Endocrine basis for the clinical presentation of hidradenitis suppurativa

Abstract

Clinical assessment of 134 patients with hidradenitis suppurativa revealed clinical evidence supporting an androgen-based endocrine disorder underlying the condition. Such features included postpubertal onset maximal during the third decade; female preponderance (13:5); premenstrual flare in 57 per cent of women; absence of this flare associated with irregular or anovulatory menstrual cycles; and an increased incidence of obesity and acne. Detailed hormone profiles in 36 female patients and 14 controls showed evidence of relative androgen excess and decreased progesterone levels in those patients without a premenstrual flare. Obesity and enhanced peripheral androgen conversion by apocrine tissue are possible explanations for normal serum androgen profiles in patients with a flare. Precise elucidation of the hormonal abnormality is a prerequisite for effective medical treatment of early disease.

Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder?

“…Apocrine involvement appears to be a secondary phenomenon in the context of dissemination of the granulomatous inflammation in deep skin structures [2]. Moreover, the apocrine glands in HS patients showed no significant changes of their size, their density or morphological abnormalities compared with healthy controls [5].…”

“…The apocrine cystic activity is increased premenstrually and decreases during the midmenstruation. Shorter menstrual cycles and longer duration of menstrual flow are associated with the disease [8] and absence of a premenstrual flare of the disease is associated with anovulatory or irregular menstrual cycles and decreased progesterone levels [5]. Accordingly, disease activity is decreasing during periods with high levels of estrogens [8].…”

Hidradenitis Suppurativa

“…[50][51][52][53][54][55] A clear female preponderance exists in HS. It appears to occur exclusively in adults, but it may occur as the presenting feature of adrenarche (n = 5) or with acne in acromegaly (n = 1).…”

“…54,59,60 Flareups may be absent in anovulatory cycles. 53 Pregnancy and childbirth are also reported to influence the intensity of the disease favorably, with subsequent postpartum flareup. 28,50 Reduced fecundity in some patients may be causally related to the changes in circulating sex hormones, but correlation with clinical markers of hyperandrogenism is poor.…”

Aerobic and Anaerobic Bacteriology of Hidradenitis Suppurativa: A Study of 22 Cases

“…In the latter, subtle defects in mucosal immunity have been shown to play a critical pathogenetic role [13,14]. Furthermore, female predominance, postpubertal onset, frequent premenstrual flares [24], usual remission of the disease in postmenopausal women [25], and improvement during pregnancy suggest that hormonal factors may also play a part [26]. …”