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Barzilai A, Toubiana S, Dalal A, Baum S. The role of piperacillin/tazobactam in the treatment of Hidradenitis suppurativa. J DERMATOL TREAT 2024; 35:2363318. [PMID: 39103159 DOI: 10.1080/09546634.2024.2363318] [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: 04/09/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024]
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Most patients with moderate-to-severe disease require long-term antibiotic treatment, or biologic treatments to control their disease. Despite these interventions, relapses are common. This study evaluated the effectiveness of piperacillin/tazobactam treatment in patients with Hurley stage II and III HS who experienced disease flares and did not respond to conventional antibiotic and biologic treatment. Methods: Patients with HS hospitalized at the Department of Dermatology, Sheba Medical Center between August 2021 and January 2023 were retrospectively analyzed. Results: A cohort of ten such patients were treated with piperacillin/tazobactam for 6-21 days. Eight (80%) and two (20%) patients respectively demonstrated 2- and 1-grade improvements, from their baseline HS-Physician Global Assessment score. During the follow-up period, nine patients were monitored. HS Clinical Response (HiSCR) was achieved in six (66.7%) and five (55.6%) patients at the 3- and 6-month follow-up visits, respectively. Conclusions: In conclusion, Piperacillin/tazobactam emerges as a promising therapeutic option for disease flare-up in patients with Hurley stage II and III HS who do not respond to conventional treatment. Thus, piperacillin/tazobactam should be considered as crisis therapy for this patient subset.
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Affiliation(s)
- Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Toubiana
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
| | - Adam Dalal
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sahl RE, Poggi AI, Nielsen VW, Yao Y, Patsi I, Poulsen SS, Dela F, Larsen S, Thomsen SF, Helge JW. Adalimumab Treatment Effects on Inflammation and Adipose Tissue Mitochondrial Respiration in Hidradenitis Suppurativa. Endocrinol Diabetes Metab 2024; 7:e70002. [PMID: 39358901 PMCID: PMC11446982 DOI: 10.1002/edm2.70002] [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: 02/16/2024] [Revised: 08/03/2024] [Accepted: 08/25/2024] [Indexed: 10/04/2024] Open
Abstract
OBJECTIVE Tumour necrosis factor (TNF)-α is a proinflammatory marker and has been shown to affect mitochondrial function in different tissues. We investigated the effect on adipose tissue (AT) inflammation and mitochondrial respiration in patients with hidradenitis suppurativa (HS) after 12 weeks of treatment with adalimumab, a TNF-α inhibitor. METHODS We sampled blood and an AT biopsy from 13 patients with HS and 10 control subjects after an overnight fast. The patients were retested after at least 12 weeks of treatment with adalimumab (40 mg/week). We measured macrophage content and mitochondrial respiration in the AT and interleukin (IL)-1β, IL-6, IL-10, high-sensitivity C-reactive protein (hsCRP), interferon-γ, TNF-α, adiponectin and leptin in plasma. Clinical scores and Dermatology Quality of Life Index (DLQI) were assessed. RESULTS We found a higher anti-inflammatory macrophage content (CD206+) in the patient group compared with the control group, but no differences between before and after the intervention. No difference in mitochondrial respiration was observed. We observed higher plasma IL-6 and hsCRP concentrations in patients with HS compared to controls, with no differences before and after the intervention. The difference between controls and HS patients was abolished after the intervention. HS patients improved their DLQI after the intervention with no change in clinical scores. CONCLUSION Treatment with adalimumab in patients with HS does not alter AT inflammation or mitochondrial respiratory capacity; however, we did see a higher content of anti-inflammatory macrophages in the patient group compared with the control group.
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Affiliation(s)
- Ronni Eg Sahl
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Axel Illeris Poggi
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Yiqiu Yao
- Department of Dermatology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ioanna Patsi
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Steen Seier Poulsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Dela
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Geriatrics, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | - Steen Larsen
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
- Department of Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Wulff Helge
- Xlab, Center for Healthy Aging, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Wu K, Larney C, Marshman G, Spelman L, Rubel D, Mcmeniman E, Veysey E, Saunders H, Frew JW. Quality-of-life evaluation in hidradenitis suppurativa in Australia: Validation and outcomes of the HiSQOL questionnaire. Australas J Dermatol 2024. [PMID: 39387265 DOI: 10.1111/ajd.14370] [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: 03/21/2024] [Revised: 06/22/2024] [Accepted: 09/20/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory disease with significant impact upon quality of life. Generic quality-of-life measures suffer from decreased face validity and content validity, leading to the development of disease-specific quality-of-life measures such as the Hidradenitis Suppurativa Quality of Life (HiSQOL) outcome measure. The aim of this study was to validate the use of the HiSQOL in the Australian population and evaluate the quality-of-life impact in HS patients in Australia. METHODS A total of 301 patients were recruited and consented to be involved in this study. All participants were invited to complete the HiSQOL questionnaire along with basic demographic and disease information, the DLQI and HADS anxiety and depression scale. Participants were then asked to repeat the questionnaires 14 days later to assess test-retest reliability. RESULTS The mean HiSQOL score was 46.5 out of a possible total score of 76 (SD = 24.2) indicating a very large impact on quality of life. Based upon the published validity bands this corresponds to a very large impact on quality of life. Validation statistics indicated a high degree of internal consistency (Cronbach's alpha = 0.956) with expected levels of convergent validity and excellent test-retest reliability (p = 0.95). Multiple regression analysis indicated individuals with a younger age of onset and positive family history had significantly greater quality-of-life impact as measured by the HiSQOL. CONCLUSIONS The HiSQOL is a valid, reliable measure for assessing the quality-of-life impact of HS. Significant factors influencing quality of life include age of onset and family history. Longitudinal measurements will enable evaluation of the impact of therapy upon QOL in the Australian context.
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Affiliation(s)
- Kyle Wu
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Conor Larney
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Gill Marshman
- Flinders Medical Centre Adelaide, Bedford Park, South Australia, Australia
| | - Lynda Spelman
- Queensland Institute of Dermatology, Brisbane, Queensland, Australia
| | - Diana Rubel
- The Canberra Hospital, Garran, Canberra, Australia
| | - Erin Mcmeniman
- Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - Emma Veysey
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - John W Frew
- The Skin Hospital Darlinghurst, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
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Alavi A, Prens EP, Kimball AB, Frew JW, Krueger JG, Mukhopadhyay S, Gao H, Ranganathan U, Ivanoff NB, Hernandez Daly AC, Zouboulis CC. Proof-of-concept study exploring the effect of spesolimab in patients with moderate-to-severe hidradenitis suppurativa: a randomized double-blind placebo-controlled clinical trial. Br J Dermatol 2024; 191:508-518. [PMID: 38576350 DOI: 10.1093/bjd/ljae144] [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: 03/12/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a considerable disease burden. Existing treatment options are limited and often suboptimal; a high unmet need exists for effective targeted therapies. OBJECTIVES To explore the effects of spesolimab treatment in patients with HS. METHODS This randomized double-blind placebo-controlled proof-of-clinical-concept (PoCC) study was conducted at 25 centres across 12 countries from 3 May 2021 to 21 April 2022. Patients had moderate-to-severe HS for ≥ 1 year before enrolment. Patients were randomized (2 : 1) to receive a loading dose of 3600-mg intravenous spesolimab (1200 mg at weeks 0, 1 and 2) or matching placebo, followed by maintenance with either 1200-mg subcutaneous spesolimab every 2 weeks from weeks 4 to 10 or matching placebo. The primary endpoint was the percentage change from baseline in total abscess and inflammatory nodule (AN) count at week 12. Secondary endpoints were the absolute change from baseline in the International Hidradenitis Suppurativa Severity Score System (IHS4), percentage change from baseline in draining tunnel (dT) count, the proportion of patients achieving a dT count of 0, absolute change from baseline in the revised Hidradenitis Suppurativa Area and Severity Index (HASI-R), the proportion of patients achieving Hidradenitis Suppurativa Clinical Response (HiSCR50), the proportion of patients with ≥ 1 flare (all at week 12) and patient-reported outcomes. RESULTS In this completed trial, randomized patients (n = 52) received spesolimab (n = 35) or placebo (n = 17). The difference vs. placebo in least squares mean is reported. At week 12, the percentage change in total AN count was similar between treatment arms: -4.1% [95% confidence interval (CI) -31.7 to 23.4]. There was greater numerical improvement in the spesolimab arm, as measured by IHS4 (13.9, 95% CI -25.6 to -2.3); percentage change from baseline in dT count (-96.6%, 95% CI -154.5 to -38.8); and the proportion of patients achieving a dT count of 0 (18.3%, 95% CI -7.9 to 37.5). Spesolimab treatment also improved HASI-R and HiSCR50 vs. placebo. Spesolimab demonstrated a favourable safety profile, similar to that observed in trials in other diseases. CONCLUSIONS This exploratory PoCC study supports the development of spesolimab as a new therapeutic option in HS.
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Affiliation(s)
- Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - John W Frew
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | | | - Heli Gao
- Boehringer Ingelheim Shanghai Pharmaceuticals Co. Ltd, Shanghai, China
| | - Usha Ranganathan
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | | | | | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Raudonis T, Šakaitytė A, Vileikis TP, Černel V, Gancevičiene R, Zouboulis CC. Demographic Data, Risk Factors, and Disease Burden of HS Patients in Lithuania at a Reference Center. Healthcare (Basel) 2024; 12:1849. [PMID: 39337190 PMCID: PMC11431364 DOI: 10.3390/healthcare12181849] [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: 06/26/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) diagnosis often faces a global delay of 7.2 years due to factors like lack of recognition, stigma, and socioeconomic barriers. Limited effective therapies and frequent exacerbations impact patients' quality of life, posing a significant burden on healthcare systems. METHODS HS patients were assessed according to European Hidradenitis Suppurativa Foundation (EHSF) Registry questionnaire guidelines at various stages of the disease and treatment. RESULTS The study included 49 patients; 57.14% (n = 28) of them were male. The average age of the subjects was 39.91 ± 13.665 years; the average BMI was 27.84 ± 7.362. A total of 59.18% (n = 29) were active or previous smokers. There were statistically more male smokers than female (p < 0.01). Average disease onset was 25.71 ± 13.743 years; the mean time to diagnosis was 5.2 ± 7.607 years. A total of 70.2% (n = 33) were previously misdiagnosed. Subjects had 6.17 ± 6.98 painful days over the preceding 4 weeks. The average intensity of pain according to the visual analogue scale (VAS) was 5.60 ± 3.36 points. The mean dermatology life quality index (DLQI) at baseline was 8.9 ± 7.436. CONCLUSIONS The research revealed delayed diagnoses, especially for females. Smoking was linked to higher Hurley stages, with a prevalence among male smokers, and HS had a substantial impact on patients' quality of life.
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Affiliation(s)
- Tadas Raudonis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Austėja Šakaitytė
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
| | - Tomas Petras Vileikis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
| | - Vitalij Černel
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania;
| | - Rūta Gancevičiene
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
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Lackner L, Zyriax BC, Stephan B. To what Extent does Vitamin D and its Serum Levels Influence the Severity of Hidradenitis Suppurativa: A Literature Review. Acta Derm Venereol 2024; 104:adv40321. [PMID: 39254290 PMCID: PMC11407108 DOI: 10.2340/actadv.v104.40321] [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: 03/08/2024] [Accepted: 07/01/2024] [Indexed: 09/11/2024] Open
Abstract
Vitamin D plays a role in inflammatory skin conditions and can improve them. Hidradenitis suppurativa (HS) is an autoinflammatory chronic skin disease in which most patients exhibit a hypovitaminosis D. However, it is uncertain whether vitamin D supplementation could relieve the severity of HS. A systematic literature search of PubMed and Web of Science was conducted on 4 September 2023. Studies that investigated vitamin D and its potential implications for the severity of HS were included. In contrast, studies that focused on the prevalence of vitamin D deficiency were excluded, as well as studies on syndromic HS. Seven studies with a total of 575 patients were included in the qualitative synthesis, of which 3 utilized a cross-sectional design, 2 were pilot studies, 1 a controlled cohort study, and 1 a prospective case-control study. In all included studies, HS patients were vitamin D deficient. There was evidence indicating that serum vitamin D levels negatively correlated with the severity of the disease, and at least suggestive evidence that vitamin D supplementation could have a positive impact on the course of HS. To better understand these correlations, conducting a randomized controlled trial study on vitamin D and its effects on HS severity is imperative.
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Affiliation(s)
- Lea Lackner
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
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Marzano AV, Magnoni C, Micali G, De Magnis A, Pintori G, Fiorini S, Simonella V, Bastioli L, Nappi F, Pappagallo G, Prignano F. Improving hidradenitis suppurativa management: consensus statements from physicians and patients' perspectives. Arch Dermatol Res 2024; 316:577. [PMID: 39180694 PMCID: PMC11344722 DOI: 10.1007/s00403-024-03316-2] [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: 06/05/2024] [Revised: 06/05/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024]
Abstract
Hidradenitis suppurativa (HS) is a frequent chronic inflammatory skin condition primarily affecting areas rich in apocrine sweat glands, presenting with comedones, papules, nodules, and abscesses, as well as tunnels and hypertrophic scarring. Despite its prevalence and impact on quality of life, the pathogenesis of HS remains incompletely understood. Notably, its diagnosis often suffers from delays and misidentification, therefore an improved education for healthcare providers is mandatory. Moreover, HS is frequently associated with systemic comorbidities and a multidisciplinary approach is suggested for its management. Recognizing these challenges, a group of Italian HS experts and patients convened to develop consensus guidelines via the Nominal Group Technique. Through iterative meetings and remote collaboration, they identified key areas for improvement and formulated consensus statements to guide healthcare providers in delivering optimal care. This collaborative effort highlights the importance of standardized approaches and interdisciplinary collaboration in managing HS effectively.
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Affiliation(s)
- Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Via Pace, 9, 20122, Milan, Italy.
| | - Cristina Magnoni
- Università Degli Studi Di Modena E Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Giuseppe Micali
- Università Di Catania, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | | | - Linda Bastioli
- AISI-Associazione Italiana Sostegno Idrosadenite, Viterbo, Italy
| | - Francesca Nappi
- AISI-Associazione Italiana Sostegno Idrosadenite, Viterbo, Italy
| | - Giovanni Pappagallo
- Scuola Di Metodologia Clinica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Verona, Italy
| | - Francesca Prignano
- Dipartimento Di Scienze Della Salute, Sezione Di Dermatologia, Università Di Firenze, Florence, Italy
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Liakou AI, Tsantes AG, Routsi E, Agiasofitou E, Kalamata M, Bompou EK, Tsante KA, Vladeni S, Chatzidimitriou E, Kotsafti O, Samonis G, Bonovas S, Stratigos AI. Could Vaccination against COVID-19 Trigger Immune-Mediated Inflammatory Diseases? J Clin Med 2024; 13:4617. [PMID: 39200759 PMCID: PMC11355883 DOI: 10.3390/jcm13164617] [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: 07/08/2024] [Revised: 07/29/2024] [Accepted: 08/04/2024] [Indexed: 09/02/2024] Open
Abstract
Exacerbations and new onset of immune-mediated inflammatory diseases, such as psoriasis and hidradenitis suppurativa, have been reported following COVID-19 vaccination. In patients with hidradenitis suppurativa, recent studies have shown that those who received mRNA vaccines were 3.5 times as likely to develop flares following vaccination compared to patients who received non-mRNA vaccines, indicating that mRNA COVID-19 vaccines are associated with hidradenitis suppurativa flares. Similar findings have been found in other studies evaluating the association between COVID-19 vaccines and other immune-mediated inflammatory diseases such as psoriasis, atopic dermatitis, lichen planus, and alopecia areata. However, further research is warranted in larger populations to validate these findings.
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Affiliation(s)
- Aikaterini I. Liakou
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Andreas G. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attikon” Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (A.G.T.); (K.A.T.)
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece
| | - Eleni Routsi
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Efthymia Agiasofitou
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Magdalini Kalamata
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Evangelia-Konstantina Bompou
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Konstantina A. Tsante
- Laboratory of Haematology and Blood Bank Unit, “Attikon” Hospital, National and Kapodistrian University of Athens Medical School, 12462 Athens, Greece; (A.G.T.); (K.A.T.)
| | - Soultana Vladeni
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Eleni Chatzidimitriou
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - Ourania Kotsafti
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
| | - George Samonis
- Department of Medicine, University of Crete, 71500 Heraklion, Greece;
- Department of Oncology, Metropolitan Hospital, 18547 Athens, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy;
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Alexander I. Stratigos
- 1st Department of Dermatology-Venereology, “Andreas Sygros” Hospital, National and Kapodistrian University of Athens Medical School, 16121 Athens, Greece; (E.R.); (E.A.); (M.K.); (E.-K.B.); (S.V.); (E.C.); (O.K.); (A.I.S.)
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Leboit PE, Patel DU, Cohen JN, Moss MI, Naik HB, Yates AE, Harris HW, Klufas DM, Kim EA, Neuhaus IM, Hansen SL, Kyle RL, Kelly M, Rosenblum MD, Lowe MM. A Novel Whole Tissue Explant Model of Hidradenitis Suppurativa. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.19.603617. [PMID: 39211108 PMCID: PMC11360975 DOI: 10.1101/2024.07.19.603617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Hidradenitis Suppurativa (HS) is a relatively common and highly morbid inflammatory skin disease. Due to our relatively limited understanding of HS's pathogenesis, there are currently insufficient treatment options available, and many patients' medical needs are not being met. This is partly due to a scarcity of ex vivo human assays and animal models that accurately recapitulate the disease. To address this deficit, we have developed a whole-tissue explant model of HS to examine its pathogenic mechanisms and the efficacy of potential treatments within intact human tissue. We measured cytokine protein and RNA within whole tissue maintained in an agar-media solution, finding that IL-6 and IL-8 concentrations trended upwards in both HS explants and healthy controls, while IL-17A, IL-1β, and TNF-α exhibited increases in HS tissue alone. We also show that the explants were responsive to treatment with both dexamethasone and IL-2. Not only do our results show that this model effectively delivers treatments throughout the explants, but they also elucidate which cytokines are related to the explant process regardless of tissue state and which are related to HS tissue specifically, laying the groundwork for future implementations of this model.
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Lai PT, Tseng HC. Adopting adalimumab combined surgery in the management of moderate to severe hidradenitis suppurativa: Experience from a single medical center in southern Taiwan. J Dermatol 2024. [PMID: 39032108 DOI: 10.1111/1346-8138.17375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/22/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder primarily affecting the intertriginous and anogenital regions. Guidelines recommend various treatments for HS, including biologic agents like adalimumab for moderate to severe cases. Adalimumab is a type of human monoclonal IgG1 antibody designed to target tumor necrosis factor α. Recent studies have shown the effectiveness of adalimumab, either alone or combined with surgery, in managing HS. We retrospectively analyzed the medical chart of HS patients in a southern Taiwan medical center from 2019 to 2022 and investigated clinical features and treatment response. The institutional review board at Chang Gung Medical Foundation granted approval for the study. We primarily focused on moderate to severely affected patients. One hundred and two clinically diagnosed HS patients participated, with a male-to-female ratio of 2:1 and an average age of 31.8 at diagnosis. Among them, 41.2% were in Hurley stage III and 32.4% in stage II. Nineteen patients received excision with pre-surgical adalimumab; their average age at diagnosis was 31.1, with a gender ratio of 5.3:1. Surgery was most common on the buttocks (68%), axillae (21%), and groin (10%). Excision patients were primarily in advanced stages (Hurley III 94.7%, II 5.3%) with high body mass index. Adalimumab and surgery combined yielded a 68.4% improvement rate, while 15.8% remained stable and 15.8% did not respond as expected. In addition, smoking and obesity were prevalent among patients. Adalimumab showed promising results in moderate to severe HS, with significant improvement observed in our cases. The combination of adalimumab and surgery appeared effective in advanced HS patients with larger involved areas and more tunnels. No severe adverse events were reported. However, our study was limited by its retrospective nature and the lack of a control group. Despite these limitations, our study revealed the benefits of integrating adalimumab with suitable surgical procedures in managing patients experiencing moderate to severe HS in real-world scenarios.
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Affiliation(s)
- Po-Ta Lai
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
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Offidani A, Marzano AV, Peris K, Molinelli E, Bettoli V, Magnoni C, Vaienti L, Pappagallo G, Amerio P, Atzori L, Balato A, Bianchi L, Bongiorno MR, Contedini F, Dapavo P, Di Benedetto G, Dini V, Donini M, Fabbrocini G, Fania L, Foti C, Gatti A, Guarneri C, Malara G, Manfredini M, Morrone P, Naldi L, Parodi A, Potenza C, Schianchi S, Stingeni L, Trovato E, Vaira F, Valenti M, Venturini M, Chiricozzi A, Prignano F. Guidelines How to Integrate Surgery and Targeted Therapy with Biologics for the Treatment of Hidradenitis Suppurativa: Delphi Consensus Statements from an Italian Expert Panel. Dermatology 2024:1-12. [PMID: 39004081 DOI: 10.1159/000539264] [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: 05/17/2023] [Accepted: 04/14/2024] [Indexed: 07/16/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent and painful nodules and abscesses in intertriginous skin areas, which can progress to sinus tract formation, tissue destruction, and scarring. HS is highly debilitating and severely impairs the psychological well-being and quality of life of patients. The therapeutic approach to HS is based on medical therapy and surgery. First-line medical therapy includes topical antibiotics, systemic antibiotics, and biologics. Main surgical procedures include deroofing, local excision, and wide local excision. Despite the availability of multiple therapeutic options, the rates of disease recurrence and progression continue to be high. In recent years, the possibility of combining biologic therapy and surgery has raised considerable interest. In a clinical trial, the perioperative use of adalimumab has been associated with greater response rates and improved inflammatory load and pain, with no increased risk of postoperative infectious complications. However, several practical aspects of combined biologic therapy and surgery are poorly defined. In June 2022, nine Italian HS experts convened to address issues related to the integration of biologic therapy and surgery in clinical practice. To this purpose, the experts identified 10 areas of interest based on published evidence and personal experience: (1) patient profiling (diagnostic criteria, disease severity classification, assessment of response to treatment, patient-reported outcomes, comorbidities); (2) tailoring surgery to HS characteristics; (3) wide local excision; (4) presurgery biologic treatment; (5) concomitant biologic and surgical treatments; (6) pre- and postsurgery management; (7) antibiotic systemic therapy; (8) biologic therapy after radical surgery; (9) management of adverse events to biologics; and (10) management of postoperative infectious complications. Consensus between experts was reached using the Estimate-Talk-Estimate method (Delphi Method). The statements were subsequently presented to a panel of 27 HS experts from across Italy, and their agreement was assessed using the UCLA Appropriateness Method. This article presents and discusses the consensus statements.
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Affiliation(s)
- Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, 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
| | - Ketty Peris
- UOC of Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Vincenzo Bettoli
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Cristina Magnoni
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Pappagallo
- School of Clinical Research Methodology, IRCCS "Sacro Cuore - Don Calabria Hospital", Negrar di Valpolicella, Italy
| | - Paolo Amerio
- Dermatologic Clinic, G. D'Annunzio University, Chieti, Italy
| | - Laura Atzori
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Bianchi
- UOSD of Dermatology, Policlinico Tor Vergata, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Rita Bongiorno
- Department of Health Promotion Sciences, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Federico Contedini
- Department of Plastic Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Di Benedetto
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Massimo Donini
- Department of Dermatology, SS Giovanni e Paolo Civil Hospital, Venice, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Fania
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - Caterina Foti
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Gatti
- Department of Dermatology, AULSS2 Marca Trevigiana, Hospital Ca' Foncello, Treviso, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giovanna Malara
- Dermatology Unit, Hospital "Bianchi Melacrino Morelli", Reggio Calabria, Italy
- Department of Dermatology, Papardo Hospital, Messina, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Morrone
- Unit of Dermatology, Mariano Santo Hospital, Cosenza, Italy
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Aurora Parodi
- Unit of Dermatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | | | - Luca Stingeni
- Dermatology Section, Medical and Surgical Department, University of Perugia, Perugia, Italy
| | - Emanuele Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabrizio Vaira
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Valenti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marina Venturini
- Section of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Chiricozzi
- UOC of Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Prignano
- Department of Health Science, Section of Dermatology, University of Firenze, Firenze, Italy
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Maronese CA, Piguet V, Marzano AV. IRAK4: A Novel Target in the Therapeutic Landscape of Hidradenitis Suppurativa? J Invest Dermatol 2024:S0022-202X(24)01821-9. [PMID: 39023474 DOI: 10.1016/j.jid.2024.06.1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Carlo A Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Vincent Piguet
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Canada
| | - 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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Masson R, Seivright J, Grogan T, Atluri S, Hamzavi I, Hogeling M, Shi VY, Hsiao JL. Ustekinumab in Hidradenitis Suppurativa: A Systematic Review and Meta-analysis. Dermatol Ther (Heidelb) 2024; 14:1901-1916. [PMID: 38907878 PMCID: PMC11265041 DOI: 10.1007/s13555-024-01207-y] [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: 04/03/2024] [Accepted: 06/04/2024] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a frequently debilitating, inflammatory skin condition. Patients may have a limited response to adalimumab, currently the only Food and Drug Administration (FDA)-approved biologic treatment for HS. Ustekinumab is an interleukin-12/23 inhibitor that has been utilized in HS, but there is a lack of an updated systematic review on its efficacy and safety. The aim of this study is to perform a systematic review and meta-analysis of the literature on the efficacy and safety of ustekinumab for HS. METHODS In October 2022, MEDLINE and Embase databases were searched for articles on ustekinumab in HS. Data extraction was performed on relevant articles by two reviewers. The primary study outcome was the pooled response rate of HS to ustekinumab. A fixed-effects meta-analysis was performed, and Cochran's Q statistic and I squared index were used to assess heterogeneity. Statistical significance was determined at p < 0.05. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors. RESULTS From 2012 to 2022, ten articles (nine case series and one prospective trial) with 88 patients met the inclusion criteria. Patients with reported disease severity had Hurley stage II (17.6%, 12/68) or III (82.4%, 56/68) disease. The majority (80.7%, 71/88) had previously failed at least one biologic treatment. A meta-analysis of all ten studies showed a pooled response rate of 67% (95% CI 0.57-0.76). Study limitations include a small number of patients and randomized controlled trials (RCTs). CONCLUSIONS Ustekinumab may be a helpful treatment option to consider for HS that is recalcitrant to first-line biologic therapies, but RCTs are needed to determine optimal dosing regimens and the specific patient populations that would benefit the most from this agent.
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Affiliation(s)
- Rahul Masson
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Justine Seivright
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Swetha Atluri
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Marcia Hogeling
- Division of Dermatology, University of California Los Angeles, 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, 90033-9174, USA.
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Jariene V, Valiukevicius P, Maciulaitis J, Kuzaityte U, Insodaite R, Ciapiene I, Maciulaitis R, Valiukeviciene S. Activated and Naïve Allogenic Human Placental Mesenchymal Stromal Cells Exert an Immunomodulatory Effect on Hidradenitis Suppurativa Patient Peripheral Blood Mononuclear Cells. J Interferon Cytokine Res 2024; 44:291-299. [PMID: 38607317 DOI: 10.1089/jir.2024.0035] [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: 04/13/2024] Open
Abstract
This pilot study aimed to evaluate the immunomodulatory effect of placental mesenchymal stem/stromal cells (MSCs) on peripheral blood mononuclear cells (PBMCs) from patients with hidradenitis suppurativa (HS). Blood samples were collected from 3 healthy and 3 patients with HS. Isolated PBMCs were stained with carboxyfluorescein succinimidyl ester (CFSE) and stimulated with phorbol 12-myristate 13-acetate (PMA)/Ionomycin solution. The PBMCs of patients with HS were co-cultured with naïve MSCs (n-MSCs), activated with tumor necrosis factor (TNF)-α (10 ng/mL) and interferon (IFN)-γ (10 ng/mL) MSCs (a-MSCs), or adalimumab (30 μg/mL). The division index (proliferation inhibition) of PBMCs was analyzed by flow cytometry using the Proliferation Modeling tool after 5 days of coculture. The relative inflammatory gene expression dynamics and cytokine secretion were quantified in triplicate using real-time polymerase chain reaction (PCR) and Luminex assays. PBMCs from the HS control group showed statistically significant increases in interleukin (IL)-6 and IFN-γ cytokine concentrations and IL-17A gene expression when compared with healthy subjects. Statistically significant reduction of the division index was found in the a-MSCs group (P = 0.04). Also, the Luminex assay revealed significantly reduced proinflammatory cytokine concentrations of IL-9 (P = 0.022) and IL-17A (P = 0.022) in the a-MSCs group with the same trend of numerical lowering in n-MSCs group when compared to HS control. The results of real-time PCR revealed a numerical increase in the expression of the IL-1β, IL-36α, and TNF-α genes in both the a-MSCs and n-MSCs groups compared with the HS control. In conclusion, our findings suggest that MSCs can effectively curb PBMCs proliferation and suppress the production of inflammatory cytokines. Moreover, the preactivation of MSCs with IFN-γ and TNF-α before use can enhance their therapeutic effectiveness. Nevertheless, a larger sample size is imperative to validate these results.
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Affiliation(s)
- Vaiva Jariene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LSMU), Kaunas, Lithuania
- European Reference Network for Rare and Complex Diseases of the Skin (ERN- Skin) member, Hospital of LSMU Kauno Klinikos, Kaunas, Lithuania
| | - Paulius Valiukevicius
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justinas Maciulaitis
- Institute of Physiology and Pharmacology, LSMU, Kaunas, Lithuania
- Institute of Cardiology, LSMU, Kaunas, Lithuania
| | - Ugne Kuzaityte
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ruta Insodaite
- Institute of Physiology and Pharmacology, LSMU, Kaunas, Lithuania
- Institute of Biology Systems and Genetic Research, LSMU, Kaunas, Lithuania
| | | | | | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LSMU), Kaunas, Lithuania
- European Reference Network for Rare and Complex Diseases of the Skin (ERN- Skin) member, Hospital of LSMU Kauno Klinikos, Kaunas, Lithuania
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Li CP, Lo SW, Tsai RY, Chang HC, Gau SY. New-Onset Hidradenitis Suppurativa in Psoriasis Patients: A Multi-Center, Retrospective Cohort Study. Life (Basel) 2024; 14:730. [PMID: 38929713 PMCID: PMC11205059 DOI: 10.3390/life14060730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Previous research has indicated a potential correlation between hidradenitis suppurativa (HS) and psoriasis (PSO), two chronic inflammatory dermatological diseases. However, there is a lack of comprehensive evaluations that consider a variety of clinical and demographic factors, and the risk of developing HS in PSO patients remains unclear. Our study aims to examine HS risk over time among PSO patients versus matched controls while considering the influence of confounders to provide insights into the potential link between these two diseases. METHOD In this multi-institutional cohort study using the TriNetX database, we matched 202,318 patients with PSO with an equivalent number of individuals without PSO, using propensity score matching. The study period extended from 1 January 2005 to 31 December 2018. We computed hazard ratios and their respective 95% confidence intervals (CIs) to evaluate the probability of HS manifestation over a period of 5 years in patients with PSO in comparison to those without PSO. RESULTS PSO patients demonstrated a consistently higher risk of developing HS than matched controls across all analytic models with the hazard ratios (HR) ranging from 1.43 (95% CI 1.30-1.56) to 5.91 (95% CI 2.49-14.04). Stratified analyses showed the increased HS risk was observed in both genders but only significant in those aged 18-64 years. Kaplan-Meier analysis indicated PSO patients had a higher cumulative probability of developing HS over time (HR 1.77, 95% CI 1.49-1.89). CONCLUSIONS PSO was associated with increased HS risk, highlighting the importance of considering HS as a potential comorbidity in PSO patients and may have implications for early detection, prevention, and management strategies for both conditions. Shared inflammatory pathways, genetic components, and skin dysbiosis may contribute. Further research should elucidate underlying mechanisms.
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Affiliation(s)
- Chen-Pi Li
- Department of Nursing, Tungs’ Taichung MetroHarbor Hospital, Taichung 435403, Taiwan;
| | - Shao-Wei Lo
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Ru-Yin Tsai
- Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Hui-Chin Chang
- Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Orthopedics Department, Chi-Mei Medical Center, Tainan 71004, Taiwan
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Johnston LA, Nagalla RR, Li M, Whitley SK. IL-17 Control of Cutaneous Immune Homeostasis. J Invest Dermatol 2024; 144:1208-1216. [PMID: 38678465 DOI: 10.1016/j.jid.2023.11.016] [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: 07/26/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 05/01/2024]
Abstract
IL-17 is widely recognized for its roles in host defense and inflammatory disorders. However, it has become clear that IL-17 is also an essential regulator of barrier tissue physiology. Steady-state microbe sensing at the skin surface induces low-level IL-17 expression that enhances epithelial integrity and resists pathogens without causing overt inflammation. Recent reports describe novel protective roles for IL-17 in wound healing and counteracting physiologic stress; however, chronic amplification of these beneficial responses contributes to skin pathologies as diverse as fibrosis, cancer, and autoinflammation. In this paper, we discuss the context-specific roles of IL-17 in skin health and disease and therapeutic opportunities.
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Affiliation(s)
- Leah A Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raji R Nagalla
- Medical Scientist Training Program, School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Mushi Li
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah K Whitley
- Department of Dermatology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA; Autoimmune Therapeutics Institute, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA; NeuroNexus Institute, University of Massachusetts Chan Medical School, Worcester, Massachusettes, USA.
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17
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AbdelHameid D, Wang L, Mauskar MM, Dominguez AR, Thomas C. Sepsis-like features in hidradenitis suppurativa flares requiring admission: A retrospective cohort study. J Am Acad Dermatol 2024; 90:1291-1294. [PMID: 38395228 DOI: 10.1016/j.jaad.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Duaa AbdelHameid
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura Wang
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa M Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Arturo R Dominguez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cristina Thomas
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [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: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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Singh S, Desai K, Gillern S. Management of Pilonidal Disease and Hidradenitis Suppurativa. Surg Clin North Am 2024; 104:503-515. [PMID: 38677816 DOI: 10.1016/j.suc.2023.11.003] [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: 04/29/2024]
Abstract
Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.
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Affiliation(s)
- Sneha Singh
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA
| | - Kaushal Desai
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA
| | - Suzanne Gillern
- Colon & Rectal Surgery, Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA.
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20
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [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: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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21
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Maronese CA, Marzano AV. Identifying candidates for early intervention in hidradenitis suppurativa. Br J Dermatol 2024; 190:787-788. [PMID: 38282335 DOI: 10.1093/bjd/ljae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 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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22
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Zouboulis CC, Passeron T, Pariser D, Wozniak MB, Li X, Uhlmann L, Lobach I, Martinez AL, Ravichandran S, Alarcon I, Offidani A, Alam MS, Mendes-Bastos P. Secukinumab in patients with moderate-to-severe hidradenitis suppurativa based on prior biologic exposure: an efficacy and safety analysis from the SUNSHINE and SUNRISE phase III trials. Br J Dermatol 2024; 190:836-845. [PMID: 38470171 DOI: 10.1093/bjd/ljae098] [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: 12/07/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with a substantial disease burden. Secukinumab has previously been reported to have sustained efficacy with a favourable safety profile in patients with moderate-to-severe HS. It is unknown whether prior biologic exposure affects the efficacy and safety of secukinumab. OBJECTIVES To investigate the efficacy and safety of secukinumab in patients with moderate-to-severe HS based on prior exposure to -biologics. METHODS This was an analysis of the SUNSHINE and SUNRISE phase III trials of secukinumab in patients with moderate-to-severe HS. Patients were randomized at baseline to receive secukinumab every 2 (SECQ2W) or 4 weeks (SECQ4W), or placebo for 16 weeks. After week 16, patients on the SECQ2W and SECQ4W schedules remained on the same treatment regimen, while patients randomized to placebo were switched to either SECQ2W or SECQ4W up to week 52. Assessments based on prior exposure to biologics included Hidradenitis Suppurativa Clinical Response (HiSCR), abscess and inflammatory nodule (AN) count, flare rates, HS-related pain [numerical rating scale 30 (NRS30)], 55% reduction in the International Hidradenitis Suppurativa Severity Score System (IHS4-55), Dermatology Life Quality Index, EuroQol-5D and safety. RESULTS Overall, 1084 patients were randomized in the SUNSHINE and SUNRISE trials and included in this analysis; 255 (23.5%) were biologic-experienced [SECQ2W (n = 80); SECQ4W (n = 81); placebo (n = 94)] and 829 (76.5%) were biologic-naïve [SECQ2W (n = 281); SECQ4W (n = 279); placebo (n = 269)]. At week 16, responses were more efficacious for secukinumab than for placebo with regard to HiSCR in patients who were biologic-experienced {SECQ2W 37.0% [odds ratio (OR) 1.60, 95% confidence interval (CI) 0.83-3.08]; SECQ4W 38.8% [OR 1.67, 95% CI 0.86-3.22]; placebo 27.3%} and biologic-naïve [SECQ2W 45.6% (OR 1.64, 95% CI 1.15-2.33); SECQ4W 45.4% (OR 1.61, 95% CI 1.13-2.29); placebo 34.2%]. Similar results were observed for AN count, NRS30 and IHS4-55. The higher response seen at week 16 with secukinumab was sustained, with a trend toward improvement over time, through to week 52 in both subgroups. Additional efficacy was observed for quality-of-life assessments, and no differences in safety between subgroups were observed. CONCLUSIONS Regardless of prior biologic exposure, secukinumab was efficacious in improving the signs and symptoms of HS. This finding positions secukinumab as the first option in patients who are biologic-naïve, as well as in patients who have previously been treated with other biologic therapy, based on individual patient needs.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thierry Passeron
- Department of Dermatology, CHU Nice
- INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Xianjun Li
- Novartis Pharma Co., Ltd, Shanghai, China
| | | | | | | | | | | | - Annamaria Offidani
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Maryam S Alam
- Simcoderm Medical and Surgical Dermatology Centre, Barrie, ON, Canada
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Almuhanna N, Aljughayman M, Fidler L, Alhusayen R. Risk of respiratory diseases among hospitalized patients with hidradenitis suppurativa. Int J Dermatol 2024. [PMID: 38634645 DOI: 10.1111/ijd.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease. METHODS This is a cross-sectional, case-control, population-based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD-9-CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls. RESULTS Twenty-three thousand seven hundred and sixty-seven hospital admissions for HS were compared with 95,068 age- and sex-matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170-1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419-1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157-2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182-1.374]; P < 0.001). CONCLUSION HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients.
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Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Lee Fidler
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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Heudens S, Sarkis AS, Daoud M, Daxhelet M, Benhadou F, Suppa M, Nobile L, Karama J, Njimi H, White JM, Del Marmol V. Belgian Patients of the European Registry for Hidradenitis Suppurativa (ERHS-Be): Data, Scores, and Phenotypes since 2015. Dermatology 2024; 240:553-564. [PMID: 38621365 DOI: 10.1159/000538804] [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: 08/22/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, characterized by painful and recurrent lesions in apocrine gland-bearing skin areas. It is a heterogeneous disease, which makes assessment and data collection difficult. Questionnaires with detailed items, such as the Belgian European Registry for Hidradenitis Suppurativa (ERHS-Be), are useful to study HS and its associated comorbidities. The aim of this registry was to uncover new factors associated with HS and understand HS patients' clinical profiles and efficacy of treatments. MATERIAL AND METHODS The ERHS-Be registry is based on questionnaires, with sections for sociodemographic data, medical and HS history, clinical examination, and treatment plan. It allows identification of different clinical phenotypes and automatic calculation of severity scores. RESULTS At present, 606 patients are included in the ERHS-Be (67% women, 33% men). The mean age at the first visit is 38.5 years. Tobacco use is present in 72.6% of patients. A family history of HS is noted in 42% of patients. Comorbidities are documented in this cohort: depression is present in 43.8% of patients, arthritis in 27.8%, obesity in 31.5%, hypertension in 10.6%, diabetes mellitus in 6.4%, and dyslipidemia in 12.4%. Moreover, 7.7% of patients suffer from IBD and 27.4% have a pilonidal sinus. History of severe acne is found in 32.1% of patients and psoriasis in 9.3%. Thirteen percent of women in our cohort suffer from polycystic ovarian syndrome. Severity of disease is quantified in 533 patients: for instance, Hurley I, II, and III scores proportions are, respectively, 32.3%, 52.7%, and 15%, while the mean IHS4 score is 5.2. This registry also enables determination of relative phenotype proportions in our cohort, according to different classifications. CONCLUSION The ERHS-Be questionnaires allow systematic and larger data collection, including detailed comorbidities, phenotypes, and severity of disease. Analysis of this large database will contribute to a better understanding and management of HS, at a time where new therapeutic options are becoming available.
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Affiliation(s)
- Stephanie Heudens
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium,
| | - Anne-Sophie Sarkis
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathieu Daoud
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathilde Daxhelet
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mariano Suppa
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Nobile
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jalila Karama
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Hassane Njimi
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan M White
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Del Marmol
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Greenlund L, Herzog C, Wendland Z, Rypka K, Frew JW, Kirby JS, Alavi A, Khalid B, Lowes MA, Garg A, Marzano AV, Zouboulis CC, Tzellos T, Jaleel T, Goldfarb N. Discrepancies in hidradenitis suppurativa lesion characterization by providers and patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595320 DOI: 10.1111/jdv.19999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The hidradenitis suppurativa (HS) clinical response (HiSCR) has come under scrutiny as several HS clinical trials failed to meet primary endpoints with high placebo responses. This may be due to limitations of the tool and raters' ability to accurately characterize and count lesions, rather than lack of efficacy of the studied drug. Due to HS lesion complexity and potential differences in rater training, it was hypothesized that there would be discrepancies in how providers characterize and count lesions for HS clinical trials. OBJECTIVE To evaluate how HS providers and patients name and count HS lesions and to identify discrepancies among providers to initiate the development of consensus-driven guidance for HS rater training. METHODS An online survey was distributed to the members of HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Respondents were asked to classify lesion images composed of multiple and different morphology types and answer questions regarding inclusion of associated dermatological conditions. RESULTS Forty-seven HISTORIC members responded (29 providers; 18 patients). There was variability in how respondents classified HS lesions. Of 12 questions containing images, four had ≥50% of respondents choosing the same answer. With an image of a lesion composed of different morphologies, 45% of providers counted it as a single lesion and 45% counted it as multiple distinct lesions. With an image of multiple interconnected draining tunnels, 7% of providers classified it as a single draining tunnel while 79% categorized it as multiple draining tunnels with the number estimated by visual inspection. There was also variability in deciding whether lesions occurring in associated conditions should be considered separately or included in HS lesion counts. Patient responses were also variable. CONCLUSIONS The result of the current study reaffirms the gap in how providers characterize and count HS lesions for clinical trials and the need to develop consensus-driven rater training related to HS outcome measures.
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Affiliation(s)
| | - Claire Herzog
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Zachary Wendland
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katelyn Rypka
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health, Hershey, Pennsylvania, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bisma Khalid
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Amit Garg
- Northwell Health, New York, New York, USA
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, NLSH Bodø, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, TRomsø, Norway
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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Moltrasio C, Silva CA, Tricarico PM, Marzano AV, Sueleman M, Crovella S. Biosensing circulating MicroRNAs in autoinflammatory skin diseases: Focus on Hidradenitis suppurativa. Front Genet 2024; 15:1383452. [PMID: 38655054 PMCID: PMC11035790 DOI: 10.3389/fgene.2024.1383452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
MicroRNAs (miRNAs) play a crucial role in the early diagnosis of autoinflammatory diseases, with Hidradenitis Suppurativa (HS) being a notable example. HS, an autoinflammatory skin disease affecting the pilosebaceous unit, profoundly impacts patients' quality of life. Its hidden nature, with insidious initial symptoms and patient reluctance to seek medical consultation, often leads to a diagnostic delay of up to 7 years. Recognizing the urgency for early diagnostic tools, recent research identified significant differences in circulating miRNA expression, including miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p, between HS patients and healthy controls. These miRNAs serve as potential biomarkers for earlier disease detection. Traditional molecular biology techniques, like reverse transcription quantitative-polymerase chain reaction (RT-qPCR), are employed for their detection using specific primers and probes. Alternatively, short peptides offer a versatile and effective means for capturing miRNAs, providing specificity, ease of synthesis, stability, and multiplexing potential. In this context, we present a computational simulation pipeline designed for crafting peptide sequences that can capture circulating miRNAs in the blood of patients with autoinflammatory skin diseases, including HS. This innovative approach aims to expedite early diagnosis and enhance therapeutic follow-up, addressing the critical need for timely intervention in HS and similar conditions.
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Affiliation(s)
- Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, 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
| | | | - Sergio Crovella
- Laboratory of Animal Research (LARC), Qatar University, Doha, Qatar
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Wainman HE, Chandran NS, Frew JW, Garg A, Gibbons A, Gierbolini A, Horvath B, Jemec GB, Kirby B, Kirby J, Lowes MA, Martorell A, McGrath BM, Naik HB, Oon HH, Prens E, Sayed CJ, Thorlacius L, Van der Zee HH, Villumsen B, Ingram JR. Global consensus process to establish a core dataset for hidradenitis suppurativa registries. Br J Dermatol 2024; 190:510-518. [PMID: 37976235 DOI: 10.1093/bjd/ljad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Several registries for hidradenitis suppurativa (HS) already exist in Europe and the USA. There is currently no global consensus on a core dataset (CDS) for these registries. Creating a global HS registry is challenging, owing to logistical and regulatory constraints, which could limit opportunities for global collaboration as a result of differences in the dataset collected. The solution is to encourage all HS registries to collect the same CDS of information, allowing registries to collaborate. OBJECTIVES To establish a core set of items to be collected by all HS registries globally. The core set will cover demographic details, comorbidities, clinical examination findings, patient-reported outcome measures and treatments. METHODS Beginning in September 2022, 20 participants - including both clinicians with expertise in HS and patient advocates - from eight countries across three continents participated in a Delphi process consisting of four rounds of voting, with all participants completing each round. A list of potential items for inclusion in the core set was generated from the relevant published literature, including systematic reviews of comorbidities in HS, clinical and examination findings, and epidemiology. For disease severity and progression items, the Hidradenitis SuppuraTiva Core outcome set International Collaboration (HiSTORIC) core set and other relevant instruments were considered for inclusion. This resulted in 47 initial items. Participants were invited to suggest additional items to include during the first round. Anonymous feedback was provided to inform each subsequent round of voting to encourage consensus. RESULTS The eDelphi process established a CDS of 48 items recommended for inclusion in all HS registries globally. CONCLUSIONS The routine adoption of this CDS in current and future HS registries should allow registries in different parts of the world to collaborate, enabling research requiring large numbers of participants.
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Affiliation(s)
- Hannah E Wainman
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nisha S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - Angela Gibbons
- Patient Representative, The HS Support Network UK and Ireland, UK
| | | | - Barbara Horvath
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Brian Kirby
- Charles Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Joselyn Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | | | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Hazel H Oon
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H Van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bente Villumsen
- Patient Representative, The Patients' Association HS Denmark, Denmark
| | - John R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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Kirby JS, Okun MM, Alavi A, Bechara FG, Zouboulis CC, Brown K, Santos LL, Wang A, Bibeau KB, Kimball AB, Porter ML. Efficacy and safety of the oral Janus kinase 1 inhibitor povorcitinib (INCB054707) in patients with hidradenitis suppurativa in a phase 2, randomized, double-blind, dose-ranging, placebo-controlled study. J Am Acad Dermatol 2024; 90:521-529. [PMID: 37871805 DOI: 10.1016/j.jaad.2023.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Janus kinase 1 inhibition may alleviate hidradenitis suppurativa (HS)-associated inflammation and improve symptoms. OBJECTIVE To assess efficacy and safety of povorcitinib (selective oral Janus kinase 1 inhibitor) in HS. METHODS This placebo-controlled phase 2 study randomized patients with HS 1:1:1:1 to receive povorcitinib 15, 45, or 75 mg or placebo for 16 weeks. Primary and key secondary end points were mean change from baseline in abscess and inflammatory nodule count and percentage of patients achieving HS Clinical Response at week 16. RESULTS Of 209 patients randomized (15 mg, n = 52; 45 mg, n = 52; 75 mg, n = 53; placebo, n = 52), 83.3% completed the 16-week treatment. At week 16, povorcitinib significantly reduced abscess and inflammatory nodule count from baseline (least squares mean [SE] change: 15 mg, -5.2 [0.9], P = .0277; 45 mg, -6.9 [0.9], P = .0006; 75 mg, -6.3 [0.9], P = .0021) versus placebo (-2.5 [0.9]). More povorcitinib-treated patients achieved HS Clinical Response at week 16 (15 mg, 48.1%, P = .0445; 45 mg, 44.2%, P = .0998; 75 mg, 45.3%, P = .0829) versus placebo (28.8%). A total of 60.0% and 65.4% of povorcitinib- and placebo-treated patients had adverse events. LIMITATIONS Baseline lesion counts were mildly imbalanced between groups. CONCLUSION Povorcitinib demonstrated efficacy in HS, with no evidence of increased incidence of adverse events among doses.
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Martin M Okun
- Department of Dermatology, Fort Memorial Hospital, Fort Atkinson, Wisconsin
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Falk G Bechara
- Department of Dermatology, Allergology and Venereology, Ruhr University Bochum, Bochum, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Kurt Brown
- Incyte Corporation, Wilmington, Delaware
| | | | - Annie Wang
- Incyte Corporation, Wilmington, Delaware
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martina L Porter
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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29
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González-López MA. [Hidradenitis suppurativa]. Med Clin (Barc) 2024; 162:182-189. [PMID: 37968174 DOI: 10.1016/j.medcli.2023.09.018] [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: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.
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Affiliation(s)
- Marcos A González-López
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, España; Real Academia de Medicina de Cantabria, Santander, Cantabria, España.
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Szukala W, Lichawska-Cieslar A, Krajewski PK, Kulecka M, Rumienczyk I, Mikula M, Matusiak Ł, Jura J, Szepietowski JC. An Atlas of the Hidradenitis Suppurativa Transcriptome. Dermatol Ther (Heidelb) 2024; 14:409-420. [PMID: 38183615 PMCID: PMC10890996 DOI: 10.1007/s13555-023-01083-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTIONS Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the skin. Both genetic and environmental factors contribute to the risk of developing HS, but the pathogenesis of this disease is currently not fully understood. The aim of this study was to further current understanding of the molecular background of HS with the use of global transcriptome analyses. METHODS Transcriptome profiling of perilesional and lesional skin of five patients with HS and six healthy control patients was performed by next-generation sequencing. Groups of differentially expressed genes characteristic of the skin of patients with HS were shortlisted by bioinformatic analysis. RESULTS RNA sequencing followed by bioinformatic profiling revealed profound enrichment of inflammatory-related processes in both lesional and perilesional skin of patients with HS. There were, however, distinct differences in the gene expression profiles between the lesional and perilesional skin, with 1488 genes differentially expressed. Genes encoding typical proinflammatory cytokines were profoundly enriched within HS lesions. In contrast, those encoding mediators of extracellular matrix organization were highly expressed mostly in the perilesional area. CONCLUSIONS Our study provides novel insights into the mechanisms underlying the pathogenesis of HS, and the results also have potential clinical implications in both diagnosis and therapeutics.
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Affiliation(s)
- Weronika Szukala
- Department of General Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Kraków, Poland
- Doctoral School of Exact and Natural Sciences, Jagiellonian University, Lojasiewicza 11, 30-348, Kraków, Poland
| | - Agata Lichawska-Cieslar
- Department of General Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Kraków, Poland
| | - Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368, Wrocław, Poland
| | - Maria Kulecka
- Department of Gastroenterology, Hepatology and Clinical Oncology, Medical Center for Postgraduate Education, Marymoncka 99/103, 01-813, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Izabela Rumienczyk
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Michał Mikula
- Maria Sklodowska-Curie National Research Institute of Oncology, Roentgena 5, 02-781, Warsaw, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368, Wrocław, Poland
| | - Jolanta Jura
- Department of General Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Gronostajowa 7, 30-387, Kraków, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368, Wrocław, Poland.
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Riera-Martí N, Vilarrasa E, López-Llunell C, Gamissans M, Sin M, Romaní J. Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:137-142. [PMID: 37797882 DOI: 10.1016/j.ad.2023.09.021] [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: 08/04/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement. OBJECTIVE To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile. MATERIAL AND METHODS We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661). RESULTS Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions. LIMITATIONS The study's limitations include its retrospective nature, bicentric design, and small sample size. CONCLUSION The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.
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Affiliation(s)
- N Riera-Martí
- Department of Dermatology, Hospital Universitari Parc Taulí, Sabadell (Barcelona), Spain.
| | - E Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - C López-Llunell
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Gamissans
- Department of Dermatology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - M Sin
- Department of Dermatology, Hospital Universitari Parc Taulí, Sabadell (Barcelona), Spain
| | - J Romaní
- Department of Dermatology, Hospital General de Granollers, Barcelona, Spain
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32
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Chu YL, Yu S. Hidradenitis Suppurativa: An Understanding of Genetic Factors and Treatment. Biomedicines 2024; 12:338. [PMID: 38397941 PMCID: PMC10886623 DOI: 10.3390/biomedicines12020338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
Hidradenitis suppurativa (HS), recognized as a chronic and debilitating skin disease, presents significant challenges in both diagnosis and treatment. This review explores the clinical manifestations, genetic landscape, and molecular mechanisms underlying HS. The disease's association with a predisposing genetic background, obesity, smoking, and skin occlusion underscores the complexity of its etiology. Genetic heterogeneity manifests in sporadic, familial, and syndromic forms, with a focus on mutations in the γ-secretase complex genes, particularly NCSTN. The dysregulation of immune mediators, including TNF-α, IL-17, IL-1β, and IL-12/23, plays a crucial role in the chronic inflammatory nature of HS. Recent advancements in genetic research have identified potential therapeutic targets, leading to the development of anti-TNF-α, anti-IL-17, anti-IL-1α, and anti-IL-12/23 therapies and JAK inhibitors. These interventions offer promise in alleviating symptoms and improving the quality of life for HS patients.
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Affiliation(s)
- Yi-Lun Chu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan;
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Sebastian Yu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan;
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Master of Public Health Degree Program, National Taiwan University, Taipei 100025, Taiwan
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Riera-Martí N, Vilarrasa E, López-Llunell C, Gamissans M, Sin M, Romaní J. Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T137-T142. [PMID: 38048948 DOI: 10.1016/j.ad.2023.11.003] [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] [Received: 08/04/2023] [Accepted: 09/15/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement. OBJECTIVE To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile. MATERIAL AND METHODS We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661). RESULTS Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions. LIMITATIONS The study's limitations include its retrospective nature, bicentric design, and small sample size. CONCLUSION The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two "subphenotypes" with a different clinical profiles and management.
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Affiliation(s)
- N Riera-Martí
- Department of Dermatology, Hospital Universitari Parc Taulí, Sabadell (Barcelona), España.
| | - E Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - C López-Llunell
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Gamissans
- Department of Dermatology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, España
| | - M Sin
- Department of Dermatology, Hospital Universitari Parc Taulí, Sabadell (Barcelona), España
| | - J Romaní
- Department of Dermatology, Hospital General de Granollers, Barcelona, España
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Heidari A, Ghane Y, Heidari N, Sadeghi S, Goodarzi A. A systematic review of Janus kinase inhibitors and spleen tyrosine kinase inhibitors for Hidradenitis suppurativa treatment. Int Immunopharmacol 2024; 127:111435. [PMID: 38150881 DOI: 10.1016/j.intimp.2023.111435] [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: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUNDS AND AIMS Hidradenitis suppurativa (HS) is a challenging skin disease with an underlying inflammatory process. Substantial progress has been made in our understanding of HS over the last few years, with the advancement of novel treatment approaches. The current systematic review aims to evaluate the safety and efficacy of Janus kinase (JAK) inhibitors and spleen tyrosine kinase (Syk) inhibitors in treating HS. METHOD A thorough systematic search was performed on PubMed/Medline, Web of Science, and Ovid Embase databases up to September 23th, 2023. Clinical studies published in English were included. RESULTS Our search yielded ten articles with a total of 165 patients treated with four types of JAK inhibitors (upadacitinib, povorcitinib, tofacitinib, and baricitinib) and one Syk inhibitor (fostamatinib). Upadacitinib, povorcitinib, and tofacitinib improved clinical outcomes, with a significant reduction in hidradenitis suppurativa clinical response (HiSCR) and abscess and inflammatory nodule count (AN count) during the treatment period. Also, these drugs are well tolerated in most HS patients with minimal adverse events (AEs). Moreover, baricitinib depicted an amelioration in signs and symptoms of HS in one case report. Also, fostamatinib exhibited favorable tolerability throughout a 12-week in moderate-to-severe HS patients. The remarkable clinical improvement, as assessed through HiSCR and hidradenitis suppurativa severity (IHS4), corresponded closely with serological indicators of inflammation following fostamatinib administration was achieved. CONCLUSION JAK and Syk inhibitors are potentially efficacious in managing moderate-to-severe HS since the proinflammatory cytokines are mediated by JAK and Syk signaling pathways. However, further research with a more rigorous examination is mandatory to evaluate such medication's long-term safety and efficacy.
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Affiliation(s)
- Amirhossein Heidari
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Yekta Ghane
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nazila Heidari
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Sara Sadeghi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Department of Medicine, New York Health System, South Brooklyn Hospital, Brooklyn, NY, USA.
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Rymaszewska JE, Karczewski M, Krajewski PK, Matusiak Ł, Maj J, Szepietowski JC. Patients' Expectations and Satisfaction with the Patient-Doctor Relationship in Hidradenitis Suppurativa. Healthcare (Basel) 2023; 11:3139. [PMID: 38132029 PMCID: PMC10742400 DOI: 10.3390/healthcare11243139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with a vast psychosocial burden. We analyzed the actual and ideal patient-doctor relationship and patients' satisfaction with the patient-doctor relationship in relation to their satisfaction with life (SWL), HS-related quality of life, and psychopathological symptoms. METHODS 105 HS patients (53% females; mean age 37.64 ± 14.01 years) were enrolled. Severity of the disease was measured using Hurley staging and the International HS Score System (IHS4). Instruments utilized: Patient Expectation Test; Satisfaction with Life Scale; HS Quality of Life; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; General Health Questionnaire. RESULTS Patients with Hurley I and mild IHS4 had the lowest satisfaction with the patient-doctor relationship. There were significant correlations between the actual patient-doctor relationship and the patients' SWL (r = 0.30; p = 0.002), depressive (r = -0.36; p < 0.01), anxiety (r = 0.37; p < 0.01) and psychopathological symptoms (r = -0.47; p < 0.0001) and between the satisfaction with the patient-doctor relationship and their SWL (r = -0.32; p = 0.00098). Multiple regression analysis revealed a significant influence of the following factors: Hurley II + III, psychopathological symptoms, and severe anxiety about the actual patient-doctor relationship and the satisfaction with the patient-doctor relationship. CONCLUSIONS Assessment of relations between patients and doctors is related to the patients' mental health and SWL. The usage of the Patient Expectation Test in clinical practice can improve the patient-doctor relationship and the general quality of care for and compliance by HS patients.
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Affiliation(s)
- Julia Ewa Rymaszewska
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Maciej Karczewski
- Department of Applied Mathematics, Wrocław University of Environmental and Life Sciences, Grunwaldzka Str. 53, 50-357 Wrocław, Poland;
| | - Piotr K. Krajewski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Joanna Maj
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
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Ingram JR, Bates J, Cannings-John R, Collier F, Gibbons A, Harris C, Hood K, Howells L, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study: the THESEUS prospective cohort study. Health Technol Assess 2023; 27:1-107. [PMID: 38149635 PMCID: PMC11017627 DOI: 10.3310/hwnm2189] [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: 12/28/2023] Open
Abstract
Background Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom. Objective To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials. Design Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop. Setting Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments. Participants Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment. Interventions Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery. Main outcome measures Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness. Results Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study's primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days. Limitations It was not possible to characterise conventional surgery due to a low number of participants. Conclusion The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials. Future work The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment. Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Janine Bates
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Angela Gibbons
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ceri Harris
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Howes
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Kashyap MP, Mishra B, Sinha R, Jin L, Kumar N, Goliwas KF, Deshane J, Elewski BE, Elmets CA, Athar M, Shahid Mukhtar M, Raman C. NK and NKT cells in the pathogenesis of Hidradenitis suppurativa: Novel therapeutic strategy through targeting of CD2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.31.565057. [PMID: 37961206 PMCID: PMC10634971 DOI: 10.1101/2023.10.31.565057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disease with poorly understood pathogenesis. Single-cell RNAseq analysis of HS lesional and healthy individual skins revealed that NKT and NK cell populations were greatly expanded in HS, and they expressed elevated CD2, an activation receptor. Immunohistochemistry analyses confirmed significantly expanded numbers of CD2+ cells distributed throughout HS lesional tissue, and many co-expressed the NK marker, CD56. While CD4+ T cells were expanded in HS, CD8 T cells were rare. CD20+ B cells in HS were localized within tertiary follicle like structures. Immunofluorescence microscopy showed that NK cells (CD2 + CD56 dim ) expressing perforin, granzymes A and B were enriched within the hyperplastic follicular epidermis and tunnels of HS and juxtaposed with apoptotic cells. In contrast, NKT cells (CD2 + CD3 + CD56 bright ) primarily expressed granzyme A and were associated with α-SMA expressing fibroblasts within the fibrotic regions of the hypodermis. Keratinocytes and fibroblasts expressed high levels of CD58 (CD2 ligand) and they interacted with CD2 expressing NKT and NK cells. The NKT/NK maturation and activating cytokines, IL-12, IL-15 and IL-18, were significantly elevated in HS. Inhibition of cognate CD2-CD58 interaction with blocking anti-CD2 mAb in HS skin organotypic cultures resulted in a profound reduction of the inflammatory gene signature and secretion of inflammatory cytokines and chemokines in the culture supernate. In summary, we show that a cellular network of heterogenous NKT and NK cell populations drives inflammation, tunnel formation and fibrosis in the pathogenesis of HS. Furthermore, CD2 blockade is a viable immunotherapeutic approach for the management of HS.
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Agnese ER, Tariche N, Sharma A, Gulati R. The Pathogenesis and Treatment of Hidradenitis Suppurativa. Cureus 2023; 15:e49390. [PMID: 38146560 PMCID: PMC10749691 DOI: 10.7759/cureus.49390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a multifactorial disease involving the skin and subcutaneous tissues characterized by deep-seated, painful nodules and abscesses with draining sinus tracts. It affects mostly younger individuals between the ages of 18 and 34. The discomfort and embarrassment that patients affected by HS experience negatively impact their daily lives. It is associated with decreased quality of life and high rates of comorbid depression and anxiety. The rate of depression in HS was reported to be as high as 26%. Its pathogenesis is multifactorial and as such requires a multimodal approach to treatment, which subsequently is reviewed here. Moreover, the pathogenesis of HS is complex and only partially understood. Autoinflammation is the key driver of disease development and is linked with dysregulated inflammasome activation with the subsequent production of inflammatory cytokines. Genetics and cutaneous microbiome play a role in the development of chronic inflammation and lesion formation. Risk factors such as obesity, metabolic syndrome, diabetes, and smoking also add to the systemic inflammation. Targeting these risk factors is a key aspect of the treatment of HS. Lifestyle modifications are used in conjunction with pharmacotherapy and procedures to effectively manage the disease.
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Affiliation(s)
- Erica R Agnese
- Dermatology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Nicole Tariche
- Obstetrics and Gynecology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Amit Sharma
- Dermatology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Raj Gulati
- General Surgery, Lake Erie College of Osteopathic Medicine, Elmira, USA
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Bens L, Green SI, Jansen D, Hillary T, Vanhoutvin T, Matthijnssens J, Sabino J, Vermeire S, Van Laethem A, Wagemans J, Lavigne R. Phage therapy for hidradenitis suppurativa: a unique challenge and possible opportunity for personalized treatment of a complex, inflammatory disease. Clin Exp Dermatol 2023; 48:1221-1229. [PMID: 37315154 DOI: 10.1093/ced/llad207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
Phage therapy is an emerging antimicrobial treatment for critical multidrug-resistant pathogens. In this review, the specific potential and challenges of phage therapy for patients with hidradenitis suppurativa (HS) are discussed. This represents a unique challenge as HS is a chronic inflammatory disease, but presenting with acute exacerbations, which have an enormous negative impact on patient's quality of life. The therapeutic arsenal for HS has expanded in the past decade, for example, with adalimumab and several other biologicals that are currently under investigation. However, treatment of HS remains challenging for dermatologists because there are individuals who do not respond to any classes of the current treatment options when used for a first or second time. Furthermore, after several courses of treatment, a patient may lose their response to therapy, meaning long-term use is not always an option. Culturing studies and 16S ribosomal RNA profiling highlight the complex polymicrobial nature of HS lesions. Despite the detection of various bacterial species in lesion samples, several key pathogens, including Staphylococcus, Corynebacterium and Streptococcus, may be potential targets for phage therapy. Using phage therapy for the treatment of a chronic inflammatory disease could potentially provide new insights into the role of bacteria and the immune system in HS development. In addition, it is possible more details on the immunomodulatory effects of phages may come to light.
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Affiliation(s)
| | | | - Daan Jansen
- Microbiology, Immunology and Transplantation, Rega Institute, KU LeuvenBelgium
| | | | | | - Jelle Matthijnssens
- Microbiology, Immunology and Transplantation, Rega Institute, KU LeuvenBelgium
| | - João Sabino
- Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
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Alabdulkareem M, Berkane Y, Le Bras E, Rousson E, Chrelias T, Beaufils T, Leclere FM, Watier E, Bertheuil N. Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5301. [PMID: 37811354 PMCID: PMC10558224 DOI: 10.1097/gox.0000000000005301] [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: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023]
Abstract
Background Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS. Methods We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications. Results Although not statistically significant (P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time (P = 0.0006), defect size (P = 0.0064), and flap size (P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%). Conclusion After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment.
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Affiliation(s)
- Mohammad Alabdulkareem
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- Department of Surgery, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Yanis Berkane
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
- Shriners Children’s Boston, Harvard Medical School, Boston, Mass
| | - Enna Le Bras
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Etienne Rousson
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Theodoros Chrelias
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Tristan Beaufils
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Franck-Marie Leclere
- Department of Plastic, Reconstructive and Hand Surgery, Poitiers University Hospital, CHU de la Miletrie de Poitiers, Poitiers, France
- Laboratoire d’anatomie et de Simulation, Université de Poitiers, Poitiers, France
| | - Eric Watier
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Nicolas Bertheuil
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
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Agamia NF, Sorror OA, Sayed NM, Ghazala RA, Echy SM, Moussa DH, Melnik BC. Overexpression of hypoxia-inducible factor-1α in hidradenitis suppurativa: the link between deviated immunity and metabolism. Arch Dermatol Res 2023; 315:2107-2118. [PMID: 36961533 PMCID: PMC10366312 DOI: 10.1007/s00403-023-02594-6] [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: 01/13/2023] [Revised: 01/13/2023] [Accepted: 02/23/2023] [Indexed: 03/25/2023]
Abstract
Hypoxia-inducible factor-1α (HIF-1α) is the master transcription factor of glycolysis, Th17 cell differentiation and suppression of regulatory T cells. In the skin and serum of patients with psoriasis vulgaris, increased expression of HIF-1α has been reported, whereas HIF-1α expression in the skin and serum of patients with hidradenitis suppurativa (HS) has not yet been studied. The objective of the study is to demonstrate is there a role for HIF-1α in the pathogenesis of hidradenitis suppurativa, and its relation to HS severity. Twenty patients suffering from hidradenitis suppurativa were included in the study. Punch biopsies were taken from lesional skin for the determination of HIF-1α expression by immunohistochemical staining, and HIF-1α gene expression by quantitative reverse transcription real time PCR. Quantification of HIF-1α protein concentration was done by enzyme-linked immunosorbent assay. Twenty socio-demographically cross-matched healthy volunteers served as controls. We found increased serum levels of HIF-1α. Literature-derived evidence indicates that the major clinical triggering factors of HS, obesity, and smoking are associated with hypoxia and enhanced HIF-1α expression. Pro-inflammatory cytokines such as tumor necrosis factor-[Formula: see text] via upregulation of nuclear factor [Formula: see text]B enhance HIF-1α expression. HIF-1α plays an important role for keratinocyte proliferation, especially for keratinocytes of the anagen hair follicle, which requires abundant glycolysis providing sufficient precursors molecules for biosynthetic pathways. Metformin via inhibition of mTORC1 as well as adalimumab attenuate HIF-1α expression, the key mediator between Th17-driven deviated immunity and keratinocyte hyperproliferation. In accordance with psoriasis, our study identifies HS as an HIF-1α-driven inflammatory skin disease and offers a new rationale for the prevention and treatment of HS by targeting HIF-1[Formula: see text] overexpression.
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Affiliation(s)
- Naglaa Fathi Agamia
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.
| | - Osama Ahmed Sorror
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Naglaa Mohamed Sayed
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Rasha Abdelmawla Ghazala
- Department of Medical Biochemistry, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Sammar Mohamed Echy
- Department of Clinical Pathology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Doaa Helmy Moussa
- Department of Dermatology, Andrology and Venereology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Bodo Clemens Melnik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
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Nazzaro G, Calzari P, Vaienti S, Passoni E, Marzano AV. The role of imaging technologies in the diagnosis of hidradenitis suppurativa. Clin Dermatol 2023; 41:611-621. [PMID: 37652192 DOI: 10.1016/j.clindermatol.2023.08.023] [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: 09/02/2023]
Abstract
Hidradenitis suppurativa is a chronic, inflammatory, recurrent, and debilitating disease of the hair follicle. It presents with painful, deep-seated, inflamed lesions, such as nodules, abscesses, sinus tracts, and fistulas, generally located in the main folds. Clinical severity assessment alone can be reductive; noninvasive skin imaging technologies, such as ultrasound, magnetic resonance imaging, medical infrared thermography, computed tomography, and positron emission tomography, provide subclinical anatomical and functional details. These instrumental techniques confirm the clinical suspect, thus allowing an earlier diagnosis and improving patients' clinical evaluation, staging, and management. Finally, they might be helpful for preoperative mapping. In this contribution, we provide an overview of the current knowledge about noninvasive skin imaging techniques with a particular focus on ultrasonography, which is widely used thanks to its precision, versatility, and availability.
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Affiliation(s)
- Gianluca Nazzaro
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Dermatology Unit, Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Paolo Calzari
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Silvia Vaienti
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuela Passoni
- Dermatology Unit, Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Dermatology Unit, Foundation IRCCS, Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Mintoff D, Agius R, Benhadou F, Das A, Frew JW, Pace NP. Obesity and hidradenitis suppurativa: targeting meta-inflammation for therapeutic gain. Clin Exp Dermatol 2023; 48:984-990. [PMID: 37171791 DOI: 10.1093/ced/llad182] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the pilosebaceous unit. The typical patient with HS is characterized as someone with obesity, who smokes and who has nodules, abscesses and/or draining tunnels predominantly distributed in intertriginous skin. It has been established that lifestyle and genetic factors are the main pathophysiological drivers of HS. In this critical review, we explore the interrelatedness of meta-inflammation, obesity and HS and discuss if and how this relationship may be manipulated for a therapeutic end.
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Affiliation(s)
- Dillon Mintoff
- Department of Dermatology
- Department of Pathology, Faculty of Medicine and Surgery
| | - Rachel Agius
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Anupam Das
- Department of Dermatology, Venereology and Leprosy; KPC Medical College & Hospital, Kolkata, India
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Nikolai P Pace
- Faculty of Medicine and Surgery
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
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Jiminez V, Yusuf N. Bacterial Metabolites and Inflammatory Skin Diseases. Metabolites 2023; 13:952. [PMID: 37623895 PMCID: PMC10456496 DOI: 10.3390/metabo13080952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
The microbiome and gut-skin axis are popular areas of interest in recent years concerning inflammatory skin diseases. While many bacterial species have been associated with commensalism of both the skin and gastrointestinal tract in certain disease states, less is known about specific bacterial metabolites that regulate host pathways and contribute to inflammation. Some of these metabolites include short chain fatty acids, amine, and tryptophan derivatives, and more that when dysregulated, have deleterious effects on cutaneous disease burden. This review aims to summarize the knowledge of wealth surrounding bacterial metabolites of the skin and gut and their role in immune homeostasis in inflammatory skin diseases such as atopic dermatitis, psoriasis, and hidradenitis suppurativa.
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Affiliation(s)
- Victoria Jiminez
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Nabiha Yusuf
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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45
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Grotenhermen F, Oláh A. Case in Context: Acne Inversa (Hidradenitis Suppurativa). Cannabis Cannabinoid Res 2023; 8:608-611. [PMID: 37074343 DOI: 10.1089/can.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Affiliation(s)
| | - Attila Oláh
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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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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Gierek M, Kitala D, Łabuś W, Glik J, Szyluk K, Pietrauszka K, Bergler-Czop B, Niemiec P. The Impact of Telemedicine on Patients with Hidradenitis Suppurativa in the COVID-19 Era. Healthcare (Basel) 2023; 11:healthcare11101453. [PMID: 37239740 DOI: 10.3390/healthcare11101453] [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: 04/04/2023] [Revised: 05/11/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Hidradenitis suppurativa is a chronic, inflammatory skin disease. It is characterized by the transformation of normal skin into skin with abscesses, nodules, tunnels, and scars. The most commonly affected areas are the armpits, groins, buttocks, and subscapular area. Patients with HS require constant care under the supervision of the outpatient clinic. Due to the COVID-19 pandemic, consultations have been introduced in the form of telemedicine. The aim of this study was to evaluate the availability of HS treatment during the COVID-19 pandemic and to assess patient satisfaction, problems with access to medical care, and the impact of the pandemic on the course of the disease. (2) Methods: An internet survey with an anonymous questionnaire was used to assess the effectiveness of telemedicine consultations. The survey consisted of 25 closed questions, and responses were kept fully anonymous. (3) Results: Most respondents reported minor problems with accessing specialized HS medical care during the COVID-19 pandemic (n = 25, 35.71%). However, 35.71% (n = 25) of them reported major problems with appointments for specialized ambulatory treatment during the last few months of the pandemic, mainly due to delayed appointments. Almost half of the respondents had been diagnosed with COVID-19 (n = 34, 48.57%), and 58.57% (n = 41) of respondents did not see a correlation between COVID-19 infection and HS progression. (4) Conclusions: Our study showed that the pandemic significantly limited access to medical advice, and patients with hidradenitis suppurativa prefer standard consultations.
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Affiliation(s)
- Marcin Gierek
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Diana Kitala
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Wojciech Łabuś
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Justyna Glik
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
- Department of Organisation of Chronic Wound Healing, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-055 Katowice, Poland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Street, 41-940 Piekary Slaskie, Poland
| | - Kornelia Pietrauszka
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street, 40-027 Katowice, Poland
| | - Beata Bergler-Czop
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street, 40-027 Katowice, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Street 18, 40-752 Katowice, Poland
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Molinelli E, Gioacchini H, Sapigni C, Diotallevi F, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. New Insight into the Molecular Pathomechanism and Immunomodulatory Treatments of Hidradenitis Suppurativa. Int J Mol Sci 2023; 24:ijms24098428. [PMID: 37176138 PMCID: PMC10179439 DOI: 10.3390/ijms24098428] [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: 01/30/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Hidradenitis suppurativa (HS) is an immune-mediated inflammatory disorder characterized by deep-seated nodules, abscesses, sinus tracts and scars localized in the intertriginous areas. It is accompanied by pain, malodourous secretion and a dramatically decreased quality of life. Although the pathogenesis has not been entirely elucidated, the primary event is follicular hyperkeratosis of the pilosebaceous apocrine unit. Since the registration of the tumor necrosis factor-alpha inhibitor Adalimumab in 2015, several cytokines have been implicated in the pathomechanism of HS and the research of novel therapeutic targets has been intensified. We provide an update on the inflammatory cytokines with a central role in HS pathogenesis and the most promising target molecules of future HS management.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Helena Gioacchini
- 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
| | - Federico Diotallevi
- 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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49
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Young KZ, Dimitrion P, Zhou L, Adrianto I, Mi QS. Sex-biased immunological processes drive hidradenitis suppurativa. Front Immunol 2023; 14:1167021. [PMID: 37215102 PMCID: PMC10192729 DOI: 10.3389/fimmu.2023.1167021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can manifest with abscesses, sinus tracts, and scarring in the intertriginous areas of the body. HS is characterized by immune dysregulation, featuring elevated levels of myeloid cells, T helper (Th) cells, and pro-inflammatory cytokines, particularly those involved in Th1- and Th17-mediated immunity. In most epidemiological studies, HS shows a strong female sex bias, with reported female-to-male ratios estimated at roughly 3:1, suggesting that sex-related factors contribute to HS pathophysiology. In this article, we review the role of intrinsic and extrinsic factors that contribute to immunological differences between the sexes and postulate their role in the female sex bias observed in HS. We discuss the effects of hormones, X chromosome dosage, genetics, the microbiome, and smoking on sex-related differences in immunity to postulate potential immunological mechanisms in HS pathophysiology. Future studies are required to better characterize sex-biased factors that contribute to HS disease presentations.
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Affiliation(s)
- Kelly Z. Young
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- University of Michigan Medical School, Ann Arbor, MI, United States
| | - Peter Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Indra Adrianto
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, United States
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, United States
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
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50
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Liu H, Santos LL, Smith SH. Modulation of Disease-Associated Pathways in Hidradenitis Suppurativa by the Janus Kinase 1 Inhibitor Povorcitinib: Transcriptomic and Proteomic Analyses of Two Phase 2 Studies. Int J Mol Sci 2023; 24:ijms24087185. [PMID: 37108348 PMCID: PMC10139090 DOI: 10.3390/ijms24087185] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Janus kinase (JAK)/signal transducer and activator of transcription signaling (STAT) has been implicated in the pathophysiology of hidradenitis suppurativa (HS). This study evaluated treatment-related transcriptomic and proteomic changes in patients with moderate-to-severe HS treated with the investigational oral JAK1-selective inhibitor povorcitinib (INCB054707) in two phase 2 trials. Lesional skin punch biopsies (baseline and Week 8) were taken from active HS lesions of patients receiving povorcitinib (15 or 30 mg) once daily (QD) or a placebo. RNA-seq and gene set enrichment analyses were used to evaluate the effects of povorcitinib on differential gene expression among previously reported gene signatures from HS and wounded skin. The number of differentially expressed genes was the greatest in the 30 mg povorcitinib QD dose group, consistent with the published efficacy results. Notably, the genes impacted reflected JAK/STAT signaling transcripts downstream of TNF-α signaling, or those regulated by TGF-β. Proteomic analyses were conducted on blood samples obtained at baseline and Weeks 4 and 8 from patients receiving povorcitinib (15, 30, 60, or 90 mg) QD or placebo. Povorcitinib was associated with transcriptomic downregulation of multiple HS and inflammatory signaling markers as well as the reversal of gene expression previously associated with HS lesional and wounded skin. Povorcitinib also demonstrated dose-dependent modulation of several proteins implicated in HS pathophysiology, with changes observed by Week 4. The reversal of HS lesional gene signatures and rapid, dose-dependent protein regulation highlight the potential of JAK1 inhibition to modulate underlying disease pathology in HS.
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Affiliation(s)
- Huiqing Liu
- Incyte Corporation, Wilmington, DE 19803, USA
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