Hidradenitis suppurativa: Pathogenesis, burden of disease and surgical strategies

The general aim of this thesis was to gain more knowledge about the cause, burden and surgical treatment of hidradenitis suppurativa (HS). HS is a chronic, debilitating inflammatory skin disease affecting the inguinal, axillary and gluteal regions. The disease usually develops after puberty, and the prevalence of HS in Europe is approximately 1% with a female preponderance of 3:1. HS is associated with smoking and being overweight To learn more about the cause of HS, we investigated the association of inflammatory bowel disease (IBD) and HS. The prevalence of HS in our IBD cohort was significantly higher than in the general population (6.8%–10.6% versus 1%–2%). We also identified two genes that are associated with HS and IBD. Furthermore, we compared the constitution of the hair follicles of HS skin with that of healthy controls. Our findings do not support the hypothesis that the hair follicles of HS patients are more fragile than those of healthy individuals. A lot of HS patients experience feelings of depression and shame. We investigated the psychological impact of HS and found that the quality of life and sexual health are severely impaired. Medical management of HS is aimed at suppression of inflammation. Different surgical methods have been described for removing the chronic, inflammatory tissue. We provided an overview on all surgical interventions in HS. Furthermore, we prospectively evaluated a new surgical technique (STEEP) in 16 HS patients