Endocrine factors in pre- and postmenopausal women with hidradenitis suppurativa

Abstract

The relationship between hidradenitis suppurativa (HS) and hyperandrogenism is largely based on the finding of an increased free androgen index due to a low sex hormone binding globulin (SHBG). As SHBG is now believed to be regulated by factors that influence body weight, and previous studies were not controlled for body weight, we have re-evaluated the androgen status of female patients with HS. We have studied the endocrine status of 66 women with HS. Twenty-three had acne, and 23 were significantly obese (body mass index: BMI > 30). There was no relationship between obesity and disease duration. Nineteen of 56 women were hirsute. A premenstrual flare in disease activity was reported by 32 women, but this was not related to menstrual disturbances. No consistent relationship was reported with pregnancy. Eight women with HS were menopausal at presentation, and one developed her disease 6 years after the menopause. Plasma androgens in women with HS were compared with controls matched for BMI and hirsuties. There was no difference between HS and controls. Testosterone and dehydroepiandrosterone sulphate were normal in all subjects with HS. In obese subjects, SHBG was reduced, consistent with BMI-matched controls. We have found no supporting evidence for biochemical hyperandrogenism in women with HS when compared with age-, weight- and hirsuties-matched controls. We report the continuation and primary development of HS in postmenopausal women.

Non‐Infective Cutaneous Conditions of the Vulva

“…The patients had irregular periods, premenstrual exacerbation of their disease, acne and hirsutes, a higher concentration of free testosterone and a higher free androgen index than did normal control subjects. However, hidradenitis suppurativa is often worse in overweight patients; Barth et al (1996) found that these findings are no longer significant when the results are controlled for body weight, and concluded that there is no evidence of hyperandrogenism. The skin's innate and adaptive immune responses may be at fault.…”

“…It is rare before puberty and tends to involute after the menopause, although cases occasionally do still occur after this time (Barth et al 1996). Anogenital lesions are common, being found in the genitocrural folds, mons pubis, labia majora, perianal skin and buttocks.…”

Surgical therapy for uncontrolled chronic hidradenitis suppurativa

“…Many women describe a worsening condition with menses, while others report alleviation with pregnancy, followed by postpartum flaring [4,14,19]. HS is not present in eunuchs or eunuchoids [27].…”

“…The disorder rarely occurs before puberty. However, the occasional onset in neonates and infants may reflect the relatively hyperandrogenic state in the first year of life [4,17]. HS occurs in both sexes with equal frequency, although in women there is a greater tendency for axillary involvement, whereas in men there is a greater propensity for perineal involvement.…”

Acne inversa Eine Dapson-sensitive Dermatose

“…Entsprechend empfehlen Mortimer [19] und Sawers [23] die antiandrogene Therapie mit Cyproteronacetat. Jemec [11] und Barth [2] finden hingegen keine Hinweise auf eine vermehrte kutane Virilisierung bzw. eine allgemeine Hyperandrogenisierung.…”