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Dimitrion PM, Krevh R, Veenstra J, Ge J, Siddiqui A, Ferguson D, Hans A, Zuniga B, Sidhu K, Daveluy S, Hamzavi I, Zhou L, Adrianto I, Mi QS. High-throughput proteomics identifies inflammatory proteins associated with disease severity and genetic ancestry in patients with hidradenitis suppurativa. Br J Dermatol 2025; 192:1063-1071. [PMID: 39778115 DOI: 10.1093/bjd/ljaf012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/21/2024] [Accepted: 12/31/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition with a greater prevalence and disease burden in patients who identify as African American and those with a family history of HS, suggesting a strong genetic component to its pathogenesis. OBJECTIVES To evaluate the relationship between plasma inflammatory protein expression, HS disease severity and genetic ancestry in a diverse cohort of patients with HS. METHODS We performed a case-control, single-centre study of patients with HS and age-, sex- and ethnicity-matched healthy control participants. We profiled circulating inflammatory proteins using Olink® high-throughput proteomics and determined genetic ancestry from whole-genome sequencing data. RESULTS Using linear regression, we identified novel proteins associated with HS, after adjusting for age, sex and ethnicity. Our analysis also revealed differences in the inflammatory proteome linked to disease severity. Specifically, we found that plasma levels of interleukin (IL)-6 can distinguish between different Hurley stages, indicating that IL-6 may serve as a marker of disease severity. Additionally, we found variations in inflammatory protein levels based on genetic ancestry: patients with predominantly African ancestry exhibited higher levels of inflammatory proteins associated with neutrophilic inflammation, while those with predominantly European ancestry showed increased levels of T helper 1-related inflammatory proteins. CONCLUSIONS Although we were unable to account for treatment status or comorbidities that may influence the level of inflammatory cytokines, genetic ancestry and disease severity may influence the plasma inflammatory profile in patients with HS.
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Affiliation(s)
- Peter M Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Rachel Krevh
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Jesse Veenstra
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - James Ge
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Aamir Siddiqui
- Department of Plastic Surgery, Henry Ford Health, Detroit, MI, USA
| | | | - Aakash Hans
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Bobby Zuniga
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Kermanjot Sidhu
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - Iltefat Hamzavi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA
| | - Indra Adrianto
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, USA
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, USA
- Department of Dermatology, Henry Ford Health, Detroit, MI, USA
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA
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Tolson H, Yamamoto RK, Kikuchi R, Sadrolashrafi K, Hao A, Guo L, Bilimoria S, Yee D, Armstrong AW. Comparing antibiotic prescribing patterns for hidradenitis suppurativa between the emergency department and ambulatory care setting. PLoS One 2025; 20:e0310651. [PMID: 40388367 PMCID: PMC12088064 DOI: 10.1371/journal.pone.0310651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 09/04/2024] [Indexed: 05/21/2025] Open
Abstract
BACKGROUND Oral antibiotics are a mainstay of treatment for hidradenitis suppurativa (HS), primarily due to their anti-inflammatory and anti-microbial properties. There is a paucity of literature comparing how antibiotic prescribing patterns for HS patients differ between the emergency department (ED) and ambulatory care settings. OBJECTIVE This study aims to compare antibiotic prescribing patterns for HS patients in the ED versus ambulatory care setting. METHODS We utilized the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to identify visits for HS patients in 2005-2016, 2018, and 2019. We performed multivariate logistic regression analysis to compare the likelihood of prescribing antibiotic therapy versus no antibiotic therapy between the ED and ambulatory care settings. RESULTS We identified a weighted total of 3,041,193 HS patient visits. Approximately 49.0% of ambulatory visits resulted in antibiotic prescriptions. The most frequently prescribed antibiotics in the ambulatory setting were tetracyclines (41.2%), clindamycin (35.9%), and trimethoprim/sulfamethoxazole (21.6%). Approximately 74.7% of ED visits resulted in antibiotic prescriptions. The most frequently prescribed antibiotics in the ED setting were trimethoprim/sulfamethoxazole (44.5%), beta-lactams (33.2%), and clindamycin (27.7%). Multivariate logistic regression demonstrated significantly higher odds of receiving antibiotics in ED visits compared to ambulatory care visits. (OR 3.88; 95% Cl, 1.28-11.77; p = 0.02). CONCLUSION Antibiotic class selection varied significantly between the ED and ambulatory settings. Additionally, ED visits were more likely to result in antibiotic prescriptions than ambulatory visits for HS patients.
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Affiliation(s)
- Hannah Tolson
- University of Arizona College of Medicine, Phoenix, Arizona, United States,
| | - Rebecca K. Yamamoto
- Georgetown University School of Medicine, Washington, District of Columbia, United States,
| | - Robin Kikuchi
- Keck School of Medicine of University of Southern California, Los Angeles, California, United States,
| | | | - Audrey Hao
- Keck School of Medicine of University of Southern California, Los Angeles, California, United States,
| | - Lily Guo
- Duke University School of Medicine, Durham, North Carolina, United States,
| | - Sara Bilimoria
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
| | - Danielle Yee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
| | - April W. Armstrong
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, California, United States
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3
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Tzellos T. Conventional treatment of hidradenitis suppurativa: serving the "window of opportunity" concept. Clin Dermatol 2025:S0738-081X(25)00157-9. [PMID: 40373947 DOI: 10.1016/j.clindermatol.2025.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2025]
Abstract
Hidradenitis suppurativa (HS) is a chronic, systemic, inflammatory skin disease characterized by inflammatory nodules, painful abscesses, and draining tunnels. It is associated with significant comorbidities, including inflammatory bowel disease, arthritis, pain, and a reduced quality of life. Unlike psoriasis or atopic dermatitis, it can progress from an inflammatory state to a nonreversible scaring component if not treated early enough and in an evidence-based manner. Until recently, adalimumab has been the only approved treatment for HS. Many conventional systemic treatments are currently used and have an appropriate role in HS therapy, provided they are used correctly in suitable patients. Unfortunately, many therapies, including antimicrobials, are used empirically, leading to continuous cycles of incorrect and inefficient treatment, disease progression, and reduced quality of life. Contributing to the problem is the delay in diagnosis which may be as long as seven years and insufficient or inappropriate intervention.. Capturing the "window of opportunity" is essential for a disease such as HS.
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Affiliation(s)
- T Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany; Department of Dermatology, Nordland Hospital Trust, Bodø, Norway.
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Barrea L, Verde L, Annunziata G, Antiga E, Camajani E, Caprio M, Carbonelli MG, Carducci A, Cava E, Di Marco G, Grassi D, Guida S, Martinelli B, Marzano AV, Moltrasio C, Petrelli M, Prignano F, Rongioletti F, Savastano S, Paolini B, Bagnato C, Argenziano G, Cicero AFG, Colao A, Ferone D, Aimaretti G, Muscogiuri G. Medical Nutrition Therapy in Dermatological Diseases: A Joint Consensus Statement of the Italian Association of Dietetics and Clinical Nutrition (ADI), the Italian Society of Dermatology and Sexually Transmitted Diseases (SIDeMaST), the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut" and the Italian Society of Endocrinology (SIE), Club Nutrition, Hormones and Metabolism. Curr Obes Rep 2025; 14:42. [PMID: 40358870 PMCID: PMC12075311 DOI: 10.1007/s13679-025-00630-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2025] [Indexed: 05/15/2025]
Abstract
Dermatological diseases such as acne, hidradenitis suppurativa (HS), and psoriasis are driven by chronic inflammation and oxidative stress. Emerging evidence highlights the role of nutrition in modulating these conditions, particularly through dietary patterns rich in antioxidants, polyphenols, and unsaturated fatty acids. RECENT FINDINGS: The Mediterranean diet (MedDiet) has demonstrated potential benefits due to its anti-inflammatory and immunomodulatory effects, while very low-energy ketogenic therapy (VLEKT) has shown promise in rapidly improving disease severity. Specific nutrients, including omega-3 fatty acids, probiotics, and micronutrients, may further contribute to disease management. However, the current literature is limited by small-scale studies and the lack of standardized dietary guidelines. PURPOSE OF REVIEW: This Consensus Statement, developed collaboratively by the Italian Association of Dietetics and Clinical Nutrition (ADI), the Italian Society of Dermatology and Sexually Transmitted Diseases (SIDeMaST), the Italian Society of Nutraceuticals (SINut), Club Ketodiets and Nutraceuticals "KetoNut-SINut" and the Italian Society of Endocrinology (SIE), Club Nutrition, Hormones and Metabolism, aimed to establish an evidence-based framework for medical nutrition therapy (MNT) of the most common inflammatory skin diseases, including acne, HS and psoriasis.
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Affiliation(s)
- Luigi Barrea
- Dipartimento Di Psicologia E Scienze Della Salute, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143, Naples, Italy.
| | - Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy
- Department of Medicine, Division of Endocrinology, University of Arizona, Tucson, AZ, USA
| | - Giuseppe Annunziata
- Facoltà Di Scienze Umane, Della Formazione E Dello Sport, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143, Naples, Italy
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Elisabetta Camajani
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
- Department for the Promotion of Human Sciences and Quality of Life, San Raffaele Roma Open University, Via Di Val Cannuta 247, 00166, Rome, Italy
| | - Massimiliano Caprio
- Laboratory of Cardiovascular Endocrinology, IRCCS San Raffaele, Rome, Italy
- Department for the Promotion of Human Sciences and Quality of Life, San Raffaele Roma Open University, Via Di Val Cannuta 247, 00166, Rome, Italy
| | - Maria Grazia Carbonelli
- Clinical Nutrition and Dietetics, San Camillo Forlanini Hospital, Rome Cir.Ne Gianicolense 87, 00152, Rome, Italy
| | - Augusto Carducci
- Internal Medicine Unit-Val Vibrata Hospital-Sant'Omero (TE)-Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Edda Cava
- Clinical Nutrition and Dietetics, San Camillo Forlanini Hospital, Rome Cir.Ne Gianicolense 87, 00152, Rome, Italy
| | - Giorgia Di Marco
- Department of Dermatology, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Grassi
- Internal Medicine Unit-Val Vibrata Hospital-Sant'Omero (TE)-Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefania Guida
- Department of Dermatology, Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Martinelli
- Department of Medical Sciences, Unit of Dietetics and Clinical Nutrition, Santa Maria Alle Scotte Hospital, University of Siena, 53100, Siena, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, 20122, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Massimiliano Petrelli
- Clinic of Endocrinology and Metabolic Diseases, Polytechnic University of Ancona, 60100, Ancona, Italy
| | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, Ancona, Italy
| | - Franco Rongioletti
- Department of Dermatology, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Savastano
- Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Naples, Italy
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Endocrinologia, Diabetologia, Andrologia e Nutrizione, AOU Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Barbara Paolini
- UOSA of Dietetics and Clinical Nutrition, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria Alle Scotte, Siena, Italy
| | - Carmela Bagnato
- UOSD Clinical Nutrition and Dietetic, Hospital Matera, 75100, Matera, Italy
| | | | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Factors Research Unit, Medical and Surgical Sciences Dept, Alma Mater Studiorum University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOU Di Bologna, Bologna, Italy
| | - Annamaria Colao
- Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Naples, Italy
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Endocrinologia, Diabetologia, Andrologia e Nutrizione, AOU Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, School of Medical and Pharmaceutical Sciences, University of Genova, 16132, Genoa, Italy
| | - Gianluca Aimaretti
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Giovanna Muscogiuri
- Dipartimento Di Medicina Clinica E Chirurgia, Unità Di Endocrinologia, Università Degli Studi Di Napoli Federico II, Naples, Italy.
- Centro Italiano Per La Cura E Il Benessere del Paziente Con Obesità (C.I.B.O), Dipartimento Di Endocrinologia, Diabetologia, Andrologia e Nutrizione, AOU Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy.
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Haddad NR, Badiei B, Curvin-Aquilla SL, Johnson AY, Willis A, Minsky HB, Williams KL, Garza LA. Links between Plastics Use, Processed Food, Sweating, and Hidradenitis Suppurativa. J Invest Dermatol 2025; 145:1199-1202. [PMID: 39481530 PMCID: PMC12018160 DOI: 10.1016/j.jid.2024.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/16/2024] [Accepted: 09/23/2024] [Indexed: 11/02/2024]
Affiliation(s)
- Nina Rossa Haddad
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Beita Badiei
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Leigh Curvin-Aquilla
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arieana Y Johnson
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aiden Willis
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hana B Minsky
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kaitlin L Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luis A Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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6
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Schell SL, Sennett ML, Feehan RP, Wallace TE, Meiszberg EC, Longenecker AL, Helm MF, Kirby JS, Nelson AM. Pilot study of topical ruxolitinib demonstrates efficacy and blunting of heterogeneous inflammatory processes in mild hidradenitis suppurativa. Br J Dermatol 2025; 192:845-856. [PMID: 39708369 DOI: 10.1093/bjd/ljae495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 11/15/2024] [Accepted: 12/13/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Therapeutic options for mild hidradenitis suppurativa (HS) represent a significant gap in the current treatment landscape, with no U.S. Food and Drug Administration-approved therapies for early-stage HS. Topical Janus kinase (JAK) inhibitors (JAKi) are a compelling option due to the known upregulation of inflammatory JAK signalling in HS lesions and the recent success of systemic JAKi for the treatment of moderate-to-severe HS. OBJECTIVES To assess the clinical efficacy of ruxolitinib in a pilot cohort and to investigate the underlying biologic mechanisms associated with clinical response. METHODS This was a pilot single-site open-label prospective 24-week clinical trial of topical ruxolitinib (NCT04414514). Men and women with mild HS (Hurley stage I or II), with active inflammatory nodules, were recruited. All participants were observed for 8 weeks to monitor lesion counts (observational phase); active therapy (treatment phase) was then administered for 16 weeks. Topical ruxolitinib 1.5% cream was applied twice daily, covering the entirety of each HS-affected body site. Clinician- and patient-reported outcome measures were recorded throughout the study. Lesional skin punch biopsies were taken at the start and end of treatment for downstream mechanistic RNA sequencing and histological analyses. RESULTS Ten participants were enrolled in the study; four dropped out before the treatment phase of the trial. Six individuals with Hurley stage I (no tunnels) HS completed the study, five of whom successfully achieved Hidradenitis Suppurativa Clinical Response (HiSCR50) through 16 weeks of therapy. In this interim analysis, differential gene expression and gene set enrichment analyses revealed reduced activation of JAK-dependent interferon, interleukin (IL)-6, IL-2 and epidermal growth factor receptor signalling, and antimicrobial and keratinocyte responses. In contrast, signatures of wound healing and lipid metabolism were increased following JAKi treatment, indicating a return to homeostasis. Histological analyses revealed that clinically responsive patients had significantly reduced epidermal and dermal inflammation. Affected inflammatory infiltrate included neutrophils, T cells and plasma cells, with the predominantly affected cell types specific to the patient. CONCLUSIONS Collectively, the broad activity of topical ruxolitinib on inflammatory signalling processes resulted in promising efficacy, even with heterogeneity in baseline inflammation, in this pilot cohort. Importantly, topical treatment not only resolved epidermal inflammation, but also cleared deeper inflammatory infiltrate. The observed efficacy provides rationale to further investigate topical JAKi and other novel topical treatments in HS.
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Affiliation(s)
- Stephanie L Schell
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Mackenzie L Sennett
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Robert P Feehan
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Tierney E Wallace
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Elizabeth C Meiszberg
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Amy L Longenecker
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Matthew F Helm
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Joslyn S Kirby
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
| | - Amanda M Nelson
- The Pennsylvania State University College of Medicine, Department of Dermatology, Hershey, PA, USA
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7
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Pham J, Frew JW. Hidradenitis Suppurativa: Pathogenesis and Inflammatory Pathways. Dermatol Clin 2025; 43:179-191. [PMID: 40023620 DOI: 10.1016/j.det.2024.12.004] [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: 03/04/2025]
Abstract
The pathogenesis of hidradenitis suppurativa (HS) remains to be fully elucidated. Seminal clinical and translational investigations from the preceding 10 years have highlighted substantial variability in the contributors to inflammatory pathways involved in HS. These span from hormonal, metabolic, and microbial to genetic factors, each with potential flow on effects on immune cell polarization and subsequent clinically apparent inflammation. Understanding the heterogeneous drivers of HS and its progression may empower clinicians to take a more holistic approach in treatment planning, including addressing inflammatory comorbidities; therapeutic selection based on clinicopathological biomarkers; and appropriate patient counseling.
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Affiliation(s)
- James Pham
- School of Clinical Medicine, UNSW Medicine and Health, Southwest Sydney Clinical Campus, Liverpool, NSW 2170, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, NSW 2010, Australia
| | - John W Frew
- School of Clinical Medicine, UNSW Medicine and Health, Southwest Sydney Clinical Campus, Liverpool, NSW 2170, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, NSW 2010, Australia; The Skin Hospital, Darlinghurst, NSW 2010, Australia.
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8
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Fang V, Gupta R, Micheletti RG. Managing Hidradenitis Suppurativa with Biologics and Small Molecule Inhibitors. Dermatol Clin 2025; 43:231-245. [PMID: 40023624 DOI: 10.1016/j.det.2024.12.008] [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: 03/04/2025]
Abstract
"Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a significant quality-of-life impact. In addition to the 2 drugs approved by the Food and Drug Administration for HS, adalimumab and secukinumab, several other biologic and small molecule inhibitors are used off-label or are in clinical trials. A systematic and evidence-based approach using these and other therapies-considering patient comorbidities, response to therapy, dose adjustment, and frequent troubleshooting-is required. In this article, we review the latest evidence supporting anti-inflammatory biologic and small molecule therapies for HS and provide a practical, algorithmic approach to management incorporating experience and expert opinion."
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Affiliation(s)
- Victoria Fang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Radhika Gupta
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, PCAM 7 South, Room 724, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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9
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van Dalen SCM, Stein JWJ, Bruurmijn T, Foster ML, Chirivi RGS, van der Linden M, van Es H, Szepietowski JC, Krajewski PK, van Straalen KR, Prens EP, Ingram JR, Meldrum E. Neutrophil Extracellular Traps Are Widely Distributed Across Lesional and Perilesional Hidradenitis Suppurativa Skin, and Elevated Serum NET Markers Associate With Moderate to Severe HS Disease. Int J Dermatol 2025. [PMID: 40083018 DOI: 10.1111/ijd.17706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 02/07/2025] [Accepted: 02/11/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Neutrophils are scarce in healthy skin but infiltrate lesions of hidradenitis suppurativa (HS) patients. Activated neutrophils release proinflammatory neutrophil extracellular traps (NETs), which have been implicated in the pathophysiology of HS. This study aimed to describe the distribution of NETs relative to the features of HS skin lesions and reveal whether serum NET markers were elevated in association with disease activity. METHODS Immunohistochemistry assessed the distribution of the key NET component citrullinated histone H3 (CitH3) in lesional, perilesional, and unaffected HS skin. Several markers of NETs (nucleosomes, calprotectin, and CitH3) were quantified in HS serum with ELISA. RESULTS HS lesional skin biopsies showed increased CitH3-positive staining compared to unaffected skin. This signal was widely distributed across both lesional and perilesional regions of HS skin and was associated with HS structures such as the lining of epithelialized skin tunnels. Moreover, several NET-associated markers were elevated in the serum of HS patients compared to healthy volunteers and correlated with each other. Finally, serum NET markers showed significant elevation in patients with moderate to severe disease activity based on IHS-4 scores, compared to those with no or mild activity. CONCLUSIONS Elevated NET markers are widely distributed in HS skin and serum. These data indicate that NET-associated markers in serum are candidate biomarkers for HS disease severity. The results confirm the rationale for anti-inflammatory therapy targeting NETs in HS.
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Affiliation(s)
| | | | | | | | | | | | | | - Jacek C Szepietowski
- Faculty of Medicine, Wroclaw University of Science and Technology, Wrocław, Poland
| | - Piotr K Krajewski
- University Centre of General Dermatology and Oncodermatology, Wrocław Medical University, Poland
| | | | | | - John R Ingram
- Division of Infection & Immunity, Cardiff University, Cardiff, UK
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10
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Zhu Z, Wang X. Causal relationship and potential common pathogenic mechanisms between hidradenitis suppurativa and related cancer. Discov Oncol 2025; 16:304. [PMID: 40072688 PMCID: PMC11904070 DOI: 10.1007/s12672-025-02075-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 03/05/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory and common skin disease. Observation studies have reported the association between HS and cancers, however no studies reported whether a causal relationship exists between HS and cancers. This study aimed to explore the causal relationship between HS and differential subtypes of cancers by conducting a bidirectional Mendelian randomization (MR) analysis. METHOD Genome-wide association study (GWAS) data related to HS and 16 subtypes of cancers were collected. The inverse variance weighted (IVW) method was primarily applied for our MR analysis, MR-Egger, weighted median, simple mode, and weighted mode methods were used additionally. Heterogeneity, horizontal pleiotropy, and potential outliers were assessed for the MR analysis results. Subsequently, disease-related genes were retrieved from the GeneCards database. To investigate the potential functions of these associated genes, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted. RESULT The results of our MR analysis indicated a causal association between HS and pancreatic cancer (PAC). Specifically, HS was found to elevate the risk of developing PAC (odds ratio (OR), 1.074; 95% confidence interval (CI) 1.015-1.135; p = 0.013). Conversely, reverse MR analysis demonstrated that PAC does not exert a causal effect on HS. Furthermore, our findings did not reveal any significant causal relationships between HS and other types of cancer. No evidence of heterogeneity or pleiotropy was identified in the analysis. Additionally, we identified disease-related genes, and subsequent GO and KEGG enrichment analyses indicated that the genes common to both HS and PAC are implicated in pathways associated with immune and inflammatory processes. CONCLUSION The results of this study offer novel evidence regarding the causal relationship between HA and PAC. Our Mendelian randomization analysis indicates that HS may have a causal influence on PAC, which could inform the development of improved treatment strategies for patients suffering from HS. However, the underlying mechanisms warrant further exploration.
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Affiliation(s)
- Zexin Zhu
- Department of Surgical Oncology, the Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoxue Wang
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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11
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Shishido-Takahashi N, Garcet S, Cueto I, Miura S, Li X, Rambhia D, Kunjravia N, Hur HB, Lee YI, Ham S, Anis N, Kim J, Krueger JG. Hepatocyte Growth Factor Has Unique Functions in Keratinocytes that Differ from those of IL-17A and TNF and May Contribute to Inflammatory Pathways in Hidradenitis Suppurativa. J Invest Dermatol 2025; 145:536-547.e7. [PMID: 39038532 DOI: 10.1016/j.jid.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/19/2024] [Accepted: 07/02/2024] [Indexed: 07/24/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is difficult to control, and its mechanism remains unclear. Hepatocyte GF (HGF) has been reported to be significantly upregulated in the serum and skin of patients with HS, especially in the lesions with tunnels. In this study, we examined the transcriptome of HGF-treated keratinocytes and compared it with genetic profiling of HS lesions. HGF was highly expressed in HS skin, especially in the deep dermis, compared with that in healthy controls, and its source was mainly fibroblasts. HGF upregulated more genes in keratinocytes than IL-17A or TNF-a, and these genes included multiple epithelial-mesenchymal transition-related genes. Differentially expressed genes in HGF-stimulated keratinocytes were involved in activation of epithelial-mesenchymal transition-related pathways. These HGF-induced genes were significantly upregulated in HS lesions compared with those in healthy skin and nonlesions and were more strongly associated with HS tunnels. In summary, HGF was highly expressed in HS and induced epithelial-mesenchymal transition-related genes in keratinocytes; HGF-induced genes were highly associated with gene profiling of HS with tunnels, suggesting that HGF may be involved in HS tunnel formation through epithelial-mesenchymal transition.
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Affiliation(s)
- Naomi Shishido-Takahashi
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA; Department of Dermatology, The University of Tokyo, Tokyo, Japan
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Inna Cueto
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Shunsuke Miura
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA; Department of Dermatology, The University of Tokyo, Tokyo, Japan
| | - Xuan Li
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Darshna Rambhia
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Norma Kunjravia
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Hong Beom Hur
- Research Bioinformatics, Center for Clinical and Translational Science, The Rockefeller University, New York, New York, USA
| | - Young In Lee
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Seoyoon Ham
- Department of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Nabeeha Anis
- West Windsor-Plainsboro High School South, West Windsor, New Jersey, USA
| | - Jaehwan Kim
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA; Department of Dermatology, University of California, Davis, Sacramento, California, USA
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York, USA.
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12
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Marzano AV, Bartoletti M, Bettoli V, Bianchi L, Chiricozzi A, Clerici M, Dapavo P, Dini V, Foti C, Magnoni C, Megna M, Micali G, Molinelli E, Prignano F. Hidradenitis suppurativa, from basic science to surgery and a new era of tailored targeted therapy: An expert opinion paper. Arch Dermatol Res 2025; 317:511. [PMID: 40021535 PMCID: PMC11870890 DOI: 10.1007/s00403-025-04016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 01/23/2025] [Accepted: 02/12/2025] [Indexed: 03/03/2025]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterised by an aberrant activation of innate immunity and increased production of pro-inflammatory mediators such as interleukin 17 (IL-17). IL-17 has been shown to play a key role in the pathogenesis of HS and evidence highlights the potential of IL-17-targeted therapies. The fully human IgG/κ monoclonal antibody secukinumab, which specifically targets IL-17A and inhibits interaction with its receptor, has recently been approved for the treatment of moderate-to-severe HS. Secukinumab offers patients an efficacious and well-tolerated treatment option in terms of sustained response by rapidly improving signs and symptoms, and preventing disease progression in the absence of loss of response. Being a challenging disease, HS is associated with a delay to diagnosis of 3-10 years and, consequently, late implementation of appropriate treatment, leading to disease progression. Misdiagnosis due to flawed understanding and lack of awareness among medical providers and patients is considered an important factor contributing to the delayed diagnosis. Thus, serious efforts must be made on a large scale to urgently reduce the delay in HS diagnosis and reduce the disease burden in patients, including raising awareness, implementation of education programmes at medical and specialisation schools, as well as continuous education of healthcare providers at different levels for the early detection of HS and initiation of appropriate treatment. Here, we present the main critical unmet needs in the diagnosis and treatment of patients affected by HS, address how disease awareness and comprehensive multidisciplinary management (offering both medical and surgical care) can benefit patients, and suggest therapeutic options, based on clinical characterisation and early identification and intervention (window of opportunity), to be adopted for a timely and better management of disease progression and to fill current gaps.
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Affiliation(s)
- Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Infectious Disease Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Vincenzo Bettoli
- O.U. Of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Luca Bianchi
- Dermatology, Fondazione Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Mario Clerici
- Università Degli Studi Di Milano, Milan, Italy
- Don C Gnocchi Foundation IRCCS, Milan, Italy
| | - Paolo Dapavo
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - Cristina Magnoni
- Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Elisa Molinelli
- Department of Clinical and Molecular Science, Dermatologic Clinic, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Francesca Prignano
- Department of Health Sciences, Dermatology Section, Università degli Studi di Firenze, Florence, Italy
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13
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Leboit PE, Patel DU, Cohen JN, Moss MI, Naik HB, Yates AE, Harris HW, Klufas DM, Kim EA, Neuhaus IM, Hansen SL, Kyle RL, Kelly M, Rosenblum MD, Lowe MM. The Inflammatory Landscape of a Whole-Tissue Explant Model of Hidradenitis Suppurativa. Exp Dermatol 2025; 34:e70057. [PMID: 39930604 PMCID: PMC11811487 DOI: 10.1111/exd.70057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/19/2024] [Accepted: 01/26/2025] [Indexed: 02/14/2025]
Abstract
Hidradenitis suppurativa (HS) is a relatively common and highly morbid inflammatory skin disease. Due to the relatively limited understanding of HS's pathogenesis, there are currently insufficient treatment options available, and many patients' medical needs are not being met. This is partly due to the historical scarcity of ex vivo assays and animal models that accurately recapitulate the disease. Thus, we have developed a standardised whole-tissue explant model of HS to examine its pathogenic mechanisms and the efficacy of potential treatments within intact human tissue. We measured cytokine protein and RNA within whole tissue maintained in an agar-media solution, finding that IL-6 and IL-8 concentrations trended upwards in both HS explants and healthy controls, while IL-17A, IL-1β, and TNF-α exhibited increases in HS tissue alone. We also show that the explants were responsive to treatment with both dexamethasone and IL-2. Not only do our results show that this model effectively delivers treatments throughout the explants, but they also elucidate which cytokines are related to the explant process regardless of tissue state and which are related to HS tissue specifically, laying the groundwork for future implementations of this model.
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Affiliation(s)
- Phoebe E. Leboit
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Dhara U. Patel
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Jarish N. Cohen
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | | | - Haley B. Naik
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Ashley E. Yates
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | | | - Daniel M. Klufas
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | | | - Isaac M. Neuhaus
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | | | | | | | - Michael D. Rosenblum
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Margaret M. Lowe
- Department of DermatologyUniversity of California, San Francisco (UCSF)San FranciscoCaliforniaUSA
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14
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Moltrasio C, Moura R, Conti A, Fania L, Jaschke W, Caposiena Caro RD, Chersi K, Margiotta FM, Di Cesare A, Rosi E, Regensberger F, Boeckle B, Frischhut N, Cappellani S, Del Vecchio C, Nardacchione EM, Zalaudek I, von Stebut E, Berti I, Boniotto M, d'Adamo AP, Schmuth M, Dini V, Prignano F, Abeni D, Chiricozzi A, Marzano AV, Crovella S, Tricarico PM. Polygenic Score: A Tool for Evaluating the Genetic Background of Sporadic Hidradenitis Suppurativa. J Invest Dermatol 2024:S0022-202X(24)03042-2. [PMID: 39736307 DOI: 10.1016/j.jid.2024.11.019] [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: 06/25/2024] [Revised: 11/20/2024] [Accepted: 11/25/2024] [Indexed: 01/01/2025]
Abstract
Sporadic hidradenitis suppurativa (spHS) is a multifactorial disease in which genetic predisposition is intertwined with environmental factors. Owing to the still-to-date limited knowledge of spHS genetics, we calculated polygenic scores (PGSs) to study the genetic underpinnings that contribute to spHS within European demographic. A total of 256 patients with spHS and 1686 healthy controls were analyzed across 6 European clinical centers. PGSs were calculated using a clumping and thresholding technique on 70% of the total sample, with the remaining 30% used for testing. The PANTHER tool was used to identify overrepresented genes. We generated a PGS characterized by 923 SNPs with a statistically significant association with spHS (P = 2 × 10-2). The statistically significant age-, sex-, and ancestry-adjusted association of our developed PGSs in spHS allows us to attribute a genetic contribution to the susceptibility of spHS (pseudo-R2 = 0.0053). Variants enriched for developing PGSs show a statistically significant preference for mapping to genes that encode primarily for cell adhesion proteins. Although this study developed a polygenic model associated with spHS, the low number of patients enrolled is a limitation. However, we believe that with larger experimental datasets, our model has the potential to serve as a valuable tool for predicting spHS states in future studies.
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Affiliation(s)
- Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ronald Moura
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Andrea Conti
- SS Endocrinologia, auxologia e diabetologia, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Luca Fania
- Dermatology Unit, IDI-IRCSS, Rome, Italy
| | - Wolfram Jaschke
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Karin Chersi
- Dermatology Clinic, Hospital Clinics Giuliano Isontino (ASUGI), University of Trieste, Trieste, Italy
| | | | - Antonella Di Cesare
- Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Elia Rosi
- Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Florian Regensberger
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Boeckle
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | - Nina Frischhut
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefania Cappellani
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Cecilia Del Vecchio
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Iris Zalaudek
- Dermatology Clinic, Hospital Clinics Giuliano Isontino (ASUGI), University of Trieste, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - Irene Berti
- Pediatric Department, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Michele Boniotto
- INSERM, IMRB, Translational Neuropsychiatry, University Paris Est Créteil, Créteil, France
| | - Adamo Pio d'Adamo
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Matthias Schmuth
- Department of Dermatology, Venereology and Allergy, Medical University of Innsbruck, Innsbruck, Austria
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Science, University of Florence, Florence, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, IDI-IRCCS, Rome, Italy
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Rome, Italy; Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Sergio Crovella
- Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar
| | - Paola Maura Tricarico
- Pediatric Department, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
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15
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van Straalen KR, Piguet V, Gudjonsson JE. Hidradenitis suppurativa: key insights into treatment success and failure. J Clin Invest 2024; 134:e186744. [PMID: 39484718 PMCID: PMC11527436 DOI: 10.1172/jci186744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024] Open
Affiliation(s)
- Kelsey R. van Straalen
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Vincent Piguet
- Division of Dermatology, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Women’s College Hospital, Toronto, Canada
| | - Johann E. Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Taubman Medical Research Institute, Ann Arbor, Michigan, USA
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16
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Leboit PE, Patel DU, Cohen JN, Moss MI, Naik HB, Yates AE, Harris HW, Klufas DM, Kim EA, Neuhaus IM, Hansen SL, Kyle RL, Kelly M, Rosenblum MD, Lowe MM. A Novel Whole Tissue Explant Model of Hidradenitis Suppurativa. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.19.603617. [PMID: 39211108 PMCID: PMC11360975 DOI: 10.1101/2024.07.19.603617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Hidradenitis Suppurativa (HS) is a relatively common and highly morbid inflammatory skin disease. Due to our relatively limited understanding of HS's pathogenesis, there are currently insufficient treatment options available, and many patients' medical needs are not being met. This is partly due to a scarcity of ex vivo human assays and animal models that accurately recapitulate the disease. To address this deficit, we have developed a whole-tissue explant model of HS to examine its pathogenic mechanisms and the efficacy of potential treatments within intact human tissue. We measured cytokine protein and RNA within whole tissue maintained in an agar-media solution, finding that IL-6 and IL-8 concentrations trended upwards in both HS explants and healthy controls, while IL-17A, IL-1β, and TNF-α exhibited increases in HS tissue alone. We also show that the explants were responsive to treatment with both dexamethasone and IL-2. Not only do our results show that this model effectively delivers treatments throughout the explants, but they also elucidate which cytokines are related to the explant process regardless of tissue state and which are related to HS tissue specifically, laying the groundwork for future implementations of this model.
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17
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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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18
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Eble SM, Wisco OJ, Boccuto L, Laffin B, Parker VG, Davis NJ, Temples HS. Genetic factors associated with hidradenitis suppurativa, a literature review. Int J Womens Dermatol 2024; 10:e158. [PMID: 38884063 PMCID: PMC11177810 DOI: 10.1097/jw9.0000000000000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 05/14/2024] [Indexed: 06/18/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by deep-seated, painful lesions most frequently occurring in intertriginous areas of the skin. HS leads to poor quality of life in affected individuals and is difficult to diagnose and treat. Objective Understanding the genetics associated with familial inheritance may lead to a better understanding of the pathogenesis of this debilitating disease. Methods Articles published until March 9, 2023, were identified in PubMed using the following search terms: hidradenitis suppurativa and gene* or acne inversa and gene*. Results The rate of monogenic mutations associated with HS is less than 7%, with the most common genetic mutations reported in sporadic and familial HS cases being in NCSTN and less frequently in PSENEN. Individuals with mutations in the gamma-secretase complex tended to have more severe HS and an early age of onset. Limitations This study was limited to the case studies available in PubMed, the majority of which used targeted gene panels to detect genetic mutations. Conclusion Approximately 30% of individuals diagnosed with HS report having a positive family history; however, very few studies demonstrate monogenic familial transmission of HS. The case studies of syndromic HS reported a variety of genetic mutations associated with HS, some of which were familial, while others were sporadic, suggesting that other pathways may be involved in the pathogenesis of HS and other potential mutations that have yet to be evaluated. More research is needed to understand the genetic mutations in HS.
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Affiliation(s)
- Shannon M Eble
- College of Behavioral, Social, and Health Sciences, College of Nursing, Clemson University, Clemson, South Carolina
- Bristol Myers Squibb, Princeton, New Jersey
| | - Oliver J Wisco
- Department of Dermatology, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Luigi Boccuto
- College of Behavioral, Social, and Health Sciences, College of Nursing, Clemson University, Clemson, South Carolina
| | | | - Veronica G Parker
- College of Behavioral, Social, and Health Sciences, College of Nursing, Clemson University, Clemson, South Carolina
| | - Nicole J Davis
- College of Behavioral, Social, and Health Sciences, College of Nursing, Clemson University, Clemson, South Carolina
| | - Heide S Temples
- College of Behavioral, Social, and Health Sciences, College of Nursing, Clemson University, Clemson, South Carolina
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19
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Sattele L, Andrews L, Shope C, Lee LW, Cotton CH. An assessment of skin cancer incidence in patients with hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:1068-1069. [PMID: 38266684 DOI: 10.1016/j.jaad.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/04/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Lauren Sattele
- College of Graduate Studies, Medical University of South Carolina, Charleston, South Carolina
| | - Laura Andrews
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Chelsea Shope
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lara Wine Lee
- Department of Dermatology & Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina; Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Colleen H Cotton
- Division of Dermatology, Children's National Hospital, Washington, District of Columbia; Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia
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20
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Maronese CA, Moltrasio C, Genovese G, Marzano AV. Biologics for Hidradenitis suppurativa: evolution of the treatment paradigm. Expert Rev Clin Immunol 2024; 20:525-545. [PMID: 38130204 DOI: 10.1080/1744666x.2023.2298356] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is an autoinflammatory skin disease with a high unmet need for effective medical management. Clinically, it is characterized by inflammatory nodules that may progress into abscesses, draining tunnels and extensive scarring, mainly affecting apocrine gland-bearing areas. AREAS COVERED Treatment options include topical and systemic medications and a variety of surgical procedures. The anti-TNF-α antibody adalimumab and the anti-IL-17 secukinumab are the only two approved biologics for HS, showing moderate efficacy. HS research is a rapidly growing field, with a wide range of agents leveraging distinct mechanisms of action currently under development. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways are the most advanced in both ongoing and completed Phase 3 studies, promising deeper levels of response. Use of other, off-label biologics is also discussed. EXPERT OPINION A therapeutic algorithm is proposed based on comorbidities and existing evidence. Patient-tailored combinations between biologics and other biologics or small molecules will hopefully allow clinicians to target most events in HS pathophysiology in a complementary way while obtaining a meaningful effect on their devastating manifestations.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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21
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Flora A, Jepsen R, Pham J, Frew JW. Alterations to the Hidradenitis Suppurativa Serum Proteome with Spleen Tyrosine Kinase Antagonism: Proteomic Results from a Phase 2 Clinical Trial. J Invest Dermatol 2024; 144:786-793.e1. [PMID: 37879397 DOI: 10.1016/j.jid.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/24/2023] [Accepted: 10/10/2023] [Indexed: 10/27/2023]
Abstract
Hidradenitis suppurativa is a disease in great need of novel therapies. Given the heterogeneous nature of the disease and the variable response to therapies, biomarkers are essential to predict response to therapies and increase our understanding of disease pathogenesis. Our recent phase 2 clinical trial of spleen tyrosine kinase antagonism using fostamatinib in hidradenitis suppurativa demonstrated a 75% clinical response, with the greatest benefit in individuals with elevated serum inflammation and IgG. In this study, we present results of an in-depth serum proteomic analysis in this patient cohort identifying downregulation of IL-12B as well as B-cell-associated proteins CCL19 and CCL20 and IFN-γ-mediated proteins CXCL10 and CX3CL1. Clinical responders demonstrated greater reduction in serum IL-17A, IL-6, IL-8, and CX3CL1 compared with clinical nonresponders. Baseline levels of CCL28 were associated with clinical response to fostamatinib therapy at week 12. Overall, this suggests that fostamatinib, by targeting B-cell receptor and Fc receptor activity in B cells, monocytes, and macrophages, has a significant molecular impact on the inflammatory serum proteome of hidradenitis suppurativa. In addition, potential therapeutic biomarkers may aid in patient selection for targeted therapy.
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Affiliation(s)
- Akshay Flora
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, Australia; School of Clinical Medicine, University of New South Wales Sidney, Kensington, Australia
| | - Rebecca Jepsen
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, Australia
| | - James Pham
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, Australia; School of Clinical Medicine, University of New South Wales Sidney, Kensington, Australia
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, Australia; School of Clinical Medicine, University of New South Wales Sidney, Kensington, Australia.
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22
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Huynh FD, Damiani G, Bunick CG. Rethinking Hidradenitis Suppurativa Management: Insights into Bacterial Interactions and Treatment Evolution. Antibiotics (Basel) 2024; 13:268. [PMID: 38534703 DOI: 10.3390/antibiotics13030268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Hidradenitis suppurativa (HS), or acne inversa, is a chronic inflammatory dermatological condition characterized by painful and recurrent nodules and purulent abscesses. HS can have a devastating impact on the quality of life of patients. This condition is commonly localized to the axilla, groin, perineal, and inframammary regions, and can develop fistulas and sinus tracts over time. Its pathogenesis remains elusive and is best characterized at the moment as multi-factorial. Additionally, questions remain about the role of cutaneous dysbiosis as a primary HS trigger or as a secondary perturbation due to HS inflammation. This article features works in relation to HS and its interplay with bacterial microflora. We address current treatment approaches and their impact on HS-related bacteria, as well as areas of therapeutic innovation. In the future, disease-modifying or remittive therapy will likely combine an advanced/targeted anti-inflammatory approach with one that effectively modulates cutaneous and deep tissue dysbiosis.
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Affiliation(s)
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
- Italian Centre of Precision Medicine and Chronic Inflammation, 20122 Milan, Italy
| | - Christopher G Bunick
- Department of Dermatology and Program in Translational Biomedicine, Yale School of Medicine, New Haven, CT 06520, USA
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23
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Kirby JS, Okun MM, Alavi A, Bechara FG, Zouboulis CC, Brown K, Santos LL, Wang A, Bibeau KB, Kimball AB, Porter ML. Efficacy and safety of the oral Janus kinase 1 inhibitor povorcitinib (INCB054707) in patients with hidradenitis suppurativa in a phase 2, randomized, double-blind, dose-ranging, placebo-controlled study. J Am Acad Dermatol 2024; 90:521-529. [PMID: 37871805 DOI: 10.1016/j.jaad.2023.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Janus kinase 1 inhibition may alleviate hidradenitis suppurativa (HS)-associated inflammation and improve symptoms. OBJECTIVE To assess efficacy and safety of povorcitinib (selective oral Janus kinase 1 inhibitor) in HS. METHODS This placebo-controlled phase 2 study randomized patients with HS 1:1:1:1 to receive povorcitinib 15, 45, or 75 mg or placebo for 16 weeks. Primary and key secondary end points were mean change from baseline in abscess and inflammatory nodule count and percentage of patients achieving HS Clinical Response at week 16. RESULTS Of 209 patients randomized (15 mg, n = 52; 45 mg, n = 52; 75 mg, n = 53; placebo, n = 52), 83.3% completed the 16-week treatment. At week 16, povorcitinib significantly reduced abscess and inflammatory nodule count from baseline (least squares mean [SE] change: 15 mg, -5.2 [0.9], P = .0277; 45 mg, -6.9 [0.9], P = .0006; 75 mg, -6.3 [0.9], P = .0021) versus placebo (-2.5 [0.9]). More povorcitinib-treated patients achieved HS Clinical Response at week 16 (15 mg, 48.1%, P = .0445; 45 mg, 44.2%, P = .0998; 75 mg, 45.3%, P = .0829) versus placebo (28.8%). A total of 60.0% and 65.4% of povorcitinib- and placebo-treated patients had adverse events. LIMITATIONS Baseline lesion counts were mildly imbalanced between groups. CONCLUSION Povorcitinib demonstrated efficacy in HS, with no evidence of increased incidence of adverse events among doses.
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Martin M Okun
- Department of Dermatology, Fort Memorial Hospital, Fort Atkinson, Wisconsin
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Falk G Bechara
- Department of Dermatology, Allergology and Venereology, Ruhr University Bochum, Bochum, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Kurt Brown
- Incyte Corporation, Wilmington, Delaware
| | | | - Annie Wang
- Incyte Corporation, Wilmington, Delaware
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martina L Porter
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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24
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González-López MA. [Hidradenitis suppurativa]. Med Clin (Barc) 2024; 162:182-189. [PMID: 37968174 DOI: 10.1016/j.medcli.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.
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Affiliation(s)
- Marcos A González-López
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, España; Real Academia de Medicina de Cantabria, Santander, Cantabria, España.
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25
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Pardo LM, Wang C, Ardon CB, Kraaij R, Prens EP, Van Straalen KR. Bacterial Microbiota Composition in Hidradenitis Suppurativa Differs per Skin Layer. J Invest Dermatol 2024; 144:426-430.e5. [PMID: 37717935 DOI: 10.1016/j.jid.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/19/2023]
Affiliation(s)
- Luba M Pardo
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Cong Wang
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christine B Ardon
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert Kraaij
- Laboratory of Population Genomics, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kelsey R Van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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26
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Martora F, Marasca C, Cacciapuoti S, Fariello F, Potestio L, Battista T, Scalvenzi M, Megna M. Secukinumab in Hidradenitis Suppurativa Patients Who Failed Adalimumab: A 52-Week Real-Life Study. Clin Cosmet Investig Dermatol 2024; 17:159-166. [PMID: 38283798 PMCID: PMC10821645 DOI: 10.2147/ccid.s449367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
Background The treatment of hidradenitis suppurativa (HS) has always been a real challenge for dermatologists; to date, adalimumab the only biologic drug approved for HS is adalimumab, an anti-tumor necrosis factor (TNF)-α drug, the approval of this drug dates to 2015, data provided by real life show an effectiveness rate of about 60% percent. Recently (31 October 2023) FDA approves secukinumab for moderate-severe HS. The treatment and management of HS is very challenging as available treatments are very limited and show very variable outcomes. Methods We conducted a prospective monocentric study designed to evaluate the efficacy and safety of secukinumab treatment in HS patients in a real-life setting. Results The initial cohort of patients recruited included 21 HS patients including 12 females and 9 males. About 57.1% of patients achieved the primary endpoint and recorded significant decrease in all the severity assessment scales (IHS4, DLQI and VAS pain scale) at week 16 and 52, when HiSCR reached 71.4%. Conclusion The results of our study highlight that treatment with secukinumab in patients with severe HS who failed adalimumab may be a safe and effective therapeutic weapon.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio Marasca
- Dermatology Unit, Medical Department, “Antonio Cardarelli” National Hospital, Naples, Italy
| | - Sara Cacciapuoti
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Federica Fariello
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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27
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Abuhijleh Z, Elmejrab A, Leonidou E, Stosic T, Tsakalidis K. A near-fatal case of hidradenitis suppurativa associated with sepsis and ischaemic heart disease. Br J Hosp Med (Lond) 2024; 85:1-3. [PMID: 38300673 DOI: 10.12968/hmed.2023.0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
| | | | - Elena Leonidou
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus
| | - Tamara Stosic
- Department of Cardiology, Limassol General Hospital, Limassol, Cyprus
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28
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van der Zee HH, Aarts P. The Cystic Sponge Anus. Case Rep Dermatol 2024; 16:94-96. [PMID: 38567034 PMCID: PMC10987178 DOI: 10.1159/000536085] [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: 09/04/2023] [Accepted: 01/01/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction A peculiar spongy appearance of the perianal skin was observed in a patient who underwent wide excision surgery for inguinal and gluteal hidradenitis suppurativa (HS). Case Presentation This peculiar appearance was observed in a 62-year-old male patient. It included multiple orifices and cavities forming the spongy aspect of the perianal skin with multiple cysts and giant comedones. The perianal lesions were asymptomatic and the patient had never received any perianal treatment for the comedones or cysts. Histopathology was performed and demonstrated dilated hair follicles with flaky keratin and loose hair shafts in the center. The spongy appearance was most likely the result of spontaneous shedding of the cystic contents. Conclusion We suspect that the "cystic sponge anus" might be associated with HS, smoking, the male gender, and may yet be another expression of an occlusive follicular disease. Future studies will be needed to clarify the prevalence and comorbidities of the "cystic sponge anus."
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Affiliation(s)
- Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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29
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Dimitrion P, Loveless I, Zhou L, Mi QS, Adrianto I. The Hidradenitis Suppurativa Omics Database (HS-OmicsDB). J Invest Dermatol 2024; 144:173-177.e1. [PMID: 37271451 PMCID: PMC10692306 DOI: 10.1016/j.jid.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Peter Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, Michigan, USA; Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, Michigan, USA
| | - Ian Loveless
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, Michigan, USA; Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA; Department of Computational Mathematics, Science, and Engineering; Medical Imaging and Data Integration Lab; Michigan State University, East Lansing, Michigan, USA
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, Michigan, USA; Department of Biochemistry, Microbiology, and Immunology, School of Medicine, Wayne State University, Detroit, Michigan, USA; Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, Michigan, USA; Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, Michigan, USA; Department of Biochemistry, Microbiology, and Immunology, School of Medicine, Wayne State University, Detroit, Michigan, USA; Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Indra Adrianto
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, Michigan, USA; Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, Michigan, USA; Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan, USA; Department of Biochemistry, Microbiology, and Immunology, School of Medicine, Wayne State University, Detroit, Michigan, USA; Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA.
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30
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Kashyap MP, Mishra B, Sinha R, Jin L, Kumar N, Goliwas KF, Deshane J, Elewski BE, Elmets CA, Athar M, Shahid Mukhtar M, Raman C. NK and NKT cells in the pathogenesis of Hidradenitis suppurativa: Novel therapeutic strategy through targeting of CD2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.31.565057. [PMID: 37961206 PMCID: PMC10634971 DOI: 10.1101/2023.10.31.565057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disease with poorly understood pathogenesis. Single-cell RNAseq analysis of HS lesional and healthy individual skins revealed that NKT and NK cell populations were greatly expanded in HS, and they expressed elevated CD2, an activation receptor. Immunohistochemistry analyses confirmed significantly expanded numbers of CD2+ cells distributed throughout HS lesional tissue, and many co-expressed the NK marker, CD56. While CD4+ T cells were expanded in HS, CD8 T cells were rare. CD20+ B cells in HS were localized within tertiary follicle like structures. Immunofluorescence microscopy showed that NK cells (CD2 + CD56 dim ) expressing perforin, granzymes A and B were enriched within the hyperplastic follicular epidermis and tunnels of HS and juxtaposed with apoptotic cells. In contrast, NKT cells (CD2 + CD3 + CD56 bright ) primarily expressed granzyme A and were associated with α-SMA expressing fibroblasts within the fibrotic regions of the hypodermis. Keratinocytes and fibroblasts expressed high levels of CD58 (CD2 ligand) and they interacted with CD2 expressing NKT and NK cells. The NKT/NK maturation and activating cytokines, IL-12, IL-15 and IL-18, were significantly elevated in HS. Inhibition of cognate CD2-CD58 interaction with blocking anti-CD2 mAb in HS skin organotypic cultures resulted in a profound reduction of the inflammatory gene signature and secretion of inflammatory cytokines and chemokines in the culture supernate. In summary, we show that a cellular network of heterogenous NKT and NK cell populations drives inflammation, tunnel formation and fibrosis in the pathogenesis of HS. Furthermore, CD2 blockade is a viable immunotherapeutic approach for the management of HS.
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31
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Maronese CA, Ingram JR, Marzano AV. Has the time come to assess small-molecule/biologic drug combinations for the management of moderate-to-severe hidradenitis suppurativa? Br J Dermatol 2023; 189:467-468. [PMID: 37406224 DOI: 10.1093/bjd/ljad224] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/12/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
As the landscape for hidradenitis suppurativa (HS) medical treatment is rapidly expanding, seemingly taking the same steps that marked the evolution of psoriasis management, upcoming agents still do not appear to offer complete disease control. Better control of severe cases of HS refractory to biologic monotherapy may require investigation of pathogenesis-driven, combination regimens sooner rather than later.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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32
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Dimitrion P, Hamzavi I, Yin C, Toor J, Subedi K, Khalasawi N, Miller A, Huggins R, Adrianto I, Veenstra J, Vellaichamy G, Hans A, Daveluy S, Athar M, Liao W, Lim H, Ozog D, Zhou L, Mi QS. Mass cytometry uncovers a distinct peripheral immune profile and upregulated CD38 expression in patients with hidradenitis suppurativa. Cell Mol Immunol 2023; 20:972-975. [PMID: 37248290 PMCID: PMC10387467 DOI: 10.1038/s41423-023-01037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Peter Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, 48202, USA
| | - Iltefat Hamzavi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Congcong Yin
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Jugmohit Toor
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, 48202, USA
| | - Kalpana Subedi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Namir Khalasawi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Angela Miller
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Richard Huggins
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Indra Adrianto
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Jesse Veenstra
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Gautham Vellaichamy
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Aakash Hans
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, 48202, USA
| | - Mohammad Athar
- University of Alabama at Birmingham (UAB) Research Center of Excellence in Arsenicals, Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Henry Lim
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - David Ozog
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA.
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
- Department of Biochemistry, Microbiology, and Immunology, School of Medicine, Wayne State University, Detroit, MI, 48202, USA.
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, 48202, USA.
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, 48202, USA.
- Department of Biochemistry, Microbiology, and Immunology, School of Medicine, Wayne State University, Detroit, MI, 48202, USA.
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33
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Lahham EE, Billan S, Atrash F, Fararja W. A late presentation of inguinoscrotal cutaneous squamous cell carcinoma (cSCC) masquerading as hidradenitis suppurativa-a case report. J Surg Case Rep 2023; 2023:rjad459. [PMID: 37564053 PMCID: PMC10411990 DOI: 10.1093/jscr/rjad459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects apocrine gland-bearing skin in intertriginous areas; it is characterized by persistent or recurrent abscesses that culminate in a purulent discharge, sinuses and scarring. Although it is a common condition, it is rarely associated with cutaneous squamous cell carcinoma (cSCC). Whereas the female-to-male ratio of HS is 3:1, SCC in HS has a female-to-male ratio of 1:5. In this study, we present a 50-year-old male patient with a late presentation of inguinoscrotal cSCC with extensive ulceration and erythema that was hidden by neglected HS and the presence of underlying human papillomavirus in the affected area. The histomorphologic and immunohistochemical findings support the diagnosis of cSCC. Timely detection is the key to improve prognosis, regular clinical examination and biopsy of any suspicious lesions in high-risk patients is highly recommended.
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Affiliation(s)
- Elias Edward Lahham
- Department of Radiation Oncology, Augusta Victoria Hospital, Palestinian Authority, Palestine
| | - Salem Billan
- Head and Neck Unit, Joseph Fishman Oncology Center, Rambam Health Care Campus, Haifa, Israel
| | - Fadi Atrash
- Department of Radiation Oncology, Augusta Victoria Hospital, Palestinian Authority, Palestine
| | - Walid Fararja
- Department of Radiation Oncology, Augusta Victoria Hospital, Palestinian Authority, Palestine
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34
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Mi QS, Dimitrion P, Hamzavi I, Yin C, Loveless I, Toor J, Subedi K, Huggins R, Khalasawi N, Adrianto I, Veenstra J, Vellaichamy G, Hans A, Daveluy S, Athar M, Liao W, Lim H, Ozog D, Zhou L. Dysregulated CD38 expression in blood and skin immune cells of patients with hidradenitis suppurativa. RESEARCH SQUARE 2023:rs.3.rs-2609421. [PMID: 36865257 PMCID: PMC9980201 DOI: 10.21203/rs.3.rs-2609421/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Hidradenitis suppurativa (HS) is a multifactorial, inflammatory skin disease. Increased systemic inflammatory comorbidities and serum cytokines highlight systemic inflammation as a feature of HS. However, the specific immune cell subsets contributing to systemic and cutaneous inflammation have not been resolved. Here, we generated whole-blood immunomes by mass cytometry. We performed a meta-analysis of RNA-seq data, immunohistochemistry, and imaging mass cytometry to characterize the immunological landscape of skin lesions and perilesions from patients with HS. Blood from patients with HS exhibited lower frequencies of natural killer cells, dendritic cells, and classical (CD14+CD16-) and nonclassical (CD14-CD16+) monocytes, as well as higher frequencies of Th17 cells and intermediate (CD14+CD16+) monocytes than blood from healthy controls. Classical and intermediate monocytes from patients with HS had increased expression of skin-homing chemokine receptors. Furthermore, we identified a CD38+ intermediate monocyte subpopulation that was more abundant in the immunome of blood from patients with HS. Meta-analysis of RNA-seq data found higher CD38 expression in lesional HS skin than in perilesional skin, and markers of classical monocyte infiltration. Imaging mass cytometry showed that CD38+ classical monocytes and CD38+ monocyte-derived macrophages were more abundant in lesional HS skin. Overall, we report targeting CD38 may be worth pursuing in clinical trials.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wilson Liao
- University of California-San Francisco School of Medicine
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35
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Krajewski PK, Matusiak Ł, Szepietowski JC. Adipokines as an important link between hidradenitis suppurativa and obesity: a narrative review. Br J Dermatol 2023; 188:320-327. [PMID: 36641766 DOI: 10.1093/bjd/ljac107] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/16/2022] [Accepted: 11/26/2022] [Indexed: 01/16/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, debilitating disorder of the pilosebaceous unit. Although its pathophysiology is not fully explained, inflammation seems to play an essential role in the development of HS. A link between obesity - often considered a state of chronic inflammation - and a higher prevalence of HS has been described. Nevertheless, the exact association is not well understood. Adipose tissue is a highly active endocrine organ that produces and secretes a variety of metabolically and immunologically active molecules called adipokines. The imbalances in concentrations of several adipokines in patients with HS have already been described. A shift towards the overproduction of proinflammatory adipokines (including leptin, resistin and visfatin) with the suppression of anti-inflammatory ones (adiponectin) has been noted. We conducted a review of the available data on adipokines in HS, concentrating on the described imbalances in adipokine concentrations, as well as possible implications in HS pathogenesis. Moreover, new, unstudied adipokines with possible implications in the development of HS are proposed.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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36
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Lowe MM, Cohen JN, Moss MI, Clancy S, Adler J, Yates A, Naik HB, Pauli M, Taylor I, McKay A, Harris H, Kim E, Hansen SL, Rosenblum MD, Moreau JM. Tertiary Lymphoid Structures Sustain Cutaneous B cell Activity in Hidradenitis Suppurativa. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.14.528504. [PMID: 36824918 PMCID: PMC9949072 DOI: 10.1101/2023.02.14.528504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Background Hidradenitis suppurativa (HS) skin lesions are highly inflammatory and characterized by a large immune infiltrate. While B cells and plasma cells comprise a major component of this immune milieu the biology and contribution of these cells in HS pathogenesis is unclear. Objective We aimed to investigate the dynamics and microenvironmental interactions of B cells within cutaneous HS lesions. Methods We combined histological analysis, single-cell RNA-sequencing (scRNAseq), and spatial transcriptomic profiling of HS lesions to define the tissue microenvironment relative to B cell activity within this disease. Results Our findings identify tertiary lymphoid structures (TLS) within HS lesions and describe organized interactions between T cells, B cells, antigen presenting cells and skin stroma. We find evidence that B cells within HS TLS actively undergo maturation, including participation in germinal center reactions and class switch recombination. Moreover, skin stroma and accumulating T cells are primed to support the formation of TLS and facilitate B cell recruitment during HS. Conclusion Our data definitively demonstrate the presence of TLS in lesional HS skin and point to ongoing cutaneous B cell maturation through class switch recombination and affinity maturation during disease progression in this inflamed non-lymphoid tissue.
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37
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Tzellos T, van Straalen KR, Kyrgidis A, Alavi A, Goldfarb N, Gulliver W, Jemec GBE, Lowes MA, Marzano AV, Prens EP, Sayed CJ, van der Zee HH, Zouboulis CC. Development and validation of IHS4-55, an IHS4 dichotomous outcome to assess treatment effect for hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2023; 37:395-401. [PMID: 36184889 DOI: 10.1111/jdv.18632] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Validated, inclusive and easy-to-use outcomes for hidradenitis suppurativa are essential both in the clinical trial setting and clinical practice. The continuous IHS4 is a validated tool that dynamically assesses nodules/abscesses/draining tunnels and classifies disease severity as mild/moderate/severe. However, dichotomous outcomes are often required for clinical trials reporting. OBJECTIVE To develop and validate a dichotomous outcome based on IHS4 that can be used in clinical trial settings and day-to-day clinical practice. METHODS De-identified data from the PIONEER-I and -II studies were accessed through Vivli. Potential IHS4 thresholds were analysed using baseline to Week 12 data from adalimumab- and placebo-treated hidradenitis suppurativa patients in the PIONEER-I trial. The final threshold was chosen based on its ability to discriminate between patients treated with adalimumab or placebo and its association with reduction in inflammatory lesions. The final threshold was validated using data from baseline to Week 12 from adalimumab- and placebo-treated hidradenitis suppurativa patients in both the PIONEER-II and the combined PIONEER-I and -II studies. RESULTS The best performing cut-off for the IHS4 was a 55% reduction of the IHS4 score (IHS4-55). Patients who achieved the IHS4-55 had an odd's ratio of 2.00 [95%-CI 1.26-3.18, p = 0.003], 2.79 (95%-CI 1.76-4.43, p < 0.001) and 2.16 (95%-CI 1.43-3.29, p < 0.001) for being treated with adalimumab rather than placebo in PIONEER-I, PIONEER-II and the combined dataset, respectively. Additionally, the achievement of the IHS4-55 was associated with a significant reduction in inflammatory nodules, abscesses and draining tunnels in all analysed datasets. CONCLUSIONS IHS4-55, a novel dichotomous IHS4 version, based on a 55% reduction of the total score was developed. The IHS4-55 performs similarly to the HiSCR in discriminating between adalimumab- and placebo-treated hidradenitis suppurativa patients and shows significant associations with reductions in lesion counts. Moreover, the IHS4-55 addresses some of the HiSCR drawbacks by dynamically including draining tunnels in a validated manner. By allowing the analysis of hidradenitis suppurativa patients with an abscess and nodule count below 3 but many draining tunnels, this outcome measure will improve inclusivity in clinical trials.
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Affiliation(s)
- Thrasivoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
| | - Kelsey R van Straalen
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Athanassios Kyrgidis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Maxillofacial Surgery, Papanikolaou General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Afsaneh Alavi
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Noah Goldfarb
- Departments of Medicine and Dermatology, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.,Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Wayne Gulliver
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Gregor B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | | | - Angelo Valerio Marzano
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hessel H van der Zee
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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38
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Dimitrion P, Hamzavi I, Yin C, Loveless I, Toor J, Subedi K, Khalasawi N, Miller A, Huggins R, Adrianto I, Veenstra J, Vellaichamy G, Hans A, Daveluy S, Athar M, Liao W, Lim H, Ozog D, Zhou L, Mi QS. Dysregulated CD38 expression in blood and skin immune cells of patients with hidradenitis suppurativa. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.27.525867. [PMID: 36891290 PMCID: PMC9993884 DOI: 10.1101/2023.01.27.525867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Background Hidradenitis suppurativa (HS) is a multifactorial, inflammatory skin disease. Increased systemic inflammatory comorbidities and serum cytokines highlight systemic inflammation as a feature of HS. However, the specific immune cell subsets contributing to systemic and cutaneous inflammation have not been resolved. Objective Identify features of peripheral and cutaneous immune dysregulation. Methods Here, we generated whole-blood immunomes by mass cytometry. We performed a meta-analysis of RNA-seq data, immunohistochemistry, and imaging mass cytometry to characterize the immunological landscape of skin lesions and perilesions from patients with HS. Results Blood from patients with HS exhibited lower frequencies of natural killer cells, dendritic cells, and classical (CD14+CD16-) and nonclassical (CD14-CD16+) monocytes, as well as higher frequencies of Th17 cells and intermediate (CD14+CD16+) monocytes than blood from healthy controls. Classical and intermediate monocytes from patients with HS had increased expression of skin-homing chemokine receptors. Furthermore, we identified a CD38+ intermediate monocyte subpopulation that was more abundant in the immunome of blood from patients with HS. Meta-analysis of RNA-seq data found higher CD38 expression in lesional HS skin than in perilesional skin, and markers of classical monocyte infiltration. Imaging mass cytometry showed that CD38+ classical monocytes and CD38+ monocyte-derived macrophages were more abundant in lesional HS skin. Conclusion Overall, we report targeting CD38 may be worth pursuing in clinical trials. Key Messages 3.Monocyte subsets express markers of activation in circulation and HS lesionsTargeting CD38 may be a viable strategy for treating systemic and cutaneous inflammation in patients with HS. Capsule Summary 4.Dysregulated immune cells in patients with HS express CD38 and may be targeting by anti-CD38 immunotherapy.
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39
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Dimitrion P, Loveless I, Zhou L, Mi QS, Adrianto I. The Hidradenitis Suppurativa 'Omics Database (HS-OmicsDB). BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.26.524600. [PMID: 36747861 PMCID: PMC9901174 DOI: 10.1101/2023.01.26.524600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Large scale meta-analyses of genomics and genetics have spurred research in a number of fields, such as cancer, genetics and immunology. Publicly available 'omics databases provide valuable hypothesis generating and validation tools. To date, no such initiative has been undertaken for Hidradenitis Suppurativa (HS), an inflammatory skin disease of unknown etiology. We present here, a longitudinal initiative seeking to aggregate publicly available 'omics data to enhance research efforts in HS. In its first iteration, we include bulk and single-cell RNA sequencing data from untreated HS patients. Our data, aggregated from publicly available GEO datasets provides a tool to profile gene expression in specific tissue types (i.e. lesional, perilesional, nonlesional and healthy skin) as well as map cell-specific gene expression on single-cell data from HS lesions.
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40
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Zagona-Prizio C, Maynard N, Khan S, Yee DK, Reddy R, Mehta MD, Khan S, Armstrong AW. Perceptions of biologic treatment among hidradenitis suppurativa patients on social media: an analysis of content, engagement, and sentiment. Int J Dermatol 2022. [PMID: 36250292 DOI: 10.1111/ijd.16448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Nicole Maynard
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sabrina Khan
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Danielle K Yee
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Manan D Mehta
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samiya Khan
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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41
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van Straalen KR, Dudink K, Aarts P, van der Zee HH, van den Bosch TPP, Giang J, Prens EP, Damman J. Complement activation in Hidradenitis suppurativa: Covert low-grade inflammation or innocent bystander? Front Immunol 2022; 13:953674. [PMID: 36211440 PMCID: PMC9535337 DOI: 10.3389/fimmu.2022.953674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a complex and multifactorial pathogenesis involving both the innate and adaptive immune system. Despite limited evidence for local complement activation, conflicting results have been published on the role of systemic complement activation in HS. It was hypothesized that complement was consumed in highly inflamed HS skin, trapping complement from the circulation. Therefore, the aim of this study was to evaluate this local complement deposition in HS skin lesions using routine and commonly used complement antibodies.Direct immunofluorescence for C1q, C3c, C4d, C5b-9, and properdin was performed on frozen tissue sections of 19 HS patients and 6 controls. C5a receptor 1 (C5aR1) was visualized using immunohistochemistry.Overall, we found no significant local complement deposition in HS patients versus controls regarding C1q, C3c, C4d, C5b-9, or properdin on either vessels or immune cells. C5aR1 expression was exclusively found on immune cells, predominantly neutrophilic granulocytes, but not significantly different relatively to the total infiltrate in HS lesions compared with controls. In conclusion, despite not being able to confirm local complement depositions of C1q, C3c, C4d, or properdin using highly sensitive and widely accepted techniques, the increased presence of C5aR1 positive immune cells in HS suggests the importance of complement in the pathogenesis of HS and supports emerging therapies targeting this pathway.
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Affiliation(s)
- K. R. van Straalen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - K. Dudink
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - P. Aarts
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - H. H. van der Zee
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - T. P. P. van den Bosch
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. Giang
- Department of Pathology, Maasstad Hospital, Rotterdam, Netherlands
| | - E. P. Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - J. Damman
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: J. Damman,
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42
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Vellaichamy G, Amin AT, Dimitrion P, Hamzavi Z, Zhou L, Adrianto I, Mi QS. Recent advances in hidradenitis suppurativa: Role of race, genetics, and immunology. Front Genet 2022; 13:918858. [PMID: 36092908 PMCID: PMC9458948 DOI: 10.3389/fgene.2022.918858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a multifactorial chronic skin disease characterized by inflammation around the hair follicles commonly affecting intertriginous areas. The underlying pathogenesis of HS and its molecular mechanisms are largely understudied. Genetic studies in families have identified variants within the γ-secretase complex associated with HS; however, no definitive genotype-phenotype correlations have been made. The lack of knowledge regarding the intersection of genetics, immunology and environmental risk factors is a major obstacle to improving treatment for patients with HS. This article provides an overview of the role of race, genetics, and immunology in HS to provide insight into the multiple factors influencing the pathophysiology of HS.
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Affiliation(s)
- Gautham Vellaichamy
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
| | - Anya T. Amin
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | - Peter Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Zaakir Hamzavi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Department of Internal Medicine, Henry Ford Health, Detroit, MI, United States
| | - Indra Adrianto
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, United States
- Department of Internal Medicine, Henry Ford Health, Detroit, MI, United States
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