Refractory Hailey-Hailey disease successfully treated with sandpaper dermabrasion

Area of Science:

• Dermatology
• Surgical Procedures
• Histopathology

Background:

• Hailey-Hailey disease (HHD) is a chronic, inherited blistering skin disorder characterized by recurrent, pruritic dermatitis.
• This patient presented with a 20-year history of HHD refractory to numerous conventional topical, intralesional, and systemic therapies, including corticosteroids, immunomodulators, retinoids, and biologics.
• Previous treatments such as intralesional corticosteroids, botulinum toxin, CO2 laser, and systemic agents like prednisone, azathioprine, mycophenolate mofetil, acitretin, isotretinoin, adalimumab, and etanercept had failed.

Observation:

• The patient underwent sandpaper dermabrasion with hyfrecation for HHD affecting the groin, axillae, inframammary folds, posterior neck, and popliteal fossae.
• The procedure involved sterile preparation, local anesthesia, abrasion to the superficial dermis using fine-grit sandpaper, and hyfrecation.
• Treated areas were dressed with petrolatum and sterile gauze, with prescribed antibiotics and pain medication.

Findings:

• Three months post-treatment, the posterior neck and bilateral popliteal fossae showed desirable functional and cosmetic results with no recurrence of clinically active HHD.
• Histopathological examination of biopsies from the dermabraded popliteal fossae sites revealed marked improvement, with healing peripheries showing only scattered acantholysis and sparse perivascular infiltrate compared to untreated HHD.
• While the neck and popliteal fossae were successfully treated, active HHD persisted in the axillae despite sandpaper dermabrasion.

Implications:

• Sandpaper dermabrasion represents a potentially effective physical treatment modality for recalcitrant Hailey-Hailey disease, offering significant clinical and histological improvement.
• The procedure's success in specific anatomical locations suggests a targeted approach for managing chronic HHD.
• Further investigation and larger studies are warranted to establish the long-term efficacy and safety of dermabrasion for HHD and to explore its application in different body areas.