triggered by follicular occlusion with subsequent inflammation and destruction of the skin appendage, affecting hair follicles located in apocrine gland-bearing body areas. Clinical presentation of hidradenitis suppurativa is extremely variable showing a wide spectrum of cutaneous lesions in different stages of evolution, different pattern of distribution and grades of severity. Traditionally for severity staging the Hurley clinical grading system has been used where stage I stands for mild disease while stage II and III for moderate and severe stages respectively. 2015 classification of Van Der Zee and Jemec proposed 6 phenotypes of hidradenitis suppurativa: regular type, frictional furuncle type, scarring folliculitis type, conglobata type, syndromic type, ectopic type. We present a photogallery on this problem.
BACKGROUND: Pilonidal disease is the 4th most common disease among inpatient coloproctological patients and surgery remains the gold standard of its treatment. However, patients with pilonidal disease often have combined conditions with other follicular occlusion diseases which are most often encountered by dermatologists in their practice. In most cases it is difficult to treat follicular occlusion syndrome with pilonidal disease within one specialty. We demonstrate the complexity of follicular occlusion diseases diagnostics in combination with pilonidal disease, systemize the diagnostic protocol for patient management and present the treatment strategy for coloproctologists. CLINICAL CASE DESCRIPTION: There was one case of patient with pilonidal disease combined with other conditions of follicular occlusion syndrome noted in the clinic of coloproctology and minimally invasive surgery. Surgery was the first step. There were no complications in the early postoperative period. After hospital discharge, the patient was consulted by a dermatologist, and local and systemic conservative therapy was prescribed for concomitant diseases, which resulted in a significant improvement. There have been no recent reports of recurrence. CONCLUSION: The treatment of follicular occlusion syndrome with pilonidal disease requires a multidisciplinary approach. At the same time the optimal treatment for pilonidal disease is radical excision of all altered tissues. In cases of such diseases as hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp treatment should be comprehensive and begin with a dermatologist consultation.
Hidradenitis suppurativa, dissecting cellulitis of the scalp, acne conglobata and pilonidal sinus ― are four diseases united by similar clinical findings and common mechanisms of pathogenesis. These conditions often coexist. The primer pathogenetic event is stratum corneum thickening and keratin plugging of the hair follicle ductal isthmus. The discovery of this mechanism led to association of all the diseases with the term "follicular occlusion syndrome". If three nosologies are detected follicular occlusion triad is diagnosed, if four are present ― follicular occlusion tetrad. We present a photogallery on this problem.
Acne inversa is a rare skin disease characterized by recurrent nodules and abscesses that rupture with suppurative discharge and lead to sinus tracts and scarring. The disease is chronic and debilitating. In typical cases, it is diagnosed at late stages, when more aggressive therapeutic treatment is obligatory. There is not generally any accepted therapeutic algorithms, therefore, it is a difficult-to-manage disease, which determines the necessity for further study. We present a clinical case of acne inversa with non-classical phenotypic features and the results of its treatment with systemic retinoids, and metformin. We also provide a review of the literature on the etiology, pathogenesis, and diagnosis of acne inversa. Currently, there is no reliable algorithms of diagnostics and effective treatment for patients with acne inversa, which underlines the importance of further study of this disease.
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