Pathogenesis and comorbidities of hidradenitis suppurativa

Abstract:

 Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease characterized by the appearance of deep, painful nodules, abscesses, fistulae, sinus channels and scars in intertriginous regions, including: the axillar, inguinal, inframammar, intermammar, perineal, and gluteal regions. Due to its chronic course, pain, localization and unpleasant smell of draining lesions, HS strongly disrupts the quality of life of those affected. Consequently, HS patients often suffer from anxiety and depression. Other comorbidities include diseases that often share similar pathophysiological or genetic features with HS, including metabolic syndrome, inflammatory bowel disease, rheumatic diseases, other diseases of the pilosebaceous follicle, squamous cell carcinoma of the skin, and auto inflammatory syndromes. Since the first description of the disease in the 19th century, significant progress has been made in understanding its etiopathogenesis. Due to the prevalence of lesions in the apocrine sweat glands, it was initially thought that the inflammation of apocrine sweat glands was the fundamental disorder of the disease, hence the name of the disease. It was later understood that this historical etiopathogenetic concept was not correct. Today, the initial events in the pathogenesis of HS are considered to be hyperkeratosis and occlusion of the pilosebaceous follicle, which cause dilation as well as follicular rupture, followed by secondary inflammatory reactions that activate the immunological mechanisms that support the inflammatory process. Immune system disorders and genetic factors play an important role in the pathophysiological processes of HS, while smoking and obesity are considered to be additional risk factors. 

Key words:
comorbidity; follicular occlusion; hidradenitis suppurativa; pathogenesis