HS is a chronic, infammatory, recurrent, debilitating skin disease (of the hair follicle) that usually presents after

puberty with painful, deep-seated, infamed lesions in the apocrine gland-bearing areas of the body, most
commonly the axillary, inguinal, and anogenital regions.
Epidemiology

Common disorder with a point prevalence of 1-4%

More common in females ( : = 2:1 to 5:1)

HS rarely develops before puberty or after menopause

The average age of onset is 23 years.

Genitofemoral lesions are more prevalent in women, whereas axillary involvement does not demonstrate a
gender predilection.
Etiology

Adnexal structures
HS was thought to represent a primary disorder of apocrine glands, and was also referred to as apocrinitis.

Genetic factors
A family history of HS may be elicited in 26% of patients. Several studies have not demonstrated HLA
associations.

Associated diseases
The coexistence of HS and Crohn disease, particularly with perianal involvement has been associated with a
more fulminant course

Hormones and androgens

The tendency of HS to develop at puberty or postpuberty suggests an androgen infuence.

Obesity
Obesity is unlikely to be a causal factor in HS but is often regarded as an exacerbating factor.

Bacterial infection
The role of bacterial infection in HS is unclear. It is believed that the pathogenic role is similar in acne. Bacterial
involvement is thought to occur secondarily. The bacteria can be found such as Staphylococcus aureus and
Streptococcus.

Smoking
The use of tobacco products is more common in HS patients than in healthy controls. It is postulated that
smoking affects polymorphonuclear cell chemotaxis.

Why hidradenitis supurative commonly develop after puberty?

-As we know, HS was thought to represent a primary disorder of apocrine gland, and was also referred to as
apocrinitis. In HS there are occlusion of the secretion of apocrine gland by keratin. apocrine sweat glands are found
in humans, largely in the regions of the axillae and perineum. They do not become functional until just before
puberty; thus, it is assumed that their development is associated with the hormonal changes at puberty, although
the exact hormones have not been identifed.
How obesity can cause hidradenitis supuratif?
- Obesity is unlikely to be a causal factor in HS but is often regarded as an exacerbating factor by increasing
shearing forces, occlusion, keratinocyte hydration, and maceration. Obesity may also exacerbate disease by
creating a state of androgen excess. Weight reduction is recommended for over-weight patients and may help to
control disease.