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Eshmawi MT, Yousef Al-Mudaiheem H, Fatani M, Binamer Y, Alajlan M, Alharithy R, Alotaibi H, Almohanna HM, Alsantali A, Madani A, Al-Faraidy N, Bechara FG, Hamden Al-Jedaie A. Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia. J DERMATOL TREAT 2024; 35:2353693. [PMID: 38862417 DOI: 10.1080/09546634.2024.2353693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024]
Abstract
Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.
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Affiliation(s)
- Maysa T Eshmawi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- King Abdullah Medical Complex Jeddah, MOH, Saudi Arabia
| | | | - Mohammed Fatani
- Department of Dermatology, Hera General Hospital, Makkah, Saudi Arabia
| | - Yousef Binamer
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Alajlan
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ru'aa Alharithy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Hend Alotaibi
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Almohanna
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Adel Alsantali
- Department of Dermatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulaziz Madani
- Department of Dermatology, College of medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nadya Al-Faraidy
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
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Raudonis T, Šakaitytė A, Vileikis TP, Černel V, Gancevičienė R, Zouboulis CC. Comorbidities, Clinical Presentation, Subtypes, and Treatment of HS Patients in Lithuania. J Clin Med 2024; 13:3900. [PMID: 38999466 PMCID: PMC11242771 DOI: 10.3390/jcm13133900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a persistent, recurring skin inflammatory condition linked to various comorbidities. Management involves antibiotics, hormone therapy, immune-modulating drugs, surgery, and treatment of comorbidities. The objectives of the study were to assess the comorbidities, clinical presentation subtypes, and applied treatment of patients with HS. Methods: Patients with HS who visited the Centre of Dermatovenereology at Vilnius University Hospital Santaros Klinikos in Lithuania underwent evaluation based on the guidelines of the European Hidradenitis Suppurativa Foundation Registry questionnaire. Results: The study included 49 patients, and 61.22% (n = 30) had comorbidities. A strong positive correlation was found between a family history of inflammatory diseases (69.38% (n = 34)) and the severity of HS according to Hurley stage (r = 0.71 p < 0.05). A statistically significant correlation (r = 0.944, p = 0.02) was found between metabolic comorbidities and Hurley stage. Patients on biologic treatment had a mean IHS4 of 7.38 at the beginning of treatment and 3.22 at follow-up (p < 0.05). For patients not on biologics, the initial IHS4 score was 6.21 and 5.42 at follow-up (p > 0.05). Conclusions: A family history of inflammatory diseases and metabolic comorbidities showed a strong correlation with HS severity. Treatment with biologics showed significant improvement in HS scores compared to systemic antibiotics.
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Affiliation(s)
- Tadas Raudonis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Austėja Šakaitytė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (V.Č.)
| | - Tomas Petras Vileikis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
| | - Vitalij Černel
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (V.Č.)
| | - Rūta Gancevičienė
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
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3
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Alter M. [Hidradenitis suppurativa]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:497-506. [PMID: 38512397 DOI: 10.1007/s00105-024-05321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin and systemic disease that is associated with considerable discomfort and a significant reduction in the quality of life. Despite a significantly increased understanding of the disease, the diagnosis is still delayed for many years. Delayed patient access to suitable treatment often leads to disease progression with increased surgical interventions and the occurrence of possible comorbidities. In recent years, there has been an improved understanding of the pathophysiology and, as a result the authorization of modern therapeutic agents for HS. The treatment of HS is based on three treatment pillars: surgery, antibiotics and biologics. Additionally, risk factors, such as smoking and obesity should be positively influenced. Knowledge of comorbidities and their interdisciplinary treatment is important for the individualized care of patients.
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Affiliation(s)
- M Alter
- Klinik für Dermatologie, Johannes-Wesling-Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, 32429, Minden, Deutschland.
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4
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Maronese CA, Moltrasio C, Marzano AV. Hidradenitis Suppurativa-Related Autoinflammatory Syndromes: An Updated Review on the Clinics, Genetics, and Treatment of Pyoderma gangrenosum, Acne and Suppurative Hidradenitis (PASH), Pyogenic Arthritis, Pyoderma gangrenosum, Acne and Suppurative Hidradenitis (PAPASH), Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO), and Rarer Forms. Dermatol Clin 2024; 42:247-265. [PMID: 38423685 DOI: 10.1016/j.det.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Hidradenitis suppurativa (HS) is an autoinflammatory skin disorder of the terminal hair follicle, which can present in sporadic, familial, or syndromic form. A classification has been proposed for the latter, distinguishing cases associated with a known genetic condition, with follicular keratinization disorders or with autoinflammatory diseases. This review focuses on the clinical and genetic features of those entities (ie, pyoderma gangrenosum [PG], acne and HS; PG, acne, pyogenic arthritis and HS; psoriatic arthritis, PG, acne and HS; synovitis, acne, pustulosis, hyperostosis, osteitis; and so forth) for which the collective term HS-related autoinflammatory syndromes is proposed.
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Affiliation(s)
- Carlo Alberto Maronese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace, 9, Milan 20122, Italy; Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace, 9, Milan 20122, Italy; Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy.
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5
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Chang HC, Wu CL, Chiu TM, Liao WC, Gau SY. Risk of osteoarthritis in patients with hidradenitis suppurativa: a global federated health network analysis. Front Immunol 2023; 14:1285560. [PMID: 38173729 PMCID: PMC10763244 DOI: 10.3389/fimmu.2023.1285560] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Background Osteoarthritis and hidradenitis suppurativa (HS) share a common inflammatory pathway. However, whether patients with HS have higher risk developing osteoarthritis remained unclear. Methods A retrospective cohort design was adopted in this study. Electronic medical records had been retrieved from the US collaborative network in the TriNetX research network. A propensity score matching of 1:1 was performed to match for covariates. In total, 50,931 patients with HS and the same amount of non-HS controls were identified for analyses. Hazard ratio (HR) of osteoarthritis in patient with HS was calculated. Results Risk of patients with HS developing osteoarthritis was 1.37-fold higher than that of non-HS controls [95% confidence interval (CI), 1.21-1.55] when followed up for 1 year. The significance remained when the follow-up periods were extended to 3 years and 5 years. When osteoarthritis was stratified on occurring sites, the HR of knee osteoarthritis was 1.19 (95% CI, 1.09-1.29) and the HR of hip osteoarthritis was 1.17 (95% CI, 1.01-1.35) in the 5-year follow-up. The 5-year risk of osteoarthritis remained significant in sensitivity models. Conclusion Patients with HS were of high risk of developing osteoarthritis compared with people without HS. The clinical association was recommended to be considered while approaching patients with HS.
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Affiliation(s)
- Hui-Chin Chang
- Evidence-based Medicine Center, Chung Shan Medical University Hospital, Taichung, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Lung Wu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Orthopedic Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Man Chiu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Wen-Chieh Liao
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Doctoral Program in Tissue Engineering and Regenerative Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medical Education, Chi Mei Medical Center, Tainan, Taiwan
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6
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Bukvić Mokos Z, Markota Čagalj A, Marinović B. Epidemiology of hidradenitis suppurativa. Clin Dermatol 2023; 41:564-575. [PMID: 37696341 DOI: 10.1016/j.clindermatol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disease affecting hair follicles in predominantly intertriginous areas, characterized by deep, painful nodules and abscesses, fistulas, sinus tracts, and scarring. The estimated global prevalence of HS is highly variable, as revealed in a growing body of published literature, and ranges from 0.053% to 4.1%. In North American and European patients, HS is three times more common in women than men, whereas in South Korea and Japan, male predominance is found. The disease most frequently manifests itself between the ages of 18 and 29. Numerous published studies have reported the association between smoking, obesity, and HS, although there are limitations in confirming the causal relationship due to the retrospective design of the available studies. Case-control studies have frequently evaluated the association between HS, metabolic syndrome, and other systemic comorbidities. Due to increased mental health problems, a higher risk of suicide in patients with HS has been reported. We provide up-to-date evidence about the epidemiology, genetic and environmental risk factors, comorbidities, and quality of life of patients with HS. The divergence in HS frequency, possibly due to differences in populations and methodologies, remains to be explained in future worldwide studies.
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Affiliation(s)
- Zrinka Bukvić Mokos
- School of Medicine University of Zagreb, University Hospital Centre Zagreb, Department of Dermatology and Venereology, European Reference Network (ERN) - Skin, Zagreb, Croatia
| | - Adela Markota Čagalj
- University Hospital Centre Split, Department of Dermatology and Venereology, School of Medicine, University of Split, Split, Croatia
| | - Branka Marinović
- School of Medicine University of Zagreb, University Hospital Centre Zagreb, Department of Dermatology and Venereology, European Reference Network (ERN) - Skin, Zagreb, Croatia.
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7
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Witte K, Wolk K, Witte-Händel E, Krause T, Kokolakis G, Sabat R. Targeting Metabolic Syndrome in Hidradenitis Suppurativa by Phytochemicals as a Potential Complementary Therapeutic Strategy. Nutrients 2023; 15:3797. [PMID: 37686829 PMCID: PMC10490062 DOI: 10.3390/nu15173797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by the appearance of painful inflamed nodules, abscesses, and pus-draining sinus tracts in the intertriginous skin of the groins, buttocks, and perianal and axillary regions. Despite its high prevalence of ~0.4-1%, therapeutic options for HS are still limited. Over the past 10 years, it has become clear that HS is a systemic disease, associated with various comorbidities, including metabolic syndrome (MetS) and its sequelae. Accordingly, the life expectancy of HS patients is significantly reduced. MetS, in particular, obesity, can support sustained inflammation and thereby exacerbate skin manifestations and the chronification of HS. However, MetS actually lacks necessary attention in HS therapy, underlining the high medical need for novel therapeutic options. This review directs attention towards the relevance of MetS in HS and evaluates the potential of phytomedical drug candidates to alleviate its components. It starts by describing key facts about HS, the specifics of metabolic alterations in HS patients, and mechanisms by which obesity may exacerbate HS skin alterations. Then, the results from the preclinical studies with phytochemicals on MetS parameters are evaluated and the outcomes of respective randomized controlled clinical trials in healthy people and patients without HS are presented.
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Affiliation(s)
- Katrin Witte
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Inflammation and Regeneration of Skin, BIH Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Inflammation and Regeneration of Skin, BIH Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Ellen Witte-Händel
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Torben Krause
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Georgios Kokolakis
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
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8
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Macca L, Li Pomi F, Ingrasciotta Y, Morrone P, Trifirò G, Guarneri C. Hidradenitis suppurativa and psoriasis: the odd couple. Front Med (Lausanne) 2023; 10:1208817. [PMID: 37484864 PMCID: PMC10360127 DOI: 10.3389/fmed.2023.1208817] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Psoriasis and hidradenitis suppurativa are chronic inflammatory skin diseases that can develop together, negatively impacting on the patient's quality of life. We aimed to review the most up-to-date information regarding the epidemiology, pathogenesis, clinical presentation and possible therapeutical choices in patients with both psoriasis and hidradenitis suppurativa, thus linking these two autoimmune and autoinflammatory conditions. A narrative review of articles dating from 2017 to 2022 has been performed using the PubMed database. We analyzed the case reports and case series found in the literature regarding patients who suffered from both psoriasis and HS. Psoriasis arose before hidradenitis suppurativa in the majority of cases, while only a minority of them had hidradenitis suppurativa before psoriasis. Interestingly, some patients suffered from paradoxical hidradenitis suppurativa following biological therapy administered to treat the already present psoriasis. Lastly, new biological drugs have been marketed with great success for the outcome of psoriasis, but similar progress did not happen for hidradenitis. Novel therapeutic approaches and lines of research are needed for the treatment of these pathologies, even if concomitant, in order to improve patient's quality of life.
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Affiliation(s)
- Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pietro Morrone
- Unit of Dermatology, Mariano Santo Hospital, Cosenza, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Messina, Italy
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9
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Sabat R, Šimaitė D, Gudjonsson JE, Brembach TC, Witte K, Krause T, Kokolakis G, Bartnik E, Nikolaou C, Rill N, Coulibaly B, Levin C, Herrmann M, Salinas G, Leeuw T, Volk HD, Ghoreschi K, Wolk K. Neutrophilic granulocyte-derived B-cell activating factor supports B cells in skin lesions in hidradenitis suppurativa. J Allergy Clin Immunol 2023; 151:1015-1026. [PMID: 36481267 DOI: 10.1016/j.jaci.2022.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/17/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful inflamed nodules, abscesses, and pus-draining tunnels appearing in axillary, inguinal, and perianal skin areas. HS lesions contain various types of immigrated immune cells. OBJECTIVE This study aimed to characterize mediators that support lesional B/plasma cell persistence in HS. METHODS Skin samples from several cohorts of HS patients and control cohorts were assessed by mRNA sequencing, quantitative PCR on reverse-transcribed RNA, flow cytometry, and immunohistofluorescence. Blood plasma and cultured skin biopsy samples, keratinocytes, dermal fibroblasts, neutrophilic granulocytes (neutrophils), monocytes, and B cells were analyzed. Complex systems biology approaches were used to evaluate bulk and single-cell RNA sequencing data. RESULTS Proportions of B/plasma cells, neutrophils, CD8+ T cells, and M0 and M1 macrophages were elevated in HS lesions compared to skin of healthy and perilesional intertriginous areas. There was an association between B/plasma cells, neutrophils, and B-cell activating factor (BAFF, aka TNFSF13B). BAFF was abundant in HS lesions, particularly in nodules and abscesses. Among the cell types present in HS lesions, myeloid cells were the main BAFF producers. Mechanistically, granulocyte colony-stimulating factor in the presence of bacterial products was the major stimulus for neutrophils' BAFF secretion. Lesional upregulation of BAFF receptors was attributed to B cells (TNFRSF13C/BAFFR and TNFRSF13B/TACI) and plasma cells (TNFRSF17/BCMA). Characterization of the lesional BAFF pathway revealed molecules involved in migration/adhesion (eg, CXCR4, CD37, CD53, SELL), proliferation/survival (eg, BST2), activation (eg, KLF2, PRKCB), and reactive oxygen species production (eg, NCF1, CYBC1) of B/plasma cells. CONCLUSION Neutrophil-derived BAFF supports B/plasma cell persistence and function in HS lesions.
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Affiliation(s)
- Robert Sabat
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany; Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Deimantė Šimaitė
- Data and Data Sciences, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - Johann Eli Gudjonsson
- Department of Dermatology, University of Michigan, and Taubman Medical Research Institute, University of Michigan Medical School, Ann Arbor, Mich
| | - Theresa-Charlotte Brembach
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany; Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Department of Food Chemistry, Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Katrin Witte
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany; Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Inflammation and Regeneration of the Skin, BIH Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Torben Krause
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Kokolakis
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eckart Bartnik
- Immunology & Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - Christos Nikolaou
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany; Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Natascha Rill
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany; Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Béma Coulibaly
- Molecular Histopathology & Bio-Imaging, R&D, Sanofi-Aventis, Vitry-sur-Seine, France
| | - Clément Levin
- Molecular Histopathology & Bio-Imaging, R&D, Sanofi-Aventis, Vitry-sur-Seine, France
| | - Matthias Herrmann
- Immunology & Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - Gabriela Salinas
- NGS-Integrative Genomics Core Unit, Institute of Human Genetics, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Leeuw
- Immunology & Inflammation Research TA, Sanofi-Aventis Deutschland GmbH, Frankfurt, Germany
| | - Hans-Dieter Volk
- BIH Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany; Interdisciplinary Group Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany; Inflammation and Regeneration of the Skin, BIH Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany.
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Macchiarella G, Cornacchione V, Cojean C, Riker J, Wang Y, Te H, Ceci M, Gudjonsson JE, Gaulis S, Goetschy JF, Wollschlegel A, Gass SK, Oetliker-Contin S, Wettstein-Ling B, Schaefer DJ, Meschberger P, de Roche R, Osinga R, Wieczorek G, Naumann U, Lehmann JCU, Schubart A, Hofmann A, Roth L, Florencia EF, Loesche C, Traggiai E, Avrameas A, Prens EP, Röhn TA, Roediger B. Disease Association of Anti‒Carboxyethyl Lysine Autoantibodies in Hidradenitis Suppurativa. J Invest Dermatol 2023; 143:273-283.e12. [PMID: 36116506 DOI: 10.1016/j.jid.2022.08.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 01/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurring suppurating lesions of the intertriginous areas, resulting in a substantial impact on patients' QOL. HS pathogenesis remains poorly understood. An autoimmune component has been proposed, but disease-specific autoantibodies, autoantigens, or autoreactive T cells have yet to be described. In this study, we identify a high prevalence of IgM, IgG, and IgA antibodies directed against Nε-carboxyethyl lysine (CEL), a methylglyoxal-induced advanced glycation end-product, in the sera of patients with HS. Titers of anti-CEL IgG and IgA antibodies were highly elevated in HS compared with those in healthy controls and individuals with other inflammatory skin diseases. Strikingly, the majority of anti-CEL IgG was of the IgG2 subclass and correlated independently with both disease severity and duration. Both CEL and anti-CEL‒producing plasmablasts could be isolated directly from HS skin lesions, further confirming the disease relevance of this autoimmune response. Our data point to an aberration of the methylglyoxal pathway in HS and support an autoimmune axis in the pathogenesis of this debilitating disease.
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Affiliation(s)
- Giulio Macchiarella
- Biomarker Development (BMD), Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland; Biozentrum, Faculty of Sciences, University of Basel, Basel, Switzerland
| | - Vanessa Cornacchione
- NIBR Biologics Center (NBC), Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Celine Cojean
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Julia Riker
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Yichen Wang
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Helene Te
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Melanie Ceci
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | | | - Swann Gaulis
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Jean François Goetschy
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Audrey Wollschlegel
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Stephanie K Gass
- Department of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, University Hospital, University of Basel, Switzerland
| | - Sofia Oetliker-Contin
- Department of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, University Hospital, University of Basel, Switzerland
| | - Barbara Wettstein-Ling
- Department of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, University Hospital, University of Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, University Hospital, University of Basel, Switzerland
| | | | | | - Rik Osinga
- Department of Plastic, Reconstructive & Aesthetic Surgery and Hand Surgery, University Hospital, University of Basel, Switzerland; Praxis beim Merian Iselin, Basel, Switzerland
| | - Grazyna Wieczorek
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Ulrike Naumann
- Chemical Biology and Therapeutics (CBT), Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Joachim C U Lehmann
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Anna Schubart
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Andreas Hofmann
- Biotherapeutic and Analytical Technologies, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Lukas Roth
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Edwin F Florencia
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Christian Loesche
- Translational Medicine, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Elisabetta Traggiai
- NIBR Biologics Center (NBC), Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Alexandre Avrameas
- Biomarker Development (BMD), Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Till A Röhn
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Ben Roediger
- Autoimmunity, Transplantation and Inflammation (ATI) Disease Area, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland.
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11
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Bao B, Zhu C, Shi J, Lu C. Causal association between inflammatory bowel disease and hidradenitis suppurativa: A two-sample bidirectional Mendelian randomization study. Front Immunol 2023; 14:1071616. [PMID: 36776852 PMCID: PMC9909343 DOI: 10.3389/fimmu.2023.1071616] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Background Epidemiological studies have revealed a link between inflammatory bowel disease (IBD) and hidradenitis suppurativa (HS). To determine whether IBD and HS are causally related, we used the Mendelian randomization (MR) approach. Methods A two-sample MR was performed using an analysis of 12,882 patients and 21,770 controls with IBD and its main subtypes, ulcerative colitis (UC) and Crohn's disease (CD). A total of 409 cases and 211,139 controls without hidradenitis suppurativa (HS) were included in the data for this condition from various GWAS investigations. Odds ratios (ORs) with 95% confidence intervals (CIs) are used to estimate causal effects. Results The study assessed the causal relationship between HS and IBD in both directions. The risk of HS was increased by IBD (IVW OR = 1.34, 95% CI = 1.20-1.49, p = 2.15E-07) and, in addition, HS was affected by UC (IVW OR = 1.27, 95% CI = 1.13-1.43, p = 8.97E-04) and CD (IVW OR = 1.18, 95% CI = 1.08-1.29, p = 4.15E-04). However, there was no evidence of a causal relationship between HS and IBD or its subtypes (IBD IVW OR = 1.00, 95% CI = 0.96-1.05, p = 0.85; UC IVW OR = 0.99, 95% CI = 0.95-1.03, p = 0.65; CD IVW OR = 1.03, 95% CI = 0.98- 1.07, p = 0.28). Conclusion This study demonstrates that IBD and its subtypes have a causal effect on HS, whereas HS does not affect IBD. Gut-skin axis interactions may help to understand this association. Nevertheless, further studies are needed to clarify the pathophysiology of the causal relationship between IBD and HS.
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Affiliation(s)
- Bingzhou Bao
- Department of Anorectal, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Chao Zhu
- College of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Jian Shi
- Department of Anorectal, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Canxing Lu
- Department of Anorectal, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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12
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Ocker L, Abu Rached N, Seifert C, Scheel C, Bechara FG. Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:7240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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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Affiliation(s)
- Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | | | | | | | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
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13
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Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan AM. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol 2022; 61:1372-1379. [PMID: 35485975 PMCID: PMC10835602 DOI: 10.1111/ijd.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders. OBJECTIVE Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions. METHODS From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups. RESULTS A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others. LIMITATIONS Our study was limited by its retrospective design. CONCLUSIONS Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.
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Affiliation(s)
- Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL
| | - David O. Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Sophia A. Ederaine
- Student, Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, AZ
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Ali M. Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, CA
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14
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De Felice B, Montanino C, Mallardo M, Babino G, Mattera E, Ragozzino G, Argenziano G, Daniele A, Nigro E. Circulating microRNAs in Hidradenitis Suppurativa. Genes (Basel) 2022; 13:genes13091544. [PMID: 36140712 PMCID: PMC9498560 DOI: 10.3390/genes13091544] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a pathology characterized by chronic inflammation and skin lesions. The molecular basis of the inflammatory network remains unclear; however, since microRNAs (miRNAs) are involved in the modulation of inflammation, the composition of a micro-transcriptome RNA library using the blood of HS patients was analysed here. The total miRNA expression profiles of miRNAs from HS patients was assayed by real-time qPCR. Here, compared to healthy controls, miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p expression was found significantly different in HS. Knowing the significance of the miRNA mechanism in inflammatory and immune progression, we suggest that miRNA profiles found in HS patients can be significant in understanding the pathogenesis modality and establishing efficient biomarkers for HS early diagnosis. In particular, miR-338-5p was closely related to HS invasiveness and production of cytokines and was atypically overexpressed. miR-338-5p may represent a good promise as a non-invasive clinical biomarker for HS.
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Affiliation(s)
- Bruna De Felice
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DISTABIF), University of Campania Luigi Vanvitelli, Via Vivaldi 43, 81100 Caserta, Italy
- Correspondence: ; Tel.: +39-0823-274543; Fax: +39-0823-274571
| | - Concetta Montanino
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DISTABIF), University of Campania Luigi Vanvitelli, Via Vivaldi 43, 81100 Caserta, Italy
| | - Marta Mallardo
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DISTABIF), University of Campania Luigi Vanvitelli, Via Vivaldi 43, 81100 Caserta, Italy
- CEINGE-Biotecnologie Avanzate, Via G. Salvatore, 486, 80145 Napoli, Italy
| | - Graziella Babino
- Dermatology Unit, Università Degli Studi della Campania “Luigi Vanvitelli”, 80126 Naples, Italy
| | - Edi Mattera
- Department of Internal and Experimental Medicine and Surgery Unit of Internal Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Via Pansini, 80126 Napoli, Italy
| | - Giovanni Ragozzino
- Department of Internal and Experimental Medicine and Surgery Unit of Internal Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Via Pansini, 80126 Napoli, Italy
| | - Giuseppe Argenziano
- Department of Internal and Experimental Medicine and Surgery Unit of Internal Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Via Pansini, 80126 Napoli, Italy
| | - Aurora Daniele
- CEINGE-Biotecnologie Avanzate, Via G. Salvatore, 486, 80145 Napoli, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli “Federico II”, 80126 Napoli, Italy
| | - Ersilia Nigro
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DISTABIF), University of Campania Luigi Vanvitelli, Via Vivaldi 43, 81100 Caserta, Italy
- CEINGE-Biotecnologie Avanzate, Via G. Salvatore, 486, 80145 Napoli, Italy
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15
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Chen W, Ito T, Lin S, Song Z, Al‐Khuzaei S, Jurik A, Plewig G. Does
SAPHO
syndrome exist in dermatology? J Eur Acad Dermatol Venereol 2022; 36:1501-1506. [DOI: 10.1111/jdv.18172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022]
Affiliation(s)
- W. Chen
- Department of Dermatology and Allergy Technical University of Munich Munich Germany
| | - T. Ito
- Department of Dermatology Hamamatsu University School of Medicine Hamamatsu Japan
| | - S.‐H. Lin
- Department of Dermatology, Chang Gung Memorial Hospital Kaohsiung Medical Center Kaohsiung Taiwan
| | - Z. Song
- Department of Dermatology and Venereology, Southwest Hospital, Army Medical Universtiy Chongqing China
| | - S. Al‐Khuzaei
- Department of Dermatology, Rumailah Hospital, Hamad Medical Cooperation, Al Rumaila, Off Al Istiolal Street, P.O. Box 3050 Doha Qatar
| | - A.G. Jurik
- Department of Radiology Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University Aarhus Denmark
| | - G. Plewig
- Department of Dermatology and Allergy, Ludwig‐Maximilian‐University of Munich Munich Germany
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16
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van Straalen KR, Prens EP, Gudjonsson JE. Insights into hidradenitis suppurativa. J Allergy Clin Immunol 2022; 149:1150-1161. [PMID: 35189127 DOI: 10.1016/j.jaci.2022.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. A complex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate in vitro and animal models.
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Affiliation(s)
- Kelsey R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Mich; Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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17
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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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18
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Hua VJ, Kilgour JM, Cho HG, Li S, Sarin KY. Characterization of comorbidity heterogeneity among 13,667 patients with hidradenitis suppurativa. JCI Insight 2021; 6:151872. [PMID: 34546979 PMCID: PMC8663549 DOI: 10.1172/jci.insight.151872] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent abscesses in the groin and flexural areas. HS is associated with a wide range of comorbidities that complicate the disease course. Although these comorbidities have been well described, it remains unclear how these comorbidities coassociate and whether comorbidity profiles affect disease trajectory. In addition, it is unknown how comorbidity associations are modulated by race and sex. In this comprehensive analysis of 77 million patients in a large US population–based cohort, we examined coassociation patterns among HS comorbidities and identified clinically relevant phenotypic subtypes within HS. We demonstrated that these subtypes not only differed among races, but also influenced clinical outcomes as measured by HS-related emergency department visits and cellulitis. Taken together, our findings provide key insights that elucidate the unique disease trajectories experienced by patients with HS and equip clinicians with a framework for risk stratification and improved targeted care in HS.
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19
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Mitrovic S, Hassold N, Kamissoko A, Rosine N, Mathian A, Mercy G, Pertuiset E, Nocturne G, Fautrel B, Koné-Paut I. Adult-onset Still's disease or systemic-onset juvenile idiopathic arthritis and spondyloarthritis: overlapping syndrome or phenotype shift? Rheumatology (Oxford) 2021; 61:2535-2547. [PMID: 34559214 DOI: 10.1093/rheumatology/keab726] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/16/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Systemic-onset juvenile idiopathic arthritis (SJIA) and adult-onset Still's disease (AOSD) are the same sporadic systemic auto-inflammatory disease. Spondyloarthritis (SpA) is a group of inflammatory non-autoimmune disorders. We report the observations of eight patients with SJIA/AOSD who also presented features of SpA during their disease evolution and estimate the prevalence of SpA in SJIA/AOSD. METHODS This was a retrospective national survey of the departments of paediatric and adult rheumatology and internal medicine. To be included, SJIA patients had to fulfil the ILAR criteria, AOSD patients the Yamaguchi or Fautrel criteria, and all patients the ASAS classification criteria for axial or peripheral SpA, ESSG criteria for spondyloarthropathy or CASPAR criteria for psoriatic arthritis. The data were collected with a standardized form. RESULTS Eight patients (five adults) were identified in one paediatric and two adult departments. In all but one patient, SpA manifestations occurred several years after SJIA/AOSD onset (mean delay 6.2 ± 3.8 years). Two patients had peripheral and three axial SpA, and four later exhibited psoriatic arthritis and one SAPHO syndrome. The prevalence of SpA in an adult cohort of 76 patients with AOSD was 6.58% (95% CI [2.17-14.69]), greater than the prevalence of SpA in the French general population (0.3%, 95%CI [0.17-0.46]). The prevalence of SpA in an SJIA cohort of 30 patients was 10% (95%CI [2.11-26.53]), more than that reported in the general population of industrialized countries, estimated at 0.016% to 0.15%. CONCLUSION Whilst the temporal disassociation between SpA and AOSD in most cases might suggest a coincidental finding, our work raises the possibility of an SpA AOSD spectrum overlap that needs further study.
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Affiliation(s)
- Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP.,Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R network, Paris, France.,Département de Médecine Interne, Unité de Rhumatologie, Institut Mutualiste Montsouris, Paris, France
| | - Nolan Hassold
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Saclay, INSERM, Paris, France.,Service de Rhumatologie, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France.,Service de rhumatologie pédiatrique, and CEREMAIA, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France
| | - Aly Kamissoko
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP.,Service de Rhumatologie, Hôpital National Ignace Deen, Conakry, Guinée
| | - Nicolas Rosine
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP
| | - Alexis Mathian
- Service de Médecine Interne 2, Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Guillaume Mercy
- Service de Radiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Edouard Pertuiset
- Centre hospitalier René Dubos, Service de rhumatologie, Pontoise, France
| | - Gaëtane Nocturne
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Saclay, INSERM, Paris, France.,Service de Rhumatologie, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP.,Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R network, Paris, France.,Institut d'Epidémiologie, et de Santé Publique Pierre Louis, UMR S 1136, Equipe PEPITES, Paris, France
| | - Isabelle Koné-Paut
- Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R network, Paris, France.,Service de rhumatologie pédiatrique, and CEREMAIA, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France
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20
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Hanna N, Silverberg OM, Reaume M, Gladman D, Davis MDP, Piguet V, Alavi A. Incidence, prevalence, and predictors of inflammatory arthritis in patients with hidradenitis suppurativa: a systematic review and meta-analysis. Int J Dermatol 2021; 61:1069-1079. [PMID: 34432308 DOI: 10.1111/ijd.15860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
An increasing amount of evidence has emerged suggesting that hidradenitis suppurativa (HS) is associated with inflammatory arthritis. This study reviewed the incidence, prevalence, and predictors of inflammatory arthritis in patients with HS. A comprehensive literature search was conducted in CINAHL, Embase, and Medline from inception to February 14, 2020. Articles were included in the review if they provided data on disease epidemiology or predictors of adult or pediatric HS patients with comorbid inflammatory arthritis. There are no validated diagnostic criteria for HS, thus we considered patients as having HS if they had at least one diagnostic code in a hospital or claims database or a diagnosis of HS/inflammatory arthritis in a medical record. The same criteria were used to confirm presence of inflammatory arthritis. We identified an increased incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in HS patients when compared with estimates in the general population. We identified a relatively high prevalence of RA, spondyloarthritis (SpA), and PsA in HS patients when compared with estimates in the general population. There was evidence to suggest that patients who are younger than 30, male, have severe HS, or are taking infliximab or adalimumab (which may also be confounded by HS disease severity) may be at greater risk for specific subtypes of inflammatory arthritis. However, further data are needed to confirm these associations. The increased incidence and prevalence of inflammatory arthritis within HS patients underscore the need for increased awareness and interdisciplinary partnership within rheumatology and dermatology.
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Affiliation(s)
- Nardin Hanna
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Michael Reaume
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dafna Gladman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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21
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Hidradenitis suppurativa and rheumatoid arthritis: evaluating the bidirectional association. Immunol Res 2021; 69:533-540. [PMID: 34409549 PMCID: PMC8580926 DOI: 10.1007/s12026-021-09221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
Despite some common pathogenic themes, the association of hidradenitis suppurativa (HS) and rheumatoid arthritis (RA) has been poorly investigated. We aimed to evaluate the bidirectional association between HS and RA. A population-based study was conducted to compare HS patients (n = 6779) with age-, sex- and ethnicity-matched control subjects (n = 33,260) with regard to the incidence of new-onset and the prevalence of preexisting RA. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were estimated. The prevalence of preexisting RA was greater among patients with HS relative to controls (0.5% vs 0.3%. respectively; p = 0.019). The odds of being diagnosed with HS were 1.6-fold higher in patients with a history of RA (fully-adjusted OR, 1.66; 95% CI, 1.11–2.49; p = 0.014). The incidence rate of new-onset RA was estimated at 4.3 (95% CI, 2.5–6.8) and 2.4 (95% CI, 1.8–3.2) cases per 10,000 person-years among patients with HS and controls, respectively. The risk of RA was comparable between patients with HS and controls (fully-adjusted HR, 1.45; 95% CI, 0.77–2.72; p = 0.249). Compared to other patients with HS, those with HS and comorbid RA were older, had a higher prevalence of diabetes mellitus, hypertension, and hyperlipidemia, and had a comparable risk of all-cause mortality. In conclusions, a preexisting diagnosis of RA predisposes individuals to develop HS. Clinicians managing patients with HS and RA should be aware of this association. Further research is required to delineate the underlying pathomechanism of this observation.
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22
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McCarthy S, Barrett M, Kirthi S, Pellanda P, Vlckova K, Tobin AM, Murphy M, Shanahan F, O'Toole PW. Altered Skin and Gut Microbiome in Hidradenitis Suppurativa. J Invest Dermatol 2021; 142:459-468.e15. [PMID: 34364884 DOI: 10.1016/j.jid.2021.05.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/26/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the formation of nodules, abscesses, and fistula at intertriginous sites. The skin-gut axis is an area of emerging research in inflammatory skin disease and is a potential contributory factor to the pathogenesis of HS. 59 patients with HS provided fecal samples, nasal and skin swabs of affected sites for analysis. 30 healthy controls provided fecal samples and 20 healthy controls provided nasal and skin swabs. We performed bacterial 16S rRNA gene amplicon sequencing on total DNA derived from the samples. Microbiome alpha diversity was significantly lower in the fecal, skin and nasal samples of individuals with HS which may be secondary to disease biology or related to antibiotic usage. Ruminococcus gnavus was more abundant in the fecal microbiome of individuals with HS, which is also reported in Crohn's disease (CD), suggesting comorbidity due to shared gut microbiota alterations. Finegoldia magna was over-abundant in HS skin samples relative to healthy controls. It is possible local inflammation is driven by F. magna through promoting the formation of neutrophil extracellular traps (NET). These alterations in both the gut and skin microbiome in HS warrant further exploration, and therapeutic strategies including fecal microbiota transplant (FMT) or bacteriotherapy could be of benefit.
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Affiliation(s)
- S McCarthy
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland; South Infirmary Victoria University Hospital, Cork, Ireland.
| | - M Barrett
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland; School of Microbiology, University College Cork, National University of Ireland, Cork, Ireland
| | - S Kirthi
- Tallaght University Hospital, Dublin, Ireland
| | - P Pellanda
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland; School of Microbiology, University College Cork, National University of Ireland, Cork, Ireland
| | - K Vlckova
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland; School of Microbiology, University College Cork, National University of Ireland, Cork, Ireland
| | - A M Tobin
- Tallaght University Hospital, Dublin, Ireland
| | - M Murphy
- South Infirmary Victoria University Hospital, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland
| | - F Shanahan
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland
| | - P W O'Toole
- APC Microbiome Ireland, University College Cork, National University of Ireland, Cork, Ireland; School of Microbiology, University College Cork, National University of Ireland, Cork, Ireland
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23
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Mitrovic S, Fautrel B. Clinical Phenotypes of Adult-Onset Still's Disease: New Insights from Pathophysiology and Literature Findings. J Clin Med 2021; 10:jcm10122633. [PMID: 34203779 PMCID: PMC8232697 DOI: 10.3390/jcm10122633] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 01/02/2023] Open
Abstract
Adult-onset Still's disease (AOSD) is a non-familial, polygenic systemic autoinflammatory disorder. It is traditionally characterized by four cardinal manifestations-spiking fever, an evanescent salmon-pink maculopapular rash, arthralgia or arthritis and a white-blood-cell count (WBC) ≥ 10,000/mm3, mainly neutrophilic polymorphonuclear cells (PMNs)-but many other manifestations and complications can be associated, making clinical expression very heterogeneous and diagnosis sometimes difficult. The AOSD course can be diverse and is currently impossible to predict. Several clinical phenotypes have been described, either on the basis of the evolution of symptoms over time (monocyclic, polycyclic and chronic evolution) or according to dominant clinical evolution (systemic and arthritis subtypes). However, these patterns are mainly based on case series and not on robust epidemiological studies. Furthermore, they have mainly been established a long time ago, before the era of the biological treatments. Thus, based on our personal experience and on recent advances in the understanding of disease pathogenesis, it appears interesting to reshuffle AOSD phenotypes, emphasizing the continuum between AOSD profiles and other systemic autoinflammatory disorders, eventually proposing a research agenda.
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Affiliation(s)
- Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université—APHP, 75013 Paris, France;
- Centre d’Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network, 75013 Paris, France
- Département de Médecine Interne, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université—APHP, 75013 Paris, France;
- Centre d’Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network, 75013 Paris, France
- Institut d’Epidémiologie et de Santé Publique Pierre Louis, UMR S 1136, Equipe PEPITES, 75013 Paris, France
- Correspondence:
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24
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Preda-Naumescu A, Ahmed HN, Mayo TT, Yusuf N. Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations. Int J Dermatol 2021; 60:e449-e458. [PMID: 33890304 DOI: 10.1111/ijd.15579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/08/2021] [Indexed: 02/06/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is clinically defined by lesions ranging from painful, deep seated nodules to abscesses, draining sinus tracts, and ultimately, irreversible fibrotic scars. While the etiology remains unclear, a number of mechanisms ranging from genetics to aberrations of the immune system have been proposed. In addition, HS has a number of associations and may occur in conjunction with several diseases that span a host of medical specialties. The estimated prevalence ranges are from 1% to 4%; however, a large degree of under-reporting and misdiagnosis of this condition likely underestimates its true clinical significance. The debilitating consequences of missed diagnoses or improper management leads to severe pain and irreversible cutaneous manifestations (i.e., fistulae, sinus tracts, disfiguring scarring). HS has been found to significantly impair patients' quality of life to a greater degree when compared with other skin conditions. Early recognition and treatment are critical for a favorable prognosis, and diagnostic delays may be related to variable presentations within numerous comorbidities. Here we provide an in-depth, clinical-based review of HS, highlighting the clinical presentation, pathophysiology, grading systems, epidemiology, and comorbidities, in hopes of shedding light on an often misunderstood disease and ultimately moving closer to a more conclusive understanding of its various presentations and association.
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Affiliation(s)
- Ana Preda-Naumescu
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Hana N Ahmed
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany T Mayo
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nabiha Yusuf
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Almuhanna N, Finstad A, Alhusayen R. Association between Hidradenitis Suppurativa and Inflammatory Arthritis: A Systematic Review and Meta-Analysis. Dermatology 2021; 237:740-747. [PMID: 33774640 DOI: 10.1159/000514582] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies report a high prevalence of inflammatory arthritis among hidradenitis suppurativa (HS) patients. OBJECTIVES To study the association between HS and inflammatory arthritis. METHODS The systematic review and meta-analysis were performed according to the PRISMA guidelines to identify the association between HS and inflammatory arthritis, spondyloarthritis, ankylosing spondylitis (AS), and rheumatoid arthritis (RA). RESULTS Seven studies were entered in the analysis, with 200,361 HS patients and 385,599 controls. Pooled analysis illustrated a significantly increased risk of inflammatory arthritis in HS patients compared to controls (odds ratio [OR] 3.44; 95% confidence interval [CI] 1.92-6.17). There was also a statistically significant association between HS and spondyloarthritis (OR 2.10; 95% CI 1.40-3.15), and between HS and AS (OR 1.89; 95% CI 1.14-3.12). Moreover, pooled analysis showed a statistically significant association between HS and RA (OR 1.96; 95% CI 1.28-2.98). CONCLUSIONS Our findings show that HS patients have a 3-fold increased risk of developing inflammatory arthritis. HS patients are specifically at a higher risk for spondyloarthritis, its subtype AS, and RA.
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Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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26
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Wolk K, Brembach T, Šimaitė D, Bartnik E, Cucinotta S, Pokrywka A, Irmer M, Triebus J, Witte‐Händel E, Salinas G, Leeuw T, Volk H, Ghoreschi K, Sabat R. Activity and components of the granulocyte colony‐stimulating factor pathway in hidradenitis suppurativa*. Br J Dermatol 2021; 185:164-176. [DOI: 10.1111/bjd.19795] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 12/12/2022]
Affiliation(s)
- K. Wolk
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
- Inflammation and Regeneration of Skin BIH Center for Regenerative Therapies Charité – Universitätsmedizin Berlin Berlin Germany
| | - T.‐C. Brembach
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
- University of PotsdamInstitute of Nutritional ScienceDepartment of Food Chemistry Potsdam Germany
| | - D. Šimaitė
- Data and Data Sciences Sanofi‐Aventis Deutschland GmbH FrankfurtGermany
| | - E. Bartnik
- Immunology and Inflammation Research Sanofi‐Aventis Deutschland GmbH Frankfurt Germany
| | - S. Cucinotta
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
| | - A. Pokrywka
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Germany
| | - M.L. Irmer
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
| | - J. Triebus
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
| | - E. Witte‐Händel
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
| | - G. Salinas
- Transcriptome and Genome Core Unit University Medical Center Göttingen Göttingen Germany
| | - T. Leeuw
- Immunology and Inflammation Research Sanofi‐Aventis Deutschland GmbH Frankfurt Germany
| | - H.‐D. Volk
- BIH Center for Regenerative Therapies Charité – Universitätsmedizin Berlin Berlin Germany
- Institute of Medical Immunology Charité – Universitätsmedizin Berlin Germany
| | - K. Ghoreschi
- Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin Germany
| | - R. Sabat
- Psoriasis Research and Treatment Centre Charité – Universitätsmedizin Berlin Berlin Germany
- Interdisciplinary group Molecular Immunopathology Dermatology/Medical Immunology Charité – Universitätsmedizin Berlin Berlin Germany
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27
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Condamina M, Penso L, Tran VT, Hotz C, Guillem P, Villani AP, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts. Dermatology 2021; 237:748-758. [PMID: 33503635 DOI: 10.1159/000513447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in "real-life" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in "real-life" interventions.
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Affiliation(s)
- Morgane Condamina
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Laetitia Penso
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Claire Hotz
- Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Philippe Guillem
- Department of Visceral and Digestive Surgery, Val d'Ouest Clinic, Écully, France.,RésoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation, Dessau, Germany.,Groupe de Recherche en Proctologie de la Société Nationale Française de Coloproctologie, Paris, France
| | | | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - Marie-France Bru
- Patient Member of the Scientific Committee of ComPaRe Verneuil Disease, Paris, France
| | - Eric Jacquet
- Department of Visceral Surgery, Beau Soleil Clinic, Montpellier, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Hervé Bachelez
- Department of Dermatology-Venereology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM U1163, Imagine Institute, Paris, France
| | - Pierre Wolkenstein
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France.,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Marie Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Dermatology Department, University Hospital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Emilie Sbidian
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France, .,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France, .,INSERM, Centre d'Investigation Clinique 1430, Créteil, France,
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28
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Rafiei-Sefiddashti R, Hejrati A, Mohammadi S, Gholami A, Hejrati L, Rohani M. Hidradenitis suppurativa; classification, remedies, etiology, and comorbidities; a narrative review. J Family Med Prim Care 2021; 10:4009-4016. [PMID: 35136760 PMCID: PMC8797099 DOI: 10.4103/jfmpc.jfmpc_795_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is more common in females, especially during puberty and menopause. These inflammatory lesions include painful deep-seated nodules and abscesses, draining sinus tracts, and fibrotic scars. This article is a narrative review to explain whole disease aspects, including complication, causes, epidemiology, history, classification, prognosis, comorbidities, the effect of sex hormone, and potent treatments. Most patients with HS, who are not aware of their primary disease, visit primary care physicians to superinfection lesions instead of specialists. If these physicians suspect HS, their illness will not get misdiagnosed. This brief and comprehensive information in this article may help doctors to decide better about the same situation.
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29
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Meier K, Schloegl A, Poddubnyy D, Ghoreschi K. Skin manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20975915. [PMID: 33343725 PMCID: PMC7727049 DOI: 10.1177/1759720x20975915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) - the main skin disease in SpA - has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn's disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.
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Affiliation(s)
- Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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30
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Nikolakis G, Kaleta K, Vaiopoulos A, Wolter K, Baroud S, Wojas-Pelc A, Zouboulis C. Phenotypes and Pathophysiology of Syndromic Hidradenitis Suppurativa: Different Faces of the Same Disease? A Systematic Review. Dermatology 2020; 237:673-697. [DOI: 10.1159/000509873] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently autoinflammatory syndromes and their diagnostic delay might have detrimental effects on affected patients. <b><i>Methods:</i></b> A systematic review was performed on the databases MEDLINE, EMBASE, and CENTRAL utilizing a standardized extraction form according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. <b><i>Results:</i></b> Sixty-four eligible articles on syndromic HS were retrieved. The identified syndromes included already described ones (pyoderma gangrenosum-acne-suppurative hidradenitis, pyogenic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, psoriatic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, pyoderma gangrenosum-acne vulgaris-hidradenitis suppurativa-ankylosing spondylitis, synovitis-acne-pustulosis-hyperostosis-osteitis) and further novel symptom constellations. Cutaneous signs, including HS lesions, usually precede signs from other organs. The cutaneous signs of a considerable proportion of patients appear refractory to conventional treatment, and monotherapy with biologics does not suffice to sustain remission. <b><i>Conclusion:</i></b> The results are subsequently discussed with focus on the pathophysiology and treatment of the detected syndromes. The dermatologist’s role in the precise diagnosis and early treatment administration of HS is pivotal. The purpose of the treatment should be the effective prevention or delay of the autoinflammatory march and its irreversible consequences.
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Nguyen T, Damiani G, Orenstein L, Hamzavi I, Jemec G. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol 2020; 35:50-61. [DOI: 10.1111/jdv.16677] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T.V. Nguyen
- Bellevue Dermatology Clinic & Clinical Research Center Bellevue WA USA
| | - G. Damiani
- Department of Dermatology Emory University School of Medicine Atlanta GA USA
| | - L.A.V. Orenstein
- Dipartimento di Fisiopatologia Medico‐Chirurgica e dei Trapianti Università degli Studi di Milano Unità Operativa di Dermatologia IRCCS Fondazione Ca' GrandaOspedale Maggiore Policlinico Milano Italy
| | - I. Hamzavi
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - G.B. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
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Kokolakis G, Wolk K, Schneider-Burrus S, Kalus S, Barbus S, Gomis-Kleindienst S, Sabat R. Delayed Diagnosis of Hidradenitis Suppurativa and Its Effect on Patients and Healthcare System. Dermatology 2020; 236:421-430. [PMID: 32610312 PMCID: PMC7592906 DOI: 10.1159/000508787] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a neglected chronic inflammatory disease with long delay in diagnosis. Besides pain, purulent discharge, and destruction of skin architecture, HS patients experience metabolic, musculoskeletal, and psychological disorders. OBJECTIVES To determine the delay in HS diagnosis and its consequences for patients and the healthcare system. METHODS This was a prospective, multicenter, epidemiologic, non-interventional cross-sectional trial carried out in Germany and based on self-reported questionnaires and medical examinations performed by dermatologists. In total, data of 394 adult HS patients were evaluated. RESULTS The average duration from manifestation of first symptoms until HS diagnosis was 10.0 ± 9.6 (mean ± SD) years. During this time, HS patients consulted on average more than 3 different physicians - most frequently general practitioners, dermatologists, surgeons, gynecologists - and faced more than 3 misdiagnoses. Diagnosis delay was longer in younger and non-smoking patients. In most cases, HS was correctly diagnosed by dermatologists. The longer the delay of diagnosis, the greater the disease severity at diagnosis. Delayed HS diagnosis was also associated with an increased number of surgically treated sites, concomitant diseases, and days of work missed. CONCLUSION This study demonstrates an enormous delay in the diagnosis of HS, which results in more severe disease. It also shows for the first time that a delay in diagnosis of a chronic inflammatory disease leads to a higher number of concomitant systemic disorders. In addition to the impaired health status, delayed diagnosis of HS was associated with impairment of the professional life of affected people.
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Affiliation(s)
- Georgios Kokolakis
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Wolk
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Psoriasis Research and Treatment Centre, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Centre for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylke Schneider-Burrus
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Centre for Dermatosurgery, Havelklinik, Berlin, Germany
| | - Stefanie Kalus
- GKM Gesellschaft für Therapieforschung mbH, Munich, Germany
| | | | | | - Robert 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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33
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George A, George R, Mathew AJ, Telugu RB. Dowling-Degos Disease with Hidradenitis Suppurativa and Inflammatory Arthritis in Two Generations. Indian Dermatol Online J 2020; 11:413-415. [PMID: 32695705 PMCID: PMC7367576 DOI: 10.4103/idoj.idoj_337_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 11/23/2022] Open
Abstract
Dowling–Degos disease (DDD) is a rare autosomal dominant genodermatosis characterized by reticulate brown-to-black pigmentation of the flexures, pitted perioral acneiform scars, and comedo-like follicular papules on the flexures. The diagnosis is based on characteristic clinical and histopathological features. DDD has been found to occur in association with hidradenitis suppurativa (HS), arthritis, epidermoid cysts, keratoacanthomas, and squamous cell carcinoma. To date, there is only one report of DDD associated with HS and polyarticular arthritis.
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Affiliation(s)
- Anju George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Renu George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashish J Mathew
- Department of Rheumatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ramesh B Telugu
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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34
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Hidradenitis suppurativa. J Am Acad Dermatol 2020; 82:1045-1058. [DOI: 10.1016/j.jaad.2019.08.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
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35
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Fania L, Moro F, Clemente A, Sordi D, Scarabello A, Mazzanti C, Caggiati A, Zecchi V, Panebianco A, Cassotta G, Abeni D. Successful treatment of Sapho syndrome and hidradenitis suppurativa: A therapeutic challenge. Dermatol Ther 2020; 33:e13453. [PMID: 32319137 DOI: 10.1111/dth.13453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/12/2020] [Accepted: 04/19/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Luca Fania
- First Dermatology Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | - Francesco Moro
- First Dermatology Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | - Antonio Clemente
- Anesthesia and Intensive Care Department, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | - Donatella Sordi
- First Dermatology Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | | | - Cinzia Mazzanti
- First Dermatology Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | - Alessio Caggiati
- Plastic Surgery Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | - Viola Zecchi
- Radiology Department, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | | | - Gabriella Cassotta
- Plastic Surgery Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS via dei Monti di Creta 104, 00167, Rome, Italy
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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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Genovese G, Caorsi R, Moltrasio C, Marzano AV. Successful treatment of co-existent SAPHO syndrome and hidradenitis suppurativa with adalimumab and methotrexate. J Eur Acad Dermatol Venereol 2020; 33 Suppl 6:40-41. [PMID: 31535768 DOI: 10.1111/jdv.15849] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/24/2019] [Indexed: 12/24/2022]
Abstract
SAPHO syndrome, namely Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis, is a rare autoinflammatory chronic disease presenting with non-infectious inflammatory osteitis, sterile joint inflammation and skin manifestations, including palmoplantar pustulosis and severe acne. The case of a 15-year-old boy affected by SAPHO syndrome and hidradenitis suppurativa (HS) is presented and discussed. Coexistence of these two diseases may represent a therapeutic challenge and this case confirms literature data reporting the efficacy of the combination of methotrexate and adalimumab in SAPHO complicated by HS.
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Affiliation(s)
- G Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - R Caorsi
- Centro per le malattie autoinfiammatorie ed immunodeficienze, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - C Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, Università degli Studi di Milano, Milan, Italy
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38
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and acne vulgaris and conglobata—systematic review and meta-analysis. BIOMEDICAL DERMATOLOGY 2019. [DOI: 10.1186/s41702-019-0045-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder which involves painful nodules and draining abscesses in flexural areas. Acne vulgaris and its more severe variants including acne conglobata and acne fulminans are also disorders involving the follicular unit. Given that follicular obstruction, dilatation and inflammation feature in both HS and acne vulgaris/conglobata, it has been suggested that HS is associated with acne vulgaris/conglobata.
Methods
The present systematic review and meta-analysis was performed according to recommended PRISMA guidelines. All eligible case-control studies comparing patients with HS vs non-HS were included in the present review. All studies must have included either the proportion of patients with acne vulgaris/conglobata in each group, or the summary effect size for association between HS and acne vulgaris/conglobata. The odds ratio (OR) was used as a summary statistic.
Results
From pooled unadjusted meta-analysis, we found a significantly higher proportion of patients with acne vulgaris/conglobata in HS cases compared to controls (OR 3.44, 95% CI 1.95–6.07, P < 0.0001, I2 = 100%). Pooled meta-analysis was also performed with adjusted effect sizes. This demonstrated that HS was significantly associated with acne vulgaris/conglobata after adjustment for potential confounders (OR 3.44, 95% CI 2.43–4.87, P < 0.00001, I2 = 99%).
Conclusions
In summary, a significant association was found between HS and acne vulgaris/conglobata. This has implications in terms of understanding the burden of disease on patient quality of life as well as consideration of optimal management strategies to target both disorders. Physicians taking care of patients with HS should be aware of this association.
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Yüksel M, Basım P. Demographic and Clinical Features of Hidradenitis Suppurativa in Turkey. J Cutan Med Surg 2019; 24:55-59. [DOI: 10.1177/1203475419887732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The literature contains conflicting reports on the epidemiology and frequency of hidradenitis suppurativa (HS), a chronic, recurrent inflammatory disease of the apocrine glands. Objective To evaluate the clinical and demographic characteristics of HS cases in Turkey and investigate the similarities with world epidemiology. Method The records of 208 patients that presented to our polyclinics and were diagnosed with HS between June 2012 and July 2017 were retrospectively evaluated. Results Of the cases, 68.3% were male and 31.7% were female. Of the patients, 75.5% had no family history of HS, 60.6% were smokers, 39.4% were aged 20-29 years, and 36.1% were aged 30-39 years. The most commonly involved regions were the axilla (62%), groin (50.5%), and gluteus (15.9%). According to univariate analyses, male patients had higher disease stages than females (odds ratio=1.67). The patients with groin involvement, high body mass index (BMI), and low education level (0-8 years) had higher risk of severe disease stage (odds ratio=1.63, 8.91, and 1.51, respectively). The most commonly used treatment was oral antibiotics in Hurley stages I and II, and surgical intervention in Hurley III. In all 3 Hurley stages, clavulanic acid–amoxicillin combination was the mostly used systemic antibiotic (41.8%, 43.2%, and 47.8%, respectively). Conclusions This is the first epidemiological study on HS in the Turkish population, where HS shows male predominance. Male gender, low education level, absence of acne, high BMI, and groin involvement were associated with severe disease stages. Determining associated comorbidities and possible risk factors is important in progression and prevention of the disease.
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Affiliation(s)
- Mavişe Yüksel
- Department of Dermatology, Istanbul Medipol University Hospital, Istanbul, Turkey
| | - Pelin Basım
- Department of General Surgery, Istanbul Medipol University Hospital, Istanbul, Turkey
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40
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Alavi A, Shavit E, Archer J, Pagnoux C. Hidradenitis suppurativa and vasculitis: A case series and literature review of a rare association. SAGE Open Med Case Rep 2019; 7:2050313X19882852. [PMID: 31673357 PMCID: PMC6804353 DOI: 10.1177/2050313x19882852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory skin disease with dysregulation of the immune system. Its pathophysiology is not clear, and it has been reported in association with various inflammatory disorders such as pyoderma gangrenosum, arthritis, familial Mediterranean fever and inflammatory bowel diseases. However, the co-existence of HS and vasculitis is exceptional and has not been investigated. We report on five patients with vasculitis that are followed in our centers: one with Takayasu’s arteritis, three with granulomatosis with polyangiitis and one with Behcet’s disease and compare them with those previously reported in the literature. A case series and literature review with key words of “vasculitis,” “hidradenitis suppurativa,” and “acne inversa” found only one previous report of hidradenitis suppurativa and cutaneous vasculitis and two with Behcet’s disease. Whereas the association of pyoderma gangrenosum and vasculitis is well-known, that with hidradenitis suppurativa is rarer. There may be some pathogenic continuum between hidradenitis suppurativa, pyoderma gangrenosum and vasculitis.
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Affiliation(s)
- Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada.,York Dermatology Center, Richmond Hill, ON, Canada
| | - Eran Shavit
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Christian Pagnoux
- Department of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Phan K, Tatian A, Woods J, Cains G, Frew JW. Prevalence of inflammatory bowel disease (IBD) in hidradenitis suppurativa (HS): systematic review and adjusted meta‐analysis. Int J Dermatol 2019; 59:221-228. [DOI: 10.1111/ijd.14697] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/07/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Kevin Phan
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
- Faculty of Medicine University of New South Wales Sydney Australia
| | - Artiene Tatian
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
| | - Jane Woods
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
| | - Geoffrey Cains
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
| | - John W. Frew
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
- Faculty of Medicine University of New South Wales Sydney Australia
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Kjærsgaard Andersen R, Saunte SK, Jemec GBE, Saunte DM. Psoriasis as a comorbidity of hidradenitis suppurativa. Int J Dermatol 2019; 59:216-220. [DOI: 10.1111/ijd.14651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Rune Kjærsgaard Andersen
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - Sara K. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Gregor B. E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - Ditte M. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
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Garg A, Hundal J, Strunk A. Overall and Subgroup Prevalence of Crohn Disease Among Patients With Hidradenitis Suppurativa: A Population-Based Analysis in the United States. JAMA Dermatol 2019; 154:814-818. [PMID: 29800049 DOI: 10.1001/jamadermatol.2018.0878] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Limited evidence supports a link between hidradenitis suppurativa (HS) and Crohn disease (CD), and this relationship has not been established in the United States. Objective To evaluate the prevalence of CD among patients with HS in the United States and to determine the strength of association between the 2 conditions. Design, Setting, and Participants Cross-sectional analysis of data from 51 340 patients with HS identified using electronic health records data in the Explorys multiple health system data analytics and research platform, which includes data from more than 50 million unique patients across all US census regions. Main Outcomes and Measures Primary outcome was diagnosis of CD. Results Of the 18 455 660 total population considered, 51 340 had HS (35 000 women). Of these patients with HS, 29 010 (56.5%) were aged 18 to 44 years; 17 580 (34,2%), 45 to 64 years; and 4750 (9.3%), 65 years or older. Prevalence of CD among patients with HS was 2.0% (1025/51 340), compared with 0.6% (113 360/18 404 260) among those without HS (P < .001). Prevalence of CD was greatest among patients with HS who were white (2.3%), aged 45 to 64 years (2.4%), nonobese (2.8%), and tobacco smokers (2.3%). In univariable and multivariable analyses, patients with HS had 3.29 (95% CI, 3.09-3.50) and 3.05 (95% CI, 2.87-3.25) times the odds of having CD, respectively, compared with patients without HS. Crohn disease was associated with HS across all patient subgroups. The association was strongest for men (OR, 3.61; 95% CI, 3.24-4.03), patients aged 45 to 64 years (OR, 3.49; 95% CI, 3.16-3.85), nonobese patients (OR, 4.09; 95% CI, 3.69-4.54), and nonsmokers (OR, 3.44; 95% CI, 3.10-3.82). Conclusions and Relevance These data suggest that patients with HS are at risk for CD. Gastrointestinal symptoms or signs suggestive of CD warrant additional evaluation by a gastroenterologist.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Jessica Hundal
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
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44
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Chen WT, Chi CC. Association of Hidradenitis Suppurativa With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:1022-1027. [PMID: 31290938 DOI: 10.1001/jamadermatol.2019.0891] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Hidradenitis suppurativa (HS) and inflammatory bowel disease (IBD) are inflammatory diseases that share common genetic susceptibility and immunologic features. However, the link between HS and IBD has been largely unclear. Objective To conduct a meta-analysis to investigate the association between HS and IBD. Data Sources A search of the MEDLINE, Cochrane Central Register of Controlled Trials, and Embase databases yielded 397 relevant studies from inception to June 10, 2018. Two additional studies were supplied by one of the investigators. Study Selection Case-control, cross-sectional, or cohort studies that examined the odds or risk of IBD in patients with HS were included. No geographic or language limitations were imposed. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The Newcastle-Ottawa Scale was used to assess the risk of bias of included studies. Crohn disease and ulcerative colitis were analyzed separately, and a random-effects model meta-analysis was conducted. Main Outcomes and Measures The odds ratios (ORs) and hazard ratios (HRs) of IBD, Crohn disease, and ulcerative colitis in association with HS. Results Five case-control studies, 2 cross-sectional studies, and 1 cohort study with a total of 93 601 unique participants were included. The meta-analysis of case-control and cross-sectional studies showed significant associations of HS with Crohn disease (pooled OR, 2.12; 95% CI, 1.46-3.08) and ulcerative colitis (pooled OR, 1.51; 95% CI, 1.25-1.82). Two case-control studies found significant association of HS with IBD (ORs, 2.16 [95% CI, 1.40-3.34] and 10.00 [95% CI, 1.94-51.50]). One cohort study found an increased risk of IBD in patients with HS (HR, 5.6; 95% CI not reported; P < .002). Conclusions and Relevance The evidence to date supports an association of HS with IBD. These results suggest that consultation with gastroenterologists should be sought when patients with HS present with recurrent abdominal pain, chronic diarrhea, bloody stool, and body weight loss.
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Affiliation(s)
- Wei-Ti Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan , Taiwan.,Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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45
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Gottlieb J, Madrange M, Gardair C, Sbidian E, Frazier A, Wolkenstein P, Hickman G, Schneider P, Baudry C, Claudepierre P, Bertheau P, Richette P, Smahi A, Bachelez H. PAPASH
, Ps
APASH
and
PASS
autoinflammatory syndromes: phenotypic heterogeneity, common biological signature and response to immunosuppressive regimens. Br J Dermatol 2019; 181:866-869. [DOI: 10.1111/bjd.18003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- J. Gottlieb
- Department of Dermatology APHP Hôpital St‐Louis Paris France
| | - M. Madrange
- UMR Inserm 1163 Laboratoire de Génétique des Maladies Cutanées Institut Imagine, Necker Hospital Paris France
| | - C. Gardair
- Department of Pathology APHP Hôpital St‐Louis Paris France
- Department of Gastroenterology APHP Hôpital St‐Louis Paris France
| | - E. Sbidian
- Sorbonne Paris Cité Université Paris Diderot Paris France
- Department of Dermatology APHP Hôpital Henri MondorCréteil
- Department of Rheumatology APHP Hôpital Henri Mondor Créteil
| | - A. Frazier
- Université Paris Est Créteil Créteil France
| | - P. Wolkenstein
- Sorbonne Paris Cité Université Paris Diderot Paris France
- Department of Dermatology APHP Hôpital Henri MondorCréteil
- Department of Rheumatology APHP Hôpital Henri Mondor Créteil
| | - G. Hickman
- Department of Dermatology APHP Hôpital St‐Louis Paris France
| | - P. Schneider
- Department of Dermatology APHP Hôpital St‐Louis Paris France
| | - C. Baudry
- Department of Gastroenterology APHP Hôpital St‐Louis Paris France
- EA 7379 – EpidermE Créteil France
| | - P. Claudepierre
- Department of Dermatology APHP Hôpital Henri MondorCréteil
- Department of Rheumatology APHP Hôpital Henri Mondor Créteil
- Department of Rheumatology APHP Hôpital Lariboisière, Paris, France APHP Hôpital Henri Mondor Créteil France
| | - P. Bertheau
- Department of Pathology APHP Hôpital St‐Louis Paris France
- Department of Gastroenterology APHP Hôpital St‐Louis Paris France
| | - P. Richette
- Université Paris Est Créteil Créteil France
- Inserm U1132, UFR de médecine Paris Diderot University Paris France
| | - A. Smahi
- UMR Inserm 1163 Laboratoire de Génétique des Maladies Cutanées Institut Imagine, Necker Hospital Paris France
| | - H. Bachelez
- Department of Dermatology APHP Hôpital St‐Louis Paris France
- UMR Inserm 1163 Laboratoire de Génétique des Maladies Cutanées Institut Imagine, Necker Hospital Paris France
- Department of Gastroenterology APHP Hôpital St‐Louis Paris France
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Cartron A, Driscoll MS. Comorbidities of hidradenitis suppurativa: A review of the literature. Int J Womens Dermatol 2019; 5:330-334. [PMID: 31909152 PMCID: PMC6938918 DOI: 10.1016/j.ijwd.2019.06.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/17/2019] [Accepted: 06/22/2019] [Indexed: 01/12/2023] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects the follicular portion of folliculopilosebaceous units. It causes painful nodules, abscesses, and draining sinus tracts throughout multiple regions of the body. HS primarily affects women; the overall HS prevalence in women is three times that in men. Although cutaneous disease itself causes substantial morbidity, recent evidence has shown that HS is a systemic inflammatory disease with multiple associated comorbidities. Objective A review of the literature was conducted to elucidate existing information on this topic to assist in clinical decision-making for dermatologists. Methods A review of the literature using the PubMed database was conducted with the search term "hidradenitis suppurativa comorbidities". The search was conducted from March 3, 2019 to March 20, 2019, and yielded 55 articles, case reports, and reviews. Results Metabolic and cardiovascular comorbidities were the most commonly associated with HS. HS has a significant comorbidity burden beyond the skin, including metabolic, cardiovascular, endocrine, gastrointestinal, rheumatologic, and psychiatric disorders, which collectively decrease the quality of life of patients. Conclusions Dermatologists should be aware of these associations to encourage appropriate screening and referral for management of these disorders.
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Affiliation(s)
- Alexander Cartron
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marcia S Driscoll
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
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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 I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol 2019; 81:76-90. [PMID: 30872156 PMCID: PMC9131894 DOI: 10.1016/j.jaad.2019.02.067] [Citation(s) in RCA: 181] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 01/28/2023]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are 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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Vural S, Gündoğdu M, Gökpınar İli E, Durmaz CD, Vural A, Steinmüller-Magin L, Kleinhempel A, Holdt LM, Ruzicka T, Giehl KA, Ruhi HI, Boyvat A. Association of pyrin mutations and autoinflammation with complex phenotype hidradenitis suppurativa: a case-control study. Br J Dermatol 2019; 180:1459-1467. [PMID: 30488432 DOI: 10.1111/bjd.17466] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a rare, debilitating neutrophilic dermatosis characterized by chronic inflammation of hair follicles. Many inflammatory conditions may accompany HS. OBJECTIVES To investigate the association of variants of the MEFV gene with a complex HS phenotype. METHODS Firstly, we identified the clinical characteristics of 119 patients with HS with a complex phenotype (Hurley stage III disease and/or additional inflammatory symptoms). Then, we searched for MEFV variants among these patients. The odds ratios (ORs) for pathogenic MEFV mutations were calculated using data from these patients with HS and 191 healthy controls. RESULTS The male/female ratio was higher, and the mean age of onset was earlier, in our complex HS group compared with patients with HS in general. Five of the patients with HS (4·2%) had a diagnosis of familial Mediterranean fever (FMF) with a standardized morbidity ratio of 45 [95% confidence interval (CI) 16·50-99·84, P < 0·001] when compared with the frequency of FMF in the general Turkish population. Of the patients with complex HS, 38% were positive for pathogenic variants of MEFV. The OR for carrying a pathogenic MEFV allele was 2·80 (95% CI 1·31-5·97, P < 0·001). CONCLUSIONS The frequency of MEFV mutations in the group of patients with complex HS was higher than that in healthy controls, suggesting that MEFV mutations may contribute to the pathogenesis of HS. Understanding the role of autoinflammation in HS is of fundamental importance for the development of novel therapies.
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Affiliation(s)
- S Vural
- Department of Dermatology and Venereology, Ankara University, Ankara, Turkey.,Department of Dermatology, Koç University, Istanbul, Turkey
| | - M Gündoğdu
- Department of Dermatology and Venereology, Ankara University, Ankara, Turkey
| | - E Gökpınar İli
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - C D Durmaz
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - A Vural
- Department of Neurology, Koç University, Istanbul, Turkey
| | | | - A Kleinhempel
- Institute of Laboratory Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - L M Holdt
- Institute of Laboratory Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - T Ruzicka
- Department of Dermatology and Allergy, Ludwig Maximilian University of Munich, Munich, Germany
| | - K A Giehl
- Department of Dermatology and Allergy, Ludwig Maximilian University of Munich, Munich, Germany
| | - H I Ruhi
- Department of Medical Genetics, Ankara University, Ankara, Turkey
| | - A Boyvat
- Department of Dermatology and Venereology, Ankara University, Ankara, Turkey
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49
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Hidradenitis suppurativa - known and unknown disease. Reumatologia 2018; 56:337-339. [PMID: 30647478 PMCID: PMC6330680 DOI: 10.5114/reum.2018.80709] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 01/03/2023] Open
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50
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Rondags A, van Straalen KR, Arends S, van der Zee HH, Prens EP, Spoorenberg A, Horváth B. High prevalence of clinical spondyloarthritis features in patients with hidradenitis suppurativa. J Am Acad Dermatol 2018; 80:551-554.e1. [PMID: 30554892 DOI: 10.1016/j.jaad.2018.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/03/2018] [Accepted: 06/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Angelique Rondags
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | | | - Suzanne Arends
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Errol P Prens
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anneke Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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