Rune Kjærsgaard Andersen, MD, Department of Dermatology University Hospital Zealand, Roskilde, Sygehusvej 10, 4000 Roskilde, Denmark;
Acta Dermatovenerol Croat. 2021 Jul;29(2):72-79.
Hidradenitis suppurativa (HS) is an under-diagnosed chronic inflammatory skin disease of the pilosebaceous unit of apocrine gland-rich parts of the body. The mammary area is the fourth most HS-affected area and, as typical lesions include non-fluctuating nodules, abscesses, and tunnels/sinus tracts, mammary HS is often mistaken for other mammary "boils", such as sub-areolar and granulomatous non-lactating breast abscesses. Our objective was to present a spectrum of mammary HS lesions, explore a possible classification, and expose mammary HS as a possible differential diagnosis to non-lactational breast abscesses.
A cross-sectional study on current and newly-referred patients treated for HS affecting the mammary area. Anamnestic information, subjective outcome measures, and lesion counts including anatomical location were collected. Patients with similar morphologies were grouped, and characteristics for the groups were investigated.
We were not aware of the number of morphologies we would find, and as a result the study did not have sufficient power to show significant differences after correction for multiple testing.
We found three morphologically different subtypes of mammary HS; the Sternal, the Frictional, and the Nodule types. These groups differed in anatomical lesion characteristics and other patient characteristics. Furthermore, we found a fourth Mixed type - a combination of the other three.
Differential diagnosis between mammary HS and sub-areolar or granulomatous non-fluctuating non-lactating breast abscess is most easily performed by assessing the precise anatomical location of the lesion and determining if the mammary lesion is the only lesion present or if similar lesions exist in other HS-specific areas.
化脓性汗腺炎（HS）是一种发生于顶泌汗腺丰富区域的毛囊皮脂腺单位的慢性炎症性皮肤疾病，常常漏诊。乳房是第四个最常受累的部位，由于典型病变包括非波动性结节、脓肿和窦道/瘘管，因此化脓性汗腺炎常被误诊为其他乳房“痈”，如乳晕下和肉芽肿性非哺乳期乳腺炎脓肿。我们的目的是展示一系列乳房化脓性汗腺炎病变，探索一种可能的分类，并将化脓性汗腺炎作为非哺乳期乳腺炎脓肿的一种可能鉴别诊断。
对当前和新转诊来治疗乳房区域化脓性汗腺炎的患者进行横断面研究。收集病史信息、主观结局测量值和病变计数，包括解剖位置。将具有相似形态的患者进行分组，并研究各分组的特征。
我们不知道会发现多少种形态，因此该研究没有足够的效力来显示在经过多次检验校正后有统计学差异。
我们发现了三种形态不同的乳房化脓性汗腺炎亚型；胸骨型、摩擦型和结节型。这些组在解剖病变特征和其他患者特征方面存在差异。此外，我们还发现了第四种混合型——其他三种的组合。
通过评估病变的确切解剖位置以及确定乳房病变是否是唯一存在的病变，或者在其他化脓性汗腺炎特定区域是否存在类似病变，来对乳房化脓性汗腺炎和乳晕下或肉芽肿性非波动性非哺乳期乳腺炎脓肿进行鉴别诊断是最容易的。
