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Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.

Objective To calculate the incidence of burning mouth syndrome (BMS) in Olmsted County, Minnesota, from 2000 to 2010. Patients and Methods Using the medical record linkage system of the Rochester Epidemiology Project, we identified newly diagnosed cases of BMS from January 1, 2000, through December 31, 2010. Diagnoses were confirmed through the presence of burning pain symptoms of the oral mucosa with normal oral examination findings and no associated clinical signs. Incidence was estimated using decennial census data for Olmsted County. Results In total, 169 incident cases were identified, representing an annual age- and sex-adjusted incidence of BMS of 11.4 per 100,000 person-years. Age-adjusted incidence was significantly higher in women than men (18.8 [95% CI, 16.4–22.9] vs 3.7 [95% CI, 2.6–5.7] per 100,000 person-years [P<.001]). Postmenopausal women aged 50 to 89 years had the highest disease incidence, with the maximal rate in women aged 70 to 79 years (70.3 per 100,000 person-years). After age 50 years, BMS incidence in men and women significantly increased across age-groups (P=.02). Olmsted County study participants were predominantly white, which is a study limitation. In addition, diagnostic criteria for identifying BMS in the present study may not apply for all situations because no diagnostic criteria are universally recognized for identifying BMS. Conclusion To our knowledge, this is the first population-based incidence study of BMS reported to date. The data show that BMS is an uncommon disease highly associated with female sex and advancing age.

Background Burning mouth syndrome (BMS) is defined as symptoms of persistent burning in the mouth without objective findings accounting for the symptoms. Objectives To calculate the point prevalence of BMS in Olmsted County, Minnesota, on December 31, 2010. Methods The Rochester Epidemiology Project (REP) medical records linkage system was used to identify BMS cases diagnosed or potentially diagnosed before December 31, 2009. Inclusion criteria were subjective oral discomfort, normal oral examination, and documented BMS diagnosis by a REP physician. Results In total, 149 BMS cases were confirmed, representing age- and sex-adjusted point prevalence of BMS in Olmsted County of 0.11%, or 105.6 (95% CI, 88.6–122.6) per 100,000 persons. Age-adjusted prevalence in women was significantly higher than men: 168.6 (95% CI, 139.0–198.2) vs 35.9 (95% CI, 21.4–50.3) per 100,000 persons (P<.001). The highest prevalence was in women aged 70 through 79 years (527.9 per 100,000 persons). Mean (SD) age at BMS diagnosis was 59.4 (15.1) years (range, 25–90 years). Conclusions To our knowledge, we provide the first report of population-based BMS prevalence. The data show that BMS most commonly affects women older than 50 years, and when defined through diagnostic criteria, it is less prevalent than described previously.

Decades of research in rodent models has shown that early postnatal overnutrition induces excess adiposity and other components of metabolic syndrome that persist into adulthood. The specific biologic mechanisms explaining the persistence of these effects, however, remain unknown. On postnatal day 1 (P1), mice were fostered in control (C) or small litters (SL). SL mice had increased body weight and adiposity at weaning (P21), which persisted to adulthood (P180). Detailed metabolic studies indicated that female adult SL mice have decreased physical activity and energy expenditure but not increased food intake. Genome-scale DNA methylation profiling identified extensive changes in hypothalamic DNA methylation during the suckling period, suggesting that it is a critical period for developmental epigenetics in the mouse hypothalamus. Indeed, SL mice exhibited subtle and sex-specific changes in hypothalamic DNA methylation that persisted from early life to adulthood, providing a potential mechanistic basis for the sustained physiological effects. Expression profiling in adult hypothalamus likewise provided evidence of widespread sex-specific alterations in gene expression. Together, our data indicate that early postnatal overnutrition leads to a reduction in spontaneous physical activity and energy expenditure in females and suggest that early postnatal life is a critical period during which nutrition can affect hypothalamic developmental epigenetics.

Background Environmental exposures during critical periods of prenatal and early postnatal life affect the development of mammalian body weight regulatory mechanisms, influencing lifelong risk of obesity. The specific biologic processes that mediate the persistence of such effects, however, remain poorly understood. Objective The objectives were to determine the developmental timing and physiological basis of the obesity-promoting effect previously reported in offspring of obese agouti viable yellow (Avy/a) mothers. Design Newborn offspring of obese agouti viable yellow (Avy/a) and lean (a/a) mothers were cross-fostered shortly after birth to study separately the effects of in utero or suckling-period exposure to Avy/a dams. Body composition, food intake, physical activity, and energy expenditure were measured in offspring shortly after weaning and in adulthood. Results Offspring of obese Avy/a dams paradoxically experienced fetal growth restriction, which was followed by adult-onset obesity specifically in females. Our main analyses focused on wild type (a/a) offspring, because a subset of adult Avy/a offspring contracted a kidney disease resembling diabetic nephropathy. Detailed physiological characterization demonstrated that, both shortly after weaning and in adulthood, female wild type mice born to Avy/a mothers are not hyperphagic, but have reduced physical activity and energy expenditure. No such coordinated changes were detected in male offspring. Mediational regression analysis of our longitudinal data supported a causal pathway in which fetal growth restriction persistently reduces physical activity, leading to adult obesity. Conclusions Our data are consistent with several recent human epidemiologic studies showing female-specific effects of perinatal nutritional restriction on later obesity, and provide the novel mechanistic insight that this may occur via permanent and sex-specific changes in one’s inherent propensity for physical activity.

Hidradenitis suppurativa surgical management was well regarded by patients and should be considered by future patients to limit the morbidity of HS.

Background: Few reports describe squamous cell carcinoma (SCC) arising in hidradenitis suppurativa (HS).Objective: The two objectives were 1) to describe the clinical characteristics, pathologic findings, and postoperative outcomes of SCC in HS; and 2) to assess whether human papillomavirus (HPV) is involved in the pathogenesis. Materials and Methods:Cases of SCC in HS were identified through institutional medical records and the Rochester Epidemiology Project. Tumor specimens were assessed for HPV DNA/RNA with in situ hybridization.Results: Twelve patients were identified (11 caucasian, 9 men). All SCCs involved gluteal, perianal, or perineal skin; one patient had, in addition, involvement of the vagina. Surgical excision was done on all 12 patients, 4 of whom had a colostomy. Mean duration of HS before SCC development was 28.5 years (range, 15-53 years). Mean follow-up was 4.3 years after surgical excision. Seven of 12 patients followed had postoperative SCC recurrence. SCC caused death despite wide surgical excision in these 7 patients. Of the remaining 5 patients, 4 are unknown and 1 that did not recur had an in-situ SCC (Bowen's disease carcinoma). SCC was not associated with high-risk or low-risk HPV.Conclusions: Invasive SCC arising in HS carries a high risk of death.