Early Lesions Fig 43ad

Follicular hyperkeratosis with plugging and dilatation of the hair follicle is seen as an early event in HS. The follicular epithelium may proliferate or may be destroyed. Inflammation is frequently not apparent in early lesions but peri-folliculitis will ensue and the inflammatory infiltrate embraces neutrophils, lymphocytes and histiocytes. Early lesions may show acute inflammation involving the apocrine gland and duct but this is not always apparent and would appear to be a rare primary event [7]. In a study of 36 patients apocrinitis was present in only 5% [11].

Rupture of the follicle spills its contents, including keratin and bacteria, into the surrounding dermis [12].

What Vomeronasal Lesion
Fig. 4.3 a-d. Early lesions in hidradenitis suppurativa. a Acute HS - lower power. b Follicular plugging. c Folliculitis - dense collection of neutrophils around hair follicle. d Acute folliculitis in HS

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