Hidradenitis Suppurativa: Absence of Hyperhidrosis but Presence of a Proinflammatory Signature in Patients’ Sweat

Abstract

The role of sweat glands in hidradenitis suppurativa has been largely neglected, despite the fact that its original designation, as “hidrosadénite phlegmoneuse”, implied an inflammatory malfunction of the apocrine sweat glands as the underlying pathogenic driver. The aim of this study was to evaluate the role of apocrine sweat glands with respect to the proinflammatory environment of hidradenitis suppurativa. Therefore, gravimetric assessment and multiplex cytokine assays from sweat obtained from patients with hidradenitis suppurativa along with immunofluorescence cytokine/chemokine analysis of lesional apocrine glands-bearing hidradenitis suppurativa skin were performed. Gravimetric assessment of 17 patients with hidradenitis suppurativa revealed that the condition is not associated with hyperhidrosis. However, patients seem to be more affected by subjective sweating. The current data identified a complex proinflammatory signature in hidradenitis suppurativa sweat characterized by a significant upregulation of monocyte chemoattractant protein-1, interleukin-8 (CXCL8), and interferon-γ. In agreement with this, a strong in situ expression of these mediators could be observed in apocrine glands of lesional hidradenitis suppurativa skin. These data shed new light on the proinflammatory capacity of apocrine sweat glands in hidradenitis suppurativa, which may lead to reconsideration of the role of sweat glands in hidradenitis suppurativa pathology.

S2k-Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa (ICD-10-Code: L73.2)

“…Nach dem Einteilungsprinzip der psychosomatischen Hauterkrankungen lässt sich erkennen, dass bei HS/AI vorwiegend sekundäre psychische Störungen entstehen, wenngleich Stress und Leistungsdruck von den Betroffenen als Triggerfaktoren angegeben werden 16 . In zahlreichen, meist älteren Arbeiten wird auf die umfangreichen assoziierten psychosozialen Erkrankungen (Komorbidität) der HS/AI hingewiesen, die die Lebensqualität der HS/AI-Patienten erheblich beeinflussen.…”

Rethinking Hidradenitis Suppurativa Management: Insights into Bacterial Interactions and Treatment Evolution

“…Increased perspiration has been reported by HS patients, which could be an effect of sweat gland dysfunction and potentially contribute to sweat retention. This may be related to follicular plugging, thus leading to the accumulation of cytokines and bacteria [ 43 ]. Povorcitinib is currently undergoing phase III clinical trials for HS [ 44 ].…”