Abstract
Hidradenitis suppurativa is a debilitating chronic skin disease often failure to recognise by healthcare professionals with an average of diagnostic delay of seven years, that has resulted in misdiagnosis and mismanagement of many patients. Knowledge of the pathogenesis is limited, although it seems to be associated with follicular obstruction, follicular rupture and an associated immune response.
Highlights
Hidradenitis suppurativa [1] is a chronic, inflammatory skin disease of the hair follicle characterized by the development of recurrent inflammatory nodules, abscesses, sinus tracts and scarring, involving the intertriginous regions, as axillary, perianal and inguinal areas [2].Physical pain, malodor, scars, chronic drainage, and disfigurement are common features of this disorder, which can lead to several emotional reactions, including anger, sadness, anxiety, and depression [3]
Using Pubmed and UpToDate databases we selected 43 articles referring to hidradenitis suppurativa, in English language and published within the last 5 years
Follicular occlusion with posterior dilatation and rupture, leads to the spill of keratin, corneocytes, hair shaft and sebum products from breached pilosebaceous units into the dermis, which can act as danger-associated molecular patterns that stimulate an immune response [14]
Summary
The etiopathogenesis of hidradenitis is not fully understood [13]. The idea that the disorder is primarily caused by an inflammation of apocrine glands is nowadays rejected and follicular occlusion by hyperkeratosis and perifolliculitis. A sulfone drug with immunomodulatory and antibacterial properties that is utilized for the treatment of multiple neutrophil predominant skin diseases, may be effective in mild to moderate hidradenitis (category of evidence IV, strength of recommendation D [25]), in the early neutrophil-mediated phase of new lesions. Conventional immunosuppressants - Occasionally, systemic glucocorticoids (category of evidence IV, strength of recommendation D (25)) 40 to 60 mg per day for two to three days followed by a 7- to 10-day taper, or cyclosporine (category of evidence IV, strength of recommendation D [25]), 4 to 5 mg/kg per day orally, are prescribed for hidradenitis (Figure 1), evidence on the efficacy of these treatments for hidradenitis is limited Because these drugs may induce severe adverse effects, they are rarely utilized for long-term therapy [23]. As surgery is an invasive procedure that will result in additional scarring and carries a high recurrence rate, prior to proceeding, the risks, benefits, and alternatives should be discussed with the patient [9,36]
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