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Centre of Evidence of Dermatology Best practice guidelines

Guidelines hidradenitis suppurativa Updated on august 2019

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Physiopathology of hidradenitis suppurativa

Back to decision-making tree Print last updated on 12/02/2020

Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicles; how it perturbs the skin’s innate immunity mechanisms is currently unknown.

The pathological changes hidradenitis suppurativa causes seem to result from peripilar inflammation, leading to an accumulation of keratine and hair follicle obstruction, dilation and rupture.

After the follicle has ruptured, the secondary inflammation, associated with bacterial infections, would appear to cause abscesses and sinus tracts.

A family history of hidradenitis suppurativa is reported in 30-40% of patients. Several genes of the gamma-secretase pathway have been implicated in this disease.

The mutations of this pathway would seem to cause errors in the Notch pathway, which in turn seems to play an essential role in recruiting and activating T and B lymphocytes and in activating innate immune reactions.

A causal role of hormones is also suspected (occurrence of the disease from puberty onwards and the presence of 5α-reductase enzymes in apocrine glands).

pathogenesis of hs
Figure 1. Pathogenesis of hidradenitis suppurativa lesions
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