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Preliminary findings suggest hidradenitis suppurativa may be due to defective follicular support.
MedLine Citation:
PMID:  23320858     Owner:  NLM     Status:  Publisher    
BACKGROUND: The initial pathology in hidradenitis suppurativa / acne inversa (HS) 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: Operative specimens obtained from 20 patients diagnosed with HS were cut stepwise. Within each specimen focus was set on heavily involved HS regions (centre) and clinically uninvolved regions (border). All (n=65) were stained with Periodic Acid Schiff (PAS) to visualise the epithelial support structures (basement membrane zone, BMZ) of the FPSU, the sinus tracts (ST) and the interfollicular epidermis (BM). The intensity of BMZ PAS staining was graded 0-4+. RESULTS: Compared to axillary skin of human controls the sebofollicular junction in HS patients was found to be almost devoid of PAS positive material (0/1+) in both the border and centre lesions of HS, whereas STs and BMs showed uniformly 2-3+ positivity irrespective of inflammation present. The distribution of inflammatory cells around the sebofollicular junction occurred predominantly in areas of BMZ thinning CONCLUSIONS: BMZ PAS-positivity of clinically uninvolved FPSUs of HS patients appears to be wispy or missing entirely. 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, whilst inflammatory cells are scarce in areas where the PAS material is intact. It is hypothesised that the PAS gap identifies areas susceptible to leakage, trauma and rupture, leading to release of materials that trigger inflammatory mediators, and the seeding of the dermis with free-living stem cells generating benign but invasive epithelialised sinuses, spreading horizontally in the dermis.
F William Danby; G B E Jemec; W Ch Marsch; M von Laffert
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-16
Journal Detail:
Title:  The British journal of dermatology     Volume:  -     ISSN:  1365-2133     ISO Abbreviation:  Br. J. Dermatol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0004041     Medline TA:  Br J Dermatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©The Authors BJD © 2013 British Association of Dermatologists.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
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