Arif Nawa, Schneider-Burrus Sylke
Klinik für Dermatologie, Venerologie and Allergologie, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany.
Case Rep Dermatol. 2025 Jun 11;17(1):268-273. doi: 10.1159/000546384. eCollection 2025 Jan-Dec.
Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin disease that leads to painful nodules, abscesses, and fistulas.
This case describes the treatment of a 49-year-old male patient with progressive and massively inflamed HS for 20 years who also suffered from heart failure (NYHA II-III, EF 35-40%) and hypochromic microcytic anaemia (Hb 7.8 g/dL). Upon presentation, he was suffering from fatigue and severe pain (8-9/10, NRS). Due to prolonged immobility, knee and hip joint contractures with extension deficits were present. At the initial presentation, communicating, and purulent sinus tracts were observed bilaterally from the gluteal to femoral region and perianal area. Hurley score III, HS-PGA score: very severe, Dermatology Life Quality Index (DLQI) score: 19, ISH4 score: severe (16). Under adalimumab s.c. 40 mg/week combined with clindamycin (300 mg bd), the condition had worsened. The patient was admitted to the hospital for i.v. administration of ertapenem 1 g/day for 14 days in preparation for sinus tract resection. With an Hb level of 7.8 g/dL, the patient received iron carboxymaltose and erythropoietin. After a significant reduction in inflammatory markers (leukocytes 17.11/nL to 7.42/nL), a large excision of the sinus tracts was performed bilaterally in the gluteal region and left femoral area. Following 4 weeks of wound granulation, split-thickness skin grafting was performed. The knee and hip joint contractures improved with intensive physiotherapy. After surgery, the patient received antibiotic therapy with clindamycin, rifampicin, and metronidazole (clindamycin 600 mg, rifampicin 300 mg, metronidazole 500 mg, each p.o. 2×/day). In parallel, anti-inflammatory therapy with secukinumab 300 mg s.c. twice a month was initiated. Over the following 3 months, no progression or recurrence occurred. Quality of life and pain levels improved significantly under the therapy (DLQI from 19 to 10, pain from 8 to 9 to 3/10 NRS).
In extensive cases of HS, a combination of surgical and conservative therapy is necessary. We demonstrate that severe cases can be successfully treated with a combination of antibiotic, anti-inflammatory, and surgical therapy.
化脓性汗腺炎（HS），又称反向性痤疮，是一种慢性炎症性皮肤病，可导致疼痛性结节、脓肿和瘘管。
本病例描述了一名49岁男性患者的治疗情况，该患者患有进行性且严重发炎的HS达20年，同时还患有心力衰竭（纽约心脏协会II - III级，射血分数35 - 40%）和低色素小细胞贫血（血红蛋白7.8 g/dL）。就诊时，他感到疲劳且疼痛剧烈（数字评分量表8 - 9/10）。由于长期不动，出现了膝关节和髋关节挛缩伴伸展功能障碍。初诊时，双侧从臀区至股部区域及肛周可见相通的脓性窦道。Hurley评分III级，HS - PGA评分：非常严重，皮肤病生活质量指数（DLQI）评分：19，ISH4评分：严重（16）。在皮下注射阿达木单抗40 mg/周联合克林霉素（300 mg，每日两次）治疗后，病情恶化。患者入院接受静脉注射厄他培南1 g/天，共14天，为窦道切除术做准备。鉴于血红蛋白水平为7.8 g/dL，患者接受了羧基麦芽糖铁和促红细胞生成素治疗。炎症标志物显著降低（白细胞从17.11/μL降至7.42/μL）后，在双侧臀区和左股部区域对窦道进行了大面积切除。伤口肉芽形成4周后，进行了中厚皮片移植。通过强化物理治疗，膝关节和髋关节挛缩情况有所改善。术后，患者接受了克林霉素、利福平和甲硝唑的抗生素治疗（克林霉素600 mg，利福平300 mg，甲硝唑500 mg，均口服，每日两次）。同时，开始每月两次皮下注射司库奇尤单抗300 mg进行抗炎治疗。在接下来的3个月里，病情没有进展或复发。治疗期间，生活质量和疼痛程度显著改善（DLQI从19降至10，疼痛程度从数字评分量表8 - 9降至3/10）。
在HS的广泛病例中，手术和保守治疗相结合是必要的。我们证明，严重病例可通过抗生素、抗炎和手术治疗相结合成功治愈。
