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Lee H, Patel K, Singam V, Rastogi S, Silverberg J. Associations of cutaneous and extracutaneous infections with hidradenitis suppurativa in U.S. children and adults. Br J Dermatol 2019; 182:327-334. [DOI: 10.1111/bjd.18093] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2019] [Indexed: 12/29/2022]
Affiliation(s)
- H.H. Lee
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - K.R. Patel
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - V. Singam
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - S. Rastogi
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
| | - J.I. Silverberg
- Department of Dermatology Suite 1600, 676 N St Clair St, Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
- Department of Dermatology, Preventive Medicine and Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL U.S.A
- Northwestern Medicine Multidisciplinary Eczema Center Chicago IL U.S.A
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52
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Scala E, Di Caprio R, Cacciapuoti S, Caiazzo G, Fusco A, Tortorella E, Fabbrocini G, Balato A. A new T helper 17 cytokine in hidradenitis suppurativa: antimicrobial and proinflammatory role of interleukin-26. Br J Dermatol 2019; 181:1038-1045. [PMID: 30829398 DOI: 10.1111/bjd.17854] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Interleukin (IL)-26 is a signature T helper 17 cytokine described as a proinflammatory and antimicrobial mediator. So far, IL-26 has been reported in several immune-mediated inflammatory diseases, but its involvement in inflammatory skin disorders is poorly known. OBJECTIVES To investigate the role of IL-26 in hidradenitis suppurativa (HS), through its involvement in antimicrobial activity. METHODS IL-26 was assessed in patients with HS through gene expression and protein analysis at skin and circulating levels. Ex vivo HS organ skin cultures, together with IL-26 antibody treatment, were performed to determine the IL-26 activity. Peripheral blood mononuclear cells (PBMCs) from patients with HS and healthy controls were either silenced or not with IL-26 small interfering (si)RNA in order to measure its antimicrobial, cytotoxic and phagocytic activities against Staphylococcus aureus. RESULTS Firstly, we observed that IL-26 is able to modulate the proinflammatory response at the immune cell level. IL-26 was increased in the plasma of patients with HS compared with healthy controls. Subsequently, we explored the bactericidal, cytotoxic and phagocytic activities of PBMCs against S. aureus in patients with HS and healthy controls. These activities were lower in patients with HS than in controls. Remarkably, the killing activities were reduced when healthy control PBMCs were transfected with IL-26 siRNA. However, the transfection did not affect the killing activity of HS PBMCs, supporting the idea that IL-26 lacks efficacy in HS. CONCLUSIONS Our findings suggest that infection susceptibility in HS might be related to IL-26. Although the role of bacteria remains controversial in HS, this paper supports that there is a defect of antimicrobial response in these patients. What's already known about this topic? Interleukin (IL)-26 is a T helper 17 cytokine described as an antimicrobial and proinflammatory mediator. IL-26 has been reported in immune-mediated inflammatory diseases, but its involvement in inflammatory skin disorders remains unclear. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by deficiency of IL-20 and IL-22 (a close homologue of IL-26), which causes antimicrobial peptide pauperization leading to severe and recurrent skin infections. What does this study add? IL-26 plasma levels are higher in patients with HS than in healthy control individuals. The antimicrobial activity of IL-26 might be ineffective in patients with HS. What is the translational message? Cutaneous antimicrobial incompetence in HS could be related to IL-26.
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Affiliation(s)
- E Scala
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - R Di Caprio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - S Cacciapuoti
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - G Caiazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - A Fusco
- Department of Experimental Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - E Tortorella
- Institute of Protein Biochemistry, National Research Council, Naples, Italy
| | - G Fabbrocini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - A Balato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
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Duchatelet S, Join-Lambert O, Delage M, Miskinyte S, Guet-Revillet H, Lam T, Coignard-Biehler H, Ungeheuer MN, Chatenoud L, Lortholary O, Nassif X, Hovnanian A, Nassif AS. Remission of chronic acne fulminans and severe hidradenitis suppurativa with targeted antibiotherapy. JAAD Case Rep 2019; 5:525-528. [PMID: 31205996 PMCID: PMC6558272 DOI: 10.1016/j.jdcr.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sabine Duchatelet
- Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Olivier Join-Lambert
- Laboratoire de Microbiologie, Hôpital Necker Enfants Malades, Paris, France.,Physiopathologie des Infections Systémiques, Institut Necker-Enfants Malades, Paris, France.,CHU de Caen, Laboratoire de Microbiologie, Caen, France.,Groupe de Recherche sur l'Adaptation Microbienne, Caen, France.,Normandy University, Normandy, France
| | - Maïa Delage
- Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Snaigune Miskinyte
- Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Hélène Guet-Revillet
- Laboratoire de Microbiologie, Hôpital Necker Enfants Malades, Paris, France.,Physiopathologie des Infections Systémiques, Institut Necker-Enfants Malades, Paris, France
| | - Thi Lam
- Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Hélène Coignard-Biehler
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Paris, France
| | | | - Lucienne Chatenoud
- Laboratoire d'immunologie, Hôpital Necker Enfants Malades, Paris, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Paris, France
| | - Xavier Nassif
- Laboratoire de Microbiologie, Hôpital Necker Enfants Malades, Paris, France.,Physiopathologie des Infections Systémiques, Institut Necker-Enfants Malades, Paris, France
| | - Alain Hovnanian
- Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cité, Paris, France.,Department of Genetics, Hôpital Necker Enfants Malades, Paris, France
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54
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Ring HC, Sigsgaard V, Thorsen J, Fuursted K, Fabricius S, Saunte DM, Jemec GB. The microbiome of tunnels in hidradenitis suppurativa patients. J Eur Acad Dermatol Venereol 2019; 33:1775-1780. [PMID: 30908704 DOI: 10.1111/jdv.15597] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels and scarring involving the intertriginous regions. Recent next-generation sequencing (NGS) studies suggest genera such as Prevotella spp., Peptoniphilus spp. and Porphyromonas spp. are associated with chronic and early HS lesions. However, a systematic investigation of the bacterial microbiome in HS tunnels remains unexplored using NGS. OBJECTIVE We aimed to investigate the bacterial composition of the luminal white gelatinous material found in HS tunnels using NGS. METHODS An exploratory study of patients with diagnosis of HS (n = 32) with tunnels. The tunnels were present either in the groin (n = 17) or in the axilla (n = 15). During deroofing of the tunnels, a sterile E-swab was taken of the luminal gelatinous material. The samples were investigated using NGS targeting 16S ribosomal RNA. RESULTS The skin microbiome was characterized in 32 HS patients. Overall, five microbiome types were identified: Porphyromonas spp. (type I), Corynebacterium spp., (type II), Staphylococcus spp. (type III), Prevotella spp. (type IV) and Acinetobacter spp (type V). Porphyromonas spp. (type I) and Prevotella spp. (IV) were the most frequent genera found the tunnels. CONCLUSION This study points to a potential association between the presence of certain anaerobic bacteria (Porphyromonas spp., Prevotella spp.) and HS tunnels. It may be speculated that these two genera are associated with the pathogenesis in HS either as drivers or as biomarkers.
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Affiliation(s)
- H C Ring
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - V Sigsgaard
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - K Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Fabricius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - D M Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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55
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Morand M, Hatami A. Silver-coated textiles in hidradenitis suppurativa: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19845212. [PMID: 31080599 PMCID: PMC6498763 DOI: 10.1177/2050313x19845212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hidradenitis suppurativa is a chronic and debilitating skin disease of apocrine gland–bearing areas. The mainstay of treatment usually includes topical and systemic antibiotics. These agents can be used as monotherapy or combination therapy. The therapeutic role of functional textiles with antimicrobial activity has been recently emerging in the treatment of other skin diseases such as atopic dermatitis and epidermolysis bullosa. The pathologic processes involved in the development of atopic dermatitis and hidradenitis suppurativa are still incompletely understood, but these two diseases share some similarities including bacterial proliferation and chronic inflammation. We report the case of a 14-year-old boy with hidradenitis suppurativa that has been successfully treated with silver-coated textiles. To the best of our knowledge, this article is the first to report the benefits of silver-coated textiles in the treatment of hidradenitis suppurativa.
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Affiliation(s)
- Meggie Morand
- Centre Hospitalier Universitaire de Montréal, Division of Dermatology, Department of Medicine, University of Montreal, Montréal, QC, Canada
| | - Afshin Hatami
- Centre Hospitalier Universitaire Sainte-Justine, Division of Dermatology, Department of Pediatrics, University of Montreal, Montreal, QC, Canada
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56
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Damiani G, Leone S, Fajgenbaum K, Bragazzi NL, Pacifico A, Conic RRZ, Pigatto PDM, Maiorana C, Poli P, Berti E, Pace MC, Malagoli P, Bettoli V, Fiore M. Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis. World J Hepatol 2019; 11:391-401. [PMID: 31114643 PMCID: PMC6504856 DOI: 10.4254/wjh.v11.i4.391] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/25/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease (ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern. Hidradenitis suppurativa (HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.
AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.
METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.
RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients (P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index (ADDI) was significantly higher among patients with HS/NASH (5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only (2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.
CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.
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Affiliation(s)
- Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, OH 44195, United States
- Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo 24100, Italy
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20100, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20161, Italy
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
| | - Kristen Fajgenbaum
- University of North Carolina School of Medicine, Chapel Hill, NC 27516, United States
| | - Nicola L Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Gevova 16132, Italy
| | - Alessia Pacifico
- San Gallicano Dermatological Institute, IRCCS, Rome 00144, Italy
| | - Rosalynn RZ Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, OH 44195, United States
| | - Paolo DM Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan 20100, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan 20161, Italy
| | - Carlo Maiorana
- Center for Jawbone Atrophies Policlinico Hospital, University of Milan School of Dentistry, Milan 20123, Italy
| | - Pierpaolo Poli
- Center for Jawbone Atrophies Policlinico Hospital, University of Milan School of Dentistry, Milan 20123, Italy
| | - Emilio Berti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Maria C Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | | | - Vincenzo Bettoli
- Department of Clinical and Experimental Dermatology, O.C. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara 44121, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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57
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Tricarico PM, Boniotto M, Genovese G, Zouboulis CC, Marzano AV, Crovella S. An Integrated Approach to Unravel Hidradenitis Suppurativa Etiopathogenesis. Front Immunol 2019; 10:892. [PMID: 31105704 PMCID: PMC6494959 DOI: 10.3389/fimmu.2019.00892] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022] Open
Abstract
Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory disease involving hair follicles that presents with painful nodules, abscesses, fistulae, and hypertrophic scars, typically occurring in apocrine gland bearing skin. Establishing a diagnosis of HS may take up to 7 years after disease onset. HS severely impairs the quality of life of patients and its high frequency causes significant costs for health care system. HS patients have an increased risk of developing associated diseases, such as inflammatory bowel diseases and spondyloarthropathies, thereby suggesting a common pathophysiological mechanism. Familial cases, which are around 35% of HS patients, have allowed the identification of susceptibility genes. HS is perceived as a complex disease where environmental factors trigger chronic inflammation in the skin of genetically predisposed individuals. Despite the efforts made to understand HS etiopathogenesis, the exact mechanisms at the basis of the disease need to be still unraveled. In this review, we considered all OMICs studies performed on HS and observed that OMICs contribution in the context of HS appeared as not clear enough and/or rich of useful clinical information. Indeed, most studies focused only on one aspect—genome, transcriptome, or proteome—of the disease, enrolling small numbers of patients. This is quite limiting for the genetic studies, from different geographical areas and looking at a few aspects of HS pathogenesis without any integration of the findings obtained or a comparison among different studies. A strong need for an integrated approach using OMICs tools is required to discover novel actors involved in HS etiopathogenesis. Moreover, we suggest the constitution of consortia to enroll a higher number of patients to be analyzed following common and consensus OMICs strategies. Comparison and integration with the findings present in the OMICs repositories are mandatory. In a theoretic pipeline, the Skin-OMICs profile obtained from each HS patient should be compared and integrated with repositories and literature data by using appropriate InterOMICs approach. The final goal is not only to improve the knowledge of HS etiopathogenesis but also to provide novel tools to the clinicians with the eventual aim of offering a tailored treatment for HS patients.
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Affiliation(s)
- Paola M Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Michele Boniotto
- University of Paris Est-Créteil and INSERM U955/IMRB-Team 16, Créteil, France
| | - Giovanni Genovese
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e Dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Angelo V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e Dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Sergio Crovella
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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Albrecht J, Baine PA, Ladizinski B, Jemec GB, Bigby M. Long-term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. A Critically Appraised Topic. Br J Dermatol 2019; 180:749-755. [PMID: 30281779 DOI: 10.1111/bjd.17265] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 12/15/2022]
Abstract
CLINICAL QUESTION/SCENARIO Can therapy with clindamycin and rifampicin be safely continued long term beyond the recommended 10-week course? BACKGROUND Clindamycin and rifampicin are used in combination to treat hidradenitis suppurativa (HS). There is no data on the efficacy and safety of clindamycin/rifampicin combination therapy for HS beyond 10 weeks. METHODS We identified the following major concerns that still lack a proper evidenced-based analysis: for rifampicin, drug-induced liver injury, interstitial nephritis, drug interaction and hepatic p450 3A4 enzyme induction; for clindamycin, the concern was community-acquired Clostridium difficile infection (CA-CDI); and experience with long-term treatment. Data sources were used as appropriate to answer the question. Systematic searches were used to assess the risk of CA-CDI and experience with long-term treatment with clindamycin. RESULTS/IDENTIFIED EVIDENCE The risk for rifampicin-induced liver injury is highest in the first 6 weeks of treatment, whereas interstitial nephritis is primarily observed during intermittent treatment. Enzyme induction due to rifampicin is usually complete after about 2 weeks of treatment and reduces clindamycin blood levels by about 90%. Three meta-analyses identified antibiotic use as a risk factor for CA-CDI. Two of them assigned the highest risk to clindamycin. None of them stratified by length of treatment. There is extensive experience with rifampicin, primarily for the treatment of tuberculosis. Long-term experience with clindamycin is limited. DISCUSSION AND RECOMMENDATION FOR CLINICAL CARE The analysed risks associated with a combination of clindamycin and rifampicin for hidradenitis suppurative cluster within the first 10 weeks. Treatment can be continued beyond 10 weeks, if clinically necessary.
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Affiliation(s)
- J Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, 1900 West Polk Street, Chicago, IL, 60612, U.S.A.,Department of Dermatology, Rush Medical College, Chicago, IL, U.S.A
| | - P A Baine
- Countway Library of Medicine, Harvard Medical School, Boston, MA, U.S.A
| | - B Ladizinski
- Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, 1900 West Polk Street, Chicago, IL, 60612, U.S.A
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Bigby
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, U.S.A
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59
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Ardon CB, Prens EP, Tkadlec J, Fuursted K, Abourayale S, Jemec GBE, Jenssen H. Virulent Staphylococcus lugdunensis with limited genetic diversity in hidradenitis suppurativa lesions. J Eur Acad Dermatol Venereol 2019; 33:e248-e250. [PMID: 30801776 DOI: 10.1111/jdv.15523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C B Ardon
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.,Department of Science and Environment, Roskilde University, Universitetsvej 1, Roskilde, DK-4000, Denmark
| | - E P Prens
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - J Tkadlec
- Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, V Úvalu 84, 150 06 Praha 5, Czech Republic
| | - K Fuursted
- Department of Microbiology and Infection Control, Staten Serum Institute, 5 Artillerivej, DK-2300, Copenhagen, Denmark
| | - S Abourayale
- Department of Science and Environment, Roskilde University, Universitetsvej 1, Roskilde, DK-4000, Denmark
| | - G B E Jemec
- Department of Dermatology, University Hospital Zealand, Sygehusvej 10, 4000 Roskilde, Denmark
| | - H Jenssen
- Department of Science and Environment, Roskilde University, Universitetsvej 1, Roskilde, DK-4000, Denmark
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Bettoli V, Manfredini M, Massoli L, Carillo C, Barozzi A, Amendolagine G, Ruina G, Musmeci D, Libanore M, Curtolo A, Mantovani L, Contini C, Pellacani G, Corazza M. Rates of antibiotic resistance/sensitivity in bacterial cultures of hidradenitis suppurativa patients. J Eur Acad Dermatol Venereol 2019; 33:930-936. [PMID: 30394587 DOI: 10.1111/jdv.15332] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antibiotic (AB) treatment is one of the first steps in the management of hidradenitis suppurativa (HS). Bacteria, in HS patients, may play a double role, as triggering factors of inflammatory reactions and/or agents of infection. OBJECTIVES The aims of this study are as follows: (i) to assess prevalence and AB resistance of bacterial growths in HS patients (ii) assessment of the clinical relevance of obtained data in guiding the selection of the most effective AB therapy. METHODS Purulent material from 137 skin lesions of HS patients was collected with swabs. Bacterial flora and AB sensitivity were determined using microbiological cultures for aerobic and anaerobic bacteria. RESULTS A total of 114 samples resulted positive for bacteria. Sample was collected from the axillae, groin and perianal areas. A total of 163 single bacterial growths were observed; 55% were Gram-positive and 44% were Gram-negative. Among them, 18.4% were anaerobic. The most frequent bacterial families included enterobacteriaceae (30.7%), Staphylococcus (25.2%) and Streptococcus (14.1%). The most frequent genus or species were proteus spp. (13.5%) and Escherichia coli (9.8%). The prevalence of AB resistance observed was clindamycin 65.7%, rifampicin 69.3%, penicillin 70.0%, ciprofloxacin 74%, tetracycline 84.7% and erythromycin 89.0%. A limitation of the study is represented the short culture period adopted which may have impaired the isolation of anaerobes. CONCLUSIONS Bacterial growth in HS patients has shown a high level of resistance to ABs, including rifampicin, clindamycin and tetracyclines, cited as an empiric choice in HS therapeutic guidelines. A targeted and specific AB therapy, driven by microbiological evaluations with prolonged culture periods, seems more appropriate than empiric, generic, non-specific, therapeutic approaches. Current knowledge regarding HS bacterial AB resistance should be considered in the update of current therapeutic guidelines for HS.
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Affiliation(s)
- V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Manfredini
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.,Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - L Massoli
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - C Carillo
- O.U. Microbiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - A Barozzi
- O.U. Microbiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - G Amendolagine
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - G Ruina
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - D Musmeci
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Libanore
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - A Curtolo
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - L Mantovani
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - C Contini
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - G Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - M Corazza
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
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61
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Vossen ARJV, van der Zee HH, Prens EP. Hidradenitis Suppurativa: A Systematic Review Integrating Inflammatory Pathways Into a Cohesive Pathogenic Model. Front Immunol 2018; 9:2965. [PMID: 30619323 PMCID: PMC6302105 DOI: 10.3389/fimmu.2018.02965] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Background: The pathogenesis of hidradenitis suppurativa (HS) is not fully understood. This systematic review examined the latest evidence for molecular inflammatory pathways involved in HS as a chronic inflammatory skin disease. Methods: A systematic literature search was performed in PubMed/Medline and EMBASE from January 2013 through September 2017, according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Findings on HS pathogenesis were also compared with those of other immune-mediated inflammatory diseases (IMIDs) in a non-systematic review. In addition, current therapeutic options for HS are briefly discussed on the basis of the findings for the inflammatory pathways involved in HS. Results: A total of 32 eligible publications were identified by the systematic search; these were supplemented with three additional publications. The extracted data indicated that four key themes underlie the pathogenesis of HS and related syndromic conditions. First, nicastrin (NCSTN) and PSTPIP1 mutations are directly associated with auto-inflammatory disease. Secondly, the up-regulation of several cytokines including tumor necrosis factor-α and T helper-17/interleukin-23 are connected to auto-inflammatory mechanisms in the pathogenesis of HS. Thirdly, the microbiome of lesional skin differs significantly vs. normal-appearing skin. Fourthly, HS risk is enhanced through physiological and environmental factors such as smoking, obesity, and mechanical friction. There is significant overlap between the pathogenesis of HS, its syndromic forms and other IMIDs, particularly with respect to aberrations in the innate immune response. Conclusions: The evidence presented in this review supports HS as an auto-inflammatory skin disorder associated with alterations in the innate immune system. Based on these most recent data, an integrative viewpoint is presented on the pathogenesis of HS. Current management strategies on HS consist of anti-inflammatory therapies, surgical removal of chronic lesions, and lifestyle changes such as smoking cessation and weight loss. As large gaps remain in the understanding of the pathogenesis of HS, further research is warranted to ultimately improve the management and treatment of patients with HS and related syndromic conditions.
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Affiliation(s)
- Allard R J V Vossen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
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Naik HB, Nassif A, Ramesh MS, Schultz G, Piguet V, Alavi A, Lowes MA. Are Bacteria Infectious Pathogens in Hidradenitis Suppurativa? Debate at the Symposium for Hidradenitis Suppurativa Advances Meeting, November 2017. J Invest Dermatol 2018; 139:13-16. [PMID: 30414909 DOI: 10.1016/j.jid.2018.09.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
In November 2017, a formal debate on the role of bacteria in the pathogenesis of hidradenitis suppurativa (HS) was held at the 2nd Symposium on Hidradenitis Suppurativa Advances (SHSA) in Detroit, Michigan. In this report, we present both sides of the argument as debated at the SHSA meeting and then discuss the potential role of bacteria as classic infectious pathogens versus an alternative pathogenic role as activators of dysregulated commensal bacterial-host interactions. Although there was consensus that bacteria play a role in pathogenesis and thus are pathogenic, there was a compelling discussion about whether bacteria in HS incite an infectious disease as we classically understand it or whether bacteria might play a different role in HS pathogenesis.
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Affiliation(s)
- Haley B Naik
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, San Francisco, California, USA.
| | - Aude Nassif
- Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Mayur S Ramesh
- Division of Infectious Disease, Henry Ford Hospital, Detroit, Michigan, USA
| | - Gregory Schultz
- Institute of Wound Research, Department of Obstetrics and Gynecology, University of Florida, Miami, Florida, USA
| | - Vincent Piguet
- Division of Dermatology, University of Toronto, Toronto, Canada
| | - Afsaneh Alavi
- Division of Dermatology, University of Toronto, Toronto, Canada
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63
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Association between hidradenitis suppurativa and spondyloarthritis. Joint Bone Spine 2018; 85:593-597. [DOI: 10.1016/j.jbspin.2017.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 09/13/2017] [Indexed: 11/19/2022]
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64
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Ardon CB, Prens EP, Fuursted K, Ejaz RN, Shailes J, Jenssen H, Jemec GBE. Biofilm production and antibiotic susceptibility of Staphylococcus epidermidis strains from Hidradenitis Suppurativa lesions. J Eur Acad Dermatol Venereol 2018; 33:170-177. [PMID: 30022542 DOI: 10.1111/jdv.15183] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/10/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND An aberrant interaction between commensal skin bacteria and the host skin immune system is considered important in the pathogenesis of hidradenitis suppurativa (HS). OBJECTIVE In this study, we investigated the antibiotic susceptibility and biofilm-forming capabilities of S. epidermidis strains isolated from HS patients. METHODS Skin biopsies were taken from active HS lesions such as inflammatory nodules and/or sinuses and non-involved skin from 26 patients and cultured under optimal microbiological conditions for 24 h. Planktonic growth, biofilm production, antibiotic susceptibility and biofilm eradication by clindamycin, doxycycline, rifampicin and tetracycline were tested including a laboratory control strain of S. epidermidis for reference. RESULTS Staphylococcus epidermidis was cultured in 16 of 26 HS patients (62%). In total 27 different S. epidermidis isolates were identified; 16 (59%) from non-involved skin and 11 (41%) from HS lesions. All bacterial strains showed planktonic growth. Twenty-four of 27 (89%) isolates were strong biofilm producers in vitro. The biofilm-forming capability varied amongst the strains from non-involved skin and lesional skin. Twenty-four strains had an intermediate to resistant antibiotic susceptibility to clindamycin (89%). Rifampicin was the most effective antibiotic at inhibiting planktonic growth and at eradication of biofilm (P < 0.05). CONCLUSION We observed a slight increase in S. epidermidis virulence, characterized by resistance to commonly used antibiotics, increased biofilm production and resistance to biofilm eradication. In particular, the reduced sensitivity to tetracycline and clindamycin, two standard antibiotics in the treatment of HS, is alarming. Rifampicin, also important in HS treatment, showed the greatest efficacy at eradicating the biofilm at low MIC concentrations.
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Affiliation(s)
- C B Ardon
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - E P Prens
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Fuursted
- Department of Microbiology and Infection Control, Staten Serum Institute, Copenhagen, Denmark
| | - R N Ejaz
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - J Shailes
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - H Jenssen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - G B E Jemec
- Department of Dermatology, University Hospital Zealand, Roskilde, Denmark
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65
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Zaaroura H, Geffen Y, Bergman R, Avitan-Hersh E. Clinical and microbiological properties of Staphylococcus lugdunensis skin infections. J Dermatol 2018; 45:994-999. [PMID: 29897142 DOI: 10.1111/1346-8138.14496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Abstract
Staphylococcus lugdunensis is an emerging pathogen in skin and soft tissue infections that was previously considered a commensal. The aim of this study was to elucidate the characteristics of skin infections by S. lugdunensis and its appropriate management, in a tertiary referral medical center. The clinical files, bacterial cultures and histopathology reports of all S. lugdunensis isolates from skin infections over a period of 8 years (September 2009-September 2017) were reviewed. S. lugdunensis was isolated from 29 patients with skin infections, aged 7-89 years (mean 33.3 years). A state of immune suppression (drug-induced, malignancy or diabetes) was present in five patients (17%). Folliculitis and cutaneous pustulosis were the most common presentations (16 cases, 55%), followed by secondary infection of hidradenitis suppurativa (five cases, 17%). Other sources of isolation were infected molluscum contagiosum (two cases), folliculitis decalvans (one case), dissecting cellulitis (one case), abscess (one case), cyst (one case), impetigo (one case) and granuloma after trauma (one case). The in vitro antibiotic sensitivity tests showed susceptibility to most tested antibiotics, although a few isolates were resistant to gentamycin, penicillin and oxacillin. In 19 of 20 patients for whom follow ups were available, cutaneous manifestations improved or resolved with proper local and/or oral antibiotic therapy. S. lugdunensis may play a role as a primary or secondary pathogen in various skin infections, most commonly folliculitis and pustulosis. Proper antibiotic therapy may lead to improvement or resolution.
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Affiliation(s)
- Hiba Zaaroura
- Department of Dermatology, Rambam Health Care Campus, Technion, Haifa, Israel
| | - Yuval Geffen
- Clinical Microbiology Laboratory, Rambam Health Care Campus, Technion, Haifa, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Technion, Haifa, Israel.,Department of Pathology, Rambam Health Care Campus, Technion, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emily Avitan-Hersh
- Department of Dermatology, Rambam Health Care Campus, Technion, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Guet-Revillet H, Jais JP, Ungeheuer MN, Coignard-Biehler H, Duchatelet S, Delage M, Lam T, Hovnanian A, Lortholary O, Nassif X, Nassif A, Join-Lambert O. The Microbiological Landscape of Anaerobic Infections in Hidradenitis Suppurativa: A Prospective Metagenomic Study. Clin Infect Dis 2018; 65:282-291. [PMID: 28379372 DOI: 10.1093/cid/cix285] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/27/2017] [Indexed: 12/12/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a frequent and severe disease of the skin, characterized by recurrent or chronic skinfold suppurative lesions with a high impact on quality of life. Although considered inflammatory, antimicrobial treatments can improve or lead to clinical remission of HS, suggesting triggering microbial factors. Indeed, mixed anaerobic microbiota are associated with a majority of HS lesions. Our aim in this study was to characterize the landscape of anaerobic infections in HS using high-throughput sequencing. Methods We sampled and cultured 149 lesions and 175 unaffected control skinfold areas from 65 adult HS patients. The microbiome of 80 anaerobic lesions was compared to that of 88 control samples by 454 high-throughput sequencing after construction of 16S ribosomal RNA gene libraries. Results Bacterial cultures detected anaerobes in 83% of lesions vs 53% of control samples, combined with milleri group streptococci and actinomycetes in 33% and 26% of cases, respectively. High-throughput sequencing identified 43 taxa associated with HS lesions. Two gram-negative anaerobic rod taxa, Prevotella and Porphyromonas, predominated, contrasting with a reduced abundance of aerobic commensals. These rare taxa of normal skinfold microbiota were associated with lesions independently of gender, duration and familial history of HS, body mass index, and location. Two main additional taxa, Fusobacterium and Parvimonas, correlated with the clinical severity of HS. Conclusions In this study we reveal the high prevalence and particular landscape of mixed anaerobic infection in HS, paving the way for rationale targeted antimicrobial treatments.
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Affiliation(s)
- Hélène Guet-Revillet
- Paris Descartes University, Sorbonne Paris Cité.,Department of Clinical Microbiology, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris.,INSERM U11151, Team 11.,Centre d'Infectiologie Necker-Pasteur
| | - Jean-Philippe Jais
- Paris Descartes University, Sorbonne Paris Cité.,Department of Biostatistics, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris
| | | | - Hélène Coignard-Biehler
- Paris Descartes University, Sorbonne Paris Cité.,Centre d'Infectiologie Necker-Pasteur.,Department of Tropical Medicine and Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris
| | - Sabine Duchatelet
- Paris Descartes University, Sorbonne Paris Cité.,INSERM U1163, Imagine Institute, Department of Genetics
| | - Maïa Delage
- Centre d'Infectiologie Necker-Pasteur.,Department of Dermatology, Avicenne Hospital, Assistance Publique - Hôpitaux de Paris
| | - Thi Lam
- Centre d'Infectiologie Necker-Pasteur.,Department of Tropical Medicine and Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris.,Medical Center, Institut Pasteur
| | - Alain Hovnanian
- Paris Descartes University, Sorbonne Paris Cité.,INSERM U1163, Imagine Institute, Department of Genetics
| | - Olivier Lortholary
- Paris Descartes University, Sorbonne Paris Cité.,Centre d'Infectiologie Necker-Pasteur.,Department of Tropical Medicine and Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris
| | - Xavier Nassif
- Paris Descartes University, Sorbonne Paris Cité.,Department of Clinical Microbiology, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris.,INSERM U11151, Team 11.,Centre d'Infectiologie Necker-Pasteur
| | - Aude Nassif
- Centre d'Infectiologie Necker-Pasteur.,Department of Tropical Medicine and Infectious Diseases, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris.,Medical Center, Institut Pasteur
| | - Olivier Join-Lambert
- Paris Descartes University, Sorbonne Paris Cité.,Department of Clinical Microbiology, Necker-Enfants malades Hospital, Assistance Publique - Hôpitaux de Paris.,INSERM U11151, Team 11.,Centre d'Infectiologie Necker-Pasteur
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Marzuillo P, Piccolo V, Mascolo M, Apicella A, Argenziano G, Della Vecchia N, Guarino S, Miraglia del Giudice E, La Manna A. Patients affected by dent disease 2 could be predisposed to hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2018; 32:e309-e311. [DOI: 10.1111/jdv.14860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P. Marzuillo
- Department of Woman, Child and of General and Specialized Surgery; Università degli Studi della Campania “Luigi Vanvitelli”; Via Luigi De Crecchio 2 80138 Napoli Italy
| | - V. Piccolo
- Dermatology Unit; Università degli Studi della Campania “Luigi Vanvitelli”; via Pansini 5 80131 Naples Italy
| | - M. Mascolo
- Department of Advanced Biomedical Sciences; University of Naples Federico II; Via Pansini 5 80131 Naples Italy
| | - A. Apicella
- Department of Pediatrics; AORN Santobono-Pausilipon; Via Mario Fiore 6 80129 Naples Italy
| | - G. Argenziano
- Dermatology Unit; Università degli Studi della Campania “Luigi Vanvitelli”; via Pansini 5 80131 Naples Italy
| | - N. Della Vecchia
- Department of Woman, Child and of General and Specialized Surgery; Università degli Studi della Campania “Luigi Vanvitelli”; Via Luigi De Crecchio 2 80138 Napoli Italy
| | - S. Guarino
- Department of Woman, Child and of General and Specialized Surgery; Università degli Studi della Campania “Luigi Vanvitelli”; Via Luigi De Crecchio 2 80138 Napoli Italy
| | - E. Miraglia del Giudice
- Department of Woman, Child and of General and Specialized Surgery; Università degli Studi della Campania “Luigi Vanvitelli”; Via Luigi De Crecchio 2 80138 Napoli Italy
| | - A. La Manna
- Department of Woman, Child and of General and Specialized Surgery; Università degli Studi della Campania “Luigi Vanvitelli”; Via Luigi De Crecchio 2 80138 Napoli Italy
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68
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Hidrosadenitis supurativa: Visión desde la Microbiología. Semergen 2017; 43:594-595. [DOI: 10.1016/j.semerg.2017.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/16/2017] [Indexed: 11/21/2022]
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69
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Ring HC, Thorsen J, Saunte DM, Lilje B, Bay L, Riis PT, Larsen N, Andersen LO, Nielsen HV, Miller IM, Bjarnsholt T, Fuursted K, Jemec GB. The Follicular Skin Microbiome in Patients With Hidradenitis Suppurativa and Healthy Controls. JAMA Dermatol 2017; 153:897-905. [PMID: 28538949 DOI: 10.1001/jamadermatol.2017.0904] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Although the pathogenesis of hidradenitis suppurativa (HS) remains enigmatic, several factors point to potential involvement of the cutaneous microbiome. Insight into the cutaneous microbiome in HS using next-generation sequencing may provide novel data on the microbiological diversity of the skin. Objective To investigate the follicular skin microbiome in patients with HS and in healthy controls. Design, Setting, and Participants This case-control study obtained punch biopsy specimens from patients with HS (lesional and nonlesional) and healthy controls between October 1, 2014, and August 1, 2016. Data were analyzed from March to November 2016. Patients with HS were recruited from the Department of Dermatology, Zealand University Hospital, Roskilde, Denmark. Biopsy specimens were analyzed at the Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark. None of the participants received any antibiotics (systemic or topical therapy) within 1 month before the study. In patients with HS, biopsy specimens were obtained from lesional skin (axilla or groin) and nonlesional skin. Only nodules containing at least 1 visible hair follicle were biopsied. Biopsy specimens from healthy controls were obtained from the axilla only. Main Outcomes and Measures The different microbiomes were investigated using next-generation sequencing targeting 16S and 18S ribosomal RNA. Results The skin microbiome was characterized in 30 patients with HS (mean [SD] age, 46.9 [14.0] years; 19 [63% female]) and 24 healthy controls (mean [SD] age, 32.2 [12.0] years; 13 [54% female]). The next-generation sequencing data provided a previously unreported (to our knowledge) characterization of the skin microbiome in HS. The study demonstrated that the microbiome in HS differs significantly from that in healthy controls in lesional and nonlesional skin. Overall, the following 5 microbiome types were identified: Corynebacterium species (type I), Acinetobacter and Moraxella species (type II), Staphylococcus epidermidis (type III), Porphyromonas and Peptoniphilus species (type IV), and Propionibacterium acnes (type V). In lesional skin, microbiome types consisted predominantly of type I or type IV. Microbiome type IV was not detected in healthy controls. Several taxa, including Propionibacterium, showed a significantly higher relative abundance in healthy controls vs HS skin, indicating that Propionibacterium may be part of the pathogenesis in HS. Conclusions and Relevance The study findings suggest a link between a dysbiotic cutaneous microbiome and HS.
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Affiliation(s)
- Hans Christian Ring
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - Jonathan Thorsen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ditte M Saunte
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - Berit Lilje
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Lene Bay
- Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Peter Theut Riis
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | | | - Lee O'Brien Andersen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik V Nielsen
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Iben M Miller
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - Thomas Bjarnsholt
- Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Kurt Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Gregor Borut Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
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Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: an update on connecting the tracts. F1000Res 2017; 6:1272. [PMID: 28794864 PMCID: PMC5538037 DOI: 10.12688/f1000research.11337.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 12/18/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a devastating disease involving abscesses, sinus tracts, and inflammation classically affecting the axilla, groin, and/or anogenital region. Although the disease pathogenesis is not fully understood, recent advances suggest that HS pathology runs much deeper than the cutaneous manifestations. It is now believed that HS is a systemic inflammatory disease that gives rise to the characteristic cutaneous manifestations. This disease is problematic for both patients and physicians to manage because of a variety of diagnostic and management difficulties. This article seeks to provide updates on the current understanding of HS to increase awareness and improve management.
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71
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Napolitano M, Megna M, Timoshchuk EA, Patruno C, Balato N, Fabbrocini G, Monfrecola G. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol 2017; 10:105-115. [PMID: 28458570 PMCID: PMC5402905 DOI: 10.2147/ccid.s111019] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body and presenting with painful nodules, abscesses, sinus tracts, and scarring. HS is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture, and immune responses (perifollicular lympho-histiocytic inflammation), finally leading to the development of clinical HS lesions. HS has a destructive impact on the patient’s quality of life, being a very challenging disease. Available treatments are limited, mostly off-label and with high variability in the reported efficacy. Fortunately, a monoclonal antibody against tumor necrosis factor alpha has been recently approved for treatment of moderate to severe HS, offering patients a promising new option. This review focuses on the main features of HS, including epidemiology, clinical aspects, pathogenesis, severity classifications, comorbidities, and currently available treatments.
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Affiliation(s)
- Maddalena Napolitano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Elena A Timoshchuk
- Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Cataldo Patruno
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nicola Balato
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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72
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Ring HC, Bay L, Nilsson M, Kallenbach K, Miller IM, Saunte DM, Bjarnsholt T, Tolker-Nielsen T, Jemec GB. Bacterial biofilm in chronic lesions of hidradenitis suppurativa. Br J Dermatol 2017; 176:993-1000. [PMID: 27564400 DOI: 10.1111/bjd.15007] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chronic nonhealing or recurrent inflammatory lesions, reminiscent of infection but recalcitrant to antibiotic therapy, generally characterize biofilm-driven diseases. Chronic lesions of hidradenitis suppurativa (HS) exhibit several characteristics, which are compatible with well-known biofilm infections. OBJECTIVES To determine and quantify the potential presence of bacterial aggregates in chronic HS lesions. METHODS In 42 consecutive patients with HS suffering from chronic lesions, biopsies were obtained from lesional as well as from perilesional skin. Samples were investigated using peptide nucleic acid-fluorescence in situ hybridization in combination with confocal laser scanning microscopy. In addition, corresponding histopathological analysis on haematoxylin and eosin slides was performed. RESULTS Biofilms were seen in 67% of the samples of chronic lesions and in 75% of the perilesional samples. The mean diameter of aggregates in lesional skin was significantly greater than in perilesional skin (P = 0·01). Large biofilms (aggregates > 50 μm in diameter) were found in 42% of lesional samples and in only 5% of the perilesional samples (P = 0·009). The majority of the large biofilms were situated in sinus tracts (63%) or in the infundibulum (37%). The majority of the sinus tract samples (73%) contained active bacterial cells, which were associated with inflammation. CONCLUSIONS This study suggests that biofilm formation is associated with inflammation of chronic HS lesions. The aggregates most likely occur as a secondary event, possibly due to predisposing local anatomical changes such as sinus tracts (tunnels), keratinous detritus and dilated hair follicles.
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Affiliation(s)
- H C Ring
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - L Bay
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark
| | - M Nilsson
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark
| | - K Kallenbach
- Department of Pathology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - I M Miller
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - D M Saunte
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
| | - T Bjarnsholt
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark.,Department for Clinical Microbiology, Section 9301, Copenhagen University Hospital, Denmark
| | - T Tolker-Nielsen
- Department of Immunology and Microbiology, Costerton Biofilm Centre, University of Copenhagen, Denmark
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark
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73
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Shirah BH, Shirah HA. The Clinical Pattern of Axillary Hidradenitis Suppurativa among Saudi Arabians: Mode of Presentation and Treatment Challenges. J Cutan Aesthet Surg 2017; 10:95-100. [PMID: 28852296 PMCID: PMC5561718 DOI: 10.4103/jcas.jcas_80_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Hidradenitis suppurativa is a chronic follicular occlusive disease affecting the folliculopilosebaceous unit. The clinical course is variable, ranging from mild to severe cases. Definitive evidence-based guidelines for the management are lacking. In addition, the multifaceted clinical features and the unpredictable course of the disease make a uniform approach to treatment impractical. As a result, there are multiple therapeutic approaches. Therefore, in this study, we aim to analyze the results of management of axillary hidradenitis suppurativa among the local community in Saudi Arabia. Materials and Methods: A retrospective cohort database analysis of 1369 patients diagnosed and treated for axillary hidradenitis suppurativa between January 2004 and December 2013 was done. Seven hundred and forty-one (54.12%) were females and 628 (45.87%) were males. All patients with Stage I disease favored the conservative method while all patients with Stage II chose the surgical approach. Results: The mean age was 25.5 years. Nine hundred and seventy-four (71.15%) patients were treated conservatively; the mean healing time was 5.5 weeks. Three hundred and ninety-five (28.85%) patients were treated surgically. One hundred and fourteen (28.9%) had incision and drainage, 281 (71.1%) had complete excision; all wounds eventually healed without significant scarring. The recurrence rate was 12.5% (122 patients) in the conservative method group and zero (0%) in the surgical method group. Conclusions: Hidradenitis suppurativa remains a challenging clinical condition for patients and physicians. Further studies need to focus not only on the etiology of this disease but also on the optimal treatment regimen. Public awareness programs are necessary to avoid late presentation and complications.
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Affiliation(s)
- Bader Hamza Shirah
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hamza Asaad Shirah
- Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia
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74
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Maraki S, Evangelou G, Stafylaki D, Scoulica E. Actinotignum schaalii subcutaneous abscesses in a patient with hidradenitis suppurativa: Case report and literature review. Anaerobe 2016; 43:43-46. [PMID: 27913316 DOI: 10.1016/j.anaerobe.2016.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/24/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022]
Abstract
Actinotignum schaalii (formerly Actinobaculum schaalii) is a Gram-positive, facultative anaerobic rod that is typically involved in urinary tract infections in elderly patients or those with underlying urological pathologies. In contrast, abscess formation caused by A. schaalii is very rare. We present a case of multiple abscesses in the perineal area in a young patient with hidradenitis suppurativa associated with A. schaalii and Prevotella melaninogenica and review the relevant literature on the topic.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Microbiology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Crete, Greece.
| | - George Evangelou
- Department of Dermatology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Crete, Greece
| | - Efstathia Scoulica
- Laboratory of Clinical Bacteriology and Molecular Microbiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
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75
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Abstract
Hidradenitis suppurativa (HS) is not easily treated. Although not uncommon, HS is often misdiagnosed outside specialized clinics and inappropriately treated as a simple boil or abscess. In recent years, guidelines have been developed on the basis of expert opinion and the available literature. A multifaceted approach is necessary as HS lesions include both inflammation (amenable to medical treatment) as well as fibrosis (amenable to surgery only). The recommended antiinflammatory therapies encompass both antimicrobials and regular anti-inflammatory drugs. We have, therefore, reviewed treatments with the following agents: clindamycin, tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab, and anakinra. The development of new medical treatments, however, is an ongoing effort, and important new data have been presented since the publication of the guideline. The current approach to the management of fibrotic lesions is surgery. It is important, as manifest fibrosis is generally not susceptible to medical treatment. Here minor excision, carbon dioxide-laser, and major surgery are discussed, and current evidence supporting their use is provided. A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended. The importance of adjuvant therapy, that is, pain management, wound care, and attention, is stressed. Adjuvant therapy not only plays a major role in patients' perception of a successful treatment but also is of practical importance to their coping and self-management. HS presents a significant unmet need, and this review provides a mechanistic update on the current real-world therapeutic option for the management of this distressing disease.
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76
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Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission.
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Affiliation(s)
- I E Deckers
- Department of Dermatology, Erasmus University Medical Center, Burg. s' Jacobplein 51, 3015 CA, Rotterdam, The Netherlands.
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Burg. s' Jacobplein 51, 3015 CA, Rotterdam, The Netherlands.
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77
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Abstract
Although the clinical presentation of Hidradenitis Suppurativa (HS) is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacterial specimens as well as biofilm formation in lesional HS skin. Consistent findings of Gram-positive cocci and -rods including Staphylococus aureus, Coagulase-negative staphylococci (CoNS) and Corynebacterium species (spp) in deep tissue samples have been demonstrated in HS. Although efficacy of antibiotics, i.e., rifampicin, clindamycin or tetracycline may support a microbial role in disease pathogenesis, the most often isolated bacterial specimens are commensal bacteria (CoNS).
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Affiliation(s)
- Hans Christian Ring
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Køgevej 7-13, Roskilde 4000, Denmark.
| | - Lennart Emtestam
- Department of Dermatology & Venereology, Karolinska University Hospital, Stockholm, Sweden
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78
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Abstract
Although hidradenitis suppurativa (HS) is not primarily an infectious disease, antibiotics are widely used to treat HS. Recent microbiological data show that HS suppurating lesions are associated with a polymorphous anaerobic flora, including actinomycetes and milleri group streptococci, and can therefore be considered as polymicrobial soft tissue and skin infections. Analysis of the literature provides little information on the efficacy of antibiotics in HS but suggests a beneficial effect of certain antimicrobial treatments, depending on the clinical severity of the disease. Patients must be informed and should agree with the treatment strategy before starting antibiotic treatments.
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Affiliation(s)
- Vincenzo Bettoli
- Department of Clinical and Experimental Medicine, OU of Dermatology, Azienda Ospedaliera - University of Ferrara, Via Aldo Moro 8, Località Cona, Ferrara 44100, Italy.
| | - Olivier Join-Lambert
- Department of Microbiology, INSERM UMR 1151, Team 11 Necker Enfants-Malades Hospital, 149, rue de Sèvres, Paris 75015, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, 25 rue du Dr Roux, Paris 75015, France
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79
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Abstract
Hidradenitis suppurativa (HS) is a chronic relapsing disease of follicular occlusion that causes immense clinical and psychosocial morbidity when refractory to treatment. HS is no longer considered a disease of primary infectious etiology, although bacteria play a role. There is increasing evidence that HS is associated with immune dysregulation, based on its clinical association with other immune-mediated disorders, by its response to biologic therapy in the clinical arena, and from molecular research. This article summarizes what is known in relation to the inflammatory pathways in HS.
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Affiliation(s)
- G Kelly
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland.
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Centre Rotterdam, s-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands
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80
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Incorporating Cutaneous and Wound Bacterial Bioburden Biomarkers into Clinical Research: A Review of Best Practices. Adv Skin Wound Care 2016; 29:422-30. [PMID: 27538110 DOI: 10.1097/01.asw.0000489561.52393.0e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To provide information about initiating interdisciplinary research related to microbiomes and their role in human immunity, disease, and metabolic processes. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES After participating in this educational activity, the participant should be better able to:1. Describe techniques to identify and characterize bacterial bioburden.2. Identify optimal collection, transport, and storage of samples. ABSTRACT OBJECTIVE The purpose of this review is to provide a roadmap for clinical scientists interested in integrating bacterial bioburden (BB) biomarkers into the next generation of cutaneous or wound disease research studies. DISCUSSION Complex relationships exist between humans and their microbiome. Until now, clinical scientists have been limited in fully characterizing relationships between humans and their microbiome. Recent technological innovations, such as next-generation DNA sequencing, also known as deep sequencing or pyrosequencing, have enhanced clinicians' capacity to identify, characterize, and elucidate the role of BB (ie, bacterial load, diversity, pathogenicity) in human immunity, disease, and metabolic processes. The understanding of common terminology, intervening variables that influence BB, limitations of next-generation DNA sequencing, and specimen selection, collection, transport, and storage practices are needed to support interdisciplinary communication, research design, and integrity of the specimen. CONCLUSION This review serves as a primer for building foundational knowledge in microbiome research, which will aid clinical scientists with initiating interdisciplinary communication necessary for scientific team building.
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81
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van der Zee HH, Horvath B, Jemec GBE, Prens EP. The Association between Hidradenitis Suppurativa and Crohn's Disease: in Search of the Missing Pathogenic Link. J Invest Dermatol 2016; 136:1747-1748. [PMID: 27542293 DOI: 10.1016/j.jid.2016.05.102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Hidradenitis suppurativa is a chronic, autoinflammatory skin disease. Shalom et al. demonstrate in a large cross-sectional study an association between Crohn's disease and hidradenitis suppurativa, but not with ulcerative colitis. This association supports the hypothesis that a similar pathogenic mechanism contributes to both diseases, providing new possibilities for functional studies and therapy development.
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Affiliation(s)
- Hessel H van der Zee
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Barbara Horvath
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Denmark
| | - Errol P Prens
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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82
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Delage M, Guet-Revillet H, Duchatelet S, Hovnanian A, Nassif X, Nassif A, Join-Lambert O. Deciphering the microbiology of hidradenitis suppurativa: a step forward towards understanding an enigmatic inflammatory skin disease. Exp Dermatol 2016; 24:736-7. [PMID: 26269245 DOI: 10.1111/exd.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Maïa Delage
- Centre Médical, Institut Pasteur, Paris, France.,Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Hélène Guet-Revillet
- Centre d'Infectiologie Necker-Pasteur, Paris, France.,Université Paris Descartes -Sorbonne Paris Cité, Paris, France.,Service de Microbiologie, Hôpital Necker-Enfants malades, AP-HP, Paris, France.,INSERM UMR 1151, Team 11: Pathophysiology of Systemic Infections, Institut Necker Enfants Malades, Paris, France
| | - Sabine Duchatelet
- Université Paris Descartes -Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, Laboratory of Genetic Skin Diseases: From Disease Mechanism to Therapies, Imagine Institute, Paris, France
| | - Alain Hovnanian
- Université Paris Descartes -Sorbonne Paris Cité, Paris, France.,INSERM UMR 1163, Laboratory of Genetic Skin Diseases: From Disease Mechanism to Therapies, Imagine Institute, Paris, France
| | - Xavier Nassif
- Centre d'Infectiologie Necker-Pasteur, Paris, France.,Université Paris Descartes -Sorbonne Paris Cité, Paris, France.,Service de Microbiologie, Hôpital Necker-Enfants malades, AP-HP, Paris, France.,INSERM UMR 1151, Team 11: Pathophysiology of Systemic Infections, Institut Necker Enfants Malades, Paris, France
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Paris, France.,Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Olivier Join-Lambert
- Centre d'Infectiologie Necker-Pasteur, Paris, France.,Université Paris Descartes -Sorbonne Paris Cité, Paris, France.,Service de Microbiologie, Hôpital Necker-Enfants malades, AP-HP, Paris, France.,INSERM UMR 1151, Team 11: Pathophysiology of Systemic Infections, Institut Necker Enfants Malades, Paris, France
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83
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Miller IM, Ring HC, Prens EP, Rytgaard H, Mogensen UB, Ellervik C, Jemec GB. Leukocyte Profile in Peripheral Blood and Neutrophil-Lymphocyte Ratio in Hidradenitis Suppurativa: A Comparative Cross-Sectional Study of 462 Cases. Dermatology 2016; 232:511-9. [DOI: 10.1159/000446021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022] Open
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84
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Principi M, Cassano N, Contaldo A, Iannone A, Losurdo G, Barone M, Mastrolonardo M, Vena GA, Ierardi E, Di Leo A. Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association. World J Gastroenterol 2016; 22:4802-4811. [PMID: 27239107 PMCID: PMC4873873 DOI: 10.3748/wjg.v22.i20.4802] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/11/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn’s disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as “the explosive mixture” at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.
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85
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Hotz C, Boniotto M, Guguin A, Surenaud M, Jean-Louis F, Tisserand P, Ortonne N, Hersant B, Bosc R, Poli F, Bonnabau H, Thiébaut R, Godot V, Wolkenstein P, Hocini H, Lévy Y, Hüe S. Intrinsic Defect in Keratinocyte Function Leads to Inflammation in Hidradenitis Suppurativa. J Invest Dermatol 2016; 136:1768-1780. [PMID: 27206704 DOI: 10.1016/j.jid.2016.04.036] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 03/17/2016] [Accepted: 04/08/2016] [Indexed: 01/06/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating, follicular disease of the skin. Despite a high prevalence in the general population, the physiopathology of HS remains poorly understood. The use of antibiotics and immunosuppressive agents for therapy suggests a deregulated immune response to microflora. Using cellular and gene expression analyses, we found an increased number of infiltrating CD4(+) T cells secreting IL-17 and IFN-γ in perilesional and lesional skin of patients with HS. By contrast, IL-22-secreting CD4(+) T cells are not enriched in HS lesions contrasting with increased number of those cells in the blood of patients with HS. We showed that keratinocytes isolated from hair follicles of patients with HS secreted significantly more IL-1β, IP-10, and chemokine (C-C motif) ligand 5 (RANTES) either constitutively or on pattern recognition receptor stimulations. In addition, they displayed a distinct pattern of antimicrobial peptide production. These findings point out a functional defect of keratinocytes in HS leading to a balance prone to inflammatory responses. This is likely to favor a permissive environment for bacterial infections and chronic inflammation characterizing clinical outcomes in patients with HS.
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Affiliation(s)
- Claire Hotz
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Michele Boniotto
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Aurélie Guguin
- Plateforme de Cytométrie en flux, IMRB, UFR de Médecine, Créteil, France
| | - Mathieu Surenaud
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Francette Jean-Louis
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Pascaline Tisserand
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Nicolas Ortonne
- Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Pathology Department, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France; Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France
| | - Barbara Hersant
- Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France; Plastic, Reconstructive and Aesthetic Surgery Department, Henri Mondor Hospital, Créteil, France
| | - Romain Bosc
- Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France; Plastic, Reconstructive and Aesthetic Surgery Department, Henri Mondor Hospital, Créteil, France
| | - Florence Poli
- Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France; Dermatology Department, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - Henri Bonnabau
- Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France; INSERM U897, INRIA SISTM, Univ. Bordeaux Segalen ISPED, Bordeaux, France
| | - Rodolphe Thiébaut
- Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France; INSERM U897, INRIA SISTM, Univ. Bordeaux Segalen ISPED, Bordeaux, France
| | - Véronique Godot
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Pierre Wolkenstein
- Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France; Dermatology Department, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - Hakim Hocini
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France
| | - Yves Lévy
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France; Service d'Immunologie Clinique, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France.
| | - Sophie Hüe
- INSERM U955, Team 16, Créteil, France; Vaccine Research Institute (VRI), Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Université Paris Est Créteil, Faculté de Médecine, Créteil, France; Assistance publique, Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris Est Créteil, Val-de Marne (UPEC), Créteil, France; Service d'Immunologie Biologique, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
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86
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Nikolakis G, Join-Lambert O, Karagiannidis I, Guet-Revillet H, Zouboulis CC, Nassif A. Bacteriology of hidradenitis suppurativa/acne inversa: A review. J Am Acad Dermatol 2016; 73:S12-8. [PMID: 26470608 DOI: 10.1016/j.jaad.2015.07.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/16/2015] [Indexed: 01/30/2023]
Abstract
Given that follicular papules and pustules, as well as nodules and abscesses, are the clinical hallmarks of hidradenitis suppurativa (HS), an infectious, bacterial pathway has been suspected in the pathogenesis of this chronic, inflammatory condition. Elucidating the behavior and role of bacterial species in HS and their interaction with cutaneous innate immunity will provide more insight into the pathophysiology of this condition. This review of prospective investigations suggests a synergistic relationship between impaired innate immunity and microbial factors in the etiology of HS.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Olivier Join-Lambert
- Laboratory of Clinical Microbiology, Necker-Enfants Malades Hospital, Assistance publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm U1151, équipe 11 "Physiopathologie des infections systémiques", Paris, France; Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Ioannis Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Hélène Guet-Revillet
- Laboratory of Clinical Microbiology, Necker-Enfants Malades Hospital, Assistance publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm U1151, équipe 11 "Physiopathologie des infections systémiques", Paris, France; Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.
| | - Aude Nassif
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany; Institut Pasteur, Centre Médical, Service de Pathologie Infectieuse et Tropicale, Paris, France; Centre d'Infectiologie Necker-Pasteur, Paris, France
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Join-Lambert O, Duchatelet S, Delage M, Miskinyte S, Coignard H, Lemarchand N, Alemy-Carreau M, Lortholary O, Nassif X, Hovnanian A, Nassif A. Remission of refractory pyoderma gangrenosum, severe acne, and hidradenitis suppurativa (PASH) syndrome using targeted antibiotic therapy in 4 patients. J Am Acad Dermatol 2016; 73:S66-9. [PMID: 26470620 DOI: 10.1016/j.jaad.2015.07.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/18/2015] [Indexed: 11/16/2022]
Abstract
Pyoderma gangrenosum, severe acne, and suppurative hidradenitis (PASH) syndrome can prove refractory to treatment and is characterized by relapses and recurrences. The combination of antibiotic therapy and surgery can produce success in the management of the syndrome. Acute treatment is required, but maintenance therapy is also necessary to prevent disease relapse. The response to antibiotic therapy is hypothesis generating, raising the issue of a modified host response. To date, anecdotal reports support the use of surgery and medical therapy, but controlled investigations with extended follow-up are necessary to substantiate preliminary data observed with individual cases.
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Affiliation(s)
- Olivier Join-Lambert
- INSERM U1151 eq. 11, Université Paris Descartes - Sorbonne Paris Cité, Laboratory of Microbiology, Necker-Enfants Malades Hospital, Paris, France
| | - Sabine Duchatelet
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases: from Disease Mechanism to Therapies, Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Maïa Delage
- Institut Pasteur, Medical Center, Paris, France
| | - Snaigune Miskinyte
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases: from Disease Mechanism to Therapies, Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Hélène Coignard
- Department of Infectious Diseases, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Lemarchand
- Institut de Proctologie Léopold Bellan, Hôpital St Joseph, Paris, France
| | | | - Olivier Lortholary
- Department of Infectious Diseases, Hôpital Necker-Enfants Malades, Paris, France
| | - Xavier Nassif
- INSERM U1151 eq. 11, Université Paris Descartes - Sorbonne Paris Cité, Laboratory of Microbiology, Necker-Enfants Malades Hospital, Paris, France
| | - Alain Hovnanian
- INSERM UMR 1163, Laboratory of Genetic Skin Diseases: from Disease Mechanism to Therapies, Paris Descartes - Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - Aude Nassif
- Institut Pasteur, Medical Center, Paris, France.
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Join-Lambert O, Coignard-Biehler H, Jais JP, Delage M, Guet-Revillet H, Poirée S, Duchatelet S, Jullien V, Hovnanian A, Lortholary O, Nassif X, Nassif A. Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients. J Antimicrob Chemother 2015; 71:513-20. [PMID: 26565016 DOI: 10.1093/jac/dkv361] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/02/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Hidradenitis suppurativa (HS) is an inflammatory skin disease typically localized in the axillae and inguinal and perineal areas. In the absence of standardized medical treatment, severe HS patients present chronic suppurative lesions with polymicrobial anaerobic abscesses. Wide surgery is the cornerstone treatment of severe HS, but surgical indications are limited by the extent of lesions. Intravenous broad-spectrum antibiotics may help control HS, but their efficacy is not documented. This study was designed to assess the efficacy of a 6 week course of ertapenem (1 g daily) and of antibiotic consolidation treatments for 6 months (M6) in severe HS. PATIENTS AND METHODS Thirty consecutive patients with severe HS were retrospectively included in this study. The clinical severity of HS was assessed using the Sartorius score, which takes into account the number and severity of lesions. RESULTS The median (IQR) Sartorius score dropped from 49.5 (28-62) at baseline to 19.0 (12-28) after ertapenem (P < 10(-4)). Five patients were lost to follow-up thereafter. At M6 the Sartorius score further decreased for the 16 patients who received continuous consolidation treatments, since 59% of HS areas reached clinical remission at M6 (i.e. absence of any inflammatory symptoms, P < 10(-4)). Nine patients interrupted or received intermittent consolidation treatments due to poor observance or irregular follow-up. Their Sartorius score stopped improving or returned to baseline. No major adverse event occurred. CONCLUSIONS Ertapenem can dramatically improve severe HS. Consolidation treatments are needed to further improve HS and are mandatory to prevent relapses. Combined with surgery, optimized antibiotic treatments may be promising in severe HS.
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Affiliation(s)
- Olivier Join-Lambert
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Inserm U1151, eq. 11, Paris, France
| | - Hélène Coignard-Biehler
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Jais
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Service d'Informatique Médicale et de Biostatistiques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Inserm U1138, eq. 22, Paris, France
| | - Maïa Delage
- Centre d'Infectiologie Necker-Pasteur, Paris, France Service de Dermatologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France Institut Pasteur, Centre Médical, Paris, France
| | - Hélène Guet-Revillet
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Inserm U1151, eq. 11, Paris, France
| | - Sylvain Poirée
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Service de Radiologie Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sabine Duchatelet
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Inserm U1163, Laboratory of Genetic Skin Diseases: From Disease Mechanism to Therapies, Imagine Institute, Paris, France
| | - Vincent Jullien
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Inserm U663, Paris, France
| | - Alain Hovnanian
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Inserm U1163, Laboratory of Genetic Skin Diseases: From Disease Mechanism to Therapies, Imagine Institute, Paris, France
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Nassif
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Inserm U1151, eq. 11, Paris, France
| | - Aude Nassif
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Institut Pasteur, Centre Médical, Paris, France
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Lotte R, Lotte L, Ruimy R. Actinotignum schaalii (formerly Actinobaculum schaalii): a newly recognized pathogen-review of the literature. Clin Microbiol Infect 2015; 22:28-36. [PMID: 26577137 DOI: 10.1016/j.cmi.2015.10.038] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/14/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022]
Abstract
The genus Actinotignum contains three species, Actinotignum schaalii (formerly Actinobaculum schaalii), Actinotignum urinale and Actinotignum sanguinis. A. schaalii is the species most frequently involved in human infections, with 172 cases, mostly urinary tract infections (UTIs), reported so far. Invasive infections have also been described. This facultative anaerobic Gram-positive rod is part of the urinary microbiota of healthy patients. It is responsible for UTIs, particularly in elderly men and young children. A. schaalii is an underestimated cause of UTIs because of its fastidious growth on usual media and difficulties associated with its identification using phenotypic methods. Indeed, this slow-growth bacterium requires blood-enriched media and an incubation time of 48 hours under anaerobic or 5% CO2 atmosphere. Furthermore, only matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) or molecular-based methods allow the accurate identification of this bacteria. MALDI-TOF using Microflex LT with the Biotyper database (Bruker Daltonics, Bremen, Germany) is the most reliable technology for the routine identification of A. schaalii. The identification of this uropathogen is all the more important because it is resistant to trimethoprim/sulfamethoxazole and second-generation quinolones that are widely used in the treatment of UTIs. Antimicrobial therapy using β-lactams prolonged for up to 2 weeks is the most efficient treatment and should be recommended. Microbiologists should assess the presence of A. schaalii in urine using appropriate culture and identification methods in the case of a direct examination that is positive for small coccoid rods, a negative nitrite urinary stick associated with leukocyturia, treatment failure with trimethoprim/sulfamethoxazole or fluoroquinolones, or undocumented, repeated UTIs.
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Affiliation(s)
- R Lotte
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France; INSERM U1065 (C3M), Bacterial Toxins in Host Pathogen Interactions, C3M, Bâtiment Universitaire Archimed, Nice, France.
| | - L Lotte
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France
| | - R Ruimy
- Department of Bacteriology at Nice Academic Hospital, Nice, France; Nice Medical University, Nice-Sophia Antipolis University, Nice, France; INSERM U1065 (C3M), Bacterial Toxins in Host Pathogen Interactions, C3M, Bâtiment Universitaire Archimed, Nice, France
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Ring HC, Riis Mikkelsen P, Miller IM, Jenssen H, Fuursted K, Saunte DM, Jemec GBE. The bacteriology of hidradenitis suppurativa: a systematic review. Exp Dermatol 2015; 24:727-31. [PMID: 26119625 DOI: 10.1111/exd.12793] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2015] [Indexed: 12/14/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disabling skin disease consisting of recurrent nodules, sinuses, fistulas and scarring involving the intertriginous regions. HS is often a therapeutic challenge and most treatments are off-label. A better understanding of aetiology and pathogenesis of HS may facilitate the development of effective treatment. Although the clinical presentation is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacteria specimens. Consistent findings of Gram-positive cocci and Gram-positive rods including Staphylococus aureus, coagulase-negative staphylococci (CoNS) and Corynebacterium species in deep tissue samples have been demonstrated in HS and may constitute a central target for the immune system. Efficacy of antibiotics, that is rifampicin, clindamycin or tetracycline, supports a microbial role in disease pathogenesis. However, these antibiotics also work as immunomodulators of especially T cells, and the underlying mechanisms may therefore be more complex. We performed a systematic review of previous studies investigating the bacterial flora in hidradenitis suppurativa. We searched PubMed, EMBASE, Royal Danish Library and Cochrane library (search date 11 December 2014). A total of 66 papers were identified and nine papers published between 1988 and 2014 matched our inclusion criteria, yielding bacteriological data of a total of 324 patients with HS (mean age 36.8 years and female/male ratio 215/109). This overview of the bacteriology may aid researchers and physicians exploring the potential role of bacteria in HS. Furthermore, to stimulate a broader debate, we also present different viewpoints on the possible role of bacteria in HS.
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Affiliation(s)
- Hans Christian Ring
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Peter Riis Mikkelsen
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Iben Marie Miller
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Håvard Jenssen
- Department of Science, Systems and Models, Roskilde University, Roskilde, Denmark
| | - Kurt Fuursted
- Department of bacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Ditte Marie Saunte
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
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Abstract
Actinomycosis is a chronic infection caused by Actinomyces species characterized by abscess formation, tissue fibrosis, and draining sinuses. The spectrum of infections caused by Actinomyces species ranges from classical invasive actinomycosis to a less invasive form of superficial skin and soft tissue infection. We present a review detailing all Actinomyces species isolated from breast infections in NHS Lothian between 2005 and 2013, Actinomyces species isolated from breast infections referred to the United Kingdom Anaerobe Reference Unit between 1988 and 2014, and cases describing Actinomyces breast infections published in the medical literature since 1994. Actinomyces species are fastidious organisms which can be difficult to identify and are likely to be underascertained as a cause of breast infections. Due to improved diagnostic methods, they are increasingly associated with chronic, recurrent breast infections and may play a more significant role in these infections than has previously been appreciated.
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