• Archives of Plastic Surgery
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• v.46 no.3
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• pp.272-276
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• 2019

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular occlusive disease that involves the intertriginous areas. Treatment methods include conventional topical and systemic medication, radiotherapy, biologic agents, and surgical excision. Of late, there has been an increased focus on the use of biologic agents in patients with moderate to severe HS. Here, we present the case of a 46-year-old man with Hurley stage III HS for whom wide excision was ultimately curative, after aggressive medical therapy with the use of infliximab and adalimumab had succeeded in limiting the body surface area affected by the disease. This case demonstrates the effective treatment of severe HS with a combination of biologic therapy and surgery.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.566-571
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• 2019

Background In Western nations, hidradenitis suppurativa (HS) typically affects the apocrine gland-bearing skin of people of African origin, women, smokers, and individuals with obesity. The clinical characteristics of HS in Korea and Japan, however, are reportedly different from those in the West. We therefore hypothesized that wet earwax is associated with HS because most East Asian people are genetically predisposed to produce dry earwax. Methods The medical charts of 53 Japanese patients with HS were reviewed retrospectively. Results Unlike the results of surveys conducted in Western nations, most of our patients were men (72%), whose buttocks were the most commonly affected site. Apocrine gland-bearing areas, such as the axilla, were affected less often. The proportion of HS patients with wet earwax was 51%, which was substantially higher than that found in the general Japanese population. Moreover, when patients with gluteal HS were excluded, the proportion of patients with wet earwax became even higher (68%). Conclusions Although the etiology of HS is unknown, our survey indicated that HS in apocrine gland-bearing skin, such as the axillary and anogenital areas, may be associated with wet earwax. As this study was conducted in a limited clinical setting, a nationwide, multicenter survey is warranted to clarify the clinical characteristics of HS in Japan.

• Archives of Craniofacial Surgery
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• v.24 no.2
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• pp.73-77
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• 2023

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that is difficult to diagnose, with a period of 10.0±9.6 years from symptom onset to diagnosis. A 32-year-old Asian man presented with bilateral postauricular abscesses that first appeared 5 years previously. Despite several incisions and drainage, the symptoms only temporarily improved and continued to recur. On physical examination, chronic scars and sinus tracts were observed around the lesion. Postauricular HS was diagnosed, and surgical treatment was performed. We performed a wide excision and reconstructed the defect using a posterior auricular artery perforator-based keystone flap. Histological examination confirmed the diagnosis of HS. The reconstruction was successful, and there was no recurrence for 2 years after surgery. HS is difficult to diagnose without specific attention. Although the postauricular region is not a typical site of HS, it can occur in this area. Therefore, if a patient presents with recurrent abscesses in the postauricular region, HS should be considered. Additionally, if HS is diagnosed in the postauricular region, wide excision with reconstruction using a posterior auricular artery perforator-based keystone flap can lead to a favorable outcome.

• Korean Journal of Radiology
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• v.23 no.8
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• pp.785-793
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• 2022

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease involving apocrine-bearing sites. It is characterized by recurrent painful nodules and abscesses that potentially rupture, resulting in sinus tract formation, fistulas, and scarring. HS tends to be found in the intertriginous areas (i.e., the axillary, inguinal, and perianal areas of the body). HS may be uncommon for radiologists because its diagnosis is usually based on clinical assessment. However, diagnosis based solely on clinical manifestations can underestimate the severity of HS. Ultrasonography and MRI play a critical adjunct role in determining the severity and extent of the disease and greatly aid its management. Given that MRI is an effective imaging tool, its role in the analysis of severe and anogenital HS lesions merits considerable attention. Unfortunately, anoperineal HS imposes diagnostic dilemmas. It has multiple symptoms and presentations and often mimics other diseases in the intertriginous areas. Therefore, a thorough understanding of HS is essential to avoid delayed diagnoses. This review highlights the typical MRI imaging features and staging of HS, emphasizing on the anoperineal location. The review also differentiates the disease from mimics to facilitate the prompt delivery of appropriate treatment and improve patients' quality of life.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.663-666
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• 2012

Current treatments for hidradenitis suppurativa (HS) include prolonged courses of antibiotics, retinoids, immunosuppressants, and biologics. Severe cases that are resistant to prolonged medical treatment pose a therapeutic challenge. We propose radical excision and lateral thoracic flap reconstruction as a treatment option for such cases. In our experience with two patients, good aesthetic and functional outcomes were achieved, with a high level of patient satisfaction. The availability of suitable flap coverage allows for wide resection of all of the hair-bearing skin, leading to a low incidence of residual disease and subsequent recurrence. Following excision of the affected tissue, the ideal reconstructive method in the axilla provides suitable coverage without unacceptable donor site morbidity and also avoids axillary contractures. A long lateral thoracic flap with delay has excellent coverage with minimal donor tissue sacrifice. With a suitable flap coverage option, the management paradigm of intractable HS should shift from prolonged medical treatment to allow decisive radical excision, which will improve the quality of life for patients.

• Archives of Plastic Surgery
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• v.44 no.3
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• pp.228-233
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• 2017

Background Hidradenitis suppurativa (HS) is a chronic skin condition that can affect any area with apocrine sweat glands and has the potential to involve multiple sites concurrently. Commonly affected sites include the axilla, groin, perineum and perianal areas. In this study we performed a literature review on the surgical methods for HS and describe an innovative technique for reconstructing axilla HS using an inner-arm transposition flap. Methods We reviewed all cases (5 cases from 4 patients) of transposition flap reconstruction performed by the senior author at a single London tertiary hospital from 2008-2013. Patient related outcome measures were collected using the Derriford appearance scale (DAS 24) and a study specific questionnaire. Results All patients were satisfied with their final result. One out of five cases had a complication but did not result in flap failure. There is no disease recurrence to date. DAS 24 scores collected demonstrated acceptable postoperative distress that did not deviate far from the norm tables while study specific questionnaire reveal desirable outcomes. Conclusions We have managed to achieve our aim through the use of the innovative inner-arm transposition flap. Our study hopes to provide an additional technique for axillary reconstruction. This technique offers the effective concealment of scars with the benefit of tightening of the arm tissue producing 'brachioplasty like' effects. All things considered it would be reasonable to conclude the innovative flap technique is a reliable, effective, and simple method that results in multiple benefits.

• Journal of Life Science
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• v.33 no.4
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• pp.343-348
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• 2023

Acne is one of the most common skin diseases, mainly occurring in adolescence. The pathophysiology of acne involves not only hormonal, genetic and environmental factors, but also other factors including hyperseborrhea, inflammation, over-keratinization of follicular keratinocytes and overgrowth of Cutibacterium acnes (C. acnes). Cannabidiol (CBD) is known to relieve pain, stress and inflammation. Moreover, cannabis extracts containing CBD have been reported to be effective in treating acne. However, the therapeutic effect of CBD on acne remains unclear. Therefore, this study aimed to investigate the effect and mechanism of CBD on lipogenesis in SEB-1 sebocytes. We treated sebocytes with CBD and found that it not only inhibited lipid synthesis, but also inhibited cell proliferation by inducing apoptosis. We then demonstrated that sterol response element-binding protein-1 (SREBP-1) mediates the inhibitory effect of CBD on lipogenesis. Furthermore, Akt and adenosine monophosphate-activated protein kinase (AMPK), upstream regulators of SREBP-1, were regulated by CBD treatment. Taken together, our studies demonstrate that CBD inhibits adipogenesis by regulating the Akt/AMPK-SREBP-1 signaling pathway, providing potential for use as a therapeutic agent for acne. Further research is needed to confirm the effect of CBD on inflammation caused by hyperkeratosis, which will increase the possibility of using CBD for acne treatment.