Preliminary findings suggest hidradenitis suppurativa may be due to defective follicular support
- 16 January 2013
- journal article
- research article
- Published by Oxford University Press (OUP) in British Journal of Dermatology
- Vol. 168 (5), 1034-1039
- https://doi.org/10.1111/bjd.12233
Abstract
Background The initial pathology in hidradenitis suppurativa (HS)/acne inversa takes place in the folliculopilosebaceous unit (FPSU) and its surrounding tissue. The process involves follicular hyperkeratosis, inflammation and perifolliculitis. Identification of the exact origin of inflammation may shed new light on the pathogenesis and aetiology of the disease. Objectives To study the morphology of the basement membrane zone (BMZ) in patients with HS. Methods In total, 65 operative specimens from 20 patients diagnosed with HS were cut stepwise. Within each specimen, the focus was set on heavily involved HS regions (centre) and clinically uninvolved regions (border). All specimens were stained with periodic acid–Schiff (PAS) to visualize the epithelial support structures of the FPSU (i.e. the BMZ), the sinus tracts (STs) and the interfollicular basement membrane (BM). The intensity of BMZ PAS staining was graded from 0 to 4+. Results Compared with the axillary skin of human controls, the sebofollicular junction in patients with HS was found to be almost devoid of PAS-positive material (grade 0/1+) in both the border and centre lesions of HS, whereas STs and BMs showed uniformly grade 2–3+ positivity irrespective of any inflammation present. The distribution of inflammatory cells around the sebofollicular junction occurred predominantly in areas of BMZ thinning. Conclusions The BMZ PAS positivity of clinically uninvolved FPSUs of patients with HS appears to be wispy or not present at all. It is speculated that this may explain the apparent fragility of the sebofollicular junction. There is an increased concentration of inflammatory cells adjacent to these areas, while inflammatory cells are scarce in areas where the PAS-positive material is intact. It is hypothesized that the PAS gap identifies (i) areas susceptible to leakage, trauma and rupture, leading to release of materials that trigger inflammatory mediators, and (ii) the seeding of the dermis with free-living stem cells generating benign but invasive epithelialized sinuses, spreading horizontally in and below the dermis.Keywords
This publication has 19 references indexed in Scilit:
- Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin and early and chronic hidradenitis suppurativa lesionsBritish Journal of Dermatology, 2011
- Hidradenitis suppurativa/acne inversa: bilocated epithelial hyperplasia with very different sequelaeBritish Journal of Dermatology, 2010
- Hidradenitis suppurativa (acne inversa): early inflammatory events at terminal follicles and at interfollicular epidermis*Experimental Dermatology, 2010
- Hidradenitis suppurativaJournal of the European Academy of Dermatology and Venereology, 2009
- Hidradenitis suppurativa: A comprehensive reviewJournal of the American Academy of Dermatology, 2009
- Medical treatment of hidradenitis suppurativaExpert Opinion on Pharmacotherapy, 2004
- The homogeneity of hidradenitis suppurativa lesionsAPMIS, 1997
- Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesionsBritish Journal of Dermatology, 1996
- Histology of hidradenitis suppurativaJournal of the American Academy of Dermatology, 1996
- Hidradenitis suppurativa: a disease of follicular epithelium, rather than apocrine glandsBritish Journal of Dermatology, 1990