Suggested Work Modifications for Patients with Environmental and Occupational Risk Factors in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition characterized by painful nodules, abscesses, and scarring, primarily affecting areas rich in apocrine glands. Environmental and occupational risk factors, including prolonged exposure to heat, friction, and certain chemicals, have been identified as exacerbating conditions for HS. Yet, there remains a lack of tailored recommendations for modifying work environments to alleviate these triggers. This review presents novel suggestions for work modifications to reduce HS flare-ups, such as implementing breathable, friction-reducing workwear, ergonomic adjustments to minimize pressure on affected areas, and introducing low-irritant hygiene protocols in workplaces with chemical exposure. These recommendations are grounded in emerging evidence linking specific occupational exposures to the exacerbation of HS symptoms. The novelty of this approach lies in its proactive stance, shifting from reactive management of HS symptoms to preventative environmental modifications. Future studies should explore the long-term efficacy of these modifications and investigate the potential for personalized work environment adjustments based on individual patient profiles. Targeted workplace interventions may significantly improve the quality of life for HS patients, highlighting the need for multidisciplinary collaboration between dermatologists, occupational health specialists, and employers.

Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association

Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn’s disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as “the explosive mixture” at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.

Association of hidradenitis suppurativa with Crohn’s disease

Hidradenitis suppurativa(HS)is a chronic inflammatory skin disorder characterized by recurrent nodules,abscesses,and sinus tracts.Crohn’s disease(CD)is characterized by inflammation of the entire digestive tract and belongs to the group of inflammatory bowel diseases,and there are many extraintestinal manifestations,among which hidradenitis suppurativa is one of the rare extraintestinal manifestations.There appears to be a strong association between CD and HS based on clinical and histological similarities(sinus tract development,granulomatous inflammation,and scarring),intersections in pathogenesis(genetic loci,immune dysregulation mechanisms,and microbiome changes),and commonality in treatment.In this review,we summarize recent studies on the association between HS and CD.

Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis

BACKGROUND Nonalcoholic fatty liver disease(NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver(NAFL) and non-alcoholic steatohepatitis(NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease(ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern.Hidradenitis suppurativa(HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients(P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index(ADDI) was significantly higher among patients with HS/NASH(5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only(2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.

Mammographic Features of Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic suppurative inflammation of the apocrine sweat glands. Axillary, inframammary, intermammary, and peri-areolar apocrine gland involvement may be visualized mammographically. Characteristic lesions tend to be round or oval, lucent, and smooth-bordered, with or without central densities. While diagnosis made purely via mammography is unlikely, having an awareness of this entity may prove useful in patient care in regards to proper utilization of both imaging and consultative resources.

Efficacy of Nd:YAG Laser for the Treatment of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is an inflammatory skin disease that involves sebaceous glands and hair follicles of intertriginous areas, including axillary and inguinal regions. It is often chronic, painful, disabling, and can worsen over time. Besides surgically excising affected areas, effective treatments are currently lacking. The long-pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is a device that has traditionally been used for hair removal, but has recently shown promise in clearing old lesions of HS and preventing new eruptions. In accordance with studies in the current literature, we hypothesize that the Nd:YAG laser will significantly improve subjects with hidradenitis suppurativa compared to standard, uninvasive treatment with topical antibiotics [1,2]. Study aims include: to treat subjects with hidradenitis suppurativa with Nd:YAG laser therapy once monthly for 3 consecutive months, with a one month follow-up;to compare the effectiveness of Nd:YAG treatment on one side of the subject (e.g., right) to treatment with topical antibiotics on the subject’s other side (e.g., left);to assess treatment response using a visual analogue scale;to assess subject satisfaction with treatment using a questionnaire;and to photodocument treatment response at each visit.

Surgical Management of Severe Hidradenitis Suppurativa in Women: Outcome and Quality of Life Assessment

Background: Hidradenitis suppurativa (HS) or Acne inversa sometimes referred to as Verneuil’s disease, is a rare and debilitating condition arising in the intertriginous folds that bear apocrine glands (axillae, groin, perineum, pubis, ano-genital area). It has a deleterious impact on the life of affected persons who tend to be more depressive and poorly socially and sexually connected because of pain, malodor and stigmatization. Methods: We conducted a retrospective study in Henri Mondor Hospital in Créteil, France, in order to assess the effectiveness of surgery as a radical treatment and also assess the factors related to recurrence and the surgical and sexual satisfaction in women operated for severe HS of perineum and genitalia. Results: Fifty-five women were included. We got a recurrence rate of 23.6%. 66.7% of recurrence occurred after localized excision. 83% of patients were satisfied with surgery results and would undergo a revision surgery or recommend it. The factors significantly associated with recurrence were overweight (p = 0.0046), location in groin (p = 0.0040), localized excision (p = 0.02), total excision (p = 0.009), healing via secondary intention (p = 0.001) and disability due to HS (p = 0.006). Assessment of sexual response thanks to the FSFI showed an alteration of all the domains of sexual response but the composite index of 18.51 was below the threshold to diagnose pathologic sexual condition.

Topical 5-aminolevulinic acid photodynamic therapy improved refractory acne conglobata and perifolliculitis capitis abscedens et suffodiens rather than hidradenitis suppurativa

Acne conglobata(AC),perifolliculitis capitis abscedens et suffodiens(PCAS)and hidradenitis suppurativa(HS)are uncommon refractory chronic,inflammatory,scarring diseases but cause serious damage to the quality of life.These three diseases are associated with follicular occlusion.Several studies indicated topical 5-aminolevulinic acid photodynamic therapy(ALA-PDT)improved follicular occlusion besides acne treatment.So we attempted to apply ALA-PDT to medicine resistant AC,PCAS and HS.Topical ALA-PDT was applied to 10 patients with AC,seven patients with PCAS and three patients with HS for more than three sessions.All the patients completed the dermatology life quality index(DLQI)questionnaire and were assessed for the efficacy at the baseline and on two weeks after each treatment.Adverse effects were recorded at each visit.The results showed 25.5%(5/20,two cases of AC and three cases of PCAS)of patients achieved excellent improvement after three sessions of PDT and another 60.0%(12/20,eight cases of AC and four cases of PCAS)of patients achieved good improvement.15.0%(3/20,three cases of HS)got poor response(<20%lesions clearance).Anotherfive cases(three cases of AC and two cases of PCAS)also achieved excellent response after 5–7 sessions of PDT.We also found that papular/nodular,cyst/abscess showed higher clearance rate than sinus/¯stula(88.5%,86.1%versus 11.1%).DLQI was reduced after three sessions of PDT in AC and PCAS patients rather than HS patients.5-ALA-PDT could improve refractory AC and PCAS but could not lead to improvement in late stage of HS.The e±cacy increased with more treatment sessions.

清热生肌法治疗化脓性汗腺炎原位中厚皮片移植术失败1例

天津中医药大学第一附属医院2021年11月10日收治1例化脓性汗腺炎(HS)(HurleyⅢ期)患者。在内科治疗的基础上,采用外科手术以彻底清除病灶。因患者病变区窦道、瘢痕形成,致原位中厚皮片移植术失败,故选择更换为中医外治法。在保留原位中厚皮片的基础上,外用京万红及复方黄柏液以清热生肌。换药时,发现原位中厚皮片的存在可以保护新鲜创面;外用京万红可去腐生肌、修复创面,促进肉芽生长;间隔使用复方黄柏液湿敷以清热解毒燥湿,对于抑制肉芽过度增生有明显效果,同时减少创面分泌物、减轻创周红肿,取得明显治疗效果。术后随访局部情况改善良好。

10例手术联合生物制剂治疗化脓性汗腺炎的方法和护理体会

目的探讨手术联合生物制剂治疗化脓性汗腺炎的治疗及护理要点。方法选取2021年10月至2023年10月于中国医学科学院皮肤病医院确诊化脓性汗腺炎并行手术联合生物制剂治疗的患者10例为研究对象,总结治疗及护理要点:采用切开引流、排脓、去顶等手术方法,术后联合生物制剂治疗,术前完善相关检查,做好术前准备及个性化的心理护理,术后做好生物制剂注射的护理,提供细致的生活指导、饮食指导。结果所有患者术后生命体征平稳,无严重感染,随访结果显示,有9例患者治疗后伤口恢复良好,无复发;1例患者复发,再次手术治疗后无复发。结论手术联合生物制剂治疗中重度化脓性汗腺炎,通过综合的心理护理、用药护理、饮食护理和生活护理等措施,患者的治疗效果好,复发率低,值得进一步在临床推广。

化脓性汗腺炎4例临床分析

目的探讨化脓性汗腺炎的临床、组织病理特点。方法回顾性分析4例化脓性汗腺炎临床资料。结果本组病例表现为单发或多发紫红色或化脓性结节,有不同程度的疼痛和压痛,潜行性不规则溃疡,融合性斑块、脓肿及瘢痕形成等。组织病理表现为棘层肥厚,假上皮瘤样增生,真皮全层不等数量的中性粒细胞、浆细胞、淋巴细胞、组织细胞和少量嗜酸性粒细胞浸润,分布不均,典型的毛囊、汗腺等附属器罕见。部分见真皮中浅层血管内皮细胞增生、新生毛细血管及异物肉芽肿形成,毛囊周围炎和小汗腺周围炎,胶原纤维细胞增生和胶原化。4例抗酸染色和PAS染色均未查到结核杆菌和真菌。分泌物真菌和结核杆菌培养均阴性。4例均依据其临床特征、组织病理学表现、实验室检查及排除其他诊断证实。结论化脓性汗腺炎诊断需结合病史、临床表现、微生物学检查等,并排除结核及真菌感染等。应早发现早治疗,晚期病变对治疗反应不佳。

毛囊闭锁三联征一家系致病基因精细定位研究

目的对1例毛囊闭锁三联征家系进行连锁分析精细定位研究,确定其致病基因位点。方法应用覆盖1号染色体1p21.1～1q25.3区域的17个微卫星标记对该家系进行基因分型、连锁分析和单倍型分析。结果在1号染色体上的微卫星标记D1S2707处获得最大LOD值为2.11(重组率θ=0.00)。通过单倍型分析将该家系致病基因定位在微卫星标记D1S2715和D1S484之间的染色体1q21.3～1q23.2区域。结论该研究提示1p21.1～1q25.3(61.8cM)是毛囊闭锁三联征致病基因连锁区域,并将致病基因支持连锁范围缩小至1q21.3～1q23.2(9.8cM)区域。

去顶开窗手术治疗肛周化脓性汗腺炎疗效分析(附12例报告)

目的探讨去顶开窗术治疗肛周化脓性汗腺炎的疗效。方法对12例肛周化脓性汗腺炎患者采用去顶开窗手术治疗的临床资料作回顾性分析。结果 2例患者术后平均6个月复发,再次手术后痊愈。10例患者术后平均随访33个月,治疗部位无复发。结论去顶开窗手术是一种有效、简单、微创、保留组织的外科治疗技术,适用于肛周化脓性汗腺炎的治疗。

毛囊闭锁三联征伴Dowling-Degos病一家系致病基因定位研究

目的:通过对一家系4代毛囊闭锁三联征患者进行致病基因连锁分析定位研究,定位毛囊闭锁三联征家系致病基因,探索毛囊闭锁三联征遗传学发病机制。方法:收集毛囊闭锁三联征伴发Dowling-Degos病家系成员血样并提取DNA,作角蛋白5基因扩增和直接测序;选取覆盖1p21.1～1q25.3区域的12个微卫星标记,应用CEQ8800测序仪对该家系个体样本进行微卫星标记的基因分型,利用Linkage软件(5.2Version)进行连锁分析。结果:该家系成员中未发现角蛋白5基因突变;在染色体1p21.1～1q25.3区域上的微卫星标记处均获得小于-2的LOD值(重组率θ=0.00)。结论:该毛囊闭锁三联征伴发Dowling-Degos病家系与1p21.1～1q25.3区域不存在连锁,毛囊闭锁三联征可能存在遗传异质性。

阿达木单抗治疗反常性痤疮3例

患者1,男性,60岁,臀部脓肿反复发作伴疼痛20余年。患者2,男性,59岁,臀部反复皮疹、破溃伴疼痛3年。患者3,男性,18岁,头皮反复红疹破溃溢脓伴疼痛6个月。诊断:反常性痤疮。治疗上给予皮下注射阿达木单抗注射液,治疗时间分别为18月、5月及6月,治疗后观察国际化脓性汗腺炎严重程度评分(ISH4)均下降,均达到化脓性汗腺炎临床反应评价(HiSCR)临床有效。所有患者未出现严重感染、恶性肿瘤、上呼吸道感染、注射部位反应、头痛及骨骼肌疼痛等不良反应,停药后随诊6个月均未复发。

病变区域刃厚皮片联合头皮刃厚皮片移植修复大面积顽固性Ⅲ期化脓性汗腺炎切除后创面

目的:评估利用病变区域有活力的上皮组织,回植修复化脓性汗腺炎病变组织切除后大面积皮肤缺损的临床效果。方法:将笔者科室2002年1月-2019年3月的7例顽固性Ⅲ期化脓性汗腺炎患者作为研究对象,以滚轴刀削取病变区较完整的表皮及真皮浅层皮片,清洗干净后回植到病变切除后的创面上,剩余创面以头皮刃厚皮片覆盖,加压包扎,创面规律换药,观察皮片成活情况。结果:本组共7例患者,创面植皮成活率高,创面经规律换药治疗后愈合良好。结论:利用病变区域刃厚皮片回植治疗顽固性化脓性汗腺炎切除后创面,减少了正常皮肤供皮区取皮量,可以一次性切除较大面积病变组织,有利于缩短治疗大面积顽固性化脓性汗腺炎的疗程,减少手术次数,值得临床上广泛应用。

冰-矾散耳道施药治疗急性化脓性中耳炎80例

目的观察中医验方冰-矾散治疗急性化脓性中耳炎(脓耳)临床疗效。方法对117例患者分别采用冰-矾散(治疗组)与复方氧氟沙星滴耳液(对照组)治疗,并进行临床观察。结果治疗(80例)临床有效率为91.25%,细菌清除率81.40%;对照组(37例)临床有效率为86.49%,细菌清除率为78.85%。两组疗效均明显,但对重症患者的疗效有极显著性差异(P<0.01)。结论中医验方冰-矾散协同抗生素,以外耳道施药治疗急性化脓性中耳炎,能提高疗效、缩短疗程。

化脓性汗腺炎一家系γ-分泌酶基因突变检测

目的:检测一化脓性汗腺炎(HS)家系γ-分泌酶基因亚基(PS-1,PENEN-2,APH-1,NCSTN)的突变。方法:提取一化脓性汗腺炎家系及50名无亲缘关系的健康对照血DNA,采用PCR技术扩增PS-1、PENEN-2、APH-1和NCSTN基因的全部外显子,经测序、比对确定致病基因突变位点。结果:该家系HS患者均存在NCSTN c.1300 C>T(p.R434X)突变,而该家系正常成员及50名健康对照者未发现该突变,检索NCBI网站单核苷酸多态性(SNP)数据库亦未发现该突变。其余3个亚基未检测到突变位点。结论:NCSTN基因c.1300C>T突变可能是该家系的致病基因位点。

超声在肛周化脓性汗腺炎诊断与手术治疗中的应用

目的探讨超声在肛周化脓性汗腺炎的诊断与手术治疗中的应用价值。方法回顾性分析15例肛周化脓性汗腺炎患者的临床资料。结果肛周化脓性汗腺炎术前诊断主要依靠肛门周围超声检查，检出率为100％，并可应用超声检查与其他疾病进行鉴别诊断。手术采用超声引导下切除病变腺体、窦道切开引流的方法，15例患者病灶组织均被完整切除，痊愈出院，无术后并发症发生。15例患者术后随访0．5～1．0年，无复发病例。结论超声在肛周化脓性汗腺炎的诊断与手术治疗中具有一定的应用价值。

VSD负压封闭引流术在肛周化脓性汗腺炎中的应用

目的探讨对肛周化脓性汗腺炎行VSD封闭引流术的临床效果。方法随机选取该院肛肠科2012年3月—2015年8月期间收治的肛周化脓性汗腺炎患者60例,采用随机数字表法将其分为观察组和对照组。其中对照组患者接受常规开放换药治疗,对照组患者则使用VSD封闭引流术进行治疗,对两组患者的临床治疗效果进行回顾性分析。结果观察组患者经治疗其中90.00%临床症状明显改善,创面基本愈合;对照组则为63.33%。观察组患者的临床治疗总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论在肛周化脓性汗腺炎术后应用VSD负压封闭引流术,有利于创面水肿消除和渗液清除,对于创口的尽快愈合具有十分积极的意义,有利于减轻患者痛苦,保证手术效果的顺利发挥,建议在临床上进一步推广。