ISSN:
1365-2133
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
Hidradenitis suppurativa (HS) is a chronic inflammatory condition of apocrine glands: poral occlusion and added bacterial infection are important aetiological factors but the underlying cause remains unknown. Published animal work shows the apocrine gland to be hormone dependent. A similar mechanism is suggested in man by the failure of HS to appear before puberty and its frequent association with acne vulgaris and other androgen-dependent conditions.Forty-two patients with HS have been clinically and biochemically assessed for signs of increased androgen activity. Plasma total testosterone (T) sex hormone binding globulin (SHBG), dehydroepiandrosterone sulphate (DHEAS), prolactin, FSH, LH and 17-β-oestradiol were measured and compared with groups of normal female controls (n = 25) and subjects with idiopathic hirsutes (n = 37). Nineteen patients with no medical contra-indications were randomly allocated to a double-blind within-patient crossover trial comparing ethinyloestradiol (50 μg) and cyproterone acetate (CPA) (50 mg in a reverse sequential regimen) with ethinyloestradiol (50 mg and levonorgestrel (500 μg) (EU/50). Treatments were sequential for 12 months with crossover at 6 months. Patients were assessed by clinical grading.Results demonstrate total testosterone and T/SHBG (index of free testosterone) to be significantly higher than normal controls in the HS group (P 〈 0·01) as well as the hirsutes group (P 〈 0·01).Treatment with CPA demonstrated significant improvement as compared to EU/50. Seven of the 19 patients were ultimately clear of the disease.We propose clinical criteria, including the presence of comedones, associated acne and pilonidal sinus, for establishing the diagnosis of HS. Early recognition is important for satisfactory control of the disease.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1111/j.1365-2133.1985.tb12987.x
Permalink
