Dowling-Degos disease and hidradenitis suppurativa: Co occurrence or association?
A 44-year-old female patient presented with multiple painful, tender nodular lesions and plaques with multiple sinuses discharging pus involving the buttocks, inner aspect of upper thigh, perianal region and both upper legs since the past 4 years but which aggravated since 1 month. The patient had similar lesions on and off since the past 17 years. There was no history of similar lesions in any family members. Two years back, she was diagnosed as a case of scrofuloderma and had received anti-tubercular treatment for 6 months. The patient frequently took systemic antibiotics for the skin lesions with only temporary relief.\nCutaneous examination revealed multiple tender nodules and plaques with multiple sinuses discharging pus involving the buttocks, inner aspect of upper thigh, anogenital region [Figures and ] and both upper legs. Few plaques over the leg revealed crusting []. Post inflammatory atrophic scarring was seen over the lower abdomen and inner aspect of the right thigh []. Bilateral tender inguinal lymphadenopathy was present. The patient also had asymptomatic, multiple, symmetrical, dark brown pigmented macules over the axillae [Figures and ] and groins. Scattered comedo-like lesions (dark dot follicles) were seen over the abdomen, thighs [], back and upper extremity. The patient had multiple discrete pitted scars over the face [], back and axillae.\nInvestigations revealed normal blood counts, liver and renal function tests, but the erythrocyte sedimentation rate was raised. Blood glucose levels were normal. Mantoux test was negative. Pus for gram staining and culture sensitivity revealed gram positive Staphylococcus aureus. Enzyme-linked immunosorbent assay test for human immunodeficiency virus-1 and 2 was negative. Biopsy from the nodular lesion revealed neutrophilic and histiocytic infiltration around the pilosebaceous apocrine units []. Histopathology from the pigmented lesion revealed irregular epidermis, acanthosis and elongation of rete ridges with increased basal melanin pigmentation [].