HS: No Medical Consensus of the Cause

[asterroc]

Today instead of cleaning or doing errands, I ended up researching whether there is a concensus in the medical community of what causes hidradenitis suppurativa. I did this to settle in my head a debate that continues on the Yahoo group I follow on it. My posting regarding it is below for my reference, or in case you're curious.

We seem to always be disagreeing about what what we think causes HS, bacteria, autoimmune, or something else. I've also heard different opinions about what the medical establishment's consensus is about it. So I decided to take a look for myself.

For my mini-study, I used PubMed, a database/search engine of peer-reviewed biomedical journals, that is, the official papers that doctors and medical researchers write. It is maintained by the US National Library of Medicine and the US National Institute of Health, so I felt it was a legitmate source to get a list of papers, a list which would include all the papers on HS and not just those supporting one side or the other.

PubMed can be accessed at the URL http://www.ncbi.nlm.nih.gov/ - I picked to Search PubMed, for the search string hidradenitis suppurativa. This returned 452 hits, and I looked at the first 40 of them. I read the abstracts of all the 40 (one turned out to be about something else, a false hit) and I also accessed the whole text of the paper (when free) and read the intro and conclusion sections. These papers were all published in 2005-2006 and thus represent current opinions, rather than being outdated.

For the 39 relevant papers, with more than 200 patients numbered in total, I created an Excel spreadsheet with info on what the article said about the causes and how they treated it. In sum, I found the following.

* 14 treated the symptoms with surgery but did not give a root cause of the disease
* 27 papers gave no cause or had inconclusive results (including the 14 surgery papers listed above)
* 7 treated HS as an autoimmune disease (e.g., remicade/infliximab, ciclosporin)
* 2 treated HS as a bacterial infection
* 2 found a genetic or hereditary component (one even suggesting which genomes)
* 1 used antiandrogen therapy
* 1 referred to it as a disease of the hair follicles (but provided no evidence)

In addition 5 papers found that people with severe cases were more prone to cancer, and 2 papers had patients die of HS complications (one patient from cancer, second paper said there were deaths from surgery/sepsis in perianal cases but did not number the patients).

My conclusions are as follows.

1) The medical establishment leans towards surgery as a treatment for HS in extreme cases.
2) There is no discussion of treatment in mild cases, nor of prevention.
3) There is no consensus on the actual cause of HS.