Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

  • Miguel Costa e Silva Interno do Internato Complementar de Dermatologia e Venereologia, Centro Hospitalar São João, EPE, Porto, Portugal http://orcid.org/0000-0003-4012-5660
  • Filomena Azevedo Dermatologia e Venereologia Centro Hospitalar São João, EPE, Porto, Portugal
  • Carmen Lisboa Dermatologia e Venereologia Centro Hospitalar São João, EPE, Porto, Portugal
Keywords: Hidradenitis suppurativa, Epidemiology, Pathogenesis, Quality of life.

Abstract

Hidradenitis suppurativa (HS) is as a chronic, inflammatory and recurrent skin disease of the hair follicle. Prevalence of HS is a matter of debate, with estimate rates as low as 0.00033% and as high as 4.1%. HS prevalence appears significantly higher in women and has a mean age of onset in the early 20s. The primary histopathologic event seems to be a follicular hyperkeratosis with plugging, dilatation and rupture of the hair follicle resulting with subsequent inflammation and formation of abscesses and sinus tracts. The cause of this is likely multifactorial, involving genetic factors, cigarette smoking, mechanical stress, obesity, immune aberrant response and hormonal abnormalities. HS, as a chronic inflammatory dermatosis, is associated with a variety of concomitant and secondary diseases such as metabolic syndrome, inflammatory and rheumatologic diseases, depression and malignancy, and, for this reason HS management often requires a multidisciplinary team.

 

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References

Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29:619-44.

Oliveira MP, Gazzalle A,Narvaes G. Hidradenitis suppurativa (acne inversa): review of the literature and case report on the surgical treatment of a presternal lesion. Rev Bras Cir Plást. 2015;30:487-94.

Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60:539-61.

van der Zee HH, Jemec GB. New insights into the diagnosis of hidradenitis suppurativa: Clinical presentations and phenotypes. J Am Acad Dermatol. 2015;73(Suppl 1):S23-6.

Hurley H. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach. In: Roenigh R, Roenigh H, editors. Dermatologic surgery. New York: Marcel Dekker; 1989. p.729-39.

Horváth B, Janse IC, Blok JL, Driessen RJ, Boer J, Mekkes JR, et al. Hurley Staging Refined: A Proposal by the Dutch Hidradenitis Suppurativa Expert Group. Acta Dermatol Venereol. 2017;97:412-13.

Sartorius K, Lapins J, Emtestam L, Jemec GB. Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol. 2003;149:211-3.

Kimball AB, Kerdel F, Adams D, Mrowietz U, Gelfand JM, Gniadecki R, et al. Adalimumab for the treatment of moderate to severe Hidradenitis suppurativa: a parallel randomized trial. Ann Intern Med. 2012;157:846-55.

Kimball AB, Jemec GB, Yang M, Kageleiry A, Signorovitch JE, Okun MM, et al. Assessing the validity, responsiveness and meaningfulness of the Hidradenitis Suppurativa Clinical Response (HiSCR) as the clinical endpoint for hidradenitis suppurativa treatment. Br J Dermatol. 2014; 171:1434-42.

Zouboulis CC, Tzellos T, Kyrgidis A, Jemec GB, Bechara FG, Giamarellos-Bourboulis EJ, et al; EHSF Investigator Group. Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity. Br J Dermatol. 2017; 177:1401-9.

Martorell A, Wortsman X, Alfageme F, Roustan G, Arias--Santiago S, Catalano O, et al. Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa: Proposal of a Standarized Report. Dermatol Surg. 2017;43:1065-73.

Jemec GB. Commentary on Ultrasound Evaluation as a Complementary Test in Hidradenitis Suppurativa. Dermatol Surg. 2017;43:1074-5.

Virgilio E, Bocchetti T, Balducci G. Utility of MRI in the diagnosis and post-treatment evaluation of anogenital hidradenitis suppurativa. Dermatol Surg. 2015;41:865–6.

Makris GM, Poulakaki N, Papanota AM, Kotsifa E, Sergentanis TN, Psaltopoulou T. Vulvar, perianal and perineal cancer after hidradenitis suppurativa: a systematic review and pooled analysis. Dermatol Surg. 2017;43:107–15.

Wortsman X, Jemec GB. Real-time compound imaging ultrasound of hidradenitis suppurativa. Dermatol Surg. 2007;33:1340–2.

Horváth B, Janse IC, Sibbald GR. Pain management in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(Suppl 1):S47-51.

Gooderham M, Papp K. The psychosocial impact of hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(Suppl 1):S19-22.

Miller IM, McAndrew RJ, Hamzavi I. Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa. Dermatol Clin. 2016;34:7-16.

Jemec GB, Heidenheim M, Nielsen NH. Hidradenitis suppurativa--characteristics and consequences. Clin Exp Dermatol. 1996;21:419-23.

von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389-92.

Kurek A, Peters EM, Chanwangpong A, Sabat R, Sterry W, Schneider-Burrus S. Profound disturbances of sexual health in patients with acne inversa. J Am Acad Dermatol. 2012;67: 422–8, 8.e1.

Santos JV, Lisboa C, Lanna C, Costa-Pereira A, Freitas A. Hospitalisations with hidradenitis suppurativa: an increasing problem that deserves closer attention. Dermatology. 2016;232:613-18

Barlev D, Eisen DB, Alikhan A. Hidradenitis suppurativa: a review with a focus on treatment data. Skin Therapy Lett. 2015;20:1-8.

Mebazaa A, Ben Hadid R, Cheikh Rouhou R, Trojjet S, El Euch D, Mokni M, et al. Hidradenitis suppurativa: a disease with male predominance in Tunisia. Acta Dermatovenerol Alp Panonica Adriat. 2009;18:165-72

Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133:97-103.

Revuz JE, Canoui-Poitrine F, Wolkenstein P, Viallette C, Gabison G, Pouget F, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008;59:596-601.

Jemec GB, Heidenheim M, Nielsen NH. The prevalence of hidradenitis suppurativa and its potential precursor lesions. J Am Acad Dermatol. 1996;35:191-4.

Jemec GB. The symptomatology of hidradenitis suppurativa in women. Br J Dermatol. 1988;119:345-50.

Santos JV, Lisboa C, Lanna C, Costa-Pereira A, Freitas A. Is the prevalence of hidradenitis suppurativa being overestimated in Europe? Or is the disease underdiagnosed?

Evidence from a nationwide study across Portuguese public hospitals. Int J Dermatol. 2017;56:1491-2.

Reeder VJ, Mahan MG, Hamzavi IH. Ethnicity and hidradenitis suppurativa. J Invest Dermatol. 2014;134:2842-3

Muzy G, Cocco EI, Alves EO. Hidradenite supurativa: atualização e revisão de suas modalidades terapêuticas. Surg Cosmet Dermatol 2014;6:206-12

Mikkelsen PR, Jemec GB. Hidradenitis suppurativa in children and adolescents: a review of treatment options. Paediatr Drugs. 2014;16:483–9.

Kelly G, Prens EP. Inflammatory Mechanisms in Hidradenitis Suppurativa. Dermatol Clin. 2016;34:51-8.

Karagiannidis I, Nikolakis G, Sabat R, Zouboulis CC. Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder? Rev Endocr Metab Disord. 2016;17:335-41.

Kelly G, Hughes R, McGarry T, van den Born M, Adamzik K, Fitzgerald R, et al. Dysregulated cytokine expression in lesional and nonlesional skin in hidradenitis suppurativa. Br J Dermatol. 2015;173:1431-9.

Schlapbach C, Hänni T, Yawalkar N, Hunger RE. Expression of the IL-23/Th17 pathway in lesions of hidradenitis suppurativa. J Am Acad Dermatol. 2011;65:790-8.

van der Zee HH, Laman JD, Boer J, Prens EP. Hidradenitis suppurativa: viewpoint on clinical phenotyping, pathogenesis and novel treatments. Exp Dermatol. 2012;21:735–9.

Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: An update. J Am Acad Dermatol. 2015;73(Suppl 1):S8-11.

Sweeney CM, Tobin AM, Kirby B. Innate immunity in the pathogenesis of psoriasis. Arch Dermatol Res, 2011;303:691–705

Kelly G, Sweeney CM, Tobin AM, Kirby B. Hidradenitis suppurativa: the role of immune dysregulation. Int J Dermatol. 2014;53:1186–96.

Khandalavala BN, Do MV. Finasteride in Hidradenitis Suppurativa: A "Male" Therapy for a Predominantly "Female" Disease. J Clin Aesthet Dermatol. 2016;9:44-50.

Theut Riis P, Saunte DM, Benhadou F, Del Marmol V, Guillem P, El-Domyati M, et al. Low and high body mass index in hidradenitis suppurativa patients-different subtypes? J Eur Acad Dermatol Venereol. 2018;32:307-12.

Mortimer PS, Dawber RP, Gales MA, Moore RA. Mediation of hidradenitis suppurativa by androgens. Br Med J. 1986;292:245–8.

Harrison BJ, Kumar S, Read GF, Edwards CA, Scanlon MF, Hughes LE. Hidradenitis suppurativa: evidence for an endocrine abnormality. Br J Surg. 1985;72:1002–4.

Kraft JN, Searles GE. Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy. J Cutan Med Surg. 2007;11:125–31.

Goldsmith PC, Dowd PM. Successful therapy of the follicular occlusion triad in a young woman with high dose oral antiandrogens and minocycline. J R Soc Med. 1993;86:729–30.

Liy-Wong C, Pope E, Lara-Corrales I. Hidradenitis suppurativa in the pediatric population. J Am Acad Dermatol. 2015;73(Suppl 1):S36-41.

Kromann CB, Deckers IE, Esmann S, Boer J, Prens EP, Jemec GB. Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol 2014;171:819-24.

Principi M, Cassano N, Contaldo A, Iannone A, Losurdo G, Barone M, et al. Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association. World J Gastroenterol. 2016;22:4802-11.

Gentle ME, Rose A, Bugeon L, Dallman MJ. Noncanonical Notch signaling modulates cytokine responses of dendritic cells to inflammatory stimuli. J Immunol. 2012;189:1274-84.

Melnik BC, Plewig G. Impaired Notch signalling: the unifying mechanism explaining the pathogenesis of hidradenitis suppurativa (acne inversa). Br J Dermatol. 2013;168: 876-8.

Nazary M, van der Zee HH, Prens EP, Folkerts G, Boer J. Pathogenesis and pharmacotherapy of Hidradenitis suppurativa. Eur J Pharmacol. 2011; 672:1-8.

Wang B, Yang W, Wen W, Sun J, Su B, Liu B, et al. Gamma-secretase gene mutations in familial acne inversa. Science. 2010;330:1065.

Boer J, Nazary M, Riis PT. The role of mechanical stress in hidradenitis suppurativa. Dermatol Clin. 2016;34:37-43.

Ring HC, Riis Mikkelsen P, Miller IM, Jenssen H, Fuursted K, Saunte DM, et al. The bacteriology of hidradenitis suppurativa: a systematic review. Exp Dermatol. 2015;24:727-31.

Ring HC, Emtestam L. The microbiology of hidradenitis suppurativa. Dermatol Clin. 2016;34:29-35.

Sartorius K, Killasli H, Oprica C, Sullivan A, Lapins J. Bacteriology of hidradenitis suppurativa exacerbations and deep tissue cultures obtained during carbon dioxide laser treatment. Br J Dermatol. 2012;166:879–83.

Lapins J, Jarstrand C, Emtestam L. Coagulase negative staphylococci are the most common bacteria found in cultures from the deep portions of hidradenitis suppurativa

lesions, as obtained by carbon dioxide laser surgery. Br J Dermatol. 1999; 140:90–5.

Jahns AC, Killasli H, Nosek D, Lundskog B, Lenngren A, Muratova Z, et al. Microbiology of hidradenitis suppurativa (acne inversa): a histological study of 27 patients. APMIS. 2014;122:804–9.

Sabat R, Chanwangpong A, Schneider-Burrus S, Metternich D, Kokolakis G, Kurek A, et al. Increased prevalence of metabolic syndrome in patients with acne inversa. PLoS One. 2012;7:e31810.

Church JM, Fazio VW, Lavery IC, Oakley JR, Milsom JW. The differential diagnosis and comorbidity of hidradenitis suppurativa and perianal Crohn’s disease. Int J Colorectal Dis. 1993;8:117–9.

van der Zee HH, de Winter K, van der Woude CJ, Prens EP. The prevalence of hidradenitis suppurativa in 1093 patients with inflammatory bowel disease. Br J Dermatol. 2014;171:673-5.

Bruzzese V. Pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis: efficacy of anti-tumor necrosis factor alpha therapy. J Clin Rheumatol. 2012;18:413–5.

Vasanth V, Chandrashekar BS. Follicular occlusion tetrad. Indian Dermatol Online J. 2014;5:491–3.

Blok J, Jonkman M, Horvath B. The possible association of hidradenitis suppurativa and Down syndrome: is increased amyloid precursor protein expression resulting in impaired Notch signaling the missing link? Br J Dermatol. 2014;170:1375–7.

Lavogiez C, Delaporte E, Darras-Vercambre S, Martin De Lassalle E, Castillo C, Mirabel X, et al. Clinicopathological study of 13 cases of squamous cell carcinoma complicating hidradenitis suppurativa. Dermatology. 2010;220:147-53.

Scheinfeld N. A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma. Dermatol Online J. 2014;20:3.

Crowley JJ, Mekkes JR, Zouboulis CC, Scheinfeld N, Kimball A, Sundaram M, et al. Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities. Br J Dermatol. 2014;171:1561–5.

Onderdijk AJ, van der Zee HH, Esmann S, Lophaven S, Dufour DN, Jemec GB, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2013;27:473-8.

Matusiak L, Bieniek A, Szepietowski JC. Psychophysical aspects of hidradenitis suppurativa. Acta Derm Venereol. 2010;90:264-8.

Wortsman X, Revuz J, Jemec GB. Lymph nodes in hidradenitis suppurativa. Dermatology. 2009;219:22-4

Miller IM, Carlson N, Mogensen UB, Ellervik C, Jemec GB. A Population- and Hospital-based Cross-sectional Study of Renal Function in Hidradenitis Suppurativa. Acta Derm Venereol. 2016;96:68-71.

Tennant F Jr, Bergeron JR, Stone OJ, Mullins JF. Anemia associated with hidradenitis suppurativa. Arch Dermatol. 1968;98:138–40.

Girouard SD, Falk RH, Rennke HG, Merola JF. Hidradenitis suppurativa resulting in systemic amyloid A amyloidosis: a case report and review of the literature. Dermatol Online J. 2012;18:2.

Deckers IE, van der Zee HH, Prens EP. Severe fatigue based on anaemia in patients with hidradenitis suppurativa: report of two cases and a review of the literature. J Eur Acad Dermatol Venereol. 2016;30:174-5.

Jemec GB, Revuz J, Leyden J. Hidradenitis suppurativa. Berlin: Springer; 2006. 77- Ingram JR, McPhee M. Management of hidradenitis suppurativa: a U.K. survey of current practice. Br J Dermatol. 2015;173:1070-2.

Boer J, Jemec GB. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol. 2010;35:36–40.

van der Zee HH, Gulliver WP. Medical Treatments of Hidradenitis Suppurativa: More Options, Less Evidence. Dermatol Clin. 2016;34:91-6.

Riis PT, Boer J, Prens EP, Saunte DM, Deckers IE, Emtestam L, Sartorius K, et al. Intralesional triamcinolone for flares of hidradenitis suppurativa (HS): A case series. J Am Acad Dermatol. 2016;75:1151-5.

Feito-Rodriguez M, Sendagorta-Cudos E, Herranz- Pinto P, de Lucas-Laguna R. Prepubertal hidradenitis suppurativa successfully treated with botulinum toxin A. Dermatol Surg. 2009;35:1300–2.

Khoo AB, Burova EP. Hidradenitis suppurativa treated with Clostridium botulinum toxin A. Clin Exp Dermatol. 2014;39:749–50.

Alhusayen R, Shear NH. Scientific evidence for the use of current traditional systemic therapies in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(Suppl 1):S42-6.

Kohorst JJ, Hagen C, Baum CL, Davis MD. Treatment experience in a local population with hidradenitis suppurativa. J Drugs Dermatol. 2014;13:827-31.

12- Alavi A, Kirsner RS. Local wound care and topical management of hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(Suppl 1):S55-61.

Mendonça CO, Griffiths CE. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol. 2006;154:977-8.

Gener G, Canoui-Poitrine F, Revuz JE, Faye O, Poli F, Gabison G, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology. 2009;219:148-54.

van der Zee HH, Boer J, Prens EP, Jemec GB. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa. Dermatology.

;219:143-7.

Bettoli V, Zauli S, Borghi A, Toni G, Minghetti S, Ricci M, et al. Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa/acne inversa: a prospective study on 23 patients. J Eur Acad Dermatol Venereol. 2014;28:125-6.

Join-Lambert O, Coignard H, Jais JP, Guet-Revillet H, Poirée S, Fraitag S, et al. Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa. Dermatology. 2011;222:49-58.

Matusiak L, Bieniek A, Szepietowski JC. Acitretin treatment for hidradenitis suppurativa: a prospective series of 17 patients. Br J Dermatol. 2014;171:170-4.

Verdolini R, Simonacci F, Menon S, Pavlou P, Mannello B. Alitretinoin: a useful agent in the treatment of hidradenitis suppurativa, especially in women of childbearing age. G Ital Dermatol Venereol. 2015;150:155-62.

Bianchi L, Hansel K, Stingeni L. Recalcitrant severe hidradenitis suppurativa successfully treated with cyclosporine A. J Am Acad Dermatol. 2012;67:e278-9.

Rose RF, Goodfield MJ, Clark SM. Treatment of recalcitrant hidradenitis suppurativa with oral ciclosporin. Clin Exp Dermatol. 2006;31:154–5.

Buckley DA, Rogers S. Cyclosporin-responsive hidradenitis suppurativa. J R Soc Med. 1995;88:289P–90P.

Jemec GB. Methotrexate is of limited value in the treatment of hidradenitis suppurativa. Clin Exp Dermatol. 2002;27:528-9.

Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, et al. Two Phase 3 Trials of Adalimumab for Hidradenitis Suppurativa. N Engl J Med. 2016;375:422-34.

Blok JL, van Hattem S, Jonkman MF, Horváth B. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. Br J Dermatol. 2013;168:243-52.

Blok JL, Jonkman MF, Horvath B. Results of the first prospective open label study investigating the effectiveness and safety of usekinumab in hidradenitis suppurativa. EADV Congress. Amsterdam, The Netherlands, October 8–12, 2014.

Tzanetakou V, Kanni T, Giatrakou S, Katoulis A, Papadavid E, Netea MG, et al. Safety and Efficacy of Anakinra in Severe Hidradenitis Suppurativa: A Randomized Clinical Trial. JAMA Dermatol. 2016;152:52-9.

Zarchi K, Dufour DN, Jemec GB. Successful treatment of severe hidradenitis suppurativa with anakinra. JAMA Dermatol. 2013;149:1192-4.

Jaeger T, Andres C, Grosber M, Zirbs M, Hein R, Ring J, et al. Pyoderma gangrenosum and concomitant hidradenitis suppurativa - rapid response to canakinumab (anti-IL-1beta). Eur J Dermatol. 2013;23:408-10.

Schuch A, Fischer T, Boehner A, Biedermann T, Volz T. Successful treatment of severe recalcitrant hidradenitis suppurativa with the interleukin-17A antibody secukinumab. Acta Derm Venereol. 2017 (in press).

- Takahashi K, Yanagi T, Kitamura S, Hata H, Imafuku K, Iwami D, et al. Successful treatment of hidradenitis suppurativa with rituximab for a patient with idiopathic carpotarsal osteolysis and chronic active antibody-mediated rejection. J Dermatol. 2017 (in press).

Veilleux MS, Shear NH. Biologics in patients with skin diseases. J Allergy Clin Immunol. 2017;139:1423-30.

36- Faivre C, Villani AP, Aubin F, Lipsker D, Bottaro M, Cohen JD, et al. Hidradenitis suppurativa (HS): Anunrecognized paradoxical effect of biologic agents (BA) used in chronicinflammatory diseases. J Am Acad Dermatol. 2016;74:1153-9. .

Stellon AJ, Wakeling M. Hidradenitis suppurativa associated with use of oral contraceptives. BMJ. 1989;298:28-9.

Doménech C, Matarredona J, Escribano-Stablé JC, Devesa JP, Vicente J, Jaén A. Facial hidradenitis suppurativa in a 28-year-old male responding to finasteride. Dermatology. 2012;224:307–8.

41 Randhawa HK, Hamilton J, Pope E. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. JAMA Dermatol. 2013;149:732-5.

Mota F, Machado S, Selores M. Hidradenitis suppurativa in children treated with finasteride-a case series. Pediatr Dermatol. 2017;34:578-83.

Verdolini R, Clayton N, Smith A, Alwash N, Mannello B. Metformin for the treatment of hidradenitis suppurativa: a little help along the way. J Eur Acad Dermatol Venereol. 2013;27:1101-8.

Yazdanyar S, Boer J, Ingvarsson G, Szepietowski JC, Jemec GB. Dapsone therapy for hidradenitis suppurativa: a series of 24 patients. Dermatology. 2011;222:342–6.

Brocard A, Knol AC, Khammari A, Dréno B. Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study. Dermatology. 2007;214:325-7.

Goo B, Chung HJ, Chung WG, Chung KY. Intramuscular immunoglobulin for recalcitrant suppurative diseases of the skin: a retrospective review of 63 cases. Br J Dermatol. 2007;157:563–8.

Ducroux E, Ocampo MA, Kanitakis J, Morelon E, Jullien D, Faure M, et al. Hidradenitis suppurativa after renal transplantation: complete remission after switching from oral cyclosporine to oral tacrolimus. J Am Acad Dermatol. 2014;71:e210–1.

Arnadottir M, Jonsson E, Jonsson J. Inactivity of hidradenitis suppurativa after renal transplantation. Transplantation. 2006;82:849.

Deckers IE, van der Zee HH, Balak DM, Prens EP. Fumarates, a new treatment option for therapy-resistant hidradenitis suppurativa: a prospective open-label pilot study. Br J Dermatol. 2015;172:828–9.

Angel MF, Ramasastry SS, Manders EK. Beneficial effects of staphage lysate in the treatment of chronic recurrent hidradenitis suppurativa. Surgical Forum. 1987; 38:111–12.

Armyra K, Kouris A, Markantoni V, Katsambas A, Kontochristopoulos G. Hidradenitis suppurativa treated with tetracycline in combination with colchicine: a prospective series of 20 patients. Int J Dermatol. 2017;56:346-50.

Danby FW, Hazen PG, Boer J. New and traditional surgical approaches to hidradenitis suppurativa. J Am Acad Dermatol. 2015;73:S62-5.

van der Zee HH, Prens EP, Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol. 2010;63:475-80.

Blok JL, Spoo JR, Leeman FW, Jonkman MF, Horváth B. Skin-Tissue-sparing Excision with Electrosurgical Peeling (STEEP): a surgical treatment option for severe hidradenitis suppurativa Hurley stage II/III. J Eur Acad Dermatol Venereol. 2015;29:379-82.

Bieniek A, Matusiak Ł, Chlebicka I, Szepietowski JC. Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non-melanoma skin cancers. J Eur Acad Dermatol Venereol. 2013;27:1015-21.

Mehdizadeh A, Hazen PG, Bechara FG, Zwingerman N, Moazenzadeh M, Bashash M, et al. Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis. J Am Acad Dermatol. 2015; 73(Suppl 1):S70-7.

Pagliarello C, Fabrizi G, Feliciani C, Di Nuzzo S. Cryoinsufflation for Hurley stage II hidradenitis suppurativa: a useful treatment option when systemic therapies should be avoided. JAMA Dermatol. 2014;150:765-6.

Hazen PG, Hazen BP. Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg. 2010;36:208-13.

Madan V, Hindle E, Hussain W, et al. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol. 2008;159:1309-14.

Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and istopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. 2010;62:637-45.

Xu LY, Wright DR, Mahmoud BH, Ozog DM, Mehregan DA, Hamzavi IH. Histopathologic study of hidradenitis suppurativa following long-pulsed 1064-nm Nd:YAG laser treatment. Arch Dermatol. 2011;147:21-8.

Highton L, Chan WY, Khwaja N, Laitung JK. Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study. Plast Reconstr Surg. 2011;128:459-65.

Gold M, Bridges TM, Bradshaw VL, Boring M. ALA-PDT and blue light therapy for hidradenitis suppurativa. J Drugs Dermatol. 2004;3:S32-5.

Strauss RM, Pollock B, Stables GI. Photodynamic therapy using aminolaevulinic acid does not lead to clinical improvement in hidradenitis suppurativa. Br J Dermatol.

;152:803-4.

Sotiriou E, Apalla Z, Maliamani F, Ioannides D. Treatment of recalcitrant hidradenitis suppurativa with photodynamic therapy: report of five cases. Clin Exp Dermatol. 2009;34:e235-6.

Schweiger ES, Riddle CC, Aires DJ. Treatment of hidradenitis suppurativa by photodynamic therapy with aminolevulinic acid: preliminary results. J Drugs Dermatol. 2011;10:381-6.

Shareef M, Dawe R. Bath psoralen plus ultraviolet A for hidradenitis suppurativa: a review of 13 patients. Br J Dermatol. 2011;164:895-6.

Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2009;23:985-98.

Horváth B, Janse IC, Sibbald GR. Pain management in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(Suppl 1):S47-51.

Shelley WB, Cahn MM. The pathogenesis of hidradenitis suppurativa in man. Arch Dermatol. 1955;72:562–5.

Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular eventsand all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429-34.

Stjernsward J. WHO cancer pain relief programme. Cancer Surv. 1988;7:195-208.

Yale University [homepage na Internet]. [accessed 2017 Oct 16] Available from: http://assessment-module.yale.edu/im-palliative/visual-analogue-scale.

Published
2018-04-05
How to Cite
Costa e Silva, M., Azevedo, F., & Lisboa, C. (2018). Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities. Journal of the Portuguese Society of Dermatology and Venereology, 76(1), 9-24. https://doi.org/10.29021/spdv.76.1.835
Section
Continuous Medical Education