نبذة مختصرة : Hidradenitis suppurativa (HS) is a chronic inflammatory disease withrecurrent abscesses. In most cases, it involves the axillar andanogenital regions. In industrialised countries, the prevalence is of0.3% to 4%, and the disease is over-represented in young adult females.Various medical treatments have been used but they are seldom effective.Surgical treatment is recommended as soon as the condition is diagnosed,but wide excisions very well outside the clinical borders of activity,are mandatory. A simple local incision is of no value. According toHurley's clinical classification, stage I consists of one or moreabscesses with no sinus tract and cicatrisation and stage II consists ofone or more widely separated recurrent abscesses, with a tract andcicatrisation. The severest cases (stage III) have multipleinterconnected tracts and abscesses throughout an entire area.In this thesis we report a method in which horisontal vaporisation withcarbon dioxide laser is used to remove the inflamed infiltratingabscesses with precision. Patients classified as Hurley stage H wereselected consecutively, in 1989 and by the year 2000 that had undergonethis treatment. Most patients were females, in their twenties andthirties and had had the disease for a mean of more than ten years. Byusing a radical but selective, tissue-sparing technique, we removed theinflamed, foreign body-like tissues of HS, including its squamousepitheliumlined and keratin- containing sinuses. Initially, we used afree hand and more surgeondependent technique that was later abandonedfor a scanner assisted technique providing better accuracy, safety andfaster ablation. The use of these carbon dioxide laser, rapid beam,optomechanical scanner systems in a continuous mode gives a fast and evenablation with better visualisation of the macro- pathology duringsurgery. The surgical results were satisfactory cosmetically,functionally and as regards quality of life. We believe that thistechnique offers a safe and efficient strategy for many colleagues whotreat HS.Squamous cell carcinoma is a rare but serious complication of HS. Toinvestigate this association and the risk of other malignancies, weperformed a population-based retrospective cohort study on 2119 HSpatients selected from a computerised database of hospital dischargediagnoses in Sweden during 1965-1997. We found a significantly increasedrisk of non- melanoma skin cancer in patients with HS. The risks ofbuccal cancer and primary liver cancer were also higher.Aerobic and anaerobic cultures from superficial and deep levels weretaken during laser surgery in 24 patients. In all cases, bacterialcultures were positive for one or more specimens from at least one leveland from deep levels in all but three cases. Sixteen species orsubspecies were found. Staphylococcus OBS aureus OBS andcoagulase-negative OBS staphylococci OBS (CNS) were the most frequentlyfound species which suggests that CNS is a true pathogen.In our comparison of forty-two unrelated Swedish patients with HS and 250controls we found no association with HLA-A, -B or -DRB1 alleles usingthe genetic tissue typing technique. Genetic factors associated with theHLA class I or II regions do not seem to contribute significantly to thepossible genetic susceptibility of HS.We also compared the release of oxygen radicals and of primary granulafrom in vitro activated peripheral neutrophils from HS patients withinactive disease to that from a group of healthy controls. Our findingssuggest that dysfunctional neutrophils may be involved in thepathogenesis of hidradenitis suppurativa.
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