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Liao YH, Chu CB, Hui CYR, Li CY, Lin SY, Tseng HC, Wang YJ, Wu J, Yu WW, Chao SC. Taiwanese Dermatological Association (TDA) consensus recommendations for the definition, classification, diagnosis, and management of hidradenitis suppurativa. J Formos Med Assoc 2023:S0929-6646(23)00492-8. [PMID: 38160191 DOI: 10.1016/j.jfma.2023.12.012] [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: 08/08/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful, recurrent, inflamed lesions most commonly occurring in the axillary, inguinal, and anogenital regions. HS can inflict immense physical and psychological impact on patients who suffer from this distressing disease. Management of HS generally requires combining various medical and procedural treatment modalities; however, the disease is often recalcitrant to conventional treatments. In light of recent evidence supporting the effectiveness of biologic agents in the treatment of HS, the Taiwanese Dermatological Association established an expert panel of nine dermatologists to develop consensus statements aimed to provide up-to-date evidence-based guidance in optimizing HS patient management in Taiwan. The recommendations described in the statements were summarized in a management algorithm in terms of general care, topical treatment, systemic treatment, and procedural treatment.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Yao Lin
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Molinelli E, De Simoni E, Candelora M, Sapigni C, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. Systemic Antibiotic Therapy in Hidradenitis Suppurativa: A Review on Treatment Landscape and Current Issues. Antibiotics (Basel) 2023; 12:978. [PMID: 37370297 DOI: 10.3390/antibiotics12060978] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, and inflammatory skin disease characterized by painful, deep-seated, nodules, abscesses, and sinus tracts in sensitive areas of the body, including axillary, inguinal, and anogenital regions. Antibiotics represent the first-line pharmacological treatment of HS because of their anti-inflammatory properties and antimicrobial effects. This narrative review summarizes the most significant current issues on the role of systemic antibiotics in the management of HS, critically analyzing the main limits of their use (antibiotic resistance and toxicity). Although, in the last decades, several cytokines have been implicated in the pathomechanism of HS and the research on the use of novel biologic agents in HS has been intensified, antibiotics remain a valid therapeutic approach. Future challenges regarding antibiotic therapy in HS comprise their use in association with biologics in the management of acute flare or as a bridge therapy to surgery.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Edoardo De Simoni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Matteo Candelora
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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Reply to "Rifampin and clindamycin are safe long-term". J Am Acad Dermatol 2023; 88:e33. [PMID: 31568805 DOI: 10.1016/j.jaad.2019.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 11/21/2022]
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Albrecht J, Bigby M. Rifampin and clindamycin are safe long-term: Response to "North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations Part II: Topical, intralesional, and systemic medical management". J Am Acad Dermatol 2023; 88:e31. [PMID: 31568806 DOI: 10.1016/j.jaad.2019.08.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Joerg Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, Chicago, Illinois; Department of Dermatology, Rush Medical College, Chicago, Illinois.
| | - Michael Bigby
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Tetracyclines-An Important Therapeutic Tool for Dermatologists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127246. [PMID: 35742496 PMCID: PMC9224192 DOI: 10.3390/ijerph19127246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 11/27/2022]
Abstract
Tetracyclines are a group of antibiotics whose first representative was discovered over 70 years ago. Since then, they have been of great interest in dermatology. In addition to their antibacterial activity, they are able to inhibit metalloproteinases and exhibit anti-inflammatory, anti-apoptotic and antioxidant effects. The side effects have been thoroughly studied over the years, the most characteristic and important ones in daily dermatological practice being: phototoxicity, hyperpigmentation, onycholysis, photoonycholysis, induced lupus erythematosus, and idiopathic intracranial hypertension. In this article, we summarize the use of tetracyclines in infectious diseases and inflammatory dermatoses, and further discuss the instances where the efficacy and safety of tetracyclines have been highlighted over the past few years.
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Schultheis M, Staubach P, Grabbe S, Ruckes C, von Stebut E, Kirschner U, Matusiak Ł, Szepietowski JC, Nikolakis G. LAight® Therapy Is an Effective Treatment Option to Maintain Long-Term Remission of Hurley I and II Hidradenitis Suppurativa: Results from Period B of RELIEVE, a Multicenter Randomized, Controlled Trial. Dermatology 2022; 238:1092-1103. [PMID: 35679831 PMCID: PMC9808664 DOI: 10.1159/000524739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa is a chronic, inflammatory, burdensome skin disease where current first-line treatments are limited to topical and/or systemic antibiotics which cannot be applied for long-term disease management. Period B of the RELIEVE study analyzes whether LAight® therapy can sustain or even increase remission after a first topical antibiotic treatment cycle. METHODS The RELIEVE study was performed as a two-period multicenter randomized controlled trial with blinded assessment. For period A from week 0 to week 16, the 88 participating Hurley I and II patients were randomized to either a group receiving topical clindamycin 1% solution combined with 8 additional bi-weekly treatments with LAight® therapy (group TC + L) or a group which was treated with topical clindamycin 1% solution only (group TC). After 16 weeks, patients entered open-label period B and both groups were treated exclusively with LAight® therapy for an additional 16 weeks (8 sessions, group TC + L/L and group TC/L). RESULTS In total, 88 patients were enrolled in RELIEVE. Seventy-eight patients entered period B; 39 belonged to group TC + L/L and 39 to group TC/L. The IHS4-response at the start of period B was 62% (group TC + L/L) and 33% (group TC + L). During the 16 weeks of additional monotherapy with LAight, in both groups >90% of patients who responded to therapy in period A maintained their IHS4-response at week 32. IHS4 response rates continued to rise up to 79% of the TC + L/L group and up to 71% of the TC/L group during period B at week 32. Achievement of HiSCR and certain patient reported outcomes confirmed primary endpoint results. CONCLUSION LAight® therapy is an effective approved therapy option for Hurley I and II HS that can be used continuously to maintain treatment success. During 16 weeks of follow-up in period B, over 90% of patients with response after period A maintained their treatment outcome, while more than 60% of prior nonresponders gained response. The fact that LAight® therapy can be applied continuously, is very effective and is well tolerated makes it a valuable treatment tool in the design of HS long-term treatment modalities.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Studies, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Shah RA, Hsu JI, Patel RR, Mui UN, Tyring SK. Antibiotic resistance in dermatology: The scope of the problem and strategies to address it. J Am Acad Dermatol 2022; 86:1337-1345. [PMID: 34555484 DOI: 10.1016/j.jaad.2021.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023]
Abstract
Antibiotic resistance is a growing health concern that has attracted increasing attention from clinicians and scientists in recent years. Although resistance is an inevitable consequence of bacterial evolution and natural selection, misuse and overuse of antibiotics play a significant role in its acceleration. Antibiotics are the mainstay of therapy for common dermatoses, including acne and rosacea, as well as for skin and soft tissue infections. Therefore, it is critical for dermatologists and physicians across all disciplines to identify, appropriately manage, and prevent cases of antibiotic resistance. This review explores dermatologic conditions in which the development of antibiotic resistance is a risk and discusses mechanisms underlying the development of resistance. We discuss disease-specific strategies for overcoming resistant strains and improving antimicrobial stewardship along with recent advances in the development of novel approaches to counter antibiotic resistance.
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Affiliation(s)
- Radhika A Shah
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas.
| | | | - Ravi R Patel
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Uyen Ngoc Mui
- Department of Dermatology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Stephen K Tyring
- Center for Clinical Studies, Houston, Texas; Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas
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Kirsch SH, Haeckl FPJ, Müller R. Beyond the approved: target sites and inhibitors of bacterial RNA polymerase from bacteria and fungi. Nat Prod Rep 2022; 39:1226-1263. [PMID: 35507039 DOI: 10.1039/d1np00067e] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Covering: 2016 to 2022RNA polymerase (RNAP) is the central enzyme in bacterial gene expression representing an attractive and validated target for antibiotics. Two well-known and clinically approved classes of natural product RNAP inhibitors are the rifamycins and the fidaxomycins. Rifampicin (Rif), a semi-synthetic derivative of rifamycin, plays a crucial role as a first line antibiotic in the treatment of tuberculosis and a broad range of bacterial infections. However, more and more pathogens such as Mycobacterium tuberculosis develop resistance, not only against Rif and other RNAP inhibitors. To overcome this problem, novel RNAP inhibitors exhibiting different target sites are urgently needed. This review includes recent developments published between 2016 and today. Particular focus is placed on novel findings concerning already known bacterial RNAP inhibitors, the characterization and development of new compounds isolated from bacteria and fungi, and providing brief insights into promising new synthetic compounds.
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Affiliation(s)
- Susanne H Kirsch
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, 66123 Saarbrücken, Germany. .,German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
| | - F P Jake Haeckl
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, 66123 Saarbrücken, Germany. .,German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany
| | - Rolf Müller
- Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Helmholtz Centre for Infection Research (HZI), Saarland University Campus, 66123 Saarbrücken, Germany. .,German Centre for Infection Research (DZIF), Partner Site Hannover-Braunschweig, 38124 Braunschweig, Germany.,Department of Pharmacy, Saarland University, 66123 Saarbrücken, Germany
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Haferland I, Wallenwein CM, Ickelsheimer T, Diehl S, Wacker MG, Schiffmann S, Buerger C, Kaufmann R, Koenig A, Pinter A. Mechanism of anti-inflammatory effects of Rifampicin in an ex vivo culture system of Hidradenitis Suppurativa. Exp Dermatol 2022; 31:1005-1013. [PMID: 35048417 DOI: 10.1111/exd.14531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of the hair follicles leading to painful lesions, associated with increased levels of pro-inflammatory cytokines. Numerous guidelines recommend antibiotics like clindamycin and rifampicin in combination, as first-line systemic therapy in moderate to severe forms of inflammation. HS has been proposed to be mainly an auto-inflammatory disease associated with but not initially provoked by bacteria. Therefore, it has to be assumed that the pro-inflammatory milieu previously observed in HS skin is not solely dampened by the bacteriostatic inhibition of DNA-dependent RNA polymerase. To further clarify the mechanism of anti-inflammatory effects of rifampicin, ex vivo explants of lesional HS from 8 HS patients were treated with rifampicin, and its effect on cytokine production, immune cells as well as the expression of Toll-like receptor 2 (TLR2) were investigated. Analysis of cell culture medium of rifampicin treated HS explants revealed an anti-inflammatory effect of rifampicin that significantly inhibiting interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumour necrosis factor (TNF) -α production. Immunohistochemistry of the rifampicin-treated explants suggested a tendency for it to reduce the expression of TLR2 while not affecting the number of immune cells.
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Affiliation(s)
- Isabel Haferland
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Chantal M Wallenwein
- Fraunhofer Insitute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Tanja Ickelsheimer
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Sandra Diehl
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias G Wacker
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Susanne Schiffmann
- Fraunhofer Insitute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Claudia Buerger
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Anke Koenig
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Pinter
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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Clinical Effect of Clarithromycin Combined with Tinidazole on Helicobacter pylori-Related Gastritis and Its Influence on COX-2 Expression. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4171019. [PMID: 34888378 PMCID: PMC8651390 DOI: 10.1155/2021/4171019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/17/2022]
Abstract
Studies have shown that COX-2 expression is upregulated in gastric cancer (GC) as well as in precancerous lesions and in Helicobacter pylori-induced inflammation, suggesting that cyclooxygenase-2 (COX-2) may play an important role in gastric carcinogenesis. We attempted to investigate the role of clarithromycin with tinidazole on Helicobacter pylori-related gastritis from the aspects of clinical effect and COX-2 expression. From January 2016 to January 2019, 130 patients with Helicobacter pylori-related chronic gastritis were collected and grouped into the observation group (OG) and the control group (CG). Altogether, 80 patients in the OG were treated with clarithromycin with tinidazole, while 50 patients in the CG were treated with amoxicillin with metronidazole. Clinical symptom improvement time, content of COX-2 and B cell lymphoma-2 (BCL-2), content of inflammatory factors interleukin-1 (IL-1), IL-4, and C-reactive protein (CRP), expression level of nutritional indicators serum albumin (ALB), realbumin (PA), and transferrin (TF), clearance of Helicobacter pylori, total effective rate, and incidence of adverse reactions were detected. Compared with the CG, the OG had shorter clinical symptom improvement time, lower COX-2 and Bcl-2, lower expression of inflammatory factors IL-1, IL-4, and CRP, higher expression of nutritional indicators ALB, TF, and PA, higher clearance rate of Helicobacter pylori, higher total effective rate, and lower incidence of adverse reactions. Clarithromycin combined with tinidazole can effectively improve the clinical effect of Helicobacter pylori-related gastritis and reduce the expression level of COX-2.
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Kwak R, Lopez CG, Noe MH, Nambudiri VE, Charrow AP. No increased incidence of Clostridium difficile infection among patients with hidradenitis suppurativa treated with systemic clindamycin. J Am Acad Dermatol 2021; 87:406-407. [PMID: 34428535 DOI: 10.1016/j.jaad.2021.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Ruby Kwak
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christina G Lopez
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vinod E Nambudiri
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra P Charrow
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Clinical Epidemiology and Management of Hidradenitis Suppurativa. Obstet Gynecol 2021; 137:731-746. [PMID: 33706337 PMCID: PMC7984767 DOI: 10.1097/aog.0000000000004321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1-1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18-40 years, obstetrician-gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.
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[Hidradenitis suppurativa /acne inversa-surgical options, reconstruction and combinations with drug therapies-an update]. Hautarzt 2021; 72:692-699. [PMID: 34228137 PMCID: PMC8258492 DOI: 10.1007/s00105-021-04864-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/22/2022]
Abstract
Hidradenitis suppurativa/Acne inversa (HS/AI) ist eine chronisch-entzündliche Hauterkrankung, deren Behandlung sowohl konservative als auch chirurgische Behandlungsmöglichkeiten umfasst. In den Hurley-Stadien II und III ist die chirurgische Resektion irreversibel zerstörten Gewebes anzustreben. Hierzu existieren verschiedene Resektionstechniken, die sich vor allem in ihrer Invasivität und Rezidivneigung unterscheiden. Bis heute gibt es keinen allgemein akzeptierten Konsens hinsichtlich verschiedener Resektions- und Rekonstruktionstechniken sowie der Einbeziehung medikamentöser Therapien in das therapeutische Gesamtkonzept.
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Zheng X, Fang R, Wang C, Tian X, Lin J, Zeng W, Zhou T, Xu C. Resistance Profiles and Biological Characteristics of Rifampicin-Resistant Staphylococcus aureus Small-Colony Variants. Infect Drug Resist 2021; 14:1527-1536. [PMID: 33911880 PMCID: PMC8071703 DOI: 10.2147/idr.s301863] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/12/2021] [Indexed: 01/01/2023] Open
Abstract
Background Staphylococcus aureus (S. aureus) is a major contributor to nosocomial and community-acquired infections. S. aureus small colony variants (SCVs) which changed in relevant phenotype have made more limited and difficult for therapeutic options against S. aureus infections increasingly. Rifampicin is considered as the "last-resort" antibiotic against S. aureus. Our study investigated resistance profiles and biological characteristics of rifampicin-resistant S. aureus SCVs. Methods We collected S. aureus SCVs that were selected from 41 rifampicin-resistant clinical isolates. Then, biological characteristics, resistance spectrum, and rifampicin resistance mechanisms of tested S. aureus SCVs and corresponding parental strains were investigated by classic microbiological methods, agar dilution method, polymerase chain reaction (PCR). Moreover, the fitness cost of S. aureus SCVs, including growth, biofilm formation ability, and virulence profile, was also determined by bacterial growth curve assay, biofilm formation assay, and Galleria mellonella infection model. Results There were three S. aureus SCVs (JP310 SCVs, JP1450 SCVs, JP1486 SCVs) that were selected from 41 rifampicin-resistant S. aureus. S. aureus SCVs colonies were tiny, with decreased pigmentation, and the hemolysis circle was not obvious compared with corresponding parental strains. And SCVs could not be restored to normal-colony phenotype after hemin, menaquinone, or thymidine supplementation. Different rpoB mutations occurred in JP1486 SCVs. Antimicrobial susceptibility testing revealed MICs of SCVs were higher than corresponding parental strains. Besides, the growth ability and virulence of SCVs were lower, and biofilm formation ability of which increased compared with parental strains. Conclusion S. aureus SCVs share the rifampicin resistance mechanisms with parental strains, although there were some differences in the position of rpoB mutations. Moreover, we found that the biological characteristics of SCVs were significantly different from corresponding parental strains. In contrast, decreased susceptibility to other antibiotics of SCVs was observed during phenotype switch. Furthermore, SCVs incur the fitness cost.
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Affiliation(s)
- Xiangkuo Zheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Renchi Fang
- Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, People's Republic of China
| | - Chong Wang
- Department of Laboratory Medicine, Qingdao Municipal Hospital, Qingdao, 266000, People's Republic of China
| | - Xuebin Tian
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Jie Lin
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Weiliang Zeng
- School of Laboratory Medicine and Life Sciences, Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Tieli Zhou
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Chunquan Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
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Iannone M, Janowska A, Bartolomei G, Puntoni M, Oranges T, Romanelli M, Dini V. Systemic antibiotics in hidradenitis suppurativa: efficacy and effects of body mass index and smoking pack-year on the response to therapy. Dermatol Ther 2021; 34:e14919. [PMID: 33634552 DOI: 10.1111/dth.14919] [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] [Received: 11/16/2020] [Revised: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 01/10/2023]
Abstract
The combination of oral clindamycin with rifampicin is recommended by European guidelines as a first-line treatment in moderate-to-severe hidradenitis suppurativa (HS). Recent studies highlight that oral clindamycin in monotherapy (CM) may be a useful alternative treatment. We included 36 patients with a diagnosis of moderate-to-severe HS. A total of 19 patients were treated with combination oral clindamycin plus rifampicin (C + R) and 17 with oral CM for 12 weeks. The efficacy of CM vs C + R was analyzed by multilinear regression models which showed a higher reduction in mSartorius (Δ = -13.2, P = .058) and AISI (Δ = -4.91, P = .034) in the C + R group. In the C + R group, smoking pack-year was positively correlated with AISI (Spearman's rho = 0.51, P = .036) and with DLQI (0.47, P = .061). In the CM group, a positive correlation was found between BMI and AISI (0.47, P = .041). The data on the efficacy of C + R combination therapy are in line with guidelines, evidence-based approaches, and recommendations from the HS ALLIANCE working group. The rationale for combining these two drugs is to increase bactericidal action and to reduce rifampicin resistance, as rifampicin is highly mutagenic. Our results suggest that the antibiotic combination of C + R is still the treatment of choice in moderate-to-severe HS with abscesses, draining fistulae and ≥ 5 inflammatory nodules. High BMI and smoking habits seem to be predictive factors of a poor response to antibiotics. Further multicenter studies and prospective randomized controlled trials are needed to confirm these results. Potential alternative antibiotic therapies should also be investigated.
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Affiliation(s)
| | - Agata Janowska
- Department of Dermatology, University of Pisa, Pisa, Italy
| | | | - Matteo Puntoni
- Clinical trial office, Scientific directorate, E.O. Ospedali Galliera, University of Genoa, Genoa, Italy
| | - Teresa Oranges
- Department of Dermatology, University of Pisa, Pisa, Italy
| | | | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
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16
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van Straalen KR, Tzellos T, Guillem P, Benhadou F, Cuenca-Barrales C, Daxhelet M, Daoud M, Efthymiou O, Giamarellos-Bourboulis EJ, Jemec GBE, Katoulis AC, Koenig A, Lazaridou E, Marzano AV, Matusiak Ł, Molina-Leyva A, Moltrasio C, Pinter A, Potenza C, Romaní J, Saunte DM, Skroza N, Stergianou D, Szepietowski J, Trigoni A, Vilarrasa E, van der Zee HH. The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study. J Am Acad Dermatol 2021; 85:369-378. [PMID: 33484766 DOI: 10.1016/j.jaad.2020.12.089] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/19/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes. OBJECTIVE To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin. METHODS A prospective, international cohort study performed between October 2018 and August 2019. RESULTS In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain. LIMITATIONS Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline. CONCLUSION This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.
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Affiliation(s)
- Kelsey R van Straalen
- Erasmus MC, University Medical Center Rotterdam, Department of Dermatology, Rotterdam, the Netherlands
| | | | - Phillipe Guillem
- Department of Surgery, Clinique du Val d'Ouest, Lyon, France; ResoVerneuil, Paris, France; Groupe de Recherche en Proctologie de la Société Nationale Française de ColoProctologie, Paris, France
| | - Farida Benhadou
- Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Carlos Cuenca-Barrales
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain; TECe19-Clinical and Translational Dermatology Investigation Group Instituto de Investigación Biosanitaria, Granada, Spain
| | - Mathilde Daxhelet
- Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Mathieu Daoud
- Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Ourania Efthymiou
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Denmark
| | - Alexandros C Katoulis
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - Anke Koenig
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main, Germany
| | - Elizabeth Lazaridou
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Angelo V Marzano
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Łucas Matusiak
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
| | - Alejandro Molina-Leyva
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain; TECe19-Clinical and Translational Dermatology Investigation Group Instituto de Investigación Biosanitaria, Granada, Spain
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main, Germany
| | - Concetta Potenza
- Dermatology Unit 'Daniele Innocenzi,' Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino-Latina, Italy
| | - Jorge Romaní
- Department of Dermatology, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Ditte M Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Denmark
| | - Nevena Skroza
- Dermatology Unit 'Daniele Innocenzi,' Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino-Latina, Italy
| | - Dimitra Stergianou
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
| | - Anastasia Trigoni
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hessel H van der Zee
- Erasmus MC, University Medical Center Rotterdam, Department of Dermatology, Rotterdam, the Netherlands.
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17
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Yao Y, Jørgensen AHR, Ring HC, Thomsen SF. Effectiveness of clindamycin and rifampicin combination therapy in hidradenitis suppurativa: a 6-month prospective study. Br J Dermatol 2020; 184:552-553. [PMID: 33000461 DOI: 10.1111/bjd.19578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 09/26/2020] [Accepted: 09/27/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Y Yao
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - A-H R Jørgensen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - H C Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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18
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Bonnaire A, Vernet-Garnier V, Lebrun D, Bajolet O, Bonnet M, Hentzien M, Ohl X, Diallo S, Bani-Sadr F. Clindamycin combination treatment for the treatment of bone and joint infections caused by clindamycin-susceptible, erythromycin-resistant Staphylococcus spp. Diagn Microbiol Infect Dis 2020; 99:115225. [PMID: 33099073 DOI: 10.1016/j.diagmicrobio.2020.115225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 01/14/2023]
Abstract
The objective of this study was to evaluate the clinical outcomes and safety of clindamycin combination antibiotherapy for the treatment of erythromycin-resistant, lincosamide-susceptible bone and joint infections caused by Staphylococcus spp. Between January 2010 and September 2018, 46 patients with Staphylococcus spp. erythromycin-resistant, lincosamide-susceptible bone and joint infections were treated with clindamycin combination antibiotherapy for 6 to 12 weeks. The type of infection was prosthetic in 20 cases (43.5%), osteosynthetic device in 15 cases (32.6%), chronic osteomyelitis in 7 cases (15.2%), and arthritis in 4 cases (8.7%). The cure rate was 67.4% by intention to treat and 84.6% per protocol, with a median follow-up of 398 days (range 86-843). Only 2 relapses (5.1%) were observed in patients with chronic osteomyelitis; an acquired resistance to lincosamides developed in 1 case. Clindamycin combination therapy appears to be effective for the treatment of bone and joint infection caused by erythromycin-resistant, lincosamide-susceptible Staphylococcus spp.
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Affiliation(s)
- Agathe Bonnaire
- Department of Internal Medicine and Infectious Diseases, Reims Teaching Hospitals, Reims, France
| | | | - Delphine Lebrun
- Department of Internal Medicine and Infectious Diseases, Manchester Hospital, Charleville-Mezieres, France
| | - Odile Bajolet
- Department of Hygiene, Reims Teaching Hospitals, Reims, France
| | - Morgane Bonnet
- Department of Pharmacy, Reims Teaching Hospitals, Reims, France
| | - Maxime Hentzien
- Department of Internal Medicine and Infectious Diseases, Reims Teaching Hospitals, Reims, France
| | - Xavier Ohl
- Department of Orthopedic Surgery, Reims Teaching Hospitals, Reims, France
| | - Saidou Diallo
- Department of Orthopedic Surgery, Reims Teaching Hospitals, Reims, France
| | - Firouzé Bani-Sadr
- Department of Internal Medicine and Infectious Diseases, Reims Teaching Hospitals, Reims, France.
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19
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Marasca C, Tranchini P, Marino V, Annunziata MC, Napolitano M, Fattore D, Fabbrocini G. The pharmacology of antibiotic therapy in hidradenitis suppurativa. Expert Rev Clin Pharmacol 2020; 13:521-530. [DOI: 10.1080/17512433.2020.1762571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Tranchini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Vincenzo Marino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Carmela Annunziata
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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20
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Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I. Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice. Dermatology 2020; 236:393-412. [PMID: 32408306 PMCID: PMC8177083 DOI: 10.1159/000507323] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS. SUMMARY This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,
| | - Tien V Nguyen
- Bellevue Dermatology Clinic and Research Center, Bellevue, Washington, USA
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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21
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Abstract
Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. The estimated prevalence of HS is ~1% in most studied countries. Typically starting in early adulthood, cutaneous inflamed nodules, abscesses and pus-discharging tunnels develop in axillary, inguinal, gluteal and perianal body sites. The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1β and IL-17. The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients' quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.
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22
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Langan EA, Recke A, Bokor-Billmann T, Billmann F, Kahle BK, Zillikens D. The Role of the Cutaneous Microbiome in Hidradenitis Suppurativa-Light at the End of the Microbiological Tunnel. Int J Mol Sci 2020; 21:ijms21041205. [PMID: 32054085 PMCID: PMC7072827 DOI: 10.3390/ijms21041205] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/14/2022] Open
Abstract
The development of next generation sequencing, coupled with advances in bio-informatics, has provided new insights into the role of the cutaneous microbiome in the pathophysiology of a range of inflammatory skin diseases. In fact, it has even been suggested that the identification of specific skin microbial signatures may not only be useful in terms of diagnosis of skin diseases but they may also ultimately help inform personalised treatment strategies. To date, research investigating the role of microbiota in the development of inflammatory skin diseases has largely focused on atopic eczema and psoriasis vulgaris. The role of the microbiome in Hidradenits suppurativa (HS)-also known as acne inversa-a chronic auto-inflammatory skin disease associated with significant morbidity, has received comparatively little attention. This is despite the fact that antimicrobial therapy plays a central role in the treatment of HS. After briefly outlining the clinical features of HS and current treatment strategies, we move on to review the evidence of microbial dysbiosis in HS pathophysiology. We conclude by outlining the potential for metagenomic studies to deepen our understanding of HS biology but more importantly to identify novel and much needed treatment strategies.
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Affiliation(s)
- Ewan A. Langan
- Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; (A.R.); (B.K.K.); (D.Z.)
- Dermatological Sciences, University of Manchester, Oxford Rd, Manchester M13 9PL, UK
- Correspondence:
| | - Andreas Recke
- Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; (A.R.); (B.K.K.); (D.Z.)
| | | | - Franck Billmann
- Department of Surgery, University of Heidelberg, 69120 Heidelberg, Germany;
| | - Birgit K. Kahle
- Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; (A.R.); (B.K.K.); (D.Z.)
| | - Detlef Zillikens
- Department of Dermatology, University Medical Centre Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany; (A.R.); (B.K.K.); (D.Z.)
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23
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Lyons AB, Kaddurah H, Peacock A, Zubair R, Vellaichamy G, Norwick P, Ramesh M, Jacobsen G, Hamzavi IH. Hidradenitis suppurativa and risk for development of Clostridium difficile colitis. Int J Dermatol 2020; 59:e218-e219. [PMID: 32010962 DOI: 10.1111/ijd.14787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Hisham Kaddurah
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Anjelica Peacock
- Department of Internal Medicine, St. Mary Mercy Hospital, Livonia, MI, USA
| | - Raheel Zubair
- Department of Dermatology, Broward Health, Ft. Lauderdale, FL, USA
| | | | - Paige Norwick
- Department of Internal Medicine, Mercy Health, Grand Rapids, MI, USA
| | - Mayur Ramesh
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Gordon Jacobsen
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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24
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Hendricks AJ, Hsiao JL, Lowes MA, Shi VY. A Comparison of International Management Guidelines for Hidradenitis Suppurativa. Dermatology 2019; 237:81-96. [PMID: 31645040 DOI: 10.1159/000503605] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that imparts a significant burden on patients and presents a management challenge for healthcare providers. As attention to this debilitating condition has grown over recent years, our understanding of HS pathogenesis and optimal treatment approaches continues to evolve. Nine HS treatment guidelines developed by various expert organizations have been published, encompassing therapeutic modalities ranging from topical agents to systemic therapies to procedural interventions. These guidelines demonstrate significant overlap in treatment recommendations and have all been published within the last 5 years. Therefore, we aim to compare and synthesize the recommendations of international HS treatment guidelines and to encourage inter-organizational communication for the development of consensus or staggered publication of recommendations for HS management.
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Affiliation(s)
| | - Jennifer L Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, California, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Vivian Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona, USA,
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25
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Vural S, Gündoğdu M, Akay BN, Boyvat A, Erdem C, Koçyiğit P, Bostancı S, Sanli H, Kundakci N. Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatol Ther 2019; 32:e13003. [DOI: 10.1111/dth.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/08/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Secil Vural
- Koç University School of Medicine, Dermatology Department İstanbul Turkey
| | | | - Bengu N. Akay
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Ayşe Boyvat
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Cengizhan Erdem
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Pelin Koçyiğit
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Seher Bostancı
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Hatice Sanli
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Nihal Kundakci
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
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26
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Yazdanyar S, Jemec GB. KITTEN following CAT on the long-term use of rifampicin in hidradenitis suppurativa and effectiveness of oral contraceptives. Br J Dermatol 2019; 181:225-226. [PMID: 30907428 DOI: 10.1111/bjd.17900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Yazdanyar
- Department of Dermatology, Roskilde Zealand University Hospital, Roskilde, Denmark
| | - G B Jemec
- Department of Dermatology, Roskilde Zealand University Hospital, Roskilde, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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27
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Hambly R, Kirby B. Prolonged clindamycin and rifampicin for hidradenitis suppurativa: resist to prevent resistance. Br J Dermatol 2019; 180:702-703. [DOI: 10.1111/bjd.17615] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Hambly
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
- University College Dublin School of Medicine and Medical Sciences DublinIreland
- Wellcome‐Health Research Board Irish Clinical Academic Training (ICAT) DublinIreland
| | - B. Kirby
- The Charles Centre Department of Dermatology St Vincent's University Hospital Elm Park Dublin 4 Ireland
- University College Dublin School of Medicine and Medical Sciences DublinIreland
- Charles Institute of Dermatology University College Dublin Ireland
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28
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Albrecht J, Barbaric J, Nast A. Rifampicin alone may be enough: is it time to abandon the classic oral clindamycin–rifampicin combination for hidradenitis suppurativa? Br J Dermatol 2019; 180:949-950. [DOI: 10.1111/bjd.17422] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- J. Albrecht
- Division of Dermatology Department of Medicine J.H. Stroger Hospital of Cook County Chicago IL U.S.A
- Department of Dermatology Rush Medical College Chicago IL U.S.A
| | - J. Barbaric
- Department of Dermatology Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Nast
- Department of Dermatology Charité – Universitätsmedizin Berlin Berlin Germany
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Marasca C, Masarà A, Annunziata MC, Bettoli V, Luciano MA, Fabbrocini G. Long-term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa: a strategy to reduce side-effects, improving patients' compliance. Br J Dermatol 2019; 180:949. [PMID: 30430549 DOI: 10.1111/bjd.17423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- C Marasca
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Via Pansini 5, Napoli, Italy
| | - A Masarà
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Via Pansini 5, Napoli, Italy
| | - M C Annunziata
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Via Pansini 5, Napoli, Italy
| | - V Bettoli
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Arcispedale S. Anna, Ferrara, Italy
| | - M A Luciano
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Via Pansini 5, Napoli, Italy
| | - G Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Via Pansini 5, Napoli, Italy
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