From the Guidelines
The fibroglass sign is a characteristic clinical finding in hidradenitis suppurativa, where a thin, fibrous strand of tissue can be expressed from sinus tracts or lesions, and is considered pathognomonic for the disease. This sign appears when gentle pressure is applied to an active lesion, causing a white, stringy, fibrous material to emerge from the opening, resembling fibreglass insulation. The fibrous material represents inflammatory debris and keratin that has accumulated within the interconnected sinus tracts that form beneath the skin in hidradenitis suppurativa, as described in the context of chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses 1. Recognizing the fibroglass sign during physical examination can aid in making a clinical diagnosis of hidradenitis suppurativa without necessarily requiring a biopsy, particularly in patients with typical distribution of lesions in axillary, inguinal, perineal, or inframammary regions. Some key points to consider when evaluating the fibroglass sign include:
- The presence of sinus tracts or lesions that can express fibrous material
- The characteristic appearance of the fibrous material, which resembles fibreglass insulation
- The location of the lesions, which are typically found in apocrine gland-bearing areas
- The importance of gentle pressure in eliciting the fibroglass sign, as described in the context of evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa 1. It is essential to note that while the provided evidence does not directly describe the fibroglass sign, the understanding of hidradenitis suppurativa as a chronic inflammatory skin disease supports the clinical significance of this sign in diagnosis.
From the Research
Hidradenitis Suppurativa Overview
- Hidradenitis suppurativa is a chronic inflammatory disease characterized by painful, deep-seated nodules, abscesses, and draining tunnels in the skin of axillary, inguinal, genitoanal, or inframammary areas 2.
- The disease typically starts in the second or third decade of life, with an average worldwide prevalence of 1% 2.
- Hidradenitis suppurativa has a profound negative effect on patients' quality of life and is often accompanied by comorbidities such as metabolic syndrome, inflammatory arthritis, and inflammatory bowel disease 2, 3.
Clinical Presentation and Diagnosis
- The clinical presentation of hidradenitis suppurativa ranges from rare, mild inflammatory nodules to widespread abscesses, sinus tracts, and scarring 3.
- The disease is associated with several comorbidities, including diabetes mellitus and Crohn disease 3.
- Quality of life is often affected, and patients should be screened for depression 3.
Treatment Options
- Treatment includes wearing loose-fitting clothes, losing weight if overweight, and smoking cessation 3.
- Topical clindamycin alone can be effective for patients with mild disease, while oral antibiotics such as tetracyclines may be used for moderate disease 3.
- Adalimumab, a tumor necrosis factor alpha inhibitor, is effective for patients with moderate to severe hidradenitis suppurativa 3.
- Surgical procedures, including local procedures and wide excision, may be necessary for definitive treatment 3, 4.