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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report outcomes for 10 patients with persistent painful nodules of hidradenitis suppurativa treated with cryotherapy. Eight patients reported improvement and to date have had no recurrence of lesions at the treated sites. Most patients had significant pain during and after treatment. Eight patients had post-treatment ulceration, infection or both. The average number of days for the treatment areas to heal was 25. Seven patients rated cryotherapy as better than oral antibiotics and eight patients would consider this treatment again in the future. Cryotherapy can be an effective treatment for patients who have limited but persistent painful nodules. However, patients must be warned about pain, prolonged healing time and risk of infection after the procedure.
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PMID:Treatment of persistent painful nodules of hidradenitis suppurativa with cryotherapy. 1278 Jul 2

This is a case report of a man with chronic hidradenitis suppurativa who developed reactive arthritis. He presented with swelling and pain in his larger joints, along with conjunctivitis involving his right eye. These symptoms coincided with a flare of the hidradenitis suppurativa. His clinical picture and laboratory findings were consistent with a diagnosis of reactive arthritis. He was initially treated with prednisone, and later with methotrexate, with improvement in his symptoms. This case report is a discussion of a rare cause of reactive arthritis. A review of the literature regarding this condition is also included.
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PMID:Reactive arthritis associated with hidradenitis suppurativa. 1939 29

Hidradenitis suppurativa (HS) is a chronically relapsing skin disorder characterized by recurring inflammatory lesion in hair and apocrine gland-bearing skin creases in the axilla; groin or perineum, buttocks, and/or breast. HS may lead to painful eruptions and malodorous discharge significantly detracting from quality of life. HS causes a high degree of morbidity with the highest scores obtained for the level of pain caused by the disease. The majority of patients rated their pain on a Numerical Rating Scale-11 ranging from 4/10 to 10/10 and described it at various times as hot, burning, pressure, stretching, cutting, sharp, taut, splitting, gnawing, pressing, sore, throbbing, and aching. Despite the severe pain associated with this disease, HS has been essentially ignored in the pain medicine literature. It is hoped that greater understanding of the diagnosis, pathophysiology, and potential treatment options available for patients with HS, may help put pain specialists in a better position to contribute to the overall care of patients with significantly painful HS. This article reviews HS and pain. Potential mechanisms of modulating nociceptive processes in the skin are presented. A greater understanding of the diagnosis, pathophysiology, and potential treatment options for HS patients may help providers to be better able to contribute to care of patients with painful hidradenitis suppurativa.
Clin J Pain 2010 Jun
PMID:Painful hidradenitis suppurativa. 2047 53

Hidradenitis suppurativa is a chronic and recurrent inflammatory disease of the apocrine glands characterized by recurrent abscesses, draining sinus tracts, and scarring that can be located in the groin, axilla, perineal, and perianal areas and less frequently in the scalp area. The chronic and relapsing nature of hidradenitis suppurativa leads to physical and psychological damage because it frequently causes disabling pain, diminished range of motion, and social isolation. Surgical removal of all apocrine glands in the affected region is the definitive treatment because conservative treatment usually does not prevent recurrence of hidradenitis suppurativa. The resultant defect can be either left to heal secondarily or closed primarily. Secondary healing in the axilla may cause contractures and stiffening of the shoulder. Primary healing requires direct closure, split-skin grafting, or locoregional flap transposition. The majority of the listed surgical procedures cause long hospital stays and leave contour defects in both the axilla and the arm. This report presents a series of 16 cases managed between March 2006 and June 2008. All the patients had endured a long period of medical treatment and subsequently required surgery for long-term relief of symptoms. The functional and aesthetic outcomes were very satisfactory in all cases despite the final scar. The initial reconstructive aims were achieved for these patients. The authors consider the thoracodorsal artery perforator flap a useful option for the surgical treatment of axillary hidradenitis suppurativa.
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PMID:Experience using the thoracodorsal artery perforator flap in axillary hidradentitis suppurativa cases. 2058 98

Treatment of hidradenitis suppurativa (HS) is often unsatisfactory. The efficacy of infliximab for treatment of the disease has been suggested. The main objective of this study was to evaluate the efficacy and side-effects of infliximab in the treatment of moderate to severe HS, resistant to local and systemic treatments. The secondary objective was to determine whether inflammation blood test results were changed. A retrospective monocentric study of all the patients seen consecutively for HS and treated with infliximab was performed. A median of six intravenous infusions (range 3-19) were performed. The end-points were self-improvement of HS (globally and in terms of pain, seeping and quality of life). The condition of six of seven patients improved (by nearly 50%) and none was aggravated. Adverse effects occurred in two patients; eczematous eruption in one case and cervical abscess in another case. We found no significant changes in inflammatory blood marker values. In conclusion, infliximab therapy was shown to be efficient and well tolerated in six of seven patients with HS resistant to previous therapy in our series. This was in agreement with pre-existing literature showing that 52 of 60 patients (87%) were improved after infliximab therapy.
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PMID:Efficacy of infliximab for hidradenitis suppurativa: assessment of clinical and biological inflammatory markers. 2138 87

Hidradenitis suppurativa influences patients' lives in many ways. It is therefore necessary to focus on the effects of the disease on daily life in order better to define patient-related outcomes in hidradenitis suppurativa studies. Interviews were conducted with 12 patients with hidradenitis suppurativa. Initial single interviews were followed by semi-structured and structured qualitative focus group interviews in order to improve the richness of the data and obtain in-depth understanding of the impact of the topics. Important topics were found to relate to aspects of interpersonal contact, especially in relation to smell and appearance, various emotional reactions, and feelings of lack of control. It was found that hidradenitis suppurativa has a great emotional impact on patients and promotes isolation due to fear of stigmatization. Shame and irritation are frequent and relate to smell, scars, itching and pain. Quality of life is adversely affected and professional support is needed.
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PMID:Psychosocial impact of hidradenitis suppurativa: a qualitative study. 2139 19

Hidradenitis suppurativa is a chronic skin disease, characterized by painful, deep-seated inflamed lesions, mainly in areas bearing apocrine sweat glands, most commonly the axillary and inguinal regions. Pain leads to mechanical problems, and bacterial growth in the lesions produces a foul-smelling discharge, which reduces the quality of life. In this type of hidradenitis the infection occurs around hair follicles and sebaceous glands, in contrast to what the name would suggest (hidradenitis = sweat-gland inflammation); hidradenitis suppurativa can, therefore be regarded more as a form of acne. The aetiology of hidradenitis is still unknown, but associated factors are smoking, obesity and familial predisposition.The syndrome can take a severe and disabling course. It is worthwhile implementing aggressive treatment at an early stage. Tumour necrosis factor-alpha inhibitors are now employed in the treatment of severe and treatment-resistant forms of hidradenitis suppurativa; under certain conditions this treatment will be reimbursed by the health insurance company. This development means that there are more treatment possibilities in hidradenitis than there were 5 years ago. The best results are achieved with a combination of antibiotic, anti-inflammatory and surgical treatment, tailored to the patient's individual situation.
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PMID:[Treatment options in severe hidradenitis suppurativa]. 2142 94

Participation in ice-skating sports, particularly figure skating, ice hockey and speed skating, has increased in recent years. Competitive athletes in these sports experience a range of dermatological injuries related to mechanical factors: exposure to cold temperatures, infectious agents and inflammation. Part I of this two part review discussed the mechanical dermatoses affecting ice-skating athletes that result from friction, pressure, and chronic irritation related to athletic equipment and contact with surfaces. Here, in Part II, we review the cold-induced, infectious and inflammatory skin conditions observed in ice-skating athletes. Cold-induced dermatoses experienced by ice-skating athletes result from specific physiological effects of cold exposure on the skin. These conditions include physiological livedo reticularis, chilblains (pernio), Raynaud phenomenon, cold panniculitis, frostnip and frostbite. Frostbite, that is the literal freezing of tissue, occurs with specific symptoms that progress in a stepwise fashion, starting with frostnip. Treatment involves gradual forms of rewarming and the use of friction massages and pain medications as needed. Calcium channel blockers, including nifedipine, are the mainstay of pharmacological therapy for the major nonfreezing cold-induced dermatoses including chilblains and Raynaud phenomenon. Raynaud phenomenon, a vasculopathy involving recurrent vasospasm of the fingers and toes in response to cold, is especially common in figure skaters. Protective clothing and insulation, avoidance of smoking and vasoconstrictive medications, maintaining a dry environment around the skin, cold avoidance when possible as well as certain physical manoeuvres that promote vasodilation are useful preventative measures. Infectious conditions most often seen in ice-skating athletes include tinea pedis, onychomycosis, pitted keratolysis, warts and folliculitis. Awareness, prompt treatment and the use of preventative measures are particularly important in managing such dermatoses that are easily spread from person to person in training facilities. The use of well ventilated footgear and synthetic substances to keep feet dry, as well as wearing sandals in shared facilities and maintaining good personal hygiene are very helpful in preventing transmission. Inflammatory conditions that may be seen in ice-skating athletes include allergic contact dermatitis, palmoplantar eccrine hidradenitis, exercise-induced purpuric eruptions and urticaria. Several materials commonly used in ice hockey and figure skating cause contact dermatitis. Identification of the allergen is essential and patch testing may be required. Exercise-induced purpuric eruptions often occur after exercise, are rarely indicative of a chronic venous disorder or other haematological abnormality and the lesions typically resolve spontaneously. The subtypes of urticaria most commonly seen in athletes are acute forms induced by physical stimuli, such as exercise, temperature, sunlight, water or particular levels of external pressure. Cholinergic urticaria is the most common type of physical urticaria seen in athletes aged 30 years and under. Occasionally, skaters may develop eating disorders and other related behaviours some of which have skin manifestations that are discussed herein. We hope that this comprehensive review will aid sports medicine practitioners, dermatologists and other physicians in the diagnosis and treatment of these dermatoses.
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PMID:Skin conditions in figure skaters, ice-hockey players and speed skaters: part II - cold-induced, infectious and inflammatory dermatoses. 2198 16

SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis) is a rare chronic inflammatory musculoskeletal disorder of unknown etiology observed in children and young adults, which involves both osteo-articular inflammation and skin abnormalities. We review the case of a 22-year-old male, who presented with a 5-year history of hidradenitis suppurativa (HS), acne vulgaris, joint stiffness, and pain. Previous ineffective treatments included isotretinoin and oral antibiotics. Marked improvement of all cutaneous features was noticed after the first dose of infliximab and methotrexate; continued treatment resulted in the complete remission of the arthritis and enthesopathy. This case report demonstrates the efficacy and safety of infliximab and methotrexate in refractory SAPHO syndrome.
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PMID:SAPHO syndrome associated with hidradenitis suppurativa successfully treated with infliximab and methotrexate. 2203

Experimental investigations have demonstrated that photodynamic therapy (PDT) with methyl aminolevulinate (MAL) may be a useful treatment in several inflammatory skin disorders and aesthetic indications. To assess the effectiveness, tolerability and safety of off-label MAL-PDT in daily clinical practice in 20 Italian hospital centers, a retrospective observational study of medical records of patients treated for off-label inflammatory and aesthetic indications was carried out. In all patients standard treatment options had been either ineffective, unacceptably toxic, or medically contraindicated. Clinical data regarding 221 patients affected by 22 different diseases were collected. The most common off-label indication was acne vulgaris, with >75% improvement in 72.8% of patients. Other disorders of the sebaceous gland, i.e. acne rosacea, hidradenitis suppurativa and sebaceous hyperplasia, were less responsive. Alopecia areata did not show any improvement. Granuloma annulare and necrobiosis lipoidica showed marked or moderate response in the majority of treated patients. The rate of patients with complete remission was lower for inflammatory skin disorders with hyperkeratosis, i.e. psoriasis (6/17) and porokeratosis (3/16). The efficacy for lichenoid dermatoses was dependent on the clinical variant (erosive and scleroatrophic were more responsive than hypertrophic). Only 1 of 6 patients with Zoon balanitis had a marked improvement. MAL-PDT of venous leg ulcers, photo-aging and hypertrophic scars led to a marked remission in 3/5, 3/6 and 5/8 patients, respectively. The treatment had to be interrupted because of strong pain and burning in 24 patients. Long term adverse events were not registered. Most patients with marked improvement had lasting remission with overall excellent cosmetic outcomes. The present findings demonstrate a high interest in off-label uses of MAL-PDT for inflammatory skin disorders. According to the observed clinical responses, safety, and favorable cosmetic results, MAL-PDT seems to have a potential therapeutic role for the treatment of granulomatous dermal disorders and follicular inflammatory diseases whereas results in other conditions are less encouraging.
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PMID:A retrospective analysis of real-life practice of off-label photodynamic therapy using methyl aminolevulinate (MAL-PDT) in 20 Italian dermatology departments. Part 1: inflammatory and aesthetic indications. 2294 35


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