title: New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer's yeast-exclusion diet.
abstract: BACKGROUND
  Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory skin disease characterized by abscesses, fistulating sinus tracts, and scarring. The exact pathogenesis of this disease remains unclear. We present our experience with HS and a possible cause of the disease and offer a surgical and clinical treatment that allows for disease resolution.
  
  
  METHODS
  We studied 12 patients who presented with axillary and perineal fistulas and underwent surgical excision (repaired by skin grafts or healing by secondary intention) or localized treatments followed by diet modification. All patients were found to have a specific immunology IgG reaction to brewer's yeast and wheat and were put on a controlled brewer's yeast-free diet for 12 months and followed monthly.
  
  
  RESULTS
  The diet demonstrated immediate stabilization of their clinical symptoms, and the skin lesions regressed over the 12-month treatment period. Similarly, all the patients demonstrated an immediate recurrence of skin lesions following accidental or voluntary consumption of beer or other foods containing brewer's yeast or wheat. The patients also demonstrated a return of their quality of life and activities, including the reestablishment of sexual activity in the patients with inguinal and perigenital lesions.
  
  
  CONCLUSIONS
  The results of the investigation suggested that the patients had severe reactions to brewer's yeast. Surgery followed by the elimination of the foods containing or made with the yeast resulted in a rapid stabilization of the dermatologic manifestation and a slow, but complete, regression of the skin lesions within a year. Despite the small number of patients in our study, our study could provide the basis for extensive and multicentric studies in order to better investigate this disabling and rare disease.
authors.affiliation: Unit of Plastic Surgery, Department of General Surgery, Hôpital Bichat C.B., Paris, France.
authors.forename: Claudio
authors.initials: C
authors.lastname: Cannistrà
authors.forename: Valerio
authors.initials: V
authors.lastname: Finocchi
authors.forename: Angelo
authors.initials: A
authors.lastname: Trivisonno
authors.forename: Damiano
authors.initials: D
authors.lastname: Tambasco
mesh_terms: D000328:Adult; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery; D005512:Food Hypersensitivity / Q000150:complications*; D017497:Hidradenitis Suppurativa / Q000178:diet therapy* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012441:Saccharomyces cerevisiae / Q000276:immunology*; D014908:Triticum / Q000009:adverse effects* / Q000276:immunology*; D055815:Young Adult