Cutaneous squamous cell carcinoma (SCC) is an invasive, malignant tumor with metastatic potential. This tumor can arise from various precursor lesions, including ulcers, actinic keratoses, and leukoplakia. A Marjolin ulcer is an aggressive malignancy of the skin, most commonly SCC, arising in chronic wounds or scars. Transformation from a chronic wound to SCC is rare and slow with an unknown pathogenesis, although proposed mechanisms include nonspecific or chronic antigenic stimulation.1,2 Malignantly transformed wounds are challenging to differentiate from primary chronic ulcers, so having a high suspicion for SCC and diagnosis in a timely manner is key.
Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1–1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18–40 years, obstetrician–gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.
Galli-Galli disease (GGD) is a rare genodermatosis that is distinguished from Dowling-Degos disease (DDD) by the histologic finding of acantholysis. We present a case of a female patient with pruritic intertriginous plaques and history of hidradenitis suppurativa (HS). While reports exist associating DDD with HS, to our knowledge, GGD in association with HS has not been reported in recent literature. HS in association with DDD has been found to have causal mutations, involving the gamma-secretase complex and POFUT1 genes. DDD also has shared causal mutations with GGD in the POGLUT1 and KRT5 genes. These three skin diseases have been linked to different gene mutations, which are all associated with the Notch signaling pathway.
Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina The authors have indicated no significant interest with commercial supporters.
Widespread use of antibiotics for hidradenitis suppurativa (HS) opens up the possibility of Clostridium difficile infection (CDI) and an increased risk of mortality. The purpose of this study was to identify risk factors for acquiring CDI in patients with HS. We suggest that providers should take risk factors including increased antibiotic class, hospitalizations, and advanced patient age into consideration when prescribing antibiotics for HS.
Introduction: Limited data are available on the associations between hidradenitis suppurativa (HS) and inflammatory bowel diseases (IBD). We sought to determine the prevalence of HS in IBD, as well as the prevalence of IBD in patients with HS, at a single US tertiary medical center. We also aimed to describe differences in the clinical characteristics of IBD and HS as compared to those with IBD alone. Methods: We performed a single center retrospective cohort between 2004-2015. We used billing international classification of diseases, 9th codes (ICD-9) to identify cases of IBD and HS at the center. We calculated prevalence of HS in IBD and IBD in HS. We then performed a nested case-control study via detailed chart review, comparing clinical characteristics of patients with HS-IBD to a random sample of patients with IBD alone via bivariate analyses. We then described treatment outcomes of HS in IBD patients. Results: We identified a total of 12,889 patients with IBD and 2,558 patients with HS treated at the center. Of these, there were 93 with both IBD and HS (HS-IBD). The prevalence of HS in patients with IBD was 0.7% while the prevalence of IBD in patients with HS was 3.6%. Among patients with HS-IBD, 75 (80%) had Crohn's disease (CD). When compared to controls with only IBD, the IBD-HS population had more women, African Americans (AA), and higher rates of smoking. Among CD patients, the HS-IBD population had higher rates of penetrating disease (67% vs. 43%, p=0.001) and perianal disease (54% vs. 26%, p < 0.001). There was a predominance of colonic disease in HS-IBD (p < 0.001) (Table 1). A total of 59 HS-IBD had follow-up to assess treatment response. The most common HS locations were the groin (57%), axilla (46%) and perianal/buttocks (39%). A total of 23.7% were on anti-TNF use for HS-IBD. The most common treatment modality prescribed for HS was antibiotic therapy, with 62% of patients on clindamycin and 25% on rifampin. Approximately half of the patients (29/59) had documentation of surgical treatment for HS. At follow-up, 16 patients (28%) had entered remission and 22 (39%) had a documented improvement in HS symptoms. A lack of clinical response was seen in 19 patients (33%). Conclusion: The prevalence of IBD in this tertiary care center population of patients with HS is >3 fold higher than the reported prevalence of IBD in the general population. IBD patients with HS were more likely to be female, AA, have penetrating, colonic and perianal disease. HS patients with IBD had higher rates of groin and perianal HS than what is reported in the general HS population, with difficult to treat HS.Figure
