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    Hidradenitis Suppurativa therapy options progressing

    Early recognition and treatment can prevent disease progression, improve prognosis


    Complex origins

    The cause for hidradenitis appears to be multi-factorial. Hormones, and especially androgens, appear to stimulate the sebaceous gland to produce sebum. Subsequently, there may be a component of intraductal keratinocyte plugging, leading to increased intraductal pressure.

    Recent data suggests that there may be a genetic weakness of the follicular duct wall at the junction point between the sebaceous gland and the follicular epithelium. Such weakness may encourage follicular rupture, and the ensuing perifollicular inflammatory responses. 

    Left axilla stage III HS, Photo credit: Paul Hazen, M.D.

    Systemic factors such as endocrine status, as well as local factors such as heat and humidity, obesity, smoking, and diet may significantly influence the follicular integrity. Strong features of family concentrations suggest genetic influences.

    As noted, the nodular lesions in HS are typically inflamed and often contain significant amounts of a purulent, odiferous, gelatinous material, referred to as the Invasive Proliferative Gelatinous Mass (IPGM).

    Large numbers of inflammatory cells, as well as epithelial stem cells, have been identified within this material. Greater quantities of this material are usually associated with more substantial inflammation and greater discomfort. With continuous inflammation, there is frequently the development of scars surrounding the nodular abscesses, and tunneling that extends to form cords or sinus tracts. Characteristic is the finding that pressure on an inflamed nodule may induce purulent drainage, through tunneling, from a distant site.

    READ: Infection-causing bacteria found in hidradenitis suppurativa lesions

    “Hidradenitis Suppurativa is a terrible disease that not only causes significant pain and suffering but is also associated with great embarrassment and social stigma in affected patients. The disease can have a huge negative impact on the patient’s social and professional life,” says Paul G. Hazen, M.D., clinical professor of dermatology at Case-Western Reserve University School of Medicine in Cleveland, Ohio, and immediate past president of the US-based Hidradenitis Suppurativa Foundation.

    NEXT: Inflammatory process


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