H15 Inflammation of the hair follicle: multiple eponyms!

Abstract Hidradenitis suppurativa (HS) had several different names in the past due to the bewildering history of conflicting bodies of knowledge and pathogenesis. In 1833, it was referred to as Velpeau disease, named after Alfred-Armand-Louis-Marie Velpeau, a French anatomist and surgeon, who was the first person who noted an unusual inflammatory process of the sebaceous follicle. He first described a ‘phlegmon tubériforme’ (tuberiform phlegmon) of the axilla, characterized by superficial abscess formation and often resulting in pain and suppuration. Velpeau then discovered painful induration and tumours, as a similar clinic aspect of HS, naming it ‘phlegmon érysipélateux’ (erysipelas phlegmon). In 1864, Verneuil renamed the disease to hidrosadénite phlegmoneuse, the French term for ‘hidradenitis suppurativa’, and defines it as a condition caused by inflammation of the sweat glands (hidradenitis) with pus collection (suppurativa). Later, Aristide Auguste Stanislas Verneuil, a French surgeon with special interest in skin and sudoral (sweat gland) tumours, found Velpeau’s discovery. He conducted the first clinical studies regarding this inflammatory condition from 1854 to 1865 and recognized that it was a disorder of sweat glands, earning it the name of Verneuil disease. In 1891, ‘acnitis’ and ‘folliclis’ were new terms introduced to describe HS as part of folliculitis, by French physician Barthélémy. However, these were soon rejected by French dermatologist William Auguste Dubreuilh, in favour of ‘hydrosadenitis’. In 1956, Pillsbury came up with the term ‘follicular occlusion triad’ as a group disorder consisting of HS, acne conglobata and dissecting cellulitis of the scalp. This decision was made on common features of follicular hyperkeratinization, with keratin retention complicated with bacterial infection in these conditions. Nineteen years later in 1975, Plewig and Kligman added pilonidal sinus to the follicular occlusion triad and introduced the new term ‘acne tetrad’. Histopathologically, all four entities are identical, with evidence of follicular occlusion causing inflammation of sweat glands. Given the inverse localizations of HS compared with the acne tetrad, Plewig suggested the term ‘acne inversa’ instead in 1989. In 2005, American dermatologists Sellheyer and Krahl observed histopathological evidence of hair follicle occlusion and noted clinical and therapeutic similarities to acne. They insisted on abandoning the name ‘HS’, replacing it with ‘acne inversa’. However, adversaries of the name ‘acne inversa’ contended that more research should be conducted, as histology alone does not define dermatology. HS is currently the recognized name of this disease, as agreement on its terminology has yet to be reached, despite centuries of research.