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Oprea Y, Antohi DR, Vague M, Delbourgo Patton C, Wu B, Ortega-Loayza AG. Human Inborn Errors of Immunity in Pyoderma Gangrenosum: A Systematic Review. Am J Clin Dermatol 2024:10.1007/s40257-024-00875-y. [PMID: 38951460 DOI: 10.1007/s40257-024-00875-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic dermatosis that can be associated with primary immunodeficiency. The pathogenesis of PG has not yet been elucidated, although contributions from dysregulation of the immune system in patients with apparent genetic predispositions have been postulated. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-guided systematic review with the objective of identifying inborn errors of immunity in the presence of PG as well as their clinical characteristics of severity including number of PG lesions and anatomic areas affected, and treatment outcomes. METHODS A literature search was performed using PubMed/MEDLINE, Embase, Cochrane Library, and Web of Science through August 24, 2023, for studies published in English using the search terms: "pyoderma gangrenosum," "inborn error of immunity," "immune defect*," and a list of genetic mutations potentially associated with PG. RESULTS Seventy-four cases of PG associated with inborn errors of immunity were identified. The results demonstrate an association of PG with a variety of inborn errors of immunity, including genetic mutations not classically associated with the condition. Genetic mutations such as BTK, IL1RN, ITGB2, LPIN2, MEFV, NFkB1, NLRP3, NLRP12, NOD2, PSMB8, PLCG2, PSTPIP1, RAG1, TTC37, and WDR1, as well as complement component 2/complement component 4 (C2/C4) and complement component 7 (C7) deficiencies were identified in the presence of either idiopathic or syndromic PG. Of note, mutations in genes such as PSMB8, NLRP3, and IL1RN were found to be associated with a more severe and atypical course of PG, whereas mutations in RAG1 as well as those causing a C2/C4 deficiency were associated with the mildest clinical presentations of PG. Mutations in NFkB1, ITGB2, and PSTPIP1 were associated with the most heterogeneous clinical presentations. CONCLUSIONS Human inborn errors of immunity may be implicated in the genetic predisposition to PG and may influence the clinical presentation. Due to the rarity of these diseases, further work must be done to describe the association between inborn errors of immunity and PG. Identifying inborn errors of immunity that may contribute to the development of PG may assist in further elucidating the mechanism of PG, guiding targeted treatment, and improving clinical outcomes for these patients.
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Affiliation(s)
- Yasmine Oprea
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Daniel R Antohi
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Morgan Vague
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | | | - Benedict Wu
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA.
- OHSU Center for Health and Healing, 3303 S Bond Avenue, Building 1, 16th Floor, Portland, OR, 97239, USA.
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Feola H, Luna Cian R, Mancinelli MC, Cordoba LM, Crespi C. PASH syndrome: A novel MEFV mutation variant with excellent response to adalimumab in a refractory case. Int J Dermatol 2024. [PMID: 38880986 DOI: 10.1111/ijd.17330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/18/2024]
Affiliation(s)
| | | | - Maria C Mancinelli
- Department of Dermatology, Hospital San Juan de Dios, La Plata, Argentina
| | - Lucia M Cordoba
- Department of Dermatology, Hospital San Juan de Dios, La Plata, Argentina
| | - Cesar Crespi
- Reference Center in Rare and Difficult-to-diagnose Diseases (CERyD), Department of Internal Medicine, Hospital San Juan de Dios, La Plata, Argentina
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3
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Thasneem A, Sif S, Rahman MM, Crovella S. Can telomeric changes orchestrate the development of autoinflammatory skin diseases? Ital J Dermatol Venerol 2024; 159:318-328. [PMID: 38502535 DOI: 10.23736/s2784-8671.23.07689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Telomeres, the safeguarding caps at the tips of chromosomes, are pivotal in the aging process of cells and have been linked to skin ailments and inflammatory conditions. Telomeres undergo a gradual reduction in length and factors such as oxidative stress hasten this diminishing process. Skin diseases including inflammatory conditions can be correlated with the shortening of telomeres and the persistent activation of DNA damage response in skin tissues. Telomere dysfunction could disrupt the balance of the skin, impairs wound healing, and may contribute to abnormal cytokine production. Skin aging and processes related to telomeres may function as one of the triggers for skin diseases. The presence of proinflammatory cytokines and dysfunctional telomeres in conditions such as Dyskeratosis Congenita implies a possible connection between the shortening of telomeres and the onset of chronic inflammatory skin disorders. In autoinflammatory skin diseases, chronic inflammation hinders wound healing thus aggravating the progression of the disease. The NF-ĸB pathway might contribute to the initiation or progression of chronic disorders by influencing mechanisms associated with telomere biology. The intricate connections between telomeres, telomerase, telomere-associated proteins, and skin diseases are still a complex puzzle to be solved. Here, we provide an overview of the impact of telomeres on both health and disease with a specific emphasis on their role in skin, inflammation and autoinflammatory skin disorders.
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Affiliation(s)
- Ayshath Thasneem
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Said Sif
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Md Mizanur Rahman
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Sergio Crovella
- Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar -
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4
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Zaino ML, Schadt CR, Callen JP, Owen LG. Pyoderma Gangrenosum: Diagnostic Criteria, Subtypes, Systemic Associations, and Workup. Dermatol Clin 2024; 42:157-170. [PMID: 38423678 DOI: 10.1016/j.det.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis with variable clinical features. The classic presentation is an ulceration with an erythematous to violaceous undermined border. Extracutaneous manifestations may occur. Associated systemic diseases include inflammatory bowel disease, inflammatory arthritides, and hematologic disorders. The pathophysiologic mechanism of disease is not completely known but likely related to the cumulative impact of inflammation, immune-mediated neutrophilic dysfunction, and genetic predisposition. Incidence is between 3 and 10 people per million but may be greater due to under recognition. In this article, we will discuss the diagnostic criteria, disease subtypes, systemic associations, and workup.
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Affiliation(s)
- Mallory L Zaino
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA.
| | - Courtney R Schadt
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
| | - Jeffrey P Callen
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
| | - Lafayette G Owen
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
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5
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Maronese CA, Moltrasio C, Marzano AV. Hidradenitis Suppurativa-Related Autoinflammatory Syndromes: An Updated Review on the Clinics, Genetics, and Treatment of Pyoderma gangrenosum, Acne and Suppurative Hidradenitis (PASH), Pyogenic Arthritis, Pyoderma gangrenosum, Acne and Suppurative Hidradenitis (PAPASH), Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO), and Rarer Forms. Dermatol Clin 2024; 42:247-265. [PMID: 38423685 DOI: 10.1016/j.det.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Hidradenitis suppurativa (HS) is an autoinflammatory skin disorder of the terminal hair follicle, which can present in sporadic, familial, or syndromic form. A classification has been proposed for the latter, distinguishing cases associated with a known genetic condition, with follicular keratinization disorders or with autoinflammatory diseases. This review focuses on the clinical and genetic features of those entities (ie, pyoderma gangrenosum [PG], acne and HS; PG, acne, pyogenic arthritis and HS; psoriatic arthritis, PG, acne and HS; synovitis, acne, pustulosis, hyperostosis, osteitis; and so forth) for which the collective term HS-related autoinflammatory syndromes is proposed.
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Affiliation(s)
- Carlo Alberto Maronese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace, 9, Milan 20122, Italy; Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace, 9, Milan 20122, Italy; Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy.
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6
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Łyko M, Ryguła A, Kowalski M, Karska J, Jankowska-Konsur A. The Pathophysiology and Treatment of Pyoderma Gangrenosum-Current Options and New Perspectives. Int J Mol Sci 2024; 25:2440. [PMID: 38397117 PMCID: PMC10889749 DOI: 10.3390/ijms25042440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity.
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Affiliation(s)
- Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Anna Ryguła
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Michał Kowalski
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Julia Karska
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alina Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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7
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Satoh TK. Genetic mutations in pyoderma gangrenosum, hidradenitis suppurativa, and associated autoinflammatory syndromes: Insights into pathogenic mechanisms and shared pathways. J Dermatol 2024; 51:160-171. [PMID: 38031879 DOI: 10.1111/1346-8138.17028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023]
Abstract
Pyoderma gangrenosum (PG), hidradenitis suppurativa (HS), and the associated autoinflammatory syndromes, including pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome, PSTPIP1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome, and pyogenic arthritis, pyoderma gangrenosum, acne, and suppurative hidradenitis (PAPASH) syndrome are dermatological conditions characterized by chronic inflammation and tissue damage. Recent advances in genetic research have identified specific mutations associated with these disorders, shedding light on their underlying pathogenic mechanisms. This review aims to summarize the current knowledge of identified mutations and presumed pathophysiology in PG, HS, and the associated autoinflammatory syndromes.
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Affiliation(s)
- Takashi K Satoh
- Department of Dermatology and Allergy, University Hospital, LMU, Munich, Germany
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8
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Marletta DA, Barei F, Moltrasio C, Genovese G, Marzano AV. A case of PASH syndrome treated with guselkumab. Int J Dermatol 2023; 62:e585-e587. [PMID: 37356041 DOI: 10.1111/ijd.16766] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/05/2023] [Accepted: 06/15/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Dario A Marletta
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Francesca Barei
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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9
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Fragoso NM, Masson R, Gillenwater TJ, Shi VY, Hsiao JL. Emerging Treatments and the Clinical Trial Landscape for Hidradenitis Suppurativa Part I: Topical and Systemic Medical Therapies. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00956-6. [PMID: 37402031 PMCID: PMC10366071 DOI: 10.1007/s13555-023-00956-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/01/2023] [Indexed: 07/05/2023] Open
Abstract
Hidradenitis suppurativa (HS) is an oftentimes debilitating condition that presents with painful nodules, abscesses, and sinus tracts. This condition is challenging to treat, in part because the pathogenesis of the condition is incompletely understood but also because there are limited therapeutic options. HS research is undergoing explosive growth with multiple new molecular pathways under study, which will hopefully lead to improved disease control for patients. Part I of this review will provide an overview of the emerging topical and systemic therapies under investigation for HS.
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Affiliation(s)
- Natalie M Fragoso
- Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Rahul Masson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - T Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA, 90089, USA.
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10
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Sandoval AGW, Vaughn LT, Huang JT, Barbieri JS. Role of Tumor Necrosis Factor-α Inhibitors in the Treatment and Occurrence of Acne: A Systematic Review. JAMA Dermatol 2023; 159:504-509. [PMID: 36930143 PMCID: PMC10024242 DOI: 10.1001/jamadermatol.2023.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/24/2023] [Indexed: 03/18/2023]
Abstract
Importance Tumor necrosis factor-α inhibitors (TNFis) approved to treat several inflammatory diseases are sometimes used off label to treat severe forms of acne that are refractory to conventional therapies. However, use of TNFis can also be followed by acne occurrence, suggesting an association between TNFis and acne. Most of the literature on the topic comprises case reports and series that have not been reviewed in a systematic manner. Objective To characterize the demographic characteristics, clinical presentations, treatments, and outcomes of patients receiving TNFis to treat acne and patients who develop acne following treatment of other conditions with TNFis. Evidence Review A systematic literature review was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. PubMed and Web of Science were searched from inception through October 17, 2022. Included studies reported on patients of any sex or age who received TNFis whose treatment was followed by resolution or occurrence of acne. Two independent reviewers screened studies based on predefined criteria and extracted data from each study, which were quantitatively combined. Findings A total of 53 studies reporting on 64 patients who received TNFis for the treatment of acne (n = 47) or who experienced acne after treatment with TNFis for a different condition (n = 17) (mean age, 28.7 years; range, 12-64 years; 6 female individuals [8.8%]) were included. The TNFis used included adalimumab, infliximab, and etanercept. Among the 47 patients treated for acne with TNFis, most had previously received antibiotics (31 [66.0%]) or isotretinoin (32 [68.1%]). Most (44 [93.6%]) experienced partial improvement (25 [53.2%]) or clearance (19 [40.4%]) with very few adverse effects reported (3 [6.4%]). Acne manifested as part of an inflammatory syndrome for 30 patients (63.8%). Among the 17 patients treated TNFis for a different condition followed by the occurrence of acne, only 1 patient (5.9%) reported having a history of acne. Therapy with TNFis was either discontinued (8 [47.1%]) or altered (6 [35.3%]) in most patients due to acne occurrence, typically with improvement in symptoms. Conclusions and Relevance The results of this systematic review suggest that TNFis can be effective in treating refractory acne but can also be associated with the occurrence of acne in certain instances. Further studies elucidating the role that TNF plays in treating and inducing acne could yield insight into off-label TNFi use and acne pathogenesis, potentially guiding clinical care of patients with acne treated or induced by TNFis.
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Affiliation(s)
| | | | - Jennifer T. Huang
- Department of Dermatology, Boston Children’s Hospital, Boston, Massachusetts
| | - John S. Barbieri
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts
- Associate Editor, JAMA Dermatology
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Moltrasio C, Cagliani R, Sironi M, Clerici M, Pontremoli C, Maronese CA, Tricarico PM, Crovella S, Marzano AV. Autoinflammation in Syndromic Hidradenitis Suppurativa: The Role of AIM2. Vaccines (Basel) 2023; 11:162. [PMID: 36680007 PMCID: PMC9862365 DOI: 10.3390/vaccines11010162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AIM2 is a key cytoplasmatic pathogen-sensor that detects foreign DNA from viruses and bacteria; it can also recognize damaged or anomalous presence of DNA, promoting inflammasome assembly and activation with the secretion of IL-1β, thus sustaining a chronic inflammatory state, potentially leading to the onset of autoinflammatory skin diseases. Given the implication of the IL-1β pathway in the pathogenesis of syndromic hidradenitis suppurativa (HS), an autoinflammatory immune-mediated skin condition, the potential involvement of AIM2 was investigated. METHODS Sequencing of the whole coding region of the AIM2 gene, comprising 5'- and 3' UTR and a region upstream of the first exon of ~800 bp was performed in twelve syndromic HS patients. RESULTS Six out of twelve syndromic HS patients carried a heterozygous variant c.-208 A ≥ C (rs41264459), located on the promoter region of the AIM2 gene, with a minor allele frequency of 0.25, which is much higher than that reported in 1000 G and GnomAD (0.075 and 0.094, respectively). The same variant was found at a lower allelic frequency in sporadic HS and isolated pyoderma gangrenosum (PG) (0.125 and 0.065, respectively). CONCLUSION Our data suggest that this variant might play a role in susceptibility to develop syndromic forms of HS but not to progress to sporadic HS and PG. Furthermore, epigenetic and/or somatic variations could affect AIM2 expression leading to different, context-dependent responses.
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Affiliation(s)
- Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, 34137 Trieste, Italy
| | - Rachele Cagliani
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Manuela Sironi
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Mario Clerici
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
- Don C. Gnocchi Foundation ONLUS, IRCCS, 20122 Milan, Italy
| | - Chiara Pontremoli
- Scientific Institute IRCCS E. MEDEA, Bioinformatics, 23842 Bosisio Parini, Italy
| | - Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha 2713, Qatar
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
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12
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Hidradenitis suppurativa: bacteriological study in surgical treatment. Postepy Dermatol Alergol 2022; 39:1101-1105. [PMID: 36686013 PMCID: PMC9837599 DOI: 10.5114/ada.2022.119008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/24/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Hidradenitis suppurativa (HS) is an inflammatory chronic disease of the hair follicles that presents with different lesions in the apocrine gland-bearing areas of the human body. There are many possible factors for HS. Acne inversa is not primarily considered to be an infectious disease. A variety of Gram-positive and Gram-negative bacteria have been found from the lesions sporadically. Aim To assess the bacteriological profile of HS before surgical treatment. Material and methods We collected specimens for aerobic microbiological testing from 18 patients before surgical treatment in our hospital. The specimens were obtained from abscesses, directly from skin fistulas, on day 1 of hospitalisation. Results The most common bacteria in HS lesions were Staphylococcus aureus and Proteus mirabilis. In 4 patients we found multi-drug-resistant bacteria (MLSB, MRSA and A. baumannii). Conclusions Long-term antibiotic treatment can cause multi-drug resistance in strains collected in HS lesions.
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Therapeutic Effect of Bee Venom and Melittin on Skin Infection Caused by Streptococcus pyogenes. Toxins (Basel) 2022; 14:toxins14100663. [PMID: 36287932 PMCID: PMC9611473 DOI: 10.3390/toxins14100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pyogenes (S. pyogenes) bacteria cause almost all primary skin infections in humans. Bee venom (BV) and melittin (Mel) have multiple effects, including antibacterial and anti-inflammatory activities. This study aims to demonstrate their effects on bacterial mouse skin infection using S. pyogenes. The dorsal skin was tape-stripped, then S. pyogenes was topically applied. BV or Mel were topically applied to the lesion. The tissues were stained with hematoxylin and eosin, while immunohistochemical staining was performed with anti-neutrophil. S. pyogenes-infected skin revealed increased epidermal and dermal layers, but it was reduced in the BV and Mel groups. Finding increased neutrophils in the mice infected with S. pyogenes, but the BV and Mel mice showed decreased expression. These results suggest that BV and Mel treatments could reduce the inflammatory reactions and help improve lesions induced by S. pyogenes skin infection. This study provides additional assessment of the potential therapeutic effects of BV and Mel in managing skin infection caused by S. pyogenes, further suggesting that it could be a candidate for developing novel treatment alternative for streptococcal skin infections.
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14
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Hidradenitis Suppurativa: A Perspective on Genetic Factors Involved in the Disease. Biomedicines 2022; 10:biomedicines10082039. [PMID: 36009585 PMCID: PMC9406067 DOI: 10.3390/biomedicines10082039] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease of the pilosebaceous unit, clinically consisting of painful nodules, abscesses, and sinus tracts mostly in, but not limited to, intertriginous skin areas. HS can be defined as a complex skin disease with multifactorial etiologies, including—among others—genetic, immunologic, epigenetic, and environmental factors. Based on genetic heterogeneity and complexity, three different forms can be recognized and considered separately as sporadic, familial, and syndromic. To date, several genetic variants associated to disease susceptibility, disease-onset, and/or treatment response have been reported; some of these reside in genes encoding the gamma-secretase subunits whereas others involve autoinflammatory and/or keratinization genes. The aim of this perspective work is to provide an overview of the contribution of several genetic studies encompassing family linkage analyses, target candidate gene studies, and -omic studies in this field. In our viewpoint, we discuss the role of genetics in Hidradenitis suppurativa considering findings based on Sanger sequencing as well as the more recent Next Generation Sequencing (i.e., exome sequencing or RNA Sequencing) with the aim of better understanding the etio-pathogenesis of the disease as well as identifying novel therapeutic strategies.
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15
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Joshi TP, Wang HY, Athukuri P, Bohac S, Farr MA, Hinson D, Kahla JA, Khalfe N, McBee DB, Stroh R, Walters N, Ren V. Biologic Therapies for the Management of Cutaneous Findings in Genodermatoses: A Review. Am J Clin Dermatol 2022; 23:673-688. [PMID: 35606649 DOI: 10.1007/s40257-022-00700-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 01/17/2023]
Abstract
Genodermatoses are genetically inherited dermatologic conditions. The management of cutaneous findings in genodermatoses is challenging, and first-line therapies, such as steroids and/or retinoids, are often inadequate. In recent years, research on the molecular basis of genodermatoses has led to the use of biologic therapies for intractable disease. Here, we review the evidence regarding the use of available biologic therapies for the management of dermatologic findings in genodermatoses. Biologic therapies appear to be promising therapeutic options for several recalcitrant genodermatoses, especially those with underlying immune dysregulation. However, not all genodermatoses are amenable to biologic therapies, and some have been shown to paradoxically worsen under treatment. Biologic therapies offer a novel avenue to target refractory genodermatoses. However, evidence supporting the use of biologic therapies in the management of genodermatoses is mostly limited to case reports and case series. Further studies are warranted to determine the safety and efficacy of biologic therapies for the management of cutaneous findings in genodermatoses.
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16
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Almughrbi AH, Crovella S. Molecular analysis of inflammatory diseases. Exp Dermatol 2022; 31 Suppl 1:9-16. [PMID: 35451529 DOI: 10.1111/exd.14581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
If we try to describe the search for molecular actors involved in inflammatory diseases, the picture best representing this task is a mission to unexplored worlds. However, researchers nowadays have powerful tools to support this journey to the complexity of the unknown: Next generation Sequencing technologies have provided a plethora of data describing the different OMICs possibly involved in the different inflammatory diseases. Here we focused on autoinflammatory skin diseases showing the progress of OMICs-related findings in the understanding of Syndromic HS pathogenesis. We described the studies reporting possible genotype/phenotype correlation in PASH and PAPASH patients (both unrelated or familial cases), highlighting those just genetic variations associated with the diseases have been observed, but the information on common pathways shared by PASH and PAPASH patients were lacking, thus rendering difficult to decipher the common molecular basis of these autoinflammatory conditions. Aimed at filling this gap of knowledge, we proposed an integrated OMICs approach able to identify common pathways shared by subjects suffering from PASH and PAPASH: pathway-based whole sequencing analysis allowed the identification of 4 pathways, keratinization, formation of the cornified envelope steroid metabolism and Vitamin D metabolism, disrupted in PASH and PAPASH patients. Finally, we mentioned the novel bioinformatic platform, named PlatOMICs, capable of integrating OMICs experimental findings also with the ones already reported in public repositories supporting the efforts of the researchers and clinicians to discover molecular pathways shared by individuals suffering of a disease, confronting, and integrating the bench findings with the in-silico ones.
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Affiliation(s)
- Aya Hamad Almughrbi
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University
| | - Sergio Crovella
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University
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17
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Fischer AH, Jourabchi N, Khalifian S, Lazarus GS. Spectrum of diseases associated with pyoderma gangrenosum and correlation with effectiveness of therapy: new insights on the diagnosis and therapy of comorbid hidradenitis suppurativa. Wound Repair Regen 2022; 30:338-344. [PMID: 35385180 DOI: 10.1111/wrr.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) has been linked to various underlying systemic diseases; many associations are based on case reports or small case series, including hidradenitis suppurativa. Literature examining systemic therapies according to underlying comorbid condition is limited. OBJECTIVE To investigate comorbid diseases of PG and correlate disease associations with effectiveness of therapeutic interventions. METHODS Using Johns Hopkins medical records, 220 patients had an ICD-9 code of 686.01 for PG between 01/01/2006-06/30/2015, of whom 130 patients met rigorous inclusion/exclusion criteria for PG (non-peristomal). RESULTS The 130 PG patients in our study were 69% female, 58% Caucasian, and 35% African American. Documented comorbid conditions included inflammatory bowel disease (IBD; 35%), rheumatoid arthritis (RA; 12%), hidradenitis suppurativa (HS; 14%), monoclonal gammopathy (12%). PG patients with HS vs without HS were more likely to be African-American (83% vs 28%; P<0.001) and had an earlier mean age of PG onset (38 vs 48 years; P=0.02). Strikingly, 53% of female African-American patients with PG onset prior to age 40 had comorbid HS. Comorbid inflammatory bowel disease was observed in 38% of PG patients with RA, 28% of PG patients with HS, and 27% of PG patients with monoclonal gammopathy. Of the 32 patients who received infliximab for active PG, complete ulcer healing was observed in 83% (5/6) of patients with comorbid HS versus 31% (8/26) of patients without HS (Fisher exact P=0.03). CONCLUSIONS Screening patients for associated systemic disease for multiple related illnesses is essential. Effectiveness of systemic therapy may depend upon the underlying systemic disease; hidradenitis suppurativa may be a specific example. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexander H Fischer
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Natanel Jourabchi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Saami Khalifian
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerald S Lazarus
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Duke University Medical Center, Durham, North Carolina, USA
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18
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Huang J, Tsang LSL, Shi W, Li J. Pyoderma Gangrenosum, Acne, and Hidradenitis Suppurativa Syndrome: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:856786. [PMID: 35402426 PMCID: PMC8987973 DOI: 10.3389/fmed.2022.856786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
Pyoderma gangrenosum, acne, and hidradenitis suppurativa syndrome is a rare inflammatory disease characterized by pyoderma gangrenosum (PG), mild to severe facial acne, and hidradenitis suppurativa (HS). It only affects the skin and represents cutaneous characteristics of a spectrum of autoinflammation. Lack of pyogenic sterile arthritis (PA) distinguishes the pyoderma gangrenosum, acne, and hidradenitis suppurativa (PASH) syndrome from pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PA-PASH), pyoderma gangrenosum, acne, hidradenitis suppurtiva, and ankylosing spondylitis (PASS), and pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndromes. The exact etiology and pathogenesis of PASH syndrome remain unknown. Both PG and HS are contained in the spectrum of neutrophilic dermatitis, which is considered as an autoinflammatory syndrome. From a pathophysiological point of view, they show similar mechanisms, including neutrophil-rich cutaneous infiltration and overexpression of the interleukin-1 (IL-1) family. These findings provide guidance for these intractable diseases. In this review, we described a case of PASH syndrome in a patient who initially failed to respond to immunosuppressive treatment but responded to a combination of colchicine and thalidomide. We reviewed the relevant literature that focuses on PASH syndrome management.
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Affiliation(s)
- Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Lemuel Shui-Lun Tsang
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Wei Shi,
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Ji Li,
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19
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Pace NP, Mintoff D, Borg I. The Genomic Architecture of Hidradenitis Suppurativa-A Systematic Review. Front Genet 2022; 13:861241. [PMID: 35401657 PMCID: PMC8986338 DOI: 10.3389/fgene.2022.861241] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/07/2022] [Indexed: 12/11/2022] Open
Abstract
Hidradenitis suppurativa is a chronic, suppurative condition of the pilosebaceous unit manifesting as painful nodules, abscesses, and sinus tracts mostly in, but not limited to, intertriginous skin. Great strides have been made at elucidating the pathophysiology of hidradenitis suppurativa, which appears to be the product of hyperkeratinization and inflammation brought about by environmental factors and a genetic predisposition. The identification of familial hidradenitis suppurativa has sparked research aimed at identifying underlying pathogenic variants in patients who harbor them. The objective of this review is to provide a broad overview of the role of genetics in various aspects of hidradenitis suppurativa, specifically the pathophysiology, diagnosis, and clinical application.
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Affiliation(s)
- Nikolai Paul Pace
- Center for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Dillon Mintoff
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Isabella Borg
- Center for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Pathology, Mater Dei Hospital, Msida, Malta
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20
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Flora A, Kozera E, Frew JW. Pyoderma Gangrenosum: A Systematic Review of the Molecular Characteristics of Disease. Exp Dermatol 2022; 31:498-515. [PMID: 35114021 DOI: 10.1111/exd.14534] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
Pyoderma Gangrenosum is a painful recurrent ulcerative neutrophilic dermatosis in which the pathogenesis is incompletely defined. Current evidence suggests that PG is associated with dysregulation of components of both the innate and adaptive immune system with dysregulation of neutrophil function and contribution of the Th17 immune axis. PG can present in numerous heterogeneous clinical presentations and be associated with multiple inflammatory conditions including Rheumatoid Arthritis, inflammatory bowel disease and hidradenitis suppurativa. However, no critical evaluation of the observed molecular characteristics in PG studies in association with their clinical findings has been assessed. Additionally, emerging evidence suggests a potential role for other cell types and immune pathways including B cells, macrophages, autoantibodies, and the complement system in PG although these have not yet been integrated into the pathogenesis of disease. This systematic review aims to critically evaluate the current molecular observations regarding the pathogenesis of PG and discuss associations with clinical characteristics as well as the evidence supporting novel cell types and immune pathways in PG.
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Affiliation(s)
- Akshay Flora
- Ingham Institute for Applied Medical Research.,Department of Dermatology, Liverpool Hospital.,University of New South Wales
| | - Emily Kozera
- Ingham Institute for Applied Medical Research.,Department of Dermatology, Liverpool Hospital
| | - John W Frew
- Ingham Institute for Applied Medical Research.,Department of Dermatology, Liverpool Hospital.,University of New South Wales
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21
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Baroud S, Wu J, Zouboulis CC. Acne Syndromes and Mosaicism. Biomedicines 2021; 9:biomedicines9111735. [PMID: 34829964 PMCID: PMC8615598 DOI: 10.3390/biomedicines9111735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 01/14/2023] Open
Abstract
Abnormal mosaicism is the coexistence of cells with at least two genotypes, by the time of birth, in an individual derived from a single zygote, which leads to a disease phenotype. Somatic mosaicism can be further categorized into segmental mosaicism and nonsegmental somatic mosaicism. Acne is a chronic illness characterized by inflammatory changes around and in the pilosebaceous units, commonly due to hormone- and inflammatory signaling-mediated factors. Several systemic disorders, such as congenital adrenal hyperplasia, polycystic ovarian syndrome, and seborrhoea-acne-hirsutism-androgenetic alopecia syndrome have classically been associated with acne. Autoinflammatory syndromes, including PAPA, PASH, PAPASH, PsAPASH, PsaPSASH, PASS, and SAPHO syndromes include acneiform lesions as a key manifestation. Mosaic germline mutations in the FGFR2 gene have been associated with Apert syndrome and nevus comedonicus, two illnesses that are accompanied by acneiform lesions. In this review, we summarize the concept of cutaneous mosaicism and elaborate on acne syndromes, as well as acneiform mosaicism.
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Affiliation(s)
- Sumer Baroud
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany; (S.B.); (J.W.)
- College of Medicine, University of Sharjah, Sharjah P.O. Box 27272, United Arab Emirates
| | - Jim Wu
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany; (S.B.); (J.W.)
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany; (S.B.); (J.W.)
- Correspondence: ; Tel.: +49-340-501-4000
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22
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Mutation in the proline-serine-threonine phosphatase-interacting protein 1 ( PSTPIP1) gene in a patient with acute lymphoblastic leukemia. Cent Eur J Immunol 2021; 46:270-274. [PMID: 34764798 PMCID: PMC8568035 DOI: 10.5114/ceji.2021.107030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/24/2020] [Indexed: 12/05/2022] Open
Abstract
Autoinflammatory syndromes are disorders characterized by recurrent or chronic inflammation caused by the dysregulation of the innate immune system. Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome of overactivation of the immune system. We present a case of a 20-month-old boy who was referred to an oncology clinic because of HLH suspicion. In the preceding time, our patient suffered from a severe form of chickenpox with prolonged fever. Tests including myelogram, cerebrospinal fluid, and magnetic resonance (MR) of the brain gave a diagnosis of acute lymphoblastic leukemia from B lymphocyte precursors, without occupying the central nervous system. To exclude inherited HLH in our patient, next-generation sequencing was performed, which revealed a heterozygous missense mutation in exon 15 of the PSTPIP1 gene (c.1213C>T, R405C). No mutations of genes associated with familial HLH syndrome were found. Our patient may be evidence that autoinflammatory diseases caused by PSTPIP1 gene mutations are not limited to the classical pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) phenotype but may have a different clinical presentation, and the spectrum of the PSTPIP1-associated inflammatory diseases (PAID) syndrome is more extensive than previously thought.
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23
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Johnston DGW, Kirby B, Tobin DJ. Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction? Exp Dermatol 2021; 30:1554-1568. [PMID: 34418166 DOI: 10.1111/exd.14451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022]
Abstract
The innate immune system of human skin consists of a multi-layered barrier consisting of cells and soluble effector molecules charged with maintaining homeostasis and responding to insults and infections. It has become increasingly clear that these barrier layers become compromised in skin diseases, especially in disorders of an (auto)inflammatory nature. In the case of hidradenitis suppurativa, great strides have been made in recent years in characterizing the underlying breakdown in homeostatic innate immunity, including an increasing understanding of the central role of the hair follicle in this process. This breakdown appears to occur at multiple levels: the pilosebaceous unit, associated epithelium, the cutaneous microbiome, alteration of immune cell function and local molecular events such as complement activation. This review seeks to summarize, contextualize and analyse critically our current understanding of how these innate immune barriers become dysregulated in the early stage(s) of hidradenitis suppurativa, and to speculate on where potential hidradenitis suppurativa research could be most fruitful.
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Affiliation(s)
- Daniel G W Johnston
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Brian Kirby
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,The Conway Institute, University College Dublin, Dublin 4, Ireland
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24
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Kirsten N, Frings V, Nikolakis GD, Presser D, Goebeler M, Zouboulis CC, Augustin M. [Epidemiology, patient quality of life, and treatment costs of hidradenitis suppurativa/acne inversa]. Hautarzt 2021; 72:651-657. [PMID: 34223939 DOI: 10.1007/s00105-021-04851-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
Hidradenitis suppurativa/acne inversa (HS) is associated with numerous and relevant restrictions on the quality of life for those affected and their relatives. The exact prevalence of HS varies significantly across studies, but it is likely to be higher than suggested in previous publications. HS care is associated with high costs for the healthcare system and for those affected. The introduction of biologic therapy has led to additional costs, but also to considerable additional benefits in terms of care. In view of the complexity of diagnostics and therapy, there is a particular need for optimized care concepts in order to reduce the burden on those affected, their relatives and the healthcare system.
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Affiliation(s)
- N Kirsten
- Institut für Versorgungforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Gebäude West 38 (W38), Martinistr. 52, 20246, Hamburg, Deutschland. .,Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.
| | - V Frings
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - G D Nikolakis
- Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - D Presser
- Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - M Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - C C Zouboulis
- Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - M Augustin
- Institut für Versorgungforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Gebäude West 38 (W38), Martinistr. 52, 20246, Hamburg, Deutschland.,Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland
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25
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The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136709. [PMID: 34206415 PMCID: PMC8293810 DOI: 10.3390/ijerph18136709] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent and debilitating inflammatory skin disease of the hair follicle that usually presents as painful, deep-seated inflamed lesions in the apocrine gland-bearing areas of the body. HS patients suffer from uncomfortable signs and symptoms, such as pain, pruritus, malodour and suppuration, which may impair patients’ quality of life (QoL). Although HS patients frequently experience these signs and symptoms, they are only occasionally assessed by clinicians and, unexpectedly, the scientific evidence available is limited and heterogeneous. The aim of this study is to summarize the evidence regarding the impact of HS signs and symptoms on QoL to serve as a basis for future research and help clinicians to consider them in the daily care of HS patients. A systematic review and meta-analysis were conducted following PRISMA Guidelines. The following search algorithm was used: (hidradenitis or “acne inversa”) and (pain or itch or odour or malodour or suppuration or oozing or drainage) and (“quality of life”). The literature search identified 836 references, 17 of them met the eligible criteria and were included for analysis, representing 4929 HS patients. Mean age of the participants was 36.28 years and there was a predominance of female sex among study participants. The BMI of the population was in the range of over-weight and about two out five patients were active smokers. Studies included patients with mild to moderate HS, with a mean disease duration of 13.69 years. The HS signs and symptoms assessed were pain, pruritus, malodour and suppuration. Overall, the higher intensity of a sign or symptom correlated with poorer general QoL or specific QoL dimensions including sexual distress, anxiety, depression and sleep. The most frequently employed tool to assess QoL was the Dermatology Life Quality Index (DLQI). DLQI was used in 52.9% of the studies (9/17) with a mean value of 10.70 (2.16 SD). The scores employed to assess signs and symptoms severity were subjective and varied between studies, being the numerical rating scale (NRS) for each of the most used symptoms. The mean NRS value for pain was 3.99 and the mean NRS for pruritus was 4.99. In conclusion, we have summarized, categorized and analyzed the scientific evidence regarding signs and symptoms in HS patients and their impairment in QoL. Their assessment should be thorough and included during routine evaluation of HS patients to motivate therapeutic modifications and increase patients’ health.
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26
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Meier-Schiesser B, French LE. Autoinflammationssyndrome. J Dtsch Dermatol Ges 2021; 19:400-428. [PMID: 33709590 DOI: 10.1111/ddg.14332_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lars E French
- Klinik und Poliklinik für Dermatologie und Allergologie, Ludwigs-Maximilians-Universität München, Deutschland
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27
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Meier-Schiesser B, French LE. Autoinflammatory syndromes. J Dtsch Dermatol Ges 2021; 19:400-426. [PMID: 33620111 DOI: 10.1111/ddg.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023]
Abstract
Autoinflammatory syndromes are a steadily growing group of inflammatory diseases caused by abnormal regulations of the innate immune system. The clinical presentation is multifaceted, but recurrent fever, skin involvement, joint inflammation and other systemic symptoms of inflammation are characteristic. In contrast to classic autoimmune diseases, autoantibodies or specific T cells are not involved in the pathogenesis. In fact, innate immunity plays the most important role in autoinflammation. While activation of the innate immune system is usually self-limiting in healthy individuals, mutations and dysregulation can lead to chronic and excessive activation of innate immune responses and to the development of autoinflammatory diseases.
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Affiliation(s)
| | - Lars E French
- Department of Dermatology, Ludwig-Maximilians University Hospital, Munich, Germany
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28
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[Painful ulceration, abscesses and scars in a 39-year-old woman]. Hautarzt 2021; 72:81-83. [PMID: 32776231 DOI: 10.1007/s00105-020-04668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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29
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Vural S, Baumgartner M, Lichtner P, Eckstein G, Hariry H, Chen WC, Ruzicka T, Melnik B, Plewig G, Wagner M, Giehl KA. Investigation of gamma secretase gene complex mutations in German population with Hidradenitis suppurativa designate a complex polygenic heritage. J Eur Acad Dermatol Venereol 2021; 35:1386-1392. [PMID: 33559291 DOI: 10.1111/jdv.17163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting apocrine gland-bearing skin in the axilla, groin and under the breasts. Mutations of the gamma secretase gene complex, which is essential in the activation of Notch signalling pathways, were shown in some families with HS and in a few sporadic cases. Although an imbalance in Notch signalling is implicated in the pathogenesis, the exact mechanism of HS development is yet unknown. OBJECTIVES We aim to investigate the genetic basis of HS by determining the presence of mutations of gamma secretase gene complex in a cohort of HS patients and by searching for a disease-causing pathogenic variant in a multi-generational HS family using parametric linkage analysis. METHODS Thirty-eight patients clinically diagnosed with HS were included in this study. All exons and exon-intron boundaries of the genes encoding gamma secretase complex consisting of six genes: APH1A, APH1B, PSENEN, NCSTN, PSEN1 and PSEN2 were sequenced by Sanger technique. Genetic mapping with parametric linkage analysis for the patients in the family was performed with eight affected and four healthy individuals. The logarithm of odds was calculated. RESULTS In a sporadic patient with early-onset, severe lesions in axilla and groin, a novel single-nucleotide deletion causing frameshift in exon 1 of the NCSTN gene was identified ((NM_015331.3): c.38delG, p.(Gly13Glufs*15)). The LOD score of 1.5 was never exceeded in any region of the genome, pointing towards intricate multi-genic inheritance pattern within the affected family. CONCLUSIONS The gamma secretase gene complex mutations were rare in our cohort (3.2%). Besides, our analysis indicates a possible complex multi-genic inheritance in a seemingly autosomal dominantly inherited large HS family. Genetics of both familial and sporadic HS may be complicated in most cases, and the role of other potential genes such as autoinflammatory and modifier genes as well as environmental factors may influence the pathogenesis.
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Affiliation(s)
- S Vural
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany.,Department of Dermatology and Venereology, Koç University School of Medicine, İstanbul, Turkey
| | - M Baumgartner
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - P Lichtner
- Institute of Human Genetics, Technical University Munich, Neuherberg, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - G Eckstein
- Institute of Human Genetics, Technical University Munich, Neuherberg, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - H Hariry
- Gemeinschaftpraxis, Gütersloh, Germany
| | - W C Chen
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - B Melnik
- Gemeinschaftpraxis, Gütersloh, Germany.,Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - G Plewig
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - M Wagner
- Institute of Human Genetics, Technical University Munich, Neuherberg, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - K A Giehl
- Department of Dermatology and Allergy, Ludwig-Maximilian-University of Munich, Munich, Germany
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Tyrkalska SD, Candel S, Mulero V. The neutrophil inflammasome. DEVELOPMENTAL AND COMPARATIVE IMMUNOLOGY 2021; 115:103874. [PMID: 32987011 DOI: 10.1016/j.dci.2020.103874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Since inflammasomes were discovered in the early 21st century, knowledge about their biology has multiplied exponentially. These cytosolic multiprotein complexes alert the immune system about the presence of infection or tissue damage, and regulate the subsequent inflammatory responses. As inflammasome dysregulation is increasingly associated with numerous autoinflammatory disorders, there is an urgent need for further research into the inflammasome's involvement in the pathogenesis of such diseases in order to identify novel therapeutic targets and treatments. The zebrafish has become a widely used animal model to study human diseases in recent years, and has already provided relevant findings in the field of inflammasome biology including the identification of new components and pathways. We provide a detailed analysis of current knowledge on neutrophil inflammasome biology and compare its features with those of the better known macrophage inflammasome, focusing on its contribution to innate immunity and its relevance for human health. Importantly, a large body of evidence points to a link between neutrophil inflammasome dysfunction and many neutrophil-mediated human diseases, but the real contribution of the neutrophil inflammasome to the pathogenesis of these disorders is largely unknown. Although neutrophils have remained in the shadow of macrophages and monocytes in the field of inflammasome research since the discovery of these multiprotein platforms, recent studies strongly suggest that the importance of the neutrophil inflammasome has been underestimated.
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Affiliation(s)
- Sylwia D Tyrkalska
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain.
| | - Sergio Candel
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain.
| | - Victoriano Mulero
- Departamento de Biología Celular e Histología, Facultad de Biología, Universidad de Murcia, Spain; Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain.
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31
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Frew JW, Marzano AV, Wolk K, Join-Lambert O, Alavi A, Lowes MA, Piguet V. A Systematic Review of Promising Therapeutic Targets in Hidradenitis Suppurativa: A Critical Evaluation of Mechanistic and Clinical Relevance. J Invest Dermatol 2021; 141:316-324.e2. [DOI: 10.1016/j.jid.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
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32
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Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos‐Bourboulis EJ, Fabbrocini G, Frew JW, Fujita H, González‐López MA, Guillem P, Gulliver WPF, Hamzavi I, Hayran Y, Hórvath B, Hüe S, Hunger RE, Ingram JR, Jemec GB, Ju Q, Kimball AB, Kirby JS, Konstantinou MP, Lowes MA, MacLeod AS, Martorell A, Marzano AV, Matusiak Ł, Nassif A, Nikiphorou E, Nikolakis G, Nogueira da Costa A, Okun MM, Orenstein LA, Pascual JC, Paus R, Perin B, Prens EP, Röhn TA, Szegedi A, Szepietowski JC, Tzellos T, Wang B, van der Zee HH. What causes hidradenitis suppurativa ?—15 years after. Exp Dermatol 2020; 29:1154-1170. [DOI: 10.1111/exd.14214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hôpital Erasme Universite Libre de Bruxelles Bruxelles Belgium
| | - Angel S. Byrd
- Department of Dermatology Howard University College of Medicine Washington DC USA
| | - Nisha S. Chandran
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Department of Medicine National University Hospital Singapore
| | - Evangelos J. Giamarellos‐Bourboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Medical School Athens Greece
| | - Gabriella Fabbrocini
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | | | - Hideki Fujita
- Division of Cutaneous Science Department of Dermatology Nihon University School of Medicine Tokyo Japan
| | - Marcos A. González‐López
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Hospital Universitario Marqués de Valdecilla University of Cantabria IDIVAL Santander Spain
| | - Philippe Guillem
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Surgery Clinique du Val d’Ouest (Lyon), ResoVerneuil (Paris) and Groupe de Recherche en Proctologie de la Société Nationale Française de ColoProctologie Paris France
| | - Wayne P. F. Gulliver
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Faculty of Medicine Memorial University of Newfoundland, and NewLab Clinical Research Inc St. John's Canada
| | - Iltefat Hamzavi
- Department of Dermatology Henry Ford Hospital Wayne State University Detroit MI USA
| | - Yildiz Hayran
- Department of Dermatology Ankara Numune Training and Research Hospital Ankara Turkey
| | - Barbara Hórvath
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology University Medical Centre Groningen University of Groningen Groningen The Netherlands
| | | | - Robert E. Hunger
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - John R. Ingram
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology & Academic Wound Healing Division of Infection and Immunity Cardiff University Cardiff UK
| | - Gregor B.E. Jemec
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Qiang Ju
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology RenJi Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - Alexa B. Kimball
- Department of Dermatology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Joslyn S. Kirby
- Department of Dermatology Penn State Milton S. Hershey Medical Center Hershey PA USA
| | - Maria P. Konstantinou
- Dermatology Department Paul Sabatier University University Hospital of Toulouse Toulouse France
| | | | - Amanda S. MacLeod
- Department of Dermatology Department of Immunology Department of Molecular Genetics and Microbiology Duke University Durham NC USA
| | - Antonio Martorell
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hospital of Manises Valencia Spain
| | - Angelo V. Marzano
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dermatology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Łukasz Matusiak
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Aude Nassif
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Institut Pasteur Paris France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases King’s College London, and Department of Rheumatology King’s College Hospital London UK
| | - Georgios Nikolakis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
| | - André Nogueira da Costa
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Translational Science and Experimental Medicine Early Respiratory and Immunology Biopharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | | | | | - José Carlos Pascual
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Alicante University General Hospital Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
| | - Ralf Paus
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - Benjamin Perin
- Division of Dermatology University of Washington Seattle WA USA
| | - Errol P. Prens
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
| | - Till A. Röhn
- Autoimmunity, Transplantation and Inflammation Novartis Institutes for BioMedical Research Novartis Pharma AG Basel Switzerland
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Jacek C. Szepietowski
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Nordland Hospital Trust Bodø Norway
| | - Baoxi Wang
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hessel H. van der Zee
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
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Saternus R, Schwingel J, Müller CSL, Vogt T, Reichrath J. Ancient friends, revisited: Systematic review and case report of pyoderma gangrenosum-associated autoinflammatory syndromes. J Transl Autoimmun 2020; 3:100071. [PMID: 33305249 PMCID: PMC7718158 DOI: 10.1016/j.jtauto.2020.100071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/29/2022] Open
Abstract
In the last decade, new scientific findings significantly improved our understanding of the molecular pathogenesis of autoinflammation and have resulted in the identification and definition of several pyoderma gangrenosum-associated autoinflammatory syndromes (PGAAIS) as new and distinct clinical entities. These different clinical entities include PAPA (pyogenic arthritis, pyoderma gangrenosum and acne conglobata), PASH (pyoderma gangrenosum, acne and suppurative hidradenitis), PAPASH (pyoderma gangrenosum, acne, suppurative hidradenitis and pyogenic arthritis), PsAPASH (pyoderma gangrenosum, acne, suppurative hidradenitis and psoriatic arthritis), PASS (pyoderma gangrenosum, acne conglobata, suppurative hidradenitis, and axial spondyloarthritis) and PAC (pyoderma gangrenosum, acne and ulcerative colitis), which can be distinguished by their clinical presentation and the presence or absence of mutations in several genes, such as the genes encoding proline-serine-threonine phosphatase-interacting protein 1 (PSTPIP1), nicastrin (NCSTN), Mediterranean fever (MEFV) and nucleotide-binding oligomerization domain-containing protein (NOD). In this systematic review, we summarize the present knowledge of this rapidly developing hot topic and provide a guide to enable the easy diagnosis of these syndromes in everyday clinical practice. Moreover, we report a rare case of PASS syndrome demonstrating successful treatment with adalimumab and another case of a previously unreported combination of symptoms, including psoriatic arthritis, pyoderma gangrenosum, suppurative hidradenitis and Crohn’s disease (newly coined PsAPSC), as examples. Because of the identification of similar genetic and pathogenic mechanisms of PGAAIS, we think the wide variety of seemingly different syndromes may represent distinct phenotypes of one disease. New scientific findings improved the understanding of the molecular pathogenesis of autoinflammation. There is a similar genetic background and clinical findings of PGAAIS. Because of the similar genetic and pathogenic mechanisms of PGAAIS may represent distinct phenotypes of one disease. We present a 4-sep guide to enable the easy diagnosis of theses disease in clinical practice.
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Affiliation(s)
- Roman Saternus
- Department of Dermatology, The Saarland University Hospital, 66421, Homburg, Germany
| | - Jérôme Schwingel
- Department of Internal Medicine, Caritasklinikum Saarbrücken St. Theresia, 66113, Saarbrücken, Germany
| | - Cornelia S L Müller
- Department of Dermatology, The Saarland University Hospital, 66421, Homburg, Germany
| | - Thomas Vogt
- Department of Dermatology, The Saarland University Hospital, 66421, Homburg, Germany
| | - Jörg Reichrath
- Department of Dermatology, The Saarland University Hospital, 66421, Homburg, Germany
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Latour-Álvarez I, Torrelo A. Cutaneous clues to diagnose autoinflammatory diseases. GIORN ITAL DERMAT V 2020; 155:551-566. [PMID: 33070568 DOI: 10.23736/s0392-0488.20.06652-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic autoinflammatory diseases (AIDs) are a group of disorders characterized by recurrent episodes of systemic inflammation. Suspecting the diagnosis can be difficult and many of the clinical manifestations are common to different diseases. Although most of the cutaneous manifestations are non-specific, it is important to know them because sometimes they can lead to the diagnosis. The purpose of this review was to synthesize the main cutaneous lesions of autoinflammatory diseases to aid in their diagnosis.
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Affiliation(s)
| | - Antonio Torrelo
- Department of Dermatology, Niño Jesús University Hospital, Madrid, Spain -
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Garcovich S, Genovese G, Moltrasio C, Malvaso D, Marzano AV. PASH, PAPASH, PsAPASH, and PASS: The autoinflammatory syndromes of hidradenitis suppurativa. Clin Dermatol 2020; 39:240-247. [PMID: 34272017 DOI: 10.1016/j.clindermatol.2020.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease usually involving the major skin folds characterized by a multifactorial pathogenesis and a wide spectrum of clinical manifestations. It can also rarely present in association with other diseases as complex clinical syndromes, causing additional diagnostic and therapeutic challenges. Different etiopathologic factors contribute to follicular inflammation and suppurative lesions of syndromic HS, including follicular hyperkeratinization and plugging, as well as activation of autoinflammatory pathways. Patients with syndromic HS frequently have a severe disease course, presenting with atypical skin involvement, signs of systemic inflammation, and resistance to conventional treatments. Systematic classification of syndromic HS is based on clinical, pathogenetic, and genetic factors, but it is constantly evolving due to increased disease awareness. Treatment of syndromic HS is difficult and should be personalized on a case-by-case basis. Investigating syndromic HS can lead to useful insights on genetics and pathogenesis, translating into new clinical approaches for sporadic hidradenitis. We review the classification, clinical presentation, disease associations, and therapeutic management of syndromic HS, focusing mainly on its autoinflammatory syndromes PASH, PAPASH, PsAPASH, and PASS.
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Affiliation(s)
- Simone Garcovich
- Institute of Dermatology, F. Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Advanced Diagnostics, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Dalma Malvaso
- Institute of Dermatology, F. Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that presents with rapidly developing, painful skin ulcers hallmarked by undermined borders and peripheral erythema. Epidemiological studies indicate that the average age of PG onset is in the mid-40s, with an incidence of a few cases per million person-years. PG is often associated with a variety of other immune-mediated diseases, most commonly inflammatory bowel disease and rheumatoid arthritis. The cause of PG is not well understood, but PG is generally considered an autoinflammatory disorder. Studies have focused on the role of T cells, especially at the wound margin; these cells may support the destructive autoinflammatory response by the innate immune system. PG is difficult to diagnose as several differential diagnoses are possible; in addition to clinical examination, laboratory tests of biopsied wound tissue are required for an accurate diagnosis, and new validated diagnostic criteria will facilitate the process. Treatment of PG typically starts with fast-acting immunosuppressive drugs (corticosteroids and/or cyclosporine) to reduce inflammation followed by the addition of more slowly acting immunosuppressive drugs with superior adverse event profiles, including biologics (in particular, anti-tumour necrosis factor (TNF) agents). Appropriate wound care is also essential. Future research should focus on PG-specific outcome measures and PG quality-of-life studies.
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Benzecry V, Grancini A, Guanziroli E, Nazzaro G, Barbareschi M, Marzano AV, Muratori S, Veraldi S. Hidradenitis suppurativa/acne inversa: a prospective bacteriological study and review of the literature. GIORN ITAL DERMAT V 2020; 155:459-463. [DOI: 10.23736/s0392-0488.18.05875-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Maitrepierre F, Marzano AV, Lipsker D. A Unified Concept of Acne in the PAPA Spectrum Disorders. Dermatology 2020; 237:827-834. [PMID: 32937626 DOI: 10.1159/000509874] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acne is a common condition. Sometimes acne or acne-like features are a part of autoinflammatory diseases such as PAPA spectrum disorders. Our objective wasto determine whether acne in PAPA spectrum disorders has specific phenotypic traits. SUMMARY This is aliterature review on reported cases of patients with PAPA, PAMI, PASH, PAPASH, PsAPASH, PAC or PASS syndrome. Acne was classified into four categories: moderate, severe, nodulocystic, acne fulminans.One hundred patients were included. Age of onset of acne and topography were the same as in acne vulgaris. Acne's phenotype was at least severe (including acne fulminans, nodulocystic and severe) in 83% of cases. Genetic mutations or variants with potential pathological significance were reported in 49 patients. The addition of isotretinoin to biotherapies was required to control acne in several patients.
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Affiliation(s)
- Flavie Maitrepierre
- Dermatology Clinic, Strasbourg University and Strasbourg University Hospitals, Strasbourg, France,
| | - Angelo Valerio Marzano
- 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, Italy
| | - Dan Lipsker
- Dermatology Clinic, Strasbourg University and Strasbourg University Hospitals, Strasbourg, France.,Faculty of Medicine, University of Strasbourg, Strasbourg, France
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Nikolakis G, Kaleta K, Vaiopoulos A, Wolter K, Baroud S, Wojas-Pelc A, Zouboulis C. Phenotypes and Pathophysiology of Syndromic Hidradenitis Suppurativa: Different Faces of the Same Disease? A Systematic Review. Dermatology 2020; 237:673-697. [DOI: 10.1159/000509873] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently autoinflammatory syndromes and their diagnostic delay might have detrimental effects on affected patients. <b><i>Methods:</i></b> A systematic review was performed on the databases MEDLINE, EMBASE, and CENTRAL utilizing a standardized extraction form according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. <b><i>Results:</i></b> Sixty-four eligible articles on syndromic HS were retrieved. The identified syndromes included already described ones (pyoderma gangrenosum-acne-suppurative hidradenitis, pyogenic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, psoriatic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, pyoderma gangrenosum-acne vulgaris-hidradenitis suppurativa-ankylosing spondylitis, synovitis-acne-pustulosis-hyperostosis-osteitis) and further novel symptom constellations. Cutaneous signs, including HS lesions, usually precede signs from other organs. The cutaneous signs of a considerable proportion of patients appear refractory to conventional treatment, and monotherapy with biologics does not suffice to sustain remission. <b><i>Conclusion:</i></b> The results are subsequently discussed with focus on the pathophysiology and treatment of the detected syndromes. The dermatologist’s role in the precise diagnosis and early treatment administration of HS is pivotal. The purpose of the treatment should be the effective prevention or delay of the autoinflammatory march and its irreversible consequences.
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Abstract
Pyogenic arthritis, pyoderma gangrenosum (PG) and acne (PAPA) syndrome is an autosomal dominant autoinflammatory syndrome due to mutations in proline-serine-threonine phosphatase interacting protein 1 (PSTPIP1) gene and presenting with cutaneous and articular manifestations. Other autoinflammatory syndromes caused by mutations in PSTPIP1 gene or characterized by clinical findings overlapping with those found in PAPA syndrome have been recently included in the group of PAPA spectrum disorders. These disorders are PASH (PG, acne and hidradenitis suppurativa [HS]), PAPASH (PASH associated with pyogenic sterile arthritis), PsAPASH (PASH combined with psoriatic arthritis [PsA], PASS (PG, acne, ankylosing spondylitis, with or without HS), PAC (PG, acne and ulcerative colitis [UC]) and PAMI syndrome (PSTPIP1-associated myeloid-related-proteinemia inflammatory syndrome). Except for PAPA and PAMI, no specific pathogenetic mutations have been identified in these syndromes. Dermatologists should be aware that PG, acne and HS may represent cutaneous signs hiding the presence of these rare entities. Systemic corticosteroids, a number of immunosuppressants and biologics, such as interleukin (IL)-1 antagonists and tumour necrosis factor (TNF) α inhibitors, are nowadays therapy for these diseases. A pathogenesis-driven treatment is the near future in the management of these conditions.
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Affiliation(s)
- Giovanni Genovese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Garcovich
- Institute of Dermatology, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Angelo V Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy - .,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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41
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Brandao L, Moura R, Tricarico PM, Gratton R, Genovese G, Moltrasio C, Garcovich S, Boniotto M, Crovella S, Marzano AV. Altered keratinization and vitamin D metabolism may be key pathogenetic pathways in syndromic hidradenitis suppurativa: a novel whole exome sequencing approach. J Dermatol Sci 2020; 99:17-22. [PMID: 32518053 DOI: 10.1016/j.jdermsci.2020.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/10/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diagnosis of pyoderma gangrenosum, acne and hidradenitis suppurativa (PASH) and pyogenic arthritis, pyoderma gangrenosum, acne, and hidradenitis suppurativa (PAPASH) patients, in spite of recently identified genetic variations, is just clinical, since most patients do not share the same mutations, and the mutations themselves are not informative of the biological pathways commonly disrupted in these patients. OBJECTIVE To reveal genetic changes more closely related to PASH and PAPASH etiopathogenesis, identifying novel common pathways involved in these diseases. METHODS Cohort study on PASH (n = 4) and PAPASH (n = 1) patients conducted using whole exome sequencing (WES) approach and a novel bioinformatic pipeline aimed at discovering potentially candidate genes selected from density mutations and involved in pathways relevant to the disease. RESULTS WES results showed that patients presented 90 genes carrying mutations with deleterious and/or damage impact: 12 genes were in common among the 5 patients and bared 237 ns ExonVar (54 and 183 in homozygosis and heterozygosis, respectively). In the pathway enrichment analysis, only 10 genes were included, allowing us to retrieve 4 pathways shared by all patients: (1) Vitamin D metabolism, (2) keratinization, (3) formation of the cornified envelope and (4) steroid metabolism. Interestingly, all patients had vitamin D levels lower than normal, with a mean value of 10 ng/mL. CONCLUSION Our findings, through a novel strategy for analysing the genetic background of syndromic HS patients, suggested that vitamin D metabolism dysfunctions seem to be crucial in PASH and PAPASH pathogenesis. Based on low vitamin D serum levels, its supplementation is envisaged.
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Affiliation(s)
- Lucas Brandao
- Department of Pathology, Federal University of Pernambuco, Recife, Brazil
| | - Ronald Moura
- Department of Genetics, Federal University of Pernambuco, Recife, Brazil
| | | | - Rossella Gratton
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Physiopathology and Transplantation, Università degli Studi di Milano Via Pace 9, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Physiopathology and Transplantation, Università degli Studi di Milano Via Pace 9, Milan, Italy
| | - Simone Garcovich
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michele Boniotto
- INSERM U955 Eq. 16, Faculté de Médecine, Institut Mondor de Recherche Biomédicale and Université Paris Est- Créteil (UPEC), Créteil, France
| | - Sergio Crovella
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Physiopathology and Transplantation, Università degli Studi di Milano Via Pace 9, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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Misitzis A, Goldust M, Jafferany M, Lotti T. Psychiatric comorbidities in patients with hidradenitis suppurativa. Dermatol Ther 2020; 33:e13541. [DOI: 10.1111/dth.13541] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Angelica Misitzis
- 1st Department of Dermatology and Venereology, School of Health Sciences National and Kapodistrian University of Athens Athens Greece
| | - Mohamad Goldust
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - Mohammad Jafferany
- Division of Psychodermatology, Department of Psychiatry Central Michigan University College of Medicine Saginaw Michigan USA
| | - Torello Lotti
- Department of Dermatology and Venereology University of Studies Guglielmo Marconi Rome Italy
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Takeichi T, Akiyama M. KLICK Syndrome Linked to a POMP Mutation Has Features Suggestive of an Autoinflammatory Keratinization Disease. Front Immunol 2020; 11:641. [PMID: 32425927 PMCID: PMC7203212 DOI: 10.3389/fimmu.2020.00641] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 03/20/2020] [Indexed: 12/17/2022] Open
Abstract
Keratosis linearis with ichthyosis congenita and sclerosing keratoderma (KLICK) syndrome is a rare autosomal recessive skin disorder characterized by palmoplantar keratoderma, linear hyperkeratotic plaques, ichthyosiform scaling, circular constrictions around the fingers, and numerous papules distributed linearly in the arm folds and on the wrists. Histologically, the affected skin shows hypertrophy and hyperplasia of the spinous, granular, and horny epidermal layers with mild infiltration of inflammatory cells in the upper dermis. There are 14 patients with KLICK syndrome described in the literature, and they all carry the same nucleotide deletion. Proteasome maturation protein (POMP), encoded by POMP, is an ubiquitously expressed protein that functions as a chaperone for proteasome maturation. KLICK syndrome is caused by a reduction in POMP levels that leads to proteasome insufficiency in differentiating keratinocytes. It is noteworthy that POMP is also known to be the causative gene for proteasome-associated autoinflammatory syndrome-2 (PRAAS2). It is considered that the disrupted proteasome assembly caused by the POMP mutation might lead to both skin inflammation and then hyperkeratosis in KLICK syndrome. Inflammation caused by the hyperactivation of innate immunity occasionally leads to inflammatory diseases of the skin, recently denoted as autoinflammatory keratinization diseases (AiKDs). We propose that KLICK syndrome caused by the specific 1-bp nucleotide deletion mutation in the regulatory region of POMP might be in a spectrum of proteasome-associated phenotypes.
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Affiliation(s)
- Takuya Takeichi
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Gausman V, McNeill MB, Balzora S. Facing Crohn's: A Rare Association. Gastroenterology 2020; 158:829-830. [PMID: 31843586 DOI: 10.1053/j.gastro.2019.11.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/02/2022]
Affiliation(s)
- Valerie Gausman
- Department of Medicine, Division of Gastroenterology, NYU Langone Health, New York, New York
| | - Matthew B McNeill
- Department of Medicine, Division of Gastroenterology, NYU Langone Health, New York, New York
| | - Sophie Balzora
- Department of Medicine, Division of Gastroenterology, NYU Langone Health, New York, New York
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45
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Tricarico PM, Zupin L, Ottaviani G, Rupel K, Celsi F, Genovese G, Boniotto M, Crovella S, Marzano AV. Photobiomodulation as potential novel third line tool for non-invasive treatment of hidradenitis suppurativa. GIORN ITAL DERMAT V 2020; 155:88-98. [DOI: 10.23736/s0392-0488.19.06247-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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46
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Constantinou CA, Fragoulis GE, Nikiphorou E. Hidradenitis suppurativa: infection, autoimmunity, or both? Ther Adv Musculoskelet Dis 2019; 11:1759720X19895488. [PMID: 31908656 PMCID: PMC6937531 DOI: 10.1177/1759720x19895488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease mainly affecting areas rich in apocrine glands. Clinically, is characterized by painful subcutaneous nodules and if left untreated to pus secretion, abscess and fistula formation. Its frequency is estimated to be 0.5-4% of the general population, affecting women more often. Pathogenesis of HS is still not clearly defined. It seems to be a combination of genetic factors with alterations in the skin microbiome. Furthermore, at tissue (i.e. skin) as well as at serum level, several inflammatory cytokines are upregulated. The most important of the latter are tumor necrosis factor (TNF), interleukin (IL)-1, IL-17, and IL-23. Adding another level of complexity, it has been suggested that keratinocytes might be intrinsically activated, contributing also to the observed inflammation. Interestingly, it has been noted that frequency of HS is increased in some autoimmune rheumatic diseases, such as spondyloarthropathies (SpA). Of note, both HS and SpA have relatively strong association with metabolic diseases and obesity implying that there are indeed some common underlying pathophysiological pathways. Although no specific microbe has been identified, alterations in the microbiome of the skin of these patients have been reported. Of note, microbes with a capability for biofilm formation are abundant. Treatment of HS among others, include antibiotics as well as biologic drugs targeting TNF and other cytokines and used for autoimmune rheumatic diseases. Herein, we review the current evidence on links between HS and autoimmune diseases and infectious diseases with a focus on epidemiology and pathophysiology.
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Affiliation(s)
- Costas A Constantinou
- Internal Medicine Department and Tuberculosis Unit, Kyperounta Rural Hospital, Kyperounta, Cyprus
- Communicable Diseases Surveillance and Control Unit, Medical and Public Health Services, Cyprus Ministry of Heath, Nicosia, Cyprus
| | - George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- First Department of Propaedeutic and Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Academic Rheumatology Department, King’s College London, Cutcombe Road, London, SE5 9RJ, UK
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Alavi A, Shavit E, Archer J, Pagnoux C. Hidradenitis suppurativa and vasculitis: A case series and literature review of a rare association. SAGE Open Med Case Rep 2019; 7:2050313X19882852. [PMID: 31673357 PMCID: PMC6804353 DOI: 10.1177/2050313x19882852] [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: 01/02/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory skin disease with dysregulation of the immune system. Its pathophysiology is not clear, and it has been reported in association with various inflammatory disorders such as pyoderma gangrenosum, arthritis, familial Mediterranean fever and inflammatory bowel diseases. However, the co-existence of HS and vasculitis is exceptional and has not been investigated. We report on five patients with vasculitis that are followed in our centers: one with Takayasu’s arteritis, three with granulomatosis with polyangiitis and one with Behcet’s disease and compare them with those previously reported in the literature. A case series and literature review with key words of “vasculitis,” “hidradenitis suppurativa,” and “acne inversa” found only one previous report of hidradenitis suppurativa and cutaneous vasculitis and two with Behcet’s disease. Whereas the association of pyoderma gangrenosum and vasculitis is well-known, that with hidradenitis suppurativa is rarer. There may be some pathogenic continuum between hidradenitis suppurativa, pyoderma gangrenosum and vasculitis.
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Affiliation(s)
- Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,York Dermatology Center, Richmond Hill, ON, Canada
| | - Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Christian Pagnoux
- Department of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Figueras-Nart I, Mascaró JM, Solanich X, Hernández-Rodríguez J. Dermatologic and Dermatopathologic Features of Monogenic Autoinflammatory Diseases. Front Immunol 2019; 10:2448. [PMID: 31736939 PMCID: PMC6828938 DOI: 10.3389/fimmu.2019.02448] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022] Open
Abstract
Autoinflammatory diseases include disorders with a monogenic cause and also complex conditions associated to polygenic or multifactorial factors. An increased number of both monogenic and polygenic autoinflammatory conditions have been identified during the last years. Although skin manifestations are often predominant in monogenic autoinflammatory diseases, clinical and histopathological information regarding their dermatological involvement is still scarce. Monogenic autoinflammatory diseases with cutaneous expression can be classified based on the predominant lesion: (1) maculopapular rashes or inflammatory plaques; (2) urticarial rashes; (3) pustular, pyogenic or neutrophilic dermatosis-like rashes; (4) panniculitis or subcutaneous nodules; (5) vasculitis or vasculopathy; (6) hyperkeratotic lesions; (7) hyperpigmented lesions; (8) bullous lesions; and (9) aphthous lesions. By using this classification, this review intends to provide clinical and histopathological knowledge about cutaneous involvement in monogenic autoinflammatory diseases.
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Affiliation(s)
- Ignasi Figueras-Nart
- Department of Dermatology, Bellvitge Hospital, University of Barcelona, Barcelona, Spain
| | - José M Mascaró
- Department of Dermatology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Xavier Solanich
- Department of Internal Medicine, Bellvitge Hospital, University of Barcelona, Barcelona, Spain
| | - José Hernández-Rodríguez
- Clinical Unit of Autoinflammatory Diseases and Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Manfredini M, Giuliani AL, Ruina G, Gafà R, Bosi C, Zoppas E, Di Virgilio F, Bettoli V. The P2X7 Receptor Is Overexpressed in the Lesional Skin of Subjects Affected by Hidradenitis Suppurativa: A Preliminary Study. Dermatology 2019; 237:111-118. [PMID: 31454821 DOI: 10.1159/000502026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 07/09/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND P2X receptors (P2XRs) are plasma membrane channels involved in the modulation of immune responses. The role of the P2X7 receptor (P2X7R) has never been investigated in hidradenitis suppurativa (HS), which is a recurrent skin disease characterized by inflammatory nodules, scarring, and suppuration. OBJECTIVE Our aim was to investigate by immunohistochemistry (IHC) P2X7R, NLRP3 (NOD-like receptor family, pyrin domain-containing 3), and interleukin-1β (IL-1β) expression in HS lesions compared to healthy control (HC) skin. METHOD The intensity of IHC immunostaining was semi-quantitatively graded for keratinocytes, neutrophils, lymphocytes, and monocytes. Statistical significance was assessed by the Mann-Whitney U test, Cohen's κ coefficient, and χ2 test. RESULTS A total of 59 samples, 31 from HS and 28 from HC, were collected and analysed. In skin keratinocytes, lymphocytes, and monocytes, but not in neutrophils, P2X7R and NLRP3 protein expression was significantly increased in HS versus the HC group. IL-1β protein expression was also higher in HS versus the HC group both in skin keratinocytes and in the inflammatory infiltrate. Cohen's κ correlation coefficients for the expression of P2X7R versus NLRP3 or IL-1β in skin keratinocytes were significant (κ = 0.43 and 0.34, respectively). The same association between P2X7R and NLRP3 or IL-1β was confirmed by χ2 tests. CONCLUSION P2X7R, NLRP3, and IL-1β are overexpressed, and therefore the entire P2X7R/NLRP3/IL-1β pro-inflammatory axis is likely overactive in the skin of HS patients. This observation might provide clues to the pathogenesis of this disease and suggest novel therapies and markers of disease activity.
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Affiliation(s)
- Marco Manfredini
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy, .,Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy,
| | - Anna Lisa Giuliani
- Oncology and Experimental Biology Section, Department of Morphology, Surgery and Experimental Medicine, Pathology, University of Ferrara, Ferrara, Italy
| | - Giulia Ruina
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Roberta Gafà
- Pathological Anatomy Section, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Cristina Bosi
- Pathological Anatomy Section, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Elisabetta Zoppas
- Oncology and Experimental Biology Section, Department of Morphology, Surgery and Experimental Medicine, Pathology, University of Ferrara, Ferrara, Italy
| | - Francesco Di Virgilio
- Oncology and Experimental Biology Section, Department of Morphology, Surgery and Experimental Medicine, Pathology, University of Ferrara, Ferrara, Italy
| | - Vincenzo Bettoli
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Abstract
The autoinflammatory diseases comprise a broad spectrum of disorders characterized by unchecked activation of the innate immune system. Whereas aberrations in adaptive immunity have long been identified in 'autoimmune' disorders, the concept of 'autoinflammation' emerged relatively recently, first describing a group of clinical disorders characterized by spontaneous episodes of systemic inflammation without manifestations typical of autoimmune disorders. Improved knowledge of innate immune mechanisms, coupled with remarkable progress in genomics and an expanding number of clinical cases, has since led to an increasing number of disorders classified as autoinflammatory or containing an autoinflammatory component. Biologic therapies targeting specific components of the innate immune system have provided immense clinical benefit, and have further elucidated the role of innate immunity in autoinflammatory disorders. This article reviews the basic mechanisms of autoinflammation, followed by an update on the pathophysiology and treatment of the monogenic and multifactorial autoinflammatory diseases, and the common dermatologic conditions in which autoinflammation plays a major role.
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