References

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/ms2024-351

medsovet-8533

Research Article

ЗАБОЛЕВАНИЯ КОЖИ

DERMAL DISEASES

Гнойный гидраденит – современные представления об этиологии, патогенезе и особенностях терапии

Hidradenitis suppurativa: latest insights on the etiology, pathogenesis and features of therapy

https://orcid.org/0000-0002-5885-4872

Свечникова

Е. В.

Svechnikova

E. V.

Свечникова Елена Владимировна, д.м.н., профессор кафедры кожных и венерических болезней, Российский биотехнологический университет (РОСБИОТЕХ); заведующая отделением дерматовенерологии и косметологии, Поликлиника №1 Управления делами Президента Российской Федерации

125080, Россия, Москва, Волоколамское шоссе, д. 11,

119002, Москва, пер. Сивцев Вражек, д. 26/28

Elena V. Svechnikova, Dr. Sci. (Med.), Professor of the Department of Skin and Venereal Diseases, Russian Biotechnological University; Chief Department of Dermatovenerology and Cosmetology, Polyclinic No. 1 of the Administrative Department of the Russian Federation;

11, Volokolamskoe Shosse, Moscow, 125080,

26/28, Sivtsev Vrazhek Lane, Moscow, 119002

elene-elene@bk.ru

https://orcid.org/0000-0001-5694-2847

Жуфина

С. Е.

Zhufina

S. Е.

Жуфина Светлана Евгеньевна, врач-дерматовенеролог отделения дерматовенерологии и косметологии

119002, Москва, пер. Сивцев Вражек, д. 26/28

Svetlana E. Zhufina, Dermatovenerologist Department of Dermatovenerology and Cosmetology

26/28, Sivtsev Vrazhek Lane, Moscow, 119002

svetlanagufina@gmail.com

Поликлиника №1 Управления делами Президента Российской Федерации; Российский биотехнологический университет (РОСБИОТЕХ)РоссияPolyclinic No. 1 of the Administrative Department of the Russian Federation; Russian Biotechnological UniversityRussian Federation

Поликлиника №1 Управления делами Президента Российской ФедерацииРоссияPolyclinic No. 1 of the Administrative Department of the Russian FederationRussian Federation

2024

14092024

0145764

2024

Свечникова Е.В., Жуфина С.Е.

Svechnikova E.V., Zhufina S.Е.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/8533

Гнойный гидраденит (ГГ) – хроническое рецидивирующее воспалительное заболевание кожи, характеризующееся появлением болезненных, рецидивирующих воспалительных узелков и абсцессов, которые склонны к самопроизвольному вскрытию, приводящему к образованию свищевых ходов и рубцеванию. Чаще всего поражения затрагивают апокринные железы в таких зонах, как подмышечные впадины, паховая и аногенитальная область. Патогенез болезни обусловлен фолликулярной окклюзией, возникающей в результате ряда биологических воспалительных процессов, включая фолликулярную эпителиальную гиперплазию и гиперкератинизацию. По данным различных стран заболеваемость составляет от 0,1 до 4%, чаще страдают ГГ женщины в возрасте от 18 до 29 лет, но также заболевание может возникнуть в период перименопаузы. Поражения кожи часто сопровождаются болью, которая может поставить под угрозу повседневную деятельность, наличие уродующих кожных поражений и зловонные гнойные выделения отрицательно влияют на личную и профессиональную жизнь пациентов. Острые и хронические боли существенно снижают качество жизни и являются фактором риска развития депрессии. В терапии данных пациентов играет важную роль междисциплинарный подход. Для лечения применяют системные и местные антибактериальные препараты в различных комбинациях и разработанных схемах, местные антисептики, нестероидные противовоспалительные препараты в качестве симптоматического лечения, системные и топические (внутриочаговое введение) глюкокортикостероиды, ретиноиды, физиотерапия, лазерная терапия, биологические препараты. Ингибиторы ФНО-альфа, ИЛ-17 выступают в качестве современной патогенетической терапии, показывающей на практике хорошие результаты. Изучение патогенеза и использование таргетной терапии являются приоритетными направлениями в исследовании данного заболевания. Пациенты с ГГ нуждаются в высокоэффективных, доступных и безопасных препаратах для поддержания стойкой ремиссии. В этой статье представлен обзор современных знаний о ГГ, включая диагностику, патогенез и лечение.

Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease characterized by the appearance of painful, recurrent inflammatory nodules and abscesses that are prone to spontaneous opening, leading to the formation of fistulous tracts and scarring. Most often, lesions affect the apocrine glands in areas such as the armpits, groin and anogenital area. The pathogenesis of the disease is due to follicular occlusion, which occurs as a result of a number of biological inflammatory processes, including follicular epithelial hyperplasia and hyperkeratinization. According to data from various countries, the incidence ranges from 0.1% to 4%; women aged 18 to 29 years are more likely to suffer from HS, but the disease can also occur during perimenopause. Skin lesions are often accompanied by pain that can compromise daily activities, the presence of disfiguring skin lesions and foul-smelling purulent discharge negatively impact the personal and professional lives of patients. Acute and chronic pain significantly reduces quality of life and is a risk factor for the development of depression. An interdisciplinary approach plays an important role in the treatment of these patients. For treatment, systemic and local antibacterial drugs are used in various combinations and developed regimens, local anesthetics and antiseptics, non-steroidal anti-inflammatory drugs as symptomatic treatment, systemic and topical (intralesional administration) glucocorticosteroids, retinoids, physiotherapy, laser therapy, and biological drugs. Inhibitors of TNF-alpha, IL-17 act as modern pathogenetic therapy, showing good results in practice. The study of pathogenesis and the use of targeted therapy are priority areas in the study of this disease. Patients with HS need highly effective, safe drugs to maintain stable remission. This article provides an overview of current knowledge of HS, including diagnosis, pathogenesis, and treatment.

гнойный гидраденитвоспалениегенно-инженерная биологическая терапияингибитор ИЛ-17А

hidradenitis suppurativainflammationgenetic engineering biological therapyIL-17A inhibitor

References1

Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76–90. https://doi.org/10.1016/j.jaad.2019.02.067.

Tchero H, Herlin C, Bekara F, Fluieraru S, Teot L. Hidradenitis Suppurativa: A Systematic Review and Meta-analysis of Therapeutic Interventions. Indian J Dermatol Venereol Leprol. 2019;85(3):248–257. https://doi.org/10.4103/ijdvl.IJDVL_69_18.

Chu C-B, Yang C-C, Tsai S-J. Hidradenitis Suppurativa: Disease Pathophysiology and Sex Hormones. Chin J Physiol. 2021;64(6):257–265. https://doi.org/10.4103/cjp.cjp_67_21.

Fernandez JM, Hendricks AJ, Thompson AM, Mata EM, Collier EK, Grogan TR et al Menses, pregnancy, delivery, and menopause in hidradenitis suppurativa: A patient survey. Int J Womens Dermatol. 2020;6(5):368–371. https://doi.org/10.1016/j.ijwd.2020.07.002.

Lyons AB, Peacock A, McKenzie SA, Jacobsen G, Naik HB, Shi VY et al Evaluation of hidradenitis suppurativa disease course during pregnancy and postpartum. JAMA Dermatol. 2020;156(6):681–685. https://doi.org/10.1001/jamadermatol.2020.0777.

Collier EK, Price KN, Grogan TR, Naik HB, Shi VY, Hsiao JL. Characterizing perimenstrual flares of hidradenitis suppurativa. Int J Womens Dermatol. 2020;6(5):372–376. https://doi.org/10.1016/j.ijwd.2020.09.002.

Kimball AB, Sundaram M, Banderas B, Foley C, Shields AL. Development and initial psychometric evaluation of patient-reported outcome questionnaires to evaluate the symptoms and impact of hidradenitis suppurativa. J Dermatolog Treat. 2018;29(2):152–164. https://doi.org/10.1080/09546634.2017.1341614.

Ring HC, Bay L, Kallenbach K, Miller IM, Prens E, Saunte DM et al. Normal skin microbiota is altered in pre-clinical hidradenitis suppurativa. Acta Derm Venereol. 2017;97(2):208–213. https://doi.org/10.2340/00015555-2503.

Ring HC, Bay L, Nilsson M, Kallenbach K, Miller IM, Saunte DM et al. Bacterial biofilm in chronic lesions of hidradenitis suppurativa. Br J Dermatol. 2017;176(4):993–1000. https://doi.org/10.1111/bjd.15007.

Scala E, Cacciapuoti S, Garzorz-Stark N, Megna M, Marasca C, Seiringer P et al. Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells. 2021;10(8):2094. https://doi.org/10.3390/cells10082094.

Garg A, Birabaharan M, Strunk A. Prevalence of type 2 diabetes mellitus among patients with hidradenitis suppurativa in the United States. J Am Acad Dermatol. 2018;79(1):71–76. https://doi.org/10.1016/j.jaad.2018.01.014.

Phan K, Charlton O, Smith S.D. Hidradenitis suppurativa and diabetes mellitus: Updated systematic review and adjusted meta-analysis. Clin Exp Dermatol. 2019;44(4):e126–e132. https://doi.org/10.1111/ced.13922.

Bui TL, Silva-Hirschberg C, Torres J, Armstrong AW. Hidradenitis suppurativa and diabetes mellitus: A systematic review and meta-analysis. J Am Acad Dermatol. 2018;78(2):395–402. https://doi.org/10.1016/j.jaad.2017.08.042.

Malara A, Hughes R, Jennings L, Sweeney CM, Lynch M, Awdeh F et al. Adipokines are dysregulated in patients with hidradenitis suppurativa. Br J Dermatol. 2018;178(3):792–793. https://doi.org/10.1111/bjd.15904.

Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan A. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol. 2022;61(11):1372–1379. https://doi.org/10.1111/ijd.16228.

Deilhes F, Rouquet RM, Gall Y, Aquilina C, Paul C, Konstantinou MP. Profile of smoking dependency in hidradenitis suppurativa patients and smoking cessation outcomes. J Eur Acad Dermatol Venereol. 2020;34(12):e790–e791. https://doi.org/10.1111/jdv.16494.

Bukvić Mokos Z, Miše J, Balić A, Marinović B. Understanding the Relationship between Smoking and Hidradenitis Suppurativa. Acta Dermatovenerol Croat. 2020;28(1):9–13. Available at: https://hrcak.srce.hr/file/358336.

Sivanand A, Gulliver WP, Josan CK, Alhusayen R, Fleming PJ. Weight Loss and Dietary Interventions for Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg. 2020;24(1):64–72. https://doi.org/10.1177/1203475419874412.

Marasca C, Balato A, Annunziata MC, Cacciapuoti S, Fabbrocini G. Insulin resistance, mTOR and hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2019;33(3):e106–e107. https://doi.org/10.1111/jdv.15271.

Frew JW. Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence. JAAD Int. 2020;1(1):62–72. https://doi.org/10.1016/j.jdin.2020.05.005.

Agnese ER, Tariche N, Sharma A, Gulati R. The Pathogenesis and Treatment of Hidradenitis Suppurativa. Cureus. 2023;15(11):e49390. https://doi.org/10.7759/cureus.49390.

Nguyen TV, Damiani G, Orenstein LA, Hamzavi I, Jemec GB. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol. 2021;35(1):50–61. https://doi.org/10.1111/jdv.16677.

Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 2020;82(5):1045–1058. https://doi.org/10.1016/j.jaad.2019.08.090.

Preda-Naumescu A, Ahmed HN, Mayo TT, Yusuf N. Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations. Int J Dermatol. 2021;60(11):е449–е458. https://doi.org/10.1111/ijd.15579.

Verma SS, Sharma K, Chhabra S. Pathogenesis of Hidradenitis Suppurativa: An Immunological Perspective. Indian J Dermatol. 2023;68(3):296–300. Available at: https://pubmed.ncbi.nlm.nih.gov/37529457/.

Mintoff D, Borg I, Pace NP. The clinical relevance of the microbiome in hidradenitis suppurativa: A systematic review. Vaccines (Basel). 2021;9(10):1076. https://doi.org/10.3390/vaccines9101076.

Del Duca E, Morelli P, Bennardo L, Di Raimondo C, Nisticò SP. Cytokine pathways and investigational target therapies in hidradenitis suppurativa. Int J Mol Sci. 2020;21(22):8436. https://doi.org/10.3390/ijms21228436.

Giamarellos-Bourboulis EJ. Neutrophil trafficking: The missing link in the pathogenesis of hidradenitis suppurativa. Br J Dermatol. 2021;185(1):15–16. https://doi.org/10.1111/bjd.20086.

Narla S, Azzam M, Townsend S, Vellaichamy G, Marzano AV, Alavi A et al. Identifying key components and therapeutic targets of the immune system in hidradenitis suppurativa with an emphasis on neutrophils. Br J Dermatol. 2021;184(6):1004–1013. https://doi.org/10.1111/bjd.19538.

Kashetsky N, Mufti A, Alabdulrazzaq S, Lytvyn Y, Sachdeva M, Rahat A, Yeung J. Treatment Outcomes of IL-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg. 2022;26(1):79–86. https://doi.org/10.1177/12034754211035667.

Markota Čagalj A, Marinović B, Bukvić Mokos Z. New and Emerging Targeted Therapies for Hidradenitis Suppurativa. Int J Mol Sci. 2022;23(7):3753. https://doi.org/10.3390/ijms23073753.

Hendricks AJ, Hsiao JL, Lowes MA, Shi VY. A Comparison of International Management Guidelines for Hidradenitis Suppurativa. Dermatology. 2021;237(1):81–96. https://doi.org/10.1159/000503605.

Мagalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M et al. Consensus on the treatment of hidradenitis suppurativa – Brazilian Society of Dermatology. An Bras Dermatol. 2019;94(2 Suppl 1):7–19. https://doi.org/10.1590/abd1806-4841.20198607.

Prussick L, Rothstein B, Joshipura D, Saraiya A, Turkowski Y, Abdat R et al. Open-Label, Investigator-Initiated, Single-Site Exploratory Trial Evaluating Secukinumab, an Anti-Interleukin-17A Monoclonal Antibody, for Patients with Moderate-to-Severe Hidradenitis Suppurativa. Br J Dermatol. 2019;181(3):609–611. https://doi.org/10.1111/bjd.17822.

Casseres RG, Prussick L, Zancanaro P, Rothstein B, Joshipura D, Saraiya A et al. Secukinumab in the Treatment of Moderate to Severe Hidradenitis Suppurativa: Results of an Open-Label Trial. J Am Acad Dermatol. 2020;82(6):1524–1526. https://doi.org/10.1016/j.jaad.2020.02.005.

Fauny M, Moulin D, D’Amico F, Netter P, Petitpain N, Arnone D et al. Paradoxical Gastrointestinal Effects of Interleukin-17 Blockers. Ann Rheum Dis. 2020;79(9):1132–1138. https://doi.org/10.1136/annrheumdis-2020-217927.

Ribero S, Ramondetta A, Fabbrocini G, Bettoli V, Potenza C, Chiricozzi A et al. Effectiveness of Secukinumab in the Treatment of Moderate-Severe Hidradenitis Suppurativa: Results from an Italian Multicentric Retrospective Study in a Real-Life Setting. J Eur Acad Dermatol Venereol. 2021;35(7):e441–e442. https://doi.org/10.1111/jdv.17178.

Marasca C, Megna M, Balato A, Balato N, Napolitano M, Fabbrocini G. Secukinumab and Hidradenitis Suppurativa: Friends or foes? JAAD Case Rep. 2019;5(2):184–187. https://doi.org/10.1016/j.jdcr.2018.12.002.

Sabat R, Gudjonsson JE, Brembilla NC, van Straalen KR, Wolk K. Biology of Interleukin-17 and Novel Therapies for Hidradenitis Suppurativa. J Interferon Cytokine Res. 2023;43(12):544–556. https://doi.org/10.1089/jir.2023.0105.

Kimball AB, Alavi A, Jemec GBE, Gottlieb A, Wei X, Wozniak MB et al. Secukinumab in moderate to severe hidradenitis suppurativa: primary endpoint analysis from the SUNSHINE and SUNRISE phase 3 trials. Skin. 2023;7(2):s129. https://doi.org/10.25251/skin.7.supp.129.

Wei X, Passera A, Muscianisi E, Uhlmann L, Chen L, Moreno SG et al. Assessing the validity and clinical meaningfulness of skin pain response (NRS30) assessed using numerical rating scale in hidradenitis suppurativa: Results from the SUNSHINE and SUNRISE trials. J Am Acad Dermatol. 2023;89(6):1285–1287. https://doi.org/10.1016/j.jaad.2023.07.1035.

The authors declare that there are no conflicts of interest present.