Acta Dermato-Venereologica 97-6 97-6CompleteContent | Page 29

SHORT COMMUNICATION 763 Double-ended Pseudocomedones in Hidradenitis Suppurativa: Clinical, Dermoscopic, and Histopatho­ logical Correlation Francesco LACARRUBBA, Maria Letizia MUSUMECI, Maria Rita NASCA, Anna Elisa VERZÌ, Federica FIORENTINI and Giuseppe MICALI* Dermatology Clinic, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Via Santa Sofia, 78, IT-95123, Catania, Italy. *E-mail: [email protected] Accepted Dec 15, 2016; Epub ahead of print Dec 16, 2016 Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the pilosebaceous unit, affecting skin areas rich in apocrine glands and their surrounding tissues, clini- cally characterized by the presence of deep-seated and painful nodules or ab- scesses, draining sinuses and prominent scarring (1). Double-ended pseudoco- medones (DEP) are also considered a typical clinical sign of this disorder (2). The aim of this study is to evaluate the clinical, dermoscopic, and histopatholo- gical features of DEP in order to identify a clinicopathological correlation. MATERIALS AND METHODS Fig. 1. Clinical and dermoscopic aspects of double-ended pseudocomedones. Two A total of 37 patients (9 males, 28 females, age cases (Nos. 8 and 6) of hidradenitis suppurativa (a and c) with pseudocomedones (yellow range 9–52 years, mean age 30.9 years) with circles). Under polarized light dermoscopy (b and d), multiple keratin accumulation, either current or past evidence of HS were evaluated superficially located (black arrows) or deep-seated (green arrow), may be observed embedded for the presence of DEP. All subjects provided in whitish cicatricial tissue. Some appear to be connected via a bluish tunnel (arrowheads). informed consent to their participation in the study. Sixty-four DEP from 20 patients (5 males, 15 females, age range 8–52 years, mean age 33.8 years) (Table scars), and generally presented large, irregular openings SI 1 ), were clinically identified and evaluated by dermoscopy at with ragged and/or undermined borders. Either deep- ×10 using polarized (Dermlite hybrid ® , 3 Gen, San Juan Capist- seated or superficially located keratin accumulations, rano, CA, USA) and incident light (KH-1300, Hirox, Hackensack, the latter well visible within the hollows, were observed USA). In 2 cases a skin biopsy was performed. RESULTS There were multiple DEP in 14 patients (mean 4.1 DEP/ patient, range 2–8), with 6 patients only showing a single DEP (Table SI 1 ). Clinically, DEP generally presented as coupled tiny cavities, usually showing a blackhead at each end (Figs 1a, c; 2a, d). Preferential localizations were those typical of HS, namely genito-femoral region (21 lesions), axillae (18 lesions), lower abdomen (14 lesions), buttocks (9 lesions) and mammary region (2 lesions). Under polarized light dermoscopy, DEP appeared as coupled hollows deepening in a slanted or parallel fashion with respect to the skin surface. The hollows were always observed within a whitish cicatricial tissue of variable depth and morphology (atrophic, bridging, and circinate https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2601 1 (Figs 1b, d; 2b, e). Incident light dermoscopy provided a 3-dimensional view of the scars, highlighting variable scar depth levels along with additional hollows (Fig. 2c, f). Histopathologically, DEP corresponded to a large, multi-loculated, superficially and horizontally-oriented hollow with dilated superficial openings. The cavity was lined by normal multilayered epithelium and filled with corneal lamellae, cellular debris, and amorphous mate- rial; there was no evidence of hair follicles (Table SII 1 ). DISCUSSION The role of imaging in HS is to enhance the visualization and to better define the extension of typical cutaneous lesions, supporting diagnosis, and assessment of disease severity. Different imaging technologies providing ob- jective information, such as ultrasound and magnetic resonance, may be used for this purpose (3, 4). Dermo­ scopy may be extended beyond pigmented skin lesions to various dermatological disorders, such as inflammatory This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340/00015555-2601 Acta Derm Venereol 2017; 97: 763–764