What is Verneuil’s disease?
Described for the first time in 1854 by Dr. Aristide Verneuil (1823 – 1895), a French surgeon, Verneuil’s disease is still poorly understood today. This dermatological pathology (which is also called “hidradenitis” or “hidradenitis suppurative” in medical language) would affect 1 in 300 people worldwide; according to the statistics, however, it would be a little rarer on the Asian continent.
“It is not a rare disease since in France, around 1 million people are affected.emphasizes Dr. Pierre-André Becherel, dermatologist. It is estimated that Verneuil’s disease affects women more (3 women for about 1 man) and that it begins between 15 and 25 years old: later forms are infrequent. It is therefore not at all a disease of old age.“
What are the symptoms of Verneuil’s disease?
Verneuil’s disease is a dermatological pathology characterized by the appearance of abscesses in the flexion folds. Very concretely, the patient who suffers from Verneuil’s disease presents “balls” filled with pus at the level of the ano-perineal region (anus…), the groin, the pubis, the armpits, more rarely behind the ears and/or nipples. “These abscesses vary in size and can get really large, up to 4-5 centimeters in diameter, the size of a tennis ball.“, specifies the doctor dermatologist.
To know. Verneuil’s disease is a chronic pathology. “It evolves by pushes, explains Dr. Becherel. The abscesses are recurrent, they come back on a regular basis.“Good news: over time, the disease subsides with fewer and less prominent abscesses – as if the pathology”was losing power“!
Verneuil’s disease: what are the possible complications?
To know. Experts distinguish 3 stages of Verneuil’s disease: stage 1 (or “mild stage”) is the most common since it affects 75% of patients. We then observe single abscesses, without complications.
When left untreated (or insufficiently), the characteristic abscesses of Verneuil’s disease can develop into fistulas. “We speak of a fistula when the abscesses join together via a network of “tunnels” deep under the skin.“explains Dr. Becherel. The skin then takes on a “cardboard” appearance: it is cracked and covered with significant fibrous scars.
It is estimated that 24% of patients suffering from Verneuil’s disease have “fistulous tracts” – this is stage 2 of the disease or “moderate stage”. In 1% of patients, we even speak of “fistulous closet” since the fistulas extend over a large area of skin – this is stage 3 of the disease or “severe stage”.
What are the causes of Verneuil’s disease?
Attention ! Verneuil’s disease is not linked to a lack of hygiene. It is also not contagious.
If Science does not yet have all the answers vis-à-vis Verneuil’s disease, we now know that it is an auto-inflammatory disease. Due to a disruption of the body, certain pilosebaceous follicles (understand: the cavity in which the hair begins to grow) and certain apocrine glands (which are in particular responsible for producing sweat) are the seat of an inflammation – this which causes the symptoms of the pathology.
This inflammation could have a hormonal origin: the researchers think that Verneuil’s disease could be linked to hyper-sensitivity of the apocrine glands to androgens, the male hormones.
Transmission. Researchers have identified genetic factors: Verneuil’s disease could therefore be transmitted from parent to child, but not systematically. A family history is thus found in approximately 35% of cases.
Verneuil’s disease: what are the risk factors?
Verneuil’s disease is thought to occur particularly in people who are overweight or obese – with a body mass index (BMI) over 25.”Overweight and obesity are indeed responsible for friction in the folds of the body, which could promote the appearance of purulent abscesses.” develops Dr. Becherel.
Smoking is also a known risk factor: it is estimated that 70% to 90% of patients with Verneuil’s disease are smokers.
And also. “There is a well-studied link between stress and Verneuil’s diseaseemphasizes the dermatologist. Thus, in the event of psychological weakening (stress, fatigue, mood disorders, strong emotions, etc.), an inflammatory flare-up can be observed, probably linked to a deregulation of the immune system.“
To know. Verneuil’s disease is often accompanied by other skin diseases – acne, folliculitis of the scalp… It can also be associated with Crohn’s disease or ankylosing spondylitis.
Verneuil’s disease: what are the treatments?
Good news: Verneuil’s disease is not incurable. “When it begins around 15-25 years old, we can hope to see it disappear spontaneously around 40-45 years old.“says Dr. Becherel. In addition, at the age of menopause, the disease (which probably has hormonal causes) tends to subside.
Verneuil’s disease is called “orphan”: at present, there is no really effective treatment to cure this pathology. The disease is monitored by a dermatologist and/or by a proctologist when the lesions mainly concern the ano-perineal region. “Management is based on the prescription of powerful antibiotics to treat abscesses and stop the inflammatory flare-up: clyndamicin, ofloxacin…” develops the specialist.
The most effective treatment for Verneuil’s disease is surgery: “it is a question of removing the abscesses in depth (under local or general anesthesia) to prevent the recurrence of the pathology in a given area” notes Dr. Becherel. Healing is long (between 6 weeks and 4 months, depending on the extent of the lesions) and nursing care is then necessary.
And also. “Dietary support is offered to patients suffering from Verneuil’s disease to promote weight loss; it is also highly recommended tostop smoking“adds the specialist. Not to mention good stress management, for example through mindful meditation!
Thanks to Dr. Pierre-André Becherel, dermatologist at the Private Hospital of Antony and member of the scientific college of the Ramsay Health Foundation.
Sources:
French National Society of Colo-Proctology (SNFCP)
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