| Abstract [eng] |
Introduction: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease that affects the intertriginous areas and results in painful nodules. Previous research has shown that there is an autoinflammatory component and that, particularly, metabolic syndrome (MetS) and androgens are increasing the severity. However, there are yet many factors that need clarification and study, therefore the objective of this study is to identify research gaps in a narrative manner. Methods: In this narrative review, these aspects, alongside progesterone, oestrogens, hyperthyroidism, and hypothyroidism, are explored and research gaps are identified. A total of 99 sources were collected and analysed. Results: Androgens and MetS were associated with increased HS severity, with intricate pathophysiological mechanisms. The exact mechanisms of androgens are yet to be elucidated. Progesterone and oestrogens might have protective effects, although more research is needed to confirm this. Hypo- and hyperthyroidism had the least research data, although there are pathophysiological mechanisms that could implicate them in the pathophysiology. Discussion: Androgens have recently been described to have novel pathways, the 11-oxygenated androgen pathway (C11-oxy) and the back-door pathway, which are yet to be studied and might explain how androgens can act in an inflammatory manner even when serum testosterone is normal. Progesterone and oestrogen need more studies, and the focus on progesterone might be on the progesterone receptor A and B, while the focus on oestrogen might be on stable environment. Hypo- and hyperthyroidism needs to be studied more, and no real conclusion can be drawn regarding the severity or pathophysiology. As for MetS, weight control has been shown to have protective effects, and novel glucagon-like peptide 1 receptor agonists (GLP-1 RA) have been identified to aid in this endeavour, alongside having cardioprotective and immunomodulatory effects. What remains to be identified is how to optimise treatment and for which patients it is indicated. Conclusion: Androgens and MetS are strongly implicated in the pathogenesis and worsening of HS, and the issue pertains to optimising treatment. Progesterone and oestrogens still need more research to elucidate their role in either an anti-inflammatory or a pro-inflammatory manner. Hyper- and hypothyroidism still need more research to determine whether there is a causal relationship between them and HS or not. |
