We read with great interest the recently published article, “Perianal Comedones: A Variant of Hidradenitis Suppurativa or an Isolated Entity? Five-Case Report,” in Actas Dermo-Sifiliográficas.1 The article describes 5 cases of perianal lesions characterized by follicular plugging, open and closed comedones, and cysts. Notably, the majority of the patients were men (n=4/5), with concomitant hidradenitis suppurativa (HS) in 4 cases, and a history of smoking (active or former) in all patients. The authors suggest that this presentation may represent a distinct entity or a mild variant of HS, potentially exacerbated by smoking.

We found this article particularly compelling, as its findings align closely with those reported in our previously published case report, “The Cystic Sponge Anus”.2 In this report, we described an HS patient presenting with multiple orifices and cavities, resulting in a spongy appearance of the perianal skin accompanied by multiple cysts and (giant) comedones. Similar to the cases described in the article, our patient was also an active smoker and had concomitant HS. We hypothesized that the spongy texture arose from the spontaneous shedding of cystic contents. While this specific spongy characteristic was not observed in the newly reported cases, we suspect that the discrepancy may be attributable to differences in the size of the follicular occlusions.

The newly described cases seem to represent a milder form of the cystic sponge anus. We propose that these cases and our previously reported patient may reflect variations of the same underlying entity, with the newly presented cases representing a less severe phase characterized by smaller occlusions. Collectively, these cases support the concept of a novel entity involving perianal occlusion, potentially linked to HS, male sex, and smoking behavior.