Photogallery. Hidradenitis suppurativa (acne inversa)

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Abstract

Hidradenitis suppurativa (acne inversa) is a chronic, inflammatory, primary follicular disease triggered by follicular occlusion with subsequent inflammation and destruction of the skin appendage, affecting hair follicles located in apocrine gland-bearing body areas. Clinical presentation of hidradenitis suppurativa is extremely variable showing a wide spectrum of cutaneous lesions in different stages of evolution, different pattern of distribution and grades of severity. Traditionally for severity staging the Hurley clinical grading system has been used where stage I stands for mild disease while stage II and III for moderate and severe stages respectively. 2015 classification of Van Der Zee and Jemec proposed 6 phenotypes of hidradenitis suppurativa: regular type, frictional furuncle type, scarring folliculitis type, conglobata type, syndromic type, ectopic type.

We present a photogallery on this problem.

About the authors

Natalya P. Teplyuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800

Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Anna S. Pirogova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: annese@mail.ru
ORCID iD: 0000-0002-2246-1321

Graduate Student

Russian Federation, Moscow

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2. Fig. 1. Patient B., 26 years old. Diagnosis: “Mammary hidradenitis suppurativa, Hurley stage I, regular type”. Breast involvement is common in women. Single inflammatory papules and nodules (“blind” boils) are present without sinus tracts and cicatrization.

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3. Fig. 2. Diagnosis: “Hidradenitis suppurativa, Hurley stage II, regular type”. Outcome of chronic inflammation: ulcerative nodules showing granulation tissue (pyogenic granulomas).

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4. Fig. 3. Patient A., 52 years old. Diagnosis: “Hidradenitis suppurativa of the left axilla, Hurley stage III, regular type”. Diffuse involvement with multiple interconnected sinus tracts. No healthy skin area in the affected region.

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5. Fig. 4. Patient S., 31 years old. Diagnosis: “Hidradenitis suppurativa, groin and perineum involvement, Hurley stage III, regular type”. Sero-purulent discharge from a draining sinus.

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6. Fig. 5. Patient Ch., 54 years old. Diagnosis: “Hidradenitis suppurativa, frictional furuncle type”. In addition to typical areas involvement of sites exposed to enhanced friction abdomen, thighs, buttocks. Usually overweight patients. The photograph shows follicular papules, pustules and characteristic circinate atrophic scars.

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7. Fig. 6. Patient Ya., 31 years old. Diagnosis: “Hidradenitis suppurativa, Hurley stage II, ectopic type”. Face involvement in addition to typical areas (groin, axillary areas). The photograph shows pathognomonic rope-like hypertrophic scar.

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8. Fig. 7. The same patient (see figures 6 and 8). Diagnosis of face hidradenitis suppurativa is based upon the presence of double-ended pseudocomedones, bridging scars and resistance to systemic retinoids (isotretinoin) at 0.8 mg/kg dosage for 2 years.

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9. Fig. 8. The same patient (see figures 6 and 7). Dermoscopy of the axillary region. Double-ended pseudocomedones are considered a pathognomonic clinical sign of hidradenitis suppurativa. These signs usually appear in long-lasting disease. Closed comedones are never present in areas of hidradenitis suppurativa.

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10. Fig. 9. Patient B., 23 years old. Diagnosis: “Hidradenitis suppurativa, Hurley stage III, conglobata type. Follicular occlusion syndrome”. Axillary involvement with severe scarring and limitation of arm mobility. Concomitant diagnosis: acne conglobata with keloids as an outcome on the chest and back.

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11. Fig. 10. Patient P., 27 years old. Diagnosis: “Hidradenitis suppurativa, scarring folliculitis type”. Predominantly follicular papules and pustules, multiple atrophic scars. The formation of sinus tracts and abscesses is unusual, all lesions are small and superficial.

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12. Fig. 11. Patient M., 44 years old. Diagnosis: “Hidradenitis suppurativa, Hurley stage II, PASH syndrome”. One of the 5 types of syndromic hidradenitis suppurativa along with PAPASH, PASS, PsAPASH and SAPHO syndromes. PASH syndrome includes pyoderma gangrenosum, hidradenitis suppurativa and acne conglobata.

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Copyright (c) 2022 Teplyuk N.P., Pirogova A.S.

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