Journal of Clinical & Experimental Dermatology Research
Open Access

A Brief Note on Hidradenitis Suppurativa

Hiraku Shamir^{* *}Correspondence: Hiraku Shamir, Department of Dermatology and Radiology, Shiraz University of Medical Sciences, Shiraz, Iran, Email:

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Description

Hidradenitis Suppurativa (HS) also known as the acne inversa is a chronic inflammatory skin disorder characterized by deep nodules and lesions such as abscesses, fibrous scars. These lesions are most common in the interstitial and apocrine glandrich areas. The most common are the axilla, groin, perianal, and perineum. Treatment depends on severity and may include topical and systemic antibiotics, hormone therapy, immune modulators, and surgery. Due to associated pain, tenderness, secretions, odours and scarring this condition can have psychosocial adverse effects.

The pathological process of HS begins when a defective hair follicle occludes and ruptures, causing contents such as keratin and bacteria to spill into the surrounding dermis. A chemotactic inflammatory response by surrounding neutrophils and lymphocytes can lead to the formation of abscesses and subsequent destruction of sebaceous gland units and other adjacent structures. Other possible factors that contribute to the pathology include abnormal antibacterial peptides, abnormal apocrine gland secretion, abnormal invagination of the epidermis leading to duct formation and an inadequate number of sebaceous glands. Immunological abnormalities have also been observed.

Elevated levels of inflammatory cytokines such as tumor necrosis factor α and various interleukins have been detected in HS lesions and are potential targets for new therapies. Bacteria do not seem to be the cause. Aspiration from unruptured lesions usually results in sterile culture. However, bacterial infections and colonization that occur during the process can secondarily exacerbate HS. The main locations are apocrine gland-rich areas such as the axilla, perianal area, and perineum. It can also affect the neck, posterior pinna, adjacent scalp, back, hips, scrotum or labia minora and in women, it can affect the under bust or chest. Multiple locations may be involved. In women, the groin and chest are more commonly affected while in men the anogenital area is more affected.

Causes hidradenitis suppurativa

"Hidradenitis Suppurativa" means an inflammatory disease of the sweat glands, but HS has been found to be an auto inflammatory syndrome.

The factors that cause Hidradenitis Suppurativa are:

• Hair follicle obstruction

• Abnormal skin or follicular microbial flora

• Release of inflammatory cytokines

Inflammation causes the follicle wall to rupture, destroying the sebaceous glands and apocrine ducts. The estimated prevalence is between less than 1% and 4%. These numbers may be underestimated due to underreporting and misdiagnosis. The onset of illness is usually between puberty and 40 years, most commonly between 21 and 29 years. Women are more commonly affected than men, with a ratio of approximately 3:1. There is no evidence of racial or ethnic preference patterns.

The primary lesion begins as erythematous, subcutaneous, hard, tender nodule, about 0.5-1.5 cm, often preceded by itching and discomfort. Initially, it is often mistaken for an infected sebaceous cyst or boils. Polymorphic acne is characteristic of the lesion and the area around the lesion. If the nodule remains dormant for days to months form an abscess that ruptures the skin in hours to days, forming a sinus that gives a foul-smelling purulent or serous secretion. There is Subcutaneous extension may occur, forming hardened plaques and thick linear bands. Ulcers can also form ulcers in adjacent structures, digging holes and piercing. There may be intermittent of acute cellulitis, fever and toxicity. Lesions often do not heal completely. Inflammation and drainage are always slowed down. They resolve with fibrosis and band-like scarring that limits limb mobility and patient activity.

There are several rating systems developed to assess the severity and stage of the disease. The most common is the Harley staging system.