Itch in Hidradenitis Suppurativa/Acne Inversa: A Systematic Review

Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory disease of the pilosebaceous unit leading to formation of painful, inflammatory nodules, abscesses and tunnels in apocrine gland-bearing areas of the skin. Pain and drainage are the most important symptoms associated with reduction of quality of life in HS. On the other hand, an overlooked symptom in quality of life studies is itch, despite the fact that several studies have reported its importance. Various theories have tried to explain the pathogenesis of itch in HS, such as the presence of mast cells in the cell infiltrates and elevated Ig E levels in the lesional skin. Smoking and advanced stage of disease have been found to be associated with increased intensity of itch. A PUBMED search was conducted to perform a systematic literature review using the term hidradenitis suppurativa [all fields], the keywords pruritus, itching, itch [all fields] and with AND as operator. Mast cells and mTor signaling were found to be raised in both lesional and perilesional skin. Itch as a presenting symptom has been found in 35-82.6% of patients across multiple studies. It often co-presents with pain and may be misinterpreted as burning, stinging, tickling, tweaking, prickling, etc. The presence of itch is associated with reduced quality of life, depression and impairment of social life. Brodalumab, a monoclonal antibody against IL-17A receptor, produced significant improvements in itch, pain, QoL and depression in patients with moderate to severe HS. Statins have shown some reduction in itch intensity score. Further studies are required to gain a better understanding of the etiopathogenesis and optimal therapeutic modalities for itch in HS that will allow clinicians to better address issue and reduce its impact on quality of life.

Automated summary

Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory disease that causes painful, inflammatory nodules, abscesses, and tunnels in the apocrine gland-bearing areas of the skin. Pain and drainage are the main symptoms that affect the quality of life in HS patients. Itch, which is often overlooked in quality of life studies, is also an important symptom and is associated with reduced quality of life, depression, and impairment of social life. Mast cells and mTor signaling are elevated in both lesional and perilesional skin. Brodalumab, a monoclonal antibody against IL-17A receptor, has shown significant improvements in itch, pain, quality of life, and depression in patients with moderate to severe HS. Statins have shown some reduction in itch intensity score. Further studies are needed to better understand the etiopathogenesis and optimal therapeutic modalities for itch in HS.