The chronic skin condition called hidradenitis suppurativa, or HS, is characterized by the formation of boils or painful bumps under the skin that can sometimes burst. It typically affects the groin and armpit areas. According to the Hidradenitis Suppurativa Foundation, between one and two percent of Americans suffer from HS, with African-American and mixed-race women being the most common victims.
Although the exact cause of HS is not yet known, the fact that the disease usually begins around puberty suggests that hormones may be involved. Since HS can run in family members of affected individuals, experts believe that heredity most likely plays a role in the disease. Studies also suggest that an excessive immune response may be the cause of HS.
What are the symptoms of hidradenitis suppurativa?
HS usually starts in the groin or armpits, where the hair is thick and coarse. People with HS may get breakouts that look like boils or pimples. These breakouts may eventually go away, but they may come back later in the same place.
“If these bumps keep coming back, especially in the same place, it could be hidradenitis suppurativa,” says Tiffany Mayo, MD, associate professor in the UAB Department of Dermatology. “I recommend seeing a medical professional for help if you think you have hidradenitis suppurativa. Tell them about your experiences and ask if it could be hidradenitis suppurativa.”
One of the first indicators of HS is the appearance of tender, deep nodules that look like cysts, boils, or pimples. People with HS may feel some discomfort in the area before the nodule develops. The nodules may enlarge and join together as HS worsens, creating tunnels under the skin. This can cause the nodules to swell with pus and become uncomfortable, which is known as an abscess. Blood and pus may drain from the abscesses if they burst. Tunnels and scarring can result from this recurring cycle of inflammation and repair. Some people see small, black pimples that look like blackheads in certain areas of the skin. Hidradenitis suppurativa flares.
People think that hidradenitis suppurativa is contagious or a result of poor hygiene because it can sometimes look like an infection, but that’s not true, according to Mayo. “Hidradenitis suppurativa is a disease that causes inflammation. It’s not an infection. It’s not contagious. Also, it doesn’t suggest poor personal hygiene.”
How is hidradenitis suppurativa diagnosed?
UAB dermatologists are trained to distinguish HS from other skin conditions, although HS can look like other skin conditions. A dermatologist may ask about a patient’s HS symptoms during an exam. To get more information that will help them make a diagnosis, they will talk with the patient and examine some of the bumps or nodules that have appeared.
How is hidradenitis suppurativa treated?
Dermatologists can create a treatment plan to manage some of the symptoms of hidradenitis suppurativa, such as minimizing flare-ups, healing wounds, reducing pain, and stopping the progression of the disease, even if there is no known cause. treatment of hidradenitis suppurativa.
“Dermatologists can help you choose the most appropriate treatment for your needs because they are familiar with hidradenitis suppurativa,” Mayo said.
Treatments may involve skin care techniques, such as using specific products to reduce inflammation related to HS, or pharmaceuticals, such as biologics, retinoids, antibiotics, or hormonal medications that can reduce pus and inflammation. Dermatologists may use in-office procedures, such as scaling (removing the skin covering an abscess so it can heal and seal the tunnel or nodule) or corticosteroid injections, laser hair removal, laser surgery, or ablation of HS lesions. Dermatologists may prioritize pain management or wound care. Dermatologists may also suggest therapy or support groups if HS has caused the patient anxiety or depression. This will help the patient feel less alone as they manage their disease. Clinical trials continue to provide HS patients with new and more effective treatments.
UAB researchers develop targeted intervention model
There is evidence to support the theory that HS is a complex inflammatory skin disease involving interactions between the immune system and the epithelium. UAB researchers discovered a targeted support model for high school students last year. The chromatin landscape of the inflammatory gene involved in Huntington's disease (HS) could be blocked by combining biologic therapy with specific drugs, according to a study published in the Proceedings of the National Academy of Sciences.
In this study, UAB researchers looked at HS epithelial cells to show that basal cells, which are found at the base of the epidermis, the outermost layer of the skin, have the ability to regulate their lineage and produce more keratinocytes, which are primarily responsible for protecting and repairing the skin.
According to this study, alterations in the skin microbiome, dysregulated immune response, and keratinocyte dysfunction are likely the causes of the onset and development of HS. Mohammad Athar, Ph.D., is a professor and vice chair of research in the UAB Department of Dermatology. However, Athar and his team, which included UAB Department of Dermatology research faculty members Lin Jin, Ph.D., and Chander Raman, Ph.D., studied HS skin cells to learn more about the underlying cause of this condition. They found that basal progenitor cells, which act as skin repair cells, dysregulate their lineage restriction and increase pathogenic keratinocyte clones, leading to increased skin cell growth and HS inflammation.
The research team identified two groups of keratinocytes that enhance immunological responses in individuals with HS and described altered transcriptional profiles in HS basal stem/progenitor cells. The genes S100A7/8/9 and KRT6, which induce IL1 and IL10 and regulate immunological and inflammatory responses to infection, are the ones that identify these populations. These signals attract specific populations of immune cells and advance the disease with hemoglobin S-specific cytokines and chemokines.
The study researchers proposed a database revealing different patterns of chromatin accessibility in HS skin compared to healthy skin. The ease with which other molecules in the body can interact with a person's DNA is called chromatin accessibility. The researchers discovered many active activators that significantly and specifically stimulate the production of inflammatory genes in HS. By combining innovative pharmacological drugs and biological therapies, the researchers were able to uncover a model for targeted intervention in HS patients by blocking the chromatin landscape of genes responsible for inflammation.
According to Athar, HS is a debilitating skin disease that reduces the quality of life of young patients, particularly black women. Our lab’s research aims to understand the root causes of gender bias and racial diversity. Ultimately, Dr. Lin Jin hopes to find a personalized treatment for this disease by creating innovative epigenetic techniques. The root cause of HS will be identified as distinct cell populations with distinct genetic signatures, which will serve as the basis for diagnosing the disease in each patient. We believe that our highly creative approach to finding a highly effective treatment for these patients will soon be successful.
