Acne fulminans and its multiple associated factors: a systematic review.

Acne fulminans (AF) is a severe form of acne that presents with an outburst of haemorrhagic pustules and ulcerations, which may or may not be associated with systemic symptoms and laboratory abnormalities. In the latest classification, four variants of AF are considered, but this does not include AF associated with systemic therapies and inherited genetic syndromes. To systematically review disease features and evaluate differences among AF. Related articles were searched using the terms "acne fulminans", "acne conglobata with septicaemia", "acute febrile ulcerative acne" and "pseudo acne fulminans". We searched Medline and Google Scholar from inception to 1977 to identify case reports, case series, commentaries and reviews reporting new AF cases. A total of 98 articles met our inclusion criteria. AF induced by higher levels of androgens more frequently presented nodules and cysts than erosions, crusted and haemorrhagic lesions and necrosis. In contrast, patients affected by AF without any apparent cause (referred to here as "miscellaneous AF") more frequently presented with ulcerations and erosions, and patients with AF associated with systemic treatment showed a similar frequency of lesions. Notably, AF in patients with high levels of androgens and AF induced by antibiotics rarely showed comedones. In addition, aseptic osteolytic lesions were more common in miscellaneous AF than other AF. AF may present with differences in clinical and laboratory features and associated systemic illnesses, which should be evaluated for the planning of a personalized therapeutic scheme. We propose a classification of AF, according to its association with certain factors.

Tumor necrosis factor inhibitors for pediatric patients with SAPHO syndrome associated with acne conglobata.

Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is a rare chronic inflammatory disease with osteoarticular and cutaneous involvements as its main manifestations. Acne conglobata as a severe acne form may affect adolescent patients. Tumor necrosis factor inhibitors are usually used as a second-line therapy for refractory SAPHO syndrome and has been reported to treat acne conglobata successfully. We herein report three cases of adolescent patients with SAPHO syndrome associated with acne conglobata who were successfully treated with TNFi therapy.

A case of 5-aminolevulinic acid photodynamic therapy(ALA-PDT)combined with surgery for the treatment of acne conglobata.

We report the case of a 20-year-old man with acne conglobata (AC) who was treated with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) sequentially to deroofing, and finally used fractional carbon dioxide laser for esthetic requirements, achieving satisfying results. AC is a severe form of acne vulgaris that can lead to significant scarring and has serious negative effects on a patient's psychological well-being and quality of life. Some cases are likely resistant to currently available treatments. This report describes a promising, and effective method for the treatment of AC.

Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA.

BACKGROUND: Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders. OBJECTIVE: Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions. METHODS: From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups. RESULTS: A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others. LIMITATIONS: Our study was limited by its retrospective design. CONCLUSIONS: Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.

Follicular occlusion triad: an isotopic response or adverse effect of rituximab?

Follicular occlusion triad is a symptom complex of three conditions with a similar pathophysiology including hidradenitis suppurativa (HS), dissecting cellulitis of the scalp, and acne conglobata. Although the exact pathogenesis of the triad is unknown, it appears to be related to follicular occlusion in areas with apocrine glands. Wolf isotopic response refers to the occurrence of a new dermatosis at the site of another, unrelated, previously healed dermatosis. We present a 26-year-old man with a history of pemphigus foliaceus (PF) who developed large draining nodules with scarring and sinus tracts, compatible with follicular occlusion triad, preferentially at areas previously affected by PF thirteen months after treatment with rituximab. To the authors' knowledge there are no reported cases of follicular occlusion triad or HS manifesting as an isotopic response. However, one member of the triad, HS, has been reported to occur infrequently following the use of biologic agents such as adalimumab, infliximab, tocilizumab, and rituximab for chronic immune-mediated inflammatory diseases (psoriasis, Crohn disease, rheumatoid arthritis, and ankylosing spondylitis).

Follicular occlusion tetrad in a male patient with pachyonychia congenita: clinical and genetic analysis.

The case of a 24-year-old male patient affected by follicular occlusion tetrad (acne conglobata, hidradenitis suppurativa, pilonidal cyst and dissecting cellulitis of the scalp) associated with clinical signs of pachyonychia congenita (PC)-2 (focal palmoplantar keratoderma, plantar pain, onycodystrophy and multiple cysts) is reported. The diagnosis was supported by genetic analysis that showed heterozygous mutation within the exon 1 of KRT17 gene. This case may reflect different expressions of a phenotypic spectrum induced by a common genetic alteration.

Gluteal hidradenitis suppurativa presenting pemphigus-like findings: case report.

BACKGROUND: Hidradenitis suppurativa is one member of the follicular occlusion triad: acne conglobata, hidradenitis suppurativa, and dissecting cellulitis of the scalp. The presence of acantholysis and desmoglein autoantibodies in hidradenitis suppurativa is rare. CASE PRESENTATION: We report a case of 68-year-old male with a diagnosis of gluteal hidradenitis suppurativa co-presenting pemphigus-like findings including acantholysis and positive desmoglein autoantibodies. CONCLUSION: To our knowledge, comorbidity of gluteal hidradenitis suppurativa and pemphigus-like findings has not been reported before. This case implies a relationship between two different conditions; the follicular occlusion triad and pemphigus, highlighting a potential induction of pemphigus-like lesion by chronic inflammatory process.

Perioperative comprehensive geriatric assessment: what do we need to know?

As a consequence of an ageing population greater numbers of elderly patients are presenting for both elective and emergency surgery. These older patients typically present with an increased burden of age-related problems and multimorbidity, which is associated with an increased risk of adverse postoperative outcomes. Traditional preoperative assessment models are adept at discerning patients' suitability for anaesthesia and surgery, but there is minimal focus on improving postoperative outcomes. Comprehensive geriatric assessment is a multidisciplinary approach used both to assess existing 'known' pathology and to screen for previously undiagnosed issues across medical, functional, social and/or psychological domains. This diagnostic phase then leads to the development and implementation of an individualized 'optimization' strategy across these domains. There is emerging evidence that comprehensive geriatric assessment and optimization in the surgical setting leads to improved outcomes, and it is reasonable to conclude that it would benefit the patient's long-term health.

Scrotal elephantiasis associated with follicular occlusion triad: A case report and literature review.

RATIONALE: Follicular occlusion triad (FOT) is an autosomal recessive inherited disease and no more than 3 variants of the triad have been reported. We give a report in which scrotal elephantiasis is a variant of FOT and further perform a literature review. PATIENT CONCERNS: A 41-year-old man came to us because of a large scrotal cyst and generalized skin lesions that had occurred over the past 10 years. The generalized skin lesions consisted of hidradenitis suppurativa on the perineum and back, acne conglobata in the armpit, and dissecting cellulitis of the scalp. He took antibiotics for a long time but achieved poor effect. Furthermore, he told his father and elder brother also manifested such skin lesions. DIAGNOSES: Magnetic resonance showed a mass in the left scrotum with clear boundaries. A routine blood test showed a high leukocyte level of 12 × 10/L and a hemoglobin content of 78 g/L. C-reactive-protein increased. Series of autoimmune antibody tests were negative. The postoperative pathologic findings showed that the mass was an epidermoid cyst, and hematoxylin and eosin staining showed hyperkeratosis of the skin as well as inflammatory and edematous changes. A diagnosis of a variant of FOT was made. INTERVENTIONS: We removed skin abscesses and lesioned the inner part with hydrogen peroxide. Then we performed an excision of the scrotal lesion. OUTCOME: The patient recovered well and had no evidence of recurrence at a 16-month follow-up. LESSONS: We reported a case in which scrotal elephantiasis was a variant of FOT and surgical intervention played an important role in secondary urologic diseases.

Unusual Course of Acne Conglobata as a Skin Manifestation due to Bilateral Luteoma of Pregnancy

No abstract available.

Tratamiento del acné en la adolescencia / Treatment of acne in adolescents

El acné es la enfermedad dermatológica más común de la adolescencia. Aunque casi todos los casos remiten alrededor de la tercera década de la vida, cuando este problema conlleva una carga emocional para el paciente se requiere indicar tratamiento. En esta actualización, los autores revisan los distintos grados de compromiso de esta patología, el tratami-ento y los niveles de evidencia que tiene cada uno de ellos, con el objetivo de facilitar a los médicos de atención primaria el manejo de los pacientes que presentan esta enfermedad. (AU)

Acne is the most common dermatological condition in adolescents. Even though almost all cases will resolve around the third decade of life, treatment is indicated when this health problem carries an emotional burden for the patient. In this update, the authors review the grades of involvement of the disease and the available treatments according to levels of evidence, with the aim of helping primary care physicians to manage the patients presenting this illness. (AU)

Prevalence and comorbidities associated with hidradenitis suppurativa in Korea: a nationwide population-based study.

BACKGROUND: The prevalence of hidradenitis suppurativa (HS) in Asia is unknown. The associations between HS and other autoimmune disorders have rarely been reported. OBJECTIVE: We sought to determine the prevalence of and diseases associated with HS using the National Health Insurance (NHI) database. METHODS: We examined Korean NHI claim database data from 2007 to 2016. We enrolled all patients with HS and age- and sex-matched control subjects without HS. We estimated the period prevalence of HS and associated comorbidities in Korea. RESULTS: We identified 28 516 patients with HS (61.3% males and 38.7% females). The period prevalence rate was 0.06%, 55.8 patients (95% confidence interval 55.1-56.4) per 100 000 persons, and the female-to-male ratio was 1 : 1.6. HS patients were at significantly increased risk of rheumatoid arthritis, ankylosing spondylitis, type 1 diabetes, ulcerative colitis, type 2 diabetes, hypertension, hyperlipidaemia, acne conglobata, pilonidal cysts, psoriasis, pyoderma gangrenosum, alopecia areata and vitiligo. CONCLUSION: The overall prevalence of HS in Korea was lower than that in Western populations, and male patients predominated.

Síndrome SAPHO en la infancia. Presentación de un caso clínico / SAPHO syndrome in childhood. A case report

El acrónimo síndrome SAPHO (sinovitis, acné, pustulosis, hiperostosis y osteítis) engloba tanto manifestaciones cutáneas como muculoesqueléticas, entre ellas hiperostosis de los huesos y de las articulaciones de la pared torácica anterior, asociado a manifestaciones cutáneas; acné fulminans e hidradenitis supurativa. Los criterios diagnósticos no han sido validados en niños. El tratamiento inicial con antiinflamatorios no esteroideos en ocasiones es insuficiente y puede ser preciso asociar corticoides, fármacos modificadores de la enfermedad, antagonistas del factor de necrosis tumoral o bifosfonatos. Presentamos el caso clínico de un escolar con afectación poliarticular, osteoartritis de articulación esternoclavicular con importante componente inflamatorio y acné conglobata, con buena respuesta al tratamiento con pamidronato por vía intravenosa (AU)

The acronym of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis) combines a cluster of cutaneous and musculoskeletal manifestations, such as hyperostosis of bones of the anterior chest wall associated with acne fulminans and hidradenitis suppurativa. There are no validated diagnostic criteria in children. Nonsteroidal anti-inflammatory drugs are not always sufficient, and the use of corticosteroids, disease-modifying agents, tumor necrosis factor-α inhibitors or bisphosphonates may be necessary. We present the case of a child with polyarticular involvement, osteoarthritis of the sternoclavicular joint with severe inflammatory disorders and acne conglobata, with an excellent response to intravenous pamidronate (AU)