nigel scott
TRANSCRIPT
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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