Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), UOC of Dermatology, University of Palermo, AOUP Paolo Giaccone, Via del Vespro 131, 90127, Palermo, PA, Italy.
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), UOC of Pathology, University of Palermo, AOUP Paolo Giaccone, Palermo, PA, Italy.
Wien Med Wochenschr. 2022 Apr;172(5-6):126-134. doi: 10.1007/s10354-021-00859-1. Epub 2021 Jun 29.
It is generally acknowledged that the first morphological change of hidradenitis suppurativa/acne inversa (HS/AI) consists of infundibular plugging of the folliculosebaceous apocrine apparatus, which is followed by acute and chronic inflammation, cysts with sinus formation, and fibrosis. Alternatively, it has been hypothesized that HS/AI is primarily a neutrophilic autoinflammatory disease and that the follicular plugging typical of this disease is secondary to inflammation.
To review the sequence of the changes that mark the disease development, we have performed a histopathologic study on the surgical material from a series of axillary and inguinal/perineal cases.
The histologic material from surgery on Hurley's second and third stage HS/AI was retrieved and collected with the patients' clinical images. The virtually uninvolved skin peripheral to the lesions was studied together with the main inflammatory foci on vertical sections stained with hematoxylin-eosin and immunohistochemistry for the follicle sheaths.
The fully developed lesions showed acute and chronic, suppurative and granulomatous inflammation overlapping fibrosis, cysts, and sinuses. Instead, the skin adjacent to florid inflammation showed plugging and dysmorphic alterations of the hair follicles associated with immunopathological changes of the inner root sheath keratin expression.
Our observations coincide with the classical pathological studies on the progressive changes of HS/AI; however, in our specimens, the virtually normal skin peripheral to the fully developed lesions show seemingly initial follicular changes that suggest development error. This finding would support the hypothesis of combined mutation-induced epithelial differentiative defects and immunological derangement in HS/AI pathogenesis.
人们普遍认为，化脓性汗腺炎/反向痤疮（HS/AI）的最初形态学变化包括毛囊皮脂腺顶泌汗腺的囊状堵塞，随后是急性和慢性炎症、囊肿伴窦道形成以及纤维化。或者，人们假设 HS/AI 主要是一种中性粒细胞自身炎症性疾病，而这种疾病的典型毛囊堵塞是炎症的继发表现。
为了回顾标志疾病发展的变化顺序，我们对一系列腋窝和腹股沟/会阴部位的手术标本进行了组织病理学研究。
检索并收集 Hurley 第二和第三阶段 HS/AI 手术的组织学材料，并结合患者的临床图像。对病变周围几乎未受累的皮肤与垂直切片上的主要炎症灶一起进行研究，这些切片用苏木精-伊红和免疫组织化学染色进行染色，以研究毛囊鞘。
完全发育的病变表现为急性和慢性、化脓性和肉芽肿性炎症重叠纤维化、囊肿和窦道。相反，与华丽炎症相邻的皮肤显示出堵塞和毛发的畸形改变，与内根鞘角蛋白表达的免疫病理学变化有关。
我们的观察结果与 HS/AI 进行性变化的经典病理学研究一致；然而，在我们的标本中，完全发育病变周围的几乎正常皮肤显示出似乎是最初的毛囊变化，提示发育错误。这一发现将支持 HS/AI 发病机制中联合突变诱导的上皮分化缺陷和免疫紊乱的假说。
