Verneuil's Disease: New Aspects of Pathogenesis
Purulent hidradenitis (also known as Verneuil's disease, or acne inversa) is a chronic recurrent skin and skin appendages disease, which usually manifests as very painful inflammatory nodes, abscesses, draining fistulas and hypertrophic scars. The inflammatory process in Verneuil's disease often affects intertriginous localizations with predominant involvement of axillary and inguinal areas, less often - back of the neck, scalp, inner thighs and submammary area. Much more often this disease occurs in genetically predisposed smoking women with obesity, and its overall incidence reaches 4%. Despite the fact that the disease occurs in limited areas and can be successfully hidden by patients, the quality of life in patients with purulent hidradenitis is significantly reduced as a result of the continuous and recurrent endurance of this disease. The etiology of purulent hidradenitis is still not completely clear, but there are several theories explaining the pathogenesis of the disease. The previously widespread theory of the infectious cause of this disease is currently not relevant due to the establishment of a pathogenetic mechanism. Currently, the cause of the disease is a violation of transmission of intracellular and intercellular signals in the apocrine gland and hair follicles, which leads to uncontrolled proliferation of keratinocytes in the terminal part of the hair follicle and to further damage of morphological structures then turning into septic inflammation. In current studies, the main mechanism of disease development is a dysregulation of skin immunity with involving of many proinflammatory mediators - DAMPs associated with T-helper-17 activation, as well as the Notch signal transduction pathway in the cell, normally regulating the differentiation of keratinocytes.