“…18,19 This may be predictable in the presence of many sinuses lined by squamous epithelium. These findings indicate that sinus tracts with inflammation persisted chronically.…”
Hidradenitis suppurativa (HS) represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses followed by the formation of sinus tracts and scarring. It is an uncommon disorder frequently involving the perianal region. We review the clinical and pathological features of 12 patients (10 men and two women) with perianal HS (PHS). The mean age at presentation was 43 years (range 24-65), and the mean duration of illness was 14 years (range 2-30). Two patients exhibited multiple areas of involvement, including the axilla and the nape of the neck, in addition to the perianal region. Histological examinations showed epidermis-lined sinuses surrounded by dense plasma cell infiltration in four of nine specimens. The complications related with PHS included anal fistula (seven patients), diabetes mellitus (four), malignant tumour (two) and sepsis (one). Three patients died of the complications. Eight patients underwent wide local excision. The defects were managed with a meshed split-thickness skin graft in five patients, and open treatment in the remainder. New lesions developed in untreated skin of two patients. However, no patient relapsed in the surgically treated sites. PHS is frequently complicated with anal fistula and is occasionally life-threatening as a result of the occurrence of malignant tumours or sepsis. Early surgical excision followed by meshed split-thickness skin graft can successfully cure the lesion without functional disturbance.
“…18,19 This may be predictable in the presence of many sinuses lined by squamous epithelium. These findings indicate that sinus tracts with inflammation persisted chronically.…”
Hidradenitis suppurativa (HS) represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses followed by the formation of sinus tracts and scarring. It is an uncommon disorder frequently involving the perianal region. We review the clinical and pathological features of 12 patients (10 men and two women) with perianal HS (PHS). The mean age at presentation was 43 years (range 24-65), and the mean duration of illness was 14 years (range 2-30). Two patients exhibited multiple areas of involvement, including the axilla and the nape of the neck, in addition to the perianal region. Histological examinations showed epidermis-lined sinuses surrounded by dense plasma cell infiltration in four of nine specimens. The complications related with PHS included anal fistula (seven patients), diabetes mellitus (four), malignant tumour (two) and sepsis (one). Three patients died of the complications. Eight patients underwent wide local excision. The defects were managed with a meshed split-thickness skin graft in five patients, and open treatment in the remainder. New lesions developed in untreated skin of two patients. However, no patient relapsed in the surgically treated sites. PHS is frequently complicated with anal fistula and is occasionally life-threatening as a result of the occurrence of malignant tumours or sepsis. Early surgical excision followed by meshed split-thickness skin graft can successfully cure the lesion without functional disturbance.
“…“ I make this observation only with reservations, for it is chiefly the curious distribution of these collections that made me adopt the interpretation which I give here. It is therefore a point to be restudied and to be demonstrated in a more satisfactory manner .”(Verneuil, 1854, quoted in translation by Lane 7 )…”
Section: The Evolution Of the Term “Hidradenitis Suppurativa”mentioning
The term "hidradenitis suppurativa" is firmly entrenched in the dermatological literature although it refers to a false pathogenetic concept. The term was historically coined based merely on the characteristic distribution of the apocrine glands and the anatomical coincidence with the disease process. At center stage is not a suppurative inflammation of the apocrine sweat glands but an occlusion of the hair follicles, comparable to acne vulgaris. Reviewing the literature on this subject, we were astonished to find that even articles that concluded that the entity represents a form of follicular occlusion still referred to it as hidradenitis suppurativa. The disorder shares histopathological and clinical aspects with acne vulgaris modified under the special circumstances of anatomical regions rich in apocrine glands. It is acne inversa because, in contrast to acne vulgaris, the disease involves intertriginous localizations and not the regions classically affected by acne. We suggest that the term "hidradenitis suppurativa" for this disease should (finally) be abandoned in favour of "acne inversa".
“…A search for illnesses in the correspondence sections of the MECW , volumes 38–46, revealed that although the skin lesions were called ‘furuncles’, ‘boils’ and ‘carbuncles’ by Marx, his wife and his physicians, they were too persistent, recurrent, destructive and site‐specific for that diagnosis; my guess was that Marx had hidradenitis suppurativa. This recurrent infective condition arises from blockage of apocrine ducts opening into hair follicles, mostly in axillary, mammary, inguinal, perianal and genital skin 8–11 . Although individual lesions may resemble boils, and are often misdiagnosed as such, certain associated clinical features make the correct diagnosis, and I found all of them in the original correspondence.…”
Section: The Skin Diseasementioning
confidence: 98%
“…Marx’s physicians’ various diagnoses of ‘boils’, ‘furuncles’ and ‘carbuncles’, and their contemporary treatment with arsenic, poultices and lancing, are not surprising: hidradenitis suppurativa was described, somewhat hesitantly, between 1854 and 1864 8 in France; and unlike wine, intellectual property travelled poorly across the channel to where Marx spent most of his adult life: the first English publication was in 1933 9 . Perhaps the reason Marx’s skin disease has only now been diagnosed is that few physicians are familiar with hidradenitis suppurativa and even fewer dermatologists are familiar with Marx.…”
From an analysis of the original correspondence, it has been possible to establish that Karl Marx's incapacitating skin disease was hidradenitis suppurativa, not 'boils' as was universally assumed at the time and since; the psychological effect of this illness on the man and his work appears to have been considerable.
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