Hidradenitis Suppurativa: From Physiopathologies to Targeted Therapeutics

Hidradenitis suppurativa (HS), otherwise referred to as acne inversa is a chronic inflammatory skin disorder affecting many parts of the body where two surfaces rub together and causes multiple systemic complications and currently has a reported worldwide prevalence of approximately 1.0%. The condition typically presents in early adulthood, presents with painful bumps, abscesses, and draining sinus tracts that commonly affect the armpit (axillary), vagina, buttocks (gluteal), and anal (perianal) areas. There is also an association with Metabolic Disease and Cardiovascular Disease that reduced the expected longevity of the patient with HS. There are several recognised contributing risk factors for progression of HS which include genetic predisposition, smoking, being overweight, and hormones. The pathophysiological process begins around the area of the hair follicle due to abnormalities of both the innate and acquired immune systems. The inflammatory mediators that are thought to initiate this inflammation are TNF, IL-1β, and IL-17(Sabat et al., 2020). The disease usually first appears after someone has gone through puberty but is often diagnosed around the age of 30 and can continue into the senile years. The nature of the disease is primarily chronic and often leads to the development of extensions underneath the skin that can cause indurations, sinus, and fistulae that drastically impacts an individual's quality of life. The treatment options for the disease will vary depending on the stage of disease when it is first diagnosed. In cases where nodular lesions appear early in the disease process (like in the beginning of the disease), antibiotics can be used for acute treatment; long-term antibacterials, zinc salts can often be used as maintenance medication; and anti-TNF medications have been recommended for severe cases of the disease. Systemic steroids, estrogens, anti-androgens, and retinoids can sometimes be employed as options, but usually with limited success. Surgical options may be used to treat abscesses that are limited in nature, but incision and drainage should only be used to treat abscesses that have not expanded beyond that point; for locally recurrent draining sinuses, limited excisions should be performed. In cases of advanced disease, total wide excision with healing by secondary intention or flaps or grafts is the only option for actual cure (Revuz, 2009).