Comparison of the microenvironments between pilonidal sinus disease and hidradenitis suppurativa

Pilonidal sinus disease (PSD) is a chronic inflammatory condition thought to result from the insertion of external hairs through the epidermis, effectively leading to inflammation and cyst formation. Presenting clinical features comparable to those of PSD, hidradenitis suppurativa (HS) is also characterized as a chronic inflammatory skin disorder associated with hormonal and gene dysregulation, although the exact etiology remains unclear. Given the overlapping clinical features between PSD and HS, this study aimed to evaluate the histologic and immunohistochemical differences between PSD and HS. Using 70 patient tissues and 19 normal skin controls in formalin-fixed paraffin-embedded tissues, protein expressions of cytokeratin 5/6, KLK7, filaggrin, envoplakin, and EPHA2 were analyzed in the epithelium of PSD and HS lesions using immunohistochemistry. Additionally, iron levels, hair shaft presence, and multinucleated macrophage counts were compared, along with disease prevalence across sex and ethnicity. PSD lesions exhibited higher iron levels, and more frequent intralesional hair shafts than HS. The condition was noted more frequently in younger White males while HS was more frequently found in older African American females. The immunohistochemical assays determined that cytokeratin 5/6, KLK7, filaggrin, envoplakin, and EPHA2 increased in lesional skin. The results support the theory that the immune and epithelial response in PSD and HS are similar despite their mechanistically divergent origins.