HIDRADENITIS SUPPURATIVA OR ACNE INVERSA - A CLINICOPATHOLOGICAL STUDY OF EARLY LESIONS

The pathogenesis of hidradenitis suppurativa (HS) has given rise to co ntroversy about whether the central pathogenetic feature is an apocrin e follicular occlusion (with subsequent bacterial infection) or it is a folliculitis with secondary involvement of both apocrine and eccrine sweat glands, Most previous concepts have focused on apocrine gland i nvolvement. A prospective study of 27 consecutive patients (39 biopsie s) was performed to investigate the immune-histological findings in ea rly, newly formed lesions. Most of them were examined within 3 days of clinical onset. Histopathological findings showed that the initial le sion is an occluding spongiform infundibulo-folliculitis. Furthermore, it was found that T cells predominated in the lymphocytic cell popula tion, A high percentage of HLA-DR positive lymphocytes was found in an inverse relationship with Leu-8 positive lymphocytes. Additionally, a sharp decline in the T-helper/suppressor ratio was observed after the initiation. These results reveal that the primary event in HS is an i nfundibulo-folliculitis with secondary involvement of apocrine glands. Acne inversa would be a more appropriate name.