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Autoinflammation is defined by aberrant, antigen-independent activation of the innate immune signaling pathways. This leads to increased, pro-inflammatory cytokine expression and subsequent inflammation. In contrast, autoimmune and allergic diseases are antigen-directed immune responses from activation of the adaptive immune system. The innate and adaptive immune signaling pathways are closely interconnected. The group of ‘complex multigenic diseases’ are a result of mutual dysregulation of both the autoinflammatory and autoimmune physiologic components. In contrast, monogenic autoinflammatory syndromes (MAIS) result from single mutations and are exclusively autoinflammatory in their pathogenesis. Studying the clinical and histopathological findings for the various MAIS explains the phenotypical correlates of their specific mutations. This review aims to group the histopathologic clues for autoinflammation into three recognizable patterns. The presence of these histologic patterns in a pediatric patient with recurrent fevers and systemic inflammation should raise suspicion of an autoinflammatory component in MAIS, or, more frequently, in a complex multigenic disease. The three major histopathological patterns seen in autoinflammation are as follows: (i) the ‘neutrophilic’ pattern, seen in urticarial neutrophilic dermatosis, pustular psoriasis, aseptic neutrophilic folliculitis, and Sweet’s syndrome; (ii) the ‘vasculitic’ pattern seen in small vessel-vasculitis (including hypersensitivity/leukocytoclastic vasculitis, thrombosing microangiopathy and lymphocytic vasculitis), and intermediate-sized vessel vasculitis, mimicking polyarteritis nodosa; and (iii) the ‘granulomatous’ pattern. Beyond these three patterns, there are additional histopathologic clues, which are detailed below. It is important for a dermatopathologist to recognize the patterns of autoinflammation, so that a diagnosis of MAIS or complex multigenic diseases may be obtained. Finally, careful histopathologic analyses could contribute to a better understanding of the various clinical manifestations of autoinflammation.

Antecedentes: La hidradenitis supurativa (HS) es una enfermedad inflamatoria crónica relacionada con el síndrome metabólico(SM), con un mayor riesgo de comorbilidades cardiovasculares; por lo tanto, se debe mantener un alto grado de sospecha clínica frente al hallazgo de alguno de sus componentes. Objetivo: Evaluar la prevalencia del SM en los pacientes con diagnóstico de HS en comparación con la población general. Diseño: Estudio retrospectivo descriptivo. Métodos: Se revisaron las historias clínicas y el archivo fotográfico de los pacientes con diagnóstico de HS que consultaron entre el 1/9/2017 y el 31/8/2019. Se analizaron las variables: sexo, edad, antecedentes familiares, tiempo de evolución, índice de masa corporal, obesidad abdominal, laboratorio (glucemia y perfil lipídico), presión arterial, tabaquismo, número y localización de las lesiones, gravedad clinicoecográfica, respuesta al tratamiento y evolución clínica. Resultados: Se evaluaron 30 pacientes con HS valorados en nuestro servicio en los últimos 2 años; 23 mujeres y 7 varones. Predominó el grupo etario de 31-40 años. De ellos, 19 pacientes (63,3%) cumplieron con los criterios necesarios para diagnosticar el SM, hallazgo que no se relacionó con el grado de severidad de la HS. Conclusiones: La prevalencia del SM en nuestros pacientes con HS fue del 63,3% con respecto al 27,5% de la población general. La importancia de este hallazgo radica en detectar de forma temprana y oportuna la presencia de este síndrome en los pacientes con HS para evitar el riesgo de comorbilidades cardiovasculares a futuro.

Botulinum toxin is a superfamily of neurotoxins produced by the bacterium Clostridium Botulinum with well-established efficacy and safety profile in focal idiopathic hyperhidrosis. Recently, botulinum toxins have also been used in many other skin diseases, in off label regimen. The objective of this manuscript is to review and analyze the main therapeutic applications of botulinum toxins in skin diseases. A systematic review of the published data was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Botulinum toxins present several label and off-label indications of interest for dermatologists. The best-reported evidence concerns focal idiopathic hyperhidrosis, Raynaud phenomenon, suppurative hidradenitis, Hailey–Hailey disease, epidermolysis bullosa simplex Weber–Cockayne type, Darier’s disease, pachyonychia congenita, aquagenic keratoderma, alopecia, psoriasis, notalgia paresthetica, facial erythema and flushing, and oily skin. Further clinical trials are still needed to better understand the real efficacy and safety of these applications and to standardize injection and doses protocols for off label applications.

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Suppurative hidradenitis and pyoderma gangrenosum are rare disorders that can be seen isolated or even more rare, as part of different autoinflammatory syndromes: Pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH), pyoderma gangrenosum, acne, pyogenic arthritis, and hidradenitis suppurativa (PAPASH) or psoriatic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PsAPASH). Although they have different clinical features, suppurative hidradenitis and pyoderma gangrenosum seem to share similar pathogenic pathways involving a dysregulated innate immune system, with neutrophilic inflammation, mediated by IL-1β, controlled by NALP3 inflammasome pathway. We report a case of a 53-year-old male patient previously diagnosed with HS in inguinal-scrotal area that developed rapidly after a traumatic injury on his left anterior calf, a painful inflammatory plaque with pustules on the surface that rapidly progressed (24-48 h) to form ulcers. The lesions ended up healing with a large scarring plaque with cribriform openings, multiple fibrous bridges, open comedones, and double-ended pseudo-comedones. Although the clinical aspect at presentation together with the aspect on the first biopsy were suggestive for pyoderma gangrenosum, the healing aspect is more commonly seen in suppurative hidradenitis. Commonly seen in acne, in the healing phase of suppurative hidradenitis but more rarely in pyoderma gangrenosum, the formation of comedones seem to be a complex process and raise the question if these entities represent in our patient an association, an overlap or the spectrum of the same disease.

Introduction: Pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) is an autoinflammatory syndrome. Up to now no case of PASH syndrome has been reported from Iran and we report the first case in this paper. Case Presentation: In case report, we report a 44-year-old Iranian female with PASH syndrome. Her skin manifestation was first suppurative hidradenitis when she was 16 years old, then acne 20 years ago and now PG. In addition, she had history of a mass in pituitary diagnosed as prolactinoma, hormonal problems like hypothyroidism, abnormal menstrual cycles and obesity that were not reported in previous cases of PASH. It should be noted that no sign of remission and recurrence was seen in this case after 2 years. Conclusions: Further studies are being performed on the reported patient to achieve a better presentation of this disease and report the case in further papers especially with focus on laboratory and therapeutic information.

The clinical triad of pyoderma gangrenosum, acne conglobata and hidradenitis suppurativa has been named PASH syndrome. Polycystic ovary syndrome (PCOS) is associated with hyperandrogenism and inflammation. Hidradenitis suppurativa, like acne vulgaris, may be a feature of hyperandrogenism. Obesity may be associated with both hidradenitis suppurativa and PCOS. We describe a possible association between PASH syndrome and PCOS.

Highlights • Mucinous adenocarcinoma associated with suppurative hidradenitis is extremely rare. • Magnetic resonance imaging findings help in the diagnosis of mucinous adenocarcinoma. • The surgery is highly complex, and even in a tertiary hospital, complications may occur., Introduction Chronic suppurative hidradenitis (CSH) is a benign condition that can affect the perineal region and often leads to the formation of abscesses and fistulas. It is rare for CSH to undergo malignant degeneration into mucinous adenocarcinoma. Presentation of case We report a case of a 55-year-old male patient with perineal CSH who suffered worsening long-term pain despite multiple surgical procedures to alleviate his symptoms. Pelvic magnetic resonance imaging (MRI) showed multiloculated cystic lesion on the left side wall of the distal rectum with gluteal extension. Pathological examination revealed mucinous adenocarcinoma. The patient underwent an abdominoperineal resection (APR) of the rectum with cutaneous muscle flap reconstruction. Although histopathological sections showed clear margins, the tumor recurred 6 months following surgery. Discussion Perineal mucinous adenocarcinoma arising in a patient with CSH is an extremely rare condition. This diagnosis is often difficult, due to the paucity of signs of malignant degeneration as well as the rarity of the disease itself. Surgical resection of the lesions is a well-established approach. In this case, diagnosing the tumor at such a late stage likely compromised his outcome. Conclusion Malignant degeneration to mucinous adenocarcinoma must be suspected in patients with a history of long-term CSH. In such cases, local biopsies and a radiological examination, such as MRI can help in the diagnosis.

Les auteurs rapportent le cas d'une patiente de 58 ans, nulligeste, aux antécédents de maladie de Niemann-Pick qui a consulté pour une tuméfaction vulvo-périnéale de 10 cm, fluctuante et fistulisé avec une ulcération. La patiente était fébrile et présentant un état général altéré. Cette masse a fait craindre le développement d'une tumeur maligne vulvaire nécrosée et infectée sur une dermatose chronique. Elle a eu une incision en vue de drainage des collections purulentes associée à des biopsies multiples qui ont infirmé la présence d'un processus néoplasique. L'association lésionnelle et leurs distributions ont fait porter alors le diagnostic d'une hidradenite suppurative ou maladie de Verneuil. Ensuite le problème posé était celui du choix de la conduite de prise en charge ultérieure parmi les traitements médicamenteux et chirurgicaux décrits. Les auteurs discuteront à travers ce cas et une brève revue de la littérature récente les modalités du diagnostic, les complications et la prise en charge thérapeutique de cette maladie.

We here report the case of a 58-year old nulliparous patient with a history of Niemann-Pick disease who presented with vulvoperineal, fluctuant, fistulized swelling measuring 10 cm associated with ulceration. The patient was febrile with impaired general state This mass caused some concern about necrotic and infected malignant tumor of the vulva associated with chronic dermatosis. Incision and purulent drainage associated with multiple biopsies excluded the presence of a neoplastic process. The diagnosis of suppurative hidradenitis or Verneuil's disease was based on the associations between lesions and their distributions. Then, the problem that arose was that of the choice between drug treatment and surgical procedures. This study, including a short review of the recent literature, aims to outline the diagnostic modalities, the complications and the therapeutic management of this disease.

The clinical triad of pyoderma gangrenosum (PG), acne and suppurative hidradenitis (HS) has been described under the acronym PASH syndrome and is considered to represent a distinct entity in the group of autoinflammatory diseases. It is a fairly new, only recently recognized disorder with a limited number of reported cases and without defined treatment recommendations. We aimed to summarize currently available data on the use of tumor necrosis factor (TNF) antagonists in the management of PASH syndrome and report on our own experience with the use of adalimumab in a patient presenting with this specific constellation of clinical signs and symptoms. Among the 11 cases identified in the literature, infliximab and adalimumab were the most commonly used agents, both exhibiting favorable effects in the majority of, but not all, patients. This was particularly evident in terms of relatively rapid remission of PG whereas HS lesions seemed to be more resistant to treatment. In our patient, adalimumab monotherapy resulted in a remarkable and sustained remission, although significant improvement of HS lesions was observed only from week 16 of therapy onwards. In summary, TNF antagonists are a promising treatment for PASH ; however, conclusions regarding the choice of a specific agent, optimal dosing or use in combination with other treatment modalities cannot yet be drawn.

Cutaneous ultrasound is a dermatological diagnostic imaging technique based on the interaction of high-frequency ultrasounds with the skin. Because it is non-invasive, rapid and accessible, it has increasingly wide clinical applications. This article reviews its use in the management of inflammatory dermatological diseases.

PASH syndrome (pyoderma gangrenosum, acne, and suppurative hidradenitis) forms part of the spectrum of autoinflammatory diseases. We report an unusual case of PASH syndrome in a patient with end-stagerenal disease (ESRD) who was successfully treated with the tumor necrosis factor inhibitor, adalimumab. The case underscores the challenges associatedwith the treatment of PASH syndrome as well as the ongoing search to establish a genetic basis for the syndrome. Renal impairment has been reported in association with pyoderma gangrenosum but has notbeen described in PASH syndrome. We believe this to be the first reported case of a patient who developed PASH syndrome in the setting of ESRD.

Aim: Suppurative hidradenitis is a chronic relapsing inflammatory disease that affects the apocrine sweat glands, and is most often located in the perianal area.Perineal and perianal locations cover about 37% of the total morbidity and it is more common in males. Materials and Methods: A prospective interventional study of 13 patients with suppurative fistulizing hidradenitis of perineum, treated in the Department of Coloproctological and purulent-septic surgery, University Hospital, Pleven for the period 2008 - 2013. Results: The period between the occurrences of diseaseand surgical treatment is very long – from 2 to 36 years (average - 9.2 years). The average hospital stay was 13.5 days. Operative wounds healed secondarily an average of about 30 days. Patients were followed for 6 months, 1 year and 2 years. Two patients with relapses on the 6th postoperative month, have re-hospitalization and surgery with good results. Conclusion: Treatment of suppurative hidradenitis of the perineum is complex, both in terms of local status and systematic violations resulting chronic infection. The advantages of deroofing are: minimal trauma to the patient, requires no special equipment, there is a lower rate of recurrence compared with other methods (in our study - 15.38%) and leads to the formation of aesthetically acceptable scar.

OBJETIVO: Avaliar a utilização de retalho dermogorduroso de vizinhança, numa única etapa, na reparação da área resultante da ressecção de lesões de hidradenite supurativa. PACIENTE E MÉTODOS: Estudo epidemiológico transversal e retrospectivo de prontuários de pacientes com hidradenite supurativa crônica extensa em regiões perianal e glútea submetidos à ressecção ampla e rotação de retalho cutâneo de vizinhança, no período de janeiro de 2000 a novembro de 2008. RESULTADOS: O retalho dermogorduroso permitiu, em única etapa, a cobertura total da área ressecada em oito pacientes. Não houve necrose ou infecção em nenhum dos casos. No seguimento, seis pacientes compareceram a todas as consultas ambulatoriais agendadas. Todos se mostraram satisfeitos com o resultado. CONCLUSÃO: O tratamento da hidroadenite supurtiva perianal e/ou glútea deve ser individualizado segundo a extensão, gravidade e grau de interferência na qualidade de vida. A ressecção cirúrgica com procedimentos plásticos como a rotação de retalho de vizinhança em única etapa é segura e traz resultados satisfatórios e deve ser sempre considerada nos casos crônicos, extensos e refratários ao tratamento clínico e com grandes áreas ressecadas.OBJECTIVE: To evaluate the use of skin flaps neighborhood in a single step in the repair of the area from the resection of lesions of Suppurative Hidradenitis. METHODS: Retrospective cross-sectional epidemiological study of patients with chronic extensive Suppurative Hidradenitis in perianal and gluteal regions underwent extensive resection and skin flap rotation of the neighborhood, from January 2000 to November 2008. RESULTS: The skin flaps allowed in single step, the total coverage of the area resected in eight patients. There was no necrosis or infection in any cases. Following, six patients attended all scheduled outpatient consultations. All were satisfied with the result. CONCLUSIONS: The treatment of suppurative perianal hidradenitis and / or gluteal should be individualized according to the extent, severity and degree of interference in the quality of life. Surgical resection with plastic procedures such as rotation of retail in the neighborhood in one step is safe and has satisfactory results and should be considered for chronic cases, extensive and refractory to medical treatment and with large areas resected.

SUMMARY We describe a patient who suffered over 40 years from persistent, extensive hidradenitis suppurativa (HS) and who developed squamous cell carcinomas at two different sites.

Resume— Une analyse retrospective clinicopathologique a ete menee chez 100 chiens presentant une hydradenite suppurative diagnostiquee par biopsie cutanee. Aucune predisposition d'âge, de race ou de sexe n'a ete mise en evidence. Tous les chiens presentaient cliniquement une folliculite bacterienne, ou une furonculose, ou les deux, qu'elle soit primaire ou secondaire a d'autres dermatoses. Aucene lesion clinique n'etait pathognomonique d'hidradenite suppurative. Chez 73 chiens, l'hidradenite suppurative etait associee microscopiquement a des degres variables d'inflammation du follicule pileux. Chez 27 chiens, l'hidradenite suppurative etait la seule evidence histologique d'inflammation annexielle. L'observation histopathologique d'hidradenite suppurative suggere l'existence sur le plan clinique d'une folliculite bacterienne, d'une furonculose, ou des 2. [Scott, D.W. Suppurative inflammation of apocrine sweat glands (suppurative hidradentis) in the dog: a retrospective clinicopathological analysis of 100 cases (inflammation suppurative des glandes sudorales apocrines (hidradenite suppurative) chez le chien: une analyse retrospective clinicopathologique de 100 cas). Resumen— Se llevo a cabo un estudio clinicopatologico retrospectivo en 100 perros con hidradenitis supurativa diagnosticada mediante biopsia cutanea. No se detecto predominancia alguna de raza, sexo o edad. A todes los perros se les habia diagnosticado clinicamente foliculitis o furunculosis bacteriana, o ambas, ya sea de forma primaria o secundaria a otras dermatosis. No se encontraron lesiones clinicas especificas indicativas de hidradenitis supurativa. En 73 animales, la hidradenitis supurativa estaba asociada con varios grados de inflamacion folicular a nivel microscopico. En los 27 casos restantes, los anejos presentaban unicamente hidradenitis supurativa. La presencia de hidradenitis supurativa a nivel microscopico sugiere la existencia de foliculitis o furunculosis bacteriana clinicas, o de ambas. [Scott, D.W. Suppurative inflammation of apocrine sweat glands (suppurative hidradenitis) in the dog: a retrospective clinicopathological analysis of 100 cases (inflamacion supurativa de las glandulas sudoriparas apocrinas (hidradenitis supurativa) en el perro: estudio clinicopatologico retrospectivo de 100 casos). Abstract— A retrospective clinicopathological study was conducted on 100 dogs with suppurative hidradenitis as determined by skin biopsy. No apparent age, breed, or sex predilections were recognized. All dogs had been given a clinical diagnosis of bacterial folliculitis, furunculosis, or both of these, whether primary or secondary to other dermatoses. There were no clinical lesions that uniquely suggested the presence of suppurative hidradenitis. In 73 dogs, suppurative hidradenitis occurred in conjunction with varying degrees of hair follicle inflammation microscopically. In 27 dogs, suppurative hidradenitis was the only histological evidence of adnexal inflammation. The histopathologic finding of suppurative hidradenitis suggests the existence of clinical bacterial folliculitis, furunculosis, or both of these.

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.

OBJETIVO: Avaliar a utilização de retalho dermogorduroso de vizinhança, numa única etapa, na reparação da área resultante da ressecção de lesões de hidradenite supurativa. PACIENTE E MÉTODOS: Estudo epidemiológico transversal e retrospectivo de prontuários de pacientes com hidradenite supurativa crônica extensa em regiões perianal e glútea submetidos à ressecção ampla e rotação de retalho cutâneo de vizinhança, no período de janeiro de 2000 a novembro de 2008. RESULTADOS: O retalho dermogorduroso permitiu, em única etapa, a cobertura total da área ressecada em oito pacientes. Não houve necrose ou infecção em nenhum dos casos. No seguimento, seis pacientes compareceram a todas as consultas ambulatoriais agendadas. Todos se mostraram satisfeitos com o resultado. CONCLUSÃO: O tratamento da hidroadenite supurtiva perianal e/ou glútea deve ser individualizado segundo a extensão, gravidade e grau de interferência na qualidade de vida. A ressecção cirúrgica com procedimentos plásticos como a rotação de retalho de vizinhança em única etapa é segura e traz resultados satisfatórios e deve ser sempre considerada nos casos crônicos, extensos e refratários ao tratamento clínico e com grandes áreas ressecadas. OBJECTIVE: To evaluate the use of skin flaps neighborhood in a single step in the repair of the area from the resection of lesions of Suppurative Hidradenitis. METHODS: Retrospective cross-sectional epidemiological study of patients with chronic extensive Suppurative Hidradenitis in perianal and gluteal regions underwent extensive resection and skin flap rotation of the neighborhood, from January 2000 to November 2008. RESULTS: The skin flaps allowed in single step, the total coverage of the area resected in eight patients. There was no necrosis or infection in any cases. Following, six patients attended all scheduled outpatient consultations. All were satisfied with the result. CONCLUSIONS: The treatment of suppurative perianal hidradenitis and / or gluteal should be individualized according to the extent, severity and degree of interference in the quality of life. Surgical resection with plastic procedures such as rotation of retail in the neighborhood in one step is safe and has satisfactory results and should be considered for chronic cases, extensive and refractory to medical treatment and with large areas resected.

We report a case in which one patient had Dowling-Degos disease (reticulate pigmented anomaly of the flexures), hidradenitis suppurativa, and multiple keratoacanthomas. Abnormal epithelial proliferation involving mainly the pilosebaceous apparatus has been recognized in all three conditions. We speculate that a single underlying defect in follicular epithelial proliferation, characterized by variable expressivity, accounts for the coexistence of these clinically distinct disorders of follicular derivation.

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.

Idiopathic palmoplantar hidradenitis is a new entity consisting of plantar or palmoplantar painful erythematous nodules which affect children in good health. The histopathologic study shows a neutrophilic hidradenitis. We report on 3 new cases of idiopathic plantar hidradenitis and review the literature.

The differential diagnosis for a solitary axillary mass is extensive. Based on the initial history and physical examination of the patient presented in this case report, the diagnosis of suppurative hidradenitis was incorrectly reached. This subjected her to a surgical procedure that was not indicated for the actual diagnosis of ectopic axillary breast tissue. This article reviews the workup for a solitary axillary mass and discusses multiple aspects of ectopic breast tissue.

Clinical and histological similarities between hidradenitis suppurativa and acne have been pointed out. The possible role of sebaceous glands in hidradenitis has not previously been investigated. Acne treatment, in particular is however not effective in hidradenitis. No previous information was found on regional sebum excretion in hidradenitis.Investigate the sebum excretion (SE) and markers of cutaneous virilization in hidradenitis patients.Sebutapes and scores of acne, hirsutes and alopecia in 16 women with hidradenitis suppurativa were compared with 16 healthy controls.The SE and the number of active glands followed a similar pattern in both groups (faceaxillae/genitofemoral fold, p0.0001) but no significant differences were seen between the two groups. No differences were seen in the median Body Mass Index, number of obese persons in either group or any of the clinical markers of virilization studied.No significant axillary, genitofemoral or facial seborrhea was found in hidradenitis. It is suggested that SE is not an important factor in the development of hidradenitis, and this may help explain the generally unsatisfactory therapeutic effect of retinoids in this disease. The results further suggest that general cutaneous virilization is not a feature of hidradenitis.

The scapular island flap technique has been used in the treatment of seven cases of axillary hidradenitis suppurativa. This flap, providing a smooth skin surface with good elastic properties, easily covers the axilla and permits the cutaneous reconstruction of the involved axillary tissue excision with satisfying aesthetic, functional results and a rapid local cicatrization. The donor site was closed by primary suture.

Three patients with Crohn's disease who developed the clinical features of hidradenitis suppurativa (HS) are reported. To our knowledge this association has not been previously described. These cases illustrate the similarity between cutaneous Crohn's and ano-genital HS once chronic and established.