Insights into hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. A complex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1b, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate in vitro and animal models. (J Allergy Clin Immunol 2022;149:1150-61.)

Automated summary

Hidradenitis suppurativa is a chronic, inflammatory skin disorder that affects around 1% of the population and significantly impacts patients' quality of life. It is characterized by inflammatory lesions such as nodules, abscesses, and sinus tracts in areas like the armpits, groin, and buttocks, typically appearing during or after puberty. The development and maintenance of the disease involve a complex interplay of genetic predisposition, hormonal factors, obesity, and smoking. It is believed to stem from a defect in the hair follicle, leading to follicular plugging, cyst formation, and subsequent acute inflammation. Over time, acute lesions progress to a chronic condition with draining sinus tracts and extensive fibrosis. Hidradenitis suppurativa is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities.