Fox-den disease – из ихнего SURGINET'a

[Вячеслав Дмитриевич РЫНДИН]

Вот эту картинку выставили в ихнем SURGINET'е
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Меня это очень тронуло, посколько приходилось сходные штуки оперировать

Полазил в Гуугле и нашёл лекционный материал - вот вам:

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Вот название публикации

Author(s):
Ryan C. Stehr, MD; Nicholas Kim, MD; John A. LoGiudice, MD; Kirk Ludwig, MD, FACS, FASCRS

Issue:
Volume 27 - Issue 6 - June 2015
Login toDownload PDF version
Index:
Wounds 2015;27(6):170-173

Key words:
fox den diseasepyoderma fistulans sinificahidradenitis suppurativaSplit-Thickness Skin Graftperianal abscess
Abstract: Pyoderma fistulans sinifica, also known as fox den disease, is a rare and poorly understood inflammatory disorder of the skin and subcutaneous tissues. This disorder is often mistaken for other inflammatory skin disorders and treated inappropriately. The authors describe the case of a 53-year-old male who presented to the colorectal surgery service with a longstanding diagnosis of perirectal Crohn’s disease. Despite aggressive immunosuppression and numerous surgical procedures, the patient continued to have unrelenting purulent drainage from the skin of his buttocks.

Following wide excision of the affected skin and subcutaneous tissues by the colorectal surgeon, the plastic surgery team reconstructed the 30 cm x 55 cm wound using a combination of local flaps and skin grafts. The initial pathology report of the excised specimen confirmed the presence of nonspecific abscesses and inflammation. Upon special request by the plastic surgery team, the sample was resectioned with the specific intent of establishing a diagnosis of fox den disease. The additional slides met the criteria for an unequivocal diagnosis of fox den disease. Immunosuppression was discontinued and the patient healed his wounds without complication. Fox den disease is often overlooked because of the obscurity of the disease and the special histological sectioning needed to establish a diagnosis. In this case, the patient was unnecessarily treated with immunosuppressive drugs for more than 3 decades because of a misdiagnosis. With increased awareness of fox den disease, perhaps its pathophysiology can be better elucidated as more patients are appropriately diagnosed and treated.

- See more at: http://www.woundsresearch.com/article/f ... GZzqW.dpuf

https://en.wikipedia.org/wiki/Hidradenitis_suppurativa
HS is an orphan disease due to lack of publicity and sparse research efforts. ..... Fox-den disease – a term not used in medical literature, based on the deep fox ...


А здесь длинный список методов лечения...

Medication

Antibiotics- taken orally, these are used for their anti-inflammatory properties rather than to treat infection. Most effective is a combination of rifampicin and clindamycin given concurrently for 2–3 months. This brings about remission in around three quarters of cases. A few popular antibiotics used to treat hidradenitis suppurativa include tetracycline, minocycline, and clindamycin.

Corticosteroid injections. Also known as intralesional steroids: can be particularly useful for localized disease, if the drug can be prevented from escaping via the sinuses.

Vitamin A supplementation

Anti-androgen therapy: hormonal therapy with cyproterone acetate and ethinyl estradiol proved effective in randomized, controlled trials. Dosages reported have been very high.

Intravenous or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade),etanercept (Enbrel),[30] and adalimumab (Humira).[31] This use of these drugs is not currently Food and Drug Administration(FDA) approved and is somewhat controversial, and therefore may not be covered by insurance.

TNF inhibitor: Studies have supported that various TNF inhibitors have a positive effect on hidradenitis suppurativa lesions.There is a large efficacy and safety study of adalimumab registered with the FDA. It recruited 309 patients and is currently completed. The results have not yet been published. FDA cleared Adalimumab for the treatment for Hidradenitis suppurativa.

Zinc gluconate taken orally has been shown to induce remission.

Chlorhexidine (Hibiclens) plus an antibiotic soap for cleansing the skin surface. Covering sores with Metrolotion after medicated showers. These are considered to be general measures and are the foundation of any good medical treatment and management plan for hidradenitis suppurativa.[citation needed]

Topical clindamycin has been shown to have an effect in double-blind placebo controlled studies.

Topical resorcinol is a keratolytic agent that targets the follicular keratin plug and has been shown to have efficacy in several case series studies.

Topical isotretinoin is usually ineffective in people with HS and is more commonly known as a medication for the treatment of acne vulgaris. Individuals affected by HS who responded to isotretinoin treatment tended to have milder cases of the condition.

Radiation
Electron beam radiotherapy has been a successful treatment of hidradenitis, especially in Europe; it is not a common treatment option in most of the United States, as radiation oncologists generally are disinclined to treating patients with non-malignant diseases because of the potential for secondary radiation-induced tumors in the long term.

Surgery
When the process becomes chronic, wide surgical excision is the procedure of choice. Wounds in the affected area do not heal by secondary intention, and immediate application of a split thickness skin graft is more appropriate.

Laser hair removal
The 1064 nanometer wavelength laser for hair removal aids in the treatment of HS.[38] A randomized control study has shown improvement in HS lesions with the use of an Nd:YAG laser.

[dr.Viktor]

Если по последним двум снимкам судить, то это очень похоже на БОЛЕЗНЬ ВЕРНЕЯ , и это есть на Форуме в Теме, еще в 27.01.2012года, где есть очень похожее фото, представленное с моего скромного ЛО=Личного Опыта..., в теме-:
«Что Это? Фурнье-не Фурнье..злокачественный дерматит??»

http://surgery.forumshealth.com/t1543-topic

Особенно фото №3, очень похоже, на фото, что в теме...

[Вячеслав Дмитриевич РЫНДИН]

[Вячеслав Дмитриевич РЫНДИН]

[dr.Viktor]

Последние два фото, что Вы представили, почти 1 к 1, что фото, в Теме, по Болезни Вернея---:
«Что Это? Фурнье-не Фурнье..злокачественный дерматит??»

http://surgery.forumshealth.com/t1543-topic

хорошо открывается тема....Найду оригинал фото вставлю, тут, вот, получилось, перезагрузить фото через радикал, со старой темы, сюда-:





Это и есть Болезнь Вернея...
Где-то есть Гистологическое подтверждения этому, во Франции исследования делали...

[dr.Viktor]

[Вячеслав Дмитриевич РЫНДИН]

Dr Victor, доброе утро...

Мир дерматологии сложен для понимания нашим скудным хирургическим умишком

ИМХО, выявленный микроб далеко не всегда даёт правильный диагноз, за редким исключением типа ТБК, проказа, грибки, сифилис и т.п.
Иногда бывает, что микроб высевают один и тот же при разных болезнях - полный атас )

Потому =-то у почтенных дерматологов таком большой лист лечения (см мой повтор), а у нас, у чудаков на букву М, только нож, про который многои старики хирурги говорили, что он не может решить всех проблем..
Medication

Antibiotics- taken orally, these are used for their anti-inflammatory properties rather than to treat infection. Most effective is a combination of rifampicin and clindamycin given concurrently for 2–3 months. This brings about remission in around three quarters of cases. A few popular antibiotics used to treat hidradenitis suppurativa include tetracycline, minocycline, and clindamycin.

Corticosteroid injections. Also known as intralesional steroids: can be particularly useful for localized disease, if the drug can be prevented from escaping via the sinuses.

Vitamin A supplementation

Anti-androgen therapy: hormonal therapy with cyproterone acetate and ethinyl estradiol proved effective in randomized, controlled trials. Dosages reported have been very high.

Intravenous or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade),etanercept (Enbrel),[30] and adalimumab (Humira).[31] This use of these drugs is not currently Food and Drug Administration(FDA) approved and is somewhat controversial, and therefore may not be covered by insurance.

TNF inhibitor: Studies have supported that various TNF inhibitors have a positive effect on hidradenitis suppurativa lesions.There is a large efficacy and safety study of adalimumab registered with the FDA. It recruited 309 patients and is currently completed. The results have not yet been published. FDA cleared Adalimumab for the treatment for Hidradenitis suppurativa.

Zinc gluconate taken orally has been shown to induce remission.

Chlorhexidine (Hibiclens) plus an antibiotic soap for cleansing the skin surface. Covering sores with Metrolotion after medicated showers. These are considered to be general measures and are the foundation of any good medical treatment and management plan for hidradenitis suppurativa.[citation needed]

Topical clindamycin has been shown to have an effect in double-blind placebo controlled studies.

Topical resorcinol is a keratolytic agent that targets the follicular keratin plug and has been shown to have efficacy in several case series studies.

Topical isotretinoin is usually ineffective in people with HS and is more commonly known as a medication for the treatment of acne vulgaris. Individuals affected by HS who responded to isotretinoin treatment tended to have milder cases of the condition.

Radiation
Electron beam radiotherapy has been a successful treatment of hidradenitis, especially in Europe; it is not a common treatment option in most of the United States, as radiation oncologists generally are disinclined to treating patients with non-malignant diseases because of the potential for secondary radiation-induced tumors in the long term.

Surgery
When the process becomes chronic, wide surgical excision is the procedure of choice. Wounds in the affected area do not heal by secondary intention, and immediate application of a split thickness skin graft is more appropriate.

Laser hair removal
The 1064 nanometer wavelength laser for hair removal aids in the treatment of HS.[38] A randomized control study has shown improvement in HS lesions with the use of an Nd:YAG laser.

[dr.Viktor]