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Vu D, Park M, Alhusayen R. Efficacy of moxifloxacin as a mono-antibiotic therapy for hidradenitis suppurativa: A retrospective cohort study. J Am Acad Dermatol 2024:S0190-9622(24)00828-4. [PMID: 38825077 DOI: 10.1016/j.jaad.2024.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 06/04/2024]
Affiliation(s)
- Don Vu
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Megan Park
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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2
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Taha AM, Hassan WS, Elmasry MS, Sayed RA. Eco-friendly micellar HPLC approach for simultaneous estimation of combination therapy for hidradenitis suppurativa: Applications to spiked human plasma and different dosage forms. Arch Pharm (Weinheim) 2024; 357:e2300509. [PMID: 37939289 DOI: 10.1002/ardp.202300509] [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: 09/17/2023] [Revised: 10/14/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023]
Abstract
This study introduces a new method for analyzing rifampicin, moxifloxacin, and metronidazole using a green micellar High Performance Liquid Chromatography-Ultraviolet method in bulk drugs, different commercial formulations, and spiked human plasma. The combined therapy of these three broad-spectrum antibiotics is used to cure refractory hidradenitis suppurativa (HS), an inflammatory condition affecting the skin. The sustainable separation was attained on a reversed-phase C18 Kinetex® column maintained at ambient temperature in less than 5 min. The mobile phase comprises 0.1 M sodium dodecyl sulfate (SDS) in water, pH 3.5, adjusted using o-phosphoric acid, and 10% n-butanol. The flow rate was 1 mL/min, with 10 μL injection volume and UV detection at 230 nm. The impact of three key significant variables, SDS concentration, n-butanol percentage, and the mobile phase pH, on suitability parameters was studied. ICH and FDA guidelines were committed to when validating the technique. The results showed linear calibration graphs with high precision and accuracy, in both pure and spiked plasma. The method is efficient, easy to use, and has a high sample throughput, making it suitable for routine analysis in the quality control department and therapeutic monitoring. It is also evaluated as a green-and-white substitute for traditional reported methods.
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Affiliation(s)
- Asmaa M Taha
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Wafaa S Hassan
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Manal S Elmasry
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
| | - Rania A Sayed
- Analytical Chemistry Department, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt
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3
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Liao YH, Chu CB, Hui CYR, Li CY, Lin SY, Tseng HC, Wang YJ, Wu J, Yu WW, Chao SC. Taiwanese Dermatological Association (TDA) consensus recommendations for the definition, classification, diagnosis, and management of hidradenitis suppurativa. J Formos Med Assoc 2023:S0929-6646(23)00492-8. [PMID: 38160191 DOI: 10.1016/j.jfma.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful, recurrent, inflamed lesions most commonly occurring in the axillary, inguinal, and anogenital regions. HS can inflict immense physical and psychological impact on patients who suffer from this distressing disease. Management of HS generally requires combining various medical and procedural treatment modalities; however, the disease is often recalcitrant to conventional treatments. In light of recent evidence supporting the effectiveness of biologic agents in the treatment of HS, the Taiwanese Dermatological Association established an expert panel of nine dermatologists to develop consensus statements aimed to provide up-to-date evidence-based guidance in optimizing HS patient management in Taiwan. The recommendations described in the statements were summarized in a management algorithm in terms of general care, topical treatment, systemic treatment, and procedural treatment.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Yao Lin
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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4
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Ben Abdallah H, Bregnhøj A, Iversen L, Johansen C. Transcriptomic Analysis of Hidradenitis Suppurativa: A Unique Molecular Signature with Broad Immune Activation. Int J Mol Sci 2023; 24:17014. [PMID: 38069342 PMCID: PMC10707244 DOI: 10.3390/ijms242317014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory skin disease with limited treatment options. The poorly understood pathogenesis hinders the development of effective treatments; therefore, a pressing need exists to further elucidate the molecular mechanisms in hidradenitis suppurativa. This study investigated the underlying inflammatory pathways and cell types in hidradenitis suppurativa using transcriptomic approaches with RNA sequencing of lesional and non-lesional skin biopsies from hidradenitis suppurativa, which was jointly analyzed with previously published transcriptomic data from atopic dermatitis and psoriasis patients. The differential expression and pathway enrichment analyses demonstrated the activation of multiple inflammatory processes, including the innate and adaptive immune systems, implicated in the hidradenitis suppurativa pathogenesis. In agreement, hidradenitis suppurativa exhibited a unique and heterogeneous cell type signature involving lymphoid and myeloid cells such as B cells and macrophages. Furthermore, hidradenitis suppurativa displayed increased expression of TH1/2/17 signatures with no predominant TH signatures unlike psoriasis (TH1/17) and atopic dermatitis (TH2). In summary, our study provides molecular insights into the pathomechanisms in hidradenitis suppurativa, revealing a strong and widespread immune activation, which may benefit from treatment strategies offering a broad immunomodulation of various key inflammatory pathways. Our data not only corroborate previously reported findings but also enhance our understanding of the immune dysregulation in hidradenitis suppurativa, uncovering novel and potential therapeutic targets.
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Affiliation(s)
- Hakim Ben Abdallah
- Department of Dermatology and Venereology, Aarhus University Hospital, 8200 Aarhus, Denmark; (A.B.); (L.I.); (C.J.)
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5
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Mansilla-Polo M, Escutia-Muñoz B, Botella-Estrada R. Narrative Review and Update on Biologic and Small Molecule Drugs for Hidradenitis Suppurativa: An Entity With a Promising Future. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T772-T783. [PMID: 37541580 DOI: 10.1016/j.ad.2023.08.001] [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: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 08/06/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory entity characterized by the appearance of multiple nodules, abscesses, and fistulas, predominantly in apocrine regions. In addition to its dermatological involvement, it is associated with multiple systemic comorbidities. Its treatment is combined: topical pharmacological, systemic pharmacological and surgical. Regarding biologic or small molecule drugs, currently only adalimumab is approved. A narrative review of the literature on biological or small molecule drugs used in the treatment of hidradenitis suppurativa is presented. The arsenal we found is large, with multiple targets: inhibitors of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-17, IL-23, IL-1, inhibitors of the janus kinase (JAK) pathway, and multiple other drugs in study. New prospective studies and comparative trials are needed to analyze the effectiveness and safety of these treatments, in an entity with a promising future.
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Affiliation(s)
- M Mansilla-Polo
- Departmento de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España.
| | - B Escutia-Muñoz
- Departmento de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España
| | - R Botella-Estrada
- Departmento de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España; Universitat de Valéncia, Valencia, España
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6
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Mansilla-Polo M, Escutia-Muñoz B, Botella-Estrada R. Narrative Review and Update on Biologic and Small Molecule Drugs for Hidradenitis Suppurativa: An Entity With a Promising Future. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:772-783. [PMID: 37211274 DOI: 10.1016/j.ad.2023.05.015] [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: 04/18/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory entity characterized by the appearance of multiple nodules, abscesses, and fistulas, predominantly in apocrine regions. In addition to its dermatological involvement, it is associated with multiple systemic comorbidities. Its treatment is combined: topical pharmacological, systemic pharmacological and surgical. Regarding biologic or small molecule drugs, currently only adalimumab is approved. A narrative review of the literature on biological or small molecule drugs used in the treatment of hidradenitis suppurativa is presented. The arsenal we found is large, with multiple targets: inhibitors of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-17, IL-23, IL-1, inhibitors of the janus kinase (JAK) pathway, and multiple other drugs in study. New prospective studies and comparative trials are needed to analyze the effectiveness and safety of these treatments, in an entity with a promising future.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain.
| | - B Escutia-Muñoz
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain
| | - R Botella-Estrada
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain; Departament of Dermatology. Universitat de Valéncia, Valencia, Spain; Dermatology, Valencia, Spain
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7
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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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Molinelli E, De Simoni E, Candelora M, Sapigni C, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. Systemic Antibiotic Therapy in Hidradenitis Suppurativa: A Review on Treatment Landscape and Current Issues. Antibiotics (Basel) 2023; 12:978. [PMID: 37370297 DOI: 10.3390/antibiotics12060978] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, and inflammatory skin disease characterized by painful, deep-seated, nodules, abscesses, and sinus tracts in sensitive areas of the body, including axillary, inguinal, and anogenital regions. Antibiotics represent the first-line pharmacological treatment of HS because of their anti-inflammatory properties and antimicrobial effects. This narrative review summarizes the most significant current issues on the role of systemic antibiotics in the management of HS, critically analyzing the main limits of their use (antibiotic resistance and toxicity). Although, in the last decades, several cytokines have been implicated in the pathomechanism of HS and the research on the use of novel biologic agents in HS has been intensified, antibiotics remain a valid therapeutic approach. Future challenges regarding antibiotic therapy in HS comprise their use in association with biologics in the management of acute flare or as a bridge therapy to surgery.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Edoardo De Simoni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Matteo Candelora
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med 2023; 136:42-53. [PMID: 36252715 DOI: 10.1016/j.amjmed.2022.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
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10
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Delage M, Jais JP, Lam T, Guet-Revillet H, Ungeheuer MN, Consigny PH, Nassif A, Join-Lambert O. Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley stage 1 hidradenitis suppurativa: prospective short-term trial and 1-year follow-up in 28 consecutive patients. J Am Acad Dermatol 2023; 88:94-100. [PMID: 31931082 DOI: 10.1016/j.jaad.2020.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Severe Hurley stage 1 hidradenitis suppurativa (HS1) is a difficult-to-treat form of the disease. OBJECTIVE To assess the efficacy and tolerance of the oral combination of rifampin (10 mg/kg once daily)/moxifloxacin (400 mg once daily)/metronidazole (250-500 mg 3 times daily) (RMoM) treatment strategy in patients with severe HS1. METHODS Prospective, open-label, noncomparative cohort study in 28 consecutive patients. Nineteen patients were treated for 6 weeks by RMoM, followed by 4 weeks of rifampin/moxifloxacin alone, then by cotrimoxazole after remission. Moxifloxacin was replaced by pristinamycin (1 g 3 times daily) in 9 patients because of contraindications or intolerance. The primary endpoint was a Sartorius score of 0 (clinical remission) at week 12. RESULTS The median Sartorius score dropped from 14 to 0 (P = 6 × 10-6) at week 12, with 75% of patients reaching clinical remission. A low initial Sartorius score was a prognosis factor for clinical remission (P = .049). The main adverse effects were mild gastrointestinal discomfort, mucosal candidiasis, and asthenia. At 1 year of follow-up, the median number of flares dropped from 21/year to 1 (P = 1 × 10-5). LIMITATIONS Small, monocentric, noncontrolled study. CONCLUSIONS Complete and prolonged remission can be obtained in severe HS1 by using targeted antimicrobial treatments.
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Affiliation(s)
- Maïa Delage
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Jean-Philippe Jais
- Unit of Biostatistics, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1163, Institut Imagine, Paris, France; Université de Paris, Paris, France
| | - Thi Lam
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Hélène Guet-Revillet
- Department of Bacteriology, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - Marie-Noelle Ungeheuer
- Investigation Clinique et d'Accès aux Bio-ressources platform, Center for Translational Science, Institut Pasteur, Paris, France
| | - Paul-Henri Consigny
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Olivier Join-Lambert
- Normandie University, UNICAEN, UNIROUEN, CHU de Caen Normandie, Department of Microbiology, Groupe de Recherche sur l'Adaptation Microbienne, Caen, France.
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11
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Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:jcm11237240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed.
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12
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Our Experience in Using Lateral Chest Flap to Treat Axillary Hidradenitis Suppurativa. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4569. [PMID: 36246081 PMCID: PMC9556028 DOI: 10.1097/gox.0000000000004569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/11/2022] [Indexed: 11/26/2022]
Abstract
Hidradenitis suppurativa is a chronic inflammatory condition that affects apocrine gland-bearing areas' causing abscesses and sinuses. Multimodality treatment is suggested for management. The surgical option is becoming more widely used, especially in drug-resistant cases. In this article, we describe a series of bilateral axillary hidradenitis cases which we treated with wide local excision and immediate reconstruction with lateral chest flap. Methods Fourteen patients presented to our clinic with bilateral hidradenitis suppurativa of the axilla. The cases were all resistant to medical treatment. They were managed by excision and simultaneous reconstruction with lateral chest flaps. Results At 3 months postoperatively, all patients had full shoulder range of motion and were completely satisfied with the aesthetic outcome, except for one patient who complained of the bulky look of his axilla. Liposuction was performed for him' with a pleasant resultant outcome. Conclusions Our patients underwent wide local excision of bilateral disease plus reconstruction with lateral chest flaps in the same session. Our aim was to introduce a treatment option for moderate to severe axillary hidradenitis suppurativa that offers good aesthetic and functional outcomes.
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13
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Johnston LA, Alhusayen R, Bourcier M, Delorme I, George R, O'Brien E, Wong SM, Poelman SM. Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update. J Cutan Med Surg 2022; 26:2S-24S. [PMID: 36000460 DOI: 10.1177/12034754221116115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.
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Affiliation(s)
- Leah A Johnston
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Raed Alhusayen
- 282299 Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Isabelle Delorme
- Dr Isabelle Delorme Inc, Dermatologue, Drummondville, QC, Canada
| | - Ralph George
- 7938 Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth O'Brien
- 12367 Faculty of Medicine, Dermatology, McGill University, Montreal, QC, Canada
| | - Se Mang Wong
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Susan M Poelman
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada.,Beacon Dermatology, Calgary, AB, Canada
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14
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Markota Čagalj A, Marinović B, Bukvić Mokos Z. New and Emerging Targeted Therapies for Hidradenitis Suppurativa. Int J Mol Sci 2022; 23:ijms23073753. [PMID: 35409118 PMCID: PMC8998913 DOI: 10.3390/ijms23073753] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/20/2022] [Accepted: 03/25/2022] [Indexed: 12/24/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease deriving from the hair follicles. The formation of inflammatory nodules, abscesses, fistulas, and sinus tracts is characterized by a large inflow of key pro-inflammatory mediators, such as IFN-γ, TNF-α, IL-1, IL-17, and IL-12/23. Adalimumab is currently the only Food and Drug Administration (FDA)- and European Medicines Agency (EMA)-approved biologic therapy for moderate to severe HS in adults and adolescents. However, the long-term effectiveness of this TNF-α inhibitor in HS patients has shown to be highly variable. This review aims to review the evidence for emerging therapies that target the main pro-inflammatory cytokines in HS pathogenesis. A review of the literature was conducted, using the PubMed and Google Scholar repositories, as well as Clinicaltrials.gov. Presently, the most promising biologics in phase III trials are anti-IL-17 antibodies, secukinumab, and bimekizumab. Furthermore, an anti-IL-1 biologic, bermekimab, is currently in phase II trials, and shows encouraging results. Overall, the clinical efficacies of all new targeted therapies published up to this point are limited. More studies need to be performed to clarify the precise molecular pathology, and assess the efficacy of biological therapies for HS.
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Affiliation(s)
- Adela Markota Čagalj
- Department of Dermatology and Venereology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia;
- School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
| | - Branka Marinović
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
- Department of Dermatology and Venereology, European Reference Network (ERN), Skin Reference Centre, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
| | - Zrinka Bukvić Mokos
- School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia;
- Department of Dermatology and Venereology, European Reference Network (ERN), Skin Reference Centre, University Hospital Centre Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-12368915
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15
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Hwang J, Rick J, Hsiao J, Hamzavi IH, Shi VY. Microbiome in Hidradenitis Suppurativa: Current Evidence and Practice. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-021-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Lewandowski M, Świerczewska Z, Barańska‐Rybak W. Hidradenitis suppurativa: a review of current treatment options. Int J Dermatol 2022; 61:1152-1164. [DOI: 10.1111/ijd.16115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Miłosz Lewandowski
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| | - Zuzanna Świerczewska
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
| | - Wioletta Barańska‐Rybak
- Department of Dermatology, Venereology and Allergology Medical University of Gdansk Gdansk Poland
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17
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Rabindranathnambi A, Jeevankumar B. Dapsone in Hidradenitis Suppurativa: A Systematic Review. Dermatol Ther (Heidelb) 2022; 12:285-293. [PMID: 34997914 PMCID: PMC8850499 DOI: 10.1007/s13555-021-00674-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disease, usually presenting after puberty with inflammatory lesions that mainly affect the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal and anogenital regions. The treatment of HS is associated with certain challenges due to intrinsic resistance to various treatments and the presence of comorbidities and complications. The antibiotic dapsone is an established treatment for HS, but the current evidence base is limited. The aim of this review is to systematically review the literature on the efficacy of dapsone in the treatment of HS. METHODS The Cochrane, PubMed and CINAHL databases were searched for relevant articles to be included in the systematic review. RESULTS A total of seven studies, with a cumulative patient population of 135 patients, were included. Of these 135 patients, 62.2% demonstrated various degrees of improvement following treatment. However, as only three of the seven studies used dapsone monotherapy it is difficult to assess the effectiveness of dapsone because the benefits observed may be due to concurrently administered treatment. CONCLUSION Overall, the quality of evidence supporting the use of dapsone is weak. However, it is a well established treatment recommended in current, various national guidelines. There is a crucial need for well-designed randomized controlled trials to support its usage.
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18
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Hidradenitis Suppurativa: Host-Microbe and Immune Pathogenesis Underlie Important Future Directions. JID INNOVATIONS 2021; 1:100001. [PMID: 34909706 PMCID: PMC8659377 DOI: 10.1016/j.xjidi.2021.100001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disease of the skin with a chronic, relapsing-remitting course. The pathogenesis of the disease is poorly understood and involves multiple factors, including genetics, environment, host-microbe interactions, and immune dysregulation. In particular, the composition of the cutaneous microbiome shifts as the disease progresses, although it is unclear whether this is a primary or secondary process. Trials with immunomodulatory therapy elucidate the role of specific immune pathways and cytokine signaling in disease mechanism, such as TNF-α, IL-1β, IL-12, IL-17, IL-23, and complement. Future studies should continue examining the causes of and contributing factors to microbial changes and immune dysregulation in HS pathogenesis.
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Key Words
- AMP, antimicrobial peptide
- BD, β-defensin
- BMI, body mass index
- DC, dendritic cell
- DCD, dermcidin
- GSC, γ-secretase complex
- HS, hidradenitis suppurativa
- HiSCR, hidradenitis suppurativa clinical response
- IBD, inflammatory bowel disease
- IHS4, International Hidradenitis Suppurativa Severity Score System
- KC, keratinocyte
- MMP, matrix metalloproteinase
- NET, neutrophil extracellular traps
- NMSC, nonmelanoma skin cancer
- PG, pyoderma gangrenosum
- RCT, randomized controlled trial
- SAPHO, synovitis, acne, pustulosis, hyperostosis, and osteitis
- TLR, toll-like receptor
- Th, T helper type
- iNOS, inducible nitric oxide synthase
- pDC, plasmacytoid dendritic cell
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19
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Amat-Samaranch V, Agut-Busquet E, Vilarrasa E, Puig L. New perspectives on the treatment of hidradenitis suppurativa. Ther Adv Chronic Dis 2021; 12:20406223211055920. [PMID: 34840709 PMCID: PMC8613896 DOI: 10.1177/20406223211055920] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the presence of painful nodules, abscesses, chronically draining fistulas, and scarring in apocrine gland-bearing areas of the body. The exact pathogenesis of HS is not yet well understood, but there is a consensus in considering HS a multifactorial disease with a genetic predisposition, an inflammatory dysregulation, and an influence of environmental modifying factors. Therapeutic approach of HS is challenging due to the wide clinical manifestations of the disease and the complex pathogenesis. This review describes evidence for effectiveness of current and emerging HS therapies. Topical therapy, systemic treatments, biological agents, surgery, and light therapy have been used for HS with variable results. Adalimumab is the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS, but new therapeutic options are being studied, targeting different specific cytokines involved in HS pathogenesis. Comparing treatment outcomes between therapies is difficult due to the lack of randomized controlled trials. Treatment strategy should be selected in concordance to disease severity and requires combination of treatments in most cases.
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Affiliation(s)
- Victoria Amat-Samaranch
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Eugènia Agut-Busquet
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041 Barcelona, Spain
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20
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Vulvoperineal Hidradenitis Suppurativa: Diagnosis, Treatment, and Management of Deformities. Obstet Gynecol Surv 2021; 76:644-653. [PMID: 34724076 DOI: 10.1097/ogx.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists. Objective The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition. Evidence Acquisition Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including "hidradenitis suppurativa," "pathogenesis," "prevalence," "management," "surgery," "perineal," and "vulva." Results Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management. Conclusions Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease. Relevance Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.
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21
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Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells 2021; 10:cells10082094. [PMID: 34440863 PMCID: PMC8392140 DOI: 10.3390/cells10082094] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.
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22
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Pinter A, Mrowietz U, Volz T. [Systemic treatment of moderate/severe hidradenitis suppurativa]. DER HAUTARZT 2021; 72:686-691. [PMID: 34189590 DOI: 10.1007/s00105-021-04844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/24/2022]
Abstract
Systemic treatment together with radical surgical excision is the most important treatment option for all severity grades of hidradenitis suppurativa. Tetracycline in mild-to-moderate forms and clindamycin in combination with rifampicin in moderate-to-severe forms are guideline-compliant first-line therapy with a good clinical response. Other antibiotics such as ertepenem or multiple combinations are recommended as last-line therapy due to a lack of data. Success rate with dapsone and retinoids, on the other hand, are insufficient-only acitretin can be recommended on the basis of the available studies, but with limited success. With the TNF-alpha blocker adalimumab, an effective and safe long-term therapy is available-further biologics are in clinical trials and could significantly expand the treatment portfolio in the future.
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Affiliation(s)
- A Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - U Mrowietz
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - T Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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23
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NAFLD and Infection, a Nuanced Relationship. Can J Gastroenterol Hepatol 2021; 2021:5556354. [PMID: 33977096 PMCID: PMC8087474 DOI: 10.1155/2021/5556354] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased significantly over the last few decades mirroring the increase in obesity and type II diabetes mellitus. NAFLD has become one of the most common indications for liver transplantation. The deleterious effects of NAFLD are not isolated to the liver only, for it has been recognized as a systemic disease affecting multiple organs through protracted low-grade inflammation mediated by the metabolic activity of excessive fat tissue. Extrahepatic manifestations of NAFLD such as cardiovascular disease, polycystic ovarian syndrome, chronic kidney disease, and hypothyroidism have been well described in the literature. In recent years, it has become evident that patients suffering from NAFLD might be at higher risk of developing various infections. The proposed mechanism for this association includes links through hyperglycemia, insulin resistance, alterations in innate immunity, obesity, and vitamin D deficiency. Additionally, a risk independent of these factors mediated by alterations in gut microbiota might contribute to a higher burden of infections in these individuals. In this narrative review, we synthetize current knowledge on several infections including urinary tract infection, pneumonia, Helicobacter pylori, coronavirus disease 2019, and Clostridioides difficile as they relate to NAFLD. Additionally, we explore NAFLD's association with hidradenitis suppurativa.
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24
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Narla S, Azzam M, Townsend S, Vellaichamy G, Marzano AV, Alavi A, Lowes MA, Hamzavi IH. Identifying key components and therapeutic targets of the immune system in hidradenitis suppurativa with an emphasis on neutrophils. Br J Dermatol 2021; 184:1004-1013. [PMID: 32893875 DOI: 10.1111/bjd.19538] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/05/2020] [Accepted: 08/29/2020] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle unit that typically develops after puberty. The disorder is characterized by comedones, painful inflammatory nodules, abscesses, dermal tunnels and scarring, with a predilection for intertriginous areas of the body (axillae, inguinal and anogenital regions). Recruitment of neutrophils to HS lesion sites may play an essential role in the development of the painful inflammatory nodules and abscesses that characterize the disease. This is a review of the major mediators involved in the recruitment of neutrophils to sites of active inflammation, including bacterial components (endotoxins, exotoxins, capsule fragments, etc.), the complement pathway anaphylatoxins C3a and C5a, tumour necrosis factor-alpha, interleukin (IL)-17, IL-8 (CXCL8), IL-36, IL-1, lipocalin-2, leukotriene B4, platelet-activating factor, kallikreins, matrix metalloproteinases, and myeloperoxidase inhibitors. Pharmacological manipulation of the various pathways involved in the process of neutrophil recruitment and activation could allow for successful control and stabilization of HS lesions and the remission of active, severe flares.
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Affiliation(s)
- S Narla
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - M Azzam
- University of Nevada School of Medicine, Reno, NV, USA
| | - S Townsend
- Wayne State School of Medicine, Detroit, MI, USA
| | | | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - A Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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25
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Frew JW, Marzano AV, Wolk K, Join-Lambert O, Alavi A, Lowes MA, Piguet V. A Systematic Review of Promising Therapeutic Targets in Hidradenitis Suppurativa: A Critical Evaluation of Mechanistic and Clinical Relevance. J Invest Dermatol 2021; 141:316-324.e2. [PMID: 32919760 DOI: 10.1016/j.jid.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
Abstract
This systematic review identifies and critically evaluates the mechanistic and clinical evidence of new promising therapeutic targets in hidradenitis suppurativa (HS). Evidence for these targets is largely based on observational data with limited ex vivo and translational data from clinical trials. A number of placebo-controlled studies have been completed or are underway utilizing IL-1, IL-23, IL-17, complement, and Jak inhibition, although there is concern regarding elevated placebo response rates and the questionable validity of clinical scores in some participant subsets. Knowledge gaps are identified suggesting a direction for future mechanistic studies in HS, including more comprehensive inflammatory endotype profiling of disease.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York, USA.
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Olivier Join-Lambert
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0, EA 2656), Department of Microbiology, Normandie University, UNICAEN, UNIROUEN, CHU de Caen Normandie, Caen, France
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Michelle A Lowes
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York, USA
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
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26
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Ring HC, Knudsen A, Thomsen SF. Metronidazole for Hidradenitis Suppurativa: future potential treatment applications. J Eur Acad Dermatol Venereol 2021; 35:e323-e324. [PMID: 33393693 DOI: 10.1111/jdv.17069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- H C Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Knudsen
- Department of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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27
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Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos‐Bourboulis EJ, Fabbrocini G, Frew JW, Fujita H, González‐López MA, Guillem P, Gulliver WPF, Hamzavi I, Hayran Y, Hórvath B, Hüe S, Hunger RE, Ingram JR, Jemec GB, Ju Q, Kimball AB, Kirby JS, Konstantinou MP, Lowes MA, MacLeod AS, Martorell A, Marzano AV, Matusiak Ł, Nassif A, Nikiphorou E, Nikolakis G, Nogueira da Costa A, Okun MM, Orenstein LA, Pascual JC, Paus R, Perin B, Prens EP, Röhn TA, Szegedi A, Szepietowski JC, Tzellos T, Wang B, van der Zee HH. What causes hidradenitis suppurativa ?—15 years after. Exp Dermatol 2020; 29:1154-1170. [DOI: 10.1111/exd.14214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hôpital Erasme Universite Libre de Bruxelles Bruxelles Belgium
| | - Angel S. Byrd
- Department of Dermatology Howard University College of Medicine Washington DC USA
| | - Nisha S. Chandran
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Department of Medicine National University Hospital Singapore
| | - Evangelos J. Giamarellos‐Bourboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Medical School Athens Greece
| | - Gabriella Fabbrocini
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | | | - Hideki Fujita
- Division of Cutaneous Science Department of Dermatology Nihon University School of Medicine Tokyo Japan
| | - Marcos A. González‐López
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Hospital Universitario Marqués de Valdecilla University of Cantabria IDIVAL Santander Spain
| | - Philippe Guillem
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Surgery Clinique du Val d’Ouest (Lyon), ResoVerneuil (Paris) and Groupe de Recherche en Proctologie de la Société Nationale Française de ColoProctologie Paris France
| | - Wayne P. F. Gulliver
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Faculty of Medicine Memorial University of Newfoundland, and NewLab Clinical Research Inc St. John's Canada
| | - Iltefat Hamzavi
- Department of Dermatology Henry Ford Hospital Wayne State University Detroit MI USA
| | - Yildiz Hayran
- Department of Dermatology Ankara Numune Training and Research Hospital Ankara Turkey
| | - Barbara Hórvath
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology University Medical Centre Groningen University of Groningen Groningen The Netherlands
| | | | - Robert E. Hunger
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - John R. Ingram
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology & Academic Wound Healing Division of Infection and Immunity Cardiff University Cardiff UK
| | - Gregor B.E. Jemec
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Qiang Ju
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology RenJi Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - Alexa B. Kimball
- Department of Dermatology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Joslyn S. Kirby
- Department of Dermatology Penn State Milton S. Hershey Medical Center Hershey PA USA
| | - Maria P. Konstantinou
- Dermatology Department Paul Sabatier University University Hospital of Toulouse Toulouse France
| | | | - Amanda S. MacLeod
- Department of Dermatology Department of Immunology Department of Molecular Genetics and Microbiology Duke University Durham NC USA
| | - Antonio Martorell
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hospital of Manises Valencia Spain
| | - Angelo V. Marzano
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dermatology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Łukasz Matusiak
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Aude Nassif
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Institut Pasteur Paris France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases King’s College London, and Department of Rheumatology King’s College Hospital London UK
| | - Georgios Nikolakis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
| | - André Nogueira da Costa
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Translational Science and Experimental Medicine Early Respiratory and Immunology Biopharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | | | | | - José Carlos Pascual
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Alicante University General Hospital Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
| | - Ralf Paus
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - Benjamin Perin
- Division of Dermatology University of Washington Seattle WA USA
| | - Errol P. Prens
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
| | - Till A. Röhn
- Autoimmunity, Transplantation and Inflammation Novartis Institutes for BioMedical Research Novartis Pharma AG Basel Switzerland
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Jacek C. Szepietowski
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Nordland Hospital Trust Bodø Norway
| | - Baoxi Wang
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hessel H. van der Zee
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
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Guenin-Macé L, Morel JD, Doisne JM, Schiavo A, Boulet L, Mayau V, Goncalves P, Duchatelet S, Hovnanian A, Bondet V, Duffy D, Ungeheuer MN, Delage M, Nassif A, Di Santo JP, Demangel C. Dysregulation of tryptophan catabolism at the host-skin microbiota interface in hidradenitis suppurativa. JCI Insight 2020; 5:140598. [PMID: 32970636 PMCID: PMC7605522 DOI: 10.1172/jci.insight.140598] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 09/10/2020] [Indexed: 12/30/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic skin disorder of unknown etiology that manifests as recurrent, painful lesions. Cutaneous dysbiosis and unresolved inflammation are hallmarks of active HS, but their origin and interplay remain unclear. Our metabolomic profiling of HS skin revealed an abnormal induction of the kynurenine pathway of tryptophan catabolism in dermal fibroblasts, correlating with the release of kynurenine pathway–inducing cytokines by inflammatory cell infiltrates. Notably, overactivation of the kynurenine pathway in lesional skin was associated with local and systemic depletion in tryptophan. Yet the skin microbiota normally degrades host tryptophan into indoles regulating tissue inflammation via engagement of the aryl hydrocarbon receptor (AHR). In HS skin lesions, we detected contextual defects in AHR activation coinciding with impaired production of bacteria-derived AHR agonists and decreased incidence of AHR ligand-producing bacteria in the resident flora. Dysregulation of tryptophan catabolism at the skin-microbiota interface thus provides a mechanism linking the immunological and microbiological features of HS lesions. In addition to revealing metabolic alterations in patients with HS, our study suggests that correcting AHR signaling would help restore immune homeostasis in HS skin. Loss of homeostasis of tryptophan metabolism at the host-microbiota interface may contribute to Hidradenitis Suppurativa.
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Affiliation(s)
- Laure Guenin-Macé
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1221, Paris, France
| | - Jean-David Morel
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1221, Paris, France.,Université Paris 7, Sorbonne Paris Cité, Paris, France.,ENS de Lyon, Lyon, France
| | - Jean-Marc Doisne
- Innate Immunity Unit, Institut Pasteur, INSERM U1223, Paris, France
| | - Angèle Schiavo
- Innate Immunity Unit, Institut Pasteur, INSERM U1223, Paris, France
| | - Lysiane Boulet
- Laboratoire de Biochimie Hormonale et Nutritionnelle, CHU Grenoble-Alpes, La Tronche, France
| | - Véronique Mayau
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1221, Paris, France
| | - Pedro Goncalves
- Innate Immunity Unit, Institut Pasteur, INSERM U1223, Paris, France
| | - Sabine Duchatelet
- Université de Paris, Imagine Institute, Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Paris, France
| | - Alain Hovnanian
- Université de Paris, Imagine Institute, Laboratory of Genetic Skin Diseases, INSERM UMR 1163, Paris, France.,Department of Genetics, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur, INSERM U1223, Paris, France
| | - Darragh Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur, INSERM U1223, Paris, France
| | | | - Maïa Delage
- Centre Médical, Institut Pasteur, Paris, France
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Paris, France
| | - James P Di Santo
- Innate Immunity Unit, Institut Pasteur, INSERM U1223, Paris, France
| | - Caroline Demangel
- Immunobiology of Infection Unit, Institut Pasteur, INSERM U1221, Paris, France
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29
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Wolk K, Join-Lambert O, Sabat R. Aetiology and pathogenesis of hidradenitis suppurativa. Br J Dermatol 2020; 183:999-1010. [PMID: 33048349 DOI: 10.1111/bjd.19556] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder. Patients develop inflamed nodules and abscesses and, at later stages of disease, epithelialized tunnels and scars in skinfolds of axillary, inguinal, gluteal and perianal areas. Quality of life is affected due to severe pain, purulent secretion, restricted mobility and systemic involvement. Genetics and lifestyle factors including smoking and obesity contribute to the development of HS. These factors lead to microbiome alteration, subclinical inflammation around the terminal hair follicles, and infundibular hyperkeratosis, resulting in plugging and rupture of the follicles. Cell-damage-associated molecules and propagating bacteria trigger inflammation and lead to massive immune cell infiltration that clinically manifests as inflamed nodules and abscesses. The immune system plays a key role also in the progression and chronification of skin alterations. Innate proinflammatory cytokines (e.g. interleukin-1β and tumour necrosis factor-α), mediators of activated T helper (Th)1 and Th17 cells (e.g. interleukin-17 and interferon-γ), and effector mechanisms of neutrophilic granulocytes, macrophages and plasma cells are involved. Simultaneously, skin lesions contain anti-inflammatory mediators (e.g. interleukin-10) and show limited activity of Th22 and regulatory T cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction and scarring. Chronic inflammation in patients with HS is also frequently detected in organs other than the skin, as indicated by their comorbidities. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. This scholarly review focuses on the causes and pathogenetic mechanisms of HS and the potential therapeutic value of this knowledge.
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Affiliation(s)
- K Wolk
- Berlin-Brandenburg Centre for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - O Join-Lambert
- Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0, EA 2656), Normandie University, UNICAEN, UNIROUEN, Caen, France.,Department of Microbiology, CHU de Caen Normandie, Caen, France
| | - R Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
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30
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Lowe MM, Naik HB, Clancy S, Pauli M, Smith KM, Bi Y, Dunstan R, Gudjonsson JE, Paul M, Harris H, Kim E, Shin US, Ahn R, Liao W, Hansen SL, Rosenblum MD. Immunopathogenesis of hidradenitis suppurativa and response to anti-TNF-α therapy. JCI Insight 2020; 5:139932. [PMID: 32841223 PMCID: PMC7566733 DOI: 10.1172/jci.insight.139932] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/20/2020] [Indexed: 01/15/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a highly prevalent, morbid inflammatory skin disease with limited treatment options. The major cell types and inflammatory pathways in skin of patients with HS are poorly understood, and which patients will respond to TNF-α blockade is currently unknown. We discovered that clinically and histologically healthy appearing skin (i.e., nonlesional skin) is dysfunctional in patients with HS with a relative loss of immune regulatory pathways. HS skin lesions were characterized by quantitative and qualitative dysfunction of type 2 conventional dendritic cells, relatively reduced regulatory T cells, an influx of memory B cells, and a plasma cell/plasmablast infiltrate predominantly in end-stage fibrotic skin. At the molecular level, there was a relative bias toward the IL-1 pathway and type 1 T cell responses when compared with both healthy skin and psoriatic patient skin. Anti–TNF-α therapy markedly attenuated B cell activation with minimal effect on other inflammatory pathways. Finally, we identified an immune activation signature in skin before anti–TNF-α treatment that correlated with subsequent lack of response to this modality. Our results reveal the fundamental immunopathogenesis of HS and provide a molecular foundation for future studies focused on stratifying patients based on likelihood of clinical response to TNF-α blockade. Hidradenitis suppurativa lesions are characterized by alterations in cDC2s, relatively reduced Tregs, an influx of memory B cells and plasma cells, and biases towards IL1 pathway activation and type 1 T cell responses.
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Affiliation(s)
- Margaret M Lowe
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Haley B Naik
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Sean Clancy
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Mariela Pauli
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | | | - Yingtao Bi
- AbbVie Cambridge Research Center, Cambridge, Massachusetts, USA
| | - Robert Dunstan
- AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | | | - Maia Paul
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Hobart Harris
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Esther Kim
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Uk Sok Shin
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Richard Ahn
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA.,Institute for Quantitative and Computational Biosciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Wilson Liao
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Scott L Hansen
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Michael D Rosenblum
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
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31
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Hamad J, McCormick BJ, Sayed CJ, Paci K, Overton M, Daubert T, Figler BD. Multidisciplinary Update on Genital Hidradenitis Suppurativa: A Review. JAMA Surg 2020; 155:970-977. [PMID: 32838413 DOI: 10.1001/jamasurg.2020.2611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a predilection for the genital region. Genital HS requires medical and surgical management as well as close collaboration among a multidisciplinary team. Observations Hidradenitis suppurativa is a disease of the hair follicles that results in recurrent nodules, abscesses, and tunneling sinus tracts. Medical treatment mainstays include antibiotics and retinoids, but the evolving class of biologic medications has gained traction in the treatment of moderate and severe disease. Many of the medical therapies come with adverse effects requiring clinical and laboratory monitoring over the course of treatment. When lesions are refractory to therapy or are too large for medical therapy alone, surgical intervention is required. Surgical procedures can include treatment of affected areas with deroofing or excision of affected skin. When large portions of genital skin are removed, reconstruction is necessary to restore function and aesthetics of the genitals. We describe a variety of reconstructive techniques based on the size and location of the skin deficiency. Conclusions and Relevance Effective management of genital hidradenitis suppurativa requires a thorough understanding of medical and surgical techniques for prevention, treatment, and reconstruction of genital defects.
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Affiliation(s)
- Judy Hamad
- University of North Carolina at Chapel Hill School of Medicine
| | | | | | - Karina Paci
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Matthew Overton
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Thomas Daubert
- University of North Carolina at Chapel Hill School of Medicine
| | - Bradley D Figler
- Department of Urology, University of North Carolina at Chapel Hill
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32
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Patel K, Liu L, Ahn B, Silfvast-Kaiser AS, Paek SY. Hidradenitis suppurativa for the nondermatology clinician. Proc (Bayl Univ Med Cent) 2020; 33:586-591. [DOI: 10.1080/08998280.2020.1793643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Kavina Patel
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Lucy Liu
- University of Washington School of Medicine, Seattle, Washington
| | - Benjamin Ahn
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
| | | | - So Yeon Paek
- Division of Dermatology, Baylor University Medical Center, Dallas, Texas
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33
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Marasca C, Tranchini P, Marino V, Annunziata MC, Napolitano M, Fattore D, Fabbrocini G. The pharmacology of antibiotic therapy in hidradenitis suppurativa. Expert Rev Clin Pharmacol 2020; 13:521-530. [DOI: 10.1080/17512433.2020.1762571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Tranchini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Vincenzo Marino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Carmela Annunziata
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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34
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Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I. Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice. Dermatology 2020; 236:393-412. [PMID: 32408306 PMCID: PMC8177083 DOI: 10.1159/000507323] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS. SUMMARY This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,
| | - Tien V Nguyen
- Bellevue Dermatology Clinic and Research Center, Bellevue, Washington, USA
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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35
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Abstract
Hidradenitis suppurativa is a chronic skin condition characterized by recurrent painful abscesses usually limited to the intertriginous areas. Global prevalence has been estimated at up to 4% of the population. The exact pathogenesis of hidradenitis suppurativa is yet to be elucidated; however, recent research has shown that the disease occurs under the influence of multiple genetic, environmental, and lifestyle factors. Repeated insults result in sinus tract formation and disfigurement, which can have a significant psychosocial effect on patients. A wide range of treatments are available but none are curative. A combination antibiotic regimen is considered first line, and research into the use of biologics has been promising. Early recognition and treatment is paramount to achieving a better prognosis and improving patient quality of life.
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36
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Abstract
Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. The estimated prevalence of HS is ~1% in most studied countries. Typically starting in early adulthood, cutaneous inflamed nodules, abscesses and pus-discharging tunnels develop in axillary, inguinal, gluteal and perianal body sites. The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1β and IL-17. The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients' quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.
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37
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Tricarico PM, Zupin L, Ottaviani G, Rupel K, Celsi F, Genovese G, Boniotto M, Crovella S, Marzano AV. Photobiomodulation as potential novel third line tool for non-invasive treatment of hidradenitis suppurativa. GIORN ITAL DERMAT V 2020; 155:88-98. [DOI: 10.23736/s0392-0488.19.06247-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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38
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Constantinou CA, Fragoulis GE, Nikiphorou E. Hidradenitis suppurativa: infection, autoimmunity, or both? Ther Adv Musculoskelet Dis 2019; 11:1759720X19895488. [PMID: 31908656 PMCID: PMC6937531 DOI: 10.1177/1759720x19895488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease mainly affecting areas rich in apocrine glands. Clinically, is characterized by painful subcutaneous nodules and if left untreated to pus secretion, abscess and fistula formation. Its frequency is estimated to be 0.5-4% of the general population, affecting women more often. Pathogenesis of HS is still not clearly defined. It seems to be a combination of genetic factors with alterations in the skin microbiome. Furthermore, at tissue (i.e. skin) as well as at serum level, several inflammatory cytokines are upregulated. The most important of the latter are tumor necrosis factor (TNF), interleukin (IL)-1, IL-17, and IL-23. Adding another level of complexity, it has been suggested that keratinocytes might be intrinsically activated, contributing also to the observed inflammation. Interestingly, it has been noted that frequency of HS is increased in some autoimmune rheumatic diseases, such as spondyloarthropathies (SpA). Of note, both HS and SpA have relatively strong association with metabolic diseases and obesity implying that there are indeed some common underlying pathophysiological pathways. Although no specific microbe has been identified, alterations in the microbiome of the skin of these patients have been reported. Of note, microbes with a capability for biofilm formation are abundant. Treatment of HS among others, include antibiotics as well as biologic drugs targeting TNF and other cytokines and used for autoimmune rheumatic diseases. Herein, we review the current evidence on links between HS and autoimmune diseases and infectious diseases with a focus on epidemiology and pathophysiology.
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Affiliation(s)
- Costas A Constantinou
- Internal Medicine Department and Tuberculosis Unit, Kyperounta Rural Hospital, Kyperounta, Cyprus
- Communicable Diseases Surveillance and Control Unit, Medical and Public Health Services, Cyprus Ministry of Heath, Nicosia, Cyprus
| | - George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- First Department of Propaedeutic and Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Academic Rheumatology Department, King’s College London, Cutcombe Road, London, SE5 9RJ, UK
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39
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Hendricks AJ, Hsiao JL, Lowes MA, Shi VY. A Comparison of International Management Guidelines for Hidradenitis Suppurativa. Dermatology 2019; 237:81-96. [PMID: 31645040 DOI: 10.1159/000503605] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that imparts a significant burden on patients and presents a management challenge for healthcare providers. As attention to this debilitating condition has grown over recent years, our understanding of HS pathogenesis and optimal treatment approaches continues to evolve. Nine HS treatment guidelines developed by various expert organizations have been published, encompassing therapeutic modalities ranging from topical agents to systemic therapies to procedural interventions. These guidelines demonstrate significant overlap in treatment recommendations and have all been published within the last 5 years. Therefore, we aim to compare and synthesize the recommendations of international HS treatment guidelines and to encourage inter-organizational communication for the development of consensus or staggered publication of recommendations for HS management.
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Affiliation(s)
| | - Jennifer L Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, California, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Vivian Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona, USA,
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40
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Naik HB, Jo JH, Paul M, Kong HH. Skin Microbiota Perturbations Are Distinct and Disease Severity-Dependent in Hidradenitis Suppurativa. J Invest Dermatol 2019; 140:922-925.e3. [PMID: 31539533 DOI: 10.1016/j.jid.2019.08.445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California.
| | - Jay-Hyun Jo
- Cutaneous Microbiome and Inflammation Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Maia Paul
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Heidi H Kong
- Cutaneous Microbiome and Inflammation Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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41
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol 2019; 81:91-101. [PMID: 30872149 PMCID: PMC9131892 DOI: 10.1016/j.jaad.2019.02.068] [Citation(s) in RCA: 176] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniel B Eisen
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada
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Duchatelet S, Join-Lambert O, Delage M, Miskinyte S, Guet-Revillet H, Lam T, Coignard-Biehler H, Ungeheuer MN, Chatenoud L, Lortholary O, Nassif X, Hovnanian A, Nassif AS. Remission of chronic acne fulminans and severe hidradenitis suppurativa with targeted antibiotherapy. JAAD Case Rep 2019; 5:525-528. [PMID: 31205996 PMCID: PMC6558272 DOI: 10.1016/j.jdcr.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sabine Duchatelet
- Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Olivier Join-Lambert
- Laboratoire de Microbiologie, Hôpital Necker Enfants Malades, Paris, France.,Physiopathologie des Infections Systémiques, Institut Necker-Enfants Malades, Paris, France.,CHU de Caen, Laboratoire de Microbiologie, Caen, France.,Groupe de Recherche sur l'Adaptation Microbienne, Caen, France.,Normandy University, Normandy, France
| | - Maïa Delage
- Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Snaigune Miskinyte
- Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cité, Paris, France
| | - Hélène Guet-Revillet
- Laboratoire de Microbiologie, Hôpital Necker Enfants Malades, Paris, France.,Physiopathologie des Infections Systémiques, Institut Necker-Enfants Malades, Paris, France
| | - Thi Lam
- Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris, France
| | - Hélène Coignard-Biehler
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Paris, France
| | | | - Lucienne Chatenoud
- Laboratoire d'immunologie, Hôpital Necker Enfants Malades, Paris, France
| | - Olivier Lortholary
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker Enfants Malades, Paris, France
| | - Xavier Nassif
- Laboratoire de Microbiologie, Hôpital Necker Enfants Malades, Paris, France.,Physiopathologie des Infections Systémiques, Institut Necker-Enfants Malades, Paris, France
| | - Alain Hovnanian
- Laboratory of Genetic Skin Diseases, Imagine Institute, Paris, France.,University Paris Descartes - Sorbonne Paris Cité, Paris, France.,Department of Genetics, Hôpital Necker Enfants Malades, Paris, France
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43
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Ring HC, Sigsgaard V, Thorsen J, Fuursted K, Fabricius S, Saunte DM, Jemec GB. The microbiome of tunnels in hidradenitis suppurativa patients. J Eur Acad Dermatol Venereol 2019; 33:1775-1780. [PMID: 30908704 DOI: 10.1111/jdv.15597] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels and scarring involving the intertriginous regions. Recent next-generation sequencing (NGS) studies suggest genera such as Prevotella spp., Peptoniphilus spp. and Porphyromonas spp. are associated with chronic and early HS lesions. However, a systematic investigation of the bacterial microbiome in HS tunnels remains unexplored using NGS. OBJECTIVE We aimed to investigate the bacterial composition of the luminal white gelatinous material found in HS tunnels using NGS. METHODS An exploratory study of patients with diagnosis of HS (n = 32) with tunnels. The tunnels were present either in the groin (n = 17) or in the axilla (n = 15). During deroofing of the tunnels, a sterile E-swab was taken of the luminal gelatinous material. The samples were investigated using NGS targeting 16S ribosomal RNA. RESULTS The skin microbiome was characterized in 32 HS patients. Overall, five microbiome types were identified: Porphyromonas spp. (type I), Corynebacterium spp., (type II), Staphylococcus spp. (type III), Prevotella spp. (type IV) and Acinetobacter spp (type V). Porphyromonas spp. (type I) and Prevotella spp. (IV) were the most frequent genera found the tunnels. CONCLUSION This study points to a potential association between the presence of certain anaerobic bacteria (Porphyromonas spp., Prevotella spp.) and HS tunnels. It may be speculated that these two genera are associated with the pathogenesis in HS either as drivers or as biomarkers.
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Affiliation(s)
- H C Ring
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - V Sigsgaard
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - K Fuursted
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Fabricius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - D M Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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44
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Schneider-Burrus S, Arpa E, Kors C, Stavermann T, Sabat R, Kokolakis G. [Drug therapy of acne inversa]. Hautarzt 2019; 69:58-63. [PMID: 29234829 DOI: 10.1007/s00105-017-4094-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acne inversa is a chronic inflammatory destructive skin disease that affects about 1% of the population. The therapy should be personalized and consists of surgical and conservative procedures. Antibiotics are administered either topically or systemically. Combination therapy with clindamycin and rifampicin for 10-12 weeks can be very effective. Furthermore, TNF-α inhibitors show adequate efficacy and can be recommended. Adalimumab is the only approved drug product for systemic treatment of acne inversa. The efficacy of retinoids is controversial. Isotretinoin cannot be recommended for the treatment of acne inversa; however, acitretin has been proven to be more effective. Immune-modulating substances, like dapsone, cyclosporine A, methotrexate, colchicine, or corticosteroids, can be considered; however, the study data are insufficient for recommendation. Hormonal therapies can influence the course of the disease. Antiseptics are applied independent of the stage of disease. Patients should be informed about triggering factors.
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Affiliation(s)
- S Schneider-Burrus
- Zentrum für Dermatochirurgie, Havelklinik, Gatower Str. 191, 13595, Berlin, Deutschland. .,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - E Arpa
- Zentrum für Dermatochirurgie, Havelklinik, Gatower Str. 191, 13595, Berlin, Deutschland
| | - C Kors
- Hautzentrum Weißensee, Berlin, Deutschland
| | - T Stavermann
- Hautzentrum Gropiuspassagen, Berlin, Deutschland
| | - R Sabat
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - G Kokolakis
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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45
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Tran ML, Fu CC, Juang RS. Removal of metronidazole and amoxicillin mixtures by UV/TiO 2 photocatalysis: an insight into degradation pathways and performance improvement. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:11846-11855. [PMID: 30820920 DOI: 10.1007/s11356-019-04683-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
The degradation efficiencies and pathways of metronidazole (MNZ) and amoxicillin (AMX) in binary mixtures by UV/TiO2 photocatalysis were studied. The presence of AMX significantly decreased the degradation of MNZ, whereas the existence of MNZ slightly reduced the degradation of AMX. This is basically due to the difference in attack ability of oxidizing agents present during TiO2 photocatalysis. All oxidizing agents (hydroxyl radicals, superoxide radicals, and holes) could attack AMX molecules, but hydroxyl radicals showed insignificant attack ability in MNZ degradation. In TiO2 photocatalysis of binary mixture, six transformation products were recognized by a high-resolution LC-QTof/MS. Because of competitive effect, only one product was sourced from MNZ degradation and four others were formed due to AMX degradation. The remaining one was a new product of the side reaction. This work indicated that the molecular structure of AMX determined its preferred degradation in a mixture. It not only affected the removal of antibiotics but also figured out the appearance of transformation products. In contrast to single systems, the extent of degradation reduced for each antibiotic in the presence of the second antibiotic was related to the availability of degradation pathways of each antibiotic. Moreover, suitable pH programming was applied to enhance the mineralization of the mixtures.
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Affiliation(s)
- Mai Lien Tran
- Department of Chemical and Materials Engineering, Chang Gung University, 259 Wenhua First Road, Guishan, Taoyuan, 33302, Taiwan
- Institute of Environmental Science, Engineering and Management, Industrial University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Chun-Chieh Fu
- Department of Chemical and Materials Engineering, Chang Gung University, 259 Wenhua First Road, Guishan, Taoyuan, 33302, Taiwan
| | - Ruey-Shin Juang
- Department of Chemical and Materials Engineering, Chang Gung University, 259 Wenhua First Road, Guishan, Taoyuan, 33302, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
- Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, Taishan, New Taipei City, 24301, Taiwan.
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46
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Bettoli V, Manfredini M, Massoli L, Carillo C, Barozzi A, Amendolagine G, Ruina G, Musmeci D, Libanore M, Curtolo A, Mantovani L, Contini C, Pellacani G, Corazza M. Rates of antibiotic resistance/sensitivity in bacterial cultures of hidradenitis suppurativa patients. J Eur Acad Dermatol Venereol 2019; 33:930-936. [PMID: 30394587 DOI: 10.1111/jdv.15332] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antibiotic (AB) treatment is one of the first steps in the management of hidradenitis suppurativa (HS). Bacteria, in HS patients, may play a double role, as triggering factors of inflammatory reactions and/or agents of infection. OBJECTIVES The aims of this study are as follows: (i) to assess prevalence and AB resistance of bacterial growths in HS patients (ii) assessment of the clinical relevance of obtained data in guiding the selection of the most effective AB therapy. METHODS Purulent material from 137 skin lesions of HS patients was collected with swabs. Bacterial flora and AB sensitivity were determined using microbiological cultures for aerobic and anaerobic bacteria. RESULTS A total of 114 samples resulted positive for bacteria. Sample was collected from the axillae, groin and perianal areas. A total of 163 single bacterial growths were observed; 55% were Gram-positive and 44% were Gram-negative. Among them, 18.4% were anaerobic. The most frequent bacterial families included enterobacteriaceae (30.7%), Staphylococcus (25.2%) and Streptococcus (14.1%). The most frequent genus or species were proteus spp. (13.5%) and Escherichia coli (9.8%). The prevalence of AB resistance observed was clindamycin 65.7%, rifampicin 69.3%, penicillin 70.0%, ciprofloxacin 74%, tetracycline 84.7% and erythromycin 89.0%. A limitation of the study is represented the short culture period adopted which may have impaired the isolation of anaerobes. CONCLUSIONS Bacterial growth in HS patients has shown a high level of resistance to ABs, including rifampicin, clindamycin and tetracyclines, cited as an empiric choice in HS therapeutic guidelines. A targeted and specific AB therapy, driven by microbiological evaluations with prolonged culture periods, seems more appropriate than empiric, generic, non-specific, therapeutic approaches. Current knowledge regarding HS bacterial AB resistance should be considered in the update of current therapeutic guidelines for HS.
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Affiliation(s)
- V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Manfredini
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.,Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - L Massoli
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - C Carillo
- O.U. Microbiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - A Barozzi
- O.U. Microbiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - G Amendolagine
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - G Ruina
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - D Musmeci
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Libanore
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - A Curtolo
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - L Mantovani
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - C Contini
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - G Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - M Corazza
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
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47
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Nail-Barthelemy R, Stroumza N, Qassemyar Q, Delage M, Nassif A, Atlan M. Evaluation of the mobility of the shoulder and quality of life after perforator flaps for recalcitrant axillary hidradenitis. ANN CHIR PLAST ESTH 2019; 64:68-77. [DOI: 10.1016/j.anplas.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/04/2018] [Indexed: 01/12/2023]
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Shavit E, Alavi A, Bechara FG, Bennett RG, Bourcier M, Cibotti R, Daveluy S, Frew JW, Garg A, Hamzavi I, Hoffman LK, Hsaio J, Sciacca Kirby J, Lev-Tov H, Martinez E, Micheletti R, Naik HB, Nassif A, Nicholson C, Parks-Miller A, Patel Z, Piguet V, Ramesh M, Resnik B, Sayed C, Schultz G, Siddiqui A, Tan J, Wortsman X, Lowes MA. Proceeding report of the Second Symposium on Hidradenitis Suppurativa Advances (SHSA) 2017. Exp Dermatol 2019; 28:94-103. [PMID: 30484907 PMCID: PMC6600821 DOI: 10.1111/exd.13849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/13/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022]
Abstract
The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03-05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.
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Affiliation(s)
- Eran Shavit
- Department of Medicine, Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Falk G. Bechara
- Department of Dermatology, Dermatologic Surgery Unit, Ruhr-University Bochum, Bochum, Germany
| | - Richard G. Bennett
- Department of Dermatology, University of California, Los Angeles, Los Angeles, California
| | - Marc Bourcier
- Dermatology Clinic, Sherbrooke University, Moncton, New Brunswick, Canada
| | - Ricardo Cibotti
- National Institute of Arthritis and Musculoskeletal and skin diseases, National Institute of Health, Bethesda, Maryland
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Dearborn, Michigan
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Amit Garg
- Department of Dermatology, Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Lauren K. Hoffman
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jenny Hsaio
- Ronald Reagan UCLA Medical Center, Santa Monica, California
| | | | - Hadar Lev-Tov
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Robert Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Haley B. Naik
- Department of Dermatology, UCSF School of Medicine, San Francisco, California
| | - Aude Nassif
- Institut Pasteur, Centre Medical, Paris, France
| | - Cynthia Nicholson
- Department of Dermatology, Wayne State University, Detroit, Michigan
| | - Angie Parks-Miller
- Department of Dermatology, Dermatologic Surgery Unit, Ruhr-University Bochum, Bochum, Germany
- Clinical Research Manager, Henry Ford Hospital, Detroit, Michigan
| | - Zarine Patel
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Vincent Piguet
- Department of Medicine, Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mayur Ramesh
- Department of Internal Medicine/Infectious Diseases, Henry Ford Hospital, Detroit, Michigan
| | - Barry Resnik
- Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gregory Schultz
- Institute of Wound Research, University of Florida, Gainesville, Florida
| | - Aamir Siddiqui
- Department of Plastic Surgery, Henry Ford Hospital, Detroit, Michigan
| | - Jerry Tan
- Department of Medicine, University of Western Ontario, Windsor, Ontario, Canada
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, University of Chile, Santiago, Chile
- Department of Dermatology, Pontifical Catholic University, Santiago, Chile
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49
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Vossen ARJV, van der Zee HH, Prens EP. Hidradenitis Suppurativa: A Systematic Review Integrating Inflammatory Pathways Into a Cohesive Pathogenic Model. Front Immunol 2018; 9:2965. [PMID: 30619323 PMCID: PMC6302105 DOI: 10.3389/fimmu.2018.02965] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Background: The pathogenesis of hidradenitis suppurativa (HS) is not fully understood. This systematic review examined the latest evidence for molecular inflammatory pathways involved in HS as a chronic inflammatory skin disease. Methods: A systematic literature search was performed in PubMed/Medline and EMBASE from January 2013 through September 2017, according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Findings on HS pathogenesis were also compared with those of other immune-mediated inflammatory diseases (IMIDs) in a non-systematic review. In addition, current therapeutic options for HS are briefly discussed on the basis of the findings for the inflammatory pathways involved in HS. Results: A total of 32 eligible publications were identified by the systematic search; these were supplemented with three additional publications. The extracted data indicated that four key themes underlie the pathogenesis of HS and related syndromic conditions. First, nicastrin (NCSTN) and PSTPIP1 mutations are directly associated with auto-inflammatory disease. Secondly, the up-regulation of several cytokines including tumor necrosis factor-α and T helper-17/interleukin-23 are connected to auto-inflammatory mechanisms in the pathogenesis of HS. Thirdly, the microbiome of lesional skin differs significantly vs. normal-appearing skin. Fourthly, HS risk is enhanced through physiological and environmental factors such as smoking, obesity, and mechanical friction. There is significant overlap between the pathogenesis of HS, its syndromic forms and other IMIDs, particularly with respect to aberrations in the innate immune response. Conclusions: The evidence presented in this review supports HS as an auto-inflammatory skin disorder associated with alterations in the innate immune system. Based on these most recent data, an integrative viewpoint is presented on the pathogenesis of HS. Current management strategies on HS consist of anti-inflammatory therapies, surgical removal of chronic lesions, and lifestyle changes such as smoking cessation and weight loss. As large gaps remain in the understanding of the pathogenesis of HS, further research is warranted to ultimately improve the management and treatment of patients with HS and related syndromic conditions.
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Affiliation(s)
- Allard R J V Vossen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
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50
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[Radical treatment of hidradenitis suppurativa: Comparison of the use of the artificial dermis and pedicled perforator flaps]. ANN CHIR PLAST ESTH 2018; 64:224-236. [PMID: 30509684 DOI: 10.1016/j.anplas.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 06/25/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The objective of this study was to compare the use of artificial dermal and perforator flap after radical surgery of severe axillary and perineal hidradenitis suppurativa disease. PATIENTS AND METHODS The data on postoperative outcomes, scar assessment (POSAS) and quality of life (DLQI, SF-36) were collected during consultation or by phone call. Forty-seven patients were included in our study between January 2015 and September 2017, including 27 patients in the artificial dermal group and 20 patients in the perforator flap group. RESULTS The quality of life assessment by the SF-36 questionnaire showed a significant increase in quality of life in both groups (P<0.05), higher in the perforating flap group (P<0.001). The DLQI questionnaire showed a decrease in the impact of MV on quality of life in both groups, which was greater in the perforator flap group (P<0.05). The scarring assessment by the POSAS patient and observer questionnaire showed a better overall opinion in the perforator flap group (P<0.001). In the perforator flap group, the total hospital stay and healing time was shorter (P<0.001) and the return to work was faster (P<0.001). CONCLUSION The artificial dermis and the perforator flaps are very useful coverage solutions after radical surgery of hidradenitis suppurativa. The use of perforator flaps, however, seems more interesting while simplifying the post-operative course.
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