Hidradenite supurativa: avaliação histopatológica e imuno-histoquímica do componente inflamatório e sua correlação com o prurido

Abstract

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of universal distribution, with great impact on quality of life and whose prevalence is estimated at 1 to 4% of the population. There are few studies about Pruritus in patients with HS. Follicular occlusion, followed by disruption of the follicular structure and a foreign body reaction are necessary conditions for the development of HS. Objective: To characterize the component cells of the dermal inflammatory infiltrate of hidradenitis suppurativa and its correlation with pruritus and the TH-17 pathway. Methods: Prospective, descriptive, uncontrolled study of surgical specimens from patients with HS Hurley II/III from the Dermatology outpatient clinics of Hospital Universitário Pedro Ernesto - UERJ, from July 2017 to July 2020. Results: Seventy-two surgical specimens from predominantly female (65.3%) and non-white (66.7%) patients were analyzed. Lesions predominated in the armpits (79.7%). Clinically, the patients had nodules (98.6%), fibrotic streaks (96.8%), fistula (94.3%), erythema (89.1%), exudation (77.9%), pain (72.2%), itching (68.3%), comedos (61.9%), bad odor (50.9%) and hyperhidrosis (32.2%). Scars were observed in 68.4% of the patients. The histopathological analysis showed dermal inflammatory infiltrate in 90.3%, predominantly mononuclear (92.3%) with lymphocytes (100%), plasmacytes (100%), histiocytes (98.5%), neutrophils (75.4%) and eosinophils (32.3%). Mast cells and Langerhans cells were observed in all samples respectively between 6-68 cells/mm² and 8-58 cells/mm². IL-17 expression was observed in 97% of the samples. The inflammatory infiltrate exhibited a superficial and deep perivascular pattern (96.9%) and perifollicular pattern (88.9%), surrounding the apocrine glands in only 14.1% of the cases. Granulation tissue was present in 69.2%, fistulas in 52.7% and scarring in 100% of the samples. Conclusions: The histopathological study reinforces the concept that the pathophysiology is anchored in follicular alterations and not in apocrine glands, with the presence of comedones, hyperkeratosis and follicle dilation as primary events; The inflammatory process is mixed, with the participation of lymphocytes, neutrophils, plasmocytes, eosinophils and histiocytes; Mast cells and Langerhans cells are also present in increased numbers in the lesions of HS patients; Pruritus had an increased prevalence in relation to the general population, however, none of the analyzed histopathological characteristics correlated with it with statistical significance.