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  1. Hidradenitis Suppurativa

    MedlinePlus

    ... gov to read descriptions of these studies. Organizations Organizations Listen Nonprofit support and advocacy groups bring together ... endorsement by GARD. Suggest an organization to add. Organizations Supporting this Disease Canadian Hidradenitis Suppurativa Foundation (CHSF) ...

  2. Hidradenitis suppurativa.

    PubMed

    Revuz, Jean

    2010-12-01

    Hidradenitis suppurativa, or Verneuil's disease, is somewhat common, especially in women, but it often unrecognized. Clinical manifestations include painful nodules, abscesses, sinus tracts, and ropelike hypertrophic scars in the apocrine gland-bearing areas. It is a chronic disease. Smoking and overweight are risk factors, but the cause is unknown: it is a disease of the follicular apparatus, neither infectious nor hormonal. Severe dramatic forms are rare. Quality of life is severely affected even in the mild forms. Treatment is both medical and surgical: wide-spectrum antibiotics and excisions tailored to the extent of involvement. Anti-TNFα drugs are effective, but their risk-benefit ratio is still in question. Laser treatment is under study. PMID:20965688

  3. Hidradenitis suppurativa.

    PubMed

    Margesson, Lynette J; Danby, F William

    2014-10-01

    Hidradenitis suppurativa is a chronic relapsing disorder of the folliculopilosebaceous units (FPSUs). Its negative impact on quality of life is extreme, mainly due to the lack of early recognition, accurate diagnosis, and appropriate management. The support structure of the FPSUs is defective. Under the influence of endogenous reproductive hormones, exogenous hormones, androgens and their precursors in dairy products, and other dietary factors, the follicular unit is plugged and distended by retained keratin. Friction, shearing forces, and pressure lead to rupture and leakage of the ductal contents from the weakened FPSU, causing an inflammatory reaction mediated mainly by the innate immune system. Therapy requires patient comprehension and cooperation, counseling, aggressive hormonal and dietary modification, avoidance of the trauma that leads to rupture, active multimodal anti-inflammatory therapy, and early unroofing and debridement. The full therapeutic program is needed to avoid the aggressive surgery required if the condition is not diagnosed early and managed appropriately. PMID:25214437

  4. Diagnosing Hidradenitis Suppurativa.

    PubMed

    Revuz, Jean E; Jemec, Gregor B E

    2016-01-01

    Three diagnostic criteria must be met for hidradenitis suppurativa: typical lesions, occurrence in one or more of the predilection areas, and that it is chronic and/or recurrent. Several outcome measures are used, including patient-reported pain and itch scales, Dermatology Life Quality Index, and Skindex. Hidradenitis suppurativa is associated with significant comorbidities that must be addressed in the evaluation of the patients. PMID:26617351

  5. Finasteride in Hidradenitis Suppurativa

    PubMed Central

    Do, Melissa Voutsalath

    2016-01-01

    Objective: Hidradenitis suppurativa is associated with obesity and metabolic syndrome, and a hormonal component has been implicated. Finasteride is an anti-androgenic agent used for benign prostatic hypertrophy, androgenic alopecia, and, in females, hirsutism. Finasteride is an inhibitor of type II5 alpha-reductase that reduces dihydrotestosterone levels and appears to alter end-organ sensitivity of the folliculopilosebaceous unit. The objective is to review the use of finasteride for hidradenitis suppurativa. Design: Review of the literature. Setting: Clinical treatment of patients with hidradenitis suppurativa. Measurement/participants: Five publications described the use for hidradenitis suppurativa. Four global case reports cited 13 individual patients, four male and nine female. Females included three adolescent patients and a child aged seven with precocious puberty. In the United States, finasteride in obese male adults was mentioned to be helpful. Results: Oral finasteride, as monotherapy or additional therapy was utilized for advanced hidradenitis suppurativa. The outcomes were largely favorable, with complete resolution in three patients. A latency period was evident in a majority. Limited, or continuous use for up to six years, was detailed. Response to reintroduction was successful. A benign safety profile with excellent tolerability was described. Teratogenicity of finasteride was addressed and contraception advocated in female patients. Sexual adverse effects were not ascertained. Conclusion: In hidradenitis suppurativa, finasteride could be considered in adults of both sexes as well as in select female children and adolescents, particularly those with concurrent metabolic and hormonal alterations present. Finasteride provides another highly effective, durable, relatively safe, and inexpensive option in the treatment of hidradenitis suppurativa. PMID:27386051

  6. Management of hidradenitis suppurativa.

    PubMed

    2016-09-01

    Hidradenitis suppurativa is a recurring chronic inflammatory debilitating skin disease of the hair follicle that usually presents with painful, deep-seated and inflamed lesions in the apocrine gland-bearing areas of the body. The lesions often progress to become chronic with purulent discharge, sinus formation and scarring. Hidradenitis suppurativa is associated with systemic comorbidities, including metabolic syndrome and inflammatory bowel disease.(1) Long-term treatment is often necessary and requires coordination between primary care, dermatologists and surgeons. However, there is a lack of good quality evidence and a paucity of authoritative guidance on treatment strategies. In this article, we review the diagnosis and management of hidradenitis suppurativa and discuss some new developments, including the use of cytokine modulators. PMID:27585997

  7. Surgical Procedures in Hidradenitis Suppurativa.

    PubMed

    Janse, Ineke; Bieniek, Andrzej; Horváth, Barbara; Matusiak, Łukasz

    2016-01-01

    Hidradenitis suppurativa is difficult to treat owing to its complex pathomechanism; beside the extensive inflammation with abscesses and inflammatory nodules, there is also an architectural loss with sinus tract formation and in severe cases with extensive scarring. Therefore, surgery is mandatory in moderate and severe HS. PMID:26617363

  8. Arthritis associated with hidradenitis suppurativa.

    PubMed Central

    Bhalla, R; Sequeira, W

    1994-01-01

    OBJECTIVE--To review the presentation and clinical findings of arthritis associated with hidradenitis suppurativa. METHOD--Medical records from the rheumatology clinics of two major teaching hospitals were reviewed for arthritis and hidradenitis suppurativa. The nine patient records fulfilling these criteria were reviewed and compared with 20 previous reports. RESULTS AND CONCLUSION--The arthritis associated with hidradenitis suppurativa is rare and most commonly affects the peripheral joints. The axial skeleton is less frequently involved and is often asymptomatic. Images PMID:8311560

  9. Imaging of Hidradenitis Suppurativa.

    PubMed

    Wortsman, Ximena

    2016-01-01

    Hidradenitis suppurativa is a complex disease of chronic evolution and difficult management. Imaging, particularly color Doppler ultrasound, has demonstrated a wide range of subclinical anatomic abnormalities, allowing modification of the clinical assessment of severity of the disease and therefore management of patients. Sonography supports early and more precise diagnosis and staging by providing critical objective information in real time. The richness of these data can also support assessment of the pathogenesis of the disease, allow monitoring of patients, and contribute to clinical trials. MRI can support the diagnosis of extensive anogenital and deep lesions. PMID:26617359

  10. Antibiotic Treatment of Hidradenitis Suppurativa.

    PubMed

    Bettoli, Vincenzo; Join-Lambert, Olivier; Nassif, Aude

    2016-01-01

    Although hidradenitis suppurativa (HS) is not primarily an infectious disease, antibiotics are widely used to treat HS. Recent microbiological data show that HS suppurating lesions are associated with a polymorphous anaerobic flora, including actinomycetes and milleri group streptococci, and can therefore be considered as polymicrobial soft tissue and skin infections. Analysis of the literature provides little information on the efficacy of antibiotics in HS but suggests a beneficial effect of certain antimicrobial treatments, depending on the clinical severity of the disease. Patients must be informed and should agree with the treatment strategy before starting antibiotic treatments. PMID:26617361

  11. Hidradenitis suppurativa: an update.

    PubMed

    Ingram, John R

    2016-02-01

    Hidradenitis suppurativa (HS) is a chronic, painful skin disease characterised by recurrent inflammatory lesions in flexural locations such as the axillae, groins and perineum. The papules, nodules and abscesses may discharge blood-stained pus which, combined with pain, results in marked quality-of-life reduction. Sinus tracts and scarring may also result. Onset of HS is typically in the second to fourth decades and it affects about 1% of young European adults. There are links with smoking and obesity and an autosomal dominant pattern of inheritance is reported by one-third of patients. Medical management escalates from topical antimicrobials to oral tetracyclines, a combination of clindamycin and rifampicin typically given for 10 weeks, oral disease modifiers, and anti-tumour necrosis factor-alpha therapies. Excision of individual lesions has high recurrence rates which can be minimised by wider excisions, at the expense of longer healing times. Treatment of pain is a relatively neglected aspect of therapy. PMID:26833521

  12. [Ultrasound examination of hidradenitis suppurativa].

    PubMed

    Martorell, A; Segura Palacios, J M

    2015-11-01

    Hidradenitis suppurativa is a debilitating chronic, recurrent, inflammatory cutaneous disease of the hair follicle that usually presents with painful, deep and inflamed lesions in the areas of the body with apocrine glands, most frequently the axillary, groin and anogenital regions. This entity is difficult to manage since it can be difficult to determine the true nature and extension of the lesions. Cutaneous ultrasound allows real-time visualization of the cutaneous structures under examination, defining the type of lesion, its anatomical extension, and the degree of inflammatory activity, which affects adequate patient management. The present review analyses the importance of ultrasound in the assessment of patients with hidradenitis suppurativa. PMID:26895939

  13. Hidradenitis Suppurativa and Wound Management.

    PubMed

    Dini, Valentina; Oranges, Teresa; Rotella, Luca; Romanelli, Marco

    2015-09-01

    Hidradenitis suppurativa (HS) is a chronic, burdensome, debilitating disease of the hair follicle. It presents with recurrent painful inflamed and noninflamed lesions usually in specific body areas such as axillary, inguinal, perineal, and genital areas. It is associated with a large range of other diseases and conditions, such as obesity, arthropathy, inflammatory bowel diseases, and sqaumous cell carcinoma. Medical therapy may be systemic or topical, mainly based on antibiotics, retinoids, hormones and immunosuppressive drugs, including biological therapies. Surgical and laser therapies may be a valid therapeutic approach in order to treat locally recurring lesions. The aim of this article is to review the wound healing options after skin excision and laser treatments, with a focus on lesions left to heal by secondary intention, analyzing the efficacy of moist wound dressings, negative pressure wound therapy, bioactive dressings, such as platelet-rich plasma gel and hylarunoic acid scaffold, or autologous keratinocyte suspension in platelet concentrate and skin-grafting tecniques. PMID:26248827

  14. The Handicap of Hidradenitis Suppurativa.

    PubMed

    Deckers, Inge Elizabeth; Kimball, Alexa Boer

    2016-01-01

    Hidradenitis suppurativa (HS) is a chronic skin disease, with painful, foul-smelling, recurring inflammation, leading to a diminished quality of life. Patients with HS also often suffer from depression, have an impaired sexual health, and may have difficulty performing their work duties. PMID:26617353

  15. The Genetics of Hidradenitis Suppurativa.

    PubMed

    Ingram, John R

    2016-01-01

    A family history of hidradenitis suppurativa (HS) is reported by about one-third of patients, and the pattern of inheritance suggests a single gene disorder inherited as an autosomal dominant trait. Several γ-secretase gene mutations were identified in 6 Han Chinese families with multiple affected family members. Several of the Han Chinese patients had a severe disease phenotype, with involvement of nonflexural skin locations such as the back and chest. These findings have been repeated in other populations, but γ-secretase mutations have been found only in a minority of patients with HS. PMID:26617354

  16. Endocrinologic Aspects of Hidradenitis Suppurativa.

    PubMed

    Karagiannidis, Ioannis; Nikolakis, Georgios; Zouboulis, Christos C

    2016-01-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of unknown etiology. The role of hormones in HS remains unclear, but the observation of premenstrual flares, female predominance, and improvement during pregnancy suggest a hormonal/metabolic background. The reported positive effects of antiandrogen therapy supports a possible role of androgens. The predominant onset of the disease years after puberty may indicate a metabolic disorder. Obesity contributes significantly to HS pathogenesis; diabetes, dyslipidemia, the metabolic syndrome, and polycystic ovarian syndrome are among the commonest comorbidities. More studies are required to clarify a potential hormonal dysregulation in HS. PMID:26617357

  17. Inflammatory Mechanisms in Hidradenitis Suppurativa.

    PubMed

    Kelly, G; Prens, Errol P

    2016-01-01

    Hidradenitis suppurativa (HS) is a chronic relapsing disease of follicular occlusion that causes immense clinical and psychosocial morbidity when refractory to treatment. HS is no longer considered a disease of primary infectious etiology, although bacteria play a role. There is increasing evidence that HS is associated with immune dysregulation, based on its clinical association with other immune-mediated disorders, by its response to biologic therapy in the clinical arena, and from molecular research. This article summarizes what is known in relation to the inflammatory pathways in HS. PMID:26617358

  18. The Microbiology of Hidradenitis Suppurativa.

    PubMed

    Ring, Hans Christian; Emtestam, Lennart

    2016-01-01

    Although the clinical presentation of Hidradenitis Suppurativa (HS) is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacterial specimens as well as biofilm formation in lesional HS skin. Consistent findings of Gram-positive cocci and -rods including Staphylococus aureus, Coagulase-negative staphylococci (CoNS) and Corynebacterium species (spp) in deep tissue samples have been demonstrated in HS. Although efficacy of antibiotics, i.e., rifampicin, clindamycin or tetracycline may support a microbial role in disease pathogenesis, the most often isolated bacterial specimens are commensal bacteria (CoNS). PMID:26617355

  19. Lasers and Intense Pulsed Light Hidradenitis Suppurativa.

    PubMed

    Saunte, Ditte M; Lapins, Jan

    2016-01-01

    Lasers and intense pulsed light (IPL) treatment are useful for the treatment of hidradenitis suppurativa (HS). Carbon dioxide lasers are used for cutting or vaporization of the affected area. It is a effective therapy for the management of severe and recalcitrant HS with persistent sinus tract and scarring, and can be performed under local anesthesia. HS has a follicular pathogenesis. Lasers and IPL targeting the hair have been found useful in treating HS by reducing the numbers of hairs in areas with HS. The methods have few side effects, but the studies are preliminary and need to be repeated. PMID:26617364

  20. Comorbidities of hidradenitis suppurativa (acne inversa)

    PubMed Central

    Fimmel, Sabine

    2010-01-01

    Comorbidities of hidradenitis suppurativa (acne inversa) were reviewed by extracting original and review publications included in MEDLINE, EMBASE and COCHRANE libraries using the terms “hidradenitis,” “Verneuil” and “acne inversa.” Follicular occlusion disorders, inflammatory bowel diseases, especially Crohn disease, spondylarthropathy, other hyperergic diseases, genetic keratin disorders associated with follicular occlusion and squamous cell carcinoma were the most common hidradenitis suppurativa comorbid diseases. A first classification of these major comorbidities and their possible genetic background reveals a list of chromosome loci and genes, which could be hidradenitis suppurativa candidates. Most of these diseases belong to the group of autoinflammatory disorders, where th17 cell cytokines seem to play a central role. PMID:21547142

  1. Systemic associations of hidradenitis suppurativa.

    PubMed

    Kohorst, John J; Kimball, Alexa B; Davis, Mark D P

    2015-11-01

    Hidradenitis suppurativa (HS) is a progressive, inflammatory disease that affects mostly young women and appears to be caused by inflammation of hair follicles in areas of friction in the body (eg, the axillae, groin, perineum, and medial aspects of the thighs). Given this pathophysiology, one might expect comorbidities that contribute to inflammation and friction. Observed comorbidities fall into several categories: obesity and the metabolic syndrome, hormone-related disorders, deleterious health habits and mood, autoimmune disease, inflammatory disease and finally, the risk of skin cancer and sequelae of nonhealing wounds. The available literature on comorbid diseases of HS is limited but rapidly increasing. In this review, we summarize recent and major studies of HS disease association. PMID:26470611

  2. Hidradenitis Suppurativa and Pruritus Ani

    PubMed Central

    Asgeirsson, Theodor; Nunoo, Robert; Luchtefeld, Martin A.

    2011-01-01

    Hidradenitis suppurativa (HS) is a chronic debilitating disorder that can affect any areas bearing apocrine glands. Perineal HS is associated with high morbidity compared with other anatomic regions. Early-stage disease may mimic various other forms of cutaneous disorders, but as HS progresses pathognomonic skin changes occur. Clinical stage can guide the therapeutic approach, but the lowest recurrence rate is obtained by removing all involved skin and subcutaneous fat. Pruritus ani is a complex disease with a multitude of etiologies. Its management can be frustrating and disappointing for the patient and doctor alike. The key is to start with simple treatment options focusing on perianal hygiene and avoidance of the most common offending foods and beverages. If these measures fail, topical medications should be attempted before graduating to perianal injections of methylene blue as a last resort. PMID:22379408

  3. Two Cases of Paradoxical Hidradenitis Suppurativa while on Adalimumab

    PubMed Central

    Harvin, Glenn; Kasarala, George

    2016-01-01

    Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by recurring abscesses, nodules, and fistulas predominantly in the groin and axillae. The association between HS and Crohn's disease (CD) has been well documented. Tumor necrosis factor (TNF) inhibitors have shown to be effective in treating both HS and CD. We report 2 patients who developed HS while on TNF inhibitor treatment for CD. PMID:27403108

  4. Hidradenitis suppurativa in the pediatric population.

    PubMed

    Liy-Wong, Carmen; Pope, Elena; Lara-Corrales, Irene

    2015-11-01

    Hidradenitis suppurativa (HS) generally appears after puberty, is infrequently seen in younger children, and early onset, which is associated with more widespread disease, is more common in children with a positive family history of HS. When compared with adults with HS, children with HS are more likely to have hormonal imbalances, making hormonal investigations integral to disease management in pediatric patients. HS affects intertriginous areas, presenting with double-ended comedones, tender subcutaneous nodules, purulent discharge, and the formation of sinus tracts, hypertrophic fibrotic scars, and dermal contractures. Treatment of HS in children has not been well studied. The goals of therapy in the pediatric setting are to alleviate pain, minimize inflammation and scarring, prevent disease progression, and postpone the need for surgery. Mild cases can be treated with topical antibiotics, while topical and oral antibiotics are the primary therapies for moderate forms of HS. Modalities like biologic agents, laser therapy, or surgery have been reserved for severe pediatric cases of HS. Early recognition and treatment are critical to minimize the effects of the disease on the life course. Given the significant impact of the condition on quality of life and self-esteem, there is a clear role for psychological support. PMID:26470613

  5. Primary Cutaneous Plasmacytosis: Masquerading as Hidradenitis Suppurativa

    PubMed Central

    Goyal, Tarang; Varshney, Anupam; Zawar, Vijay; Sharma, Veena

    2016-01-01

    Isolated cutaneous plasmacytosis (CP) is a rare entity with few cases reported in world literature. CP masquerading as hidradenitis suppurativa like presentation is a unique case with some features differentiating it clinically from it which were further confirmed by histopathology and immunostaining. Our case showed hyperplasia of mature plasma cells and polyclonal hypergammaglobulinemia, immunostaining for CD138 positivity and kappa: lambda ratio more than 3:1. Extensive clinical and laboratory investigations failed to reveal any underlying pathology, presence of any underlying disease accompanying the hypergammaglobulinemia and/or plasma cell proliferation. PMID:27057027

  6. Primary Cutaneous Plasmacytosis: Masquerading as Hidradenitis Suppurativa.

    PubMed

    Goyal, Tarang; Varshney, Anupam; Zawar, Vijay; Sharma, Veena

    2016-01-01

    Isolated cutaneous plasmacytosis (CP) is a rare entity with few cases reported in world literature. CP masquerading as hidradenitis suppurativa like presentation is a unique case with some features differentiating it clinically from it which were further confirmed by histopathology and immunostaining. Our case showed hyperplasia of mature plasma cells and polyclonal hypergammaglobulinemia, immunostaining for CD138 positivity and kappa: lambda ratio more than 3:1. Extensive clinical and laboratory investigations failed to reveal any underlying pathology, presence of any underlying disease accompanying the hypergammaglobulinemia and/or plasma cell proliferation. PMID:27057027

  7. [Hidradenitis suppurativa/acne inversa: An update].

    PubMed

    Kirschke, J; Hessam, S; Bechara, F G

    2015-06-01

    Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory disease characterized by painful nodules, abscesses, fistulas, sinus tracts and scarring, which may lead to severe functional and psychological impairment. Patients often suffer for many years before the right diagnosis is finally made. HS/AI is still a therapeutic challenge. Conservative therapies play a role in mild stages of the disease; however they do not result in healing. Therapy of choice associated with the lowest recurrence rate is a radical wide excision of involved skin. PMID:25877488

  8. Pathogenesis, clinical features and management of hidradenitis suppurativa.

    PubMed Central

    Parks, R. W.; Parks, T. G.

    1997-01-01

    Hidradenitis suppurativa is a chronic skin condition involving the apocrine glandular zones. Affected patients may present with acute abscesses, but the condition often progresses to a chronic state with persistent pain, sepsis, sinus tract and fistula formation, purulent discharge and dermal scarring. Treatment of patients with severe disease can be difficult and may require complex surgical intervention. This review encompasses the pathogenesis, clinical manifestations and management options for patients with hidradenitis suppurativa. Images Figure 2 PMID:9135232

  9. Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa.

    PubMed

    Miller, Iben Marie; McAndrew, Rachel J; Hamzavi, Iltefat

    2016-01-01

    It is challenging to estimate a true prevalence of hidradenitis suppurativa (HS) because it is underdiagnosed and misdiagnosed. Prevalences have been reported from 0.00033% to 4.1%. The incidence seems to be rising. In addition to dermatologic symptoms, HS is associated with metabolic syndrome, and increased cardiovascular risk. The majority of HS patients are smokers. Additional somatic comorbidities complicating HS include autoimmune conditions, follicular syndromes, rheumatologic conditions, and malignancies. HS patients are troubled by psychological comorbidities. When treating HS patients it is imperative not only to treat the skin symptoms, but also address the screening and treatment of possible comorbidities. PMID:26617352

  10. Bacterial Pathogens Associated with Hidradenitis Suppurativa, France

    PubMed Central

    Coignard-Biehler, Hélène; Jais, Jean-Philippe; Quesne, Gilles; Frapy, Eric; Poirée, Sylvain; Le Guern, Anne-Sophie; Le Flèche-Matéos, Anne; Hovnanian, Alain; Consigny, Paul-Henry; Lortholary, Olivier; Nassif, Xavier; Nassif, Aude; Join-Lambert, Olivier

    2014-01-01

    Hidradenitis suppurativa (HS) is a skin disease characterized by recurrent nodules or abscesses and chronic suppurating lesions. In the absence of clear pathophysiology, HS is considered to be an inflammatory disease and has no satisfactory medical treatment. Recently, prolonged antimicrobial treatments were shown to improve or resolve HS lesions. We prospectively studied the microbiology of 102 HS lesions sampled from 82 patients using prolonged bacterial cultures and bacterial metagenomics on 6 samples. Staphylococcus lugdunensis was cultured as a unique or predominant isolate from 58% of HS nodules and abscesses, and a polymicrobial anaerobic microflora comprising strict anaerobes, milleri group streptococci, and actinomycetes was found in 24% of abscesses or nodules and in 87% of chronic suppurating lesions. These data show that bacteria known to cause soft tissue and skin infections are associated with HS lesions. Whether these pathogens are the cause of the lesions or are secondary infectious agents, these findings support targeted antimicrobial treatment of HS. PMID:25418454

  11. Imaging of Hidradenitis Suppurativa and Its Complications

    PubMed Central

    2014-01-01

    We present a 56-year-old man with known diabetes mellitus and a 10-year history of hidradenitis suppurativa (HS) and highlight, through MR imaging findings, the relentless natural progression of the disease, characterized by recurrent exacerbations of abscesses and fistulae and complications of perianal fistulae and sacral osteomyelitis. We also demonstrate the appearance of this condition on PET-CT with F-18 FDG, which was performed for staging after postexcision tissue specimen revealed well-differentiated squamous cell carcinoma. The association of arthritis and possible dactylitis was also manifested in our patient. Discussion of HS in the radiology literature is limited and, to our knowledge, there has been no case report describing these imaging findings in the same patient. PMID:25221681

  12. Hidradenitis suppurativa: the role of immune dysregulation.

    PubMed

    Kelly, Genevieve; Sweeney, Cheryl M; Tobin, Anne-Marie; Kirby, Brian

    2014-10-01

    Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease of follicular occlusion characterized by boils, sinus tracts, fistulae, and scarring. It has a significant underestimated morbidity. Antimicrobial, immunosuppressive, anti-androgenic, and surgical approaches have been used with varying results. Knowledge of the pathogenesis of HS is fragmented, and treatment choices have hitherto been empiric without an exact understanding of the scientific basis for their use. Tumor necrosis factor-α inhibitors have shown promise in the treatment of HS in recent years, and the concept of HS as an immunological condition has come to the fore. The focus of this review is to discuss the immunological abnormalities underpinning HS as elucidated to date. PMID:24961484

  13. Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities.

    PubMed

    Lim, Ziying Vanessa; Oon, Hazel H

    2016-04-01

    Hidradenitis suppurativa is a chronic inflammatory skin condition associated with an increased prevalence of individual metabolic conditions such as insulin resistance, obesity, hyperlipidemia, hypertension, and with the metabolic syndrome, as a constellation of these risk factors. This places affected patients at an increased risk of early cardiovascular morbidity and mortality. Moreover, many of the therapeutic options, including the newer biologics, used in the treatment of hidradenitis suppurativa have both beneficial and adverse metabolic effects. Therefore, it is critical for physicians to consider the complex interactions between the disease process and the treatment options in the holistic management of these patients with an intrinsically higher risk of metabolic consequences. Other chronic systemic inflammatory diseases such as psoriasis and rheumatoid arthritis have been studied more extensively with regard to their associations and share an underlying link with the metabolic syndrome; we can draw upon the existing knowledge in our understanding and management of hidradenitis suppurativa. PMID:27081259

  14. Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities

    PubMed Central

    Oon, Hazel H.

    2016-01-01

    Hidradenitis suppurativa is a chronic inflammatory skin condition associated with an increased prevalence of individual metabolic conditions such as insulin resistance, obesity, hyperlipidemia, hypertension, and with the metabolic syndrome, as a constellation of these risk factors. This places affected patients at an increased risk of early cardiovascular morbidity and mortality. Moreover, many of the therapeutic options, including the newer biologics, used in the treatment of hidradenitis suppurativa have both beneficial and adverse metabolic effects. Therefore, it is critical for physicians to consider the complex interactions between the disease process and the treatment options in the holistic management of these patients with an intrinsically higher risk of metabolic consequences. Other chronic systemic inflammatory diseases such as psoriasis and rheumatoid arthritis have been studied more extensively with regard to their associations and share an underlying link with the metabolic syndrome; we can draw upon the existing knowledge in our understanding and management of hidradenitis suppurativa. PMID:27081259

  15. Risk factors for hidradenitis suppurativa: a pilot study*

    PubMed Central

    Schmitt, Juliano Vilaverde; Bombonatto, Giovana; Martin, Manoela; Miot, Hélio Amante

    2012-01-01

    The hidradenitis suppurativa is a chronic debilitating inflammatory disease whose etiology is not fully understood. We conducted a pilot case-control study matched by sex and age with other dermatological patients to analyze possible risk factors associated with this disease. We included 15 cases and 45 controls, 67% were women. Bivariate and multivariate logistic regression analysis identified significant association with smoking, higher body mass index and family history. The use of hormonal contraceptives was less frequent in women with hidradenitis. PMID:23197222

  16. Treatment of persistent painful nodules of hidradenitis suppurativa with cryotherapy.

    PubMed

    Bong, J L; Shalders, K; Saihan, E

    2003-05-01

    We report outcomes for 10 patients with persistent painful nodules of hidradenitis suppurativa treated with cryotherapy. Eight patients reported improvement and to date have had no recurrence of lesions at the treated sites. Most patients had significant pain during and after treatment. Eight patients had post-treatment ulceration, infection or both. The average number of days for the treatment areas to heal was 25. Seven patients rated cryotherapy as better than oral antibiotics and eight patients would consider this treatment again in the future. Cryotherapy can be an effective treatment for patients who have limited but persistent painful nodules. However, patients must be warned about pain, prolonged healing time and risk of infection after the procedure. PMID:12780702

  17. Acne inversa goes an extra mile than hidradenitis suppurativa.

    PubMed

    Witmanowski, Henryk; Szychta, Paweł; Stępniewski, Sławomir; Mackiewicz-Wysocka, Małgorzata; Czyżewska-Majchrzak, Lucja; Wasilewska, Agnieszka

    2013-08-01

    Acne inversa (AI, hidradenitis suppurativa, Velpeau's disease, Verneuil's disease) is a severe, chronic inflammatory dermatosis of unknown etiology, detected on the basis of clinical symptoms more frequently in women than in men. Purulent lesions in the form of nodules and inflammatory tumors, fistulas and scars are present in the areas with hair follicles and apocrine glands, most commonly on the armpits, groin, around the anus and pubic region. Acne inversa can lead to physical and mental disorders. Unfortunately, it is often misdiagnosed and ineffectively treated. The paper presents a case of a 46-year-old patient who was successfully treated surgically for AI around the anus and buttocks by excision of the changes and closure of the wound with local flaps and split-thickness skin grafts, taken with dermatome from the rear surface of the thighs. Surgical treatment is the method of choice in the treatment of severe AI. PMID:24278084

  18. Acne inversa goes an extra mile than hidradenitis suppurativa

    PubMed Central

    Szychta, Paweł; Stępniewski, Sławomir; Mackiewicz-Wysocka, Małgorzata; Czyżewska-Majchrzak, Łucja; Wasilewska, Agnieszka

    2013-01-01

    Acne inversa (AI, hidradenitis suppurativa, Velpeau’s disease, Verneuil’s disease) is a severe, chronic inflammatory dermatosis of unknown etiology, detected on the basis of clinical symptoms more frequently in women than in men. Purulent lesions in the form of nodules and inflammatory tumors, fistulas and scars are present in the areas with hair follicles and apocrine glands, most commonly on the armpits, groin, around the anus and pubic region. Acne inversa can lead to physical and mental disorders. Unfortunately, it is often misdiagnosed and ineffectively treated. The paper presents a case of a 46-year-old patient who was successfully treated surgically for AI around the anus and buttocks by excision of the changes and closure of the wound with local flaps and split-thickness skin grafts, taken with dermatome from the rear surface of the thighs. Surgical treatment is the method of choice in the treatment of severe AI. PMID:24278084

  19. Compartmentalized Cytokine Responses in Hidradenitis Suppurativa

    PubMed Central

    Savva, Athina; Kersten, Brigit; Pistiki, Aikaterini; van de Veerdonk, Frank L.; Netea, Mihai G.; van der Meer, Jos W.; Giamarellos-Bourboulis, Evangelos J.

    2015-01-01

    Background Favorable treatment outcomes with TNF blockade led us to explore cytokine responses in hidradenitis suppurativa (HS). Methods Blood monocytes of 120 patients and 24 healthy volunteers were subtyped by flow cytometry. Isolated blood mononuclear cells (PBMCs) were stimulated for cytokine production; this was repeated in 13 severe patients during treatment with etanercept. Cytokines in pus were measured. Results CD14brightCD16dim inflammatory monocytes and patrolling monocytes were increased in Hurley III patients. Cytokine production by stimulated PBMCs was low compared to controls but the cytokine gene copies did not differ, indicating post-translational inhibition. The low production of IL-17 was restored, when cells were incubated with adalimumab. In pus, high concentrations of pro-inflammatory cytokines were detected. Based on the patterns, six different cytokine profiles were discerned, which are potentially relevant for the choice of treatment. Clinical improvement with etanercept was predicted by increased production of IL-1β and IL-17 by PBMCs at week 8. Conclusions Findings indicate compartmentalized cytokine expression in HS; high in pus but suppressed in PBMCs. This is modulated through blockade of TNF. PMID:26091259

  20. Squamous cell carcinoma of the vulva arising in the setting of chronic hidradenitis suppurativa: A case report.

    PubMed

    Rekawek, Patricia; Mehta, Shailja; Andikyan, Vaagn; Harmaty, Marco; Zakashansky, Konstantin

    2016-04-01

    •Highlights the sheer mass of tumor encountered with hidradenitis suppurativa.•Reviews the complexity of wound healing with hidradenitis suppurativa.•Overview of multi-team approach to a vulvar cancer. PMID:27331133

  1. Clinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa

    PubMed Central

    Tokunaga, Yukihiko; Sasaki, Hirokazu

    2015-01-01

    A variety of techniques have been described to treat complex anal fistulas. When complex anal fistulas are associated with hidradenitis suppurativa, the treatment has to be appropriately tailored for the severity and distribution of the disease so as to remove the external fistula tract to prevent recurrence while ensuring fecal continence. Between 2007 and 2011, a total of 10 males (ranging in age from 32 to 54 years) complained of recurrent purulent discharge in the buttocks and thigh regions. The discharge had started about 12 to 18 months prior, and had increased progressively resulting in complex anal fistulas and hidradenitis suppurativa in the buttocks. They underwent surgical operation according to a modified seton procedure for complex anal fistulas and coring out for hidradenitis suppurativa. They were discharged from the hospital in 4 to 5 days, while the seton dropped spontaneously about 6 to 8 months after surgery. They have been well without any morbidities or recurrence. The present paper demonstrates that cases of complex anal fistulas associated with hidradenitis suppurativa can be successfully treated with a modified seton procedure and coring out of hidradenitis suppurativa. PMID:26414817

  2. Update on hidradenitis suppurativa: connecting the tracts

    PubMed Central

    Gill, Liza; Williams, Melissa

    2014-01-01

    Hidradenitis suppurativa (HS) is a debilitating skin disease characterized by recurrent abscesses, sinus tract formation, and scarring. Prevalence estimates range from 0.053% to 4.1%, although HS is likely an underdiagnosed disease. Although the first reports of HS date back to the mid-19th century, the disease continues to plague patients and physicians desperate for a definitive treatment. Advances in the understanding of the disease process include the possibility of a defective basement membrane at the sebofollicular junction of the folliculopilosebaceous unit (FPSU; that is, where the sebaceous gland empties into the hair follicle) as an initiating event followed by secondary bacterial colonization. New evidence suggests that bacteria living in a community, known as a biofilm, rather than single planktonic bacteria in HS lesions may explain why HS can be resistant to current antibiotic treatment regimens. Available treatment options have expanded to include triple-antibiotic therapy, tumor necrosis factor (TNF-α) and interleukin-1 (IL-1) inhibitors (biologics), laser therapy, and surgical excision, including the skin tissue-sparing excision with electrosurgical peeling procedure. Despite the array of treatments available, many patients continue to struggle with the embarrassment, pain, odor, and frustration that accompany this often isolating disease. Physicians should address comorbidities in HS, including the psychosocial issues patients with HS frequently encounter. Patients can be directed to HS support groups, where they can openly discuss their frustrations, share their experiences in dealing with HS, and band together to advocate for themselves. HS is misunderstood by both patients and physicians, often resulting in a delay in clinical presentation and diagnosis. Patients and physicians across multiple specialties must work together to expand awareness of and interest in HS, so that one day, individuals with HS can be freed from this crippling disease

  3. Ultrasound Diagnosis and Staging in Pediatric Hidradenitis Suppurativa.

    PubMed

    Wortsman, Ximena; Rodriguez, Carolyn; Lobos, Carolina; Eguiguren, Gonzalo; Molina, Maria Teresa

    2016-07-01

    Hidradenitis suppurativa (HS) can affect children, and ultrasound has been proven to be useful in diagnosis and staging. The sonographic characteristics of HS in children have not been reported. We studied color Doppler ultrasound images of children (≤15 years old; n = 12) with clinically and sonographically positive criteria for HS. Sonographic scoring of hidradenitis suppurativa (SOS-HS) was used to stage the cases sonographically. Subclinical pseudocysts were found in 92% of the cases, fluid collections in 83%, and fistulous tracts in 58%. Retained hair tracts in the fluid collections and fistulous tracts were present in 100% of patients; 67% of cases were SOS-HS stage II. In 92% of cases, management was modified after the ultrasound examination. In conclusion, ultrasound can be a reliable and safe imaging tool to support diagnosis and staging and may help in the noninvasive monitoring of treatment in children. PMID:27292973

  4. Hidradenitis Suppurativa: A Guide for the Practicing Physician.

    PubMed

    Woodruff, Carina M; Charlie, Abbas M; Leslie, Kieron S

    2015-12-01

    Hidradenitis suppurativa is a chronic inflammatory disease of apocrine gland-bearing skin. Although immunologic derangements, genetic predisposition, obesity, and smoking are likely important factors, the pathogenesis of the disease and the effect of available treatments on disease course have not been fully elucidated. In the absence of proper treatment, chronic inflammation results in diffuse scarring and a wide array of complications, including the development of cutaneous squamous cell carcinoma. This severe and chronic disease can have detrimental effects on self-esteem and quality of life. No ideal treatment regimen has been defined, but several therapies have been found to reduce lesion severity and improve symptoms. We reviewed the literature through July 2014 for existing treatments. Published articles were obtained via systematic review of medical databases (PubMed, Embase, Google Scholar) and scrutiny of citation lists using the search terms "hidradenitis suppurativa" and "acne inversa". Given the scarce literature on treatment strategies, we also reviewed data from any case reports or prospective and retrospective studies that were located. On the basis of the existing literature, we provide an evidence-based algorithm for the management of this disease in the primary care setting. More research is needed to evaluate the comparative effectiveness of topical and systemic treatments and to better understand the pathogenesis, natural history, and subtypes of hidradenitis suppurativa. PMID:26653298

  5. Bacteriology of hidradenitis suppurativa/acne inversa: A review.

    PubMed

    Nikolakis, Georgios; Join-Lambert, Olivier; Karagiannidis, Ioannis; Guet-Revillet, Hélène; Zouboulis, Christos C; Nassif, Aude

    2015-11-01

    Given that follicular papules and pustules, as well as nodules and abscesses, are the clinical hallmarks of hidradenitis suppurativa (HS), an infectious, bacterial pathway has been suspected in the pathogenesis of this chronic, inflammatory condition. Elucidating the behavior and role of bacterial species in HS and their interaction with cutaneous innate immunity will provide more insight into the pathophysiology of this condition. This review of prospective investigations suggests a synergistic relationship between impaired innate immunity and microbial factors in the etiology of HS. PMID:26470608

  6. Diet in the prevention of hidradenitis suppurativa (acne inversa).

    PubMed

    Danby, F William

    2015-11-01

    Full control of hidradenitis suppurativa requires the prevention of new lesions. These appear to be induced by a complex series of hormonally driven molecular activities that lead to obstruction of the follicular duct, rupture and destruction of the sebaceous glands, the development of deep dermal sinuses that subsequently rupture to the surface, and production of an invasive subcutaneous mass that is resistant to medical therapy. Preliminary observations suggest that the use of a healthy and fully natural zero dairy and low glycemic-load diet may provide relief from progression of the lesions and possibly prevention of new lesions, even when medications fail. PMID:26470617

  7. Severe hidradenitis suppurativa complicated by renal AA amyloidosis.

    PubMed

    Utrera-Busquets, M; Romero-Maté, A; Castaño, Á; Alegre, L; García-Donoso, C; Borbujo, J

    2016-04-01

    Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease affecting the skin folds. Multiple therapeutic options have been proposed for severe cases, but persistent responses are rarely seen. Important complications of HS are uncommon, and usually seen only in severe and unresponsive disease. Amyloid A (AA) amyloidosis is secondary to inflammatory chronic diseases, and is an uncommon complication of dermatological diseases. Only a few cases related with HS have been reported. We report the case of a 37-year-old patient who developed AA amyloidosis secondary to severe HS. PMID:26206410

  8. Novel Technique for Management of Axillary Hidradenitis Suppurativa Using Setons

    PubMed Central

    Lajevardi, Sepehr Seyed; Abeysinghe, Jayantha

    2015-01-01

    Management of hidradenitis suppurativa (HS) of the axilla which is nonresponding to conservative management presents a significant therapeutic challenge. Most surgical treatment options are associated with significant morbidities and prolonged hospital stay. We present a technique of management of HS using setons which is simple and allows the ongoing treatment to be done on an outpatient basis. Given the fact that HS is a chronic relapsing condition each recurrence may again be managed using this technique. This will allow the patients to manage their recurrences with minimal impact on their activities of daily living. PMID:26301111

  9. Randomized Controlled Trials for the Treatment of Hidradenitis Suppurativa.

    PubMed

    van Rappard, Dominique C; Mekkes, Jan R; Tzellos, Thrasivoulos

    2016-01-01

    Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease. Several treatment modalities are available, but most of them lack high-quality evidence. A systematic search was performed to identify all randomized controlled trials for the treatment of HS in order to review and evaluate the evidence. Recommendations for future randomized controlled trials include using validated scores, inclusion of patient rated outcomes, and thorough report of side effects. Evidence for long-term treatment and benefit/risk ratio of available treatment modalities is needed in order to enhance evidence-based treatment in daily clinical practice. Combining surgery with antiinflammatory treatment warrants further investigation. PMID:26617360

  10. Medical Treatments of Hidradenitis Suppurativa: More Options, Less Evidence.

    PubMed

    van der Zee, Hessel H; Gulliver, Wayne P

    2016-01-01

    Hidradenitis suppurativa is a common debilitating skin disease that has been neglected by science. The disease is getting more and more attention, reflected by the rising number of scientific publications. There is a clear need for effective treatment. We are still at the beginning of improving care for these patients as demonstrated by the low levels of evidence for the medical treatments. Many of these therapies showed promising results, but are still waiting to be validated in randomized, controlled trials. Much more research is needed to strengthen the Level of Evidence for these therapies and thus improve patient care. PMID:26617362

  11. The Role of Mechanical Stress in Hidradenitis Suppurativa.

    PubMed

    Boer, Jurr; Nazary, Maiwand; Riis, Peter Theut

    2016-01-01

    Mechanical stress can act as a possible trigger in the development of hidradenitis suppurativa (HS). The mechanical stress has been supported by (1) the special biomechanical conditions in the typically topographic areas of HS; (2) the indirect proof of similar findings in associated follicular occlusion diseases such as acne mechanica and pilonidal sinus disease, and in limb amputees after expression of mechanical forces; (3) pathohistologic, ultrasonography, and immunologic findings; and (4) overweight patients seem to be most susceptible to the effects of mechanical stress. PMID:26617356

  12. [Surgical treatment of penile lymphedema associated with hidradenitis suppurativa].

    PubMed

    García-Tutor, E; Botellé del Hierro, J; San Martín Maya, A; Castro García, J; España, A; Fernández Montero, J; Robles García, J E

    2005-05-01

    Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results. PMID:16013800

  13. Bilateral Pedicled Superficial Inferior Epigastric Artery Flap in the Treatment of Hidradenitis Suppurativa

    PubMed Central

    Hoang, Don; Saber, Sepideh; Patel, Ketan; Carey, Joseph

    2016-01-01

    Summary: The authors present a new technique in surgically treating hidradenitis suppurativa (HS), a debilitating skin condition. In HS, surgical treatment is often the best option because of the high recurrence rates despite extensive medical treatment. A commonly successful surgical method is using skin flaps after excision of the affected area. A superficial inferior epigastric artery flap is demonstrated here as a new alternative approach to treating a case of extensive HS of the groin. By using the pedicled superficial inferior epigastric artery flap for groin reconstruction, inguinal HS can be widely excised and reconstructed with minimal donor-site morbidity and a good aesthetic outcome.

  14. A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma.

    PubMed

    Scheinfeld, Noah

    2014-03-01

    Although rare, severe hidradenitis suppurativa (HS) of the anal, perianal, gluteal, thigh, and groin regions can evolve into squamous cell carcinoma (SCC). This usually does not occur until the HS has been present for more than 20 years. Malignant degeneration of HS in the axilla has not been reported. SCC has developed in dissecting cellulitis, acne conglobata, and pilonidal cysts (other members of the follicular tetrad). Whereas the male to female ratio of HS is 1:3, SCC in HS has a male to female ration of 5:1. The reasons behind malignant degeneration in HS are complex and might differ from the malignant degeneration causing Marjolin ulcers. It likely involves the presence of human papilloma virus (HPV) in affected areas (a rarity in the axilla), and impaired defensins, which combat HPV, in the skin of Hurley Stage III HS. In familial HS, the odds of developing SCC are likely greater because of independent loss-of-function mutations in the γ-secretase multiprotein complex, which regulates the Notch signaling pathway. Compromise of the Notch signaling pathway can undermine immune function and increase the risk of neoplastic development. Coincident SCC with use of tumor necrosis factor α blockers has been reported. I report a patient with long standing Hurley Stage III, familial HS, wwho developed metastatic SCC after 3 courses of infliximab and expired 11 months after the infliximab was started. A 47-year-old male presented with progressive HS since early adulthood. His stage III hidradenitis suppurativa (HS) involved his groin, legs buttocks, and perineal areas. Interestingly, his HS was familial; one daughter also suffered from HS. A pilonidal cyst had been excised in the past. He suffered from hypertension for which he took ramipril, 2.5 mg per day. He did not admit to smoking. He had undergone numerous surgeries and courses of clindamycin with rifampin and clindamycin with minocycline. He used pregablin among other stronger medications for pain control. He

  15. An Update on Hidradenitis Suppurativa (Part I): Epidemiology, Clinical Aspects, and Definition of Disease Severity.

    PubMed

    Martorell, A; García-Martínez, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodriguez, J; Salgado, L; Vilarrasa, E

    2015-11-01

    Hidradenitis suppurativa is a chronic inflammatory disorder that has attracted increasing attention in recent years due to underestimations of prevalence and the considerable impact of the condition on interpersonal relationships, physical appearance, self-esteem, and body image. Although hidradenitis suppurative has a significant psychological impact on patients and can even cause physical limitations when thick scarring results in limb mobility limitation, until very recently little evidence was available relating to its epidemiology, etiology, or pathogenesis. In this review, we highlight the latest advances in our understanding of the epidemiological and clinical aspects of hidradenitis suppurativa. We will also look at the different classification systems for hidradenitis suppurativa and discuss the emergence of skin ultrasound as a promising technique for monitoring the course of this chronic inflammatory disease. PMID:26254550

  16. The Association between Hidradenitis Suppurativa and Crohn's Disease: in Search of the Missing Pathogenic Link.

    PubMed

    van der Zee, Hessel H; Horvath, Barbara; Jemec, Gregor B E; Prens, Errol P

    2016-09-01

    Hidradenitis suppurativa is a chronic, autoinflammatory skin disease. Shalom et al. demonstrate in a large cross-sectional study an association between Crohn's disease and hidradenitis suppurativa, but not with ulcerative colitis. This association supports the hypothesis that a similar pathogenic mechanism contributes to both diseases, providing new possibilities for functional studies and therapy development. PMID:27542293

  17. Concurrent hidradenitis suppurativa, inflammatory acne, dissecting cellulitis of the scalp, and pyoderma gangrenosum in a 16-year-old boy.

    PubMed

    Koshelev, Misha V; Garrison, Paige A; Wright, Teresa S

    2014-01-01

    We report the case of a 16-year-old boy who presented to our clinic with concomitant hidradenitis suppurativa, inflammatory acne, dissecting cellulitis of the scalp, and pyoderma gangrenosum. Recent reports describe the co-occurrence of pyoderma gangrenosum, acne, and hidradenitis suppurativa. This case further expands the spectrum of concomitant pyoderma gangrenosum and dissecting cellulitis of the scalp. PMID:24118007

  18. Laser and light-based treatment options for hidradenitis suppurativa.

    PubMed

    Hamzavi, Iltefat H; Griffith, James L; Riyaz, Farhaad; Hessam, Schapoor; Bechara, Falk G

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory disease that commonly develops painful, deep dermal abscesses and chronic, draining sinus tracts. Classically, pharmacologic and surgical therapies have been effective for reducing lesion activity and inflammation, but provide only modest success in the prevention of future recurrences and disease progression. Adjunctive therapies, such as laser and light-based therapies, have become more commonly used in the management of HS. These therapies work to reduce the occurrence of painful HS flare-ups by decreasing the number of hair follicles, sebaceous glands, and bacteria in affected areas, and by ablatively debulking chronic lesions. The best results are seen when treatment is individualized, taking disease severity into consideration when selecting specific energy-based approaches. This article will discuss various light-based therapies and the evidence supporting their use in the management of HS. PMID:26470622

  19. Local wound care and topical management of hidradenitis suppurativa.

    PubMed

    Alavi, Afsaneh; Kirsner, Robert S

    2015-11-01

    Hidradenitis suppurativa (HS) is a chronic, recurrent, debilitating disease predominantly involving apocrine gland-bearing skin. The folliculoinfundibular dysfunction and an aberrant cutaneous immune response to commensal bacteria are recognized as potential contributors. Topical antibiotics, such as clindamycin, and keratolytic agents have been used in the management of early stages of HS. Proper wound care is a key part of management, particularly in patients with advanced HS. The evidence for the optimal topical therapy or optimal local wound care is limited. As such, a multidisciplinary approach is necessary to address all aspects of HS, including topical therapy, systemic therapy, and proper wound care. The focus of this paper is to review the evidence for the topical management and local wound care strategies in patients with HS. PMID:26470618

  20. Scroto-perineal hidradenitis suppurativa complicated by giant scrotal elephantiasis

    PubMed Central

    Alharbi, Badr; Shlash, Ahmed; Bedaiwi, Khaled; Hooti, Qais Al; Almohaisen, Abdulrahman; Shlash, Saud; Said, Mohammad

    2015-01-01

    Scrotal elephantiasis has been a recognized complication of inguinal node irradiation, filarial infection, tumor involvement and surgical lymphatic destruction, but has rarely been reported in association with hidradenitis suppurativa (HS). HS, also known as acne inversa, is a chronic and often debilitating disease primarily affecting the axillae, inframammary regions and perineum. The location of the lesions may lead to social embarrassment and failure to seek medical treatment. Scroto-preineal HS complicated by scrotal elephantiasis is a distressing disease. Excisional surgery with reconstruction is the recommended treatment with a high likelihood of good outcome. We present a 38-year-old male patient with long-standing scroto-perineal HS complicated by giant scrotal elephantiasis. PMID:25837812

  1. Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients.

    PubMed

    Scheinfeld, Noah

    2013-01-01

    Hidradenitis suppurativa (HS), a pathological follicular disease, impacts patients' lives profoundly. HS most commonly involves cutaneous intertriginous areas, such as the axilla, inner thighs, groin and buttocks, and pendulous breasts, but can appear on any follicular skin. Protean, HS manifests with variations of abscesses, folliculitis, pyogenic granulomas, scars (oval honeycombed), comedones, tracts, fistulas, and keloids. The pathophysiology might involve both defects of the innate follicular immunity and overreaction to coagulase negative Staphylococcus. Treatment depends on the morphology, extent, severity, and duration. Topical clindamycin and dapsone are often adequate for treating mild HS. For Stage 1 and 2 HS, first line treatment combines rifampin with either oral clindamycin or minocycline. Other HS treatments include: fluoroquinolones with metronidazole and rifampin, oral dapsone, zinc, acitretin, hormone blockers (oral contraceptive pills, spironolactone, finasteride, and dutasteride), and oral prednisone. For severe HS, cyclosporine, adalimumab, or infliximab (used at double psoriatic doses) and intravenous carbapenems or cephalosporins are often required. Isotretinoin, etanercept, isoniazid, lymecycline, sulfasalazine, methotrexate, metformin, colchicine, clarithromycin, IVIG, and thalidomide are less favored treatments. The role of botulinum toxin is uncertain. The most important life style modification is weight loss. De-roofing fluctuant nodules and injection of intralesional corticosteroids ameliorates the disease and perhaps, if done at regular intervals, improves HS more permanently. Surgical excision and CO2 laser ablation are more definitive treatments. The 1064 nm laser for hair removal aids in the treatment of HS. This article centers on medical therapies and will only passingly mention surgical and laser treatments. This article summarizes my treatment experience with over 350 HS patients. PMID:24021361

  2. A Life-Threatening Multilocalized Hidradenitis Suppurativa Case

    PubMed Central

    Buyukasik, Oktay; Osmanoglu, C. Gokhan; Polat, Yilmaz; Kargici, Hulagu; Kaya, Gulay

    2005-01-01

    Abstract and Introduction Abstract The patient was a 38-year-old man. He had been suffering from hidradenitis suppurativa (HS) for approximately 20 years. He had active lesions at both axillas, hip, scrotum, and perineum, and inactive lesions located behind the ears, lower abdomen, and posterior neck. He was monitored and treated at different branches; he continuously used antibiotics and was given steroids at times. Antibiotic resistance developed subsequently. His general situation was bad; vital signs were poor; and he was in a state of sepsis and preshock, so this case was regarded as life-threatening. Total excision was performed first on the lesion at the right axilla, then on the lesion at the left axilla, and the parascapular fasciocutaneous flap was reversed. A skin graft was applied to the triangular defect on the scapula. No relapse occurred. Then the lesions at the hip were managed. Broad excision was used twice with the patient under general anesthesia; because the lesions spread to the retrococcygeal and gluteal muscles, coccyx resection and partial gluteal muscle resection were implemented. The defect was eliminated with a progressive flap. At the intergluteal sulcus, small lesions emerging at the median line were debrided with the patient under local anesthesia, and together with secondary recovery, the disease was completely managed. Lesions at the perineum and scrotum and at both inguinal areas were broadly excised and grafted. No lesion has relapsed so far. One year later, Hodgkin's lymphoma was diagnosed, and the patient was treated with chemoradiotherapy easily, because there was no infective focus. The disease is in remission now. The patient weighs 110 kg, is healthy, and is working again. Introduction HS is a disease that is characterized by intensive development of sclerosis due to abscess, sinus and fistula formation, and fibrosis as a result of a chronic infection of the apocrine sweat glands. The disease can be seen at the scrotum

  3. An Update on Medical Treatment Options for Hidradenitis Suppurativa.

    PubMed

    Deckers, I E; Prens, E P

    2016-02-01

    Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission. PMID:26659474

  4. Musculoskeletal features of acne, hidradenitis suppurativa, and dissecting cellulitis of the scalp.

    PubMed

    Olafsson, S; Khan, M A

    1992-02-01

    This article describes the various forms of acne and the clinical and radiographic features of the associated musculoskeletal manifestations. Occasionally, acne may occur together with hidradenitis suppurativa and dissecting cellulitis of the scalp, the so called "follicular occlusion triad." The current understanding of the etiology of these conditions and their treatment are also reviewed. PMID:1532858

  5. An atlas of the morphological manifestations of hidradenitis suppurativa.

    PubMed

    Scheinfeld, Noah

    2014-01-01

    This article is dermatological atlas of the morphologic presentations of Hidradenitis Suppurativa (HS). It includes: superficial abscesses (boils, furnucles, carbuncles), abscesses that are subcutaneous and suprafascial, pyogenic granulomas, cysts, painful erythematous papules and plaques, folliculitis, open ulcerations, chronic sinuses, fistulas, sinus tracts, scrotal and genital lyphedema, dermal contractures, keloids (some that are still pitted with follicular ostia), scarring, skin tags, fibrosis, anal fissures, fistulas (i.e. circinate, linear, arcuate), scarring folliculitis of the buttocks (from mild to cigarette-like scarring), condyloma like lesions in intertrigous areas, fishmouth scars, acne inversa, honey-comb scarring, cribiform scarring, tombstone comedones, and morphia-like plaques. HS can co-exist with other follicular diseases such as pilonidal cysts, dissecting cellulitis, acne conglobata, pyoderma gangrenosum, and acanthosis nigricans. In sum, the variety of presentations of HS as shown by these images supports the supposition that HS is a reaction pattern.HS is a follicular based diseased and its manifestations involve a multitude of follicular pathologies [1,2]. It is also known as acne inversa (AI) because of one manifestation that involves the formation of open comedones on areas besides the face. It is as yet unclear why HS is so protean in its manifestations. HS severity is assessed using the Hurley Staging System (Table 1). It also remains unclear why hidradentitis may remain limited to Hurley Stage 1, evolve to the more confluent (Hurley Stage 2), or progress even further to the fully confluent (Hurley Stage 3).In addition, HS can be associated with other follicular based diseases such as pilonidal cysts (PCs) of the sacrum and buttocks, dissecting cellulitis (DC), and acne conglobata (AC), which usually involves the face, chest, When HS occurs with PCs, DC, and/or AC it is referred to as the follicular occlusion triad or tetrad [2]. HS

  6. What happens after a single surgical intervention for hidradenitis suppurativa? A retrospective claims-based analysis.

    PubMed

    Jemec, Gregor B E; Guérin, Annie; Kaminsky, Michael; Okun, Martin; Sundaram, Murali

    2016-07-01

    Objective Hidradenitis suppurativa (HS) is often treated by surgery. The risk of recurrence after surgery is common and the consequences are substantial, but neither has been quantified using a claims database. This study aimed to estimate the burden associated with non-curative surgery in HS patients. Methods A retrospective analysis was performed of health insurance claims data from Q1 1999 to Q2 2011 in a US claims database. The analysis included 2668 adults with ≥1 diagnosis of HS and ≥1 claim for skin surgery within 6 months after diagnosis. Healthcare resource utilization and medical costs were compared using multivariate regressions. Results Overall, 46% of HS patients had ≥1 indicator of non-curative surgery. The incidences of inpatient, emergency department, and outpatient visits were 88%, 40%, and 30% higher, respectively, for patients with non-curative surgery vs patients without indicator of non-curative surgery (all p < 0.001). Average medical costs were $11,858 and $6427 for patients with and without indicators of non-curative surgery, respectively. The difference of $4185 (p < 0.001) was mainly driven by inpatient costs (difference = $2685; p < 0.001). Limitations Indicators of non-curative HS surgery were defined based on an empirical algorithm. Conclusions Non-curative HS surgery occurred in almost half of all cases and represents a significant burden on patients and payers in terms of resource utilization and costs. PMID:26938967

  7. Phenotypic heterogeneity in hidradenitis suppurativa (acne inversa): classification is an essential step toward personalized therapy.

    PubMed

    Ingram, John R; Piguet, Vincent

    2013-06-01

    Awareness is increasing that there is phenotypic heterogeneity within the hidradenitis suppurativa (HS) disease spectrum. However, the few randomized HS trials that are available have not distinguished between the subtypes of the disease. In this issue, Canoui-Poitrine et al. used latent class (LC) analysis of the largest HS cohort described to date to generate three phenotypic subtypes. LC 1 correlates with "typical" European HS, mainly involving the axilla, groin, and, in women, the inframammary region. "Atypical" HS, which may be linked to γ-secretase gene mutations, was subdivided further into LC2 and LC3 subtypes. PMID:23673498

  8. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa.

    PubMed

    Zouboulis, C C; Desai, N; Emtestam, L; Hunger, R E; Ioannides, D; Juhász, I; Lapins, J; Matusiak, L; Prens, E P; Revuz, J; Schneider-Burrus, S; Szepietowski, J C; van der Zee, H H; Jemec, G B E

    2015-04-01

    Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. A mean disease incidence of 6.0 per 100,000 person-years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The central pathogenic event in HS is believed to be the occlusion of the upper part of the hair follicle leading to a perifollicular lympho-histiocytic inflammation. A highly significant association between the prevalence of HS and current smoking (Odds ratio 12.55) and overweight (Odds ratio 1.1 for each body mass index unit) has been documented. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by classical surgery or LASER techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus rifampicine, tetracyclines), acitretin and biologics (adalimumab, infliximab). A Hurley severity grade-relevant treatment of HS is recommended by the expert group following a treatment algorithm. Adjuvant measurements, such as pain management, treatment of superinfections, weight loss and tobacco abstinence have to be considered. PMID:25640693

  9. Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality.

    PubMed

    Ingram, J R; Woo, P N; Chua, S L; Ormerod, A D; Desai, N; Kai, A C; Hood, K; Burton, T; Kerdel, F; Garner, S E; Piguet, V

    2016-05-01

    More than 50 interventions have been used to treat hidradenitis suppurativa (HS), and so therapy decisions can be challenging. Our objective was to summarize and appraise randomized controlled trial (RCT) evidence for HS interventions in adults. Searches were conducted in Medline, Embase, CENTRAL, LILACS, five trials registers and abstracts from eight dermatology conferences until 13 August 2015. Two review authors independently assessed study eligibility, extracted data and assessed methodological quality. Primary outcomes were quality of life and adverse effects of the interventions. Twelve trials, from 1983 to 2015, investigating 15 different interventions met our inclusion criteria. The median trial duration was 16 weeks and the median number of participants was 27. Adalimumab 40 mg weekly improved the Dermatology Life Quality Index (DLQI) by 4·0 points, which equates to the minimal clinically important difference for the scale, compared with placebo (95% confidence interval -6·5 to -1·5 points). Evidence quality was reduced to 'moderate' because the results are based on only a single study. Adalimumab 40 mg every other week was ineffective in a meta-analysis of two studies comprising 124 participants. Infliximab 5 mg kg(-1) improved the DLQI score by 8·4 points after 8 weeks in a moderate-quality study completed by 33 of 38 participants. Etanercept 50 mg twice weekly was ineffective. Inclusion of a gentamicin sponge prior to primary closure did not improve outcomes. Other interventions, including topical and oral antibiotics, were investigated by relatively small studies, preventing treatment recommendations due to imprecision. More, larger RCTs are required to investigate most HS interventions, particularly oral treatments and surgical therapy. Moderate-quality evidence suggests that adalimumab given weekly and infliximab are effective, whereas adalimumab every other week is ineffective. PMID:26801356

  10. Disutility in Patients with Hidradenitis Suppurativa: A Cross-sectional Study Using EuroQoL-5D.

    PubMed

    Riis, Peter Theut; Vinding, Gabrielle R; Ring, Hans Christian; Jemec, Gregor B E

    2016-03-01

    Disutility reflects the disability caused by a disease. The EuroQoL-5D (EQ-5D) questionnaire is a measure of health-related overall utility. The questionnaire has only been applied previously to a small number of patients with hidradenitis. In this study a survey of 421 patients with hidradenitis suppurativa was conducted using the EQ-5D questionnaire. Questions regarding pain, malodour and pruritus were included to determine quantitatively whether these factors are associated with low EQ-5D index and visual analogue scale (VAS) scores. The index and VAS scores obtained were compared with reference values for the general population in Denmark. A significantly decreased utility in patients with hidradenitis suppurativa was found for all age group levels, except for 65-74-year-olds. The total index score in the cohort was 0.705 (population mean 0.887) and the VAS was 62.25 (population mean 82.6). Multivariate analysis found significant associations between loss of utility and pain, malodour and pruritus (p < 0.0001). Patients with hidradenitis suppurativa had a significantly decreased EQ-5D compared with the background population. Malodour and pruritus were found to be associated with low index values, and pain and malodour with low VAS. Patient-reported pain and discomfort had the most negative overall effect on mean index scores. PMID:25940640

  11. Coexistence of Hidradenitis Suppurativa with Autoimmune Thyroiditis: Report of Three Cases.

    PubMed

    González-López, Marcos A; Blanco, Ricardo; Mata, Cristina; López-Escobar, María; Lacalle, Marina; Consuegra, Germana; González-Vela, M Carmen; González-Gay, Miguel A

    2016-01-01

    Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease affecting terminal hair follicles in apocrine-gland-bearing skin. The pathogenesis of HS is still unknown, although increasing evidence suggests that the immune system plays an important role. Herein we describe 3 patients with HS coexisting with autoimmune (Hashimoto's) thyroiditis (AT). To our knowledge, the co-occurrence of these two diseases has not previously been described. The coexistence of HS with autoimmune disorders, such as AT, may support the hypothesis on dysregulation of the immune system's function as implicated in the pathogenesis of HS. Based on our findings, we feel that an assessment of thyroid function and antithyroid antibodies should be performed in patients with HS. PMID:26444851

  12. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease

    PubMed Central

    Dufour, Deirdre Nathalie; Emtestam, Lennart; Jemec, Gregor B

    2014-01-01

    Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty. The primary clinical presentation is painful inflamed nodules or boils in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and buttocks/anus) that progress to abscesses, sinus tracts and scarring. Severity is typically described according to three Hurley categories, with most patients having mild or moderate disease. Estimated prevalence is 1–4% worldwide and HS is three times more common in women than men. Patients’ disease burden includes intense pain, work disability and overall poor quality of life. Although the clinical signs of the disease can often be hidden by clothing, active HS is associated with a malodorous discharge that contributes to the disabling social stigma. Risk factors include smoking and obesity. Comorbidities include inflammatory bowel disease and spondyloarthropathies. The presentation of the disease is distinct, yet HS is not well-recognised except in dermatology clinics. PMID:24567417

  13. Penile reconstruction with dermal template and vacuum therapy in severe skin and soft tissue defects caused by Fournier's gangrene and hidradenitis suppurativa.

    PubMed

    Ludolph, Ingo; Titel, Torsten; Beier, Justus P; Dragu, Adrian; Schmitz, Marweh; Wullich, Bernd; Horch, Raymund E

    2016-02-01

    The aim of this article is to improve the treatment of patients with complete skin loss of the penile shaft after Fournier's gangrene or hidradenitis suppurativa using modern biomatrices and topical negative pressure therapy. From January 2010 to December 2011, three patients with Fournier's gangrene or hidradenitis suppurativa were treated. After initial radical debridements, topical negative pressure therapy was applied for wound stabilisation. After that dermal templates (acellular dermal matrix) were used to achieve early healing and topical negative pressure-dressing in a special setting or a special foam compression bandage was used together with a urinary catheter. After integration of the dermal template, a split-thickness skin graft is used for coverage and again secured with a circular total negative pressure-dressing. In all cases, the split-thickness skin grafts healed very well applying this therapy concept. The patients were very satisfied with the functional as well as with the aesthetic outcome. We suggest a new method of staged reconstruction to successfully preserve the functionality of the penis after complete loss of the skin and soft tissue of the penile shaft using modern biomatrices and topical negative pressure therapy. PMID:24618357

  14. Hidradenitis Suppurativa

    MedlinePlus

    ... tender, red bumps with extensive scar and sinus tracking under the surface of the skin. Often, you ... these advertising practices and to make choices about online behavioral advertising, please click here . This site complies ...

  15. Hidradenitis Suppurativa

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  16. Hidradenitis Suppurativa

    MedlinePlus

    ... these products alone usually will not clear HS. Bleach baths : If certain bacteria colonize (found on the ... dermatologist may recommend taking 5- or 10-minute bleach baths. You'd take this bath in your ...

  17. Hidradenitis Suppurativa

    MedlinePlus

    ... Doctors don’t know why this happens. Poor hygiene does not cause this condition. It is not ... deodorant Stress Staying healthy, exercising and getting enough sleep may also help prevent flare-ups. If you ...

  18. Hidradenitis Suppurativa

    MedlinePlus

    ... may need to register to view the medical textbook, but registration is free. Online Mendelian Inheritance in ... Support for Patients and Families Help with Travel Costs How to Get Involved in Research FAQs About ...

  19. Hidradenitis Suppurativa

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    ... Sections of the JAOCD JAOCD Archive Published Members Online Dermatology Journals Edit This Favorite Name: Category: Share: Yes ... 2/2017 2017 AOCD Spring Current Concepts in Dermatology Meeting more Latest News ... Surveys About AOCD The AOCD was recognized in ...

  20. Intrinsic Defect in Keratinocyte Function Leads to Inflammation in Hidradenitis Suppurativa.

    PubMed

    Hotz, Claire; Boniotto, Michele; Guguin, Aurélie; Surenaud, Mathieu; Jean-Louis, Francette; Tisserand, Pascaline; Ortonne, Nicolas; Hersant, Barbara; Bosc, Romain; Poli, Florence; Bonnabau, Henri; Thiébaut, Rodolphe; Godot, Véronique; Wolkenstein, Pierre; Hocini, Hakim; Lévy, Yves; Hüe, Sophie

    2016-09-01

    Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating, follicular disease of the skin. Despite a high prevalence in the general population, the physiopathology of HS remains poorly understood. The use of antibiotics and immunosuppressive agents for therapy suggests a deregulated immune response to microflora. Using cellular and gene expression analyses, we found an increased number of infiltrating CD4(+) T cells secreting IL-17 and IFN-γ in perilesional and lesional skin of patients with HS. By contrast, IL-22-secreting CD4(+) T cells are not enriched in HS lesions contrasting with increased number of those cells in the blood of patients with HS. We showed that keratinocytes isolated from hair follicles of patients with HS secreted significantly more IL-1β, IP-10, and chemokine (C-C motif) ligand 5 (RANTES) either constitutively or on pattern recognition receptor stimulations. In addition, they displayed a distinct pattern of antimicrobial peptide production. These findings point out a functional defect of keratinocytes in HS leading to a balance prone to inflammatory responses. This is likely to favor a permissive environment for bacterial infections and chronic inflammation characterizing clinical outcomes in patients with HS. PMID:27206704

  1. A Population- and Hospital-based Cross-sectional Study of Renal Function in Hidradenitis Suppurativa.

    PubMed

    Miller, Iben M; Carlson, Nicholas; Mogensen, Ulla B; Ellervik, Christina; Jemec, Gregor B E

    2016-01-01

    The chronic inflammatory skin diseases hidradenitis suppurativa (HS) and psoriasis have been linked to cardiovascular risk factors and the latter has also been linked to possible renal dysfunction. Since basement membrane thinning in the skin of HS patients has been described, we speculated whether similar basement membrane defects might occur in renal tissue. Our objective was to investigate a possible association between HS and renal dysfunction. We performed a hospital and population-based cross-sectional study using estimated Glomerular-Filtration-Rate (eGFR) to assess renal function. Thirty-two hospital individuals with HS, 430 population individuals with HS, and 20,780 population individuals without HS were (controls) identified. The age-, sex-, smoking-, BMI-, hypertension- and diabetes-adjusted analysis revealed a statistically significant higher eGFR for the hospital group with HS and a mean difference in eGFR of 6.81 (1.27-12.35) ml/min/1.73 m2 between the hospital group with HS and the population group without HS. The observed higher eGFR in the hospital group with HS indicates a possible association of HS and renal dysfunction. PMID:25710874

  2. Prevalence of Hidradenitis Suppurativa (HS): A Population-Based Study in Olmsted County, Minnesota

    PubMed Central

    Shahi, Varun; Alikhan, Ali; Vazquez, Benjamin G.; Weaver, Amy L.; Davis, Mark D.

    2014-01-01

    BACKGROUND/AIMS Hidradenitis suppurativa (HS) is a follicular occlusion disorder occurring in apocrine-rich regions of the skin. Estimates of the prevalence of this disorder have not been population-based. We sought to provide population-based information on the prevalence of HS in Olmsted County, Minnesota as of 1/1/2009. METHODS Rochester Epidemiology Project, a unique infrastructure that combines and makes accessible all medical records in Olmsted County since the 1960s, was used to collect population-based data on the prevalence of HS. RESULTS We identified 178 confirmed cases of HS that included 135 females and 43 males, and estimated the total sex- and age-adjusted prevalence in Olmsted County to be 127.8 per 100,000 or 0.13%. The total prevalence was significantly higher among women than men. CONCLUSION This study represents the first population-based investigation on the prevalence of HS. In this population-based cohort, HS was less prevalent than previous reports have suggested. PMID:25228133

  3. Diagnoses of Hidradenitis Suppurativa in the United States, 1979-2012

    PubMed Central

    McMillan, Kathleen

    2016-01-01

    Hidradenitis suppurativa (HS) is rarely diagnosed in the United States. Delayed diagnosis is a significant problem in the management of HS. In the past decade, there has been an increase in HS research. To determine whether those efforts have led to an increase in diagnoses, an analysis of visits to physicians in the United States from 1979 to 2012 was performed, using National Center for Health Statistics (NCHS) databases. Patient visits to private physician offices, hospital outpatient departments, and emergency rooms were analyzed. An increase in visit rates at outpatient departments from 2003-2007 [6.3/100,000, 95% confidence interval (CI) 2.9-9.8] to 2008-2010 (30.4/100,000, 95% CI 13.9-46.9; p = 0.017) was found. Converting the data to estimated numbers of patients, a 7-fold increase in patients from 2002-2007 (2.5/100,000, 95% CI 1.4-3.6) to 2008-2010 (16.9/100,000, 95% CI 7.8-26.1; p = 0.003) was found. No significant increase in patient or patient visit rates were found when analyzing visits in the physician office setting or combined office and hospital settings. Localization of increased diagnosis to outpatient departments may reflect the recent increase in clinical research. NCHS data can be useful in monitoring rates of HS diagnosis as an outcome of increased awareness of the disease. PMID:27171648

  4. Diagnoses of Hidradenitis Suppurativa in the United States, 1979-2012.

    PubMed

    McMillan, Kathleen

    2016-02-01

    Hidradenitis suppurativa (HS) is rarely diagnosed in the United States. Delayed diagnosis is a significant problem in the management of HS. In the past decade, there has been an increase in HS research. To determine whether those efforts have led to an increase in diagnoses, an analysis of visits to physicians in the United States from 1979 to 2012 was performed, using National Center for Health Statistics (NCHS) databases. Patient visits to private physician offices, hospital outpatient departments, and emergency rooms were analyzed. An increase in visit rates at outpatient departments from 2003-2007 [6.3/100,000, 95% confidence interval (CI) 2.9-9.8] to 2008-2010 (30.4/100,000, 95% CI 13.9-46.9; p = 0.017) was found. Converting the data to estimated numbers of patients, a 7-fold increase in patients from 2002-2007 (2.5/100,000, 95% CI 1.4-3.6) to 2008-2010 (16.9/100,000, 95% CI 7.8-26.1; p = 0.003) was found. No significant increase in patient or patient visit rates were found when analyzing visits in the physician office setting or combined office and hospital settings. Localization of increased diagnosis to outpatient departments may reflect the recent increase in clinical research. NCHS data can be useful in monitoring rates of HS diagnosis as an outcome of increased awareness of the disease. PMID:27171648

  5. Aerobic and Anaerobic Bacteriology of Hidradenitis Suppurativa: A Study of 22 Cases

    PubMed Central

    Katoulis, Alexandros C.; Koumaki, Dimitra; Liakou, Aikaterini I.; Vrioni, Georgia; Koumaki, Vasiliki; Kontogiorgi, Dimitra; Tzima, Korina; Tsakris, Athanasios; Rigopoulos, Dimitris

    2015-01-01

    Introduction Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of unclear etiology. The role of bacteria in the pathogenesis of disease remains controversial. Materials and Methods Specimens were obtained from 22 HS patients by direct percutaneous needle aspiration. The collected material was cultured in aerobic and anaerobic conditions, and sensitivity tests were performed. Results Of the 22 patients, 32% were culture negative and 68% were culture positive. A total of 16 isolates was obtained, 14 aerobic and 2 anaerobic. Aerobic bacteria were present in 86% of the specimens, whereas only anaerobic bacteria were isolated in 7%. The predominant aerobic species were Proteus mirabilis, Staphylococcus haemolyticus and Staphylococcus lugdunensis. The isolated anaerobic bacteria were Dermacoccus nishinomiyaensis and Propionibacterium granulosum. Conclusion A variety of aerobic and anaerobic bacteria was isolated from the HS lesions of our patients. In contrast to previous studies, fewer patients were found to be culture positive, and Staphylococcus aureus was isolated in only 1 of them. More studies are necessary to elucidate the controversial role of bacteria in the pathogenesis of HS. PMID:27170935

  6. Intralymphatic Proliferation of T-cell Lymphoid Blasts in the Setting of Hidradenitis Suppurativa.

    PubMed

    Calamaro, Paola; Cerroni, Lorenzo

    2016-07-01

    Intralymphatic proliferation of T-cell lymphoid blasts (IPTCLBs) is a rare, recently described entity, associated with cutaneous inflammatory conditions and characterized by intralymphatic proliferation of highly proliferating, blastoid T lymphocytes expressing CD30, thus mimicking an intravascular lymphoma. In all reported cases, the intralymphatic proliferation was associated with an underlying inflammatory condition, with no clonal T-cell receptor rearrangement, no signs of systemic or cutaneous lymphoma, and excellent prognosis. The authors present a new case of IPTCLB arising in a patient with hidradenitis suppurativa. Histological examination revealed a dilated follicle embedded within a fibrotic stroma surrounded by a dense lymphoid infiltrate characterized by the presence of dilated small vessels filled with atypical medium-to-large sized blastoid lymphocytes expressing a CD4 T phenotype. There was also expression of CD30, but negativity for cytotoxic markers and Epstein-Barr virus. The proliferation index was high and the vessels showed expression of D2-40, confirming their lymphatic nature. No signs of systemic lymphoma could be detected after routine investigations, and the patient is alive and in good general health. IPTCLB is a rare benign entity that presents with worrying, potentially misleading histopathological features that mimic those observed in intravascular lymphoma. Careful histological and phenotypic investigations and correlation with the clinical features are necessary for a proper diagnosis. PMID:26844617

  7. Incidence of Hidradenitis Suppurativa and Associated Factors: A Population-Based Study of Olmsted County, Minnesota

    PubMed Central

    Vazquez, Benjamin G.; Alikhan, Ali; Weaver, Amy L.; Wetter, David A.; Davis, Mark D.

    2012-01-01

    There are no population-based incidence studies of hidradenitis suppurativa (HS). Using the medical records linkage system of the Rochester Epidemiology Project, we sought to determine incidence, as well as other associations and characteristics, for HS patients diagnosed in Olmsted County, Minnesota between 1968 and 2008. Incidence was estimated using the decennial census data for the county. Logistic regression models were fit to evaluate associations between patient characteristics and disease severity. A total of 268 incident cases were identified, with an overall annual age- and sex-adjusted incidence of 6.0 per 100,000. Age-adjusted incidence was significantly higher in women compared to men [8.2 (95% CI, 7.0–9.3) vs. 3.8 (95% CI, 3.0–4.7)]. The highest incidence was among young women aged 20–29 (18.4 per 100,000). The incidence has risen over the past four decades, particularly among women. Women were more likely to have axillary and upper anterior torso involvement, while men were more likely to have perineal or perianal disease. Additionally, 54.9% (140/255) patients were obese; 70.2% were current or former smokers; 42.9% carried a diagnosis of depression; 36.2% carried a diagnosis of acne; and 6% had pilonidal disease. Smoking and gender were significantly associated with more severe disease. PMID:22931916

  8. Microbiology of hidradenitis suppurativa (acne inversa): a histological study of 27 patients.

    PubMed

    Jahns, Anika C; Killasli, Hassan; Nosek, Daniel; Lundskog, Bertil; Lenngren, Anna; Muratova, Zhanna; Emtestam, Lennart; Alexeyev, Oleg A

    2014-09-01

    Hidradenitis suppurativa (acne inverse) (HS) is a chronic skin disease primarily affecting hair follicles. The aetiology of HS is unknown, but infection is believed to play some role. This retrospective study investigated the microbial colonization directly in skin appendices in HS skin samples. Archival samples from 27 patients with HS were screened by immunofluorescence labelling with monoclonal and polyclonal antibodies against Gram-positive bacteria, Propionibacterium acnes and Propionibacterium granulosum. Fluorescence in situ hybridization was used for further species identification of Staphylococcus spp. Overall, 17 patients (63%) were found positive for bacterial colonization. Of these, 15 showed colonization in hair follicles and/or sinus tracts. The most commonly identified bacteria were DAPI labelled coccoids that were seen in 71% of the positive patients in the form of biofilms and microcolonies. P. acnes was found as biofilms in hair follicles of two patients. Staphylococcus aureus and coagulase-negative staphylococci were not detected in any sample. The results of this study indicate a common bacterial presence in HS skin lesions. Bacterial biofilms are not uncommon and their pathogenic role needs further evaluation. PMID:24475943

  9. A prospective randomized controlled trial assessing the efficacy of adjunctive hyperbaric oxygen therapy in the treatment of hidradenitis suppurativa.

    PubMed

    Yildiz, Hamza; Senol, Levent; Ercan, Erdinc; Bilgili, Memet Ersan; Karabudak Abuaf, Ozlem

    2016-02-01

    Hyperbaric oxygen therapy (HBOT) appears to enhance wound healing, increase bactericidal activity, and act synergistically with a number of antibiotics. The aim of this study was to evaluate the efficacy of HBOT as an adjunctive therapy in patients with hidradenitis suppurativa (HS) treated with a combination of systemic rifampicin and clindamycin. The study was a prospective, single-center, single-dose, open-label, randomized controlled clinical study of HBOT in patients with moderate to severe HS. Efficacy was measured by modified Sartorius score (SS), HS Severity Index (HSSI), Dermatology Life Quality Index (DLQI), and a visual analog scale (VAS) before treatment and after the completion of 4 and 10 weeks of treatment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also measured. Forty-three patients were enrolled in the study. More patients in the HBOT than in the control group showed a decrease of ≥50% from baseline parameters at week 10 for SS (100%), HSSI (100%), DLQI (95.5%), VAS (100%), ESR (100%), and CRP (72.7%). Clinically and statistically significant improvements from baseline were observed at 4 and 10 weeks in HSSI (P = 0.009 at both), SS (P = 0.021 at both), and DLQI (P = 0.044 at week 4, P = 0.009 at week 10). Adjunctive HBOT was considered to be effective in significantly improving antibiotic treatment of HS. The treatment was well tolerated, and no unexpected safety issues were identified. PMID:26267600

  10. Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis.

    PubMed

    Scheinfeld, Noah

    2013-06-01

    Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Pyoderma fistulans sinifica (fox den disease) appears to be the same entity as Hurley Stage 2 of 3 HS. The rate of acne vulgaris in HS patients mirrors unaffected controls. The most common, albeit still uncommon, association is with seronegative, haplotype unlinked arthritis (most importantly B27), in particular spondolyarthritis. Crohn disease and HS occur together at a rate that varies from 0.6% to 38% in retrospective cases series. Ulcerative colitis occurred with HS in 14% of patients in one series. The next most common association is with pyoderma gangrenosum, but this association is likely under-reported. Synovitis-Acne-Pustulosis Hyperostosis-Osteitis (SAPHO) syndrome, which is rare, has more than 10 reports linking it to HS. Nine case reports have linked Dowling-Degos disease (DDD) to HS and two reports related HS to Fox-Fordyce disease (FF), but because both occur in the axilla this might be a mere coincidence. HS is rarely associated with ophthalmic pathology. Specifically, more than 5 reports link it to Keratitis-Ichthyosis-Deafness syndrome (KID); greater than10 cases link it to interstitial keratitis and 2 cases are linked to Behçet's disease. The presence of proteinuria and acute nephritis link HS to the kidney, especially since and reports have documented resolution of HS after renal transplant. Florid steatocystoma multiplex, Sjogren Syndrome, and HS have been linked and their reports likely underestimate their coincidence because all these entities involve occlusion (albeit by different mechanisms). Three reports link HS and amyloid, but both share some common genetic underpinnings and thus the coincidence of these

  11. Spondyloarthritis associated with acne conglobata, hidradenitis suppurativa and dissecting cellulitis of the scalp: a review with illustrative cases.

    PubMed

    Lim, Debbie T; James, Neena M; Hassan, Sobia; Khan, Muhammad A

    2013-08-01

    To review and highlight the association of acne conglobata, hidradenitis suppurativa, and dissecting cellulitis of the scalp with inflammatory arthritic conditions, we report five illustrative patients with this association, and a review of the literature. All our patients were African-American males, and their skin disease present before the onset of arthritis. Both asymmetric peripheral arthritis and axial disease can occur. The arthritis is usually insidious and lacks association with rheumatoid factor and HLA-B27. Imaging of peripheral joints can reveal erosions, periosteal bone reaction and new bone formation. When the axial skeleton is involved, imaging can reveal sacroiliitis, syndesmophyte formation. NSAIDs, oral and intra-articular steroids, DMARDs and TNF alpha antagonists have all been used with success. Controlled trials with larger numbers of patients are needed to assess which treatment options are the most effective for this group of patients. PMID:23771559

  12. Efficacy of magnetic resonance imaging in the diagnosis of perianal hidradenitis suppurativa, complicated by anal fistulae: A report of two cases and review of the literature

    PubMed Central

    Takiyama, Hirotoshi; Kazama, Shinsuke; Tanoue, Yusuke; Yasuda, Koji; Otani, Kensuke; Nishikawa, Takeshi; Tanaka, Toshiaki; Tanaka, Junichiro; Kiyomatsu, Tomomichi; Hata, Keisuke; Kawai, Kazushige; Nozawa, Hiroaki; Miyagawa, Takuya; Yamada, Daisuke; Yamaguchi, Hironori; Ishihara, Soichiro; Sunami, Eiji; Watanabe, Toshiaki

    2015-01-01

    Background Perianal hidradenitis suppurativa (PHS) is a chronic recurrent inflammatory disease of the apocrine glands present in the skin and soft tissue adjacent to the anus. It is often misdiagnosed or treatment is delayed, resulting in the formation of an abscess or, in the worst case, leading to sepsis. It is difficult to treat perianal lesions merged with fistulae completely due to its high recurrence rate. Therefore, we should diagnose it correctly and treat it with appropriate methods. Presentation of case We report two cases of PHS with anal fistulae that were examined preoperatively using magnetic resonance imaging (MRI) and treated safely by surgery without any recurrence. Discussion The anal sphincter area cannot be visualized and evaluated directly by fistulography. Also CT has only limited resolution, making it difficult to distinguish between soft tissues and inflammatory streaks. Endosonography is not suitable for the examination of supra-sphincteric or extra-sphincteric extensions, as it is limited by insufficient penetration of the ultrasonic beams. MRI can demonstrate the entire course of the fistulae owing to its high contrast resolution. Conclusion Our findings support the idea that PHS with complicated anal fistulae can be diagnosed accurately using MRI and treated safely and completely with surgery. PMID:26339787

  13. Photodynamic therapy with intralesional methylene blue and a 635 nm light-emitting diode lamp in hidradenitis suppurativa: a retrospective follow-up study in 7 patients and a review of the literature.

    PubMed

    Agut-Busquet, Eugènia; Romaní, Jorge; Gilaberte, Yolanda; García-Malinis, Ana; Ribera-Pibernat, Miquel; Luelmo, Jesús

    2016-08-01

    Hidradenitis suppurativa is a chronic inflammatory skin disease which has an estimated prevalence of 1%. It is characterized by the formation of recurrent painful suppurative nodules and abscesses in the flexural areas of the body. It is believed that its pathogenesis involves an aberrant, genetically-determined activation of innate immunity against the bacterial commensal flora of intertriginous areas. It has been found that the formation of antibiotic-resistant bacterial biofilms is a common finding in hidradenitis lesions. Photodynamic therapy with different compounds and light sources has demonstrated its efficacy in a number of infectious diseases such as nail mycosis and chronic periodontitis. We retrospectively report our experience in the treatment of hidradenitis with photodynamic therapy using intralesional methylene blue and a 635 nm light-emitting diode lamp in 7 patients. Two patients received one session whereas 5 patients received two sessions. At one month follow-up good response was achieved in 6 patients. After 6 months, 5 patients (71%) maintained remission of the disease in the treated area. In view of the results and literature review, we regard methylene blue as an ideal photosensitizer for photodynamic therapy in this disease. PMID:27417568

  14. Hidradenitis Suppurativa Management in the United States: An Analysis of the National Ambulatory Medical Care Survey and MarketScan Medicaid Databases

    PubMed Central

    Davis, Scott A.; Lin, Hsien-Chang; Balkrishnan, Rajesh; Feldman, Steven R.

    2015-01-01

    Purpose To present nationally representative data demonstrating how frequently hidradenitis suppurativa (HS) occurs in specific groups and how it is currently managed. Methods We analyzed data from the 1990–2009 National Ambulatory Medical Care Survey (NAMCS) and the 2003–2007 MarketScan Medicaid databases for patients with a diagnosis of HS (ICD-9-CM code 705.83). Visits per 100,000 population of each race and ethnicity were calculated using the 2000 US Census data for specific demographics. Results There were 164,000 patient visits (95% CI: 128,000–200,000) annually with a diagnosis of HS in the NAMCS, and 17,270 HS patients were found in the MarketScan Medicaid over the 5-year period. Antibiotics were the most common treatment, followed by pain medications, topical steroids, and isotretinoin. Prescriptions of biologics and systemic methotrexate, cyclosporine, and acitretin were not observed in the NAMCS. Physicians prescribed medications in 74% of visits and used procedures in 11% of visits. African Americans, females, and young adults had higher numbers of visits for HS. Conclusions Our data showing a maximum of 0.06% of the population being treated for HS in a given year are consistent with the low estimates of HS prevalence. Compared to the current prescribing patterns, the more frequent prescription of biologics and systemic treatments may yield better outcomes. PMID:27172455

  15. Recalcitrant Hidradenitis Suppurativa: An Investigation of Demographics, Surgical Management, Bacterial Isolates, Pharmacologic Intervention, and Patient-reported Health Outcomes.

    PubMed

    Thomas, Cristina; Rodby, Katherine A; Thomas, Jessina; Shay, Elizabeth; Antony, Anuja K

    2016-04-01

    Hidradenitis suppurativa (HS) is characterized by chronic inflammation, recurrent abscesses, and scarring. Surgery is performed when medical management and antibiotic therapy fails. This study sought to evaluate the demographics, surgical procedures, bacteriology, pharmacologic intervention, and quality of life of patients with recalcitrant HS requiring surgical intervention. A retrospective chart review was performed of 76 recalcitrant HS patients at the University of Illinois Medical Center. Patient demographics, bacterial culture, and surgery data were reviewed. Quality of life was assessed using the 36-item short-form health survey. Patients were mostly female (73.7%) and African American (81.6%) with a mean duration of symptoms of 8.6 years before surgery. Patients underwent at least one surgical procedure, most often to the axillae (57.6%) and 73.7 per cent received antibiotics. The most common culture isolates were Corynebacterium species (14.0%), Staphylococcus epidermidis (13.1%), and Staphylococcus aureus (10.4%) with varying resistance patterns. Surveyed patients had depressed 36-item short-form health survey physical functioning and social functioning scores. Recalcitrant HS patients with progressive symptomology over approximately nine years before surgical intervention were more likely to be African American women with axillary HS. Quality of life was diminished. We recommend initial treatment of HS with clindamycin and trimethoprim-sulfamethoxazole in clindamycin refractory cases. PMID:27097631

  16. Development of core outcome sets in hidradenitis suppurativa: systematic review of outcome measure instruments to inform the process.

    PubMed

    Ingram, J R; Hadjieconomou, S; Piguet, V

    2016-08-01

    The recent hidradenitis suppurativa (HS) Cochrane review identified outcome measure heterogeneity as an important issue to address when designing future HS trials. Our objective was to follow the Harmonising Outcome Measures for Eczema (HOME) roadmap, by performing a systematic review of HS outcome measure instruments to inform the development of an HS core outcome set. We performed a systematic review to identify validation evidence for outcome measure instruments used in HS randomized controlled trials (RCTs), and assessed the methodological quality of all HS outcome measure validity studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The 12 RCTs included in the Cochrane review utilized 30 outcome measure instruments, including 16 physician-reported instruments, 11 patient-reported instruments and three composite measures containing elements of both. Twenty-seven (90%) of the instruments lacked any validation data. Two further instruments have been developed and partially validated. Of the seven studies meeting our inclusion criteria, six were of 'fair' or 'poor' methodological quality, in part because most of the studies were not primarily designed for instrument validation. The HiSCR instrument is supported by good-quality validation data, but there are gaps, including assessment of internal consistency, inter-rater reliability and minimal clinically important difference, and convergent validity fell below the acceptable range for some comparisons. Multiple, usually unvalidated, outcome measure instruments have been used in HS RCTs. Where validation evidence is available there are issues of low methodological quality or incomplete validity assessment and so, currently, no instruments can be fully recommended. PMID:26873867

  17. Contemporary surgical treatment of hidradenitis suppurativa (HS) with a focus on the use of the diode hair laser in a case.

    PubMed

    Sehgal, Virendra N; Verma, Prashant; Sawant, Satish; Paul, Munish

    2011-08-01

    Hidradenitis suppurativa, a chronic recurrent disorder, characterized by painful, deep-seated nodules and abscesses commonly affecting the pilosebaceous-apocrine unit of the axillary, inguinal and mammary region in females, while the perianal area and buttocks are the prevalent sites in males. Its onset is after puberty, and may persist thereafter. Its exact aetiology is speculative. Follicular occlusion is the primary event leading to secondary inflammation, infection and destruction of the unit, ultimately affecting the adjoining subcutaneous tissue. Smoking and obesity may trigger or aggravate the condition. Stage of disease determines the mode of treatment. Medical treatment is valid in the early stage, but the results are transient. The early stage may warrant incision, and drainage of abscesses coupled with limited excision for locally recurring draining sinuses. While radical excision and healing with secondary intention, skin grafting, and flaps is recommended in advanced stages, laser therapy including the diode laser may prove a promising and innovative alternative. PMID:21714587

  18. Hidradenitis Suppurativa Foundation

    MedlinePlus

    ... 3) nonprofit public benefit corporation, dedicated to improving research, education, and the quality of life and care for ... the disease. The challenges of timely diagnosis, quality research, community and patient education and improvements in patient care are all elements ...

  19. High Copy Numbers of β-Defensin Cluster on 8p23.1, Confer Genetic Susceptibility, and Modulate the Physical Course of Hidradenitis Suppurativa/Acne Inversa.

    PubMed

    Giamarellos-Bourboulis, Evangelos J; Platzer, Matthias; Karagiannidis, Ioannis; Kanni, Theodora; Nikolakis, Georgios; Ulrich, Jens; Bellutti, Michael; Gollnick, Harald; Bauer, Michael; Zouboulis, Christos C; Huse, Klaus

    2016-08-01

    Hidradenitis suppurativa/acne inversa (HS) has a multifactorial pathogenesis, with many patients reporting positive family history. Nine β-defensin genes (among them DEFB4 and DEFB103, encoding for proinflammatory mediators human β-defensin-2 and human β-defensin-3, respectively) exist as a cluster (DEFB) affected by copy number (CN). We hypothesized that CNs are greater in patients with HS and that they are linked to genetic susceptibility. CNs of DEFB were studied in two independent patient cohorts: 163 patients from Greece and 98 from Germany. CNs were greater in patients than control subjects in both studied cohorts. Carriage of more than six CNs was associated with a 7.53 odds ratio for HS in the Greek cohort and a 5.76 odds ratio for HS in the German cohort. The common odds ratio after meta-analysis was 6.72 (P < 0.0001). However, presence of fewer than six copies was linked with disease onset at an earlier age (P = 0.048), less frequent presentation of permanent purulence of the affected skin lesions (P = 0.036), and fewer skin localizations (P = 0.042). A robust genetic trait for susceptibility to HS is provided, and this is confirmed in two independent cohorts. Susceptibility arises from carriage of more than six DEFB copies, which interferes directly with the HS phenotype. PMID:27164300

  20. Remission of refractory pyoderma gangrenosum, severe acne, and hidradenitis suppurativa (PASH) syndrome using targeted antibiotic therapy in 4 patients.

    PubMed

    Join-Lambert, Olivier; Duchatelet, Sabine; Delage, Maïa; Miskinyte, Snaigune; Coignard, Hélène; Lemarchand, Nicolas; Alemy-Carreau, Murielle; Lortholary, Olivier; Nassif, Xavier; Hovnanian, Alain; Nassif, Aude

    2015-11-01

    Pyoderma gangrenosum, severe acne, and suppurative hidradenitis (PASH) syndrome can prove refractory to treatment and is characterized by relapses and recurrences. The combination of antibiotic therapy and surgery can produce success in the management of the syndrome. Acute treatment is required, but maintenance therapy is also necessary to prevent disease relapse. The response to antibiotic therapy is hypothesis generating, raising the issue of a modified host response. To date, anecdotal reports support the use of surgery and medical therapy, but controlled investigations with extended follow-up are necessary to substantiate preliminary data observed with individual cases. PMID:26470620

  1. Why rifampin (rifampicin) is a key component in the antibiotic treatment of hidradenitis suppurativa: a review of rifampin's effects on bacteria, bacterial biofilms, and the human immune system.

    PubMed

    Scheinfeld, Noah

    2016-01-01

    Combinations of rifampin and clindamycin or rifampin, metronidazole, and moxifloxcin have been reported as effective treatments for hidradenitis suppurativa (HS) Hurley Stage 1 and Hurley Stage 2.  Clinical trials suggest that for stage 1 and mild stage 2 HS, clindamycin 300 mg twice daily and rifampin 300 mg twice daily for 10 weeks can substantially abate HS in ~80% of cases and remit HS in ~50% of cases.  Another study notes use of rifampin-moxifloxacin-metronidazole given for 6 weeks, dosed as rifampin (10 mg/kg once daily), moxifloxacin (400 mg daily), and metronidazole (500 mg thrice daily) with the metronidazole stopped at week 6.   Rifampin and moxifloxacin were continued if the HS improved and side effects did not occur.  Using this triple antibiotic regimen remission occurred in 100% Hurley Stage 1, 80% Hurly Stage 2, and 16.7 % of Hurley Stage 3 HS.   The author typically gives HS clindamycin 300 mg and rifampin 300 mg, each twice daily, for 10 weeks and assesses if remission has occurred.  If the patient has not achieved remission the author continues the regimen as long as the patient's clinical status continues to improve without side effects.  The reasons why rifampin is so effective against HS have not been fully defined and might involve rifampin's (1) antibacterial effects (2) effects on bacterial biofilms (3) anti-inflammatory effects (4) effects against granulomas (5) and immunomodulatory effects on neutrophils.  It is notable that rifampin, although not first line, is an effective treatment for Clostridium difficile, a pathogen that arises during treatment with clindamycin.  Thus, rifampin enhances safety when rifampin and clindamycin are combined for the treatment of HS. PMID:27617596

  2. Update on Hidradenitis Suppurative (Part II): Treatment.

    PubMed

    Martorell, A; García, F J; Jiménez-Gallo, D; Pascual, J C; Pereyra-Rodríguez, J; Salgado, L; Villarrasa, E

    2015-11-01

    Although hidradenitis suppurativa is a common and serious skin condition, its treatment is not well established. It is now accepted that the moderate and severe forms of the disease are associated with marked systemic inflammation. The goal of treatment in hidradenitis suppurative is therefore to achieve systemic control of inflammation. In some cases, surgery may also be necessary to reduce the severity of the manifestations of cutaneous inflammation. Recent advances in our understanding of hidradenitis suppurativa have been accompanied by the emergence of novel approaches to its treatment, including the use of certain biologic drugs. Several clinical trials have been undertaken to test the effects of biologics (mainly adalimumab) in this setting. In this review, we analyze the different treatments available for hidradenitis suppurativa. PMID:26277040

  3. Dissecting cellulitis (Perifolliculitis Capitis Abscedens et Suffodiens): a comprehensive review focusing on new treatments and findings of the last decade with commentary comparing the therapies and causes of dissecting cellulitis to hidradenitis suppurativa.

    PubMed

    Scheinfeld, Noah

    2014-05-01

    Dissecting cellulitis (DC) also referred to as to as perifolliculitis capitis abscedens et suffodiens (Hoffman) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. In the U.S., it predominantly occurs in African American men between 20-40 years of age. DC also occurs in other races and women more rarely. DC has been reported worldwide. Older therapies reported effective include: low dose oral zinc, isotretinoin, minocycline, sulfa drugs, tetracycline, prednisone, intralesional triamcinolone, incision and drainage, dapsone, antiandrogens (in women), topical clindamycin, topical isotretinoin, X-ray epilation and ablation, ablative C02 lasers, hair removal lasers (800nm and 694nm), and surgical excision. Newer treatments reported include tumor necrosis factor blockers (TNFB), quinolones, macrolide antibiotics, rifampin, alitretinoin, metronidazole, and high dose zinc sulphate (135-220 mg TID). Isotretinoin seems to provide the best chance at remission, but the number of reports is small, dosing schedules variable, and the long term follow up beyond a year is negligible; treatment failures have been reported. TNFB can succeed when isotretinoin fails, either as monotherapy, or as a bridge to aggressive surgical treatment, but long term data is lacking. Non-medical therapies noted in the last decade include: the 1064 nm laser, ALA-PDT, and modern external beam radiation therapy. Studies that span more than 1 year are lacking. Newer pathologic hair findings include: pigmented casts, black dots, and "3D" yellow dots. Newer associations include: keratitis-ichthyosis-deafness syndrome, Crohn disease and pyoderma gangrenosum. Older associations include arthritis and keratitis. DC is likely a reaction pattern, as is shown by its varied therapeutic successes and failures. The etiology of DC remains enigmatic and DC is distinct from hidradenitis suppurativa, which is shown by their varied responses to therapies and their

  4. Genetics Home Reference: hidradenitis suppurativa

    MedlinePlus

    ... Apr;60(4):539-61; quiz 562-3. doi: 10.1016/j.jaad.2008.11.911. Review. ... Acad Dermatol. 2009 Jul;61(1):51-7. doi: 10.1016/j.jaad.2009.02.013. Epub ... Dermatol Clin. 2010 Oct;28(4):779-93. doi: 10.1016/j.det.2010.07.003. Review. ...

  5. Hidradenitis suppurrativa (acne inversa) as a systemic disease.

    PubMed

    Dessinioti, Clio; Katsambas, Andreas; Antoniou, Christina

    2014-01-01

    Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic follicular occlusive skin disorder characterized by recurrent abscesses, draining sinuses, and scarring, with a multifactorial pathogenesis. The answer to the question whether HS may be considered a systemic disease relies on the presence of accompanying systemic manifestations, on the proof of association with other diseases or conditions, and on the occurrence of systemic implications. We address these questions based on a systemic review of the existing literature. There are several reports in the literature of the coexistence of HS with other diseases, including pyoderma gangrenosum, PASH syndrome, Adamantiades-Behcet's disease, spondylarthropathy, Crohn's disease, SAPHO, pachyonychia congenita, Dowling-Degos disease, and the keratitis-ichthyosis-deafness (KID) syndrome. Case series exist only for Crohn's disease, while most other reports are anecdotal, thus, not providing high-quality scientific evidence. Based on well-designed studies, HS has been associated with the metabolic syndrome and with excess body weight or obesity. The link between HS and systemic associations may be attributed to common genetic or environmental factors or shared inflammatory pathways. PMID:24767187

  6. Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment

    PubMed Central

    Wollina, Uwe; Koch, André; Heinig, Birgit; Kittner, Thomas; Nowak, Andreas

    2013-01-01

    Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring. PMID:23439959

  7. A hidradenitis suppurativa related SAPHO case associated with features resembling spondylarthropathy and proteinuria.

    PubMed

    Ozyemisci-Taskiran, Ozden; Bölükbasi, Nesrin; Gögüs, Feride

    2007-05-01

    We present a 53-year-old man with synovitis-acne-palmoplantar pustulosis-hyperosteosis-osteitis (SAPHO) syndrome who is HLA-B27 positive with a history of uveitis and complicated by proteinuria and osteoporosis. Interesting, yet unreported features of SAPHO syndrome and the etiology of proteinuria are further discussed. PMID:16680392

  8. Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment.

    PubMed

    Wollina, Uwe; Koch, André; Heinig, Birgit; Kittner, Thomas; Nowak, Andreas

    2013-01-01

    Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring. PMID:23439959

  9. A Classic Clinical Case: Neutrophilic Eccrine Hidradenitis

    PubMed Central

    Copaescu, Ana-Maria; Castilloux, Jean-François; Chababi-Atallah, Myrna; Sinave, Christian; Bertrand, Janie

    2013-01-01

    Background Neutrophilic eccrine hidradenitis (NEH) is a rare condition described mostly in adult patients receiving chemotherapy for acute myelogenous leukemia. When it affects the facial region, it can mimic cellulitis and delay the diagnostic, thus proper recognition is essential. Objective This article describes a classic case of NEH. We will review the diagnostic, the differential diagnostic (mostly cellulitis) and the management of this condition. Methods After a literature review, the patient's file was properly studied in order to portray a clear picture of this condition. Medical photographs and appropriate physical examination upon presentation are also included. Results The diagnostic for NEH was suggested by the clinical presentation and confirmed histopathologically (skin biopsy). Conclusion The diagnostic of NEH is essential in order to prevent multiple unnecessary antibiotics. PMID:24474918

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

    PubMed Central

    Principi, Mariabeatrice; Cassano, Nicoletta; Contaldo, Antonella; Iannone, Andrea; Losurdo, Giuseppe; Barone, Michele; Mastrolonardo, Mario; Vena, Gino Antonio; Ierardi, Enzo; Di Leo, Alfredo

    2016-01-01

    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

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

    PubMed

    Principi, Mariabeatrice; Cassano, Nicoletta; Contaldo, Antonella; Iannone, Andrea; Losurdo, Giuseppe; Barone, Michele; Mastrolonardo, Mario; Vena, Gino Antonio; Ierardi, Enzo; Di Leo, Alfredo

    2016-05-28

    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

  12. [Emotions and bodily experience in Hidradenitis Suppurative-Acne Inversa].

    PubMed

    Tugnoli, S; Bettoli, V; Agnoli, C; Caracciolo, S

    2016-01-01

    Hidradenitis Suppurative-Acne Inversa is one of the most debilitating chronic skin diseases. It seriously affects the emotional and relational life of the patient, it has a significant psychiatric comorbidity and it impairs the quality of life. We present the report of a clinical situation with onset of the illness in a young woman during pregnancy, a case characterized by particular evolution, severe systemic involvement, strong psycho-emotional impact on the patient and impairment of subjective well-being of the caregiver. The clinical evaluation highlights mainly the relevance of the bodily experience, that stands out as a central issue in the sufference of the patient. She feels an uncanny foreignness to herself and a lacerating wound of her identity, related to her desirability, her femininity and her motherhood. Specific personality factors, which are likely to have influenced and guided the experience of illness and the quality of the relationship with the treatment team, are also evaluated. This case exemplifies, at different levels, the clinical complexity of Hidradenitis Suppurative-Acne Inversa and its impact on individual subjectivity. This disease requires an integrated intervention by a multidisciplinary team, providing for the assessment, the treatment and the evaluation of outcomes. It is necessary an effective operational link between different competences, in order to promote the patient compliance and to activate and develop the best care and the right psychological support. PMID:27424511

  13. Neutrophilic eccrine hidradenitis secondary to infection with Serratia marcescens.

    PubMed

    Combemale, P; Faisant, M; Azoulay-Petit, C; Dupin, M; Kanitakis, J

    2000-04-01

    Neutrophilic eccrine hidradenitis (NEH) is a rare dermatosis which usually develops after administration of chemotherapeutic treatments. An infective origin is exceptional. We report a patient, previously operated on for ependymoma, who presented with an eruption typical of NEH even though he had not received chemotherapy. Culture of a skin biopsy revealed Serratia marcescens. The dermatosis improved after antibiotic therapy but recurred twice and culture again isolated S. marcescens; electron microscopy revealed cytoplasmic inclusions within neutrophils, suggestive of bacteria. The disease improved every time with appropriate antibiotic therapy. An infective aetiology for NEH is rare: three such cases have been reported, of which one was due to S. marcescens. The originality of our case is the recurrence of the disease on three occasions with the same bacterium isolated on each occasion, with disease remission after antibiotic therapy. This case confirms that infections may be a possible cause of NEH and underlines the necessity to search for infective agents, especially in patients immunocompromised by haematopoietic malignancies and/or chemotherapeutic treatments. PMID:10792233

  14. Pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis: efficacy of anti-tumor necrosis factor α therapy.

    PubMed

    Bruzzese, Vincenzo

    2012-12-01

    We report the case of a patient with a simultaneous presence of pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis. This condition differs from both the PASH (pyoderma gangrenosum, acne, and suppurative hidradenitis) syndrome, in which arthritis is absent, and the PAPA (pyogenic arthritis, pyoderma gangrenosum, and acne) syndrome, in which suppurative hidradenitis is lacking. Our patient failed to respond to etanercept therapy, whereas all dermatologic and rheumatic manifestations completely regressed following infliximab infusion. We therefore propose that simultaneous presence of pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and seronegative spondyloarthritis might represent a distinct syndrome that could be termed the PASS syndrome. Tumor necrosis factor α therapies seem to play selective roles. PMID:23188209

  15. Infectious eccrine hidradenitis: a report of 3 cases and a review of the literature.

    PubMed

    Bassas-Vila, J; Fernández-Figueras, M T; Romaní, J; Ferrándiz, C

    2014-03-01

    Neutrophilic eccrine hidradenitis (NEH) is a nonspecific clinicopathological reaction pattern, classified as a neutrophilic dermatosis, that usually develops in patients receiving chemotherapy for a hematologic malignancy. More rarely, it has been reported in association with infectious agents such as Serratia and Enterobacter species, Staphylococcus aureus, and human immunodeficiency virus. We describe 3 cases of infectious eccrine hidradenitis secondary to infection with Nocardia species, Mycobacterium chelonae, and S aureus. Histological findings revealed a dense infiltrate with perivascular and periductal neutrophils in the dermis. In the eccrine glands, there was vacuolar degeneration and necrosis of the epithelial cells. Our cases support the assertion that NEH is a characteristic cutaneous response to nonspecific stimuli. Clinical and histopathological findings of infectious and noninfectious NEH are generally indistinguishable and when NEH is suspected, the possibility of an infectious association must be investigated by skin tissue culture. In this article we also discuss differential diagnoses and review the literature. PMID:24011437

  16. Pyoderma gangrenosum, acne and suppurative hidradenitis syndrome following bowel bypass surgery.

    PubMed

    Marzano, Angelo V; Ishak, Rim S; Colombo, Antonella; Caroli, Francesco; Crosti, Carlo

    2012-01-01

    The clinical triad of pyoderma gangrenosum (PG), acne and suppurative hidradenitis (PASH) has recently been described as a new disease entity within the spectrum of autoinflammatory syndromes, which are an emerging group of inflammatory diseases distinct from autoimmune, allergic and infectious disorders. PASH syndrome is similar to PAPA (pyogenic arthritis, acne and PG), but it differs in lacking the associated arthritis and on a genetic basis. PAPA syndrome is caused by mutations in a gene involved in the regulation of innate immune responses, the PSTPIP1, while no mutations have been detected to date in patients with PASH syndrome. We report a young male patient who developed coexisting disseminated PG, typical suppurative hidradenitis and acneiform eruption on the face, after he had undergone bowel bypass surgery for obesity. The cutaneous manifestations associated with bowel bypass syndrome often mimic PG or other neutrophilic dermatoses, suggesting a pathogenesis related to neutrophil-mediated inflammation for this condition. This is the first report describing PASH syndrome after bariatric surgery, and we propose to include such neutrophilic dermatoses in the list of complications occurring after bowel bypass surgery. Extensive genetic studies may help to clarify the etiopathogenesis of PASH as well as of autoinflammatory diseases in general. PMID:23171584

  17. VIRTUAL REALITY HYPNOSIS FOR PAIN CONTROL IN A PATIENT WITH GLUTEAL HIDRADENITIS:A CASE REPORT().

    PubMed

    Soltani, Maryam; Teeley, Aubriana M; Wiechman, Shelley A; Jensen, Mark P; Sharar, Sam R; Patterson, David R

    2011-01-01

    This case report describes the use of hypnotic analgesia induced through immersive three-dimensional computer-generated virtual reality, better known as virtual reality hypnosis (VRH), in the treatment of a patient with ongoing pain associated with gluteal hidradenitis, The patient participated in the study for two consecutive days white hospitalized at a regional trauma centre. At pretreatment, she reported severe pain intensity and unpleasantness as well as high levels of anxiety and nervousness. She was then administered two sessions of virtual reality hypnotic treatment for decreased pain and anxiety. The patient's ratings of 'time spent thinking about pain', pain intensity, 'unpleasantness of pain', and anxiety decreased from before to after each daily VRH session, as well as from Day One to Day Two. The findings indicate that VRH may benefit individuals with severe, ongoing pain from a chronic condition, and that a controlled clinical trial examining its efficacy is warranted. PMID:23205274

  18. Association of Pyoderma Gangrenosum, Acne, and Suppurative Hidradenitis (PASH) Shares Genetic and Cytokine Profiles With Other Autoinflammatory Diseases: Erratum.

    PubMed

    2015-02-01

    [In the article "Association of Pyoderma Gangrenosum, Acne, and Suppurative Hidradenitis (PASH) Shares Genetic and Cytokine Profiles With Other Autoinflammatory Diseases", which appeared in Volume 93, Issue 27 of Medicine, one of Orietta M. Borghi's affiliations was omitted. The article should have stated that Orietta M. Borghi is associated with the IRCCS Istituto Auxologico Italiano, Milano, Italy as well as the Dipartimento di Scienze Cliniche e di Comunità, Università di Milano.]. PMID:25803365

  19. VIRTUAL REALITY HYPNOSIS FOR PAIN CONTROL IN A PATIENT WITH GLUTEAL HIDRADENITIS:A CASE REPORT1

    PubMed Central

    SOLTANI, MARYAM; TEELEY, AUBRIANA M.; WIECHMAN, SHELLEY A.; JENSEN, MARK P.; SHARAR, SAM R.; PATTERSON, DAVID R.

    2012-01-01

    This case report describes the use of hypnotic analgesia induced through immersive three-dimensional computer-generated virtual reality, better known as virtual reality hypnosis (VRH), in the treatment of a patient with ongoing pain associated with gluteal hidradenitis, The patient participated in the study for two consecutive days white hospitalized at a regional trauma centre. At pretreatment, she reported severe pain intensity and unpleasantness as well as high levels of anxiety and nervousness. She was then administered two sessions of virtual reality hypnotic treatment for decreased pain and anxiety. The patient’s ratings of ‘time spent thinking about pain’, pain intensity, ‘unpleasantness of pain’, and anxiety decreased from before to after each daily VRH session, as well as from Day One to Day Two. The findings indicate that VRH may benefit individuals with severe, ongoing pain from a chronic condition, and that a controlled clinical trial examining its efficacy is warranted. PMID:23205274

  20. Pyogenic Arthritis, Pyoderma Gangrenosum, Acne, Suppurative Hidradenitis (PA-PASH) Syndrome: An Atypical Presentation of a Rare Syndrome

    PubMed Central

    Ursani, Mohammad A.; Appleyard, Joan; Whiteru, Onome

    2016-01-01

    Patient: Male, 44 Final Diagnosis: PAPASH syndrome Symptoms: Recurrent skin ulcers • diarrhea • inflammatory arthritis Medication: Prednisone • anti-tumor necrosis factor Clinical Procedure: N/A Specialty: Rheumatology Objective: Rare disease Background: Pyogenic arthritis, pyoderma gangrenosum (PG), acne, and suppurative hidradenitis (PA-PASH) syndrome has been linked to an auto-inflammatory pathway. We report a case that is an atypical presentation of a rare syndrome, which supports literature suggesting that different phenotypes of PG-related syndromes may be a variation of the same pathogenic spectrum. Interestingly, our patient displayed a positive proteinase-3 antibody (PR-3). The clinical relevance of this is unclear. In recent literature, antineutrophil cytoplasmic autoantibodies (ANCA) positivity has been reported in various inflammatory conditions other than ANCA-associated vasculitis (AAV). Case Report: A 44-year-old African American male with history of pyogenic arthritis, acne, suppurative hidradenitis, and chronic diarrhea presented for evaluation of painful ulcers located on the bilateral lower extremities, bilateral proximal interphalangeal joints, buttocks, and scrotum, and chronic diarrhea. Infectious etiologies for the ulcers were ruled out. Biopsy of an ulcer revealed PG. Colonoscopy revealed inflammation and ulceration with biopsy consistent with ulcerative colitis (UC). After treatment with prednisone, the ulcers healed within 4 weeks, and the chronic diarrhea resolved. Conclusions: Our patient displayed a variation of PA-PASH syndrome and UC. Previously reported cases of similar phenotypes of PG-related syndromes have not presented in this fashion. Furthermore, the literature does not report cases of PG-related syndromes with an elevation in PR-3 antibody. Elevation in PR-3 has been reported in various inflammatory disorders aside from AAV. The relevance of this is currently unclear. It may be possible that the milieus of these various

  1. Pyogenic Arthritis, Pyoderma Gangrenosum, Acne, Suppurative Hidradenitis (PA-PASH) Syndrome: An Atypical Presentation of a Rare Syndrome.

    PubMed

    Ursani, Mohammad A; Appleyard, Joan; Whiteru, Onome

    2016-01-01

    BACKGROUND Pyogenic arthritis, pyoderma gangrenosum (PG), acne, and suppurative hidradenitis (PA-PASH) syndrome has been linked to an auto-inflammatory pathway. We report a case that is an atypical presentation of a rare syndrome, which supports literature suggesting that different phenotypes of PG-related syndromes may be a variation of the same pathogenic spectrum. Interestingly, our patient displayed a positive proteinase-3 antibody (PR-3). The clinical relevance of this is unclear. In recent literature, antineutrophil cytoplasmic autoantibodies (ANCA) positivity has been reported in various inflammatory conditions other than ANCA-associated vasculitis (AAV). CASE REPORT A 44-year-old African American male with history of pyogenic arthritis, acne, suppurative hidradenitis, and chronic diarrhea presented for evaluation of painful ulcers located on the bilateral lower extremities, bilateral proximal interphalangeal joints, buttocks, and scrotum, and chronic diarrhea. Infectious etiologies for the ulcers were ruled out. Biopsy of an ulcer revealed PG. Colonoscopy revealed inflammation and ulceration with biopsy consistent with ulcerative colitis (UC). After treatment with prednisone, the ulcers healed within 4 weeks, and the chronic diarrhea resolved. CONCLUSIONS Our patient displayed a variation of PA-PASH syndrome and UC. Previously reported cases of similar phenotypes of PG-related syndromes have not presented in this fashion. Furthermore, the literature does not report cases of PG-related syndromes with an elevation in PR-3 antibody. Elevation in PR-3 has been reported in various inflammatory disorders aside from AAV. The relevance of this is currently unclear. It may be possible that the milieus of these various auto-inflammatory disorders may share pathogenic commonalities. PMID:27530224

  2. Aesthetic mental and cervical reconstruction after severe acne inversa by using a bilateral pedicled expanded forehead flap.

    PubMed

    Fu, Siqi; Fan, Jincai; Liu, Liqiang; Gan, Cheng; Tian, Jia; Jiao, Hu; Chen, Wenlin; Yang, Zengjie; Yin, Zhuming

    2012-11-01

    Acne inverse (AI), also known as hidradenitis suppurativa, is characterized by inflammatory nodules, fistulating sinus tracts, and painful skin abscesses. The severe AI often produces disfiguring scars influenced in both the appearance and function, especially in the facial and cervical regions. There might be difficulties in the situation for surgical treatment. This report described a 26-year-old man with severe scarring contractures in the neck and mandible regions after a long-term AI treated successfully with a bilateral pedicled expanded forehead flap. With the achievement of mental cervical angle, the patient has been reconstructed well both aesthetically and functionally during the long-term follow-ups. PMID:23172497

  3. Updated Physician’s Guide to the Off-label Uses of Oral Isotretinoin

    PubMed Central

    Peterson, Nathan; Peterson, Michael

    2014-01-01

    While oral isotretinoin is renowned for its ability to treat acne vulgaris, many of its off-label uses continue to go underappreciated. Since the last review on the unapproved indications of isotretinoin, relevant publications have surfaced with new recommendations. This article attempts to provide physicians with the latest information regarding successful and unsuccessful use of isotretinoin as an effective treatment for dermatological conditions, such as rosacea, psoriasis, pityriasis rubra pilaris, condyloma acuminatum, granuloma annulare, Darier’s disease, systemic cutaneous lupus erythematosus, nonmelanoma skin cancer, and hidradenitis suppurativa. Variations in dosage regimens and isotretinoin viability as an alternative to other standard treatments are also discussed in relation to these conditions. PMID:24765227

  4. Association of pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) shares genetic and cytokine profiles with other autoinflammatory diseases.

    PubMed

    Marzano, Angelo V; Ceccherini, Isabella; Gattorno, Marco; Fanoni, Daniele; Caroli, Francesco; Rusmini, Marta; Grossi, Alice; De Simone, Clara; Borghi, Orietta M; Meroni, Pier Luigi; Crosti, Carlo; Cugno, Massimo

    2014-12-01

    The association of pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) has recently been described and suggested to be a new entity within the spectrum of autoinflammatory syndromes, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T-cells. We conducted an observational study on 5 patients with PASH syndrome, analyzing their clinical features, genetic profile of 10 genes already known to be involved in autoinflammatory diseases (AIDs), and cytokine expression pattern both in lesional skin and serum. In tissue skin samples, the expressions of interleukin (IL)-1β and its receptors I and II were significantly higher in PASH (P = 0.028, 0.047, and 0.050, respectively) than in controls. In PASH patients, chemokines such as IL-8 (P = 0.004), C-X-C motif ligand (CXCL) 1/2/3 (P = 0.028), CXCL 16 (P = 0.008), and regulated on activation, normal T cell expressed and secreted (RANTES) (P = 0.005) were overexpressed. Fas/Fas ligand and cluster of differentiation (CD)40/CD40 ligand systems were also overexpressed (P = 0.016 for Fas, P = 0.006 for Fas ligand, P = 0.005 for CD40, and P = 0.004 for CD40 ligand), contributing to tissue damage and inflammation. In peripheral blood, serum levels of the main proinflammatory cytokines, that is, IL-1β, tumor necrosis factor-α, and IL-17, were within the normal range, suggesting that in PASH syndrome, the inflammatory process is mainly localized into the skin. Four out of our 5 PASH patients presented genetic alterations typical of well-known AIDs, including inflammatory bowel diseases, and the only patient lacking genetic changes had clinically evident Crohn disease. In conclusion, overexpression of cytokines/chemokines and molecules amplifying the inflammatory network, along with the genetic changes, supports the view that PASH syndrome is autoinflammatory in origin. PMID:25501066

  5. Association of Pyoderma Gangrenosum, Acne, and Suppurative Hidradenitis (PASH) Shares Genetic and Cytokine Profiles With Other Autoinflammatory Diseases

    PubMed Central

    Marzano, Angelo V.; Ceccherini, Isabella; Gattorno, Marco; Fanoni, Daniele; Caroli, Francesco; Rusmini, Marta; Grossi, Alice; De Simone, Clara; Borghi, Orietta M.; Meroni, Pier Luigi; Crosti, Carlo; Cugno, Massimo

    2014-01-01

    Abstract The association of pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) has recently been described and suggested to be a new entity within the spectrum of autoinflammatory syndromes, which are characterized by recurrent episodes of sterile inflammation, without circulating autoantibodies and autoreactive T-cells. We conducted an observational study on 5 patients with PASH syndrome, analyzing their clinical features, genetic profile of 10 genes already known to be involved in autoinflammatory diseases (AIDs), and cytokine expression pattern both in lesional skin and serum. In tissue skin samples, the expressions of interleukin (IL)-1β and its receptors I and II were significantly higher in PASH (P = 0.028, 0.047, and 0.050, respectively) than in controls. In PASH patients, chemokines such as IL-8 (P = 0.004), C-X-C motif ligand (CXCL) 1/2/3 (P = 0.028), CXCL 16 (P = 0.008), and regulated on activation, normal T cell expressed and secreted (RANTES) (P = 0.005) were overexpressed. Fas/Fas ligand and cluster of differentiation (CD)40/CD40 ligand systems were also overexpressed (P = 0.016 for Fas, P = 0.006 for Fas ligand, P = 0.005 for CD40, and P = 0.004 for CD40 ligand), contributing to tissue damage and inflammation. In peripheral blood, serum levels of the main proinflammatory cytokines, that is, IL-1β, tumor necrosis factor-α, and IL-17, were within the normal range, suggesting that in PASH syndrome, the inflammatory process is mainly localized into the skin. Four out of our 5 PASH patients presented genetic alterations typical of well-known AIDs, including inflammatory bowel diseases, and the only patient lacking genetic changes had clinically evident Crohn disease. In conclusion, overexpression of cytokines/chemokines and molecules amplifying the inflammatory network, along with the genetic changes, supports the view that PASH syndrome is autoinflammatory in origin. PMID:25501066

  6. A different disease: extrasacrococcygeal pilonidal sinuses etiopathogenesis

    PubMed Central

    Çiftci, Fatih; Abdurrahman, Ibrahim

    2015-01-01

    Pilonidal sinuses (PS) predominantly affect young male adults, usually occurring in the sacrococcygeal region. However, PS occasionally occurs in other parts of the body, referred to as extrasacrococcygeal pilonidal sinus (ESPS). We herein evaluate ESPS ethiopathogenesis and treatment. Of a total of 949 PS cases treated between 2006 and 2011, 21 were of ESPS (2.2% of the total), which were evaluated retrospectively. The affected regions were the breast (n = 1), scalp (n = 2), sternum (n = 2), abdominal wall (n = 5), neck (n = 2), groin (n = 4), and axilla (n = 5). Lesions of the abdominal wall are rare, but less so than lesions in other regions. PS may mimic hidradenitis suppurativa histologically. To our knowledge, PS of the breast and groin have not previously been reported. Twelve of our patients reported shaving the affected region; we suggest this may have played a role in the disease pathogenesis. PMID:26379983

  7. Chronic pain management in dermatology: pharmacotherapy and therapeutic monitoring with opioid analgesia.

    PubMed

    Enamandram, Monica; Rathmell, James P; Kimball, Alexandra B

    2015-10-01

    A number of chronic dermatologic conditions may necessitate long-term adjunctive pain management in addition to treatment of the primary skin disease, such as hidradenitis suppurativa, lichen planus, and other systemic diseases associated with significant pain. Adequate management of chronic pain can represent a unique challenge, but remains an integral component of clinical treatment in relevant contexts. For nociceptive pain of moderate to severe intensity, opioid analgesics can be beneficial when other pain management strategies have failed to produce adequate relief. The decision to initiate long-term opioid therapy must be carefully weighed, and individualized treatment plans are often necessary to effectively treat pain while minimizing adverse effects. Part II of this 2-part continuing medical education article will describe the appropriate settings for initiation of opioid analgesia for dermatology patients and detail therapeutic strategies and patient monitoring guidelines. PMID:26369841

  8. The nature and consequence of Karl Marx's skin disease.

    PubMed

    Shuster, S

    2008-01-01

    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. PMID:17986303

  9. Difficult wounds: an update.

    PubMed

    Edlich, Richard F; Winters, Kathryne L; Britt, L D; Long, William B; Gubler, K Dean; Drake, David B

    2005-01-01

    intraseptal connective tissue grafts. More recently, surgeons have repaired large septal perforations with a radial forearm free flap. Because of its availability and deep emotional significance, the skin is a common site for self-destructive behavior with the development of factitious skin wounds. When suspected, psychiatric care must proceed immediately. Second, the ulcer can then be healed by appropriate techniques and wound repair. It is important to emphasize that the treating physician must first confront the patient, and then a psychiatrist should provide appropriate psychotherapy. Hidradenitis suppurativa is an inflammatory disease of the skin and subcutaneous tissue that occurs in apocrine-gland-bearing areas distributed in the axilla, mammary nipple areola, mons pubis, groin, scrotum, perineum, perianal region, and umbilicus. The condition has an insidious onset. The susceptibility of women's axillary skin to hidradenitis suppurativa may be related, in part, to the practice of axillary removal of hair with a safety razor. Consequently, the use of safety razors must be avoided and replaced with the use of an electric razor. The method of treatment will vary with the stage of the disease. Treatment of the chronic stage of axillary hidradenitis suppurativa is primarily surgical. More recently, carbon dioxide laser treatment, with healing by secondary intention, is proving to be a rapid, efficient, and economic treatment of this difficult wound. PMID:16022640

  10. Treating Meningitis

    MedlinePlus

    ... ways to treat bacterial meningitis. 1 They compared steroids (dexamethasone) with pla- cebo. The doctors gave medication ( ... compared anti- biotics by themselves with antibiotics plus steroids. Dr. Fritz and colleagues compared the mortality (deaths) ...

  11. Treating Sludges

    ERIC Educational Resources Information Center

    Josephson, Julian

    1978-01-01

    Discussed are some of the ways to handle municipal and industrial wastewater treatment sludge presented at the 1978 American Chemical Society meeting. Suggestions include removing toxic materials, recovering metals, and disposing treated sewage sludge onto farm land. Arguments for and against land use are also given. (MA)

  12. New described dermatological disorders.

    PubMed

    Gönül, Müzeyyen; Cevirgen Cemil, Bengu; Keseroglu, Havva Ozge; Kaya Akis, Havva

    2014-01-01

    Many advances in dermatology have been made in recent years. In the present review article, newly described disorders from the last six years are presented in detail. We divided these reports into different sections, including syndromes, autoinflammatory diseases, tumors, and unclassified disease. Syndromes included are "circumferential skin creases Kunze type" and "unusual type of pachyonychia congenita or a new syndrome"; autoinflammatory diseases include "chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome," "pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome," and "pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) syndrome"; tumors include "acquired reactive digital fibroma," "onychocytic matricoma and onychocytic carcinoma," "infundibulocystic nail bed squamous cell carcinoma," and "acral histiocytic nodules"; unclassified disorders include "saurian papulosis," "symmetrical acrokeratoderma," "confetti-like macular atrophy," and "skin spicules," "erythema papulosa semicircularis recidivans." PMID:25243162

  13. Malignant proliferating pilar tumors arising in KID syndrome: a report of two patients.

    PubMed

    Nyquist, Gurston G; Mumm, Christina; Grau, Renee; Crowson, A Neil; Shurman, Daniel L; Benedetto, Paul; Allen, Pamela; Lovelace, Kelli; Smith, David W; Frieden, Ilona; Hybarger, C Patrick; Richard, Gabriele

    2007-04-01

    We report on two young adults with KID syndrome and follicular hyperkeratosis, hidradenitis suppurativa of the groin, progressive development of proliferative pilar cysts and dissecting cellulitis of the scalp, who developed metastatic malignant pilar tumors. Based on our findings, we believe that cancer surveillance in patients with KID syndrome should include screening for pilar tumors and their early removal to avoid development of malignant proliferating pilar tumors with poor prognosis. PMID:17330861

  14. Follicular occlusion tetrad.

    PubMed

    Vasanth, Vani; Chandrashekar, Byalakere Shivanna

    2014-10-01

    Follicular occlusion tetrad is a symptom complex consisting of four conditions having a similar pathophysiology. It includes Hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus. The exact pathogenesis of this group of disease is unknown but evidence suggests that they share the same pathological process initiated by follicular occlusion in apocrine gland bearing areas. Though each of these conditions is commonly encountered singly, follicular occlusion tetrad as a symptom complex has been rarely reported in the literature. PMID:25396138

  15. Follicular occlusion tetrad

    PubMed Central

    Vasanth, Vani; Chandrashekar, Byalakere Shivanna

    2014-01-01

    Follicular occlusion tetrad is a symptom complex consisting of four conditions having a similar pathophysiology. It includes Hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus. The exact pathogenesis of this group of disease is unknown but evidence suggests that they share the same pathological process initiated by follicular occlusion in apocrine gland bearing areas. Though each of these conditions is commonly encountered singly, follicular occlusion tetrad as a symptom complex has been rarely reported in the literature. PMID:25396138

  16. Update on TNF Inhibitors in Dermatology.

    PubMed

    Sobell, Jeffrey M

    2016-06-01

    Emerging data describe new potential indications for tumor necrosis factor (TNF) inhibitors in dermatology, including pediatric psoriasis and hidradenitis suppurativa. New biosimilar TNF agents are in late stages of development and may be available in the United States in the near future. Biosimilar agents are similar but not identical to available TNF inhibitors, and approval requires extensive analytic, toxicity, pharmacokinetic, pharmacodynamic, and clinical testing. Semin Cutan Med Surg 35(supp6):S104-S106. PMID:27537073

  17. Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immune-mediated diseases: an analytical and comprehensive overview.

    PubMed

    Toussirot, Éric; Aubin, François

    2016-01-01

    Paradoxical adverse events (PAEs) have been reported during biological treatment for chronic immune-mediated diseases. PAEs are defined as the occurrence during biological agent therapy of a pathological condition that usually responds to this class of drug. A wide range of PAEs have been reported including dermatological, intestinal and ophthalmic conditions, mainly with antitumour necrosis factor α (TNF-α) agents. True PAEs include psoriasis, Crohn's disease and hidradenitis suppurativa. Other PAEs may be qualified as borderline and include uveitis, scleritis, sarcoidosis and other granulomatous diseases (granuloma annulare, interstitial granulomatous dermatitis), vasculitis, vitiligo and alopecia areata. Proposed hypotheses to explain these PAEs include an imbalance in cytokine production, the differential immunological properties between the monoclonal antibodies and TNF-α soluble receptor, an unopposed type I interferon production and a shift towards a Th1/Th2 profile. Data from registries suggest that the risk for paradoxical psoriasis is low and non-significant. We discuss management of these PAEs, which depends on the type and severity of the adverse events, pre-existing treated conditions and the possibility of alternative therapeutic options for the underlying disease. Paradoxical adverse events are not restricted to anti-TNF-α agents and close surveillance of new available biological drugs (anti-interleukin-17/23, anti-integrin) is warranted in order to detect the occurrence of new or as yet undescribed events. PMID:27493788

  18. Paradoxical reactions under TNF-α blocking agents and other biological agents given for chronic immune-mediated diseases: an analytical and comprehensive overview

    PubMed Central

    Toussirot, Éric; Aubin, François

    2016-01-01

    Paradoxical adverse events (PAEs) have been reported during biological treatment for chronic immune-mediated diseases. PAEs are defined as the occurrence during biological agent therapy of a pathological condition that usually responds to this class of drug. A wide range of PAEs have been reported including dermatological, intestinal and ophthalmic conditions, mainly with antitumour necrosis factor α (TNF-α) agents. True PAEs include psoriasis, Crohn's disease and hidradenitis suppurativa. Other PAEs may be qualified as borderline and include uveitis, scleritis, sarcoidosis and other granulomatous diseases (granuloma annulare, interstitial granulomatous dermatitis), vasculitis, vitiligo and alopecia areata. Proposed hypotheses to explain these PAEs include an imbalance in cytokine production, the differential immunological properties between the monoclonal antibodies and TNF-α soluble receptor, an unopposed type I interferon production and a shift towards a Th1/Th2 profile. Data from registries suggest that the risk for paradoxical psoriasis is low and non-significant. We discuss management of these PAEs, which depends on the type and severity of the adverse events, pre-existing treated conditions and the possibility of alternative therapeutic options for the underlying disease. Paradoxical adverse events are not restricted to anti-TNF-α agents and close surveillance of new available biological drugs (anti-interleukin-17/23, anti-integrin) is warranted in order to detect the occurrence of new or as yet undescribed events. PMID:27493788

  19. Off-label use of TNF-alpha inhibitors in a dermatological university department: retrospective evaluation of 118 patients.

    PubMed

    Sand, Freja Lærke; Thomsen, Simon Francis

    2015-01-01

    Tumor necrosis factor-alpha (TNF)-alpha inhibitors are licensed for patients with severe refractory psoriasis and psoriatic arthritis. However, TNF-alpha inhibitors have also been used off-label for various recalcitrant mucocutaneous diseases. This study aimed to evaluate the efficacy and safety of TNF-alpha inhibitors used for off-label dermatological indications. We retrospectively evaluated patient records of 118 patients treated off-label with TNF-alpha inhibitors in a dermatological university department. Patients presented with severe aphthous stomatitis/genital aphthous lesions (26), chronic urticaria (25), hidradenitis suppurativa (29), acne conglobata (11), dissecting cellulitis of the scalp (two), orofacial granulomatosis (four), sarcoidosis (four), granuloma annulare (two), granulomatous rosacea (one), granuloma faciale (one), subcorneal pustulosis (one), pyoderma gangrenosum (four), Sweet's syndrome (four), Well's syndrome (one), benign familial pemphigus (one), lichen planus (one), and folliculitis decalvans (one). A significant number of these patients went into remission during therapy with TNF-alpha inhibitors. A total of 11 patients (9%) experienced severe adverse effects during therapy. Off-label therapy with TNF-alpha inhibitors may be considered for selected patients with severe recalcitrant mucocutaneous diseases. The risk of severe adverse effects signals that a thorough benefit-risk assessment should be performed before initiating off-label treatment with TNF-alpha inhibitors for these conditions. PMID:25731720

  20. How Is Pneumonia Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Pneumonia Treated? Treatment for pneumonia depends on the type ... can go back to their normal routines. Bacterial Pneumonia Bacterial pneumonia is treated with medicines called antibiotics. ...

  1. Treating Influenza (Flu)

    MedlinePlus

    ... can be used to treat influenza illness. Antiviral drugs fight influenza viruses in your body. They are different from ... chills and fatigue. Your doctor may prescribe antiviral drugs to treat your flu illness. Should Istill get aflu vaccine? Yes. Antiviral ...

  2. Treating Children and Adolescents

    MedlinePlus

    ... Children and Adolescents Go Back Treating Children and Adolescents Email Print + Share For the most part, the ... tailored, based upon the child's weight. Children and adolescents are moving through a period of physical and ...

  3. How Is Hemophilia Treated?

    MedlinePlus

    ... Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical ... Treating donated blood products with a detergent and heat to destroy viruses Vaccinating people who have hemophilia ...

  4. How Is Sarcoidosis Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Sarcoidosis Treated? Not everyone who has sarcoidosis needs treatment. ... Content: NEXT >> Featured Video Living With and Managing Sarcoidosis 05/18/2011 This video—presented by the ...

  5. How Is Atherosclerosis Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Atherosclerosis Treated? Treatments for atherosclerosis may include heart-healthy ... Rate This Content: NEXT >> Featured Video What is atherosclerosis? 05/22/2014 Describes how the build-up ...

  6. How Are Arrhythmias Treated?

    MedlinePlus

    ... Some arrhythmias are treated with a jolt of electricity to the heart. This type of treatment is ... senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal ...

  7. How Is Thrombocytopenia Treated?

    MedlinePlus

    ... as an injection under the skin. Blood or Platelet Transfusions Blood or platelet transfusions are used to treat people who have ... Through this line, you receive healthy blood or platelets. For more information about this procedure, go to ...

  8. How Is Vaginitis Treated?

    MedlinePlus

    ... sex or use a condom during sex. 1 Yeast Infections Yeast infections are usually treated with a topical cream ... care provider can write a prescription for most yeast infection treatments. Although yeast infection treatments can be ...

  9. Electrolyte Concentrates Treat Dehydration

    NASA Technical Reports Server (NTRS)

    2009-01-01

    Wellness Brands Inc. of Boulder, Colorado, exclusively licensed a unique electrolyte concentrate formula developed by Ames Research Center to treat and prevent dehydration in astronauts returning to Earth. Marketed as The Right Stuff, the company's NASA-derived formula is an ideal measure for athletes looking to combat dehydration and boost performance. Wellness Brands also plans to expand with products that make use of the formula's effective hydration properties to help treat conditions including heat stroke, altitude sickness, jet lag, and disease.

  10. Process for treating biomass

    DOEpatents

    Campbell, Timothy J.; Teymouri, Farzaneh

    2015-08-11

    This invention is directed to a process for treating biomass. The biomass is treated with a biomass swelling agent within the vessel to swell or rupture at least a portion of the biomass. A portion of the swelling agent is removed from a first end of the vessel following the treatment. Then steam is introduced into a second end of the vessel different from the first end to further remove swelling agent from the vessel in such a manner that the swelling agent exits the vessel at a relatively low water content.

  11. Process for treating biomass

    SciTech Connect

    Campbell, Timothy J; Teymouri, Farzaneh

    2015-11-04

    This invention is directed to a process for treating biomass. The biomass is treated with a biomass swelling agent within the vessel to swell or rupture at least a portion of the biomass. A portion of the swelling agent is removed from a first end of the vessel following the treatment. Then steam is introduced into a second end of the vessel different from the first end to further remove swelling agent from the vessel in such a manner that the swelling agent exits the vessel at a relatively low water content.

  12. Biologic Therapy in Inflammatory and Immunomediated Skin Diseases: Safety Profile.

    PubMed

    Ganzetti, Giulia; Campanati, Anna; Molinelli, E; Offidani, A

    2016-01-01

    Biologic treatments have modified the therapeutic armamentarium in the treatment of many dermatological and non- dermatological diseases and data on literature have widely focused on the efficacy and safety of TNF-alpha inhibitors in psoriasis. Although the etiopathogenesis has not completely elucidated, inflammation appears the lait motif unifying the immune-pathogenesis of diverse skin disease, as atopic dermatitis, alopecia areata and hidradenitis suppurativa. Actually, data on the off-label use of biologics in cutaneous immune-mediated inflammatory diseases are scarce and restricted to anecdotal cases and case series. The present review aims to evidence the major off- label use of TNF-alpha inhibitors in dermatology. PMID:26463243

  13. Noninfectious genital ulcers.

    PubMed

    Kirshen, Carly; Edwards, Libby

    2015-12-01

    Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin, oral mucosa, nails, hair, vulva, and vaginal mucosa if needed. The differential diagnosis of noninfectious genital ulcers includes: lipschütz ulcers, complex aphthosis, Behçet's syndrome, vulvar metastatic Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum, pressure ulcers, and malignancies. It is important to come to the correct diagnosis to avoid undue testing, stress, and anxiety in patients experiencing genital ulcerations. PMID:26650697

  14. [New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases].

    PubMed

    Godoy-Gijón, Elena; Meseguer-Yebra, Carmen; Palacio-Aller, Lucía; Godoy-Rocati, Diego Vicente; Lahoz-Rallo, Carlos

    2016-01-01

    The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients. PMID:26383179

  15. [Dermatologic aspects of SAPHO-syndrome].

    PubMed

    Károlyi, Z; Harhai, I; Erós, N

    2001-08-19

    SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, osteitis) as a new disease entity was first described in 1987. The syndrome is characterized by the presence of pustular dermatoses together with aseptic osteoarticular lesions. The bone involvement includes hyperostosis, aseptic osteomyelitis or arthritis of the anterior chest wall, sacroiliac joints or long bones. Skin diseases include acne conglobata or acne fulminans, palmoplantar pustulosis and hidradenitis suppurativa. Authors describe the dermatological relationship of SAPHO syndrome reporting their 7 cases (3 acne fulminans, 4 palmoplantar pustulosis). Authors draw attention to the isotretinoin therapy as a possible provoking factor of the articular symptoms, and they emphasize the diagnostic role of bone scintigraphy. PMID:11573450

  16. Apparatus for treating garbage

    SciTech Connect

    Chen, C.L.; Chen, K.; Hsien, K.

    1994-01-11

    An apparatus for treating garbage is described. The apparatus has a conveyor, a continuous incinerator receiving garbage from the conveyor, a device for cooling ash carried out of the continuous incinerator, a device for filtering the ash, a pipe for inducing exhaust from the continuous incinerator to a water tank for removing particles and water-soluble components from the exhaust. 1 fig.

  17. Treating the Juvenile Offender

    ERIC Educational Resources Information Center

    Hoge, Robert D., Ed.; Guerra, Nancy G., Ed.; Boxer, Paul, Ed.

    2008-01-01

    This authoritative, highly readable reference and text is grounded in the latest knowledge on how antisocial and criminal behavior develops in youth and how it can effectively be treated. Contributors describe proven ways to reduce juvenile delinquency by targeting specific risk factors and strengthening young people's personal, family, and…

  18. How Is Pernicious Anemia Treated?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Pernicious Anemia Treated? Doctors treat pernicious anemia by replacing the missing vitamin B12 in the body. People who have pernicious anemia may need lifelong treatment. The goals of treating ...

  19. Preventing and Treating Blood Clots

    MedlinePlus

    ... and Treating Blood Clots Request Permissions Download PDF Preventing and Treating Blood Clots January 20, 2015 To ... 2013, ASCO updated the clinical practice guideline about preventing and treating blood clots for people with cancer ...

  20. Treating the bisexual client.

    PubMed

    Dworkin, S H

    2001-05-01

    Therapists, having recently come to terms with treating gay and lesbian clients, now must consider the issues that bisexual clients face. This article reviews the literature on what it means to identify as bisexual in a world where sexual identity is viewed as dichotomous, heterosexual at one end and gay or lesbian at the other end. The article explores sexual identity and its biological versus social origins, internalized biphobia, coming out, relationship patterns, and therapist issues. Two cases illustrate issues that might arise when a therapist is treating a bisexual client. The first case is a 17-year-old young woman who is accepting of her bisexual identity, and the second case is a 56-year-old woman, heterosexually identified and married, who suddenly fell in love with a woman. Concluding remarks focus on some future directions for research and work with bisexual clients. PMID:11304706

  1. Method of treating depression

    DOEpatents

    Henn, Fritz

    2013-04-09

    Methods for treatment of depression-related mood disorders in mammals, particularly humans are disclosed. The methods of the invention include administration of compounds capable of enhancing glutamate transporter activity in the brain of mammals suffering from depression. ATP-sensitive K.sup.+ channel openers and .beta.-lactam antibiotics are used to enhance glutamate transport and to treat depression-related mood disorders and depressive symptoms.

  2. Method of treating depression

    DOEpatents

    Henn, Fritz

    2012-01-24

    Methods for treatment of depression-related mood disorders in mammals, particularly humans are disclosed. The methods of the invention include administration of compounds capable of enhancing glutamate transporter activity in the brain of mammals suffering from depression. ATP-sensitive K.sup.+ channel openers and .beta.-lactam antibiotics are used to enhance glutamate transport and to treat depression-related mood disorders and depressive symptoms.

  3. Fluidized bed heat treating system

    SciTech Connect

    Ripley, Edward B; Pfennigwerth, Glenn L

    2014-05-06

    Systems for heat treating materials are presented. The systems typically involve a fluidized bed that contains granulated heat treating material. In some embodiments a fluid, such as an inert gas, is flowed through the granulated heat treating medium, which homogenizes the temperature of the heat treating medium. In some embodiments the fluid may be heated in a heating vessel and flowed into the process chamber where the fluid is then flowed through the granulated heat treating medium. In some embodiments the heat treating material may be liquid or granulated heat treating material and the heat treating material may be circulated through a heating vessel into a process chamber where the heat treating material contacts the material to be heat treated. Microwave energy may be used to provide the source of heat for heat treating systems.

  4. Hydrocarbon treating process

    SciTech Connect

    Verachtert, T. A.

    1984-11-06

    A process is disclosed for treating hydrocarbon streams such as naphtha by the oxidation of mercaptans into disulfide compounds which remain in the hydrocarbon stream. The conversion is effected during passage of the hydrocarbon and an aqueous stream downward through a cylindrical mass of liquid-liquid contact material. The liquids then flow through a cylindrical screen into an annular separation zone which surrounds a lower part of the contact material. After decantation in the separation zone, the aqueous material, which preferably contains the oxidation catalyst, is recycled.

  5. Immunotherapy to Treat Cancer.

    PubMed

    McCune, J S

    2016-09-01

    This issue of Clinical Pharmacology & Therapeutics focuses on immunotherapy as an approach to treat cancer by generating or augmenting an immune response against it. The enthusiasm for immunotherapy has waxed and waned over the past century. Enthusiasm for immunotherapy has risen over the past decade due, in part, to data showing that cancer immunotherapy consistently improves overall survival in select patients with advanced-stage cancer. Antitumor immunotherapy has broad potential and could be used to treat many different types of advanced-stage cancer due to the durable and robust response that it elicits across a diverse spectrum of cancers. This issue covers various aspects of relevant therapeutic topics ranging from discovery of chimeric antigen receptor (CAR) T cells, development of novel immunotherapies using novel pharmacokinetic/dynamic modeling tools, to the utilization of immune checkpoint therapy. Regarding utilization, this issue addresses biomarker selection strategies for personalized treatment of non-small cell lung cancer (NSCLC) with immune checkpoint therapy and also the management of the unique immune response adverse events (irAEs). PMID:27513619

  6. Method of treating tumors

    DOEpatents

    DeNardo, Sally J.; Burke, Patricia A.; DeNardo, Gerald L.; Goodman, Simon; Matzku, legal representative, Kerstin; Matzku, Siegfried

    2006-04-18

    A method of treating tumors, such as prostate tumors, breast tumors, non-Hodgkin's lymphoma, and the like, includes the sequential steps of administering to the patient at least one dose of an antiangiogenic cyclo-arginine-glycine-aspartic acid-containing pentapeptide (cRGD pentapeptide); administering to the patient an anti-tumor effective amount of a radioimmunotherapeutic agent (RIT); and then administering to the patient at least one additional dose of cRGD pentapeptide. The cRGD pentapeptide is preferably cyclo-(Arg-Gly-Asp-D-Phe-[N-Me]-Val), and the RIT is preferably a radionuclide-labeled chelating agent-ligand complex in which chelating agent is chemically bonded to a tumor-targeting molecule, such as a monoclonal antibody.

  7. Heat Treating Apparatus

    DOEpatents

    De Saro, Robert; Bateman, Willis

    2002-09-10

    Apparatus for heat treating a heat treatable material including a housing having an upper opening for receiving a heat treatable material at a first temperature, a lower opening, and a chamber therebetween for heating the heat treatable material to a second temperature higher than the first temperature as the heat treatable material moves through the chamber from the upper to the lower opening. A gas supply assembly is operatively engaged to the housing at the lower opening, and includes a source of gas, a gas delivery assembly for delivering the gas through a plurality of pathways into the housing in countercurrent flow to movement of the heat treatable material, whereby the heat treatable material passes through the lower opening at the second temperature, and a control assembly for controlling conditions within the chamber to enable the heat treatable material to reach the second temperature and pass through the lower opening at the second temperature as a heated material.

  8. Treating the Aging Spine.

    PubMed

    Choma, Theodore J; Rechtine, Glenn; McGuire, Robert A; Brodke, Darrel S

    2016-01-01

    Demographic trends make it incumbent on orthopaedic spine surgeons to recognize the special challenges involved in caring for older patients with spine pathology. Unique pathologies, such as osteoporosis and degenerative deformities, must be recognized and treated. Recent treatment options and recommendations for the medical optimization of bone health include vitamin D and calcium supplementation, diphosphonates, and teriparatide. Optimizing spinal fixation in elderly patients who have osteoporosis is critical; cement augmentation of pedicle screws is promising. In the management of geriatric odontoid fractures, nonsurgical support with a collar may be considered for low-demand patients, whereas surgical fixation is favored for high-demand patients. Management of degenerative deformity must address sagittal plane balance, which includes consideration of pelvic incidence. Various osteotomies may prove helpful in this setting. PMID:27049195

  9. Does Marijuana Help Treat Glaucoma?

    MedlinePlus

    ... Ophthalmologist Patient Stories Español Eye Health / Tips & Prevention Marijuana Sections Does Marijuana Help Treat Glaucoma? Why Eye ... Don't Recommend Marijuana for Glaucoma Infographic Does Marijuana Help Treat Glaucoma? Written by: David Turbert , contributing ...

  10. How Is an Aneurysm Treated?

    MedlinePlus

    ... NHLBI on Twitter. How Is an Aneurysm Treated? Aortic aneurysms are treated with medicines and surgery. Small aneurysms ... doing your normal daily activities Treatment for an aortic aneurysm is based on its size. Your doctor may ...

  11. New Described Dermatological Disorders

    PubMed Central

    Cevirgen Cemil, Bengu; Keseroglu, Havva Ozge; Kaya Akis, Havva

    2014-01-01

    Many advances in dermatology have been made in recent years. In the present review article, newly described disorders from the last six years are presented in detail. We divided these reports into different sections, including syndromes, autoinflammatory diseases, tumors, and unclassified disease. Syndromes included are “circumferential skin creases Kunze type” and “unusual type of pachyonychia congenita or a new syndrome”; autoinflammatory diseases include “chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature (CANDLE) syndrome,” “pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome,” and “pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) syndrome”; tumors include “acquired reactive digital fibroma,” “onychocytic matricoma and onychocytic carcinoma,” “infundibulocystic nail bed squamous cell carcinoma,” and “acral histiocytic nodules”; unclassified disorders include “saurian papulosis,” “symmetrical acrokeratoderma,” “confetti-like macular atrophy,” and “skin spicules,” “erythema papulosa semicircularis recidivans.” PMID:25243162

  12. How Is Fanconi Anemia Treated?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Fanconi Anemia Treated? Doctors decide how to treat Fanconi anemia (FA) based on a person's age and how ... Long-term treatments for FA can: Cure the anemia. Damaged bone marrow cells are replaced with healthy ...

  13. Heat treating of manufactured components

    DOEpatents

    Ripley, Edward B.

    2012-05-22

    An apparatus for heat treating manufactured components using microwave energy and microwave susceptor material is disclosed. The system typically includes an insulating vessel placed within a microwave applicator chamber. A moderating material is positioned inside the insulating vessel so that a substantial portion of the exterior surface of each component for heat treating is in contact with the moderating material.

  14. Diverticular disease treated with corticotrophin

    PubMed Central

    Steer, Charles

    1985-01-01

    Since 1968 the inflammatory stage of diverticular disease (acute and chronic diverticulitis) has been treated with tetracosactrin in one practice. This paper reviews 100 episodes treated in this way and compares these with 50 episodes treated with rest in bed and dietary measures. Abatement of pyrexia, swelling and tenderness, as well as relief of the symptoms of pain and malaise, were usually found to occur within 24 hours of the administration of tetracosactrin zinc (1 mg) intramuscularly. No complications directly attributable to this therapy have been observed, while the duration of the clinical illness has been reduced by more than half. In neither group were antibiotics found to influence the outcome. PMID:3001302

  15. How Is Pulmonary Embolism Treated?

    MedlinePlus

    ... Coumadin ® is a common brand name for warfarin.) Heparin is given as an injection or through an ... tube. Your doctor may treat you with both heparin and warfarin at the same time. Heparin acts ...

  16. How Is Hypersensitivity Pneumonitis Treated?

    MedlinePlus

    ... treat severe chronic disease in some patients. Avoidance strategies If your doctor is able to identify the ... will recommend that you adopt the following avoidance strategies. Remove the causative substance if possible Replace workplace ...

  17. How Is Respiratory Failure Treated?

    MedlinePlus

    ... Once your doctor figures out what's causing your respiratory failure, he or she will plan how to treat that disease or condition. Treatments may include medicines, procedures, and other therapies. Rate This Content: NEXT >> Updated: December 19, 2011 Twitter ...

  18. How Is Cardiogenic Shock Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Cardiogenic Shock Treated? Cardiogenic shock is life threatening and requires emergency medical treatment. ... arrive. The first goal of emergency treatment for cardiogenic shock is to improve the flow of blood and ...

  19. Treating P.A.D.

    MedlinePlus

    ... Issue Past Issues Special Section Treating P.A.D. Past Issues / Summer 2008 Table of Contents For ... Illustration courtesy of NHLBI Treatment for P.A.D. is designed to reduce a patient's symptoms, prevent ...

  20. Treating P.A.D.

    MedlinePlus

    ... Home Current Issue Past Issues Special Section Treating P.A.D. Past Issues / Summer 2008 Table of ... is diminished. Illustration courtesy of NHLBI Treatment for P.A.D. is designed to reduce a patient's ...

  1. COMBUSTION OF HYDROTHERMALLY TREATED COALS

    EPA Science Inventory

    The report gives results of an evaluation of: (1) the relationship of the combustion characteristics of hydrothermally treated (HTT) coals to environmental emissions, boiler design, and interchangeability of solid fuels produced by the Hydrothermal Coal Process (HCP) with raw coa...

  2. How Is Immune Thrombocytopenia Treated?

    MedlinePlus

    ... Blood Transfusion Bone Marrow Tests Thrombocytopenia Thrombotic Thrombocytopenic Purpura Send a link to NHLBI to someone by ... who have bleeding symptoms, other than merely bruising (purpura), usually are treated. Children who have mild ITP ...

  3. How to Treat Gestational Diabetes

    MedlinePlus

    ... A Listen En Español How to Treat Gestational Diabetes Be sure to see the latest Diabetes Forecast ... and a healthy start for your baby. Gestational Diabetes – Looking Ahead Gestational diabetes usually goes away after ...

  4. System of treating flue gas

    DOEpatents

    Ziegler, D.L.

    1975-12-01

    A system is described for treating or cleaning incinerator flue gas containing acid gases and radioactive and fissionable contaminants. Flue gas and a quench solution are fed into a venturi and then tangentially into the lower portion of a receptacle for restricting volumetric content of the solution. The upper portion of the receptacle contains a scrub bed to further treat or clean the flue gas.

  5. Intramural myomas: to treat or not to treat

    PubMed Central

    Thompson, Mayra J; Carr, Bruce R

    2016-01-01

    A debate among gynecologic and reproductive surgeons is whether or not there is a clinical need to treat all intramural myomas. Considerations include myoma size and number, ability to access them, whether or not they compromise the endometrium, and treatment effect on gynecologic, reproductive, and obstetric outcomes. We conducted a detailed study regarding intramural myomas, their prevalence in subject populations, the imaging methods used to detect them, their growth rate, their suspected adverse effects on gynecologic, fertility, and obstetric outcomes, and the effectiveness of various treatment methods. The growing body of evidence reported in the literature supports the need to manage intramural myomas and to treat them appropriately. PMID:27274313

  6. Oral isotretinoin. How can we treat difficult acne patients?

    PubMed

    Leyden, J J

    1997-01-01

    Isotretinoin (Roaccutane/Accutane) therapy (120 mg/kg) normally results in complete clearing of nodulocystic acne followed by prolonged remission, and many patients remain free of disease. Four groups of patients respond poorly or have a high rate of relapse. Preteens and young teenagers show a high rate of relapse and several courses of treatment are usually needed; 14 of 20 under the age of 12 years, 21 of 47 aged 12-14 and 23 of 66 aged 14-16 relapsed within 1 year. Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy. PMID:9310743

  7. The heat treating source book

    SciTech Connect

    Gupton, P.S.

    1986-01-01

    The first section of this book reviews current trends and is followed by an article describing how to design for lower cost and high-quality heat treatment. Two separate sections deal with ferrous materials and non-ferrous metals. Coverage includes stress-relief heat treating, normalizing and cold treating of steel; ultrahigh-strength steels; tool steels; maraging steels; austenitic stainless steels and cast irons, as well as aluminum alloys, titanium and its alloys, nickel-base superalloys, special purpose alloys and lead and its alloys. Other topics discussed are carburizing, carbonitriding and nitriding; vacuum methods; salt bath processing; methods of measuring case depth; and atmosphere control and nitrogen as all-purpose atmosphere. Also, information is provided on energy-efficient operations, production systems, selecting and handling quenching fluids, furnace control instrumentation, and guidelines for heat treating powdered metal parts.

  8. How Is Metabolic Syndrome Treated?

    MedlinePlus

    ... by controlling all of your risk factors. Heart-Healthy Lifestyle Changes Heart-healthy lifestyle changes include heart-healthy eating , aiming for a ... you to. You should still follow a heart-healthy lifestyle, even if you take medicines to treat your ...

  9. Current Concepts of Treating Vaginitis

    PubMed Central

    Robinson, Theresa

    1977-01-01

    Vaginitis can be a frustrating entity to treat, since the incidence of recurrence is high. This paper examines evidence from the literature concerning diagnosis and treatment of Candida albicans, Trichomonas vaginalis, Corynebacterium vaginale, herpes simplex type 2 and gonorrhea. A protocol based on these readings is outlined. PMID:21304797

  10. Method for treating waste water

    SciTech Connect

    Masaki, Y.; Odawara, Y.; Shimizu, N.

    1982-10-26

    The invention relates to an improvement of the floc-formation property of activated sludge contained in waste water. A waste water treatment process comprises steps culturing a novel strain-alcaligenes faecalis hrl-1-and adding the cultured cells to to-be-treated waste water.

  11. Medicines Used to Treat COPD

    MedlinePlus

    ... SERIES #3 The most common medications for treating chronic obstructive pulmonary disease (COPD) are bronchodilators and steroids. Both make breathing ... http://patients.thoracic.org/information-series/en/resources/ chronic-obstructive-pulmonary-disease-copd.pdf Canadian Lung Association http://www.sk. ...

  12. How Is Atrial Fibrillation Treated?

    MedlinePlus

    ... to form. If the clot breaks off and travels to the brain, it can cause a stroke. Preventing blood clots from forming is probably the most important part of treating AF. The benefits of this type of treatment have been proven ...

  13. Oral leukoplakia-to treat or not to treat.

    PubMed

    Holmstrup, P; Dabelsteen, E

    2016-09-01

    Various treatment modalities have been described for reducing or eliminating malignant development of oral leukoplakia, but no treatment has gained universal approval due to lack of randomized clinical studies. At present, it is uncertain whether we can do harm to the patients by treating or by not treating them. An essential aspect is the observation of cancer development even after surgical removal of the clinical lesions. Inadequate resection of the lesions or field cancerization may account for this phenomenon. Another challenge is whether surgical removal of the lesions in fact is associated with a cancer promotional effect resulting in increased risk of cancer. Moreover, unidentified existing cancer in non-suspicious oral leukoplakias may for diagnostic purposes imply that surgical removal is recommendable as well as serial section of all excised tissue. Intensive follow-up programmes for leukoplakias are important, independent of surgical intervention. PMID:26785709

  14. Common cold - how to treat at home

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000466.htm Common cold - how to treat at home To use the ... green snot, and sneezing Sore throat Treating your Cold Treating your symptoms will not make your cold ...

  15. Heat treat fixture and method of heat treating

    NASA Technical Reports Server (NTRS)

    Beuyukian, C. S.; Heisman, R. M.; Haynie, C. C.; Ruppe, E. P. (Inventor)

    1980-01-01

    A heat treating fixture is disclosed in which the shape of the metal specimen is maintained by cold rolled steel support plates. Glide sheets of stainless steel, coated with boron nitride, in contact with each face of the metal specimens, allow for lateral expansion of the metal specimens without binding. Grooved support bars separate the glide sheets from the upper and lower support plates and allow flow of quenching fluid to the metal specimen.

  16. [Algorithm for treating preoperative anemia].

    PubMed

    Bisbe Vives, E; Basora Macaya, M

    2015-06-01

    Hemoglobin optimization and treatment of preoperative anemia in surgery with a moderate to high risk of surgical bleeding reduces the rate of transfusions and improves hemoglobin levels at discharge and can also improve postoperative outcomes. To this end, we need to schedule preoperative visits sufficiently in advance to treat the anemia. The treatment algorithm we propose comes with a simple checklist to determine whether we should refer the patient to a specialist or if we can treat the patient during the same visit. With the blood count test and additional tests for iron metabolism, inflammation parameter and glomerular filtration rate, we can decide whether to start the treatment with intravenous iron alone or erythropoietin with or without iron. With significant anemia, a visit after 15 days might be necessary to observe the response and supplement the treatment if required. The hemoglobin objective will depend on the type of surgery and the patient's characteristics. PMID:26320341

  17. Method for treating liquid wastes

    SciTech Connect

    Katti, Kattesh V.; Volkert, Wynn A.; Singh, Prahlad; Ketring, Alan R.

    1995-01-01

    The method of treating liquid waste in a media is accomplished by exposing the media to phosphinimines and sequestering .sup.99 Tc from the media by the phosphinimine (PN) functionalities. The system for treating the liquid waste in the media includes extraction of .sup.99 TcO.sub.4.sup.- from aqueous solutions into organic solvents or mixed organic/polar media, extraction of .sup.99 Tc from solutions on a solid matrix by using a container containing PN functionalities on solid matrices including an inlet and outlet for allowing flow of media through an immobilized phosphinimine ligand system contained within the container. Also, insoluble suspensions of phosphinimine functionalities on solid matrices in liquid solutions or present on supported liquid membranes (SLM) can be used to sequester .sup.99 Tc from those liquids.

  18. Method for treating liquid wastes

    SciTech Connect

    Katti, K.V.; Volkert, W.A.; Singh, P.; Ketring, A.R.

    1995-12-26

    The method of treating liquid waste in a media is accomplished by exposing the media to phosphinimines and sequestering {sup 99}Tc from the media by the phosphinimine (PN) functionalities. The system for treating the liquid waste in the media includes extraction of {sup 99}TcO{sub 4}{sup {minus}} from aqueous solutions into organic solvents or mixed organic/polar media, extraction of {sup 99}Tc from solutions on a solid matrix by using a container containing PN functionalities on solid matrices including an inlet and outlet for allowing flow of media through an immobilized phosphinimine ligand system contained within the container. Also, insoluble suspensions of phosphinimine functionalities on solid matrices in liquid solutions or present on supported liquid membranes (SLM) can be used to sequester {sup 99}Tc from those liquids. 6 figs.

  19. Partial Priapism Treated with Pentoxifylline

    PubMed Central

    Cooper, Meghan A.; Carrion, Rafael E.; Yang, Christopher

    2015-01-01

    ABSTRACT Main findings: A 26-year-old man suffering from partial priapism was successfully treated with a regimen including pentoxifylline, a nonspecific phosphodiesterase inhibitor that is often used to conservatively treat Peyronie's disease. Case hypothesis: Partial priapism is an extremely rare urological condition that is characterized by thrombosis within the proximal segment of a single corpus cavernosum. There have only been 36 reported cases to date. Although several factors have been associated with this unusual disorder, such as trauma or bicycle riding, the etiology is still not completely understood. Treatment is usually conservative and consists of a non-steroidal anti-inflammatory and anti-thrombotic. Promising future implications: This case report supports the utilization of pentoxifylline in patients with partial priapism due to its anti-fibrogenic and anti-thrombotic properties. PMID:26401875

  20. Treating urine by Spirulina platensis

    NASA Astrophysics Data System (ADS)

    Yang, Chenliang; Liu, Hong; Li, Ming; Yu, Chengying; Yu, Gurevich

    In this paper Spirulina platensis with relatively high nutrition was cultivated to treat human urine. Batch culture showed that the consumption of N in human urine could reach to 99%, and the consumption of P was more than 99.9%, and 1.05 g biomass was obtained by treating 12.5 ml synthetic human urine; continuous culture showed that S. platensis could consume N, Cl, K and S in human urine effectively, and the consumption could reach to 99.9%, 75.0%, 83.7% and 96.0%, respectively, and the consumption of P was over 99.9%, which is very important to increase the closure and safety of the bioregenerative life support system (BLSS).

  1. Bioenergy from anaerobically treated wastewater

    SciTech Connect

    Richards, E.A.

    1981-01-01

    Breweries and other processing plants including dairy cooperatives, sugar plants, grain mills, gasohol plants, etc., produce wastewater containing complex organic matter, either in solution or as volatile suspended solids, which can be treated anaerobically to effectively reduce the pollutants by 85-95% and generate a CH4 containing gas. An example anaerobic plant to serve a 10 to the power of 6-bbl brewery is discussed.

  2. Treating the condemned to death.

    PubMed

    Sargent, D A

    1986-12-01

    Psychiatrists should refrain from treating mentally ill prisoners on death row in order to restore their "competency to be executed." Such "treatment" renders them double agents, in the service of the state as well as the prisoner. Participation in an act that will bring about a prisoner's death is expressly forbidden by the AMA Code of Ethics. It recalls the behavior of Nazi physicians, who used their professional skills not to heal but to kill. PMID:3804727

  3. [Urinary tract infections in pregnancy: when to treat, how to treat, and what to treat with].

    PubMed

    Kladenský, J

    2012-04-01

    Urinary tract infections (UTI) in pregnant women are a relatively frequent occurrence and the spectrum of these infections ranges from lower urinary tract disease (asymptomatic bacteriuria, acute cystitis) to upper urinary tract disease (acute pyelonephritis). Anatomical and functional changes in the urinary tract in pregnancy result in significantly higher susceptibility to progression of the infection from asymptomatic bacteriuria to the stage of acute pyelonephritis. Untreated asymptomatic bacteriuria in pregnancy leads, in as much as 40%, to the development of acute pyelonephritis with all the subsequent negative effects not only for the woman herself, but particularly for the fetus. Bacteriuria in pregnancy accounts for a significantly higher number of newborns with a low birth weight, low gestational age and higher neonatal mortality rate. Therefore, it is necessary to perform screening for bacteriuria in pregnant women and, when the finding is positive, to treat this bacteriuria. The selection of an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of a given drug not only for the woman, but particularly for the fetus. The article provides an overview of medications that can be safely used throughout the pregnancy or only in certain stages of pregnancy. The selection of an appropriate antibiotic should always be preceded by the result of urine culture. The article presents the principles and rules for treating asymptomatic bacteriuria, acute cystitis and acute pyelonephritis in pregnant women. PMID:22702077

  4. Recycling of treated wood poles

    SciTech Connect

    Fansham, P.

    1995-11-01

    There are approximately 150 million utilities poles in service in North America. Of the 3 million poles removed from service each year, many poles still contain a sound and structurally intact core and only the outer layer has deteriorated. Since most of the old poles are treated with either pentachlorophenol or creosote there are limited disposal options available to pole users. The practice of giving old poles away to farmers or other interested parties in falling into disfavour since this practice does not absolve the utility of the environmental liability associated with the treated wood. TWT has commercialised a thermolysis (Pyrolysis) based process capable of removing oil based preservatives from treated wood. The patented process involves: the shaving of the weathered pole exterior; the rapid distillation of oil based preservatives in an oxygen depleted environment; condensation of the vapours; and separation of liquids. TWT has constructed a 30,000 pole per year facility east of Calgary and has provided recycled poles for the construction of two power lines now in use by TransAlta Utilities Corporation, Canada`s largest investor owned electric utility. TWT has tested two thermolysis (Pyrolysis) technologies and has determined that contact thermolysis using a heated auger design performed better and with less plugging than a fast fluid bed reactor. The fluid bed reactor is prone to coke formation and contamination of the oil by fine char particles. Residual PCP concentration in the shavings was reduced from 9500 ppm to 10 ppm. Leachate testing on the char yielded a PCP concentration of 1.43 ppm in the Leachate, well below the EPA standard maximum of 100 ppm.

  5. Biochemical degradation treats produced water

    SciTech Connect

    1997-01-20

    In Colombia, Kelt Oil Co. employs a lined, reed-based, root-zone filtering system to remove contaminants from water produced with crude oil. The roots of the reeds absorb the contaminants. The treated water is then used for agriculture. Kelt has operated te system for over 1 year near Trinidad, in the Casanare district of eastern Colombia. After 1 year, the system removed 90% of the phenol compounds. It expects 3 years will be required for the system to achieve full efficiency.

  6. Treating one of our own.

    PubMed

    Consalvo, Kim E; Piscitelli, Linda D; Williamson, Lindsay; Policarpo, Gina D; Englander, Marianne; Lyons, Kara; Wise, Cynthia; Manuella, Tracy; Mintzer, David M; Lynch, Mary Pat

    2007-04-01

    As a group, oncology nurses are aging, mirroring a large portion of the American public. Many practicing nurses are approaching middle age, and with increased age comes an increased risk for cancer. Many oncology nurses are cancer survivors, and the experience of treating a colleague is becoming more common, but few publications have addressed this topic. Pennsylvania Oncology Hematology Associates (POHA), a private medical oncology practice in Philadelphia, has encountered such a situation. This article captures the experience of one oncology nurse who underwent chemotherapy treatment for breast cancer at her place of employment. She discusses her cancer, chemotherapy treatments, and new level of understanding with patients. Her colleagues also share their reactions to witnessing the survivorship process. The nursing team at POHA has been inspired and humbled by the experience, and patient care has been enhanced. The courage of one individual's journey has demonstrated how a negative situation can be transformed into a positive one. PMID:17573272

  7. [Pathogenetic approaches to treating constipations].

    PubMed

    Luzina, E V

    2014-01-01

    Constipation affects 15-25% of people. Its mechanisms are various. There are constipations due to intestinal dyskinesia (functional constipation, irritated bowel syndrome), slow transit (colonic inertia), and muscular apparatus discoordination ensuring defecation (dyssynergic defecation). The treatment of different types of constipation uses prokinetics (type 4 serotonin receptor agonists, chlorine channels activators and guanylate cyclase C channel activators) or spasmolytics, among which pinaverium bromide (dicetel) has demonstrated its high efficacy. Biofeedback therapy or surgical techniques may be used. There is a need to prescribe laxatives in any type of constipation. A pathogenetic approach to treating constipation is most efficient. The paper characterizes stimulant, osmotic, volume, and emollient laxatives and agents stimulating the urge to defecate. It also gives the data of meta-analyses evaluating the efficacy of different drug groups. Particular emphasis is laid of the effect of lactulose and its first preparation--duphalac. PMID:25306754

  8. Inverse psoriasis treated with ustekinumab.

    PubMed

    Campos, Manuel António; Varela, Paulo; Baptista, Armando; Moreira, Ana Isabel

    2016-01-01

    Inverse psoriasis is characterised by the involvement of flexural skin folds. This form of psoriasis has distinct clinical and therapeutic features. This report refers to the case of a 48-year-old Caucasian man who was observed in our department, with a clinically and biopsy proven diagnosis of inverse psoriasis. For 2 years, the patient was treated with different combinations of corticosteroids, vitamin D analogues and methotrexate, with no satisfactory response. Given the lack of a clinical response and comorbidities, latent tuberculosis was excluded, and we started treatment with ustekinumab. We chose this biological agent because the patient was a long-distance truck driver and refused the possibility of autoinjections. The patient underwent three ustekinumab injections, which resulted in significant improvement of pruritus, erythaematous lesions and quality of life. PMID:27222277

  9. Simple Solutions for Treating Dry Mouth

    MedlinePlus

    Patient Education Sheet Simple Solutions for Treating Dry Mouth Clinicians: Please make as many copies of this ... Philadelphia, for authoring “Simple Solutions for Treating Dry Mouth.” Ask your family doctor to discontinue or provide ...

  10. How Is Idiopathic Pulmonary Fibrosis Treated?

    MedlinePlus

    ... the NHLBI on Twitter. How Is Idiopathic Pulmonary Fibrosis Treated? Doctors may prescribe medicines, oxygen therapy , pulmonary ... PR), and lung transplant to treat idiopathic pulmonary fibrosis (IPF). Medicines Currently, no medicines are proven to ...

  11. How Are Genetic Conditions Treated or Managed?

    MedlinePlus

    ... are genetic conditions treated or managed? How are genetic conditions treated or managed? Many genetic disorders result ... out more about the treatment and management of genetic conditions: Links to information about the treatment of ...

  12. How Is Disseminated Intravascular Coagulation Treated?

    MedlinePlus

    ... the NHLBI on Twitter. How Is Disseminated Intravascular Coagulation Treated? Treatment for disseminated intravascular coagulation (DIC) depends ... and treat the underlying cause. Acute Disseminated Intravascular Coagulation People who have acute DIC may have severe ...

  13. How Are Holes in the Heart Treated?

    MedlinePlus

    ... do. Those that do often are repaired during infancy or early childhood. Sometimes adults are treated for ... enlarged heart chambers are treated with surgery after infancy. However, most VSDs that require surgery are repaired ...

  14. Nanotherapies for treating prostate cancer

    NASA Astrophysics Data System (ADS)

    Danquah, Michael

    Current prostate cancer treatment remains ineffective primarily due to ineffectual therapeutic strategies and numerous tumor-associated physiological barriers which hinder efficacy of anticancer agents. Therefore, the focus of this study was to investigate a new combination therapy approach for treating prostate cancer and develop polymeric nanocarriers to facilitate anticancer drug and nucleic acid delivery. It was hypothesized that simultaneously targeting androgen-androgen receptor (AR) and X-linked inhibitor of apoptosis protein (XIAP) signaling pathways would be effective in treating prostate cancer. The effect of bicalutamide (antiandrogen) and embelin (XIAP inhibitor) on the growth of prostate cancer cells in vitro and in vivo was first examined. Embelin induced caspase 3 and 9 activation in LNCaP and C4-2 cells by decreasing XIAP expression and was more potent than bicalutamide in killing prostate tumor cells irrespective of their androgen status. Using a combination of MTT assay and isobologram analyses, combination of bicalutamide and embelin was observed to be cell line and schedule dependent. Since bicalutamide and embelin are extremely hydrophobic, polymeric micelles were fabricated using polyethylene glycol-b-polylactic acid (PEG-b-PLA) copolymer to improve drug solubility. Micellar formulations were found to result in at least 60-fold increase in the aqueous solubility of bicalutamide and embelin. Tumor growth was also effectively regressed upon treatment with bicalutamide, but the extent of tumor regression was significantly higher when bicalutamide was formulated in micelles. To further improve bicalutamide aqueous solubility, a series of novel biodegradable copolymers for the systematic micellar delivery of bicalutamide was designed and synthesized. Flory-Huggins interaction parameter (χFH) was used to assess compatibility between bicalutamide and poly (L-lactide) or poly (carbonate-co-lactide) polymer pairs. Polyethylene glycol-b-poly (carbonate

  15. Method for treating waste water

    SciTech Connect

    Helke, R.C.

    1980-12-02

    A method useful for treating waste water is disclosed wherein waste water is collected in a first vessel and a portion of the large solid particles are filtered from said waste waters. The liquid waste including suspended solid particles is combined with a solids coagulant, effective in coagulating solid particles, and the waste is disinfected. In one embodiment, coagulation and disinfection occurs simultaneously in a single treatment vessel. In the treatment vessel, the disinfectant and the coagulant are reacted with the waste waters to form gas bubbles and coagulated solid particles. The reaction of the disinfectant causes a substantial portion of the coagulated solids contained in the treatment vessel to float to the upper portion of the treatment vessel as a result of being carried to the surface by the gas bubbles. The clarified waste water is then removed from an outer chamber in the treatment vessel. In another embodiment, waste water is disinfected by radiation so that gas bubbles are not formed by the disinfection reaction. In this embodiment the coagulated solids are floated to the surface of the treatment vessel by providing small gas, i.e., air, bubbles in the treatment vessel generated from an extraneous source.

  16. Method of treating waste water

    DOEpatents

    Deininger, James P.; Chatfield, Linda K.

    1995-01-01

    A process of treating water to remove metal ion contaminants contained therein, said metal ion contaminants selected from the group consisting of metals in Groups 8, 1b, 2b, 4a, 5a, or 6a of the periodic table, lanthanide metals, and actinide metals including transuranic element metals, by adjusting the pH of a metal ion contaminant-containing water source to within the range of about 6.5 to about 14.0, admixing the water source with a mixture of an alkali or alkaline earth ferrate and a water soluble salt, e.g., a zirconium salt, in an amount sufficient to form a precipitate within the water source, the amount the mixture of ferrate and water soluble salt effective to reduce the metal ion contaminant concentration in the water source, permitting the precipitate in the admixture to separate and thereby yield a supernatant liquid having a reduced metal ion contaminant concentration, and separating the supernatant liquid having the reduced metal ion contaminant concentration from the admixture is provided. A composition of matter including an alkali or alkaline earth ferrate and a water soluble salt, e.g., a zirconium salt, is also provided.

  17. Method of treating waste water

    DOEpatents

    Deininger, J. Paul; Chatfield, Linda K.

    1991-01-01

    A process of treating water to remove transuranic elements contained therein by adjusting the pH of a transuranic element-containing water source to within the range of about 6.5 to about 14.0, admixing the water source with an alkali or alkaline earth ferrate in an amount sufficient to form a precipitate within the water source, the amount of ferrate effective to reduce the transuranic element concentration in the water source, permitting the precipitate in the admixture to separate and thereby yield a supernatant liquid having a reduced transuranic element concentration, and separating the supernatant liquid having the reduced transuranic element concentration from the admixture is provided. Additionally, a water soluble salt, e.g., a zirconium salt, can be added with the alkali or alkaline earth ferrate in the process to provide greater removal efficiencies. A composition of matter including an alkali or alkaline earth ferrate and a water soluble salt, e.g., a zirconium salt, is also provided.

  18. METHOD FOR TREATING GRAPHITE PRODUCT

    DOEpatents

    Gurinsky, D.H.

    1961-08-01

    A method is described for treating a carbon body with a carbonyl consisting of nickel, iron, and mixtures thereof. The carbonyl is decomposed in a non-oxidizing atmosphere into a mixture of the metal and carbon monoxide on the surface of a carbon body heated to above the decomposition point of the carbonyl. The temperature is increased of the carbon body to an elevated temperature above the point at which a liquid eutectic mixture of the metal and carbon of the carbon body is formed at the surface and below that at which substantial carburization occurs. The elevated temperature is maintained whereby the liquid mixture flows over the surface of the carbon body. The carbon body is cooled below the decomposition temperature of the carbonyl of the metal and to a temperature suitable for forming the carbonyl of the metal. The carbon body is then contacted with carbon monoxide at the carbonyl-forming temperature, whereby carbonyl of the metal is formed in and on the carbon body. The carbonyl is removed from the carbon body by gasifying the carbonyl. (AEC)

  19. Antimicrobial drugs for treating cholera

    PubMed Central

    Leibovici-Weissman, Ya'ara; Neuberger, Ami; Bitterman, Roni; Sinclair, David; Salam, Mohammed Abdus; Paul, Mical

    2014-01-01

    Background Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. Objectives To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. Selection criteria Randomized and quasi-randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head-to-head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. Data collection and analysis Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random-effects meta-analysis. The quality of evidence was assessed using the GRADE approach. Main results Thirty-nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43

  20. [Botulinum toxin in disabling dermatological diseases].

    PubMed

    Messikh, R; Atallah, L; Aubin, F; Humbert, P

    2009-05-01

    Botulinum toxin could represent nowadays a new treatment modality especially for cutaneous conditions in course of which conventional treatments remain unsuccessful. Besides palmar and plantar hyperhidrosis, botulinum toxin has demonstrated efficacy in different conditions associated with hyperhidrosis, such as dyshidrosis, multiple eccrine hidrocystomas, hidradenitis suppurativa, Frey syndrome, but also in different conditions worsened by hyperhidrosis such as Hailey-Hailey disease, Darier disease, inversed psoriasis, aquagenic palmoplantar keratoderma, pachyonychia congenital. Moreover, different cutaneous conditions associated with sensitive disorders and/or neurological involvements could benefit from botulinum toxin, for example anal fissures, leg ulcers, lichen simplex, notalgia paresthetica, vestibulitis. Endly, a case of cutis laxa was described where the patient was improved by cutaneous injections of botulinum toxin. PMID:19576479

  1. Acne inversa: difficulties in diagnostics and therapy

    PubMed Central

    Hadasik, Karolina; Brzezińska-Wcisło, Ligia

    2015-01-01

    Acne inversa (hidradenitis suppurativa) is a potentially severe and chronic inflammatory disease with a significant negative influence on the quality of life. Usually, lesions are located in the areas of skin folds and it is characterized by the presence of painful nodules and fistulas with a tendency to tissue fibrosis. Currently, it is suggested that follicular occlusion by infundibular hyperkeratosis plays a crucial role in pathogenesis and an occupation of apocrine sweat glands is a secondary phenomenon. Most often, it refers to men after puberty. This article tries to present the latest theory concerning the etiology of inverted acne and methods of its treatment. It also describes the most common errors in diagnostic and therapeutic procedures, which are mainly connected with repeated and long antibiotic therapy and not radical surgical treatment. PMID:26366155

  2. Insulin Resistance and Skin Diseases

    PubMed Central

    Napolitano, Maddalena; Megna, Matteo; Monfrecola, Giuseppe

    2015-01-01

    In medical practice, almost every clinician may encounter patients with skin disease. However, it is not always easy for physicians of all specialties to face the daily task of determining the nature and clinical implication of dermatologic manifestations. Are they confined to the skin, representing a pure dermatologic event? Or are they also markers of internal conditions relating to the patient's overall health? In this review, we will discuss the principal cutaneous conditions which have been linked to metabolic alterations. Particularly, since insulin has an important role in homeostasis and physiology of the skin, we will focus on the relationships between insulin resistance (IR) and skin diseases, analyzing strongly IR-associated conditions such as acanthosis nigricans, acne, and psoriasis, without neglecting emerging and potential scenarios as the ones represented by hidradenitis suppurativa, androgenetic alopecia, and hirsutism. PMID:25977937

  3. Acne tetrad in a family.

    PubMed

    Zisova, L; Sakakushev, B

    1994-01-01

    The authors report, for the first time in Bulgarian literature, a case of acne tetrad syndrome in a family. The patients were sisters who were found to have three of the four components of the syndrome: hidradenitis suppurativa, acne conglobata, and cysta pillaris. There was no evidence or anamnestic data for perifolliculitis capitis abscedens et suffodiens. In one of the sisters the syndrome showed a more precipitate clinical picture and was combined with other skin disorders (lichen ruber planus, neurodermitis circumscripta, hirsutismus). The patients had a familial predisposition to acne and pilar cycts. The complete blood analysis, all biochemical parameters, the cytogenetic analysis and hormonal status (testosterone and estrogens) showed no deviation from normal values. The patients did not report any disturbances during their menstrual cycles. The cellular immunity in one of the sisters was depressed. The patients and their children will be closely monitored. PMID:8698287

  4. Metformin - For the dermatologist.

    PubMed

    Bubna, Aditya Kumar

    2016-01-01

    Metformin though primarily an antidiabetic drug, has found to play an important role in a number of cutaneous disorders. Because of its role in improving hyperinsulinemia, it has proven beneficial in hormonal acne, hidradenitis suppurativa (HS) and acanthosis nigricans. Its antiandrogenic properties further serve as an add-on to the conventional management of hirsutism associated with polycystic ovarian syndrome. Very recently, systemic usage of metformin for psoriasis and cutaneous malignancies has shown promising results. Interestingly, metformin has also been topically used in hyperpigmentary disorders with pertinent levels of improvement and happens to be the most recent addition to the list of dermatologic indications. Though an oral hypoglycemic agent to begin with, metformin today has proven to be a boon for dermatologists. PMID:26997714

  5. [Spironolactone in dermatological treatment. On and off label indications].

    PubMed

    Salavastru, C M; Fritz, K; Tiplica, G S

    2013-10-01

    There are no currently FDA/EMEA-approved dermatologic indications for spironolactone and its off-label uses are, among others, female acne, female pattern hair loss, hidradenitis suppurativa or hirsutism. The rationale behind these relays on the mechanism of action of spironolactone which interferes with the hormone-controlled sebum and sweat gland secretion and with androgen stimulated hair growth. The average dose used by the dermatologits is 50-100 mg daily. It should not be used in pregnant and lactating women and it is not used in men due to the risk of feminization. Although further studies to assess its efficacy and safety are necessary, currently spironolactone is regarded as a useful tool in the dermatologic treatment armamentarium. PMID:24150826

  6. Metformin - For the dermatologist

    PubMed Central

    Bubna, Aditya Kumar

    2016-01-01

    Metformin though primarily an antidiabetic drug, has found to play an important role in a number of cutaneous disorders. Because of its role in improving hyperinsulinemia, it has proven beneficial in hormonal acne, hidradenitis suppurativa (HS) and acanthosis nigricans. Its antiandrogenic properties further serve as an add-on to the conventional management of hirsutism associated with polycystic ovarian syndrome. Very recently, systemic usage of metformin for psoriasis and cutaneous malignancies has shown promising results. Interestingly, metformin has also been topically used in hyperpigmentary disorders with pertinent levels of improvement and happens to be the most recent addition to the list of dermatologic indications. Though an oral hypoglycemic agent to begin with, metformin today has proven to be a boon for dermatologists. PMID:26997714

  7. PASS Syndrome: An IL-1-Driven Autoinflammatory Disease.

    PubMed

    Leuenberger, Mathieu; Berner, Jeanne; Di Lucca, Julie; Fischer, Lara; Kaparos, Nikolaos; Conrad, Curdin; Hohl, Daniel; So, Alexander; Gilliet, Michel

    2016-01-01

    PASS syndrome is a rare inflammatory disease characterized by a chronic-relapsing course of pyoderma gangrenosum, acne vulgaris, hidradenitis suppurativa and ankylosing spondylitis. Here, we describe a case of a patient with spontaneously recurrent purulent skin lesions along with seronegative spondylarthritis consistent with the PASS syndrome. During his disease exacerbation, the patient displayed episodes of fever along with elevated serum levels of interleukin (IL)-1β. Skin lesions were characterized by sterile neutrophilic infiltrates and showed a rapid response to the IL-1 receptor antagonist anakinra (Kineret®) consistent with the autoinflammatory nature of this disease. However, unlike other autoinflammatory diseases such as PAPA and PAPASH, we did not find mutations in the gene PSTPIP1, raising the possibility that other specific mutations in the IL-1 pathway may be involved. PMID:26919742

  8. A case of dissecting cellulitis and a review of the literature.

    PubMed

    Scheinfeld, Noah S

    2003-02-01

    Dissecting cellulitis (also called perifolliculitis capitis abscedens et suffodiens) manifests with perifollicular pustules, nodules, abscesses and sinuses that evolve into scarring alopecia. It predominantly occurs in African American men between 20-40 years of age, but can occasionally affect other races and women too. Associated musculoskeletal findings are sometimes reported. When it occurs with acne conglobata, hidradenitis suppurativa, and pilonidal cysts, the syndrome is referred to as the follicular occlusion triad or tetrad. Its course is chronic and relapsing, and treatment is often difficult. Medical therapies include isotretinoin, antibiotics, and prednisone. Destructive therapies include X-ray therapy, surgical excision, and skin grafting. Laser epilation of hair follicles is a promising new therapy for dissecting cellulitis. PMID:12639466

  9. Perifolliculitis capitis abscedens et suffodiens successfully controlled with topical isotretinoin.

    PubMed

    Karpouzis, Anthony; Giatromanolaki, Alexandra; Sivridis, Efthymios; Kouskoukis, Constantin

    2003-01-01

    Perifolliculitis capitis abscedens et suffodiens (or dissecting folliculitis of the scalp or dissecting cellulitis of the scalp or dissecting perifolliculitis of the scalp) is a rare entity and constitutes the equivalent over the scalp, of hidradenitis suppurativa and acne conglobata. Etiologic factors are unknown. Diagnosis is proven histologically. Management is very difficult and consists in systemic administration or intralesional injection of several drugs or in surgical manipulations. An 18 year-old white patient with cystic infiltrations, alopecia plaques, pustules and other inflammatory elements (clinicohistological features consistent with dissecting folliculitis of the scalp), is presented. Isotretinoin topical application assured successful control of the disease and averted the evolution of the clinical aspect to scarring alopecia and nodule formation. Topical isotretinoin exercises a curative, inhibitory and antiproliferative action, in perifolliculitis capitis abscedens et suffodiens. PMID:12695138

  10. Should epileptiform discharges be treated?

    PubMed

    Sánchez Fernández, Iván; Loddenkemper, Tobias; Galanopoulou, Aristea S; Moshé, Solomon L

    2015-10-01

    To evaluate the impact of epileptiform discharges (EDs) that do not occur within seizure patterns--such as spikes, sharp waves or spike waves--on cognitive function and to discuss the circumstances under which treatment of EDs might be considered. Methods used in this article is "Review of the literature". EDs may disrupt short-term cognition in humans. Frequent EDs for a prolonged period can potentially impair long-term cognitive function in humans. However, there is conflicting evidence on the impact of EDs on long-term cognitive outcome because this relationship may be confounded by multiple factors such as underlying etiology, seizures, and medication effects. Limitations of existing studies include the lack of standardized ED quantification methods and of widely accepted automated spike quantification methods. Although there is no solid evidence for or against treatment of EDs, a non-evidence-based practical approach is suggested. EDs in otherwise asymptomatic individuals should not be treated because the risks of treatment probably outweigh its dubious benefits. A treatment trial for EDs may be considered when there is cognitive dysfunction or regression or neurologic symptoms that are unexplained by the underlying etiology, comorbid conditions, or seizure severity. In patients with cognitive or neurologic dysfunction with epilepsy or EDs, treatment may be warranted to control the underlying epileptic syndrome. EDs may cause cognitive or neurologic dysfunction in humans in the short term. There is conflicting evidence on the impact of EDs on long-term cognitive outcome. There is no evidence for or against treatment of asymptomatic ED. PMID:26293670

  11. A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: inflammatory and aesthetic indications.

    PubMed

    Calzavara-Pinton, Pier Giacomo; Rossi, Maria Teresa; Aronson, Erica; Sala, Raffaella

    2013-01-01

    Experimental investigations have demonstrated that photodynamic therapy (PDT) with methyl aminolevulinate (MAL) may be a useful treatment in several inflammatory skin disorders and aesthetic indications. To assess the effectiveness, tolerability and safety of off-label MAL-PDT in daily clinical practice in 20 Italian hospital centers, a retrospective observational study of medical records of patients treated for off-label inflammatory and aesthetic indications was carried out. In all patients standard treatment options had been either ineffective, unacceptably toxic, or medically contraindicated. Clinical data regarding 221 patients affected by 22 different diseases were collected. The most common off-label indication was acne vulgaris, with >75% improvement in 72.8% of patients. Other disorders of the sebaceous gland, i.e. acne rosacea, hidradenitis suppurativa and sebaceous hyperplasia, were less responsive. Alopecia areata did not show any improvement. Granuloma annulare and necrobiosis lipoidica showed marked or moderate response in the majority of treated patients. The rate of patients with complete remission was lower for inflammatory skin disorders with hyperkeratosis, i.e. psoriasis (6/17) and porokeratosis (3/16). The efficacy for lichenoid dermatoses was dependent on the clinical variant (erosive and scleroatrophic were more responsive than hypertrophic). Only 1 of 6 patients with Zoon balanitis had a marked improvement. MAL-PDT of venous leg ulcers, photo-aging and hypertrophic scars led to a marked remission in 3/5, 3/6 and 5/8 patients, respectively. The treatment had to be interrupted because of strong pain and burning in 24 patients. Long term adverse events were not registered. Most patients with marked improvement had lasting remission with overall excellent cosmetic outcomes. The present findings demonstrate a high interest in off-label uses of MAL-PDT for inflammatory skin disorders. According to the observed clinical responses, safety, and

  12. Method for melting and treating waste

    SciTech Connect

    Fujimoto, T.; Fujiuchi, H.; Shimizu, K.; Veda, S.

    1983-11-29

    A method for melting and treating waste to be treated such as waste water treatment slude and incinerated ash of garbage involves mixing the waste to be treated with an auxiliary fuel in powder, granular or solid form or in the form of mixture thereof which has its own calorie value. Powder coal, coal, coke, waste plastic material, saw-dust, waste paper, and carbonized material are used as an auxiliary fuel. In addition to the auxiliary fuel, an additive is admixed for adjusting the composition of the waste to have treated so as to be a specific composition ratio.

  13. Water control well treating solution and method

    SciTech Connect

    Boles, J. L.; Mancillas, G.

    1984-10-16

    A well treating solution is shown for changing the relative permeability of a formation being treated to water. The solution is made by mixing an amphoteric polymeric material, a mutual solvent and a surface active agent in a brine carrier liquid. The well treating solution is injected into the formation at pump rates below the fracture gradient of the formation. The well is briefly shut-in, after which production can be resumed. The treating solution and method taught lower the permeability of the producing formation to water without substantially affecting the formation's permeability to oil and gas.

  14. Drugs for treating urinary schistosomiasis

    PubMed Central

    Kramer, Christine V; Zhang, Fan; Sinclair, David; Olliaro, Piero L

    2014-01-01

    Background Urinary schistosomiasis is caused by an intravascular infection with parasitic Schistosoma haematobium worms. The adult worms typically migrate to the venous plexus of the human bladder and excrete eggs which the infected person passes in their urine. Chronic infection can cause substantial morbidity and long-term complications as the eggs become trapped in human tissues causing inflammation and fibrosis. We summarised evidence of drugs active against the infection. This is new edition of a review first published in 1997. Objectives To evaluate the efficacy and safety of drugs for treating urinary schistosomiasis. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register, MEDLINE, CENTRAL, EMBASE and LILACS and reference lists of articles up to 23 May 2014. Selection criteria Randomized controlled trials (RCTs) of antischistosomal drugs and drug combinations compared to placebo, no intervention, or each other. Data collection and analysis Two researchers independently screened the records, extracted the data and assessed risk of bias. The primary efficacy outcomes were parasitological failure (defined as the continued presence of S. haematobium eggs in the urine at time points greater than one month after treatment), and percent reduction of egg counts from baseline. We presented dichotomous data as risk ratios (RR), and continuous data as mean difference (MD), alongside their 95% confidence intervals (CIs). Where appropriate we combined trials in meta analyses or tables. We assessed the quality of evidence using the GRADE approach. Main results We included 30 RCTs enrolling 8165 participants in this review. Twenty-four trials were conducted in children in sub-Saharan Africa, and 21 trials were over 20 years old. Many studies were assessed as being at unclear risk of bias due to inadequate descriptions of study methods. Praziquantel On average, a single 40 mg/kg dose of praziquantel reduced the proportion of people still

  15. Type 1 Diabetes: How Is It Treated?

    MedlinePlus

    ... What's a Booger? Type 1 Diabetes: How Is It Treated? KidsHealth > For Kids > Type 1 Diabetes: How Is It Treated? Print A A A Text Size What's ... glucose can't get into the cells, so it stays in the blood leading to high blood ...

  16. Treating Survivors of War Trauma and Torture.

    ERIC Educational Resources Information Center

    Hanscom, Karen L.

    2001-01-01

    Proposes a mental health treatment model for survivors of torture and war trauma, presenting principles underlying such treatment and a developmental view of such abuse. Describes a Guatemalan project that uses the model to train village women to treat survivors in their communities and a U.S. torture treatment program that treats survivors…

  17. How Is Long QT Syndrome Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Long QT Syndrome Treated? The goal of treating long QT syndrome (LQTS) is to prevent life-threatening, ... levels. (For more information, go to "What Causes Long QT Syndrome?" ) Many people who have LQTS also ...

  18. Microwave heat treating of manufactured components

    DOEpatents

    Ripley, Edward B.

    2007-01-09

    An apparatus for heat treating manufactured components using microwave energy and microwave susceptor material. Heat treating medium such as eutectic salts may be employed. A fluidized bed introduces process gases which may include carburizing or nitriding gases. The process may be operated in a batch mode or continuous process mode. A microwave heating probe may be used to restart a frozen eutectic salt bath.

  19. Simple techniques to treat medical phobias.

    PubMed Central

    Taylor, C. B.; Ferguson, J. M.; Wermuth, B. M.

    1977-01-01

    Participant modelling, a behaviourally-orientated treatment technique, is an effect method of treating phobias associated with minor medical procedures or apparatus such as needles or intravenous catheters. The steps in this technique are described and two cases of severe needle phobias successfully treated with participant modelling are presented to illustrate further its application. PMID:876910

  20. Gas treating alternatives for LNG plants

    SciTech Connect

    Clarke, D.S.; Sibal, P.W.

    1998-12-31

    This paper covers the various gas treating processes available for treating sour natural gas to specifications required for LNG production. The LNG product specification requires that the total sulfur level be less than 30--40 ppmv, the CO{sub 2} level be less than 50 ppmv and the water level be less than 100 ppmv to prevent freezing problems in the LNG cryogenic column. A wide variety of natural gas compositions are encountered in the various fields and the gas treating process selection is dependent on the type of impurities present in the gas, namely, levels of H{sub 2}S, CO{sub 2}, mercaptans and other organic sulfur compounds. This paper discusses the implications various components in the feed to the LNG plant can have on process selection, and the various treating processes that are available to condition the gas. Process selection criteria, design and operating philosophies are discussed. An economic comparison for two treating schemes is provided.

  1. Locoregional use of lateral thoracic artery perforator flap as a propeller flap.

    PubMed

    Baghaki, Semih; Cevirme, Mirza; Diyarbakirli, Murat; Tatar, Cihad; Aydin, Yagmur

    2015-05-01

    Although thoracodorsal system is a fundamental source of various flaps, lateral thoracic region has not been a popular flap donor area. There is limited data on the use of lateral intercostal artery perforator flap and lateral thoracic artery perforator flap. In this case series, lateral thoracic artery perforator flap has been used in locoregional (axilla, pectoral region, and arm) reconstruction as an island or propeller flap.Eighteen patients have been operated on between September 2010 and January 2013. The age of the patients ranged between 16 and 68 years with a median of 38 years. A thorough chart review has been performed with preoperative and postoperative photographs. Duration of hospitalization, complication rate and long term results have been documented.Nine patients had severe burn contracture of axilla, 7 patients had axillary hidradenitis suppurativa, 1 patient had giant neurofibroma of arm, and 1 patient had malignant peripheral nerve sheath tumor of pectoral area. Seventeen flaps survived totally, and in 1 flap, distal superficial slough of skin has been observed. No recurrence in hidradenitis or peripheral nerve sheath tumor has been observed. Donor site scar is well hidden in anatomical position. The range of motion of affected extremities returned to normal after reconstruction.Lateral thoracic area provides a reliable flap option with a wide arc of rotation when lateral thoracic artery perforators are used. PMID:25875722

  2. How Is Alpha-1 Antitrypsin Deficiency Treated?

    MedlinePlus

    ... from the NHLBI on Twitter. How Is Alpha-1 Antitrypsin Deficiency Treated? Alpha-1 antitrypsin (AAT) deficiency has no cure, but its ... of these treatments are the same as the ones used for a lung disease called COPD (chronic ...

  3. How Is Thrombotic Thrombocytopenic Purpura Treated?

    MedlinePlus

    ... and surgery. Treatments are done in a hospital. Plasma Therapy Plasma is the liquid part of your blood. It ... nutrients to your body. TTP is treated with plasma therapy. This includes: Fresh frozen plasma for people ...

  4. Ultrasound Device Approved to Treat Essential Tremor

    MedlinePlus

    ... page: https://medlineplus.gov/news/fullstory_159817.html Ultrasound Device Approved to Treat Essential Tremor Uses MRI ... U.S. Food and Drug Administration to deliver focused ultrasound to destroy small bits of brain tissue that ...

  5. Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS)

    MedlinePlus

    ... CDC.gov . Hantavirus Share Compartir Diagnosing and Treating Hantavirus Pulmonary Syndrome (HPS) Diagnosing HPS Diagnosing HPS in ... of patients that develop HPS from New World Hantaviruses recover completely. No chronic infection has been detected ...

  6. How Is Childhood Interstitial Lung Disease Treated?

    MedlinePlus

    ... the NHLBI on Twitter. How Is Childhood Interstitial Lung Disease Treated? Childhood interstitial lung disease (chILD) is ... prevent acid reflux, which can lead to aspiration. Lung Transplant A lung transplant may be an option ...

  7. How Is High Blood Pressure Treated?

    MedlinePlus

    ... blood pressure and maintain normal blood pressure readings. Healthy Eating To help treat high blood pressure, health care ... Read more about the DASH eating plan. Heart-Healthy Eating Your health care provider also may recommend heart- ...

  8. Physics design of the upgraded TREAT reactor

    SciTech Connect

    Bhattacharyya, S.K.; Lell, R.M.; Liaw, J.R.; Ulrich, A.J.; Wade, D.C.; Yang, S.T.

    1980-01-01

    With the deferral of the Safety Test Facility (STF), the TREAT Upgrade (TU) reactor has assumed a lead role in the US LMFBR safety test program for the foreseeable future. The functional requirements on TU require a significant enhancement of the capability of the current TREAT reactor. A design of the TU reactor has been developed that modifies the central 11 x 11 fuel assembly array of the TREAT reactor such as to provide the increased source of hard spectrum neutrons necessary to meet the functional requirements. A safety consequence of the increased demands on TU is that the self limiting operation capability of TREAT has proved unattainable, and reliance on a safety grade Plant Protection System is necessary to ensure that no clad damage occurs under postulated low-probability reactivity accidents. With that constraint, the physics design of TU provides a means of meeting the functional requirements with a high degree of confidence.

  9. How Is Primary Ciliary Dyskinesia Treated?

    MedlinePlus

    ... the NHLBI on Twitter. How Is Primary Ciliary Dyskinesia Treated? Unfortunately, no treatment is available yet to ... line the airways.) Thus, treatment for primary ciliary dyskinesia (PCD) focuses on which symptoms and complications you ...

  10. Therapies for Treating Diabetic Nerve Pain

    MedlinePlus

    ... or neuropathy. Neurologists from the American Academy of Neurology are doctors who identify and treat diseases of ... an educational service of the American Academy of Neurology. It is based on an assessment of current ...