The experience of follicular occlusion syndrome treatment with tumor necrosis factor inhibitors

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Abstract

Follicular occlusion syndrome consists of several conditions that share similar pathophysiology involving infundibular follicular occlusion and secondary inflammatory cascade. This syndrome includes hidradenitis suppurativa, dissecting cellulitis of the scalp, acne conglobata and pilonidal sinus. They can develop independently or as a component of a syndrome in different combinations.

We are the first to present a clinical case of follicular occlusion tetrad and intermediate therapy outcome with tumor necrosis factor inhibitors. We also provide a full and updated review of the literature on the etiology and pathogenesis, diagnosis and treatment of similar syndromic conditions.

Currently, there is no reliable algorithm of treatment for patients with follicular occlusion syndrome, which underlines the importance of further studies. The presented clinical case confirms the need for timely administration of genetically-engineered biological drugs to patients with diseases of the follicular occlusion group (before sinus tract formation).

About the authors

Natalya P. Teplyuk

The First Sechenov Moscow State Medical University (Sechenov University)

Email: teplyukn@gmail.com
ORCID iD: 0000-0002-5800-4800
SPIN-code: 8013-3256

MD, Dr. Sci. (Med.), Professor

Russian Federation, 8-2 Trubetskaya street, 119991 Moscow

Svetlana A. Konchina

The First Sechenov Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: konchina.svetlana@yandex.ru
ORCID iD: 0000-0003-2038-1472

Student

Russian Federation, 8-2 Trubetskaya street, 119991 Moscow

Anna S. Pirogova

The First Sechenov Moscow State Medical University (Sechenov University)

Email: annese@mail.ru
ORCID iD: 0000-0002-2246-1321
SPIN-code: 1419-2147

MD, Graduate Student

Russian Federation, 8-2 Trubetskaya street, 119991 Moscow

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Supplementary files

Supplementary Files
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1. JATS XML
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2. Fig. 1. The lesions are located on the scalp, we can see an inflammatory node on the vertex of the scalp with developing scarring alopecia. Cutaneous clefts are visible and more easy to recognize on trichoscopy.

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3. Fig. 2. Note the posterior ear lesions which is an area of occlusion, that can explain why hidradenitis suppurativa manifests there typically.

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4. Fig. 3. Bilateral hidradenitis suppurativa of the armpits, multiple scars on the chest and face as an outcome of acne conglobata.

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5. Fig. 4. Improvement of the skin process in the right inguinal region and scrotum in 29 weeks: incomplete resolution of the lesions, decrease in the severity of inflammatory process, persistence of sinus tracts. Hurley stage III.

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6. Fig. 5. Improvement of the skin process in the inguinal region and scrotum in 29 weeks: no decrease in the number of fistulas with almost complete reduction of inflammatory nodules. Hurley stage II–III.

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7. Fig. 6. Improvement of the skin process in the genital area and pubic region in 29 weeks: partial response of scrotal and penile lymphedema. Note the multiple double-ended pseudocomedones, which are pathognomonic for hidradenitis suppurativa. Hurley stage II–III.

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8. Fig. 7. Improvement of the skin process in the right axillary region in 29 weeks: cessation of discharge in draining sinuses, formation of circinate atrophic scars and scars with chords and double-ended pseudocomedones as an outcome of inflammatory lesions evolution. Hurley stage III.

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