Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is clinically defined by lesions ranging from painful, deep seated nodules to abscesses, draining sinus tracts, and ultimately, irreversible fibrotic scars. While the etiology remains unclear, a number of mechanisms ranging from genetics to aberrations of the immune system have been proposed. In addition, HS has a number of associations and may occur in conjunction with several diseases that span a host of medical specialties. The estimated prevalence ranges are from 1% to 4%; however, a large degree of under-reporting and misdiagnosis of this condition likely underestimates its true clinical significance. The debilitating consequences of missed diagnoses or improper management leads to severe pain and irreversible cutaneous manifestations (i.e., fistulae, sinus tracts, disfiguring scarring). HS has been found to significantly impair patients' quality of life to a greater degree when compared with other skin conditions. Early recognition and treatment are critical for a favorable prognosis, and diagnostic delays may be related to variable presentations within numerous comorbidities. Here we provide an in-depth, clinical-based review of HS, highlighting the clinical presentation, pathophysiology, grading systems, epidemiology, and comorbidities, in hopes of shedding light on an often misunderstood disease and ultimately moving closer to a more conclusive understanding of its various presentations and association.

Hidradenitis suppurativa: Evaluating activity patterns and predictors of recalcitrant course–A population‐based study

“…Several mechanisms were presumed to underly the association of obesity with increased disease severity. Obesity is associated with greater skin folds causing mechanical friction and a humid microenvironment, which encourages bacterial overgrowth 21 . Enlarged adipose tissue contributes to a systemic inflammatory state, which renders patients susceptible to severe course of this inflammatory condition 22 …”

Treating hidradenitis suppurativa in special populations: Pregnancy, lactation, and comorbid conditions

“…Irrespective of comorbidities or pregnancy status, HS lesions predominantly affect intertriginous skin areas of the body 1 . The initial presenting lesions of HS are tender subcutaneous nodules that may spontaneously rupture and coalesce, forming abscesses 1,2,6–11 . These deep‐seated painful abscesses heal in a chronic process resulting in dermal contracture and fibrosis of the lesioned skin 2,6 .…”

“…1 The initial presenting lesions of HS are tender subcutaneous nodules that may spontaneously rupture and coalesce, forming abscesses. 1,2,[6][7][8][9][10][11] These deep-seated painful abscesses heal in a chronic process resulting in dermal contracture and fibrosis of the lesioned skin. 2,6 Double-or multi-comedones may also manifest as typical lesions of HS.…”

“…6 The examination of HS incidence, distribution of disease, and other health risk factors overall contribute to disease management. 7 The epidemiology of HS remains under investigation given a wide variation in reports of prevalence estimates. 12 The prevalence of HS, estimated from North American and European studies, ranges from 0.05% to 4.1%.…”

Plant Antimicrobial Peptides as Potential Tool for Topic Treatment of Hidradenitis Suppurativa

“…HS can be generally described as an inflammatory persistent, enduring disease characterized by the presence of inflammatory lesions mainly found in the areas of the body in which apocrine glands are localized. The inflamed suppurative lesions may cause constant pain, thus dramatically impacting patients’ quality of life ( Preda-Naumescu et al, 2021 ).…”