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The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Over the last 8 years, 61 patients with hidradenitis suppurativa (HS) have been treated at this institution. Twenty-four have also had a diagnosis of Crohn's disease (38%). This dual pathology is examined in detail in this retrospective review. There were 11 males and 13 females with a mean age of 39 years (range 18 to 75 years). The Crohn's disease was ileal in 1 patient, ileocolic in 4, and affected the large bowel only in 19. The diagnosis of Crohn's disease predated that of HS by an average of 3.5 years. At the time of review, 22 patients had a stoma, 23 had undergone laparotomy and 17 had lost their rectum. Hidradenitis suppurativa occurred in the perineal or perianal area in all patients but involved other sites in 20 cases. Skin grafting had been done in 9 and local procedures in 19 patients. Granulomas were found in excised skin in 6 cases but this finding was not associated with a poor outcome. At a mean follow-up of 3.2 years from the most recent surgery for HS (range 1 to 11 years) 11 were asymptomatic for HS, 11 had symptoms and no follow up was available in 2. These data show that HS may coexist with Crohn's proctocolitis, complicating the diagnosis and management of patients in whom it occurs. An increased appreciation of the possibility is recommended.

Résumé

Au cours des 8 ans passés, 61 patients avec hidradénite supparative (HS) ont été traités à cette institution. 24 avaient aussi un diagnostic de maladie de Crohn (38%). Cette pathologie double est examinée en détail dans une revue rétrospective. Il y avait 11 hommes et 13 femmes d'un âge moyen de 39 (18–75 ans). La maladie de Crohn était iléale chez 1 patient, iléocolique chez 4 et affectait le colon seulement chez 19. Le diagnostic de malade de Crohn était antérieur à celui de HS en moyenne de 3,5 ans. A l'époque de la revue, 22 patients avaient une stomie, 23 avaient subi une laparotomie et 17 avaient perdu le rectum. L'hidradénite suppurative est survenue dans les zones périnéales ou périanales chez tous les patients mais occupait aussi d'autres lieux dans 20 cas. Une greffe cutanée a été faite chez 9 et des traitements locaux chez 19 patients. Des granulomes ont été trouvés dans la peau excisée chez 6 malades mais ces découvertes n'étaient pas associées avec un mauvais pronostic. Avec un recul moyen de 3,2 ans après la plus récente intervention chirurgicale pour hidroadénite (1 à 11 ans) 11 étaient asymptomatiques pour leur hidroadénite, 11 avaient des symptômes et 2 étaient perdus de vue. Ces faits montrent que HS peut coexister avec la maladie de Crohn rectocolique, compliquant le diagnostic et la traitement des patients ches lesquels elle survient. Un accroissement de l'appréciation de cette possibilité est recommandée.

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Church, J.M., Fazio, V.W., Lavery, I.C. et al. The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn's disease. Int J Colorect Dis 8, 117–119 (1993). https://doi.org/10.1007/BF00341181

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