Could External Stress Factors Influence HS Lesion Distribution?

The Koebner phenomenon (KP) may help to explain the distribution of some hidradenitis suppurativa (HS) lesions, according to a recent study. The removal of external stress factors that could lead to KP should be implemented as part of HS treatment, especially in obese patients.

In order to determine if environmental factors including friction and pressure could play a role in HS, researchers examined data from 14 patients with typical HS and additional HS lesions in previously uninvolved areas exposed to mechanical stress.
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The participants were all obese with a mean BMI of 35.8, and all developed lesions at sites of friction that were clinically similar to HS.

“Mechanical stress factors or trauma play a role in obese patients with HS. It is suggested that these new induced lesions fit the concept of the KP. This phenomenon seems to occur in the so-called frictional furunculoid type of HS and may explain the unique distribution at certain localizations on the body of this follicular cutaneous eruption,” the researchers concluded.

“Removal in an early stage of HS of external stress factors that can lead to the KP should be part of the treatment, especially in obese patients.”

—Michael Potts

Reference:

Boer J. Should hidradenitis suppurativa be included in dermatoses showing Koebnerization? is it friction or fiction? [published online May 16, 2017]. Dermatology. doi: 10.1159/000472252.