Continuing medical educationHidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis
Section snippets
Epidemiology
Key points The prevalence of HS is unknown, but estimates range from 0.00033% to 4.10% HS most frequently occurs in young adults HS is more than twice as common in women compared with men, and is more common in African Americans and biracial individuals than whites
HS prevalence is unclear. Estimates range from 0.00033% to 4.10%.5 Higher estimates are derived from prospective6 and self-reported studies7,8; lower estimates derive from registries.9, 10, 11, 12 A retrospective analysis of >48 million patients
Quality of life
Key points HS significantly decreases patients' quality of life Depression and pain are associated with HS HS leads to social and work impairment
HS dramatically decreases quality of life (QoL). Patients report embarrassment, self-consciousness, and an inability to participate in social and athletic activities.17 Depression, anxiety, pain, high body mass index (BMI), and work impairment are the main factors affecting QoL.18,19 Depression occurs in 5.9% to 42.9% of patients with HS15,19, 20, 21, 22 in both
Presentation and clinical classification
Key points HS is diagnosed by clinical features and history, and there are multiple scoring systems used for the classification of disease severity Lesions include deep-seated nodules, abscesses, and sinus tracts that rupture and form scars The Hurley staging system is the most widely used HS classification system There are several clinically distinct HS phenotypes
HS is diagnosed clinically; pathologic confirmation is unnecessary.31, 32, 33 There are 3 criteria for diagnosis: characteristic lesions,
Comorbidities and risk factors
Key points HS is associated with many comorbidities, most of which are inflammatory in nature Obesity is the most common comorbidity associated with HS There is a strong association between HS and tobacco smoking There is an increased prevalence of HS among psoriasis patients HS is a component of the follicular occlusion triad/tetrad
HS patients have an incredibly high comorbidity burden.57,58 Hypertension, obesity, dyslipidemia, thyroid disorder, arthropathies, psychiatric disorders, and polycystic ovarian
Pathogenesis
Key points The primary event in HS is follicular hyperkeratosis, leading to rupture of the hair follicle and subsequent inflammation of apocrine glands TNF-α and interleukin-17 are key cytokines in HS pathogenesis Levels of TNF-α are higher in the lesional tissue of patients with HS than that of patients with psoriasis Levels of TNF-α in lesional HS skin and serum levels of interleukin-17 correlate with disease severity The role of sex hormones in HS remains unclear Thirty percent to 40% of patients with HS
Bacterial colonization
Key points HS patients have a unique skin microbiome Biofilms are a key feature of lesional skin, but distinct species have also been found There is a lack of consensus on which bacterial species are most common in HS lesions
The cutaneous microbiome is significantly different in HS lesional skin, nonlesional skin, and patients without HS.81 The lesional skin microbiome consists predominantly of Corynebacterium, Porphyromonas, and Peptoniphilus species,129 while nonlesional skin has predominantly
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Cited by (0)
Funding sources: None.
Dr Strober serves as consultant for AbbVie, Almirall, Amgen, Arena, Aristea, Boehringer Ingelheim, Bristol-Myers-Squibb, Celgene, Dermavant, Dermira, Janssen, Leo, Eli Lilly, Kyowa Hakko Kirin, Meiji Seika Pharma, Novartis, Pfizer, GlaxoSmithKline, UCB Pharma, Sun Pharma, Ortho Dermatologics, Regeneron, Sanofi-Genzyme. Dr Strober is also a speaker for AbbVie, Lilly, Janssen, Ortho Dermatologics. Dr Strober is also a scientific director for Corrona Psoriasis Registry. Dr Strober is also an investigator for Dermavant, AbbVie, Corrona Psoriasis Registry, Dermira. Dr Payette is a consultant for Abbvie Inc, Novartis, and Janssen Global Services.
Date of release: May 2020
Expiration date: May 2023