In a recent study, researchers aimed to characterize somatosensory profiles in patients with hidradenitis suppurativa (HS) at clinically affected and nonaffected areas compared with pain-free reference data. They noted that as pain is the most impactful symptom of HS, the characterization of sensory profiles may improve the understanding of pain mechanisms and therefore facilitate effective pain management strategies.
The cross-sectional study conducted at the Emory University Dermatology Clinic included 20 patients. Adult patients who had been diagnosed by a dermatologist with at least one painful HS lesion at the time of testing were enrolled between September 10, 2020, and March 21, 2022. All other patients with other diagnoses contributing to pain or neuropathy were excluded, with data analysis being conducted between March and April 2022.
The researchers performed quantitative sensitivity testing on HS lesions and control skin according to a standardized protocol. Quantitative sensory testing outcomes included innocuous thermal and mechanical sensitivity (cold, warmth, and light touch detection thresholds), noxious thermal and mechanical sensitivity (cold, heat, pinprick, and deep pressure pain thresholds and suprathreshold pinprick sensitivity), temporal summation of pinprick, paradoxical thermal sensations, and dynamic mechanical allodynia (pain upon light stroking of the skin). HS lesion sensitivity was then compared with sensitivity in a control location (the hand) and in pain-free controls using t tests.
Results of the study demonstrated that HS lesions were insensitive to innocuous cold and warmth, noxious heat, and light touch. They also showed significant hypersensitivity to deep-pressure pain and cutaneous pinprick. A subset of patients with HS also displayed changes in pain processing that are often seen in neuropathic and nociplastic pain conditions. This includes hypersensitivity to repetitive pinprick, paradoxical thermal sensations, and pain upon light stroking of the skin.
According to researchers, these findings suggest that HS involves local changes in the skin or its free nerve endings. This could lead to peripheral neuropathy and alterations in the transduction of innocuous and noxious thermal and mechanical stimuli.
Researchers also note that “For some patients, central nervous system changes in somatosensory processing may also occur, but confirmatory evidence is needed. Better understanding of neuropathic and nociplastic mechanisms in HS pain could lead to individually tailored treatments.”
The HS Clinician-Patient Summit is an engaging clinician-patient summit held in partnership with HS Connect and the HS Foundation and addresses patient concerns and clinician strategies for early diagnosis and assessment of HS symptoms, treatment plan design, and shared decision-making.
Timely Management of Moderate-to-Severe Hidradenitis Suppurativa: Addressing Barriers to Care for Patients in Need is an hour-long activity addressing the gaps in HS through clinical evidence-based discussion and case-based learning led by the foremost experts in the field.