Pores in Pores: Defective Follicles May Lead to Hidradenitis Suppurativa

Morphological defects may lead to fragility of the sebofollicular junction, allowing leakage of keratin fragments that trigger an inflammatory response.

Hidradenitis suppurativa (HS) causes painful abscesses and chronic draining sinus tracts. Its purulent nature suggests an infectious etiology, but most isolated bacteria remain nonpathogenic, and systemic antibiotics fail to control the disease. What is the starting point? Is there an abnormality of follicles in apocrine gland–rich areas? A follicular abnormality is suggested by follicular hyperkeratosis seen in biopsy specimens and by dilated follicular pores seen clinically.

Investigators obtained specimens of HS-affected skin removed by wide excision from 20 patients. Histologic study focused on three specimens per patient of periodic acid Schiff (PAS) staining of basement membrane zones (BMZs): One from the center of a “lesion,” one from…

Reviewing Author

Mark V. Dahl, MD

Disclosures

Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics

Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics

Editorial boards UpToDate

Leadership positions in professional societiesNational Rosacea Society (Chairman, Medical Board)

Mark V. Dahl, MD

Disclosures

Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics

Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics

Editorial boards UpToDate

Leadership positions in professional societiesNational Rosacea Society (Chairman, Medical Board)