The Pathogenesis, Risk Factors, and Comorbidities Associated with Hidradenitis Suppurativa: A Systematic Review
Keywords:
Hidradenitis suppurativa, Acne inversa, Systematic reviewAbstract
Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting the apocrine gland-rich areas of the body. It presents with painful nodules, abscesses, sinus tracts, and scarring.
Methods: A literature review of hidradenitis suppurativa was conducted by systematically searching relevant databases with a focus on the pathogenesis and risk factors associated with the disease.
Results: Evidence relating to pathogenesis and HS thus far supports an inflammatory component with dysregulation of the innate and adaptive immune system. However, research is ongoing in this area and many questions remain unanswered. The risk factors that have been most consistently associated with HS to date include high weight/ obesity, smoking, and female sex. Comorbidities in patients with HS encompass metabolic, endocrine, psychiatric, and inflammatory diseases.
Conclusion: Further research is warranted to enable clinicians with the knowledge necessary to manage patients presenting with HS and to deliver patients the disease-modifying treatment and care that they require. Several practical points may be discerned from research regarding risk factors and diseases associated with HS. These include raising the index of suspicion for certain physical diseases and mental conditions in patients with HS and lowering the biopsy threshold for certain malignancies.
References
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3. Boer J, Weltevreden E. Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions. British Journal of Dermatology. 1996;135(5):721-725.
4. Schuch A, Fischer T, Boehner A, Biedermann T and Volz T. Successful Treatment of Severe Recalcitrant Hidradenitis Suppurativa with the Interleukin-17A Antibody Secukinumab. Acta Dermato Venereologica. 2018;98(1), pp.151-152.
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7. Vossen M, Gattringer K, Khalifeh N, Koreny M, Spertini V, Mallouhi A, Willeit M, Volc-Platzer B, Asboth F, Graninger W, Thalhammer F and Lagler H. Gemella morbillorum Bacteremia after Anti-Tumour Necrosis Factor Alpha as Acne Inversa Therapy. Journal of Clinical Microbiology. 2011;50(3), pp.1109-1112.
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15. Ring H, Thorsen J, Saunte D, Lilje B, Bay L, Riis P, Larsen, N, Andersen, L, Nielsen H, Miller I, Bjarnsholt T, Fuursted K and Jemec G. The Follicular Skin Microbiome in Patients With Hidradenitis Suppurativa and Healthy Controls. JAMA Dermatology 2017;153(9), p.897.
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21. Pink A, Simpson M, Desai N, Dafou D, Hills A, Mortimer P et al. Mutations in the γ-Secretase Genes NCSTN, PSENEN, and PSEN1 Underlie Rare Forms of Hidradenitis Suppurativa (Acne Inversa). Journal of Investigative Dermatology. 2012;132(10):2459-2461.
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28. Simonart, T. Hidradenitis Suppurativa and Smoking. Journal of the American Academy of Dermatology. 2010;62(1), pp.149-50
29. Barresi V, Vitarelli E, Barresi G. Acne inversa complicated by squamous cell carcinoma in association with diffuse malignant peritoneal mesothelioma arising in the absence of predisposing factors: a case report. Journal of Cutaneous Pathology. 2007;0(0):070816180549005
30. Scheinfeld, N. Extensive hidradenitis suppurativa (HS) Hurly stage III disease treated with intravenous (IV) linezolid and meropenem with rapid remission. Dermatology Online Journal. 2015;21(2), pii.13030
31. Maeda T, Kimura C, Murao N, Takahashi K. Promising long-term outcomes of the reused skin-graft technique for chronic gluteal hidradenitis suppurativa. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015;68(9):1268-1275.
32. Akdogan N, Alli N, Uysal P, Topcuoglu C, Candar T, Turhan T. Visfatin and insulin levels and cigarette smoking are independent risk factors for hidradenitis suppurativa: a case–control study. Archives of Dermatological Research. 2018;310(10):785-793.
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41. Jemec GB, Heidenheim M, Nielsen NH. A case-control study of hidradenitis suppurativa in an STD population. Acta Derm Venereol. 1996 Nov;76(6):482-3. doi: 10.2340/0001555576482483. PMID: 8982418.
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43. Miller I, Carlson N, Mogensen U, Ellervik C, Jemec G. A Population- and Hospital-based Cross-sectional Study of Renal Function in Hidradenitis Suppurativa. Acta Dermato Venereologica. 2016;96(1):68-71.
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2. Velpeau A, Bechet Jeune Z. Dictionnaire de Médecine, on Repertoire Générale Des Sciences Medicals Sous le Rapport Theorique et Pratique, Paris. 1839;2:1839–91.
3. Boer J, Weltevreden E. Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions. British Journal of Dermatology. 1996;135(5):721-725.
4. Schuch A, Fischer T, Boehner A, Biedermann T and Volz T. Successful Treatment of Severe Recalcitrant Hidradenitis Suppurativa with the Interleukin-17A Antibody Secukinumab. Acta Dermato Venereologica. 2018;98(1), pp.151-152.
5. González-López MA, Blanco R, Mata C, López-Escobar M, Lacalle M, Consuegra G, González Vela MC, González-Gay MA. Coexistence of Hidradenitis Suppurativa with Autoimmune Thyroiditis: Report of Three Cases. Dermatology. 2016;232(2):162-4. doi: 10.1159/000439562. Epub 2015 Oct 8. PMID: 26444851.
6. Scheinfeld, N. A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma. Dermatology Online Journal. 2014; 20(3).
7. Vossen M, Gattringer K, Khalifeh N, Koreny M, Spertini V, Mallouhi A, Willeit M, Volc-Platzer B, Asboth F, Graninger W, Thalhammer F and Lagler H. Gemella morbillorum Bacteremia after Anti-Tumour Necrosis Factor Alpha as Acne Inversa Therapy. Journal of Clinical Microbiology. 2011;50(3), pp.1109-1112.
8. Sharon V, Garcia M, Bagheri S, Goodarzi H, Yang C, Ono Y and Maverakis E. Management of Recalcitrant Hidradenitis Suppurativa with Ustekinumab. Acta Dermato Venereologica. 2012;92(3), pp.320-321
9. Lee EY, Alhusayen R, Lansang P, Shear N, Yeung J. What is hidradenitis suppurativa? Can Fam Physician. 2017 Feb;63(2):114-120. PMID: 28209676; PMCID: PMC5395382.
10. Scheinfeld N. Diseases associated with hidradenitis suppurativa: part 2 of a series on hidradenitis. Dermatology Online Journal. 2013; 19(5).
11. de Winter K, van der Zee H, Prens E. Is mechanical stress an important pathogenic factor in hidradenitis suppurativa?. Experimental Dermatology. 2012;21(3):176-177.
12. Kathju S, Lasko L, Stoodley P. Considering hidradenitis suppurativa as a bacterial biofilm disease. FEMS Immunology & Medical Microbiology. 2012;65(2):385-389.
13. Hessam S, Sand M, Lang K, Käfferlein H, Scholl L, Gambichler T et al. Altered Global 5-Hydroxymethylation Status in Hidradenitis Suppurativa: Support for an Epigenetic Background. Dermatology. 2017;233(2-3):129- 135.
14. Theut Riis P, von Stemann J, Kjærsgaard Andersen R, Hansen M and Jemec G. Serum Anticytokine Autoantibody Levels Are Not Increased in Hidradenitis Suppurativa: A Case-Control Pilot Study. Dermatology. 2017;233(2-3), pp.126-128.
15. Ring H, Thorsen J, Saunte D, Lilje B, Bay L, Riis P, Larsen, N, Andersen, L, Nielsen H, Miller I, Bjarnsholt T, Fuursted K and Jemec G. The Follicular Skin Microbiome in Patients With Hidradenitis Suppurativa and Healthy Controls. JAMA Dermatology 2017;153(9), p.897.
16. Ring H, Bay L, Kallenbach K, Miller I, Prens E, Saunte D et al. Normal Skin Microbiota is Altered in Pre-clinical Hidradenitis Suppurativa. Acta Dermato Venereologica. 2017;97(2):208-213.
17. Mozeika E, Pilmane M, Nürnberg B, Jemec G. Tumour Necrosis Factoralpha and Matrix Metalloproteinase-2 are Expressed Strongly in Hidradenitis Suppurativa. Acta Dermato Venereologica. 2013;93(3):301- 304.
18. Kanni T, Tzanetakou V, Savva A, Kersten B, Pistiki A, van de Veerdonk F et al. Compartmentalized Cytokine Responses in Hidradenitis Suppurativa. PLOS ONE. 2015;10(6):e0130522.
19. Hessam S, Sand M, Georgas D, Anders A, Bechara F. Microbial Profile and Antimicrobial Susceptibility of Bacteria Found in Inflammatory Hidradenitis Suppurativa Lesions. Skin Pharmacology and Physiology. 2016;29(3):161-167.
20. Hoffman L, Tomalin L, Schultz G, Howell M, Anandasabapathy N, Alavi A et al. Integrating the skin and blood transcriptomes and serum proteome in hidradenitis suppurativa reveals complement dysregulation and a plasma cell signature. PLOS ONE. 2018;13(9):e0203672.
21. Pink A, Simpson M, Desai N, Dafou D, Hills A, Mortimer P et al. Mutations in the γ-Secretase Genes NCSTN, PSENEN, and PSEN1 Underlie Rare Forms of Hidradenitis Suppurativa (Acne Inversa). Journal of Investigative Dermatology. 2012;132(10):2459-2461.
22. Nikolakis G, Liakou A, Bonovas S, Seltmann H, Bonitsis N, Join-Lambert O et al. Bacterial Colonization in Hidradenitis Suppurativa/Acne Inversa: A Cross-sectional Study of 50 Patients and Review of the Literature. Acta Dermato Venereologica. 2017;97(4):493-498.
23. Banerjee A, McNish S, Shanmugam V. Interferon-gamma (IFN-γ) is Elevated in Wound Exudate from Hidradenitis Suppurativa. Immunological Investigations. 2016;46(2):149-158.
24. Boer J, Mihajlovic D. Boils at Frictional Locations in a Patient with Hidradenitis Suppurativa. Acta Dermatovenerol Croat. 2016 Dec;24(4):303-304. PMID: 28128084.
25. Joglekar K, Jackson C, Kadaria D, Sodhi A. Metastatic Squamous Cell Carcinoma of the Pleura: A Rare Complication of Hidradenitis Suppurativa. American Journal of Case Reports. 2016;17:989-992.
26. Jourabchi N, Fischer A, Cimino-Mathews A, Waters K, Okoye G. Squamous cell carcinoma complicating a chronic lesion of hidradenitis suppurativa: a case report and review of the literature. International Wound Journal. 2016;14(2):435-438.
27. Sotoodian, B, Abbas M, Brassard A. Hidradenitis Suppurativa and the Association With Hematological Malignancies. Journal of Cutaneous Medicine and Surgery. 2017;21(2), pp.158-161
28. Simonart, T. Hidradenitis Suppurativa and Smoking. Journal of the American Academy of Dermatology. 2010;62(1), pp.149-50
29. Barresi V, Vitarelli E, Barresi G. Acne inversa complicated by squamous cell carcinoma in association with diffuse malignant peritoneal mesothelioma arising in the absence of predisposing factors: a case report. Journal of Cutaneous Pathology. 2007;0(0):070816180549005
30. Scheinfeld, N. Extensive hidradenitis suppurativa (HS) Hurly stage III disease treated with intravenous (IV) linezolid and meropenem with rapid remission. Dermatology Online Journal. 2015;21(2), pii.13030
31. Maeda T, Kimura C, Murao N, Takahashi K. Promising long-term outcomes of the reused skin-graft technique for chronic gluteal hidradenitis suppurativa. Journal of Plastic, Reconstructive & Aesthetic Surgery. 2015;68(9):1268-1275.
32. Akdogan N, Alli N, Uysal P, Topcuoglu C, Candar T, Turhan T. Visfatin and insulin levels and cigarette smoking are independent risk factors for hidradenitis suppurativa: a case–control study. Archives of Dermatological Research. 2018;310(10):785-793.
33. Dessinioti C, Tzanetakou V, Zisimou C, Kontochristopoulos G, Antoniou C. A retrospective study of the characteristics of patients with early-onset compared to adult-onset hidradenitis suppurativa. International Journal of Dermatology. 2018;57(6):687-691.
34. Vilanova I, Hernández J, Mata C, Durán C, García-Unzueta M, Portilla V, Fuentevilla P, Corrales A, González-Vela M, González-Gay M, Blanco R and González-López M. Insulin resistance in hidradenitis suppurativa: a case-control study. Journal of the European Academy of Dermatology and Venereology. 2018;32(5), pp.820-824.
35. Lukach A, Saul M, Ferris L, Swoger J. Risk Factors for Hidradenitis Suppurativa in Patients with Inflammatory Bowel Disease. Digestive Diseases and Sciences. 2018;63(3):755-760.
36. Pascual J, González I, Corona D, Hispán P, Ramos J, Sánchez-Paya J et al. Assessment of subclinical atherosclerosis in hidradenitis suppurativa. Journal of the European Academy of Dermatology and Venereology. 2017;31(7):1229-1238.
37. González-López M, Hernández J, Lacalle M, Mata C, López-Escobar M, López-Mejías R et al. Increased prevalence of subclinical atherosclerosis in patients with hidradenitis suppurativa (HS). Journal of the American Academy of Dermatology. 2016;75(2):329-335.
38. Schmitt J, Bombonatto G, Martin M and Miot H. Risk factors for hidradenitis suppurativa: a pilot study. Anais Brasileiros de Dermatologia. 2012; 87(6), pp.936-938.
39. Sabat R, Chanwangpong A, Schneider-Burrus S, Metternich D, Kokolakis G, Kurek A, Philipp S, Uribe D, Wolk K and Sterry W. Increased Prevalence of Metabolic Syndrome in Patients with Acne Inversa. PLOS ONE, 2012; 7(2), p.e31810.
40. Thiers, B. Prevalence and factors associated with hidradenitis suppurativa: Results from two case-control studies. Yearbook of Dermatology and Dermatologic Surgery. 2009;pp.212-213.
41. Jemec GB, Heidenheim M, Nielsen NH. A case-control study of hidradenitis suppurativa in an STD population. Acta Derm Venereol. 1996 Nov;76(6):482-3. doi: 10.2340/0001555576482483. PMID: 8982418.
42. Riis P, Søeby K, Saunte D, Jemec G. Patients with hidradenitis suppurativa carry a higher systemic inflammatory load than other dermatological patients. Archives of Dermatological Research. 2015;307(10):885-889.
43. Miller I, Carlson N, Mogensen U, Ellervik C, Jemec G. A Population- and Hospital-based Cross-sectional Study of Renal Function in Hidradenitis Suppurativa. Acta Dermato Venereologica. 2016;96(1):68-71.
44. Schrader A, Deckers I, van der Zee H, Boer J and Prens E. Hidradenitis suppurativa: A retrospective study of 846 Dutch patients to identify factors associated with disease severity. Journal of the American Academy of Dermatology. 2014;71(3), pp.460-467.
45. Nweze N, Parsikia A, Ahuja R, Joshi A. Axillary Hidradenitis: Risk Factors for Recurrence after Surgical Excision in 214 Patients. The American Surgeon. 2018;84(3):422-427.
46. Mehdizadeh A, Rosella L, Alavi A, Sibbald G, Farzanfar D, Hazrati A et al. A Canadian Population-Based Cohort to the Study Cost and Burden of Surgically Resected Hidradenitis Suppurativa. Journal of Cutaneous Medicine and Surgery. 2018;22(3):312-317.
47. Thorlacius L, Cohen A, Gislason G, Jemec G and Egeberg A. Increased Suicide Risk in Patients with Hidradenitis Suppurativa. Journal of Investigative Dermatology. 2018;138(1), pp.52-57.
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Published
2022-01-31
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Guihen, R., Latvis, J., MacNamara, H., Quinn, E., Hennessy, S., Meagher, C., & MacMahon, J. (2022). The Pathogenesis, Risk Factors, and Comorbidities Associated with Hidradenitis Suppurativa: A Systematic Review. Trinity Student Medical Journal , 21(1), 14–19. Retrieved from https://ojs.tchpc.tcd.ie/index.php/tsmj/article/view/2191
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