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In this case report a 42-year-old woman presented with a long history of hidrosadenitis suppurativa (HS). Due to recurrent abscesses and post-operative complications, she underwent 69 operations in general anaesthesia as well as numerous incisions in local anaesthesia in 2013-2017. The abscesses were repeatedly treated with simple incisions, although a Danish guideline from 2016 does not recommend this procedure as treatment of patients with HS, since there is a high rate of recurrence. This illustrates the necessity of increasing knowledge of the treatment of HS. We recommend an interdisciplinary cooperation in a dermatological setting to avoid acute surgery.

Background: Hidradenitis suppurativa (HS) is a distressing chronic skin disease affecting apocrine-bearing regions. The management of HS is challenging, and surgical intervention is considered to be effective., Objective: To evaluate the effectiveness and patient tolerance of modified abscess drainage in the treatment of HS., Materials and Methods: Eight patients with HS were admitted to our hospital from 2005 to 2012. They were treated using modified abscess drainage, with a follow-up time of 3 months. Effectiveness of therapy and patient satisfaction were evaluated., Results: Twenty-eight lesions in eight patients with HS were treated using modified abscess drainage. After 3 months of follow-up, 13 lesions showed completely recovery, and 10 lesions improved. No patients had any serious postoperative complications. Seven patients were satisfied with the effects, and five patients were willing to accept the same treatment when lesions recurred., Conclusion: Modified abscess drainage is a simple and effective surgery for HS lesions, and patients tolerated this treatment well., (© 2013 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.)

A 39-year-old man came to us for surgical treatment of a hidradenitis suppurativa. Upon excision of a perianal abscess, the diagnosis of a rare tumor, a perianal mucinous adenocarcinoma (pT4, pN 1, MO), was made. An abdominoperineal resection was performed, followed by a combination of adjuvant radiation and chemotherapy. A year after the operation, the patient is doing well without any signs of recurrence. This carcinoma probably arises in the anal glands. It often presents as a perirectal abscess and/or an anal fistula. Therefore, the diagnosis is often delayed. At presentation, the tumor is bigger than 5 cm in diameter in 80% of the cases, and the prognosis is poor. It metastasizes mostly to the superficial inguinal or to the retrorectal lymph nodes. There are only case reports and no comparative studies in the literature. In the last 10 years, the carcinoma has mostly been treated by neoadjuvant radiation and chemotherapy, followed by abdominoperineal resection. Since then, the median survival has increased to 3 years. This is the first case report of a combination of a perianal mucinous adenocarcinoma with a hidradenitis suppurativa.

Pyoderma fistulans sinifica (PFS, also referred to as fox den disease because its multiple fistulae and sinuses resemble the structure of a fox den) is a distinct chronic infectious disease in which epithelialized tracts form within the subdermal fatty tissue. PFS, which has not been previously described in the English-language literature, must be differentiated from hidradenitis suppurativa, pilonidal sinus, and perianal fistula. The fistulous tracts of PFS are always lined by stratified squamous-cell epithelium but, unlike those of hidradenitis, reach deep into the subcutaneous fat, run epifascially for long distances, and have no relation to skin appendices. We report on 10 men (mean age +/- SD, 36 +/- 5 years) with PFS (mean duration +/- SD, 11 +/- 7 years). Bacterial cultures of affected tissue from these patients yielded a total of 14 facultative and 31 obligate anaerobic species. Treatment consisted of wide en-bloc excision down to the fascia, including all fistulae. Antibiotic therapy temporarily reduced purulent discharge but did not eradicate the infection. Two patients who underwent fistulotomy without wide en-bloc excision developed recurrences.

Report of a 35-year-old man, who suffered for 20 years from pyodermia sinifica fistulans and finally died. Description of the typical symptoms and the present therapy of pyodermia sinifica fistulans ("hidradenitis suppurativa").