‘Hidradenitis Suppurativa ( HS) is a painful, chronic inflammatory skin disease characterised by multifocal, recurrent nodules, abscesses and fistulae, predominantly affecting the axillary, inguinal, breast-fold and anogenital regions. HS ranges from localised lesions (mild disease) to multiple areas of widely dispersed lesions, including interconnected sinus tracts and hypertrophic scars (severe disease).’ A recent edition of Research Review focuses on this disease which has significant physical and psychological effects on the individual and their quality of life. The special edition which also covers diagnosis and treatment options can be found here>> In Australia, prevalence of HS has been estimated at 0.67%.25 Females are three times more likely to develop the disease than males.
‘The central pathogenic event in HS is believed to be follicular occlusion. Infundibular hyperkeratosis of the terminal follicles and hyperplasia of the follicular epithelium result in the collection of debris, cyst formation, rupture, sinus tract formation and ultimately, scarring. Approximately one third of patients with HS have a positive family history of the disease, and an autosomal dominant inheritance pattern has been suggested.
Prevalence of smoking in patients with HS has been estimated at 42-90% and has been associated with increased severity of HS.Nicotine may lead to follicular plugging via promotion
of hyperplasia of the follicular infundibulum and oversecretion of eccrine glands, or contribute to inflammation via induction of neutrophil chemotaxis.
The prevalence of obesity in patients with HS is 60-88%. Obesity is associated with HS disease severity, and weight loss can lead to clinical improvement. Likely mechanisms
linking chronic inflammation and obesity include effects on the skin and microbiome, and mechanical friction. Patients with HS have an increased prevalence of the metabolic syndrome compared with the general population, which is thought to be due to the proinflammatory state. Vekic et al. report high rates of dyslipidaemia (44%), insulin resistance (42%), diabetes (17%) and hypertension (16%) in patients with HS treated at the Liverpool Dermatology Clinic in New South Wales, Australia.
The high prevalence of polycystic ovary syndrome in female patients with HS (30% at the Liverpool Dermatology Clinic) suggests an association with the endocrine system. HS is clearly associated with autoinflammatory diseases such as Crohn’s disease and spondyloarthropathies, raising the possibility of a shared pathogenesis. Follicular occlusion diseases such as nodulocystic acne, pilonidal sinus and keratosis pilaris are also closely associated with HS.’ Treatment options can include pharmacological options, surgery and laser therapy.
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