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Reviews in Endocrine and Metabolic Disorders
Published in: Reviews in Endocrine and Metabolic Disorders 3/2016

01-09-2016

Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder?

Authors: Ioannis Karagiannidis, Georgios Nikolakis, Robert Sabat, Christos C. Zouboulis

Published in: Reviews in Endocrine and Metabolic Disorders | Issue 3/2016

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Abstract

Hidradenitis suppurativa / acne inversa (HS) is a chronic inflammatory, debilitating skin disorder with a largely unknown etiology. However, many observations such as the typical onset of the disease after puberty, the female predominance, the pre-menstrual flare ups and the improvement during pregnancy suggest a contribution of endocrinological factors to the emergence of the disease. In addition, the reported efficacy of anti-androgen treatment on HS indicates a possible involvement of androgens in the pathogenesis. Furthermore, the common comorbidity with metabolic syndrome points to possible interactions between endocrinological and metabolic alterations in the development of HS. Taking into account the endocrine functions of the human skin, several studies investigated the effects of hormones and the behavior of the pilosebaceous unit in the skin of patients with HS. In this review we describe the current view on the hormonal dysregulation and metabolic syndrome and their role in HS.
Literature
1.
2.
Kurzen H, Kurokawa I, Jemec GBE, Emtestam L, Sellheyer K, Giamarellos-Bourboulis EJ, Nagy I, Bechara FG, Sartorius K, Lapins J, Krahl D, Altmeyer P, Revuz J, Zouboulis CC. What causes hidradenitis suppurativa? Exp Dermatol. 2008;17:455–72.CrossRefPubMed
3.
von der Werth JM, Williams HC. The natural history of hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2000;14:389–92.CrossRefPubMed
4.
5.
Harrison BJ, Read GF, Hughes LE. Endocrine basis for the clinical presentation of hidradenitis suppurativa. Br J Surg. 1988;75:972–5.CrossRefPubMed
6.
Mortimer PS, Dawber RP, Gales MA, Moore RA. Mediation of hidradenitis suppurativa by androgens. Br Med J (Clin Res Ed). 1986;292:245–8.CrossRef
7.
Harrison BJ, Kumar S, Read GF, Edwards CA, Scanlon MF, Hughes LE. Hidradenitis suppurativa: evidence for an endocrine abnormality. Br J Surg. 1985;72:1002–4.CrossRefPubMed
8.
Jemec GBE. The symptomatology of hidradenitis suppurativa in women. Br J Dermatol. 1988;119:345–50.CrossRefPubMed
9.
Brunsting HA. Hidradenitis suppurativa; abscess of the apocrine sweat glands: A study of the clinical and pathologic features, with a report of twenty-two cases and a review of the literature. Arch Dermatol Syphilol. 1939;39:108–20.CrossRef
10.
Scheinfeld NS. A case of dissecting cellulitis and a review of the literature. Dermatol Online J. 2003;9(1):8.PubMed
11.
12.
Barth JH, Layton AM, Cunliffe WJ. Endocrine factors in pre- and postmenopausal women with hidradenitis suppurativa. Br J Dermatol. 1996;134:1057–9.CrossRefPubMed
13.
14.
Barth JH, Kealey T. Androgen metabolism by isolated human axillary apocrine glands in hidradenitis suppurativa. Br J Dermatol. 1991;125:304–8.CrossRefPubMed
15.
Buimer MG, Wobbes T, Klinkenbijl JH, Reijnen MM, Blokx WA. Immunohistochemical analysis of steroid hormone receptors in hidradenitis suppurativa. Am J Dermatopathol. 2015;37:129–32.CrossRefPubMed
16.
Kraft JN, Searles GE. Hidradenitis suppurativa in 64 female patients: retrospective study comparing oral antibiotics and antiandrogen therapy. J Cutan Med Surg. 2007;11:125–31.CrossRefPubMed
17.
Goldsmith PC, Dowd PM. Successful therapy of the follicular occlusion triad in a young woman with high dose oral antiandrogens and minocycline. J R Soc Med. 1993;86:729–30.PubMedPubMedCentral
18.
Mortimer PS, Dawber RP, Gales MA, Moore RA. A double-blind controlled cross-over trial of cyproterone acetate in females with hidradenitis suppurativa. Br J Dermatol. 1986;115:263–8.CrossRefPubMed
19.
Stellon AJ, Wakeling M. Hidradenitis suppurativa associated with use of oral contraceptives. Br Med J. 1989;298:28–9.CrossRef
20.
Orfanos CE, Adler YD, Zouboulis CC. The SAHA syndrome. Horm Res. 2000;54:251–8.PubMed
21.
Camacho FM. SAHA syndrome: female androgenetic alopecia and hirsutism. Exp Dermatol. 1999;8:304–5.PubMed
22.
Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhasz I, Lapins J, Matusiak L, Prens EP, Revuz J, Schneider-Burrus S, Szepietowski JC, van der Zee HH, Jemec GBE. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29:619–44.CrossRefPubMed
23.
Farrell AM, Randall VA, Vafaee T, Dawber RP. Finasteride as a therapy for hidradenitis suppurativa. Br J Dermatol. 1999;141:1138–9.PubMed
24.
Randhawa HK, Hamilton J, Pope E. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents. JAMA Dermatol. 2013;149:732–5.CrossRefPubMed
25.
Joseph MA, Jayaseelan E, Ganapathi B, Stephen J. Hidradenitis suppurativa treated with finasteride. J Dermatolog Treat. 2005;16:75–8.CrossRefPubMed
26.
Lewis F, Messenger AG, Wales JKH. Hidradenitis suppurativa as a presenting feature of premature adrenarche. Br J Dermatol. 1993;129:447–8.CrossRefPubMed
27.
28.
Kagan RJ, Yakuboff KP, Warner P, Warden GD. Surgical treatment of hidradenitis suppurativa: A 10-year experience. Surgery. 2005;138:734–41.CrossRefPubMed
29.
Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014;28:1013–27.CrossRefPubMed
30.
31.
Kamp S, Fiehn AM, Stenderup K, Rosada C, Pakkenberg B, Kemp K, Dam TN, Jemec GBE. Hidradenitis suppurativa: a disease of the absent sebaceous gland? Sebaceous gland number and volume are significantly reduced in uninvolved hair follicles from patients with hidradenitis suppurativa. Br J Dermatol. 2011;164:1017–22.CrossRefPubMed
32.
Zouboulis CC. Sebaceous cells in monolayer culture. In Vitro Cell Dev Biol. 1992;28:699.
33.
Zouboulis CC. The human skin as a hormone target and an endocrine gland. Hormones (Athens). 2004;3:9–26.CrossRef
34.
35.
Zouboulis CC, Xia L, Akamatsu H, Seltmann H, Fritsch M, Hornemann S, et al. The human sebocyte culture model provides new insights into development and management of seborrhoea and acne. Dermatology. 1998;196:21–31.CrossRefPubMed
36.
Proksch E, Feingold KR, Elias PM. Epidermal HMG CoA reductase activity in essential fatty acid deficiency: barrier requirements rather than eicosanoid generation regulate cholesterol synthesis. J Invest Dermatol. 1992;99:216–20.CrossRefPubMed
37.
Cassidy DM, Lee CM, Laker MF, Kealey T. Lipogenesis in isolated human sebaceous glands. FEBS Lett. 1986;200:173–6.CrossRefPubMed
38.
Thiboutot D, Jabara S, McAllister JM, Sivarajah A, Gilliland K, Cong Z, Clawson G. Human skin is a steroidogenic tissue: steroidogenic enzymes and cofactors are expressed in epidermis, normal sebocytes, and an immortalized sebocyte cell line (SEB-1). J Invest Dermatol. 2003;120:905–14.CrossRefPubMed
39.
Haag M, Hamann T, Kulle AE, Riepe FG, Blatt T, Wenck H, Holterhus PM, Peirano RI. Age and skin site related differences in steroid metabolism in male skin point to a key role of sebocytes in cutaneous hormone metabolism. Dermatoendocrinol. 2012;4:58–64.CrossRefPubMedPubMedCentral
40.
Grino PB, Griffin JE, Wilson JD. Testosterone at high concentrations interacts with the human androgen receptor similarly to dihydrotestosterone. Endocrinology. 1990;126:1165–72.CrossRefPubMed
41.
Chen W, Zouboulis CC, Fritsch M, Blume-Peytavi U, Kodelja V, Goerdt S, Luu-The V, Orfanos CE. Evidence of heterogeneity and quantitative differences of the type 1 5alpha-reductase expression in cultured human skin cells–evidence of its presence in melanocytes. J Invest Dermatol. 1998;110:84–9.CrossRefPubMed
42.
Wolk K, Warszawska K, Hoeflich C, Witte E, Schneider-Burrus S, Witte K, Kunz S, Buss A, Roewert HJ, Krause M, Lukowsky A, Volk HD, Sterry W, Sabat R. Deficiency of IL-22 contributes to a chronic inflammatory disease: pathogenetic mechanisms in acne inversa. J Immunol. 2011;186:1228–39.CrossRefPubMed
43.
Sabat R, Chanwangpong A, Schneider-Burrus S, Metternich D, Kokolakis G, Kurek A, Philipp S, Uribe D, Wolk K, Sterry W. Increased prevalence of metabolic syndrome in patients with acne inversa. PLoS One. 2012;7:e31810.CrossRefPubMedPubMedCentral
44.
Executive summary of The Third Report of The National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486–97.CrossRef
45.
Tzellos T, Zouboulis CC, Gulliver W, Cohen AD, Wolkenstein P, Jemec GB. Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies. Br J Dermatol. 2015;173:1142–55.CrossRefPubMed
46.
Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. JAMA Dermatol. 2016;152:429–34.CrossRefPubMed
47.
Miller IM, Ellervik C, Vinding GR, Zarchi K, Ibler KS, Knudsen KM, Jemec GBE. Association of metabolic syndrome and hidradenitis suppurativa. JAMA Dermatol. 2014;150:1273–80.CrossRefPubMed
48.
Shalom G, Freud T, Harman-Boehm I, Polishchuk I, Cohen AD. Hidradenitis suppurativa and the metabolic syndrome: a comparative cross-sectional study of 3207 patients. Br J Dermatol. 2015;173:464–70.CrossRefPubMed
49.
Gold DA, Reeder VJ, Mahan MG, Hamzavi IH. The prevalence of metabolic syndrome in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2014;70:699–703.CrossRefPubMed
50.
Zabel BA, Ohyama T, Zuniga L, Kim JY, Johnston B, Allen SJ, Guido DG, Handel TM, Butcher EC. Chemokine-like receptor 1 expression by macrophages in vivo: regulation by TGF-beta and TLR ligands. Exp Hematol. 2006;34:1106–14.CrossRefPubMed
51.
Parolini S, Santoro A, Marcenaro E, Luini W, Massardi L, Facchetti F, Communi D, Parmentier M, Majorana A, Sironi M, Tabellini G, Moretta A, Sozzani S. The role of chemerin in the colocalization of NK and dendritic cell subsets into inflamed tissues. Blood. 2007;109:3625–32.CrossRefPubMed
52.
Kralisch S, Weise S, Sommer G, Lipfert J, Lossner U, Bluher M, Stumvoll M, Fasshauer M. Interleukin-1beta induces the novel adipokine chemerin in adipocytes in vitro. Regul Pept. 2009;154:102–6.CrossRefPubMed
53.
Sell H, Laurencikiene J, Taube A, Eckardt K, Cramer A, Horrighs A, Arner P, Eckel J. Chemerin is a novel adipocyte-derived factor inducing insulin resistance in primary human skeletal muscle cells. Diabetes. 2009;58:2731–40.CrossRefPubMedPubMedCentral
54.
55.
Arun B, Loffeld A. Long-standing hidradenitis suppurativa treated effectively with metformin. Clin Exp Dermatol. 2009;34:920–1.CrossRefPubMed
56.
Verdolini R, Clayton N, Smith A, Alwash N, Mannello B. Metformin for the treatment of hidradenitis suppurativa: a little help along the way. J Eur Acad Dermatol Venereol. 2013;27:1101–8.CrossRefPubMed
57.
Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). J Am Acad Dermatol. 2015;73(suppl 1):S52–4.CrossRefPubMed
58.
Brown SC, Kazzazi N, Lord PH. Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form. Br J Surg. 1986;73:978–80.CrossRefPubMed
59.
Edlich RF, Silloway KA, Rodeheaver GT, Cooper PH. Epidemiology, pathology, and treatment of axillary hidradenitis suppurativa. J Emerg Med. 1986;4:369–78.CrossRefPubMed
60.
Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, Poli F, Faye O, Bastuji-Garin S. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol. 2009;61:51–7.CrossRefPubMed
61.
Selva DM, Hogeveen KN, Innis SM, Hammond GL. Monosaccharide-induced lipogenesis regulates the human hepatic sex hormone-binding globulin gene. J Clin Invest. 2007;117:3979–87.PubMedPubMedCentral
62.
Napolitano M, Megna M, Monfrecola G. Insulin resistance and skin diseases. ScientificWorldJournal. 2015;2015:479,354.CrossRef
63.
Shlyankevich J, Chen AJ, Kim GE, Kimball AB. Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case–control analysis. J Am Acad Dermatol. 2014;71:1144–50.CrossRefPubMed
64.
Chalmers RJ, Ead RD, Beck MH, Dewis P, Anderson DC. Acne vulgaris and hidradenitis suppurativa as presenting features of acromegaly. Br Med J. 1983;287:1346–7.CrossRef
65.
Nickle SB, Peterson N, Peterson M. Updated physician’s guide to the off-label uses of oral isotretinoin. J Clin Aesthet Dermatol. 2014;7:22–34.PubMedPubMedCentral
66.
Boer J, Nazary M. Long-term results of acitretin therapy for hidradenitis suppurativa. Is acne inversa also a misnomer? Br J Dermatol. 2011;164:170–5.CrossRefPubMed
67.
Matusiak Ł, Bieniek A, Szepietowski JC. Acitretin treatment for hidradenitis suppurativa: a prospective series of 17 patients. Br J Dermatol. 2014;171:170–4.CrossRefPubMed
68.
Chow ET, Mortimer PS. Successful treatment of hidradenitis suppurativa and retroauricular acne with etretinate. Br J Dermatol. 1992;126:415.CrossRefPubMed
69.
Hogan DJ, Light MJ. Successful treatment of hidradenitis suppurativa with acitretin. J Am Acad Dermatol. 1988;19:355–6.CrossRefPubMed
70.
Scheman AJ. Nodulocystic acne and hidradenitis suppurativa treated with acitretin: a case report. Cutis. 2002;69:287–8.PubMed
71.
Happle R, van de Kerkhof PC, Traupe H. Retinoids in disorders of keratinization: their use in adults. Dermatologica. 1987;1:107–24.CrossRef
72.
Vahlquist A, Griffiths W. Retinoid therapy in hidradenitis suppurativa - report of a case. Retinoids Today Tom. 1990;18:28–30.
73.
74.
Verdolini R, Simonacci F, Menon S, Pavlou P, Mannello B. Alitretinoin: a useful agent in the treatment of hidradenitis suppurativa, especially in women of child-bearing age. G Ital Dermatol Venereol. 2015;150:155–62.PubMed
75.
Waldron JL, Ashby HL, Cornes MP, Bechervaise J, Razavi C, Thomas OL, Chugh S, Deshpande S, Ford C, Gama R. Vitamin D: a negative acute phase reactant. J Clin Pathol. 2013;66:620–2.CrossRefPubMed
76.
Kelly G, Sweeney CM, Fitzgerald R, O’Keane MP, Kilbane M, Lally A, Tobin AM, McKenna MJ, Kirby B. Vitamin D status in hidradenitis suppurativa. Br J Dermatol. 2014;170:1379–80.CrossRefPubMed
Metadata
Title
Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder?
Authors
Ioannis Karagiannidis
Georgios Nikolakis
Robert Sabat
Christos C. Zouboulis
Publication date
01-09-2016
Publisher
Springer US
Published in
Reviews in Endocrine and Metabolic Disorders / Issue 3/2016
Print ISSN: 1389-9155
Electronic ISSN: 1573-2606
DOI
https://doi.org/10.1007/s11154-016-9366-z

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