Application of surgical removal and setons abscess drainage management in patients with moderate and severe acne inverse at gluteal and perianal area / 中华医学美学美容杂志

Objective:To investigate the application value and effect of surgical removal and setons abscess drainage in moderate and severe acne inverse.Methods:A retrospective case study of 4 patients (3 males and 1 female with an average of onset of 28 years) with acne inverse at gluteal and perianal area in the Qixia Traditioal Chinese Medical Hospital of Shandong province between June 2016 and August 2020, The operative technique was based on the complete excision of the entire diseased skin and subcutaneous fatty tissue, down to the muscular fascia. The cavity was explored using a probe, two setons were placed in each of the fistula tracts, and the wound were covered with absorptive dressing.Results:All the wounds in 4 patients healed primarily and showed no recurrence after surgery, execpt for one patient who did not take supine position in time after operation which resulted in more bleeding in a short time. The other patients recovered well. The patients were followed up for 6 months without affecting the anal skin function, skin lesions and recurrence.Conclusions:The technique of wide surgical excision and setons abscess drainage is an effective method for moderate and severe acne inverse.

Tratamiento quirúrgico en fístulas pilonidales en el síndrome de oclusión folicular / Surgical Treatment in Pilonidal Fistulas in Follicular Occlusion Syndrome

Introducción: el síndrome de oclusión folicular está compuesto por acné inverso, acné conglobata y la fístula pilonidal (triada); cuando se asocia la foliculitis disecante del cuero cabelludo entonces constituye la tétrada de oclusión folicular. El acné inverso es una enfermedad supurativa, crónica e invalidante, cuyas características clínicas son la presencia de comedones con múltiples aberturas que vinculan dos o más folículos, abscesos con comunicaciones epitelizadas, y sinus drenantes en regiones con glándulas apocrinas. La génesis de estas afecciones es básicamente genética con expresión dermatológica. Objetivo: caracterizar física e histopatológicamente a los pacientes que padecen de síndrome de oclusión folicular, así como, los resultados del tratamiento quirúrgico de la fístula pilonidal en este trastorno. Método: estudio del comportamiento de la fístula pilonidal en el síndrome de oclusión folicular en 37 enfermos con síndrome de oclusión folicular en Hospital Lenin. Se utilizó la exéresis local de las fístulas pilonidales y perianales, esta exéresis se extendió por el tejido celular subcutáneo hasta la facia. Luego la zona se reparó con injerto libre de piel. Resultados: la fístula pilonidal se presentó en cuatro pacientes de los estudiados con largos períodos evolutivos, los cuales fueron tratados con autoinjerto libre de piel. La hiperqueratosis, así como, la perifoliculitis fueron los cambios histopatológicos de mayor relevancia. Conclusiones: la fístula pilonidal es de difícil manejo en el curso del síndrome de oclusión folicular y solo encuentra solución en el tratamiento quirúrgico con autoinjerto libre de piel.

Introduction: follicular occlusive syndrome includes inverse acne, acne conglobata and pilonidal fistula (triad); when it is associated to the dissecting folliculitis of the scalp then it constitutes the tetrad of follicular occlusion. Reverse acne is a suppurative, chronic and invalidating disease. Its clinical features are the presence of comedones with multiple openings that link two or more follicles, abscesses with epithelial communications, and draining sinuses in regions with apocrine glands. The genesis of these affections is basically genetic with dermatological expression. Objective: to describe physically and histopathologically the patients with follicular occlusion syndrome, as well as the results of surgical treatment of pilonidal fistula in this disorder. Method: the study is on the prevalence of pilonidal fistula in follicular occlusion syndrome in 37 patients with follicular occlusion syndrome. The local excision of the pilonidal and perianal fistulas was performed, this exeresis extended by the subcutaneous cellular tissue until the facia. The area was then repaired with a skin-free graft. Results: four patients had the pilonidal fistula, with long periods of evolution, who were treated with autograft of skin. Hyperkeratosis, as well as, perifolliculitis were the most relevant histopathological changes. Conclusion: the pilonidal fistula is difficult for follicular occlusion syndrome management and only the surgical treatment is the most suitable .