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

( Hye Rin You ),( Sook Jung Yun ),( Seung-chul Lee ),( Young Ho Won ),( Jee-bum Lee ) 대한피부과학회 2016 大韓皮膚科學會誌 Vol.54 No.9

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. (Korean J Dermatol 2016;54(9): 723∼727)

Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities

( Ziying Vanessa Lim ),( Hazel H. Oon ) 대한피부과학회 2016 Annals of Dermatology Vol.28 No.2

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.(Ann Dermatol 28(2) 147∼151, 2016)

A case of hidradenitis suppurativa treated with adalimumab

( Ji Hoon Yang ),( Jungyoon Moon ),( Dae Hun Suh ) 대한피부과학회 2018 대한피부과학회 학술발표대회집 Vol.70 No.1

A 25-year-old man was presented with multiple painful abscesses and nodules on both buttocks over the course of 6 months. He was previously diagnosed as hidradenitis suppurativa at another hospital and treated with rifampicin and tetracycline, but there was no effect. In our hospital, he was treated with isotretinoin, amoxicillin with clavulanic acid and cefixime, but those treatments were not effective, either. We decided to use adalimumab for the patient and dosing schedules were as follows; 160mg at week 0, 80mg at week 2, and 40mg weekly from week 4. After 8 weeks, the overall disease severity of the patient showed a significant improvement. The number of boils that occurred during the first 4 weeks decreased from 18 to 3, and the degree of pain assessed by VAS decreased from 7 to 0. Hidradenitis Suppurativa Clinical Response sum of abscesses and inflammatory nodules (HiSCR) decreased from 8 to 3. Herein, we report a case of hidradenitis suppurativa successfully treated with adalimumab, a fully humanized anti TNF-α antibody which has been recently approved for the treatment of hidradenitis suppurativa.

화농성 땀샘염에서 경구 항생제와 경구 레티노이드의 치료 효과에 대한 비교

설정은 ( Jung Eun Seol ),박소희 ( So Hee Park ),정소영 ( So Young Jung ),황성환 ( Sung Hwan Hwang ),왕한영 ( Han Young Wang ),김효진 ( Hyojin Kim ),서종근 ( Jong Keun Seo ),박인호 ( In Ho Park ) 대한피부과학회 2017 大韓皮膚科學會誌 Vol.55 No.10

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. (Korean J Dermatol 2017;55(10):651∼656)

Invasive Cutaneous Squamous Cell Carcinoma Arising from Chronic Hidradenitis Suppurativa: A Case Report of Treatment by Slow Mohs Micrographic Surgery

( Seung-ju Lee ),( Jung Min Lim ),( Si-hyung Lee ),( Kee Yang Chung ),( Mi Ryung Roh ) 대한피부과학회 2021 Annals of Dermatology Vol.33 No.1

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory condition presenting with painful, deep-seated abscesses and sinus tracts in multifocal locations. Rarely, longstanding inflammation in HS may lead to serious complications, such as cutaneous squamous cell carcinoma (SCC) (also termed Marjolin ulcer). Herein, we report a case of invasive cutaneous SCC arising from chronic ulcers of a HS patient. A 40-year old Korean male, a current smoker with 20 pack-year history, presented with a history of painful, recurrent, deep-seated abscesses and ulcers on the buttocks since his late teens, thus classified as Hurley stage III. A large purulent ulcer developed on the right buttock several months ago. Initial treatment was focused on controlling infection and facilitating wound healing. The lesion showed 50% reduction of size in 6 weeks, but also developed foul odor and showed fungating margins. Multiple skin biopsies were consistent with invasive SCC. Magnetic resonance imaging revealed a few enlarged lymph nodes on the right inguinal area, which was confirmed as metastasis on frozen biopsy. Slow Mohs micrographic surgery and radical right inguinal lymph node dissection was done. Incidence rates of SCC arising from HS have been reported up to 4.6%. To our knowledge, this is the first report of cutaneous SCC arising from HS in Korea. Our case emphasizes that the diagnosis of cutaneous SCC in HS should not be delayed, and early surgical intervention is crucial for better outcomes. (Ann Dermatol 33(1) 68∼72, 2021)

Prevalence and comorbidities of hidradenitis suppurativa: a nationwide population-based study in Korea

( Ji Hae Lee ),( Hyuck Sun Kwon ),( Han Mi Jung ),( Gyong Moon Kim ),( Jung Min Bae ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.2

Background: The true prevalence of hidradenitis suppurativa (HS) is unknown. A nationwide study of the relationship of HS with associated diseases has rarely been reported. Objectives: We sought to establish standardized overall prevalence estimates and comorbidities of HS using a nationwide health claims database. Methods: We interrogated Korean health claim database data from 2007 to 2016. We defined patients with HS as those whose records showed ≥ 2 physician contacts with the principal diagnosis of HS. We also established an ageand sex-matched control group, and compared the prevalence of a priori selected comorbidities. Results: We identified 23,516 patients of HS that included 61.3% males and 38.7% females, and estimated the total sex- and age-adjusted prevalence in Korea to be 0.059%, or 59 per 100,000 persons (95% confidence interval[CI], 55-65 per 100,000 persons). The total prevalence was significantly higher among men than women. Rheumatoid arthritis, ankylosing spondylitis, type 1 diabetes and ulcerative colitis were significantly associated with HS. Conclusion: The overall prevalence was lower than that of Western population, and male dominance was observed in HS patients of Korea.

경부종괴로 발현한 화농성 한관염: 1예 보고

이승영,전민희,배일헌,한기석,차상훈,김성진,박길선 대한영상의학회 2007 대한영상의학회지 Vol.56 No.6

화농성 땀샘염은 드문 질환으로 만성 재발성 피부감염으로 피부로 누출관을 만들며, 상당한 반흔조직 형성을 특징으로 한다. 37세 남자 환자가 후경부 종괴를 주소로 내원했다. 종괴를 덮은 피부에는 농을 포함하고 있는 다수의 구멍이 관찰되었다. 자기공명영상에서 종괴는 후경부의 피하지방층에 위치하는 12×10×4 cm 가량의 종괴로, 내부에 다수의 낭종을 포함하고 있는 경계가 잘 그려지지 않는 고형 종괴였다. 종괴는 T1과 T2에서 모두 저 신호강도 종괴내부에 부분적으로 증가한 신호강도를 가지는 양상이며 조영증강은 거의 되지 않았다. 종괴 내부의 낭성부분은 T2에서 물과 비슷하고 T1에서는 물보다 높은 신호강도를 보이며, 그들 중 일부는 피부로 연결된 누출관을 형성하고 있었다. 종괴는 수술로 제거되었으며, 임상적으로 그리고 병리학적으로 화농성 땀샘염으로 확진되었다. Hidradenitis suppurativa is a rare disorder that is characterized by recurrent chronic skin infections and the formation of sinus tracts and considerable scaring. A 37-yearold man presented with a hard posterior neck mass. Multiple pus-producing sinuses were detected in the skin covering the mass. MRI demonstrated an ill-defined, soft tissue mass with multiple variable sized cystic lesions. The soft tissue mass measured 12×10×4 cm in the subcutaneous fat layer, it contained multifocal cystic lesions that revealed higher signal intensity on both the T1- and T2-weighted images, as compared with the adjacent neck muscles. The mass was not enhanced on the post-contrast T1 weighted images. Some of the cystic lesions extended to the skin. The mass was removed surgically and confirmed to be hidradenitis suppurativa.

Radiation therapy in chronic hidradenitis suppurativa: case report

Pitchaya Sakyanun,Thirada Vongvanichvathana,Prasert Lertsanguansinchai 대한방사선종양학회 2022 Radiation Oncology Journal Vol.40 No.1

A 26-year-old female presented recurrent painful, carbuncles at both axillae for 10 years. It caused offensive odor and scar. Tissue diagnosis was chronic hidradenitis suppurativa. She was treated using antibiotics followed by multiple excisions with drainage but showed no improvement. Isotretinoin provided no benefit. She was socially isolated and experienced lower quality of life. Consequently, she was sent for radiation therapy. Computed tomography simulation was performed revealing an ulcer with deep chronic pus tracts at her axilla. Three-dimensional conformal radiation therapy was provided with 6 MV photon (7.5 Gy in 3 fractions) covering all ulcers and pus tracts. On the last day of radiation therapy, carbuncles and wounds at the left axilla exhibited much improvement without pus. Three months follow-up showed much improvement of the lesions. The skin was smoother without pus or odor. Radiation therapy was confirmed one treatment option for chronic hidradenitis suppurativa.

항문 주위 화농성한선염의 임상 양상 및 수술 방법에 대한 고찰

황도연,박원갑,이종호,윤종섭,조경아,김현식,이종균,김광연 대한대장항문학회 2001 Annals of Coloproctolgy Vol.17 No.1

Intraoperative Injection of Coloring Dye in the Surgical Treatment of Hidradenitis Suppurativa: A Case Report

김범식,윤정수,SooA Lim,한예식,어수락 대한창상학회 2022 Journal of Wound Management and Research Vol.18 No.1

Hidradenitis suppurativa (HS) is a recurring and chronic inflammatory skin disease. Various medical and surgical treatments, with varying degrees of efficacy, have been applied based on the Hurley staging system. Since medical treatment cannot change the natural course of the disease and relapse is inevitable in the long-term, radical excision to reduce recurrences is considered as the only curative therapy option for patients with severe II and III stage HS. However, such methods may require intensive reconstructive surgeries and are often accompanied by intraoperative or postoperative problems, resulting in extended treatments. Several methods to detect the degree of the disease and define the resection area have been employed; coloring agents have also been recommended as an option. In this case, we focused on the use of a coloring dye to determine the precise resection margin for a patient with severe HS, as there have been no conclusive reports on the use of a coloring dye in intraoperative operations or follow-up findings. This method could help preserve more viable tissue to reduce the possibility of complications and the duration of hospitalization.