The Origin of Pilonidal Sinus: A Case Report

The etiology of pilonidal sinus remains controversial. Some think it is congenital, and others think it is acquired. It is difficult to distinguish acquired pilonidal sinus from congenital, because infection almost always complicates both. We report here one case of acquired pilonidal sinus unaccompanied by infection. Histological examination showed that no epidermis or hair pollicle was present in the inner wall of the sinus. This case shows that acquired pilonidal sinus is due to invasion of external hairs and that this condition needs to be distinguished from congenital pilonidal sinus.     

Effect of hair removal by Nd:YAG laser on the recurrence of pilonidal sinus

Background  Pilonidal sinus (PNS) is chronic inflammatory process of the skin in the natal cleft. Management of PNS is mainly surgical. Although different types of surgery have been performed, the recurrence rate is still high.
Objective  To evaluate the effectiveness of laser hair removal (LHR) in the natal cleft area on the recurrence rate of PNS as an adjuvant therapy after surgical treatment.
Methods  Twenty five patients with PNS were included in this study. Fifteen patients underwent LHR treatment using Nd:YAG laser after surgical excision of PNS (Patients group) while ten subjects with PNS did not do LHR and served as a control group.
Results  All of the patients were male patients. Their age ranged from 17 to 29 years with a mean of 21.60 ± 3.13 years. They had Fitzpatrick skin type III, IV and V. The patients have got 3 to 8 sessions of LHR (mean 4.87 ± 1.64). Follow up period lasted between 12 to 23 months. None of the patients, who underwent LHR, has required further surgical treatment to date. Seven patients out of ten in the control group have developed recurrent PNS. Pain was the most frequent side effect and it was seen in 6 patients (40%).
Conclusion  LHR can prevent the recurrence of PNS. LHR should be advised as an essential adjuvant treatment after surgical excision of PNS. In non-complicated recurrent PNS, LHR is strongly advocated to be started before and continued after doing surgical treatment.     

Cytokeratin expression in pilonidal sinus

BACKGROUND: Pilonidal sinus (PS) is considered to belong in the category of follicular occlusion diseases (acne triad). OBJECTIVES: The aim of our study was to elucidate the pathogenesis of PS by evaluating its cytokeratin (CK) expression. METHODS: CK expression in nine cases of PS was studied immunohistochemically using six antikeratin antibodies. RESULTS: Infundibular-like epithelium contained CK1, 10 and 14 similar to normal infundibulum, but it did not contain CK17. In non-infundibular-like epithelium, CK14, 16 and 17 were detected similar to that in normal outer root sheath. CK expression in PS was similar to that in hidradenitis suppurativa, suggesting that sinus epithelium may be fragile, hyperproliferative and undifferentiated. CONCLUSIONS: PS can be classified in the same entity as follicular occlusion diseases based on CK expression.     

Hedgehog pathway does not play a role in hidradenitis suppurativa pathogenesis

Hidradenitis suppurativa is a chronically relapsing skin disorder with onset after puberty and is characterized by inflammatory lesions in hair follicle and apocrine sweat gland-bearing skin that manifests as abscesses with formation of cysts and sinus tracts. Hedgehog family genes are required in normal embryonic skin, hair follicle, sebaceous and sweat gland development. Mutations of hedgehog pathway in adult skin have previously been found in basal cell carcinomas and in alopecia as well as in epidermal cysts and in odontogenic keratocysts. Therefore, we suggested that the hedgehog pathway might play a role in formation of sinus tracts and cysts as newly formed structures in hidradenitis suppurativa patients. None of the sinus tracts or cysts in 81 hidradenitis suppurativa histological slides from 34 patients showed positive finding for sonic hedgehog mutation. According to our findings, we have to conclude that there is no evidence that sonic hedgehog pathway is part of hidradenitis suppurativa pathogenesis.     

Surgical treatment of sacrococcygeal pilonidal sinus with rhomboid flap

In this review, we summarized the general characteristics of pilonidal sinus disease and details of rhomboid flap (RF) technique used in its treatment, and discussed the results of RF methods and its comparison with other techniques, principally with flap technique available in the literature. When performed studies are examined, RF technique has come into prominence nowadays with low recurrence and infection rates, and with a comfortable surgical technique. Recently, it has been anticipated that with the modification of this technique, the recurrence rate would be lower.     

Lipid raft-enriched stem cell-like keratinocytes in the epidermis, hair follicles and sinus tracts in hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a disease, that causes considerable morbidity in patients. A histological hallmark of the disorder is the formation of sinus tracts in the dermis and the subcutis. Biologically, they represent a poorly understood phenomenon involving the infiltrative growth of proliferating non-malignant keratinocytes. Lipid domains in plasma membranes (lipid rafts) play a role in the function of growth factors and are suspected of having a pathogenic role in cell migration and invasive growth. Using HS as a model, the presence of lipid rafts was studied using cholera toxin conjugated with FITC (CTx-FITC) and antibeta1 integrin (CD29)-CyChrome conjugate fluorescence staining of unfixed and acetone-fixed cryostat sections of lesional and paralesional skin samples. The double-labeled skin samples were observed in the confocal laser-scanning fluorescence microscope. Samples were obtained from five patients with HS. The lesional epidermis of HS contained three populations of keratinocytes: CD29(bright)CTx(dim), CD29(dim)CTx(bright) and a third hitherto unseen population containing double-positive CD29(bright)CTx(bright) cells. The CD29(bright)CTx(dim) population resembles the earlier described epidermal stem-like cells, while the CD29(dim)CTx(bright) basal keratinocytes overlap with the transit-amplifying cell pool. The new population of double-positive CD29(bright)CTx(bright) cells was localized on the slopes of the papillas, focally in the suprabasal epidermal layers, in some hair follicles and in the majority of sinus tracts. Such double-positive cells have not previously been encountered by us in normal epidermis and hair follicles. Using HS as a model, it is suggested that the keratinocytes involved in sinus tract formation are CD29(bright)CTx(bright) cells. Owing to the physical proximity of the cells, it is hypothesised that the described CD29(bright)CTx(bright) cells result from an increased expression of CD29 on the CTx(bright) cells. It is likely that the double-positive CD29(bright)CTx(bright) cells emerge due to the influence of local inflammatory cytokines. Sinus tract formation may represent an aberrant epidermal repair response executed by the activated CD29(bright)CTx(bright) keratinocytes capable of non-malignant infiltrative growth in the dermis and subcutis.     

The medical and surgical therapy of pseudofolliculitis barbae

Pseudofolliculitis barbae (PFB) is a common, chronic, inflammatory skin disorder seen mainly in individuals with curly hair. This condition is seen most frequently in black men who shave their beards but may also be seen in women of all races who wax or shave the axillary and pubic skin. The etiology of PFB is multifactorial, and heretofore a cure has been considered impossible for those desiring a clean-shaven face. The following article serves to discuss the current medical and surgical therapies available for this condition. Medical treatments for this condition include various combinations of topical antibiotics, corticosteroids, and retinoids. In the surgical arena, laser therapy has revolutionized the treatment of PFB and has enabled cure for the first time for those plagued by this disorder and for whom a beardless face is acceptable.     

Cutaneous manifestations of endocrine disorders: a guide for dermatologists

Dermatologists may commonly see skin lesions that reflect an underlying endocrine disorder. Identifying the endocrinopathy is very important, so that patients can receive corrective rather than symptomatic treatment. Skin diseases with underlying endocrine pathology include: thyrotoxicosis; hypothyroidism; Cushing syndrome; Addison disease; acromegaly; hyperandrogenism; hypopituitarism; primary hyperparathyroidism; hypoparathyroidism; pseudohypoparathyroidism and manifestations of diabetes mellitus. Thyrotoxicosis may lead to multiple cutaneous manifestations, including hair loss, pretibial myxedema, onycholysis and acropachy. In patients with hypothyroidism, there is hair loss, the skin is cold and pale, with myxedematous changes, mainly in the hands and in the periorbital region. The striking features of Cushing syndrome are centripetal obesity, moon facies, buffalo hump, supraclavicular fat pads, and abdominal striae. In Addison disease, the skin is hyperpigmented, mostly on the face, neck and back of the hands. Virtually all patients with acromegaly have acral and soft tissue overgrowth, with characteristic findings, like macrognathia and enlarged hands and feet. The skin is thickened, and facial features are coarser. Conditions leading to hyperandrogenism in females present as acne, hirsutism and signs of virilization (temporal balding, clitoromegaly).A prominent feature of hypopituitarism is a pallor of the skin with a yellowish tinge. The skin is also thinner, resulting in fine wrinkling around the eyes and mouth, making the patient look older. Primary hyperparathyroidism is rarely associated with pruritus and chronic urticaria. In hypoparathyroidism, the skin is dry, scaly and puffy. Nails become brittle and hair is coarse and sparse. Pseudohypoparathyroidism may have a special somatic phenotype known as Albright osteodystrophy. This consists of short stature, short neck, brachydactyly and subcutaneous calcifications. Some of the cutaneous manifestations of diabetes mellitus include necrobiosis lipoidica diabeticorum, diabetic dermopathy, scleredema adultorum and acanthosis nigricans.     

Keratoma hereditaria mutilans (Vohwinkel's disease) with congenital alopecia universalis (atrichia congenita)

A family is described in which a boy and two girls had features of keratoma hereditaria mutilans (Vohwinkel's disease) and congenital absence of hair. None of them had any hair at birth or developed any subsequently. They had congenital, nonscarring alopecia universalis. The skin over the palms and soles showed progressive thickening, which led to mutilating deformities of the hands and fingers. Histopathological examination of the scalp skin revealed no changes in the epidermis or dermis with normal sebaceous glands and identify hair structures; the skin on the palms showed a tremendously thickened horny layer. Both conditions remained unresponsive to various topical and systemic remedies used in the past. One of the girls had a meningocoele of the dorsolumbar region and died postoperatively. The simultaneous appearance of two rare hereditary diseases in siblings of one family is being reported for the first time.     

皮肤镜表现为玫瑰花瓣征的进展期白癜风1例

报告1例皮肤镜表现为玫瑰花瓣征的进展期白癜风。患者男,58岁,手背、阴囊及腹股沟白色斑片3个月。皮肤科检查：双侧手背、阴囊及腹股沟泛发性大小不一的近圆形或形状不规则的色素减退斑或瓷白色斑片,边缘模糊或清楚。皮肤镜检查：手背白斑可见亮白色玫瑰花瓣征,阴囊部位毛囊周围色素减退。皮损充分发展后,手背部位的玫瑰花瓣征消失。诊断：寻常型白癜风(进展期、散发型)。     

Eccrine sweat glands associate with the human hair follicle within a defined compartment of dermal white adipose tissue

It has always been assumed that sweat glands are distributed throughout the skin unconnected with hair follicles (hair “roots”) and their associated sebaceous (or “grease”) glands, which, together with other specialised glands and the muscles that make hairs stand up, are known as pilosebaceous units. Sweat glands and pilosebaceous units, in other words, have always been considered separate structures, with sweat glands opening on to the skin surface between hairs rather than alongside them. Sweat glands on the palms of the hands and the soles of the feet develop differently and were not considered in this study. Using a number of techniques, including looking down the microscope at sections of hair follicles taken from the scalp during hair transplants, and at manual and computer‐assisted 3D reconstructions of sections of scalp skin, this study from Spain and Manchester, UK, suggests that in hair‐bearing areas the deepest part of the sweat gland, a coiled structure, is in fact located very close to the deepest part of the pilosebaceous unit, sitting right by the sheath of the hair follicle, below the sebaceous gland and the point where the hair muscle attaches. Moreover, these structures sit together within cone‐shaped projections of fat that reach upwards into the lowest layer of the skin, the thick reticular dermis, from the fat underneath. The authors speculate that sweat glands, pilosebaceous units and this particular fatty tissue (collectively the “adnexal skin unit”) may interact in certain skin diseases, during wound healing and with drug treatments.     

Therapie des Pilonidalsinus und der Acne inversa

A pilonidal sinus is a invagination of the skin over the sacrum containing a tuft of hair which enlarges by repeated friction causing the hairs to penetrate the skin. It may become symptomatic if an infection occurs. There are similarities with acne inversa, which is present in about 23% of cases. Acne inversa is an inflammation of the sebaceous glands and terminal hair follicles, chiefly in the intertriginous areas. The first manifestation can occur at any time from puberty to advanced age. 90% of patients are smokers. Initially giant comedones and indolent subcutaneous nodules are found; they progress to form draining sinus tracts. Conservative treatment, incision and/or surgical removal of the abscesses and fistulas is futile. The method of choice is the early complete surgical excision of the involved skin extending into normal tissue both laterally and at the base. In most cases healing of the defects by secondary intention is uneventful.     

有特殊皮肤表现的二期梅毒3例报告

报道三例有特殊皮肤表现的二期梅毒,例1患者三种皮损同时存在梅毒性脱发,蔷薇疹,扁平湿疣;例2患者广泛发布的伴有恶臭的扁平湿疣,同时手足掌有暗红色斑疹;例3患者表现为阴囊阴阜境界清晰的正常皮色环状隆起性损害。     

Erythroderma,Hair Loss,and Sinus Histiocytosis with Massive Lymphadenopathy in a XYY-Male

This paper presents a case of sinus histiocytosis with massive lymphadenopathy (SHML) presenting as erythroderma in an XYY-male aged 27. The patient had little or no scalp, axillary, or pubic hair. Histologically, lymph nodes indicated dilatation of the sinuses with proliferation of benign-appearing histiocytes possessing abundant clear cytoplasm, admixed with giant cells and pericapsular fibrosis. Infiltrating histiocytes in the lymph nodes were OKM-1 (CD11b) positive, which is characteristic of monocyte-granulocyte lineages. In the present case, the abnormal presence of erythroderma, hair loss, SHML, and a chromosomal abnormality, XYY, were thought to be incidental features.     

Nasal dermoid sinus cyst

Abstract:  Midline congenital abnormalities of the skin may be related to subjacent visceral developmental defects. We report on three unrelated children presenting a small midline pit on the bridge of the nose from which a small tuft of hair was emerging. This presentation is the hallmark of a nasal dermoid sinus cyst. In one of the patients the sinus tract was connected to the anterior cerebral fossa and required neurosurgical management. Although midline cutaneous abnormalities may look trivial, dermatologists should keep a high index of suspicion for possible association with more severe underlying defect. The diagnosis of nasal dermoid sinus cyst requires appropriate imaging studies to determine the extension of the sinus tract thus allowing proper management.     

Palmoplantar keratoderma in myxedema

A 45-years-old woman came with diffuse yellowwaxy thickening, dryness and scaly skin of palms and soles and thickening of knuckles on dorsa of hands since 2 years. In addition, she had hoarseness of voice, weight gain, slow response, intolerance to cold, loss of pubic and axillary hair, generalised dryness and coarseness of skin, and mask like fades. Diagnosis of palmoplantar keratoderma and myxedema was confirmed by investigations.     

Allergic contact dermatitis to cow's hair

A 32-year-old farmer woman with delayed type of allergy to cow's hair is described in this study. She had the 5-year history of erythematous, desquamative lesions on the dorsal side of the hands and forearms. Shortly after entering the cowshed, she showed relapse of skin symptoms and total regression when she was away from the farm. The patch test to European standard series, hair of the cow from the patient's cowshed, hay, and stable hay was performed. Additionally, prick tests were performed on inhalant allergens such as hair of the cow from the patient's cowshed, hay, stable hay and cow's milk, total immunoglobulin class E (IgE) together and specific IgE to cow dander and milk. Patch test showed positive reaction to cow's hair, cobalt chloride, nickel sulfate, and thimerosal. All other tests were negative.     

Abnormal elastic tissue in cartilage-hair hypoplasia

A 29-year-old white woman had short limbs, hyperextendable joints, fine skin and body hair, anergy to common skin test antigens, subnormal lymphocyte response to phytohemagglutinin, and increased numbers of natural killer cells, characteristic of cartilage-hair hypoplasia, an autosomal, recessively inherited disorder found in America mainly among the old-order Amish. Her forearm skin was hyperextendable and numerous verrucae were present on the digits of her hands. A skin biopsy from hyperextendable skin showed ovoid, 10- to 20-micron bodies in the papillary dermis. Ultrastructurally, the bodies were interpreted as abnormal elastic fibers.     

Odontogenic sinus tract to the neck skin: a case report

We describe a 22-year-old woman with neck skin sinus tract that developed as a consequence of dental infection. The patient was treated twice in an inappropriate way with recurrence of the sinus tract. We opted for an extraction of the tooth. This case illustrates the need for cooperative diagnostic referrals between physicians and dentists.     

A case of cutaneous odontogenic sinus

Despite the fact that cutaneous sinus tracts of odontogenic origin are well documented, the condition is still commonly misdiagnosed, because chronic periapical periodontitis may be asymptomatic and is rarely open to the skin. A 75-year-old Japanese woman presented to our clinic with the chief complaint of a left cheek skin lesion with mild pain. Physical examination revealed a subcutaneous nodule covered with erythematous skin on her left buccal region. Cultures from the subcutaneous nodule grew Bacteroides species and Peptostreptococcus micros but did not yield acid-fast bacilli, fungi, or Actinomyces. Stains of smeared pus showed a considerable number of Gram-negative rods. The histopathological examination revealed a focal abscess formation in the lower dermis and subcutaneous tissue. Dental evaluation, including an orthopantogram, showed a radiolucent alveolar area at the left lower first molar apex, suggesting a periapical abscess. Antibiotic therapy for three weeks associated with surgical root canal therapy eliminated the subcutaneous nodule. A high degree of suspicion is required to correctly diagnose a lower facial lesion as being of odontogenic origin, and prompt dental evaluation should be considered.