Diagnosis and Treatment of Acne Inversa/Hidradenitis Suppurativa in China: An Expert Consensus Statement (2021 Version)

Acne inversa/hidradenitis suppurativa is a chronic,recurrent,inflammatory skin disease that affects the pilosebaceous units,causinfollicular occlusion.The etiology and pathogenesis of acne inversa/hidradenitis suppurativa involves internal and external factors such as genetic susceptibility,inflammation and immunity,microorganisms,obesity,and smoking.acne inversa/hidradenitis suppurativa is difficult to treat,and the current aim of treatment is to control the frequency and duration of disease flares and improve the quality of life.Treatment protocols for acne inversa/hidradenitis suppurativa should be selected based on the disease severity grade.Medical treatments include antibiotics,retinoids,biologics,immunosuppressive agents,and antiandrogen agents.Adjuvant treatments include surgery and laser/light therapies.This consensus aims to further standardize the diagnosis and treatment procedures of acne inversa/hidradenitis suppurativa in China to facilitate its diagnosis and treatment.

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.

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.

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.

Mucinous adenocarcinoma of the buttock associated with hidradenitis:A case report

BACKGROUND Mucinous adenocarcinomas of the buttock are rare and have an uncertain etiology and natural course.They are usually related to chronic anal fistulas,hidradenitis suppurativa,or Crohn's disease.Here,we report a case of mucinous adenocarcinoma associated with hidradenitis and contradictory immunochemistry results.CASE SUMMARY A 62-year-old man complained of recurrent abscesses of the buttock for 3 years.He had several scars and nodules in bilateral buttocks,with purulent discharge.The skin lesions did not appear to originate from the anus.The patient was diagnosed with recurrent abscesses due to hidradenitis suppurativa at the first visit.He showed purulent and subsequent mucin discharge in the first operation and was diagnosed with mucinous adenocarcinoma.Several examinations were performed to determine disease origin and staging.There were no significant findings or evidence of anal fistulas.Hence,he underwent wide local excision and V-Y advancement flap in the second operation.The final diagnosis was mucinous adenocarcinoma without any evidence of anal fistulas.Additional immunochemistry test results were negative for cytokeratin(CK)7 and positive for CK20 and CDX2,with a colorectal origin.A pathologist suggested that the disease originated from a chronic anal fistula.The patient has remained free of recurrence for 24 mo.CONCLUSION Although the patient with mucinous adenocarcinoma showed an atypical course,immunochemistry helped detect the disease origin.

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.

Prevalence of Acne Inversa(Hidradenitis Suppurativa)in China:A Nationwide Cross-Sectional Epidemiological Study

Objective:This study was performed to estimate the prevalence of hidradenitis suppurativa(HS)in China and describe the demographic and clinical features of HS in the Chinese population.Methods:This multicenter clinic-based cross-sectional study was conducted in dermatology clinics within 19 hospitals located in 15 cities/provinces across China from September to October 2020.The prevalence of HS was calculated as the percentage of patients with HS among all visitors at participating clinics during the 1-month study period.HS was independently diagnosed by two certified dermatologists at each site.All visitors at participating clinics were screened,and all patients with HS were invited to participate in a questionnaire survey to elucidate the demographics and clinical features of HS in the Chinese population.Results:We identified 92 patients with HS among 274,742 visitors at participating clinics.The prevalence rate was 0.03349%or 33.49 per 100,000 population(95%confidence interval,26.64–40.32),and the female:male ratio was 1.0:4.7.Conclusion:The overall prevalence of HS in China was lower than that in Western and other Asian countries with a predominance of male patients.

化脓性汗腺炎外科治疗研究进展

化脓性汗腺炎具有慢性、难治性、复发性的特点,其治疗应在内科治疗的基础上有针对性地联合外科干预。目前,应用于临床的外科治疗方式包括切开引流术、去顶术、激光治疗、强脉冲光治疗、光动力疗法等局部治疗,以及保留皮肤组织的电切剥离术、扩大切除术等完整的病损切除治疗。各种治疗方式的清除范围、治疗效果、术后并发症及复发风险各不相同。其中,局部治疗对患者的损伤较小,但复发率高,主要适用于轻中度患者;病损切除治疗复发率较低,但手术损伤大、术后涉及创面重建,主要适用于中重度患者。本文综述了化脓性汗腺炎的外科治疗原则及各种外科治疗方式,以期为该病的规范诊治提供参考。

黑毛雪兔子通气组织发育相关基因ShCTR1的克隆及表达

黑毛雪兔子(Saussurea inversa Raab-Straube)是一种典型的高山植物,具有发达的通气组织。该研究以黑毛雪兔子为材料,利用同源克隆和RACE技术克隆了通气组织形成相关基因(ShCTR1),并对其进行序列分析、系统进化分析、表达分析和亚细胞定位分析,以探讨该基因的功能及其与通气组织的关系。结果表明:(1)成功克隆获得ShCTR1基因cDNA全长为2891 bp(NCBI登录号为:ON081649),包含2550 bp的开放阅读框,编码849个氨基酸,理论等电点5.90,分子式C_(4066)H_(6417)N_(1159)O_(1268)S_(43),为疏水蛋白,无跨膜结构。(2)系统进化树分析显示,黑毛雪兔子ShCTR1与菜蓟(Cynara cardunculus L.)CcCTR1的氨基酸序列相似度最高;非编码区序列分析发现ShCTR1基因含有大量的光响应元件,表明ShCTR1基因可能参与对紫外胁迫的响应。(3)实时荧光定量分析显示,ShCTR1基因在根、茎和叶中均有表达,且在根中的表达量最高;在紫外、低温和低氧胁迫下,ShCTR1基因的表达量均上调,证明ShCTR1基因参与了对以上3种环境胁迫的响应。(4)亚细胞定位显示,ShCTR1主要分布于细胞核。研究推测,黑毛雪兔子ShCTR1基因可能在通气组织的形成以及对逆境胁迫的响应中具有重要作用。

1例化脓性汗腺炎青少年患者双侧腋窝皮肤溃疡的护理

本文总结1例青少年化脓性汗腺炎(HS)患者双侧腋窝皮肤溃疡的护理经验。护理要点包括:医护合作控制MRSA感染;保证有效的负压封闭引流;观察皮瓣的成活情况;健康教育以提升患者主动管理伤口和预防复发的能力;减轻患者伤口的疼痛感;预防情绪障碍等。通过综合治疗和护理,患者双侧腋窝创面达到上皮化。

克罗恩病与化脓性汗腺炎发生风险的两样本孟德尔随机化研究

目的利用两样本孟德尔随机化研究克罗恩病与化脓性汗腺炎之间的因果关系。方法从IEU open GWAS数据库获得克罗恩病和化脓性汗腺炎的汇总数据集,样本量分别为212356人和211548人,利用两样本MR研究,将遗传因素作为工具变量,运用MR-Egger法、加权中位数法、逆方差加权法、简单模型和加权模型这5种方法来探讨克罗恩病和化脓性汗腺炎之间的因果关系。结果筛选出6个单核苷酸多态性作为工具变量,IVW、加权中位数和加权模式这3种方法得到的结果均支持克罗恩病与化脓性汗腺炎风险增加的因果关系。IVW结果显示OR=1.64,95%CI:1.28~2.09,P<0.001;加权中位数法显示OR=1.71,95%CI:1.24~2.35,P<0.001;加权模式显示OR=1.74,95%CI:1.21~2.50,P=0.032。Cochran’Q检验结果IVW(P=0.412)和MR-Egger(P=0.322),表明SNP之间不存在异质性。MR-Egger回归结果(P=0.607)表明研究结果不存在基因的水平多效性。结论两样本孟德尔随机化分析结果支持克罗恩病和化脓性汗腺炎发生风险增加存在因果关系。

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。

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。

逆向性痤疮的命名、发病机制及病因学研究进展

逆向性痤疮又名化脓性汗腺炎,常与聚合性痤疮、脓肿性穿凿性头部毛囊周围炎合并发生,国内常以"毛囊闭锁三联征"报道该病。该病命名混乱,给读者造成了一定困难。本文综述不同阶段人们对该病认识的改变及其命名的变化。此外,近年来逆向性痤疮的遗传学研究取得了重大突破,本文同时探讨逆向性痤疮可能的发病机制,并对该病的病因学研究进展进行综述,希望将来可以从基因水平上对该病做出预防和治疗,解除患者病痛。

中西医结合治疗会阴、肛周化脓性大汗腺炎

会阴、肛周化脓性大汗腺炎,顽固难治,常见于多汗及皮肤卫生不佳者,多在青春期后患病,尤以身体健康、皮肤油脂较多的中年人易患,且本病易反复发作,在皮内形成相互交通的瘘道、硬结、瘢痕,使病变区皮肤凸凹不平。目前尚无统一的诊断标准,主要依靠临床表现进行诊断。

化脓性大汗腺炎的手术治疗

目的:探讨化脓性大汗腺炎的手术治疗方法。方法:2010年9月-2013年4月,笔者科室对6例8处化脓性大汗腺炎病变采用外科方法进行治疗,术前美蓝明确病变范围,切除标记范围内全部皮肤及皮下组织,直至深筋膜表面,术后直接缝合2处,游离植皮3处,皮瓣或肌皮瓣覆盖3处。结果:1处植皮区因皮片部分坏死行补充植皮,其余皮片、皮瓣均愈合良好。随访时间6～27个月,除1例术后3个月出现局部复发外,其余均未见复发。结论:手术彻底切除病变的皮肤及皮下组织是治疗进展期化脓性大汗腺炎的唯一方法。在条件允许的情况下,病灶切除后首选皮瓣或肌皮瓣修复,尤其对于外露或功能部位的创面。