Granulomatous hidradenitis suppurativa and cutaneous Crohn's disease

Abstract

Three patients with concurrent hidradenitis suppurativa and Crohn's disease are presented. The notable histological feature in each hidradenitis resection was the presence of numerous discrete epithelioid granulomas in areas of non-inflamed dermis. The purpose of the study was to determine the incidence of epithelioid granulomas in 101 hidradenitis patients and their significance in relation to systemic granulomatous disease. Discrete epithelioid granulomas were identified in 8% of the resections (10 patients). One patient had Crohn's disease and one other pulmonary sarcoidosis. Seven patients with granulomatous hidradenitis neither had nor developed any other disease during the 3-year follow-up period. Clinical review identified a further two patients with Crohn's disease but associated with non-granulomatous changes in the skin resections. Foreign body type granulomas were identified in 25% of the resections adjacent to ruptured hair follicles, sinus tracts or nearby degenerate sweat glands. The study shows that, although foreign body type granulomas are a common finding in hidradenitis, the presence of discrete epithelioid granulomas in the dermis away from the site of active inflammation is unusual and should alert the pathologist to the possibility of systemic granulomatous disease such as Crohn's disease or sarcoidosis.

Infliximab for severe hidradenitis suppurativa: Transient clinical efficacy in 7 consecutive patients

“…Second, we excluded those patients with HS associated with Crohn's disease, whose skin disease might have had a different pathogenesis. 25 Third, in our study, a poor response to infliximab occurred mainly in those patients with long-standing disease characterized by chronic inflammation, multiple sinus formation, and ''bridged'' scarring. These patients may have been in too advanced a state to respond to a treatment that mainly affects the early acute phase of inflammation.…”

Hidradenitis Suppurativa

“…Most frequently, association with Crohn's disease (n = 34) and Dowling--Dego's disease (n = 8) has been reported. [39][40][41][42][43][44][45][46] However, it is unclear to what extent these reports truly reflect hidradenitis lesions as defined in the above, and even if these observations represent causal relationships or merely the coincidental findings of a comparatively common disease such as hidradenitis.…”

Metastatic Cutaneous Crohn's Disease of the Nipple: Report of a Case

“…The presence of noncaseating granulomas in the dermis not associated with active inflammation is characteristic of Crohn's disease or sarcoidosis in contrast to other cutaneous granulomatous diseases. 6 The size and composition of the granulomas are similar to those seen in the bowel wall and perianal skin in Crohn's disease. 7 Cutaneous Crohn's disease is often reported in connection with documented intestinal Crohn's disease, but the activity of cutaneous symptoms seldom parallels that of the intestinal lesions.…”