THE PATHOGENESIS OF HIDRADENITIS SUPPURATIVA - A CLOSER LOOK AT APOCRINE AND APOECCRINE GLANDS

We undertook a retrospective pathological study of 118 skin resection specimens from 101 patients with hidradenitis suppurativa. Follicular occlusion was identified in all the specimens, regardless of disease d uration (1 month to 18 years), but was not noted in the axillary and i nguinal. skin of controls. We therefore regard follicular occlusion as an early and important feature in the pathogenesis of the disease. Th e presence of apoeccrine glands in axillary skin provided an in vivo m odel to directly observe the effects of follicular occlusion on follic le inflammation and apocrine gland destruction, In the majority of cas es, active folliculitis was associated with apocrinitis and apocrine d estruction, whereas apoeccrine glands, which drain directly on to the epidermal surface, appeared intact and non-inflamed. These observation s provide direct evidence in an in vive model that follicular occlusio n by keratinous material, with subsequent active folliculitis and seco ndary destruction of the skin adnexae and subcutis, occur as an integr al step in the pathogenesis of hidradenitis suppurativa.