John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive


Hidradenitis Suppurativa Volume 23, issue 10, Décembre 2016


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1 Hôpital Bichat,
service d’hépato-gastroentérologie,
46 rue Henri Huchard,
75018 Paris,
2 Centre Hospitalier Privé St Grégoire,
35760 Saint Gregoire,
3 Polyclinique Courlancy,
service de Dermatologie,
Reims, France
4 CHU de Nantes,
Service brûlés et chirurgie plastique,
5 Clinique du Val d’Ouest,
69130 Écully,
* Tirés à part

Hidradenitis Suppurativa (HS) is a frequent disease (1% in the French population) but underestimated in clinical practice with a long delay of several years before diagnosis in patients consulting (or not) their general practitioner, a dermatologist, a proctologist, a gynecologist or a surgeon. An optimization of the patient's management should be implemented by informing theses stakeholders. The very evocative and the suppuration at different preferred locations of this disease (axillary, mammary, inguinal, scrotum, pubis, anal margin areas) should easily led to a diagnostic. The differential diagnoses are pilonidal cyst and anal fistula more or less as part of Crohn's disease, but an increased risk of association of both diseases exists. The treatment depends on the extension and the activity of the disease. Therapeutic abstinence could be an option. As first line, antibiotics have shown their efficacy with a low level of evidence. In case of localized disabling disease, surgical excision of all lesions with second intention healing seems to be the preferred treatment. In case of a very extensive disease, in particular in the axillary area, flap plasty or skin grafting can be realized after radical excision of the lesions. In case of severe and extensive HS which is not controlled by these treatments, anti-TNF drugs have demonstrated their efficacy in terms of control of the expansion of the lesions and quality of life with currently a higher level of proof for adalimumab. The future may lie in a combination of these different therapies which remains to be defined: anti-TNF drugs before surgery, then which maintenance treatment in which case?, which associations (antibiotics and anti-TNF drugs …)?