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Pathophysiology of hidradenitis suppurativa
Lauren K Hoffman1, Mondana H Ghias2, Michelle A Lowes3
1Division of Dermatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York, USA.
Seminars in Cutaneous Medicine and Surgery
|May 25, 2017
Summary
Hidradenitis suppurativa (HS) is an immune-mediated disease, not infectious. Its complex pathophysiology involves follicular abnormalities and an exaggerated immune response, leading to chronic inflammation.
Area of Science:
- Dermatology
- Immunology
- Pathophysiology
Background:
- The pathophysiology of hidradenitis suppurativa (HS) remains poorly understood.
- Existing knowledge derives from clinical, epidemiological, histopathological, and immunohistochemical studies.
- Recent molecular and transcriptomic analyses offer insights into inflammatory processes.
Purpose of the Study:
- To propose an integrated disease pathway for hidradenitis suppurativa.
- To reclassify HS as an immune-mediated disease rather than an infectious one.
- To elucidate the complex pathogenesis and immune signature of HS.
Main Methods:
- Review of clinical and epidemiological observations.
- Analysis of histopathology and immunohistochemistry of affected skin.
- Examination of cutaneous molecular and transcriptomic data.
Main Results:
- HS pathophysiology involves primary abnormalities in the pilosebaceous-apocrine unit.
- Follicular occlusion, cyst development, and rupture trigger an exaggerated innate immune response.
- Chronic inflammation involves both cutaneous and systemic immune system recruitment.
Conclusions:
- Hidradenitis suppurativa is best classified as an immune-mediated disease.
- The proposed integrated pathway highlights follicular dysfunction and immune dysregulation.
- Further research is needed to fully understand HS pathogenesis and immune signature.
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