HIDRADENITIS SUPPURATIVA: A RETROSPECTIVE STUDY OF 15 CASES

1. Dermatology Department, Moulay Ismail Military Hospital, 50000, Meknès, Morocco. 2. Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University USMBA, 30000 Fès, Morocco. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 10 January 2020 Final Accepted: 12 February 2020 Published: March 2020 Copy Right, IJAR, 2020,. All rights reserved.

The biologic workup was performed in search of complications and comorbidities. It revealed the presence of hyperleukocytosis in 3 patients, dyslipidemia in 5 patients, and hyperglycemia in 2 others. Bacteriological samples were taken from 06 patients and were positive for germs of the commensal skin flora. We noted one case of malignant transformation into squamous cell carcinoma.
A medical treatment based on antibiotics was prescribed in all our patients. In only one acute form, a combination of metronidazole, ciprofloxacin and an anti staphylococcal agent was used. Long-term treatment was based on doxycycline 200 mg for 09 patients, a combination of clindamycin and rifampicin was administered in only one case and two patients received retinoid-based treatment. Only one patient had been treated with Methotrexate 15 466 mg/week (Table 5). Surgical treatment was performed in 4 patients for severe or drug-resistant forms and for the case with malignant transformation.
The mean duration of progression was 2.45 years with extremes of 6 months to 11 years. Hospitalisation concerned 8 patients with an average stay of 12 days with extremes ranging from 5 to 22 days. Quality of life was impaired in the majority of cases (Table 6).

Discussion:-
In March 2009, the second international symposium organized in San Francisco by the "Hidradenitis Suppurativa Foundation" adopted a consensus definition of HS: ""HS is a chronic, inflammatory, recurrent, debilitating, skin follicular disease that usually presents after puberty with painful deep-seated, inflamed lesions in the apocrine glandbearing areas of the body, most commonly, the axillary, inguinal, and anogénitale regions"" [2]. It is a rare condition whose incidence has not been clearly established. Its prevalence varies from 0.05% to 4.10% depending on the series, with a predominance of females reported in the majority of studies, not found in our series due to the military nature of our institution [3]. The average age remains higher than in the literature, which can be explained by the lack of knowledge of the disease among physicians causing a delay in diagnosis.
Several risk factors have been associated with HS: tobacco, obesity, exogenous local irritations (antiperspirant, talcum powder, deodorant). Genetic and hormonal factors have also been implicated [2]. The association with several pathologies was widely described as: metabolic syndrome, axial spondyloarthritis, chronic inflammatory bowel diseases, cardiovascular diseases, sexual disorders, depression and anxiety. Other associations have also been reported such as: acne, pilonidal cyst, Down syndrome, vitiligo, alopecia [2,4,5]. Our series confirmed the presence of the majority of reported risk factors and a few cases of associated diseases. Association in a syndromic setting is possible during HS. This is the case with PAPA syndrome (pyoderma gangrenosum, acne, pyogenic arthritis), PASH syndrome (pyoderma gangrenosum, acne, HS) or PAPASH (pyoderma gangrenosum, acne, pyogenic arthritis, HS) [4].
HS most often manifests itself in the form of nodular and painful erythematous lesions, sometimes with discharge, with an average diagnosis time of 8 years, which is in line with the results of our study. The most frequent location in the literature is the axillary region, followed by the inguinal and perineal regions, with an average of two affected areas [2].
The evaluation of the severity of the disease is essentially clinical. Several methods are used, the most commonly used being the Hurley classification. Other methods are increasingly being used with a strong interest in posttreatment surveillance, such as the Sartorius score, the PGA-HS (Physician Global Assessement) or the HiSCR (Hidradenitis Suppurativa Clinical Score) [6].
The spontaneous progression is towards chronicity with iterative relapses causing physical and psychological suffering. Complications such as amyloidosis or squamous cell carcinoma are possible [1]. In our series, one case of malignant transformation into squamous cell carcinoma has been recorded (6.6%), explained by the delay in diagnosis and thus in treatment.
There is currently no consensus on the treatment of HS. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by surgery or laser, while medical treatment alone or in combination with radical surgery is suggested for widespread lesions. Adjuvant measures such as pain management, treatment of superinfections, weight loss and smoking cessation should be considered [7].
HS is considered among the dermatological diseases with the greatest impact on patient quality. A study of 61 patients with HS showed that the impairment in quality of life was significantly higher (p<0.001) than in patients with neurofibromatosis, urticaria, psoriasis or atopic dermatitis [2]. This was also the finding in our study with a score: DLQI* > 11 (*Dermatology Life Quality Index) for more than 73% of our patients.

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Conclusion:-HS is characterized by its long evolution which can lead to a real handicap for the patient with a psychological, family and professional impact. New molecules are currently being developed and studied. The recognition of the impact of this disease would make it possible to push research in terms of treatment and to ensure the coverage of the often very expensive costs for patients.

Conflict of Interest:
The authors declare no conflict of interest.