Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder?

Abstract

Hidradenitis suppurativa / acne inversa (HS) is a chronic inflammatory, debilitating skin disorder with a largely unknown etiology. However, many observations such as the typical onset of the disease after puberty, the female predominance, the pre-menstrual flare ups and the improvement during pregnancy suggest a contribution of endocrinological factors to the emergence of the disease. In addition, the reported efficacy of anti-androgen treatment on HS indicates a possible involvement of androgens in the pathogenesis. Furthermore, the common comorbidity with metabolic syndrome points to possible interactions between endocrinological and metabolic alterations in the development of HS. Taking into account the endocrine functions of the human skin, several studies investigated the effects of hormones and the behavior of the pilosebaceous unit in the skin of patients with HS. In this review we describe the current view on the hormonal dysregulation and metabolic syndrome and their role in HS.

Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

“…33 Due to its characteristic localization in regions with a high density of apocrine glands, it was initially assumed that the inflammation of these glands, the so called apocrinitis, was the primary event. 34 However, it is now generally accepted that apocrine glands are secondarily involved and the primary histopathologic event seems to be follicular hyperkeratosis with plugging, followed by dilation and rupture of the hair follicle with subsequent inflammation and formation of abscesses and sinus tracts. 34 The cause is likely multifactorial, involving a genetic tendency, smoking, mechanical stress, obesity, immune aberrant response and hormonal abnormalities.…”

“…42 The authors concluded patients with a low and high BMI could represent two clinically different subtypes of HS suggesting a non-linear relationship between BMI and impact of HS. 42 The role of androgens and sexual hormones remains controversial, 34 but many facts support a possible relation: -the typical onset in a narrow age spectrum after puberty; -rare postmenopausal onset 34 ; -usual improvement during pregnancy and post-partum flare-up 34 ; -reports of association with irregular menses, hirsutism and higher concentration of total testosterone, 43 although not constant 28,44 ; -reports of significant remission after antiandrogen therapy, although most of HS patients have normal androgen profiles 45,46 ; -HS in children under 12 is more likely associated with hormonal imbalance, namely adrenal hyperplasia, premature adrenarche, obesity, and metabolic syndrome. 47 In fact, a diagnosis of HS in children may be a marker of precocious puberty.…”

“…34 Isotretinoin achieves its efficacy by influencing cell-cycle progression and cellular differentiation, and particularly by induction of apoptosis in sebaceous gland cells. 34 However, reduction of sebaceous gland size and inhibition of sebaceous gland activity is not a good adjuvant for HS treatment, since the volume of the sebaceous glands seems to be a priori reduced in this disease. 34 Accordingly, the effect of isotretinoin is often disappointing and this drug is not recommended for HS.…”

“…34 However, reduction of sebaceous gland size and inhibition of sebaceous gland activity is not a good adjuvant for HS treatment, since the volume of the sebaceous glands seems to be a priori reduced in this disease. 34 Accordingly, the effect of isotretinoin is often disappointing and this drug is not recommended for HS. 1,34 On the other hand, acitretin that contributes to normalization of cell differentiation and thinning of the cornified layer through direct reduction of keratinocyte proliferation rate, has been successfully used 34 in doses ranging from 0.25 to 0.88 mg/kg with reported efficacy rates between 50% and 80%.…”

“…34 Accordingly, the effect of isotretinoin is often disappointing and this drug is not recommended for HS. 1,34 On the other hand, acitretin that contributes to normalization of cell differentiation and thinning of the cornified layer through direct reduction of keratinocyte proliferation rate, has been successfully used 34 in doses ranging from 0.25 to 0.88 mg/kg with reported efficacy rates between 50% and 80%. 1,23,91 Acitretin is indicated in the early HS stages but can also be advocated in the chronic stages with recurrent abscesses with sinus tracts and scarring.…”