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Old 12-11-2013, 05:42 PM   #1
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Default hidradenitis suppurativa

Hi there boards, I have been here for years and have rarely ever posted anything. Anyway, my wife and I have been together for almost a year now and not too long after we tied the knot she was diagnosed as having this rare chronic skin ailment called hidradenitis suppurativa where her body has developed these lesions all over her body, mostly under her breasts, in between her thighs, and under her underarms. She is currently in stage 1.5 out of three stages. My wife is about 5" and 270 pounds, and she is now speaking to me about going through with the WLS to get the gastric sleeve in hopes that she will be able to neutralize her HS that way and send it completely back into remission and not have to take this extremely expensive medication (Doryx) anymore. My question is whether or not many of you have ever heard of this disease, and what have you all done about it? I feel really terrible about this whole situation, when we first got together she was around 180 pounds, and I found her attractive, but over the years as she got to be 280 when we got married I found her to be extremely sexy, and now I'm worried if she goes through with the WLS and gets the sleeve that she says that she just wants to get back to the weight when we first got together I'm worried that it's going to affect our relationship in the bedroom. But then again I really care and love her, and don't want to see her suffer anymore. I guess I'm just in a spot where I'm not sure what I should do. Any feedback would be greatly appreciated, thanks.
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Old 12-13-2013, 02:45 AM   #2
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Default (HS) or hidradentis suppurativa info.

Hi Loki,

I am sorry to hear of your wife's affliction with HS. I sympathize with you as well because it sounds like this stuff messes with everyone's life. First, I want to tell you I am not a doctor. I have a undergraduate degree in Biology, and MS in Toxicology, and a boat load of practical experience with a close relative of HS. For five or more horrible years I had pyoderma gangrenosum which is worse than HS (if there is such a thing). My problem is cured now by the marvelous doctors at the University of Arkansas - a teaching hospital. And if your wife is not treated at one of Maryland's fine teaching hospitals, I would take her to one ASAP. Most of them take people with no insurance and will let you pay what you can. Most of them will give you needed drugs and others supplies on the same basis.

I am not criticizing your current physician. With my skin disorder it took and handful of doctors to get me straightened out. What she needs is a team of minds working on this thing. I reviewed a small part of the research in the last 10 years and it is baffling. I also found three doctors at the John Hopkins whose credentials specifically list advanced work with hidradentis suppurativa. To help you get into to see these doctors faster - her current doctor should even be able to refer you to their clinic (ask the nurse).

Because this post is so long and my computer is so weird, I am going to have to split this up into several posts (probably three). So bear with me.
The first set of info is teaching hospitals in Maryland and how to get in touch with them.


Some Teaching hospitals in Maryland
1. Holy Cross Hospital is located at 1500 Forest Glen Road in Silver Spring, Maryland.
http://www.holycrosshealth.org/finan...and-assistance
The hospital is just north of Washington, D.C., and near the Capital Beltway and Metro.
Holy Cross Hospital primarily serves residents of the state's two largest jurisdictions, Montgomery and Prince George's counties.
For more information, please see the links on the left or call 301-754-7000

2. John Hopkins Hospital
http://www.hopkinsmedicine.org/the_j...tal/index.html
(Below are 3 doctors who specialize in hidradentis suppurativa.)

Hinds, Ginette Ayanna, MD
Assistant Professor of Dermatology, Director, Ethnic Skin Program
Appointment Phone: 410-550-0503 , Primary Location: Johns Hopkins Bayview Medical Center
Expertise, Disease and Conditions: Dermatology, Ethnic skin, Hidradenitis suppurativa, Hyperhidrosis, Sarcoidosis
----------------------------------------------------------------------
Puttgen, Katherine Brown, MD
Assistant Professor of Dermatology, Interim Director, Pediatric Dermatology
Medical Co-Director, Center for Sweat Disorders
Appointment Phone: 410-955-5933 - Primary Location: The Johns Hopkins Hospital
Expertise, Disease and Conditions: Acne, Atopic Dermatitis, Autoimmune Skin Diseases, Birthmarks, Botulinum Toxin Injections, Children's Skin Diseases, Cutaneous Laser Surgery, Dermatologic Surgery, Dermatology, Hidradenitis suppurativa, Hyperhidrosis, Infantile Hemangiomas, Pediatric Dermatology, Psoriasis, Vascular Malformations

Sacks, Justin Michael, MD, Assistant Professor of Plastic and Reconstructive Surgery
Appointment Phone: 443-997-9466 - Primary Location: Johns Hopkins Outpatient Center
Expertise, Disease and Conditions: Expertise, Disease and Conditions
(Snipped) Hidradenitis suppurativa, Lymphatic Surgery, Lymphedema, Microvascular Reconstruction, Microvascular Surgery, Pelvic Reconstruction, Plastic Surgery, Reconstruction After Cancer, Reconstruction After Skin Cancer, (snipped)


3. Sinai Medical Centers and Hospital, Division of Dermatology,
2401 West Belvedere Avenue, Baltimore, MD 21215, Phone: 410-601-WELL http://www.sinai-balt.com/Sinai/Sinai1.aspx

4. University of Maryland (Has numerous hospitals at various locations) - One is . . . . Maryland General Hospital
For more information about Maryland General or any of its services,
call HealthLink 2000 at 410-225-2000
or visit http://www.marylandgeneral.org/. or http://www.umms.org/
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Old 12-13-2013, 03:14 AM   #3
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Default Some research on treatment of HS

I am sending you twelve articles, but I will have to divide them into six now and six on the next post. You mentioned your wife is taking Doryx with is another name for Doxycycline (a tetracycline antibiotic). Some of the articles mention using other weapons in addition to antibiotics as a kind of arsenal of treatments. One of the most recent articles has even a more interesting approach - See Study #2.

Article #1
http://www.ncbi.nlm.nih.gov/pubmed/19036028

Br J Dermatol. 2008 Dec;159(6):1309-14. doi: 10.1111/j.1365-2133.2008.08932.x.
Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser.
Madan V, Hindle E, Hussain W, August PJ.
Source
Laser Division, The Dermatology Centre, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Salford, Manchester M6 8HD, UK. vishalmadan@doctors.org.uk
Abstract
BACKGROUND:
Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition.
OBJECTIVES:
To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments.

METHODS:
HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire.
RESULTS:
Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement.

CONCLUSIONS:
CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.

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Article #2
http://www.ncbi.nlm.nih.gov/pubmed/24173910

Lasers Med Sci. 2013 Oct 31. [Epub ahead of print]
The diverse application of laser hair removal therapy: a tertiary laser unit's experience with less common indications and a literature overview.
Koch D, Pratsou P, Szczecinska W, Lanigan S, Abdullah A.
Source
Birmingham Regional Skin Laser Centre, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Dudley Road, Birmingham, B18 7QH, UK, dimikoch@virginmedia.com.
Abstract
We describe the diversity of indications for laser hair removal (LHR) therapy and compare our experience with the literature. Patients' case notes referred to the Birmingham Regional Skin Laser Centre between 2003 and 2011 for laser hair removal, with indications other than hirsutism, were reviewed retrospectively.

Thirty-one treated patients with the following indications were identified: hair-bearing skin grafts/flaps, intra-oral hair-bearing flap, Becker's naevus, localised nevoid hypertrichosis, peristomal hair-bearing skin, scrotal skin prior to vaginoplasty in male-to-female (MTF) gender reassignment, pilonidal sinus disease (PSD), pseudofolliculitis barbae (PFB) and hidradenitis suppurativa (HS). Seven patients with the following indications have been reported before: intra-oral hair-bearing graft, naevoid hypertrichosis and peristomal hair-bearing skin.

A clinical review of the evidence available for each indication is provided. Our experience and that in the published literature suggest that LHR is a safe, well-tolerated and effective treatment modality for the indications we report, leading to significant symptom and functional improvement with high patient satisfaction. LHR appears effective in the treatment of chronic inflammatory conditions such as PSD, PFB and HS, particularly at an early disease stage. We aim to increase awareness of the diversity of laser hair removal indications and add evidence to the medical literature of the wide range of indications for this useful treatment modality.
PMID: 24173910 [PubMed - as supplied by publisher]

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Article #3
http://www.ncbi.nlm.nih.gov/pubmed/19067039

World J Surg. 2009 Mar;33(3):481-7. doi: 10.1007/s00268-008-9845-9.
Surgical approach to extensive hidradenitis suppurativa in the perineal/perianal and gluteal regions.
Balik E, Eren T, Bulut T, Büyükuncu Y, Bugra D, Yamaner S.
Source
Department of General Surgery, University of Istanbul, Istanbul Faculty of Medicine, Istanbul, Turkey. ebalik@istanbul.edu.tr
Abstract
BACKGROUND:
Verneuil's disease, or hidradenitis suppurativa, is a chronic suppurative disease with a tendency to sinus formation, fibrosis, and sclerosis. It is a disease of the apocrine sweat glands and may arise from each of the localizations where apocrine glands are prominent: axilla, nipples, umbilicus, perineum, groin, and buttocks. Extensive hidradenitis suppurativa of the perineal/perianal and the gluteal regions constitute a serious social problem. In this study, we present our experience with stage III extensive hidradenitis suppurativa cases, including our treatment methods and patient outcomes.

METHODS:
A retrospective review of the medical records from January 1990 to July 2003 of 15 patients was performed.
RESULTS:
Fifteen patients underwent treatment for extensive hidradenitis suppurativa in the gluteal, perineal/perianal, and inguinal areas with total surgical excision. All patients were men (100%) and their mean age was 42.5 (range, 23-66) years. The patients underwent a total number of 21 operations. In 11 patients wounds were left open for secondary healing, and the mean time for complete wound healing in this group was 12.2 (range, 9.5-22) weeks
. Two patients underwent primary wound closure by the application of rotation flaps, and their complete healing times were observed to be approximately 2 weeks. Delayed skin grafting was used for the remaining two patients in whom the wounds had been left open after the initial operation. In this group, complete wound healing took a total of 8 weeks

Only one diverting colostomy was needed in a patient in the delayed skin-grafting group. Squamous cell carcinoma was diagnosed in the specimens of one patient treated with total excision followed by the application of a rotation flap. This patient had had complaints of gluteal discharge for approximately 30 years. The cancer recurred after 6 months in the perianal region and immediate abdominoperineal resection was performed. He died during the second postoperative month due to systemic spread of the malignancy. At the end of a 5-year mean follow-up period, all remaining patients had no evidence of disease.

CONCLUSIONS:
Conservative treatment methods have little or no effect on extensive perineal/perianal hidradenitis suppurativa. Therefore, total surgical excision must be considered for these patients to prevent further complications, such as abscess, sinus tract formation, fistulization, and scarring. A temporary stoma may be needed in some cases. Because wound management after total excision is performed via different methods according to each individual patient, multidisciplinary team work is necessary and the patients often require a long hospital stay. If the treatment is not performed in an appropriate manner or if the patients are not followed closely until definitive healing, recurrence is almost inevitable.
Despite the low incidence of accompanying squamous cell carcinoma, it is the most serious complication. We evaluated 15 patients to present our experience with extensive perineal/perianal and gluteal hidradenitis suppurativa.

Also consider Hyperbaric oxygen therapy as an adjunct to surgical treatment of extensive hidradenitis suppurativa. [World J Surg. 2010]
Surgical approach to extensive hidradenitis suppurativa
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Article #4
http://www.ncbi.nlm.nih.gov/pubmed/12847371

Dis Colon Rectum. 2003 Jul;46(7):944-9.
Gluteal and perianal hidradenitis suppurativa: surgical treatment by wide excision.
Bocchini SF, Habr-Gama A, Kiss DR, Imperiale AR, Araujo SE.
Source - Division of Colorectal Surgery, University of São Paulo, Brazil.
Abstract
PURPOSE:
Hidradenitis suppurativa is a chronic inflammatory disease of the skin and subcutaneous tissue. Extensive gluteal and perianal disease represents a challenge presentation. The aim of this study was to present results of management of extensive hidradenitis suppurativa in gluteal, perineal, and inguinal areas.
METHODS:
From January 1980 to May 2000, 56 patients underwent treatment of hidradenitis suppurativa in gluteal, perineal, and inguinal areas through wide excision; 52 (93 percent) were male and 36 (64 percent) were white. Mean age was 40 years. We evaluated distribution of disease, associated conditions, use of diverting colostomy, management of operative wounds, time to complete healing, complications, and recurrence.

RESULTS:
Twenty-one (37.6 percent) and 17 (30.6 percent) patients had gluteal and perineal disease, respectively. Squamous-cell carcinoma and Crohn's disease were observed in one patient each. Wide surgical excision was performed in all. Healing by second intention was the choice in 32 (57.1 percent) patients, and 24 (42.9 percent) patients underwent delayed skin-grafting. Diverting colostomy was used in 23 (41 percent) patients. Mean time for complete healing in the nongrafted group was 10 (range, 7-17) weeks and in the skin graft group was 6 (range, 3-9) weeks. New resection was performed in five (8.9 percent) patients. Partial graft loss rate was 37.5 percent and recurrence was observed in only one (1.8 percent) patient.


CONCLUSION:
Significant morbidity derives from extensive gluteal and perineal hidradenitis suppurativa caused by the disease extension and large wounds that result from surgical treatment. Wide surgical excision is the treatment of choice and leads to cure. Skin-grafting and healing by second intention lead to effective wound healing.
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Old 12-13-2013, 03:52 AM   #4
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Default Can you take one more batch?

On a sidebar, your post asked some questions that cannot be answered with research. You indicated your wife is considering WLS. You probably need to discuss this with any specialist you guys hire for the HS. Find out if the two risks (sometimes the HS is cured surgically) will both be tolerated and do-able.

You also mentioned that you love her the way she is. I admire you for that. You're a good man. A sweetheart like you should love her, and she you, thru both of your highs and lows. She'll probably take care of you when you get sick too. Mr M2M and I are coming up on our 34th anniversary in a couple of weeks - believe me, you both will take your turns in sick bay. And every now and then you both will be sick at the same time.

Ready for the last of my research articles?

Please note that Article 7 agrees with your current doctor's course of medication as your described it on your post.
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Article #5
http://www.ncbi.nlm.nih.gov/pubmed/23373365

Acta Chir Iugosl. 2012;59(2):91-5.
Surgical treatment of chronic hidradenitis suppurativa in the gluteal and perianal regions.
Bilali S, Todi V, Lila A, Bilali V, Habibaj J.
Source
General Surgery Clinic, University Hospital Center "Mother Teresa", Tirana, Albania.
Abstract
INTRODUCTION:
Verneuil disease, or perianal hidradenitis suppurativa (HS), is a chronic suppurative disease with a tendency to develop sinus formation, fibrosis, and sclerosis, having a great impact on quality of life. HS affect the apocrine sweat glands or sebaceous glands and may arise in each of the regions where the apocrine glands are prominent: the axilla, breast aureole, umbilicus, perineum, groin, and buttocks. We present here moderate and extensive HS cases, with their respective treatment methods and outcomes.
METHODS:
A retrospective review of 6 patients' medical records from January 2001 to December 2010.
RESULTS:
The 6 patients underwent treatment for HS in the gluteal and perianal regions with surgical excision. Five of the patients were male (83%). The median age was 42.5 years. We performed a total of 8 operations on these patients. In 3 patients, the wound was left open for secondary healing, and the mean time for complete wound healing was 11.3 weeks (range: 9.5-19 weeks). Delayed skin grafting was used for 2 patients in whom the wounds had been left open after the first operation. In this group, complete wound healing took 2 months in total. One patient underwent primary wound closure using rotation flaps, with a complete healing time of 2 weeks. Successful treatment without recurrence was accomplished in 5 (83.3%) of the patients.
CONCLUSION:
The conservative treatment methods had little effect, particularly on gluteal and perianal/perineal HS. The only successful treatment was wide surgical excision. Management of the wound after wide excision should be tailored to the individual patient.

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Article #6
http://www.ncbi.nlm.nih.gov/pubmed/21976179

Microsurgery. 2011 Oct;31(7):539-44. doi: 10.1002/micr.20918. Epub 2011 Aug 23.
Superior and inferior gluteal artery perforator flaps in reconstruction of gluteal and perianal/perineal hidradenitis suppurativa lesions.
Unal C, Yirmibesoglu OA, Ozdemir J, Hasdemir M.
Source
Plastic Reconstructive and Aesthetic Surgery Department, Kocaeli University Medical Faculty, Umuttepe, Izmit, Turkey. cigdem_unal_75@hotmail.com
Abstract
BACKGROUND:
Hidradenitis suppurativa is a debilitating disease with a tendency to form abscesses, sinus tracts, and scar formation. In this report, our experience with reconstruction of hidradenitis lesions of the gluteal and perianal/perineal area using superior and inferior gluteal artery perforator flaps (SGAP and IGAP) are discussed.

PATIENTS:
A prospective study was conducted in collaboration with the general surgery department for patients with gluteal and perianal/perineal hidradenitis suppurativa between December 2005 and May 2010. Data of each patient included age, sex, disease localization, duration of symptoms, comorbidities, size of defect after excision, perforator flap chosen, complications, and postoperative follow-up.
RESULTS:
Eleven SGAP and six IGAP flaps were used in 12 patients with gluteal and perianal/perineal involvement. There was one flap necrosis for whom delayed skin grafting was performed. The mean follow-up period was 20 months without recurrences.
CONCLUSION:
Patients with gluteal and perineal/perianal hidradenitis suppurativa are usually neglected by surgeons because of lack of collaboration of general and plastic surgery departments. Most surgical treatment options described in the literature such as secondary healing after excision and skin grafting prevent patients from returning to daily life early, and cause additional morbidities. Fasciocutaneous flaps other than perforator flaps may be limited by design such that both gluteal regions may have to be used for reconstruction of large defects. SGAP and IGAP flaps have long pedicles with a wide arc of rotation. Large defects can be reconstructed with single propeller flap designs, enabling preservation of the rest of the perforators of the gluteal region.

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Article #7
http://www.ncbi.nlm.nih.gov/pubmed/22676319

Am J Clin Dermatol. 2012 Oct 1;13(5):283-91. doi: 10.2165/11631880
Pharmacologic interventions for hidradenitis suppurativa: what does the evidence say?
Alhusayen R, Shear NH.
Source - Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. raed.alhusayen@sunnybrook.ca
Abstract – BACKGROUND - Hidradenitis suppurativa is a chronic debilitating skin disease that is recalcitrant to treatment.
OBJECTIVE:
The aim of this article was to conduct an evidence-based review of pharmacologic interventions for the treatment of hidradenitis suppurativa (HS).
METHODS:
A systematic search of MEDLINE, EMBASE, and the Cochrane database was conducted to identify controlled trials (randomized controlled trials, cohorts, and case-control studies) published in English. The abstracts were examined using predetermined inclusion and exclusion criteria. The identified studies were used to develop the recommendations. Clinically relevant outcomes that were assessed were: clinical remission, patient global assessment, physician global assessment, number of skin lesions, and improvement in Hurley's stage, or Sartorius score.
RESULTS:
Overall there was sparse evidence to support the use of any treatment modality. There is fair evidence to support the use of antibacterials in HS and they should be used as first-line therapy (level II-1/grade B). There is fair evidence to support the use of intravenous infliximab in the treatment of advanced HS (Hurley's stage II and III). Given the high cost of anti-tumor necrosis factor therapy and its adverse-effect profile, intravenous infliximab should be offered to patients with severe disease affecting their daily activities who have failed antibacterial therapy (level I/grade B). There is insufficient evidence to support the use of antiandrogens in HS; consideration could be given to their use in women with mild to moderate disease (Hurley's stage I and II) who have failed antibacterial therapy and women with an abnormal hormone profile (level II-2/grade I).
CONCLUSIONS:
The existing evidence suggests that antibacterials and anti-tumor necrosis factor therapy are effective in the treatment of HS. Further research is required to confirm the efficacy of the different medications within these groups and to explore the efficacy of other treatment modalities

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Article #8
http://www.ncbi.nlm.nih.gov/pubmed/24278084

Postepy Dermatol Alergol. 2013 Aug;30(4):255-260. Epub 2013 Aug 27.
Acne inversa goes an extra mile than hidradenitis suppurativa.
Witmanowski H, Szychta P, Stępniewski S, Mackiewicz-Wysocka M, Czyżewska-Majchrzak L, Wasilewska A.
Source
Department of Plastic, Reconstructive and Aesthetic Surgery, Collegium Medicum , Nicolaus Copernicus University, Bydgoszcz, Poland. Head: Prof. Henryk Witmanowski MD, PhD ; Department of Physiology, Poznan University of Medical Sciences, Poland. Head: Prof. Hanna Krauss MD, PhD.
Abstract
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.

(M2M’s comments – this article has some actual photographs of individuals with hidradentis suppurativa. The photographs are graphic – medical journals show real problems in hopes some patients will be relieved of their suffering.)

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Article #9
http://www.ncbi.nlm.nih.gov/pubmed/21426594

[Treatment options in severe hidradenitis suppurativa].
Mooij JE, van't Oost L, Leenarts MF, Mekkes JR.
Source
Academisch Ziekenhuis, afd. Dermatologie, Maastricht, the Netherlands. je.mooij@mumc.nl
Abstract
Hidradenitis suppurativa is a chronic skin disease, characterized by painful, deep-seated inflamed lesions, mainly in areas bearing apocrine sweat glands, most commonly the axillary and inguinal regions. Pain leads to mechanical problems, and bacterial growth in the lesions produces a foul-smelling discharge, which reduces the quality of life. In this type of hidradenitis the infection occurs around hair follicles and sebaceous glands, in contrast to what the name would suggest (hidradenitis = sweat-gland inflammation); hidradenitis suppurativa can, therefore be regarded more as a form of acne. The aetiology of hidradenitis is still unknown, but associated factors are smoking, obesity and familial predisposition.

The syndrome can take a severe and disabling course. It is worthwhile implementing aggressive treatment at an early stage. Tumour necrosis factor-alpha inhibitors are now employed in the treatment of severe and treatment-resistant forms of hidradenitis suppurativa; under certain conditions this treatment will be reimbursed by the health insurance company. This development means that there are more treatment possibilities in hidradenitis than there were 5 years ago. The best results are achieved with a combination of antibiotic, anti-inflammatory and surgical treatment, tailored to the patient's individual situation.

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Article #10
http://www.ncbi.nlm.nih.gov/pubmed/20965015

Actas Dermosifiliogr. 2010 Oct;101(8):717-21.
[Pyoderma gangrenosum associated with hidradenitis suppurativa: a case report and review of the literature]. [Article in Spanish]
García-Rabasco AE, Esteve-Martínez A, Zaragoza-Ninet V, Sánchez-Carazo JL, Alegre-de-Miquel V.
Source - Consorcio Hospital General Universitario de Valencia, España. anagrabasco@gmail.com
Abstract
Pyoderma gangrenosum is an inflammatory disease that has been found to be associated with many systemic illnesses. The case presented here is of a man with a 20-year history of hidradenitis suppurativa who developed pyoderma gangrenosum. The pyoderma lesions appeared as a single outbreak which resolved totally after immunosuppressive treatment. This association has been reported only rarely in the literature. Furthermore, in the cases reported, no relationship was apparent between the activity of both diseases. In all cases the clinical course appeared independent, with no apparent overlap in inflammatory activity or response to the drugs administered.


M2M's comment - my pyoderma gangrenosum was finally cured by an old orphan drug that was now being tested on other skin disorders - thalidomide.
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Old 12-17-2013, 09:35 AM   #5
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Thank you, I appreciate all of the time and effort that you put into writing this post and I'll definitely check them all out. Thank you very much and Happy Holidays to you and your family!
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Old 12-17-2013, 07:32 PM   #6
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Default

Loki, You're very welcome. I hope you guys have a nice Christmas and a fun New Years too. I hoped some of the info help your wife.

One little thing I forgot to mention about teaching hospitals, in almost all of my appointments I usually was seen by several doctors at once. Usually they send in a couple of students or interns. Then their work is reviewed and checked by a very experienced doctor with lots of seniority. Quite often I would be seen by the top Dermatologist in our state. He was the chief of the medical school and the #1 in clinics and the classrooms.

For this privilege, I got to play "lab rat" for 15 minutes or so. A few times, Chief would bring in six different students and he would have some take a biopsy, have some do interviews, and have another check for other forthcoming hot spots on me. After I realized this show and tell was for the students' benefit and I could help with their education, I wouldn't let people standing around watching phase me. I was the only one in the room with my pants down - so what? It was just another day in the neighborhood.

During my entire time I was treated with courtesy and kindness. Everyone from the nurses, receptionists. and the doctors were professionals.
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Old 12-19-2013, 05:37 AM   #7
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Cookie that was so kind of you to compile all that information.
You are so kind hearted, but it does not surprise me one bit that you did this.
xo
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Old 01-02-2014, 09:40 AM   #8
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I have wondered if I have HS DUE to the boils I get. I tried doxycycline and it was to harsh for me. The next thing my doctor had me try was using mupricin in my nose for 7 days and also using a clorohexdine wash for 10 days every 3 months. It seems to help.

Also, my doctor says it has to do with insulin resistance. I am on metformin but not sure that has helped.

The last thing I want to mention is spironolactone. After researching on the web that If someone has to much testosterone like me because of pcos that could be the problem and spironolactone can help. It also helps with unwanted hair growth. I have been unable to get my doctor to prescribe it though.
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Old 01-02-2014, 11:54 AM   #9
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I had a lot of problems with something that appeared to be very close to early stage HS from around age 21-31. But my dermatologist would not confirm a diagnosis because there were a couple contradictory factors. I was also having lesions in areas not usually assocated with HS, and the lesions would go away on their own without antibiotics or other medical intervention.

They improved very quickly when I stopped taking oral contraceptives, was prescribed Metformin and Spironolactone by my endocrinologist for PCOS, and I started restricting my carbohydrate intake. Within a few years of making those medication and dietary changes they all but disappeared.

For the past 10 years, I have only ever seen them right before my period. And then maybe one or two, whereas beforehand I would have up to a half dozen on my body at any given time. And I only see them in areas of my body where clothing binds and rubs. And they come and go within a week, rarely erupting, and only leaving a small purplish dot on my skin that fades over time. The only times in the past decade I have ever had more than one or two or had them at any time other than before my period, has been when I eat more carbs than usual. But then I tighten down my diet again and they go away.

So for me, it's obviously hormonal, related to excess androgen and insulin resistance. I guess that the hormonal fluctuation before my period is enough to trigger a minor outbreak.

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Old 05-30-2015, 07:21 PM   #10
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Hi there, I also have HS as well as PCOS. I was first DX with HS and after stopping birth control...my SX of PCOS arose! If your wife ever wants to talk or anything!!! I have managed to keep my HS under control with no medication ( the only meds i take is for my PCOS and I take Metformin ER)
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