Why does hidradenitis suppurativa itch

Semiquantitative scores for histological markers of pruritus in three types of hidradenitis suppurativa lesions. Two histological pruritus markers in hidradenitis suppurativa lesional skin. For the first time, this explorative study evaluated the prevalence and clinical characteristics of pruritus in a well-defined cohort of HS patients. The overall mean intensity of itch in this study NRS score 3. In addition, the mean modified 5-D itch score of Moreover, sleep and ADL were negatively impacted by pruritus in more than half of the patients.

Pruritus is a multidimensional phenomenon and is thought to signal danger from various environmental factors or physiological abnormalities. Therefore, it frequently accompanies various inflammatory skin conditions, including atopic dermatitis, psoriasis, chronic urticaria, and burn wound healing [ 23 ].

To date, the etiology of pruritus in skin diseases is only partially understood. A possible explanation for itching in HS patients is the presence of tryptase-positive mast cells, which were found to be increased in all stages of the disease, including perilesional skin [ 24 ].

Increased serum levels of immunoglobulin Ig E have recently been reported in patients with HS. The latter, in combination with a dense infiltration of mast cells in HS, could trigger degranulation of these cells, releasing histamine and other mediators, such as proteases, causing pruritus [ 25 ]. In addition, we found an influx of eosinophilic granulocytes and the presence of a perineural infiltrate when nerve fibers were present in the majority of prototypic HS lesions. An important phenomenon supporting the hypothesis of neurogenic inflammation is the finding of an abnormal innervation of the skin in psoriasis [ 26 ].

As demonstrated in cutaneous T-cell lymphoma, interleukin IL may play a role by exerting indirect effects on sensory nerves through keratinocytes to transmit itch signals [ 27 ]. However, itch in HS patients could also result from a small fiber neuropathy due to scar formation in the course of HS. Recurrent and chronic inflammation will destroy dermal nerves and subsequently enhance nerve regeneration and neovascularization when inflammation has subsided.

This type of neuropathic itch coincides with pain and may be caused by a disproportionate number of regenerating, unmyelinated C nerve fibers within HS lesions [ 28 ]. The major strength of this explorative cross-sectional study is the recruitment of a relatively large number of physician-verified HS patients. As the occurrence of itch at a specific point in time is susceptible to confounders such as mental distress, use of systemic medication, and comorbidities [ 29 ], a comparator group and quality-of-life measurements, e.

Another strength is screening for common systemic causes of chronic recurrent itch that could interfere with the occurrence of HS-related itch. In addition, histopathological evaluation of two important skin-related mediators of pruritus have been performed, although the evaluation lacks information relating to the associated presence of pruritus.

For future analysis, it would be interesting to evaluate specific itch-related biomarkers in the serum or skin lesions, such as eosinophilic granulocytes, thymus and activation-regulated chemokine TARC , IL-2, IL, and substance P. A limitation of this study could be the use of a non-validated, HS-modified 5-D itch scale.

From a clinical point of view, the alteration of the distribution section was not expected to influence scoring as HS patients rarely have notable itch in distal, unaffected body sites such as the hands and feet. Moreover, the body areas mentioned in the distribution domain of the adapted scale are more specific to HS-related itch electronic supplementary material 1.

The modified 5-D itch scale, which could be validated for this application in future research, could therefore be a specialized and very useful tool for analysing pruritus in HS patients. Pruritus is a frequent but underreported aspect of HS.

Therefore, assessment of pruritus in both daily practice and clinical research settings, e. No sources of funding were used to assist in the preparation of this article. Allard R. Vossen, Annelien Schoenmakers, Kelsey R. Prens, Hessel H. Electronic supplementary material. National Center for Biotechnology Information , U. American Journal of Clinical Dermatology. Am J Clin Dermatol. Published online Apr Vossen , Annelien Schoenmakers , Kelsey R.

Prens , and Hessel H. Kelsey R. Errol P. Hessel H. Author information Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC. Abstract Background Pruritus is still a forgotten aspect of hidradenitis suppurativa HS and, to date, has never been adequately studied.

Objective The aim of this study was to determine the prevalence, and explore the characteristics, of pruritus in a well-defined cohort of HS patients. Setting An academic hospital-based cross-sectional study in The Netherlands. Results The prevalence rate of pruritus in HS patients was Conclusion Pruritus is a frequent but underreported symptom in patients with HS.

Electronic supplementary material The online version of this article doi Key Points Pruritus or itch is a frequent and bothersome symptom in hidradenitis suppurativa HS. The presence of eosinophilic granulocytes and a perineural infiltrate in lesional skin might explain the reason for pruritus in HS. Open in a separate window. Introduction Hidradenitis suppurativa HS , also known as acne inversa, is a chronic, recurrent, inflammatory skin disease that mostly develops after puberty and predominantly occurs in women, with a female-to-male ratio of [ 1 , 2 ].

Histological Analysis Histopathological analysis was performed on 24 random HS skin samples including eight perilesional skin samples, and six early and ten chronic lesions in order to evaluate potential skin-related mediators of pruritus.

Surgery is the best treatment for hidradenitis suppurativa. There is no sure way of stopping flare-ups. For some people, shaving or using deodorant irritates their skin.

Try not to wear tight clothing around the affected areas and avoid hot, humid climates. A warm bath, antibacterial soap, or antiseptic medicine to stop infection may help. Staying healthy, exercising, and getting enough sleep may help. If you are overweight, losing weight may help you feel better. Avoiding stress also helps some people. Already a member or subscriber? Log in. Interested in AAFP membership?

Learn more. This handout is provided to you by your family doctor and the American Academy of Family Physicians. This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Some people develop one or more of the following:.

Depression: Medical studies have found that people who have HS tend to develop depression more often than people who do not have HS. Pain: The deep lumps and tunnels that develop beneath the skin can be painful. Some people need prescription-strength painkillers to cope. Scars that restrict movement: As the body produces more and more scar tissue, the scars can thicken. Some scars become so thick that they limit how far you can move an arm, leg, or other part of your body.

Skin cancer: Some people with HS have an increased risk of developing a type of skin cancer called squamous cell carcinoma SCC. While men are most likely to get skin cancer, they have less risk of developing HS. J Am Acad Dermatol ; References Alikhan A, Sayed C, et al. Garg A, Neuren E, et al. Lee EY, Alhusayen R, et al. Narla S, Price KN, et al. Online ahead of print. Scheinfeld N. Area of skin feels uncomfortable Before you notice a lump in your skin, you may feel some discomfort. Tender, deep nodule s appears The first sign of HS is often a painful spot that looks like a deep pimple, acne cyst, or boil.

Nodules grow and start to join together As HS progresses, you see more lumps that may look like acne or boils. Large, painful abscess breaks open When an abscess breaks open, blood and pus spill out. Blackhead-like spots In the advanced stages, some people see small black bumps that look like blackheads. Abscesses heal slowly if at all and return; scars form The repetitive healing and reopening eventually cause tunnels to form beneath the skin and permanent scars.