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    Hidradenitis Suppurativum

    Nigel A. Scott MD FRCS

    Royal Preston Hospital

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    Greek !idros"s#eat $ aden"glands

    Hidradenitis Suppurativum

    %Pain&ul' in&lamed lesions in t!e a(illae' groin' and ot!er

    parts o& t!e )ody t!at contain apocrine glands*

    %+..pain&ul eruptions and malodorous disc!arge*

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    ,.M. -on Der ert!' G./.0. ,emec 123345

    Mor)idity in patients #it! !idradenitis suppurativa

    /ritis! ,ournal o& Dermatology 466 165' 738974:.

    ;uality o&

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    Hidradenitis Suppurativum

    = develop during mid pu)erty

    = s#eat contains &atty materials t!at are )roken do#n )y

    )acteria 9 main cause o& s#eat odour

    = emotional stress increases production o& s#eat

    %Apocrine* S#eat Glands

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    Hidradenitis SuppurativumApocrine

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    Hidradenitis Suppurativum>not Apocrine?

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    Hidradenitis Suppurativum

    =occlusion o& t!e !air &ollicle

    1rat!er t!an t!e apocrine

    gland5 due to a de&ect in

    terminal &ollicular epit!elium

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    Hidradenitis Suppurativum

    4. occlusion o& t!e !air &ollicle

    1rat!er t!an t!e apocrine gland5

    due to a de&ect in terminal

    &ollicular epit!elium

    2. )acteria invade t!e apocrinesystem via t!e !air &ollicles'

    )ecome trapped )eneat! t!e

    keratinous plugs' and multiply

    rapidly in t!e apocrine s#eat

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    Hidradenitis Suppurativum

    :. glands rupture and spread t!e in&ection

    e(tending t!e tissue destruction and skin

    damage

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    Hidradenitis Suppurativum

    :. glands rupture and spread t!e in&ection

    e(tending t!e tissue destruction and skin

    damage6. )acterial superin&ection #it! streptococci'

    stap!ylococci' and coli&orms

    /@ cultures &rom lesions are &reBuently

    sterile and anti)iotics are not curative

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    = c!ronic acnei&ormin&ection o& t!e cutaneousapocrine glands

    = involves adacentsu)cutaneous tissue and&ascia

    = !allmark is sinus tracts1#!ic! can )ecomedraining &istulas5 in t!eapocrine gland )odyareas.

    Hidradenitis Suppurativum

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    Hidradenitis Suppurativum

    Apocrine Gland distri)ution

    =a(illae

    =periareolar' intermammary=pu)ic area'=in&raum)ilical midline'=gluteal &olds'

    =genito&emoral areas

    =perianal region.

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    Hidradenitis Suppurativum

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    Stage 4 Single or multiplea)scesses &orm' #it!out sinus

    tracts and cicatriEation

    Stage 2 Recurrent a)scesses

    #it! tract &ormation andcicatrisation single or multiple

    #idely separated lesions.

    Stage : Di&&use or near

    di&&use involvement or multipleinterconnected tracts and

    a)scesses are o)served

    across t!e entire area

    Stage : Hidradenitis Suppurativum

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    Hidradenitis

    26 population

    6F4M

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    Gender and disease location

    Area(s) ofinvolvement

    Male (n = 15) Female (n = 42) Pvalue

    A(illa 2 14:5 37 (88%) .3334

    @nilateral 4 135 48 145 NS

    /ilateral 4 135 47 1685

    Inguinoperineal 13 (87%) 1425 .3334

    @nilateral 4 175 6 1735 .34:4

    /ilateral 42 1825 4 1235

    A(illa andinguinoperineal

    4 1J5 : 175 NS

    Kagan et al. Surgical treatment of hidradenitis suppurativa: A 10-year experience

    Surgery 2005:1!"#$%-

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    Hidradenitis 9 medical options

    =topical clindamycin

    =!ormonal cyproterone acetateK

    et!inyloestradiol

    =retinoids

    =in&li(ima)

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    CL2

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    Hidradenitis 9surgical options

    =drainage o& sepsis 9 433

    recurrence

    =laying open o& tracks

    =#ide local e(cision skin gra&ts

    '(he surgical option of choice for late stage

    )S is *ide local excision *ith healing +y

    secondary intention,

    Surgical treatment o& !idradenitis suppurativa

    /r , Surg 4882K J8 7O:O.

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    Hidradenitis 9surgical options

    A(illae 9 #ide local e(cision $ secondary !ealing

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    Hidradenitis 9surgical options

    Genito&emoral

    9 #ide local e(cision $ secondary !ealing

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    Genito&emoral

    9 #ide local e(cision $ secondary !ealing

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    Genito&emoral

    9 #ide local e(cision $ secondary !ealing

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    Genito&emoral

    9 #ide local e(cision $

    secondary !ealing

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    Genito&emoral

    9 #ide local e(cision $

    secondary !ealing

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    Perianal Hidradenitis

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    Hidradenitis 9surgical options

    Perianal Disease 9 di&&erential diagnosis

    =Cro!ns disease

    =Cryptoglandular sepsis

    =pilonidal disease

    =tu)erculosis'

    actinomycosis etc

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    Anal Canal $

    Hidradenitis

    =t!e distal t#o t!irds o& t!e

    skin o& t!e anatomic anal

    canal contains !air &ollicles#it! se)aeceous and

    apocrine glands

    =!idradenitis supprativum

    rarely involves t!e analcanal

    =i& it does it tracks

    su)cutaneously and notacross t!e sp!incter

    =it never tracks a)ove t!e

    dentate line

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    Anal Canal $ Hidradenitis

    Cro!ns

    Cryptoglandular

    Hidradenitis

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    Hidradenitis 9surgical options

    Perianal Disease 9 di&&erential diagnosis

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    =drainage o& sepsis

    =laying open o& tracks

    =#ide local e(cision skin gra&ts

    => colostomy?

    Perianal Hidradenitis

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    Perianal Hidradenitis

    9 #ide local e(cision $ secondary !ealing

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    Perianal Hidradenitis

    9 #ide local e(cision $ secondary !ealing

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    Perianal Hidradenitis

    9 #ide local e(cision $ secondary !ealing

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    Kagan et al. urgi!al treatment of "i#ra#enitis su$$urativa A 1&'ear

    e$erien!e urger 2&&5138(4)*734'741

    Ailla

    +erineum

    ,nguinal

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    Kagan et al. urgi!al treatment of "i#ra#enitis su$$urativa A 1&'ear

    e$erien!e urger 2&&5138(4)*734'741

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    -it et al /tent of surger an# re!urren!e rate of "i#ra#enitissu$$urativa ,nt 0 olore!tal is 18*1314'18.

    =:4 patients OF2:M

    =mean age :4yrs

    =surgery

    =O a)scess drained

    =46 limited e(cision' 2 suture

    =44 #ide local e(cision

    Hidradenitis 9 surgical outcomes

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    Drainage

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    Summary

    =common cause o& serious mor)idity 46K 6F4M

    =occlusion o& t!e !air &ollicle 1rat!er t!an t!e apocrine gland5 due to a

    de&ect in terminal &ollicular epit!elium

    =a(illa inguinogenital' perianal

    =Stage : Di&&use or near di&&use involvement or multiple interconnected

    tracts and a)scesses are o)served across t!e entire area

    =medical topical clindamycin' oral contraceptive

    =perianal 9 di&&erential diagnosis

    =#ide local e(cision )est results #it! or #it!out mes! skin gra&t

    Hidradenitis Suppurativum

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    !e DoH said Q!e department !as accepted t!e need &or c!ange and

    t!e revised approac! #ill no# )e tested #it! unior doctors' selectors'

    deanery recruitment teams and employers.Q