Mechanical stress and the development of pseudo‐comedones and tunnels in Hidradenitis suppurativa/Acne inversa

Boer, Jurr; Jemec, Gregor B. E.

doi:10.1111/exd.12926

Cited by 26 publications

(29 citation statements)

References 10 publications

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“…Furthermore, it has been suggested that the infundibulum can be considered as epidermis and not as a hair follicle, because of the observation that the epithelial tissue of the infundibular epidermis is indistinguishable from that of the interfollicular epidermis [23,25] . An experimental pathology investigation by Plewig [26] about comedones in acne has recently been extrapolated in the context of HS research [27] . It had been found that after stimulating the follicular epithelium experimentally by mechanical stress, the epidermis showed an invagination within, surrounded by epithelial proliferation, clearly showing sprouts similar to that seen in HS [27] .…”

Section: Discussionmentioning

confidence: 99%

“…An experimental pathology investigation by Plewig [26] about comedones in acne has recently been extrapolated in the context of HS research [27] . It had been found that after stimulating the follicular epithelium experimentally by mechanical stress, the epidermis showed an invagination within, surrounded by epithelial proliferation, clearly showing sprouts similar to that seen in HS [27] .…”

Section: Discussionmentioning

confidence: 99%

“…A complicating factor is that the KP is common in various disorders. It is postulated that mechanical trauma is implicated as a risk factor in HS and can cause microtears in the fragile acroinfundibulum and subsequently starts the whole orchestra of inflammation [27,29] , probably in analogy to the KP in HS.…”

Section: Discussionmentioning

confidence: 99%

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Should Hidradenitis Suppurativa Be Included in Dermatoses Showing Koebnerization? Is It Friction or Fiction?

Boer¹

2017

Dermatology

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Background: The etiology of hidradenitis suppurativa (HS) involves genetic and environmental factors. Well-established associated systemic factors are obesity, smoking, inflammation, and bacteria. Whether localized environmental factors such as friction and pressure may also play a causative role is still unclear. Objective: To describe the possible Koebner phenomenon (KP) in HS. Methods: The case notes on 14 patients with typical HS and additional HS lesions in previously uninvolved skin areas exposed to mechanical stress, e.g., on the abdomen at the level of the waistband, were reviewed with regard to the clinical characteristics of the cohort. Results: All 14 patients (7 females) were obese with a mean BMI of 35.8 (range 30.1-45.0). All patients developed additional ectopic HS lesions at the sites of friction on the convex abdomen. The ectopic lesions were clinically and histopathologically similar to HS. Conclusion: Mechanical stress factors or trauma play a role in obese patients with HS. It is suggested that these new induced lesions fit the concept of the KP. This phenomenon seems to occur in the so-called frictional furunculoid type of HS and may explain the unique distribution at certain localizations on the body of this follicular cutaneous eruption. Removal in an early stage of HS of external stress factors that can lead to the KP should be part of the treatment, especially in obese patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Should Hidradenitis Suppurativa Be Included in Dermatoses Showing Koebnerization? Is It Friction or Fiction?

Boer¹

2017

Dermatology

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“…Mechanical stresses induced by skin‐to‐skin rubbing, such as tension, strain and friction, exacerbate HS . Anecdotal case reports describe HS lesions developing in unusual body areas after mechanical stress and trauma . Despite these reports, the underlying mechanism(s) for why mechanical stress exacerbates HS symptoms are not entirely clear.…”

Section: Introductionmentioning

confidence: 99%

E‐cadherin and p120ctn protein expression are lost in hidradenitis suppurativa lesions

Nelson

Cong

Gettle

et al. 2019

Experimental Dermatology

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Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease affecting the pilosebaceous units in the axilla, groin and buttocks. While the pathogenesis of HS is not clear, mechanical stress exacerbates HS. In this study, we aimed to determine whether intracellular adhesive junctions may be aberrant in HS patient skin. Strikingly, we observed loss of E‐cadherin and p120ctn protein expression, two key adherens junction proteins, in ~85% of HS severe skin lesions. Moreover, loss of protein expression was apparent in non‐lesional skin from HS patients and the degree of loss positively correlated with HS Hurley Stage of disease. E‐cadherin expression was unaltered in other inflammatory skin conditions including chronic wound epithelium, atopic dermatitis, and acne vulgaris compared with healthy skin suggesting that its loss may be uniquely relevant to HS pathogenesis. A complete loss of α‐catenin, β‐catenin and ZO‐1 was not observed; however, some cytoplasmic staining of the catenins was noted in HS epithelium. We also demonstrated diminished desmosome size in HS lesional skin. Overall, our data suggested that loss of adherens junction proteins and diminished desmosome size in HS skin contributes to the skin's inability to withstand mechanical stress and provides rationale as to why mechanical stress exacerbates HS symptoms.

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“…From this perspective, split-thickness skin grafting might be preferable to full-thickness skin grafting as the former allows complete removal of hair follicles and sweat glands from grafts. In addition, Boer and Jemec 4 and Boer et al 5 reported that mechanical irritation, such as pressure and rubbing, may trigger hidradenitis suppurativa, and obese patients are more susceptible to the effects of mechanical irritation. Mechanical irritation could worsen when tissue volume increases after flap repair (e.g., in the inguinal or axillary region).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?

Sugio

Tomita

Hosokawa

2016

Plastic and Reconstructive Surgery - Global Open

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Summary:After surgical excision of hidradenitis suppurativa, reconstruction with a skin graft or a flap is performed when primary closure is not possible. However, the recurrence rate is reportedly high even after wide surgical excision. It is still unclear which reconstruction method provides the lowest recurrence rate. In this report, we present a case of intractable hidradenitis suppurativa in the bilateral perineal region. After wide excision and repair with bilateral groin flaps, a unilateral groin flap was replaced with a split-thickness skin graft because of flap necrosis. Although the skin graft repair region has been recurrence free for 4 years postoperatively, other regions with flap repair showed recurrence 1 year postoperatively, leading to reexcision and repair with a split-thickness skin graft. The current case provides an opportunity to reconsider the optimal surgical strategy for hidradenitis suppurativa. Taking into consideration the fact that hair follicles and sweat glands are involved in the etiology of hidradenitis suppurativa, split-thickness skin grafting, which lack cutaneous appendages, may be superior to flap repair or primary closure in terms of recurrence.

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Mechanical stress and the development of pseudo‐comedones and tunnels in Hidradenitis suppurativa/Acne inversa

Cited by 26 publications

References 10 publications

Should Hidradenitis Suppurativa Be Included in Dermatoses Showing Koebnerization? Is It Friction or Fiction?

Should Hidradenitis Suppurativa Be Included in Dermatoses Showing Koebnerization? Is It Friction or Fiction?

E‐cadherin and p120ctn protein expression are lost in hidradenitis suppurativa lesions

Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?

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