Hidradenitis suppurativa was associated with depression and anxiety. Dermatologists treating patients with HS should be aware of this important association.

Lipoedema is a rare painful disorder of the adipose tissue. It essentially affects females and is often misdiagnosed as lymphoedema or obesity. It is globally misdiagnosed or underdiagnosed, and the literature is lacking appropriate guidance to assist clinicians towards this diagnosis. However, the need to recognise this disorder as a unique entity has important implications to establish proper treatment and, therefore, its tremendous effect on patients. Early diagnosis and treatment can turn these patients' lives upside down. The aim of this review is to focus on the clinical guidance, differential diagnosis, and management strategies. In addition, other aspects of lipoedema, including epidemiology and pathogenesis, are also being discussed here. Lipoedema is distinct from obesity and distinct from lymphoedema, although it might progress to involve the venous and lymphatic system (venolipedema or lympholipedema or both). Late diagnosis can leave the patient debilitated. Management of lipoedema includes weight loss, control of oedema, complex decongestive physiotherapy, liposuction, and laser-assisted lipolysis. However; there are increasing reports on tumescent liposuction as the preferred surgical option with long-lasting results. The role of more randomised controlled studies to further explore the management of this clinical entity remains promising.

Cutaneous and other vasculitides are a specific inflammation of the blood wall. Vasculitis is not restricted to the skin; rather, it can take place in any organ system of the body. Vasculitis can be divided according to the caliber of the main vessels involved: (1) large-aorta and named arteries; (2) medium sized-small, medium-sized, or large vessels of the arterial and/or venous systems; and (3) small vesselsincluding arterioles, capillaries, and postcapillary venule. The small vessels are usually represented by cutaneous small vessel vasculitides (CSVV), formerly called leukocytoclastic vasculitis (LCV), which is now reserved for the histological term of fragmented white blood cells in and around affected blood vessel walls. 1 Yet the small vessel vasculitis group diseases are subdivided into antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis or immune complex small vessel vasculitis. The immune complex vasculitis group include cryoglobulinemic vasculitis, immunoglobulin (Ig)A vasculitis, previously known as Henoch-Schönlein purpura, and urticarial vasculitis (UV) that may be associated with hypocomplementemia. The ANCA-associated vessel vasculitides can involve either small-or medium-sized arteries and include the microscopic polyangiitis, Churg-Strauss syndrome, and granulomatosis with polyangiitis (GPA; formerly Wegener's granulomatosis; see Table 1), 2 IgA vasculitis, hypocomplementemic UV, and anti-glomerular basement membrane disease. The second group of medium-sized vessel is mostly represented by polyarteritis nodosa (PAN). However, as previously mentioned, there are some entities that involve both small and medium-sized vessels. The third and last on this list is represented by the large arteries, which are affected by 2 entities, temporal arteritis and Takayasu's arteritis. There is also a group of conditions that are "variable vessel disease": Behçet's disease and Cogan syndrome. Cutaneous vasculitis can be the following: (1) a primary cutaneous vasculitis with secondary systemic involvement, (2) a cutaneous manifestation of a systemic vasculitis, or (3) a cutaneous limited disease. The focus of this article will be mainly on the latter group. LCV is synonymous with small vessel vasculitis, and it relates to this latter group. Most cases of vasculitis (LCV, cryoglobulinemic vasculitis, and PAN) are mediated by immune complexes, whose deposition in vessels will activate complement, which in turn induce mast cell degranulation and neutrophil chemotaxis that release proteolytic

Lichen planus (LP) is a chronic autoimmune disease. Oral lesions may occur in isolation or in combination with other affected muco-cutaneous sites. Oral LP (OLP) may present as one of the various manifestations of LP or may present as a disease sui generis with a broad range of severity. Despite this disease targeting the oral mucosa, its great impact on quality of life is underrated. In this article, we provide an updated review of the pathophysiology and epidemiology of OLP and offer guidance for its diagnosis and management. We also propose an algorithmic approach to the clinical forms of OLP and a novel staging system to facilitate management decisions.

After participating in this educational activity, the participant should be better able to: ABSTRACT: Pyoderma gangrenosum (PG) is an uncommon cutaneous disease, presenting with recurrent painful ulcerations most commonly on the lower extremities. The diagnosis is made according to a typical presentation, skin lesion morphology, skin biopsy, histopathology, and the exclusion of other etiologies. Classically, PG presents with painful ulcers with well-defined violaceous borders; other variants including bullous, pustular, and vegetative/granulomatous can also occur. Treatment of PG involves a combination of topical and systemic anti-inflammatory and immunosuppressive medications, wound care, antimicrobial agents for secondary infections, and treatment of the underlying etiology. This article is a continuing education review of the literature with a focus on the clinical application of the pathophysiology, diagnosis, and treatment of this challenging disease.

Background Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful and ulcerating lesions on the skin. It rarely involves the face and is often difficult to diagnose. There are few cases reported in the literature of PG involving the face. Aim To share our experience with 5 patients in whom the final diagnosis was PG involving the face, and to review the literature. Methods We report a series of 5 patients with a final diagnosis of PG involving the face and reviewed relevant literature. We searched through PubMed and EMBASE using keywords such as “face” and “pyoderma gangrenosum,” “blastomycosis-like pyoderma gangrenosum, vegetative pyoderma gangrenosum and granulomatous pyoderma gangrenosum.” Results We report 5 patients (4 females) with pyoderma gangrenosum involving the face. All 5 had a final diagnosis of superficial granulomatous PG. All cases presented with nonhealing facial ulcer most commonly on cheeks and a common histopathology of mixed inflammatory infiltrates, multinucleated giant cells, and plasma cells with some granulomatous inflammation. Conclusions PG can involve the face, and all 5 of our patients had the superficial granulomatous as the most common form.

The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03–05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.

Background: Hidradenitis suppurativa (HS) is a chronic debilitating folliculopiloseba ceous disease that affects the skin most commonly in the axilla, groin, inframammary, genital and buttock areas. Surgical intervention may be an appropriate option in selected cases, but there is a risk of recurrence. The purpose of this study was to assess the results of wide local excision (WLE) to healthy subcutaneous fat with secondary intention healing in patients with HS who were under concurrent surgical and dermatologic care. Methods:We conducted a retrospective review of 192 consecutive HS consultations to a general surgical service, identifying patients treated with WLE. Cases involving minor procedures (deroofing, incision and drainage) were excluded. Data on patient demographics, surgical site, method of closure, complications and recurrence were extracted from patient charts. We also conducted a literature review of surgical pro cedures in the management of HS.Results: A total of 66 patients underwent 133 WLE to healthy subcutaneous fat. All patients were under concurrent medical care directed by a dermatologist. No medical therapies, including biological treatments, were interrupted or withheld for surgery. One hundred procedures were closed primarily with rotation or advancement flaps and 33 by secondary intention healing. Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures (p = 0.98, χ 2 test, no difference between groups). One patient with secondary intention healing returned to the emer gency department for bleeding; 34% of patients with primary closure experienced some dehiscence (23% major, 11% minor separation). Two patients with axillary dis ease had restrictions in their ability to raise their arm that required physiotherapy. Median followup was 14.5 (range 1-55) months. Conclusion:Resection to healthy subcutaneous fat during WLE provides disease control comparable to that with deeper resections, simplifying care. Contexte : L'hidradénite suppurée (HS) est une maladie invalidante chronique du follicule pilosébacé qui affecte la peau principalement au niveau de l'aisselle, de l'aine, du pli sousmammaire et du siège. Une intervention chirurgicale pourrait être une option appropriée dans certains cas, mais il y a un risque de récurrence. Le but de cette étude était d'évaluer les résultats d'une excision locale large (ELL) jusqu'aux tis sus adipeux souscutanés sains suivie de cicatrisation secondaire chez des patients atteints d'HS recevant concomitamment des soins chirurgicaux et dermatologiques.Méthodes : Nous avons procédé à une revue rétrospective de 192 consultations con sécutives pour HS dans un service de chirurgie générale et nous avons recensé les patients traités par ELL. Les cas impliquant des interventions mineures (par incision drainage) ont été exclus. Les données démographiques, le site chirurgical, la méthode de suture, les complications et les récurrences ont été enregistrés à partir des dossiers des patients. Nous avons aussi procédé à une revue de la ...