Established Hidradenitis Suppurativa Fig 44ae

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Biopsy samples from established HS lesions show sinus tracts with marked suppuration and frank abscess formation. The sinuses are lined by stratified epithelium and are surrounded by fibrosis and inflammation. The squamous epithelium extends from the associated follicular epithelium. The inflamed sinus tracts frequently contain desquamated keratin and hair shafts within the dense fibrosis [6]. Within the adjacent connective tissue there is frequently a dense chronic inflammatory infiltrate, which contains histiocytes and giant cells that may be related to keratin fragments. Granulation tissue with inflammatory cells and occasional foreign body giant cells is present in 25% of biopsy specimens [13]. Apocrine glands are generally absent in the affected area but may appear quite normal in adjacent tissue. Extensive fibrosis is frequently seen as a late result in the disease course [14].

Hence it would appear that the involvement of the apocrine as well as eccrine glands represents a secondary phenomenon in HS and results from the inflammatory problem in deep structures.

Inflammation Apocrine Glands

Fig. 4.4 a-e. Histological changes in established HS. a Chronic folliculitis - dense lymphocytic infiltrate around hair follicle. b (i) Acute and chronic inflammatory cells around apocrine glands - low power. (ii) Acute and chronic inflammatory cells around apocrine glands - high power. c Pus in follicle. d Sinus tract formation. e Scarring around hair follicle

Fig. 4.4 a-e. Histological changes in established HS. a Chronic folliculitis - dense lymphocytic infiltrate around hair follicle. b (i) Acute and chronic inflammatory cells around apocrine glands - low power. (ii) Acute and chronic inflammatory cells around apocrine glands - high power. c Pus in follicle. d Sinus tract formation. e Scarring around hair follicle

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