The homogeneity of hidradenitis suppurativa lesions

Abstract

Recent data suggest that hidradenitis suppurativa is a disease of the follicle, but the histological homogeneity of findings over time and in different anatomical regions has not been verified. Its description may help towards a better classification of the follicular diseases. Correct classification provides both knowledge by interference and a way of generalizing with respect to the significance of specific findings. The intra‐individual variation of hidradenitis was described through classification of specimens taken from patients with multiple simultaneous or consecutive excisions. A total of 51 specimens from 11 patients were examined; of these 30 were from synchronous biopsies, and 21 from consecutive biopsies (range 2 months to 6 years). The majority of specimens (44/51) contained poral occlusion, sinus tracts or cysts. This pattern was present in 50–85% of the specimens from any given patient with hidradenitis. No primary apocrine involvement was seen. Fibrosis occurred often (33/51 specimens), and eccrine involvement was seen more often than apocrine involvement (10 vs 7 specimens). The homogeneous histology of hidradenitis supports its reclassification as a follicular disease. The reproducibility of the findings further suggests that the changes are specific and that hidradenitis is therefore a definite disease entity within the spectrum of follicular diseases. Additional functional studies may help classify hidradenitis more precisely in relation to other follicular diseases.

Clinicopathological Study of 13 Cases of Squamous Cell Carcinoma Complicating Hidradenitis Suppurativa

“…Extrusion of follicular contents into the dermis produces an influx of neutrophils, lymphocytes and histiocytes leading to abscess formation [6,7]. In a histological study, eccrine involvement was seen more often than apocrine involvement [8]. …”

Hidradenitis Suppurativa Complicating Naevus Comedonicus: The Possible Influence of Mechanical Stress on the Development of Hidradenitis Suppurativa

“…Several studies have identified the hair follicle as the core element of hidradenitis, prompting some authors to suggest that the disease be renamed acne inversa, although substantial differences exist between the 2 diseases [1,3,4,5,6]. Ultrasound investigations have shown hair follicles to be dilated in the non-involved perilesional skin of hidradenitis patients, while histological studies have found signs of follicular plugging and dilated, cyst-like hair follicles, as well as the absence of lymphadenopathy [4,5,6,7,8,9,10]. In more developed lesions, the inflammatory infiltrate appears centred on the hair follicle, most often sparing any adjacent apocrine glands.…”

Dapsone Therapy for Hidradenitis Suppurativa: A Series of 24 Patients

“…Inflammatory diseases which respond to dapsone are almost invariably associated with the infiltration of large numbers of polymorphonuclear leucocytes into the affected tissue, and it appears that neutrophils and neutrophil products are the major targets for this drug [18]. The late appearance of neutrophils in the lesions of HS may therefore partly explain the limited success of this treatment [19,20,21,22]. …”