THE DIFFERENTIAL-DIAGNOSIS AND COMORBIDITY OF HIDRADENITIS SUPPURATIVA AND PERIANAL CROHN DISEASE

Over the last 8 years, 61 patients with hidradenitis suppurativa (HS) have been treated at this institution. Twenty-four have also had a dia gnosis of Crohn's disease (38%). This dual pathology is examined in de tail in this retrospective review. There were 11 males and 13 females with a mean age of 39 years (range 18 to 75 years). The Crohn's diseas e was ileal in 1 patient, ileocolic in 4, and affected the large bowel only in 19. The diagnosis of Crohn's disease predated that of HS by a n average of 3.5 years. At the time of review, 22 patients had a stoma , 23 had undergone laparotomy and 17 had lost their rectum. Hidradenit is suppurativa occurred in the perineal or perianal area in all patien ts but involved other sites in 20 cases. Skin grafting had been done i n 9 and local procedures in 19 patients. Granulomas were found in exci sed skin in 6 cases but this finding was not associated with a poor ou tcome. At a mean follow-up of 3.2 years from the most recent surgery f or HS (range 1 to 11 years) 11 were asymptomatic for HS, 11 had sympto ms and no follow up was available in 2. These data show that HS may co exist with Crohn's proctocolitis, complicating the diagnosis and manag ement of patients in whom it occurs. An increased appreciation of the possibility is recommended.