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April 8, 2020

Chronic Pain in Hidradenitis Suppurativa Explained Through the Process of Central Sensitization

Author Affiliations
  • 1Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
JAMA Dermatol. 2020;156(6):615-616. doi:10.1001/jamadermatol.2020.0225

Hidradenitis suppurativa (HS) affects up to 4% of the population worldwide and is characterized by chronic, recurrent inflammatory nodules and abscesses, leading to sinus tract formation and scarring. The local pain that patients experience during a flare is often severe and debilitating. Therefore, pain has been incorporated as one of the domains in the newly developed core outcome set for HS.1 However, clinical experience tells us that the magnitude and the overwhelming character of the pain reported by patients does not necessarily correlate with objective disease severity. Moreover, in a proportion of patients, chronic, widespread pain develops and sometimes persists when inflammation has subsided. In addition, long-term opioid use is an increasing problem among patients with HS.2 In this Viewpoint, I theorize how recurrent inflammation in HS could alter pain perception by triggering a process known as central sensitization, leading to the chronic, discrepant, and widespread pain experienced by some patients with HS.

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