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

Abstract

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.

Low and high body mass index in hidradenitis suppurativa patients—different subtypes?

“…Threshold effects for BMI in HS patients have previously been suggested. 21 Smoking as a risk factor is less well established than BMI. 5,9,12,13,22 The results of this study suggest that the packyears exert a synergistic effect with obesity.…”

Are There Indications for Isotretinoin Treatment of Hidradenitis Suppurativa?

“…Hurley stage 1C is considered as serious and is characterized by the presence of migrating lesions; it corresponds with the scarring folliculitis/frictional furuncle phenotype [13] . Recently, it has been suggested to replace this last term with the frictional furunculoid subtype [14] .…”

Botulinum Toxin Type B for Hidradenitis Suppurativa: A Randomised, Double-Blind, Placebo-Controlled Pilot Study

“…In addition to smoking, obesity is strongly associated with HS. Mechanical stress factors or trauma play a role in obese patients with HS [41]. Obesity facilitates skin friction, increases intertriginous sweating, induces the production of proliferative factors such as insulin-like growth factor-1 and promotes an androgen profile in women.…”