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Acne and Spondyloarthritis &#40;PASS&#41;&#46; Recently it was added to the spectrum the syndrome composed of Psoriatic Arthritis&#44; Pyoderma gangrenosum&#44; Acne and Hidradenitis Suppurativa &#40;PsAPASH&#41; and Pyoderma gangrenosum&#44; Acne and ulcerative Colitis &#40;PAC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Auto inflammatory syndromes are defined by an aberrant innate immune system and absence of circulating autoantibodies and autoreactive T-cells and it is believed that recurrent episodes of neutrophilic inflammation are mediated by interleukin 1&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> The symptoms are usually severe and may not respond to standard treatments and thus have devastating physical and psychological consequences for the affected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 22 year-old female patient reported painful lesions in the armpits 3 years later with dissemination to the groin and breasts&#46; One year ago&#44; acne lesions appeared in addition to lower limb ulcers and scaly lesions on the scalp appeared for 3 months and were referred to our HULW Dermatology service&#46; He also reported joint pains in hands&#44; wrists&#44; knees and lumbar spine with morning stiffness of 30<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the examination he had Grade 2 acne on the face&#59; abscesses&#44; fistulae and fibrosis in armpits and groin compatible with Hurley&#39;s Grade III suppurative hidradenitis&#59; scaly erythematous scaly plaques suggestive of psoriasis and pseudotinha amiant&#225;cea&#59; and purulent painful nodules and ulcers with violaceous&#44; protruding and undermined left breast tendrils suggestive of pyoderma gangrenosum &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was medicated with capillary solution of salicylic acid and betamethasone dipropionate and antisecretory shampoo&#44; in addition to clindamycin 300<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h and metformin 500<span class="elsevierStyleHsp" style=""></span>mg twice daily&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The anatomopathological fragment of the scalp revealed epidermis with psoriasiform acanthosis&#44; paraaceratosis&#44; hypogranulosis and intracranial microabscesses&#44; a dermis with inflammatory infiltrate of the perivascular lymphohistiocytic&#44; compatible with psoriasis&#46; Already the fragment of the left breast showed cutaneous ulcer with dense and diffuse mixed inflammatory infiltrate&#44; with abscessed foci&#44; focal areas of necrosis and frequent leukocytoclasia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">He presented laboratory tests&#44; such as non-reactive FAN&#44; VHS 54&#44; Negative Rheumatoid Factor&#44; serologic tests for Hepatitis B and C negative&#44; PPD 0<span class="elsevierStyleHsp" style=""></span>mm&#44; Chest X-Ray without changes&#46; Based on the CASPAR criteria&#44; it presents a diagnosis of psoriatic arthritis &#40;peripheral arthritis&#44; current psoriasis and negative rheumatoid factor&#41;&#44; and was referred to the Rheumatology department for interdisciplinary follow-up&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient did not present improvement with initial treatment and then started using Adalimumab in a scheme for hidradenitis suppurativa and presented an important improvement of the picture at the consultation after 2 months &#40;<a class="elsevierStyleCrossRefs" href="#fig0025">Figs&#46; 5 and 6</a>&#41;&#44; evidenced by the decrease in Sartorius score &#40;underarm&#44; previous&#58; 55&#44; after 2 months&#58; 49&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The schedule was performed with 4 syringes&#44; subcutaneously&#44; of Adalimumab &#40;40<span class="elsevierStyleHsp" style=""></span>mg&#41; at week 0 and 2 syringes at week 2 &#40;induction phase&#41;&#44; followed by 1 syringe every 7 days &#40;maintenance phase&#41;&#46; The same goes on regular quarterly monitoring in our service&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Suppurative hidradenitis is a chronic inflammatory disease of the skin&#44; clinically defined by nodules and recurrent painful abscesses that lead to the formation of fistulas&#44; nodules and scars&#46; It occurs in 1&#37; of the population&#44; is more frequent in women and tends to resolve at menopause&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Locally recurring lesions may be excised or treated with a laser&#46; Disseminated lesions&#44; however&#44; can be treated with radical surgery&#44; topical or systemic antibiotics &#40;tetracycline or clindamycin with rifampicin&#41;&#44; oral retinoids&#44; dapsone and biological agents &#40;adalimumab and infliximab&#41;&#46; Pain management&#44; weight loss&#44; tobacco abstinence and treatment of superinfections are also important recommendations for all patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Suppurative hidradenitis associated with autoinflammatory syndromes is often severe &#40;Hurley II&#44; III&#41; and does not respond to many of the usual treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Because of the likely common pathogenesis involving IL-1-induced inflammation&#44; collective experiments to date indicate that IL-1 and TNF-targeted therapies represent the most successful treatment solution for prolonged remission&#46; TNF-blocking agents&#44; adalimumab and infliximab&#44; have achieved good control of suppurative hidradenitis lesions and&#44; thus&#44; reinforce the role of a deregulated innate immune response in the disease pathogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The autoinflammatory syndrome composed of the association of psoriatic arthritis&#44; pyoderma gangrenosum&#44; acne and hidradenitis suppurativa &#40;PsAPASH&#41; was described in 2015 and there was no other similar description in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> As in the case described&#44; our patient was treated with Adalimumab and presented in remission of the disease&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">No genetic mutation associated with PsAPASH has yet been identified&#44; but the other syndromes are associated with the genetic mutation in the coding region of PSTPIP1 as well as with increased repetitions of CCTG in the promoter region of PSTPIP1&#44; leading to its deregulation and predisposition to cutaneous neutrophilic inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Thus&#44; it is very important that dermatologists know about autoinflammatory syndromic hidradenitis&#44; including typical lesions of pyoderma gangrenosum&#44; hidradenitis suppurativa&#44; psoriasis and acne&#44; and laboratory findings suggestive of systemic inflammation to establish clinical prevalence and early treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Raissa de Lima Gadelha&#58; Statistical analysis&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Renata da Silveira Rodrigues Paiva&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Esther Bastos Palitot&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Joanne Elizabeth Ferraz da Costa&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hidradenitis suppurativa is a chronic inflammatory skin disease&#44; which affects 1&#37; of the population&#44; being more common in young&#44; obese and smokers&#44; and mainly affects armpits and groin&#44; with formation of pustules&#44; nodules&#44; abscesses&#44; scars and fistulas&#46; Recently&#44; its association with other autoimmune diseases such as psoriasis&#44; psoriatic arthritis&#44; pyoderma gangrenosum&#44; pyogenic arthritis and ulcerative colitis have been reported&#46; These associated forms are usually resistant to standard treatment&#44; with immunobiologicals as promising therapy&#46; The case of a rare form of association is reported&#44; with only one case previously described in the literature&#58; psoriasis arthritis&#44; pyoderma gangrenosum&#44; acne and hidradenitis suppurativa&#46;</p></span>"
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Case Report
PsAPASH: a rare and recent autoinflammatory syndrome associated with hidradenitis suppurativa
Raissa de Lima Gadelha
Corresponding author
raissalimagadelha@hotmail.com

Corresponding author.
, Renata da Silveira Rodrigues Paiva, Esther Bastos Palitot, Joanne Elizabeth Ferraz da Costa
Department of Dermatology, Hospital Universitário Lauro Wanderley, João Pessoa, PB, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Suppurative hidradenitis is a chronic inflammatory skin disease with pathophysiology based on follicular occlusion of the pilosebaceous unit and innate deregulated immune response&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Suppurative hidradenitis and acne may be essential components of the auto-inflammatory syndromes which are described&#58; Pyoderma gangrenosum&#44; Acne and Pyogenic Arthritis &#40;PAPA&#41;&#44; pyoderma gangrenosum&#44; acne and hidradenitis suppurativa &#40;PASH&#41;&#44; Pyoderma gangrenosum&#44; Acne&#44; Pyogenic arthritis and Hidradenitis Suppurativa &#40;PAPASH&#41; and Pyoderma gangrenosum&#44; Acne and Spondyloarthritis &#40;PASS&#41;&#46; Recently it was added to the spectrum the syndrome composed of Psoriatic Arthritis&#44; Pyoderma gangrenosum&#44; Acne and Hidradenitis Suppurativa &#40;PsAPASH&#41; and Pyoderma gangrenosum&#44; Acne and ulcerative Colitis &#40;PAC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Auto inflammatory syndromes are defined by an aberrant innate immune system and absence of circulating autoantibodies and autoreactive T-cells and it is believed that recurrent episodes of neutrophilic inflammation are mediated by interleukin 1&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> The symptoms are usually severe and may not respond to standard treatments and thus have devastating physical and psychological consequences for the affected patients&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">A 22 year-old female patient reported painful lesions in the armpits 3 years later with dissemination to the groin and breasts&#46; One year ago&#44; acne lesions appeared in addition to lower limb ulcers and scaly lesions on the scalp appeared for 3 months and were referred to our HULW Dermatology service&#46; He also reported joint pains in hands&#44; wrists&#44; knees and lumbar spine with morning stiffness of 30<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the examination he had Grade 2 acne on the face&#59; abscesses&#44; fistulae and fibrosis in armpits and groin compatible with Hurley&#39;s Grade III suppurative hidradenitis&#59; scaly erythematous scaly plaques suggestive of psoriasis and pseudotinha amiant&#225;cea&#59; and purulent painful nodules and ulcers with violaceous&#44; protruding and undermined left breast tendrils suggestive of pyoderma gangrenosum &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was medicated with capillary solution of salicylic acid and betamethasone dipropionate and antisecretory shampoo&#44; in addition to clindamycin 300<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>h and metformin 500<span class="elsevierStyleHsp" style=""></span>mg twice daily&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The anatomopathological fragment of the scalp revealed epidermis with psoriasiform acanthosis&#44; paraaceratosis&#44; hypogranulosis and intracranial microabscesses&#44; a dermis with inflammatory infiltrate of the perivascular lymphohistiocytic&#44; compatible with psoriasis&#46; Already the fragment of the left breast showed cutaneous ulcer with dense and diffuse mixed inflammatory infiltrate&#44; with abscessed foci&#44; focal areas of necrosis and frequent leukocytoclasia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">He presented laboratory tests&#44; such as non-reactive FAN&#44; VHS 54&#44; Negative Rheumatoid Factor&#44; serologic tests for Hepatitis B and C negative&#44; PPD 0<span class="elsevierStyleHsp" style=""></span>mm&#44; Chest X-Ray without changes&#46; Based on the CASPAR criteria&#44; it presents a diagnosis of psoriatic arthritis &#40;peripheral arthritis&#44; current psoriasis and negative rheumatoid factor&#41;&#44; and was referred to the Rheumatology department for interdisciplinary follow-up&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patient did not present improvement with initial treatment and then started using Adalimumab in a scheme for hidradenitis suppurativa and presented an important improvement of the picture at the consultation after 2 months &#40;<a class="elsevierStyleCrossRefs" href="#fig0025">Figs&#46; 5 and 6</a>&#41;&#44; evidenced by the decrease in Sartorius score &#40;underarm&#44; previous&#58; 55&#44; after 2 months&#58; 49&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The schedule was performed with 4 syringes&#44; subcutaneously&#44; of Adalimumab &#40;40<span class="elsevierStyleHsp" style=""></span>mg&#41; at week 0 and 2 syringes at week 2 &#40;induction phase&#41;&#44; followed by 1 syringe every 7 days &#40;maintenance phase&#41;&#46; The same goes on regular quarterly monitoring in our service&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">Suppurative hidradenitis is a chronic inflammatory disease of the skin&#44; clinically defined by nodules and recurrent painful abscesses that lead to the formation of fistulas&#44; nodules and scars&#46; It occurs in 1&#37; of the population&#44; is more frequent in women and tends to resolve at menopause&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Locally recurring lesions may be excised or treated with a laser&#46; Disseminated lesions&#44; however&#44; can be treated with radical surgery&#44; topical or systemic antibiotics &#40;tetracycline or clindamycin with rifampicin&#41;&#44; oral retinoids&#44; dapsone and biological agents &#40;adalimumab and infliximab&#41;&#46; Pain management&#44; weight loss&#44; tobacco abstinence and treatment of superinfections are also important recommendations for all patients&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Suppurative hidradenitis associated with autoinflammatory syndromes is often severe &#40;Hurley II&#44; III&#41; and does not respond to many of the usual treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Because of the likely common pathogenesis involving IL-1-induced inflammation&#44; collective experiments to date indicate that IL-1 and TNF-targeted therapies represent the most successful treatment solution for prolonged remission&#46; TNF-blocking agents&#44; adalimumab and infliximab&#44; have achieved good control of suppurative hidradenitis lesions and&#44; thus&#44; reinforce the role of a deregulated innate immune response in the disease pathogenesis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The autoinflammatory syndrome composed of the association of psoriatic arthritis&#44; pyoderma gangrenosum&#44; acne and hidradenitis suppurativa &#40;PsAPASH&#41; was described in 2015 and there was no other similar description in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> As in the case described&#44; our patient was treated with Adalimumab and presented in remission of the disease&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">No genetic mutation associated with PsAPASH has yet been identified&#44; but the other syndromes are associated with the genetic mutation in the coding region of PSTPIP1 as well as with increased repetitions of CCTG in the promoter region of PSTPIP1&#44; leading to its deregulation and predisposition to cutaneous neutrophilic inflammation&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Thus&#44; it is very important that dermatologists know about autoinflammatory syndromic hidradenitis&#44; including typical lesions of pyoderma gangrenosum&#44; hidradenitis suppurativa&#44; psoriasis and acne&#44; and laboratory findings suggestive of systemic inflammation to establish clinical prevalence and early treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Raissa de Lima Gadelha&#58; Statistical analysis&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analysis&#44; and interpretation of the data&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Renata da Silveira Rodrigues Paiva&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Esther Bastos Palitot&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Joanne Elizabeth Ferraz da Costa&#58; Approval of the final version of the manuscript&#59; effective participation in research orientation&#59; intellectual participation in the propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hidradenitis suppurativa is a chronic inflammatory skin disease&#44; which affects 1&#37; of the population&#44; being more common in young&#44; obese and smokers&#44; and mainly affects armpits and groin&#44; with formation of pustules&#44; nodules&#44; abscesses&#44; scars and fistulas&#46; Recently&#44; its association with other autoimmune diseases such as psoriasis&#44; psoriatic arthritis&#44; pyoderma gangrenosum&#44; pyogenic arthritis and ulcerative colitis have been reported&#46; These associated forms are usually resistant to standard treatment&#44; with immunobiologicals as promising therapy&#46; The case of a rare form of association is reported&#44; with only one case previously described in the literature&#58; psoriasis arthritis&#44; pyoderma gangrenosum&#44; acne and hidradenitis suppurativa&#46;</p></span>"
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Article information
ISSN: 03650596
Original language: English
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