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Factors Related to Pathogenesis of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a disease of the follicle that results in painful lesions and abscesses on the skin, most often in the intertriginous areas of the body. HS occurs in both men and women, usually in young adulthood. However, women are three times more likely to suffer from the disease.

Genetics may play a role in the occurrence of HS, since approximately 40% of those diagnosed with the condition will also have a family member with symptoms of HS. Other contributing factors to HS include obesity and cigarette smoking. Overweight individuals are more likely to have hormonal issues, particularly androgen excess, that support the conditions for HS to appear. Obesity also creates strong mechanical stresses on areas prone to HS, including the skin under the arms, near the groin, and between the breasts and buttocks. This friction can exacerbate follicular occlusion, which is a major component of HS. While more research is needed about the association between smokers and HS, the prevailing thought is that nicotine might somehow advance follicular inflammation.

Stephanie Lehrhoff, MD