Nodulos plantares dolorosos tras ejercicio intenso en paciente pediátrica: un reto diagnóstico / Painful nodules on the soles in a pediatric patient: a diagnostic challenge

Resumen: Introducción: La Hidradenitis palmoplantar ecrina idiopática (HPPI) es una dermatosis neutrofílica infrecuente, que cursa con nódulos eritematosos dolorosos de comienzo brusco en regiones plantares o palmoplantares, en niños que no tienen otra enfermedad subyacente. Objetivo: Presentar un caso que ilustra las principales características clínicas e histológicas de la HPPI. Caso Clínico: Niña de 11 años evaluada por nódulos eritematovioláceos dolorosos en planta de pie derecho de 48 horas de evo lución y fiebre de hasta 38,2 °C, sin antecedentes de interés salvo hiperhidrosis y práctica intensa de ejercicio en los días previos. Ante la sospecha clínica de HPPI se realizó biopsia cutánea, que mostró infiltrado inflamatorio neutrofílico alrededor de glándulas sudoríparas ecrinas y abscesos de neutrófilos, confirmando el diagnóstico. Se indicaron antiinflamatorios no esteroidales orales y reposo, con resolución de las lesiones en 7 días. Conclusiones: Este caso demuestra los aspectos más importantes de la HPPI. Esta entidad en muchos casos es infradiagnosticada, dado que puede confundirse con otras patologías que también cursan con nódulos acrales dolorosos, pero tienen distintas implicacio nes patogénicas y terapéuticas. Identificar apropiadamente la HPPI permite evitar la alarma innece saria, tanto en pacientes y sus padres, como en los propios dermatólogos y pediatras.

Abstract: Introduction: Idiopathic Palmoplantar Eccrine Hidradenitis (IPPH) is a rare neutrophilic derma tosis, with painful erythematous nodules of sudden onset in the plantar or palmoplantar region, in children without other underlying diseases. Objective: To present a case that shows the main clinical and histological characteristics of this entity. Clinical Case: 11-year-old girl with a 48-hours history of painful erythematous-violaceous nodules on the right foot plant associated with fever of up to 38.2 °C, with no history of interest except hyperhidrosis and intense exercising on previous days. Given the clinical suspicion of IPPH, a skin biopsy was performed, which showed inflammatory neutrophil infiltration around eccrine sweat glands and neutrophilic abscesses, confirming the diagnosis. Oral NSAIDs and rest were prescribed, with resolution of the lesions in 7 days. Conclusions: This case demonstrates the most important aspects of this entity, in many cases underdiagnosed, since it can be confused with other pathologies that occur with painful acral nodules, but have different pathogenic and therapeutic implications. To properly identify the IPPH allows preventing an unnecessary alarm, both patients and their parents, as in dermatologists and pediatricians themselves.

Sports-related skin conditions

Skin diseases associated with athletic activities can be classified as skin infections, inflammatory reactions, trauma, and abnormal proliferation, depending on the cause of the condition. Athlete's nodule is a generic term for reactive nodules that occur in athletes. It is particularly common in the foot due to tight sneakers, repetitive pressure or friction, and inappropriate choice of shoes or other sports equipment. The diagnosis of black heel (calcaneal petechiae) should be considered when numerous black spots occur on the soles in patients who frequently engage in abrupt movements, such as starts, stops, or leaps. Palmoplantar eccrine hidradenitis may occur in athletes who play baseball, dance, and climb, activities in which repetitive and strong stimuli are applied to the floor of the hands and feet. Painful fat herniation should be suspected in cases of painful skin-colored firm nodules on the feet of athletes who place a large amount of weight on their feet when moving. Itching, urticaria, angioedema, chest tightness, and syncope occurring within 5 minutes after starting exercise should be suspected to be exercise-induced angioedema/anaphylaxis. Excessive force can cause deformation of nails, as in tennis toe and jogger's toenail. For the diagnosis and treatment of sports-related skin diseases, it is essential to pay attention to patients' hobbies and exercise habits, including sports, and to consider the relationship of those habits with the presumed mechanisms of the skin disease. In addition, thorough pre-exercise warm-ups, increasing strength gradually, and wearing proper equipment will help prevent the occurrence of sports-related skin diseases.

Skin Infection Caused by Serratia marcescens in an Immunocompetent Patient with Hidradenitis Suppurativa / 대한피부과학회지

No abstract available.

A Case of Idiopathic Palmoplantar Eccrine Hidradenitis in Adult / 대한피부과학회지

No abstract available.

Management of severe hidradenitis suppurativa with biologic therapy and wide excision

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular occlusive disease that involves the intertriginous areas. Treatment methods include conventional topical and systemic medication, radiotherapy, biologic agents, and surgical excision. Of late, there has been an increased focus on the use of biologic agents in patients with moderate to severe HS. Here, we present the case of a 46-year-old man with Hurley stage III HS for whom wide excision was ultimately curative, after aggressive medical therapy with the use of infliximab and adalimumab had succeeded in limiting the body surface area affected by the disease. This case demonstrates the effective treatment of severe HS with a combination of biologic therapy and surgery.

Treatment of Hidradenitis Suppurativa Patient with Klinefelter Syndrome by Adalimumab

Hidradenitis suppurativa (HS) is a chronic, inflammatory and painful skin disease with recurrent nodules and tracts involving the intertriginous regions. It is known that the patient with HS shows an increased risk of metabolic disorders such as diabetes, metabolic syndrome and autoimmune diseases. Klinefelter syndrome (KS) is a sex chromosomal disorder occurring in males due to an abnormality of sexual differentiation, characterized by 47, XXY karyotype. Also, KS is related with somatic comorbidities such as metabolic syndrome, autoimmune and rheumatologic disorders as HS is. We report a HS patient with KS who shows a big improvement while on tumor necrosis factor-alpha inhibitor treatment.

A Case of Moderate Hidradenitis Suppurativa and Psoriasis Treated with Secukinumab

Hidradenitis suppurativa (HS) is a disorder of the apocrine gland causing a chronic, recurrent and painful inflammation. It is a disabilitating condition and, though many therapeutic options are available, the response is often ineffective in most cases and patients can present many recurrences with physical and psychological sequelae. Recent data had shown increased interleukin (IL)-17 serum levels in patients with HS. Psoriasis is a chronic immune-mediated inflammatory disorder and new evidences have shown the role of Th17 cells in its pathogenesis and the therapeutic efficacy of anti-IL-17 antibodies. We present a case of a patient suffering from psoriasis and HS successfully treated with anti-IL-17 antibodies for both conditions. This is the first case report of HS treated with secukinumab.

Recurrent Adult Idiopathic Neutrophilic Eccrine Hidradenitis Treated with Colchicine: A Case Report / 대한피부과학회지

Idiopathic neutrophilic eccrine hidradenitis is usually observed in healthy children with tender erythematous nodules on the soles or palms. We report a case of a 26-year-old man with a painful erythematous swollen patch on both hands and feet. His symptom recurred once monthly over 2 years; thus, he visited Orthopedics. However, no bony abnormality was identified. We performed a skin biopsy on an erythematous indurated patch on his right sole. Histopathological findings indicated neutrophilic eccrine hidradenitis. After 2 weeks of treatment with oral colchicine, his symptom resolved, and no relapses were observed during follow-up. Only a few case reports describe idiopathic neutrophilic eccrine hidradenitis in adults, which is not associated with malignant hematological disease, solid cancer, and chemotherapy. Conventional treatment comprises bed-rest and the administration of topical steroids. Colchicine can be a good treatment option for adults with severe or recurrent idiopathic neutrophilic eccrine hidradenitis.

Comparison of the Efficacy of Systemic Antibiotics and Systemic Retinoids in Hidradenitis Suppurativa / 대한피부과학회지

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory skin disease showing recurrent painful nodules and abscesses. Many treatment modalities, such as topical antibiotics, systemic antibiotics, retinoids, immunomodulators, biologics, and surgical treatment are used to treat the disease, but there is no single effective treatment for hidradenitis suppurativa. OBJECTIVE: We conducted this study to compare the clinical outcomes of treatment with systemic antibiotics and systemic retinoids. METHODS: We analyzed the clinical features, treatment modalities, and clinical outcomes of patients with hidradenitis suppurativa and compared the clinical outcomes of treatment modalities. RESULTS: A total of 77 patients were enrolled. Male patients were predominant, and the mean age was 28.1 years. Buttock (42.0%) was the most commonly affected site and 63 patients (81.8%) had lesions at Hurley stage I. Forty-eight patients (62.3%) were treated with systemic antibiotics and 29 (37.7%) with systemic retinoid. Seventy-one patients (92.2%) showed improvement after a mean treatment duration of 8.3 weeks, and 69 (89.6%) experienced recurrence after improvement. Systemic antibiotics showed a relatively high improvement rate, short mean treatment duration, and low recurrence rate compared with systemic retinoids, but the differences were not statistically significant. Among systemic antibiotics, both tetracycline and macrolide showed good therapeutic effects for HS, but the differences were also not statistically significant. CONCLUSION: In this study, systemic antibiotics were associated with superior treatment outcomes compared to systemic retinoids, though without statistical significance. In the case of mild lesions, treatment with systemic retinoids appears to show comparable effectiveness to systemic antibiotics.

Axillary Reconstruction for Hidradenitis Suppurativa with an Inner-Arm Transposition Flap Creating a Brachioplasty Effect

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic skin condition that can affect any area with apocrine sweat glands and has the potential to involve multiple sites concurrently. Commonly affected sites include the axilla, groin, perineum and perianal areas. In this study we performed a literature review on the surgical methods for HS and describe an innovative technique for reconstructing axilla HS using an inner-arm transposition flap. METHODS: We reviewed all cases (5 cases from 4 patients) of transposition flap reconstruction performed by the senior author at a single London tertiary hospital from 2008–2013. Patient related outcome measures were collected using the Derriford appearance scale (DAS 24) and a study specific questionnaire. RESULTS: All patients were satisfied with their final result. One out of five cases had a complication but did not result in flap failure. There is no disease recurrence to date. DAS 24 scores collected demonstrated acceptable postoperative distress that did not deviate far from the norm tables while study specific questionnaire reveal desirable outcomes. CONCLUSIONS: We have managed to achieve our aim through the use of the innovative inner-arm transposition flap. Our study hopes to provide an additional technique for axillary reconstruction. This technique offers the effective concealment of scars with the benefit of tightening of the arm tissue producing ‘brachioplasty like’ effects. All things considered it would be reasonable to conclude the innovative flap technique is a reliable, effective, and simple method that results in multiple benefits.

Acné conglobata hemorrágico en un adulto joven. Caso clínico y revisión bibliográfica / Hemorrhagic conglobata acne in a young adult. Case report and bibliographic review

Se presenta un paciente adulto joven de 23 años de edad con acné conglobata hemorrágico, de 6 meses de evolución, luego de una limpieza facial. Presenta dolor facial, alza térmica, malestar general, edema y deformidad; además, depresión moderada. En estas lesiones se observa pústulas profundas y abscesos por confluencia de lesiones más pequeñas y se interconectan mediante fístulas; además, se acompañan de coágulos que drenan secreción hematopurulenta al inclinar la cabeza hacia abajo y adelante. Se diagnostica proceso infeccioso y aisla Stafilococcus aureus. Luego de realizar curaciones diarias, administrar antibiótico sistémico por vía oral y tratamiento de apoyo se logra una gran mejoría; además, se instaura tratamiento con isotreinoina durante 6 meses.AU

We present a young adult pacient of 23 years old with hemorrhagic conglobata acne, with six months of evolution after a facial cleansing, accompanied with pain, thermal rise, malaise, edema, face deformity and moderate depression. These lesions have deep postulas and abscesses that are formed by the confluence of smaller lesions and interconnected by fistulas as well as being accompanied by blood clots that drained hematopurulent secretion when tilting the head downward and forward. Infectious process is determined by isolating Staphylococcus Aureus. After daily cures, use of systemic antibiotics for oral vial and supportive treatment, it achieved a clinical improvement and begins a treatment based in isotretinoine by six months. AU

Clinical Characteristics and Epidemiology of Hidradenitis Suppurativa in Korea: A Single-center Study / 대한피부과학회지

BACKGROUND: Hidradenitis suppurativa is a chronic, recurrent, debilitating inflammatory disease characterized by tender subcutaneous nodules, painful deep dermal abscesses, and sinus tracts. However, there are few data regarding the epidemiology of hidradenitis suppurativa in Asian patients. OBJECTIVE: To investigate the clinical features, clinical stages, and associated diseases in Korean patients with hidradenitis suppurativa. METHODS: In all, 53 patients who had visited Chonnam National University Hospital from 2005 to 2014 were included. Their age of onset, distributions, Hurley stage, associated diseases, and conditions were evaluated. RESULTS: Mean onset age was 24.3±12.5 years, with male predominance (male 84.9%, female 15.1%). Lesions occurred most frequently in the buttock (75.5%), followed by the axilla, inguinal area, pubic area, and scalp. In total, 32.1% patients were at stage I, 45.3% at stage II, and 22.6% at stage III according to the Hurley staging system. Further, 58.5% patients were obese and 54.7% were current or ex-smokers. Acne conglobata (47.2%) was the most common associated disease. In addition, 9.4% patients had diabetes mellitus, 1.9% had hypertension, and 7.5% had dyslipidemia. CONCLUSION: Male predominance has been observed for hidradenitis suppurativa in Korea, which is different from that reported in previous studies. Hidradenitis suppurativa is sometimes accompanied by hypertension, diabetes mellitus, and dyslipidemia, and is more common in obese patients and smokers. Compared with non-smokers, smokers including ex-smokers show greater severity of hidradenitis suppurativa. To date, this is the first report on the clinical characteristics and epidemiology of hidradenitis suppurativa in Korea.

Clinical Characteristics and Epidemiology of Hidradenitis Suppurativa in Korea: A Single-center Study / 대한피부과학회지

BACKGROUND: Hidradenitis suppurativa is a chronic, recurrent, debilitating inflammatory disease characterized by tender subcutaneous nodules, painful deep dermal abscesses, and sinus tracts. However, there are few data regarding the epidemiology of hidradenitis suppurativa in Asian patients. OBJECTIVE: To investigate the clinical features, clinical stages, and associated diseases in Korean patients with hidradenitis suppurativa. METHODS: In all, 53 patients who had visited Chonnam National University Hospital from 2005 to 2014 were included. Their age of onset, distributions, Hurley stage, associated diseases, and conditions were evaluated. RESULTS: Mean onset age was 24.3±12.5 years, with male predominance (male 84.9%, female 15.1%). Lesions occurred most frequently in the buttock (75.5%), followed by the axilla, inguinal area, pubic area, and scalp. In total, 32.1% patients were at stage I, 45.3% at stage II, and 22.6% at stage III according to the Hurley staging system. Further, 58.5% patients were obese and 54.7% were current or ex-smokers. Acne conglobata (47.2%) was the most common associated disease. In addition, 9.4% patients had diabetes mellitus, 1.9% had hypertension, and 7.5% had dyslipidemia. CONCLUSION: Male predominance has been observed for hidradenitis suppurativa in Korea, which is different from that reported in previous studies. Hidradenitis suppurativa is sometimes accompanied by hypertension, diabetes mellitus, and dyslipidemia, and is more common in obese patients and smokers. Compared with non-smokers, smokers including ex-smokers show greater severity of hidradenitis suppurativa. To date, this is the first report on the clinical characteristics and epidemiology of hidradenitis suppurativa in Korea.

Retalho fasciocutâneo torácico lateral para reconstrução de defeitos axilares após ressecção de hidradenite supurativa: série de 10 casos / Lateral thoracic fasciocutaneous flap for reconstruction of axillary defects after resection of hidradenitis suppurativa: a series of 10 cases

INTRODUÇÃO: A hidradenite supurativa (HS) é uma inflamação folicular crônica que apresenta quadro clínico variado, desde pequenos nódulos isolados até diversas lesões abscedadas, com formação de fístulas e cicatrizes. A região axilar é uma das áreas mais frequentemente acometidas. O objetivo é analisar uma série de casos acometidos por HS na região axilar, submetidos à exérese cirúrgica ampliada e reconstrução com retalho fasciocutâneo torácico lateral. MÉTODOS: Análise retrospectiva dos prontuários dos pacientes submetidos a tratamento no período entre 2010 e 2012. RESULTADOS: Dez pacientes foram operados, sendo que em dois havia acometimento bilateral, totalizando 12 procedimentos. Foi observado um tempo médio de evolução antes da indicação cirúrgica de 38 meses. O defeito médio observado após a ressecção foi de 10 x 9 cm. O tamanho médio dos retalhos foi de 15 x 10 cm. Em relação às complicações precoces, foram observados dois casos de deiscência (região axilar) e um caso de epiteliólise parcial (segmento distal do retalho). CONCLUSÃO: Observamos que a dissecção deste retalho não é tecnicamente difícil e que não apresenta sequelas funcionais ou estéticas significativas na área doadora, sendo uma opção confiável e versátil para reconstrução de defeitos axilares de maior porte.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic follicular inflammation that presents varied clinical features, from isolated small nodules to several abscessed lesions, with formation of fistulas and scars. The axillary region is one of the most frequently affected areas. The objective is to evaluate a series of patients with HS in the axillary region who underwent extensive surgical excision and reconstruction with a lateral thoracic fasciocutaneous flap. METHODS: A retrospective analysis of the medical records of patients who underwent treatment between 2010 and 2012 was conducted. RESULTS: Ten patients were operated, of whom two had bilateral involvement, totaling 12 procedures. The mean progression time before the surgical indication was 38 months. The mean defect size after the resection was 10 x 9 cm. The mean size of the flaps was 15 x 10 cm. With regard to early complications, two cases of dehiscence (axillary region) and one case of partial epitheliolysis (distal segment of the flap) were observed. CONCLUSION: We observed that dissection of lateral thoracic fasciocutaneous flaps is not technically difficult and does not present significant functional or aesthetic sequelae in the donor area, making it a reliable and versatile option for reconstruction of larger axillary defects.

Surgical treatment of hidradenitis suppurativa with anterior and posterior lateral thoracic fasciocutaneous flaps / Tratamento cirúrgico de hidradenite supurativa com retalho fasciocutâneo torácico lateral anterior e posterior

Introduction: Hidradenitis suppurativa (HS) is a chronic, multifactorial, and often recurrent bacterial infection, affecting the skin and subcutaneous tissues. However, complete HS resolution can be achieved through surgical treatment. A series of patients with HS complications is described herein, along with their evolution and complications after complete axillary surgical resection and lateral thoracic fasciocutaneous flap rotation. The evaluation of associated affected areas is also reported. Methods: Between 2009 and 2014, 6 patients with an average age of 25.5 years (range: 15 to 35 years) underwent surgery for the treatment of HS. All patients had long-standing, chronic axillary lesions that were refractory to non-surgical treatment. Results: Six patients with HS (2 males and 4 females) underwent surgery. The average follow-up period was 16 months (range: 4 months to 5 years). Complete resolution was achieved and no HS recurrence was observed. Bilateral resection was performed in 4 cases, and unilateral resection in 2. Five patients also had inguinal involvement, and 3 had surgery concurrent with the axilla. Five patients had partial dehiscence and serosanguinous discharge, followed by complete scar formation by second intention healing. Conclusion: Surgery is often the most appropriate and definitive treatment for HS. The lateral thoracic fasciocutaneous flap technique is associated with high success rates in this patient population.

Introdução: A hidradenite supurativa (HS) é uma infecção bacteriana crônica, multifatorial e frequentemente recorrente na pele e nos tecidos subcutâneos. No entanto, a resolução completa pode ser conseguida por meio de cirurgia. É descrita uma série de pacientes com complicações de HS, sua evolução, as complicações após a ressecção cirúrgica completa axilar e a rotação de retalho fasciocutâneo torácico lateral, além da análise das áreas acometidas associadas. Métodos: Entre 2009 e 2014, seis pacientes com idade entre 25,5 anos em média (intervalo: 15-35) foram submetidos à cirurgia para HS. Todos os pacientes apresentaram lesões de longa data axilares crônicas refratárias ao tratamento clínico. Resultados: Seis pacientes com HS (dois homens e quatro mulheres) foram submetidos à cirurgia. O período de acompanhamento foi de 16 meses, em média (intervalo: 4 meses - 5 anos). A resolução completa foi alcançada e nenhuma recorrência foi observada. A ressecção foi bilateral em quatro casos e unilateral em dois. Cinco pacientes apresentaram lesão inguinal, das quais três foram operadas no mesmo tempo cirúrgico. Cinco pacientes apresentaram deiscência parcial e descarga serossanguinolenta, seguida de cura completa após cicatrização por segunda intenção. Conclusão: A cirurgia é frequentemente o tratamento definitivo mais adequado para a HS. A técnica de retalho fasciocutâneo torácico lateral está associada a altas taxas de sucesso nesta população de doentes.

Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities

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.

Uso do retalho toracodorsal para tratamento de hidradenite supurativa / Use of the thoracodorsal flap for the treatment of hidradenitis suppurativa

INTRODUÇÃO: A hidradenite é uma doença cutânea crônica, que acomete as regiões que abrigam as glândulas apócrinas. Tem uma prevalência estimada de 1% da população, com predileção pelo sexo feminino. MÉTODO:LMN, 48 anos, sexo feminino. Ao exame, a paciente apresentava nodulações palpáveis, coalescentes, dolorosas e uma área de fibrose e retração cicatricial circunjacente em ambas as axilas, principalmente em axila esquerda. Submetida a exérese ampla das lesões em axila e região torácica esquerda, sendo necessária a realização de um retalho fasciocutâneo de rotação, habitualmente usado em pacientes submetidas à quadrantectomia lateral. RESULTADOS: Obteve-se um resultado estético satisfatório associado à preservação dos movimentos. CONCLUSÃO:Apesar de existirem poucos casos relatando o uso do retalho fasciocutâneo toracodorsal lateral, essa técnica mostrou ser excelente alternativa na reconstrução axilar, devido à facilidade de ressecção, boa cobertura da área receptora além de um resultado estético satisfatório.

INTRODUCTION:Hidradenitis suppurativa is a chronic skin disease that affects the regions harboring the apocrine sweat glands. It has an estimated prevalence of 1% of the population and a preference for the female sex. METHOD: LMN, a 48-year-old female patient, presented, on examination, palpable, coalescent, painful nodules and a circumjacent area of fibrosis and scar retraction in both axillae, mainly in the left axilla. She was subjected to wide excision of the lesions at the axilla and left thoracic region, with a need for a rotational fasciocutaneous flap, usually used in patients who undergo lateral quadrantectomy. RESULTS: A satisfactory aesthetic result was attained, together with the preservation of movements. CONCLUSION: Although there are few reported cases of the use of the lateral thoracodorsal fasciocutaneous flap, this technique is an excellent alternative in axillary reconstruction, owing to the ease of resection, good coverage of the receiving area, and the satisfactory aesthetic result.

Two Clinically Unusual Cases of Folliculotropic Mycosis Fungoides: One with and the Other without Syringotropism

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma, and it rarely exhibits predilection for hair follicle and eccrine gland infiltration. Here, we present 2 similar cases that display folliculotropism with varying amounts of follicular mucinosis, with and without syringotropism. The features observed in both cases were cystic, comedo-like, acneiform lesions; generalized involvement with loss of body hair; pruritus; and hidradenitis suppurativa-like lesions. Hypohidrosis as well as nail and palmoplantar involvement with lichen planopilaris-like clinical features were unique characteristics of the first case. Despite the well-known aggressive behavior of follicular mycosis fungoides, the presented cases had a subtle, slowly progressive, but persistent, clinical course. Folliculotropic and syringotropic mycosis fungoides are variants of cutaneous T-cell lymphoma. Clinical presentations might be challenging, and multiple, deep biopsy specimens containing adnexal structures are required for this critical diagnosis. Aggressive treatment may not be necessary in cases having an indolent course, especially in those with syringotropism.

Neutrophilic Eccinre Hidroadenitis in Acquired Immune Deficiency Syndrome / 대한피부과학회지

Neutrophilic eccrine hidradenitis (NEH) usually occurs in patients receiving chemotherapy for acute myelogenous leukemia or other malignant diseases. We experienced a case of NEH occurring in an HIV (human immunodeficiency virus)-positive 35-year-old male patient. The patient presented with a 1-year history of recurrent erythematous papule on his upper extremity. Laboratory studies showed that Anti-HIV is positive and HIV RNA PCR is 1.02x106. Histopathologic study showed neutrophilic infiltration within and around the eccrine glands and degeneration of the eccrine glands.

Radical Surgical Excision and Use of Lateral Thoracic Flap for Intractable Axillary Hidradenitis Suppurativa

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.