Hidradenitis suppurativa: latest insights on the etiology, pathogenesis and features of therapy

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease characterized by the appearance of painful, recurrent inflammatory nodules and abscesses that are prone to spontaneous opening, leading to the formation of fistulous tracts and scarring. Most often, lesions affect the apocrine glands in areas such as the armpits, groin and anogenital area. The pathogenesis of the disease is due to follicular occlusion, which occurs as a result of a number of biological inflammatory processes, including follicular epithelial hyperplasia and hyperkeratinization. According to data from various countries, the incidence ranges from 0.1% to 4%; women aged 18 to 29 years are more likely to suffer from HS, but the disease can also occur during perimenopause. Skin lesions are often accompanied by pain that can compromise daily activities, the presence of disfiguring skin lesions and foul-smelling purulent discharge negatively impact the personal and professional lives of patients. Acute and chronic pain significantly reduces quality of life and is a risk factor for the development of depression. An interdisciplinary approach plays an important role in the treatment of these patients. For treatment, systemic and local antibacterial drugs are used in various combinations and developed regimens, local anesthetics and antiseptics, non-steroidal anti-inflammatory drugs as symptomatic treatment, systemic and topical (intralesional administration) glucocorticosteroids, retinoids, physiotherapy, laser therapy, and biological drugs. Inhibitors of TNF-alpha, IL-17 act as modern pathogenetic therapy, showing good results in practice. The study of pathogenesis and the use of targeted therapy are priority areas in the study of this disease. Patients with HS need highly effective, safe drugs to maintain stable remission. This article provides an overview of current knowledge of HS, including diagnosis, pathogenesis, and treatment.