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Сообщение от Surgeon04

Рецидивирующие гнойные заболевания кожи и подкожной клетчатки - одно из показаний для посещения иммунолога и исследования иммунограммы.

Обратимся к Pubmed.

"Although the precise cause of hidradenitis suppurativa is unclear, it is generally agreed that the initiating event is
occlusion of the apocrine or follicular ducts by keratinous plugging, leading to ductal dilatation and stasis in the glandular component. Bacteria enter the apocrine system via the hair follicles, become trapped beneath the keratinous plugs and subsequently multiply rapidly in the nutrient environment of the apocrine sweat. The glands may rupture, leading to extension of infection into adjacent glands and the surroundings area. Super-added bacterial infection with Streptococci, Staphylococci and other organisms may result in further local inflammation, tissue destruction and skin damage. The chronicity of the healing process results in extensive fibrosis and hypertrophic scarring of the overlying skin...

...As initial presentation of hidradenitis suppurativa is often at the time of puberty, several authors have
investigated the possible role of an endocrine abnorm¬ality. Harrison et al. reported a dysfunction of the hypothalamopituitary system in 13 women with pre¬menstrual exacerbation of hidradenitis suppurativa, but could not demonstrate a direct correlation. Mortimer also reported an exacerbation of symptoms during the premenstrual period in two-thirds of a group of 42 women and in these patients found a higher serum concentration of total testosterone than in a control group. Several authors support the concept of the condition being androgen-dependent in adult. Flare-up of hidradenitis was noted after hormone administration and in cases of increased androgen secretion associated with Cushing's syndrome. However, many women with hidradenitis suppurativa have normal androgen levels.
Several authors have noted the association of obesity and diabetes mellitus with hidradenitis suppurativa. Patients with these disorders are more prone to recurrent infections and may have problems in the healing of common inflammatory skin disorders.
It has also been suggested that hidradenitis may be related to reduced cutaneous levels of calprotectin, zinc or ascorbate. Also reported is a high incidence of atopy, eczema and drug allergies in hidradenitis sufferers.
There have been numerous reports of arthritis associated with hidradenitis, leading some authors to suspect an immunological aetiology. However, Dvorak reported normal immunological parameters in his group of patients.
Wiltz et al. reported an interesting yet unexplained association between cigarette smoking and perianal hidradenitis in 70% of the patients in their series and suggested that the disorder may be caused by the effect of nicotine on the exocrine glands. Initially, nicotine stimulates glandular secretion but eventually inhibits normal function, and hence possibly provides a mechan¬ism that prediposes to plugging of the ducts of the glands, leading to an inflammatory reaction.
There appears to be a genetic form of the disease with a single gene transmission. Jemec found that 18 of 70 patients (26%) with hidradenitis suppurativa had a positive family history, whereas of 96 control subjects chosen from hospital staff, matched for age and sex who themselves did not have hidradenitis suppurativa, only two relatives suffered from the disease."

R. W. Parks T. G. Parks
Pathogenesis, clinical features and management of hidradenitis suppurativa. - Ann R Coll Surg Engl 1997; 79: 83-89

"Hidradenitis suppurativa is a common disorder of the apo-crine gland-bearing follicular epithelium, affecting predomi¬nantly the axilla, perineum and groin, with a prevalence of up to 4•1%. Follicular hyperkeratosis, leading to occlu¬sion and follicular rupture, with inflammation and some¬times secondary infection, is thought to give rise to the clinical findings. It is more common in females than males, reported ratios varying from 2 : 1 to 5 : 1. Although it may develop in any skin bearing apocrine glands, genitofemoral lesions tend to be more common in females; axillary involve¬ment shows less of a gender predilection. It is a recurrent disorder with a variable clinical course; scarring, functional impairment and rarely malignant change may result. It usually develops in otherwise healthy post-pubertal individuals. A recent study reported a reduction in the per¬centage of natural killer cells over time and a lower mono-cyte response to bacterial components in patients with HS. A genetic predisposition is likely, 26% of patients having a family history; however, a specific genetic locus has yet to be determined. Risk factors include diabetes and smoking. The influence of hormones remains controversial. Obesity, although not causal, may aggravate HS, as may tight clothing, poor hygiene, deodorant and chemical depilation."

S. L. Johnston Clinical Immunology Review Series: An approach to the patient with recurrent superficial abscesses. - Clinical and Experimental Immunology. Accepted for publication 12 February 2008

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