The pathogenesis of hidradenitis suppurativa: a closer look at apocrine and apoeccrine glands

Abstract

We undertook a retrospective pathological study of 118 skin resection specimens from 101 patients with hidradenitis suppurativa. Follicular occlusion was identified in all the specimens, regardless of disease duration (1 month to 18 years), but was not noted in the axillary and inguinal skin of controls. We therefore regard follicular occlusion as an early and important feature in the pathogenesis of the disease. The presence of apoeccrine glands in axillary skin provided an in vivo model to directly observe the effects of follicular occlusion on follicle inflammation and apocrine gland destruction. In the majority of cases, active folliculitis was associated with apocrinitis and apocrine destruction, whereas apoeccrine glands, which drain directly on to the epidermal surface, appeared intact and non-inflamed. These observations provide direct evidence in an in vivo model that follicular occlusion by keratinous material, with subsequent active folliculitis and secondary destruction of the skin adnexae and subcutis, occur as an integral step in the pathogenesis of hidradenitis suppurativa.

Back and Face Involvement in Hidradenitis Suppurativa

“…In a recent review article however, Lee et al [12] presented a clinical photograph of the back of a patient with HS lesions. There are no apocrine glands in these territories, but we know that the apocrine gland is not the primary target in HS [13,14]. There are also no terminal hairs, but typical localizations (such as the intermammary folds in women) also lack terminal hairs, which do not seem to be an anatomical requisite of HS lesions.…”

Finasteride for the Treatment of Hidradenitis Suppurativa in Children and Adolescents

“…15,16 Accordingly, inhibition of 5␣-reductase could improve symptoms of HS by reducing local concentrations of dihydrotestosterone at the level of the hair follicles. This would explain why other antiandrogens that act by blocking dihydrotestosterone at the receptor level more globally, such as cyproterone acetate, have not been shown to be universally effective.…”

Effects of ablative 10,600‐nm carbon dioxide fractional laser therapy on suppurative diseases of the skin: A case series of 12 patients

“…In the pathogenesis of HS, follicular plugging by keratinized squamous epithelium is believed to be an essential initial step that progresses to secondary infection and the development of abscesses and sinus tracts [12][13][14][15]. The clinical course of this type of disease tends to be chronic and recurrent in a significant portion of cases, despite various pharmacological and surgical treatments [16].…”