F Benhadou1,2,3, H H Van der Zee3,4, J C Pascual3,5, D Rigopoulos6, A Katoulis3,6, A I Liakou3,6, M Daxhelet1,3, M Romanelli3,7, M Iannone7, Á Kinyó3,8, G Nikolakis3,9, C C Zouboulis3,9, C Dessinioti3,10, C Zisimou3,10, C Antoniou3,10, A Alavi3,11, D Mintoff3,12, S Aquilina3,12, L Matusiak3,13, J C Szepietowski3,13, R Sinclair3,14, H Husein-ElAhmed15, M von Laffert3,16, J Revuz3,17, B Danby3,18, L Puig3,19, P Theut Riis3,20, G B E Jemec3,20, K van Straalen3,4, K M G J Wigny4, V Del Marmol1,3, P Guillem2,3,21. 1. Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 2. ResoVerneuil, Paris, France. 3. European Hidradenitis Suppurativa Foundation e.V., Europe. 4. Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands. 5. Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain. 6. 2nd Department of Dermatology and Venereology, 'Attikon' General University Hospital, National and Kapodistrian University of Athens, Athens, Greece. 7. Department of Dermatology, University of Pisa, Pisa, Italy. 8. Department of Dermatology, Venereology and Oncodermatology, University of Pécs, Medical School, Pécs, Hungary. 9. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodore Fontane, Dessau, Germany. 10. Department of Dermatology, Andreas Syggros Hospital, Athens, Greece. 11. Department of Dermatology, York Dermatology Center, Richmond Hill, ON, U.S.A. 12. Department of Dermatology, Sir Paul Boffa Hospital, Floriana, Malta. 13. Department of Dermatology, Allergology and Venereology, Wroclaw Medical University, Wroclaw, Poland. 14. Department of Dermatology, Epworth Hospital, University of Melbourne, Melbourne, Australia. 15. Department of Dermatology, Hospital de Baza, Granada, Spain. 16. Institute of Pathology, Charité-Universitaetsmedizin Berlin, Berlin, Germany. 17. Private Practice, Paris, France. 18. Department of Dermatology, Geisel School of Medicine at Dartmouth, Manchester, NH, U.S.A. 19. Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. 20. Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark. 21. Department of Surgery, Clinique du Val d'Ouest, Ecully, France.
Abstract
BACKGROUND: Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses). The association with pilonidal sinus disease (PSD) is frequently reported but not well documented. OBJECTIVES: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS. METHODS: This was an international multicentre retrospective cross-sectional study based on data collection from a large cohort of patients with HS with and without histopathology. Results From a total of 2465 patients with HS included in the study, 661 (27%) reported lesions in the IGF. These patients were significantly more often smokers and had more severe HS. Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%). IG-HS was associated with the localization of HS in the proximity of the IGF, including the buttocks, genitals and the anus. There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available. CONCLUSIONS: The high prevalence of PSD suggests a strong link between both entities. Therefore, it may be useful to identify common pathophysiological mechanisms and develop common therapeutic strategies. What's already known about this topic? The occurrence of pilonidal sinus disease has not been clearly reported among patients with hidradenitis suppurativa/acne inversa. What does this study add? This is the first study that investigated the prevalence of pilonidal sinus disease among a large cohort of patients and identified the patient characteristics. Risk factors that might help to improve the management of patients were identified.
BACKGROUND:Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses). The association with pilonidal sinus disease (PSD) is frequently reported but not well documented. OBJECTIVES: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS. METHODS: This was an international multicentre retrospective cross-sectional study based on data collection from a large cohort of patients with HS with and without histopathology. Results From a total of 2465 patients with HS included in the study, 661 (27%) reported lesions in the IGF. These patients were significantly more often smokers and had more severe HS. Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%). IG-HS was associated with the localization of HS in the proximity of the IGF, including the buttocks, genitals and the anus. There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available. CONCLUSIONS: The high prevalence of PSD suggests a strong link between both entities. Therefore, it may be useful to identify common pathophysiological mechanisms and develop common therapeutic strategies. What's already known about this topic? The occurrence of pilonidal sinus disease has not been clearly reported among patients with hidradenitis suppurativa/acne inversa. What does this study add? This is the first study that investigated the prevalence of pilonidal sinus disease among a large cohort of patients and identified the patient characteristics. Risk factors that might help to improve the management of patients were identified.