Tchernev Georgi, Temelkova Ivanka
Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic surgery, General Skobelev 79, 1606 Sofia.
Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606 Sofia.
Open Access Maced J Med Sci. 2019 Feb 11;7(3):400-402. doi: 10.3889/oamjms.2019.148. eCollection 2019 Feb 15.
Acne inversa as a chronic inflammatory disorder can be divided into three stages according to Hurley's classification. It affects the axillary and anogenital region predominantly, and its chronic course of development is associated with a major negative impact on quality of life, especially in young patients. We discuss the different types of treatment in patients with acne inversa and the benefits of two-stage surgical treatment by serial excisions with primary wound closure under local anaesthesia.
We present a 28-year-old man with hidradenitis suppurativa stage I in the right axillary region and also in the pubic area. The patient is an active smoker. The patient was treated with Rifampicin 2x 300mg / day without any particular effect and preoperatively, systemic therapy with Clindamycin 4x 600mg / day was performed, combined with daily dressings with jodasept ointment for 7 days. The patient was treated through two surgical sessions under local anaesthesia with elliptical excision of the lesions located in the right axillary and the pubic area. Both of the two surgical defects were initially closed with single interrupted sutures. Histological examination of both lesions revealed the presence of suppurative folliculitis.
The literature describes various methods for treating acne inversa which include both systemic and local approaches. However, it is considered that drug therapy achieves only a temporary improvement in patients with hidradenitis suppurativa. For this reason, the surgical treatment of acne inversa is indicated as the only curative treatment, especially for recurrent lesions and serial excisions under local anaesthesia, followed by primary wound closure is a valuable treatment for patients with mild to moderate HS (Hurly stage I & II).
化脓性汗腺炎作为一种慢性炎症性疾病，根据赫尔利分类可分为三个阶段。它主要影响腋窝和生殖器区域，其慢性发展过程对生活质量有重大负面影响，尤其是在年轻患者中。我们讨论了化脓性汗腺炎患者的不同治疗类型以及在局部麻醉下通过连续切除并一期缝合伤口进行两阶段手术治疗的益处。
我们介绍了一名28岁男性，右侧腋窝和耻骨区域患有Ⅰ期化脓性汗腺炎。该患者是一名活跃吸烟者。患者接受了每日2次、每次300mg利福平的治疗，但没有任何特别效果，术前进行了每日4次、每次600mg克林霉素的全身治疗，并结合每日使用碘仿软膏换药7天。患者在局部麻醉下通过两个手术阶段进行治疗，对位于右侧腋窝和耻骨区域的病变进行椭圆形切除。两个手术切口最初均用单间断缝线缝合。对两个病变的组织学检查均显示存在化脓性毛囊炎。
文献描述了治疗化脓性汗腺炎的各种方法，包括全身和局部方法。然而，人们认为药物治疗仅能使化脓性汗腺炎患者得到暂时改善。因此，化脓性汗腺炎的手术治疗被认为是唯一的治愈性治疗方法，特别是对于复发性病变，在局部麻醉下进行连续切除，然后一期缝合伤口，对轻度至中度HS（赫尔利Ⅰ期和Ⅱ期）患者是一种有价值的治疗方法。
