A comment on rapid progression of hidradenitis suppurativa in the lower leg of a patient with psoriasis vulgaris.

Sir, We read with interest the article by Tanaka et al. (1). However, we conclude that the patient could have botryomycosis rather than hidradenitis suppurativa. Botryomycosis is characterized by chronic, purulent and granulomatous lesions of the dermis and subdermal tissue. Morphologically, it is characterized by plaques with sinuses, superficial pustules and crusts (2). It is reported that the patient had a plaque with central purulent draining sinuses with a deep-seated nodule, and that the peripheral part had mild scar formation over the limb. Limbs are the most common sites of affliction (2). In contrast, hidradenitis suppurativa classically affects the pilosebaceous-apocrine unit of the axillary, inguinal and mammary region in females (3). Escherichia coli and Staphylococcus epidermidis were confirmed on culture of the discharge in the case under consideration, and these are well documented in the aetiology of botryomycosis (4). Furthermore, the lesion was refractory to antibiotics and responded to surgical resection, and this may also be the case for botryomycosis.