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Sinus pilonidalis und Hidradenitis suppurativa: 2 anspruchsvolle Hauterkrankungen

Pilonidal disease and hidradenitis suppurativa: challenging skin conditions

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Zusammenfassung

Sinus pilonidalis und Hidradenitis suppurativa sind 2 dermatologische Erkrankungen, die mit Bildung von Fisteln und Abszessen einhergehen und meist operativ behandelt werden. Beide Entitäten gelten als okklusive Erkrankungen der Haarfollikel. Allerdings wird die Pathogenese des Sinus pilonidalis nach wie vor kontrovers diskutiert. Sinus pilonidalis und Hidradenitis suppurativa treten gehäuft gleichzeitig auf. Die operative Behandlung beider Erkrankungen unterscheidet sich allerdings stark. Bei Sinus pilonidalis liegen zahlreiche minimal-invasive Therapieoptionen vor. Eine offene Wundbehandlung sollte dagegen weitgehend der Vergangenheit angehören. Bei Hidradenitis suppurativa ist die vollständige – oft sehr großflächige – Exzision weiterhin die am häufigsten angewendete Operation. Um die Invasivität der operativen Therapie von Hidradenitis suppurativa zu minimieren, werden zunehmend multimodale Therapien angewendet, die Antibiotika, Lasertherapien und biologische Therapie mit Inhibitoren gegen den Tumornekrosefaktor (TNF) beinhalten. Bei Sinus pilonidalis existieren weiterhin keine nichtoperative Therapieoptionen.

Abstract

Pilonidal disease (PD) and hidradenitis suppurativa (HS) are skin conditions which are characterized by formation of abscesses and fistulae. Both conditions are usually treated surgically. Follicular occlusion has been thought to be the central pathogenetic mechanism of both diseases. However, there are still controversies regarding the etiology of PD. Although PD and HS frequently occur simultaneously, the surgical treatment of the two diseases differs considerably. Numerous minimally invasive treatment options are available for PD; thus, open excision is losing its popularity due to prolonged traumatic secondary wound healing. HS is treated mainly by complete excision of the diseased skin. Laser procedures, preoperative antibiotics and biologic therapy are frequently used to treat HS prior to surgery to minimize trauma. In contrast, the treatment of PD is solely surgical.

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  1. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Evangelisches Krankenhaus Kalk, Buchforststr. 2, 51103, Köln, Deutschland

    Igors Iesalnieks

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Iesalnieks, I. Sinus pilonidalis und Hidradenitis suppurativa: 2 anspruchsvolle Hauterkrankungen. Gastroenterologie 17, 252–260 (2022). https://doi.org/10.1007/s11377-022-00628-5

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