1
|
Pham JP, Staeger R, Frew JW. More data are needed to confirm the utility of screening for atypical fibroxanthoma and pleomorphic dermal sarcoma recurrence. J Am Acad Dermatol 2024; 90:e171-e173. [PMID: 38185252 DOI: 10.1016/j.jaad.2023.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Affiliation(s)
- James P Pham
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia.
| | - Ramon Staeger
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine and Health, University of Zurich, Zurich, Switzerland
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia; School of Clinical Medicine, University of New South Wales Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
2
|
Greenlund L, Herzog C, Wendland Z, Rypka K, Frew JW, Kirby JS, Alavi A, Khalid B, Lowes MA, Garg A, Marzano AV, Zouboulis CC, Tzellos T, Jaleel T, Goldfarb N. Discrepancies in hidradenitis suppurativa lesion characterization by providers and patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595320 DOI: 10.1111/jdv.19999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The hidradenitis suppurativa (HS) clinical response (HiSCR) has come under scrutiny as several HS clinical trials failed to meet primary endpoints with high placebo responses. This may be due to limitations of the tool and raters' ability to accurately characterize and count lesions, rather than lack of efficacy of the studied drug. Due to HS lesion complexity and potential differences in rater training, it was hypothesized that there would be discrepancies in how providers characterize and count lesions for HS clinical trials. OBJECTIVE To evaluate how HS providers and patients name and count HS lesions and to identify discrepancies among providers to initiate the development of consensus-driven guidance for HS rater training. METHODS An online survey was distributed to the members of HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Respondents were asked to classify lesion images composed of multiple and different morphology types and answer questions regarding inclusion of associated dermatological conditions. RESULTS Forty-seven HISTORIC members responded (29 providers; 18 patients). There was variability in how respondents classified HS lesions. Of 12 questions containing images, four had ≥50% of respondents choosing the same answer. With an image of a lesion composed of different morphologies, 45% of providers counted it as a single lesion and 45% counted it as multiple distinct lesions. With an image of multiple interconnected draining tunnels, 7% of providers classified it as a single draining tunnel while 79% categorized it as multiple draining tunnels with the number estimated by visual inspection. There was also variability in deciding whether lesions occurring in associated conditions should be considered separately or included in HS lesion counts. Patient responses were also variable. CONCLUSIONS The result of the current study reaffirms the gap in how providers characterize and count HS lesions for clinical trials and the need to develop consensus-driven rater training related to HS outcome measures.
Collapse
Affiliation(s)
| | - Claire Herzog
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Zachary Wendland
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katelyn Rypka
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health, Hershey, Pennsylvania, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bisma Khalid
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Amit Garg
- Northwell Health, New York, New York, USA
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, NLSH Bodø, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, TRomsø, Norway
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
Alavi A, Prens E, Kimball AB, Frew JW, Krueger JG, Mukhopadhyay S, Gao H, Ranganathan U, Ivanoff NB, Hernandez Daly AC, Zouboulis CC. Proof-of-concept study exploring the effect of spesolimab in patients with moderate-to-severe hidradenitis suppurativa: A randomized, double-blind, placebo-controlled clinical trial. Br J Dermatol 2024:ljae144. [PMID: 38576350 DOI: 10.1093/bjd/ljae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a considerable disease burden. Existing treatment options are limited and often suboptimal; a high unmet need exists for effective targeted therapies. OBJECTIVE To explore the effects of spesolimab treatment in patients with HS. METHODS This randomized, double-blind, placebo-controlled, proof-of-clinical-concept study was conducted at 25 centers across 12 countries from May 3, 2021, to April 21, 2022. Patients had moderate-to-severe HS for ≥1 year before enrollment. Patients were randomized (2:1) to receive a loading dose of 3600 mg intravenous spesolimab (1200 mg at Weeks 0, 1, and 2) or matching placebo, followed by maintenance with either 1200 mg subcutaneous spesolimab every 2 weeks from Week 4-10 or matching placebo. The primary endpoint was the percentage change from baseline in total abscess and inflammatory nodule (AN) count at Week 12. Secondary endpoints were the absolute change from baseline in International Hidradenitis Suppurativa Severity Score System (IHS4), percentage change from baseline in draining tunnel (dT) count, the proportion of patients achieving a dT count of zero, absolute change from baseline in revised Hidradenitis Suppurativa Area and Severity Index (HASI-R), the proportion of patients achieving Hidradenitis Suppurativa Clinical Response (HiSCR50), the proportion of patients with ≥1 flare (all at Week 12), and patient-reported outcomes (PROs). RESULTS In this completed trial, randomized patients (N=52) received spesolimab (n=35) or placebo (n=17). The difference (95% confidence interval) versus placebo in least squares mean are reported. At Week 12, the percentage change in total AN count was similar between treatment arms: -4.1% (-31.7, 23.4). There was greater numerical improvement in the spesolimab arm, as measured by IHS4: -13.9 (-25.6, -2.3); percentage change from baseline in dT count: -96.6% (-154.5, -38.8); and the proportion of patients achieving a dT count of zero: 18.3% (-7.9, 37.5). Spesolimab treatment also improved HASI-R and HiSCR50 versus placebo. Spesolimab demonstrated a favorable safety profile, similar to that observed in trials in other diseases. CONCLUSIONS This exploratory proof-of-clinical-concept study supports the development of spesolimab as a new therapeutic option in HS. ClinicalTrials.gov identifier: NCT04762277.
Collapse
Affiliation(s)
- Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - John W Frew
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | | | - Heli Gao
- Boehringer Ingelheim Shanghai Pharmaceuticals Co Ltd, Shanghai, China
| | - Usha Ranganathan
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | | | | | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| |
Collapse
|
4
|
Flora A, Pham J, Jepsen R, Frew JW. The serum proteome of pyoderma gangrenosum is more expansive than that of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:e348-e350. [PMID: 37909252 DOI: 10.1111/jdv.19611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/25/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Akshay Flora
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - James Pham
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Jepsen
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Pham JP, Jepsen R, Frew JW. Comment on Kridin et al.-Considering both relative and absolute risk differences in infection risk between biologics classes in patients with psoriasis. J Eur Acad Dermatol Venereol 2024; 38:e351-e353. [PMID: 37908185 DOI: 10.1111/jdv.19615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023]
Affiliation(s)
- James P Pham
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Rebecca Jepsen
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
7
|
Pham JP, Rosenø NAL, Roccuzzo G, Saal RC, Egeberg A, Ring HC, Frew JW. Drug survival of biologics in hidradenitis suppurativa: A systematic review and meta-analysis. J Am Acad Dermatol 2024:S0190-9622(24)00539-5. [PMID: 38554939 DOI: 10.1016/j.jaad.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/06/2024] [Accepted: 03/16/2024] [Indexed: 04/02/2024]
Affiliation(s)
- James P Pham
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia
| | - Nana A L Rosenø
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Ryan C Saal
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia
| | - Alexander Egeberg
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans C Ring
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia.
| |
Collapse
|
8
|
Wainman HE, Chandran NS, Frew JW, Garg A, Gibbons A, Gierbolini A, Horvath B, Jemec GB, Kirby B, Kirby J, Lowes MA, Martorell A, McGrath BM, Naik HB, Oon HH, Prens E, Sayed CJ, Thorlacius L, Van der Zee HH, Villumsen B, Ingram JR. Global consensus process to establish a core dataset for hidradenitis suppurativa registries. Br J Dermatol 2024; 190:510-518. [PMID: 37976235 DOI: 10.1093/bjd/ljad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Several registries for hidradenitis suppurativa (HS) already exist in Europe and the USA. There is currently no global consensus on a core dataset (CDS) for these registries. Creating a global HS registry is challenging, owing to logistical and regulatory constraints, which could limit opportunities for global collaboration as a result of differences in the dataset collected. The solution is to encourage all HS registries to collect the same CDS of information, allowing registries to collaborate. OBJECTIVES To establish a core set of items to be collected by all HS registries globally. The core set will cover demographic details, comorbidities, clinical examination findings, patient-reported outcome measures and treatments. METHODS Beginning in September 2022, 20 participants - including both clinicians with expertise in HS and patient advocates - from eight countries across three continents participated in a Delphi process consisting of four rounds of voting, with all participants completing each round. A list of potential items for inclusion in the core set was generated from the relevant published literature, including systematic reviews of comorbidities in HS, clinical and examination findings, and epidemiology. For disease severity and progression items, the Hidradenitis SuppuraTiva Core outcome set International Collaboration (HiSTORIC) core set and other relevant instruments were considered for inclusion. This resulted in 47 initial items. Participants were invited to suggest additional items to include during the first round. Anonymous feedback was provided to inform each subsequent round of voting to encourage consensus. RESULTS The eDelphi process established a CDS of 48 items recommended for inclusion in all HS registries globally. CONCLUSIONS The routine adoption of this CDS in current and future HS registries should allow registries in different parts of the world to collaborate, enabling research requiring large numbers of participants.
Collapse
Affiliation(s)
- Hannah E Wainman
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nisha S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - Angela Gibbons
- Patient Representative, The HS Support Network UK and Ireland, UK
| | | | - Barbara Horvath
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Brian Kirby
- Charles Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Joselyn Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | | | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Hazel H Oon
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H Van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bente Villumsen
- Patient Representative, The Patients' Association HS Denmark, Denmark
| | - John R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| |
Collapse
|
9
|
Pham JP, Flora A, Frew JW. Understanding multi-kinase inhibitor-associated cutaneous ulcers may provide molecular insights into the aetiology of pyoderma gangrenosum: A comment on Jeon et al. Australas J Dermatol 2024. [PMID: 38337172 DOI: 10.1111/ajd.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/17/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Affiliation(s)
- James P Pham
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - Akshay Flora
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Flora A, Jepsen R, Pham J, Frew JW. Rapid Attenuation of B-Cell and IFN-γ-Associated Chemokines in Clinical Responders to Jak Inhibition with Upadacitinib in Hidradenitis Suppurativa. J Invest Dermatol 2024; 144:416-419.e5. [PMID: 37633455 DOI: 10.1016/j.jid.2023.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/28/2023]
Affiliation(s)
- Akshay Flora
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, Australia; University of New South Wales, 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; University of New South Wales, 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; University of New South Wales, Kensington, Australia.
| |
Collapse
|
11
|
Navrazhina K, Garcet S, Williams SC, Gulati N, Kiecker F, Frew JW, Mitsui H, Krueger JG. Laser capture microdissection provides a novel molecular profile of human primary cutaneous melanoma. Pigment Cell Melanoma Res 2024; 37:81-89. [PMID: 37776566 PMCID: PMC10841058 DOI: 10.1111/pcmr.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 10/02/2023]
Abstract
Melanoma accounts for the majority of skin cancer-related mortality, highlighting the need to better understand melanoma initiation and progression. In-depth molecular analysis of neoplastic melanocytes in whole tissue biopsies may be diluted by inflammatory infiltration, which may obscure gene signatures specific to neoplastic cells. Thus, a method is needed to precisely uncover molecular changes specific to tumor cells from a limited sample of primary melanomas. Here, we performed laser capture microdissection (LCM) and gene expression profiling of patient-derived frozen sections of pigmented lesions and primary cutaneous melanoma. Compared to bulk tissue analysis, analysis of LCM-derived samples identified 9528 additional differentially expressed genes (DEGs) including melanocyte-specific genes like PMEL and TYR, with enriched of pathways related to cell proliferation. LCM methodology also identified potentially targetable kinases specific to melanoma cells that were not detected by bulk tissue analysis. Taken together, our data demonstrate that there are marked differences in gene expression profiles depending on the method of sample isolation. We found that LCM captured higher expression of melanoma-related genes while whole tissue biopsy identified a wider range of inflammatory markers. Taken together, our data demonstrate that LCM is a valid approach to identify melanoma-specific changes using a relatively small amount of primary patient-derived melanoma sample.
Collapse
Affiliation(s)
- Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD program, New York, NY
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Samuel C. Williams
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD program, New York, NY
| | - Nicholas Gulati
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Felix Kiecker
- Department of Dermatology and Allergy, Skin Cancer Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John W. Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Hiroshi Mitsui
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - James G. Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| |
Collapse
|
12
|
Flora A, Jepsen R, Kozera EK, Woods JA, Cains GD, Radzieta M, Jensen SO, Malone M, Frew JW. Mast cells are upregulated in hidradenitis suppurativa tissue, associated with epithelialized tunnels and normalized by spleen tyrosine kinase antagonism. Exp Dermatol 2024; 33:e14894. [PMID: 37522746 DOI: 10.1111/exd.14894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/26/2023] [Accepted: 07/16/2023] [Indexed: 08/01/2023]
Abstract
Mast cells have traditionally been associated with allergic inflammatory responses; however, they play important roles in cutaneous innate immunity and wound healing. The Hidradenitis Suppurativa tissue transcriptome is associated with alterations in innate immunity and wound healing-associated pathways; however, the role of mast cells in the disease is unexplored. We demonstrate that mast cell-associated gene expression (using whole tissue RNAseq) is upregulated, and in-silico cellular deconvolution identifies activated mast cells upregulated and resting mast cells downregulated in lesional tissue. Tryptase/Chymase positive mast cells (identified using IHC) localize adjacent to epithelialized tunnels, fibrotic regions of the dermis and at perivascular sites associated with Neutrophil Extracellular Trap formation and TNF-alpha production. Treatment with Spleen Tyrosine Kinase antagonist (Fostamatinib) reduces the expression of mast cell-associated gene transcripts, associated biochemical pathways and the number of tryptase/chymase positive mast cells in lesional hidradenitis suppurativa tissue. This data indicates that although mast cells are not the most abundant cell type in Hidradenitis Suppurativa tissue, the dysregulation of mast cells is paralleled with B cell/plasma cell inflammation, inflammatory epithelialized tunnels and epithelial budding. This provides an explanation as to the mixed inflammatory activation signature seen in HS, the correlation with dysregulated wound healing and potential pathways involved in the development of epithelialized tunnels.
Collapse
Affiliation(s)
- A Flora
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - R Jepsen
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - E K Kozera
- University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - J A Woods
- University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - G D Cains
- University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - M Radzieta
- South West Sydney Limb Preservation and Wound Research, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - S O Jensen
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - M Malone
- South West Sydney Limb Preservation and Wound Research, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - J W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Frew JW, Piguet V. Attenuated PBMC Cytokine Production in Hidradenitis Suppurativa May Be Indicative of Cellular Exhaustion, Providing Novel Biomarkers, and Future Therapeutic Potential. J Invest Dermatol 2023; 143:2334-2337. [PMID: 37315880 DOI: 10.1016/j.jid.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023]
Affiliation(s)
- John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia; Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Toronto, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Ontario, Toronto, Canada.
| |
Collapse
|
14
|
Pham JP, Wark KJL, Woods J, Frew JW. Resident cutaneous memory T cells: a clinical review of their role in chronic inflammatory dermatoses and potential as therapeutic targets. Br J Dermatol 2023; 189:656-663. [PMID: 37603832 DOI: 10.1093/bjd/ljad303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Resident memory T cells (T-RMs) remain in epithelial barrier tissues after antigen exposure and the initial effector phase. These T-RMs provide effective antimicrobial and anticancer immunity; however, pathogenic T-RMs have been shown to mediate various chronic inflammatory disorders in a variety of tissue types. In the skin, T-RMs are referred to as resident cutaneous memory T cells (cT-RMs). Understanding the mechanisms leading to the development and establishment of these cT-RMs populations may allow for targeted treatments that provide durable responses in chronic immune-mediated skin diseases, even after cessation. In this review, we summarize the evidence on cT-RMs as drivers of chronic inflammatory dermatoses, including psoriasis, vitiligo, atopic dermatitis, cutaneous lupus erythematosus and alopecia areata, among others. Data from in vitro, animal model and ex vivo human studies are presented, with a focus on the potential for cT-RMs to trigger acute disease flares, as well as recurrent disease, by establishing an immune 'memory' in the skin. Furthermore, the available data on the potential for existing and novel treatments to affect the development or survival of cT-RMs in the skin are synthesized. The data suggest a dynamic and rapidly growing area in the field of dermatology; however, we also discuss areas in need of greater research to allow for optimal treatment selection for long-term disease control.
Collapse
Affiliation(s)
- James P Pham
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Kirsty J L Wark
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Jane Woods
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - John W Frew
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| |
Collapse
|
15
|
Kozera EK, Porter M, Paek SY, Mintoff D, McMeniman E, Oon HH, Chandran NS, Glasenhardt K, Ring HC, Frew JW. Infectious Disease Screening Prior to Systemic Immunomodulatory Therapy in Hidradenitis Suppurativa: Consensus Guidelines from the Asia-Pacific Hidradenitis Suppurativa Foundation. Dermatology 2023:000534575. [PMID: 37963431 DOI: 10.1159/000534575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Current infectious disease screening recommendations for hidradenitis suppurativa (HS) are adopted from recommendations in chronic plaque psoriasis. No HS-specific guidelines for infectious disease screening prior to immunomodulatory therapy have been developed. OBJECTIVES To establish an expert Delphi consensus of recommendations regarding infectious disease screening prior to systemic immunomodulatory therapy in HS. METHODS Participants were identified via recent publications in the field and were sent a questionnaire regarding infectious diseases encountered in the setting of HS, and opinions regarding infectious disease screening prior to various systemic immunomodulatory therapies. All questions were informed by a systematic literature review regarding infections exacerbated or precipitated by immunomodulatory therapy. Questionnaire responses were followed by round-table discussion with a core group of 8 experts followed by a final round of questionnaires resulting in achievement of consensus. RESULTS 44 expert HS physicians from 12 countries on 5 continents participated in the development of the expert consensus recommendations. Consensus recommendations include screening for hepatitis B, hepatitis C and tuberculosis in all individuals with HS prior to therapy. All immunomodulatory therapies (biologic and systemic immunosuppressant therapy) should be preceded by infectious disease screening including patient and location specific considerations for endemic local diseases and high-risk activities and occupations. Clinical assessment has a significant role in determining the need for laboratory screening in the setting of many uncommon or tropical diseases such as leprosy, leishmaniasis and strongyloidiasis. CONCLUSIONS The presented consensus recommendations are the first specifically developed for pre-treatment infectious disease screening in Hidradenitis Suppurativa.
Collapse
|
16
|
Flora A, Jepsen R, Kozera EK, Woods JA, Cains GD, Radzieta M, Jensen SO, Malone M, Frew JW. Human dermal fibroblast subpopulations and epithelial mesenchymal transition signals in hidradenitis suppurativa tunnels are normalized by spleen tyrosine kinase antagonism in vivo. PLoS One 2023; 18:e0282763. [PMID: 37922232 PMCID: PMC10624284 DOI: 10.1371/journal.pone.0282763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 11/05/2023] Open
Abstract
Hidradenitis Suppurativa is a chronic inflammatory disease of which the pathogenesis is incompletely understood. Dermal fibroblasts have been previously identified as a major source of inflammatory cytokines, however information pertaining to the characteristics of subpopulations of fibroblasts in HS remains unexplored. Using in silico-deconvolution of whole-tissue RNAseq, Nanostring gene expression panels and confirmatory immunohistochemistry we identified fibroblast subpopulations in HS tissue and their relationship to disease severity and lesion morphology. Gene signatures of SFRP2+ fibroblast subsets were increased in lesional tissue, with gene signatures of SFRP1+ fibroblast subsets decreased. SFRP2+ and CXCL12+ fibroblast numbers, measured by IHC, were increased in HS tissue, with greater numbers associated with epithelialized tunnels and Hurley Stage 3 disease. Pro-inflammatory CXCL12+ fibroblasts were also increased, with reductions in SFRP1+ fibroblasts compared to healthy controls. Evidence of Epithelial Mesenchymal Transition was seen via altered gene expression of SNAI2 and altered protein expression of ZEB1, TWIST1, Snail/Slug, E-Cadherin and N-Cadherin in HS lesional tissue. The greatest dysregulation of EMT associated proteins was seen in biopsies containing epithelialized tunnels. The use of the oral Spleen tyrosine Kinase inhibitor Fostamatinib significantly reduced expression of genes associated with chronic inflammation, fibroblast proliferation and migration suggesting a potential role for targeting fibroblast activity in HS.
Collapse
Affiliation(s)
- Akshay Flora
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | | | - Emily K. Kozera
- University of New South Wales, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | - Jane A. Woods
- University of New South Wales, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | - Geoffrey D. Cains
- University of New South Wales, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | - Michael Radzieta
- South West Sydney Limb Preservation and Wound Research, Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Slade O. Jensen
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Matthew Malone
- South West Sydney Limb Preservation and Wound Research, Ingham Institute for Applied Medical Research, Liverpool, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - John W. Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia
- University of New South Wales, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- Holdsworth House Medical Practice, Sydney, Australia
| |
Collapse
|
17
|
Pham JP, Dwyer L, Phan K, Menzies AM, Frew JW. Efficacy of topical diphencyprone for melanoma in-transit metastases: a systematic review and meta-analysis. Melanoma Res 2023; 33:434-436. [PMID: 37650727 DOI: 10.1097/cmr.0000000000000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- James P Pham
- Department of Dermatology, Liverpool Hospital
- School of Clinical Medicine, UNSW Medicine and Health, Sydney
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool
| | - Liam Dwyer
- School of Clinical Medicine, UNSW Medicine and Health, Sydney
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney
- Faculty of Medicine and Health, The University of Sydney
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital
- School of Clinical Medicine, UNSW Medicine and Health, Sydney
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool
| |
Collapse
|
18
|
Jepsen R, Edwards C, Flora A, Kozera E, Frew JW. A proof-of-concept open-label clinical trial of spleen tyrosine kinase antagonism using fostamatinib in moderate-to-severe hidradenitis suppurativa. J Am Acad Dermatol 2023; 89:694-702. [PMID: 37307994 DOI: 10.1016/j.jaad.2023.05.076] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/10/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an autoinflammatory disorder of keratinization with a prominence of B cells and plasma cells. Fostamatinib is a spleen tyrosine kinase inhibitor targeting B cells and plasma cells. OBJECTIVES To assess the safety, tolerability, and clinical response at week 4 and week 12 of fostamatinib in moderate-to-severe HS. METHODS Twenty participants were administered fostamatinib 100 mg twice a day for 4 weeks, escalating to 150 mg twice a day thereafter until week 12. Participants were assessed for adverse events and clinical response assessed by HiSCR (Hidradenitis Suppurativa Clinical Response Score) and IHS4 (International Hidradenitis Suppurativa Severity Score) as well as other outcomes including DLQI (Dermatology Life Quality Index), visual analog scale, and physician global assessment. RESULTS All 20 participants completed the week 4 and week 12 endpoints. Fostamatinib was well tolerated in this cohort with no grade 2/3 adverse events reported. A total of 85% achieved HiSCR at week 4 and 85% at week 12. The greatest reduction in disease activity was seen at weeks 4/5 with worsening in a proportion of patients thereafter. Significant improvements were seen in pain, itch, and quality of life. CONCLUSIONS Fostamatinib was well tolerated in this HS cohort with no serious adverse events and improvement in clinical outcomes. Targeting B cells/plasma cells may be a viable therapeutic strategy in HS and requires further exploration.
Collapse
Affiliation(s)
- Rebecca Jepsen
- Holdsworth House Medical Practice, Sydney, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia
| | - Chloe Edwards
- Holdsworth House Medical Practice, Sydney, Australia
| | - Akshay Flora
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia; Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - Emily Kozera
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia; Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia
| | - John W Frew
- Holdsworth House Medical Practice, Sydney, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia; Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
| |
Collapse
|
19
|
Pham JP, Frew JW. Reply to Tilotta and Bongiorno: Considering the role of resident cutaneous memory T-cell suppression in providing durable atopic dermatitis remission. J Eur Acad Dermatol Venereol 2023; 37:e1173-e1174. [PMID: 37166438 DOI: 10.1111/jdv.19179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/05/2023] [Indexed: 05/12/2023]
Affiliation(s)
- James P Pham
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, Australia
| |
Collapse
|
20
|
Mintoff D, Agius R, Benhadou F, Das A, Frew JW, Pace NP. Obesity and hidradenitis suppurativa: targeting meta-inflammation for therapeutic gain. Clin Exp Dermatol 2023; 48:984-990. [PMID: 37171791 DOI: 10.1093/ced/llad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the pilosebaceous unit. The typical patient with HS is characterized as someone with obesity, who smokes and who has nodules, abscesses and/or draining tunnels predominantly distributed in intertriginous skin. It has been established that lifestyle and genetic factors are the main pathophysiological drivers of HS. In this critical review, we explore the interrelatedness of meta-inflammation, obesity and HS and discuss if and how this relationship may be manipulated for a therapeutic end.
Collapse
Affiliation(s)
- Dillon Mintoff
- Department of Dermatology
- Department of Pathology, Faculty of Medicine and Surgery
| | - Rachel Agius
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Anupam Das
- Department of Dermatology, Venereology and Leprosy; KPC Medical College & Hospital, Kolkata, India
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Nikolai P Pace
- Faculty of Medicine and Surgery
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| |
Collapse
|
21
|
Flora A, Kozera E, Frew JW. Treatment of alopecia areata with the janus kinase inhibitor upadacitinib: A retrospective cohort study. J Am Acad Dermatol 2023; 89:137-138. [PMID: 36806643 DOI: 10.1016/j.jaad.2022.12.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/19/2022] [Accepted: 12/25/2022] [Indexed: 02/17/2023]
Affiliation(s)
- Akshay Flora
- Department of Dermatology, Liverpool Hospital, Sydney, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, Australia; School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Emily Kozera
- Department of Dermatology, Liverpool Hospital, Sydney, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, Australia; School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| |
Collapse
|
22
|
Affiliation(s)
- Katina J. Selvaraj
- Department of Dermatology, Concord Repatriation General Hospital, Sydney, Australia
| | - Thomas Stewart
- Department of Dermatology, Concord Repatriation General Hospital, Sydney, Australia
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Correspondence to: John W. Frew, MBBS, MMed, MS, PhD, Laboratory of Translational Cutaneous Medicine, Department of Dermatology, Liverpool Hospital, Suite 7, Level 1, 45-47 Goulburn St, Liverpool NSW 2170, Australia
| |
Collapse
|
23
|
Pham JP, Yang A, Frew JW. Academic dermatology in Australia and New Zealand between 2017 and 2022: A cross‐sectional bibliometric analysis. Australas J Dermatol 2023; 64:213-220. [PMID: 36971373 DOI: 10.1111/ajd.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Academic dermatologists in Australia and New Zealand provide high-quality and meaningful contributions to the understanding of disease and therapeutic translational research. Concerns have been raised by the Australian Medical Association regarding the decline of clinical academics in Australia as a whole, however, such trends in scholarly output have not previously been analysed for Australasian dermatologists. METHODS A bibliometric analysis of dermatologists in Australia and New Zealand was conducted in January and February 2023. Available Scopus profiles for all dermatologists were used to measure lifetime H index, scholarly output, citation counts and field-weighted citation impact (FWCI) in the last 5 years (2017-2022). Trends in output over time were measured using non-parametric tests. Differences in output between subgroups stratified by gender and academic leadership positions (associate professor or professor) were measured using Wilcoxon rank-sum and one-way ANOVA tests. The scholarly output of recent College graduates was also analysed as a subgroup, comparing the same bibliographic variables in the 5 years preceding and 5 years following awarding of their fellowships. RESULTS From the 463 practising dermatologists in Australia and New Zealand, 372 (80%) were successfully matched to Scopus researcher profiles. Of these dermatologists, 167 were male (45%) and 205 (55%) were female, and 31 (8%) held academic leadership positions. Most dermatologists (67%) published at least one paper in the last 5 years. The median lifetime H index was 4, and between 2017 and 2022 median scholarly output was 3, the median citations were 14 and the median FWCI was 0.64. There was a non-significant trend towards fewer publications per year, however, citation count and FWCI decreased significantly. By subgroups, female dermatologists published significantly more papers between 2017 and 2022, and other bibliographic variables were comparable to male dermatologists. However, women were underrepresented in positions of academic leadership-comprising only 32% of this cohort despite representing 55% of dermatologists. Professors were also significantly more likely to have higher bibliographic outcomes than associate professors. Finally, analysis of recent College graduates highlighted a significant decline in bibliometric outcomes pre- and post-fellowship. CONCLUSION Overall, our analysis identifies a trend towards decreased research output by dermatologists in Australia and New Zealand in the last 5 years. Strategies to support dermatologists in research endeavours, particularly women and recent graduates, will be essential in maintaining strong scholarly output among Australasian dermatologists and thereby sustaining optimal evidence-based patient care.
Collapse
|
24
|
Flora A, Kozera EK, Jepsen R, Gill K, Xu J, Frew JW. Baseline clinical, hormonal and molecular markers associated with clinical response to IL-23 antagonism in hidradenitis suppurativa: A prospective cohort study. Exp Dermatol 2023. [PMID: 36933897 DOI: 10.1111/exd.14789] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/27/2023] [Accepted: 03/04/2023] [Indexed: 03/20/2023]
Abstract
Hidradenitis suppurativa is a complex inflammatory disease in which predicting therapeutic response remains challenging. IL-23 interacts with sex hormones but the relationships between the two in HS remains uninvestigated. To assess whether baseline clinical, hormonal or molecular markers are associated with clinical response to IL-23 antagonism with risankizumab in hidradenitis suppurativa. Twenty six individuals with Hurley stage 2/3 disease were administered risankizumab 150 mg Week 0, 4, 12. Baseline sex hormones and skin biopsies were taken. Clinical response at Week 16 assessed by the HiSCR, and differences between responders and non-responders assessed. Eighteen of 26 participants achieved HiSCR50 at week 16 (69.2%). Clinical response to IL-23 antagonism was associated with male gender, elevated total serum testosterone and decreased levels of FSH. Stratification by clinical responders/nonresponders identified differentially expressed genes including PLPP4 and MAPK10. Immunohistochemistry identified elevated numbers of CD11c, IL-17A and IL-17F positive cells compared to nonresponders. CD11c + cells significantly correlated with serum levels of total testosterone and inversely correlated with serum FSH. Clinical response to IL-23 antagonism in HS is associated with serum sex hormones, Th17 polarized inflammation in lesional tissue and CD11c + cells. These potential therapeutic biomarkers require further validation in larger cohorts but may suggest potential targeted HS therapy.
Collapse
Affiliation(s)
- A Flora
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - E K Kozera
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia
| | - R Jepsen
- Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| | - K Gill
- University of New South Wales, Sydney, New South Wales, Australia
| | - J Xu
- University of New South Wales, Sydney, New South Wales, Australia
| | - J W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Holdsworth House Medical Practice, Sydney, New South Wales, Australia
| |
Collapse
|
25
|
Xu J, Gill K, Flora A, Kozera E, Frew JW. The impact of psoriasis biologic therapy on HIV viral load and CD4 + cell counts in HIV-positive individuals: A real-world cohort study. J Eur Acad Dermatol Venereol 2023. [PMID: 36897246 DOI: 10.1111/jdv.19020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Psoriasis is a chronic immune-mediated inflammatory disorder that also occurs in the setting of human immunodeficiency virus (HIV). Biological therapy has transformed the treatment landscape for psoriasis; however, individuals with HIV are excluded from clinical trials. The impact of biological therapy on blood parameters in HIV is unclear and is only observed in small case series. OBJECTIVE The aim of this study was to assess the effect of biological therapy in psoriasis vulgaris in individuals with well-controlled HIV on CD4+ cell counts, CD4+ proportion and HIV viral load over 12 months. METHODS This retrospective cohort study was conducted at a tertiary referral centre in Sydney, Australia and included 36 HIV-positive individuals with psoriasis treated with biological therapy, compared with 144 age-, gender- and HAART-matched individuals without psoriasis seen between 2010 and 2022. Outcomes of interest included HIV viral load, CD4+ cell count and incidence of infections. RESULTS No statistically significant difference was seen in baseline HIV viral load and CD4+ count between individuals with and without psoriasis. No significant change in CD4+ count or HIV viral load was seen over the 12-month period of analysis in the HIV cohort without psoriasis. The HIV cohort treated with biological therapy for psoriasis also did not demonstrate any significant change in HIV viral load and CD4+ counts over the 12-month period examined. Stratification by type of biological therapy used did not identify any significant changes in these parameters. Rates of infections and adverse events were also not significantly different between cohorts. It is possible that minor blips seen in the biologics cohort may be a risk factor for future virological failure, and future prospective longitudinal studies are required. CONCLUSIONS In individuals with well-controlled HIV, the use of biological therapy for psoriasis does not significantly impact HIV viral load, CD4+ cell count, CD4+ proportion and rates of infection over the first 12 months of therapy.
Collapse
Affiliation(s)
- Jennifer Xu
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kyra Gill
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Akshay Flora
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia
| | - Emily Kozera
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - John W Frew
- Faculty of Medicine, University of New South Wales, New South Wales, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, New South Wales, Australia
| |
Collapse
|
26
|
Flora A, Frew JW. Angiotensin-converting enzyme 2 expression is elevated in tissue of hidradenitis suppurativa and pyoderma gangrenousm and demonstrates a different pattern of expression to psoriasis vulgaris. J Eur Acad Dermatol Venereol 2023; 37:e372-e374. [PMID: 35986694 DOI: 10.1111/jdv.18543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Akshay Flora
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
27
|
Affiliation(s)
- John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia; Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
| |
Collapse
|
28
|
Gill K, Xu J, Kozera E, Stewart T, Flora A, Frew JW. Strongyloides screening prior to dupilumab therapy in atopic dermatitis: a retrospective cohort study evaluating screening utility. Br J Dermatol 2023; 188:294-295. [PMID: 36763856 DOI: 10.1093/bjd/ljac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/22/2022] [Accepted: 10/24/2022] [Indexed: 01/22/2023]
Abstract
The utility of Strongyloidiasis screening in the setting of Dupilumab therapy is unknown. Our retrospective cohort study identifies a low prevalence of Strongyloidiasis with no cases of disseminated disease in the setting of Dupilumab therapy. Baseline IgE and Eosinophil levels were not associated with Strongyloidiasis and screening is likely of low utility.
Collapse
Affiliation(s)
- Kyra Gill
- University of New South Wales, Sydney, NSW, Australia
| | - Jennifer Xu
- University of New South Wales, Sydney, NSW, Australia
| | - Emily Kozera
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Thomas Stewart
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia
| | - Akshay Flora
- University of New South Wales, Sydney, NSW, Australia.,Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, NSW, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| |
Collapse
|
29
|
Frew JW. In Search of Therapeutic Biomarkers to IL-23 Antagonism in Hidradenitis Suppurativa. Br J Dermatol 2023; 188:588-589. [PMID: 36722365 DOI: 10.1093/bjd/ljad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/27/2023] [Accepted: 02/23/2023] [Indexed: 02/02/2023]
Affiliation(s)
- John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Sydney, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
| |
Collapse
|
30
|
Tatian A, Bordbar S, Sarkissian SD, Woods JA, Cains GD, Chong CW, Mariño E, Frew JW. Adalimumab therapy is associated with increased faecal short chain fatty acids in hidradenitis suppurativa. Exp Dermatol 2022; 31:1872-1880. [PMID: 36054650 PMCID: PMC10087920 DOI: 10.1111/exd.14665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
Altered gut microbiota composition has been observed in individuals with hidradenitis suppurutiva (HS) and many other inflammatory diseases, including obesity, type 1 and type 2 diabetes. Here, we addressed whether adalimumab, a systemic anti-inflammatory therapy, may impact the microbiota biochemical profile, particularly on beneficial metabolites such as short-chain fatty acids (SCFAs). We conducted an observational single-arm pilot trial to assess gut microbiota composition by 16S rRNA gene sequence analysis and to detect metabolite signatures by gas chromatography in stool samples from participants with HS prior to and 12 weeks after commencing adalimumab therapy. HS individuals that better responded to adalimumab treatment showed a shift in the composition and function of the gut microbiota with significantly increased SCFA acetate and propionate compared to age, gender and BMI-matched healthy controls. A positive correlation was observed between propionate with Prevotella sp and Faecalibacterium prausnitsii. Increased SCFAs, changes in gut microbiota composition, function and metabolic profile following 12 weeks of adalimumab suggest that targeting SCFAs may be considered a potential biomarker to be evaluated as a complementary protective factor or as a diagnostically relevant signal in HS.
Collapse
Affiliation(s)
- Artiene Tatian
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Sara Bordbar
- Infection and Immunity Program, Department of Biochemistry, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Samuel Der Sarkissian
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Jane A Woods
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Geoffrey D Cains
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Eliana Mariño
- Infection and Immunity Program, Department of Biochemistry, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| |
Collapse
|
31
|
Ring HC, Yao Y, Maul J, Ingram JR, Frew JW, Thorsen J, Nielsen M, Wu JJ, Thyssen JP, Thomsen SF, Egeberg A. The road to biologics in patients with hidradenitis suppurativa: a nationwide drug utilization study. Br J Dermatol 2022; 187:523-530. [PMID: 35603888 PMCID: PMC9796665 DOI: 10.1111/bjd.21673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/15/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Prolonged systemic antibiotic treatment is often a part of management of hidradenitis suppurativa (HS). Although biologic therapies are now available, the patient's treatment journey leading to biologic therapy is unclear. OBJECTIVES To examine treatment patterns and duration of systemic treatment use in patients with HS preceding biologic therapy. METHODS We identified all patients with HS receiving treatment with biologics in the Danish National Patient Registry from 2010 to 2018 and extracted their entire prescription history of specific systemic treatments from the Danish National Prescription Registry since its inception in 1995. The patients' treatment journeys are graphically displayed through Sankey diagrams and box plots generated to show temporal distributions. Descriptive patient characteristics were presented as frequencies with percentages for categorical variables and as means with SDs or medians with interquartile ranges (IQRs) for continuous variables. RESULTS A total of 225 patients with HS were included. Patients had most frequently been treated with penicillin (n = 214; 95·1%), dicloxacillin (n = 194; 86·2%), tetracycline (n = 145; 64·4%) and rifampicin/clindamycin (n = 111; 49·3%), as well as the retinoids isotretinoin and acitretin, and dapsone. Prior to biologic therapy, patients received a mean of 4·0 (SD 1·3) different systemic therapies, across a mean of 16·9 (SD 11·3) different treatment series. The mean time from first systemic therapy until biologic therapy was initiated was 15·3 (SD 5·1) years [8·2 (SD 5·9) years when excluding penicillin and dicloxacillin]. CONCLUSIONS Patients with HS who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS. Delay in the initiation of biologic therapy may represent a missed opportunity to prevent disease progression. What is already known about this topic? The treatment journey leading to biologic therapy in patients with HS has not previously been investigated. What does this study add? Our data from 225 patients with HS illustrate that patients who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS.
Collapse
Affiliation(s)
- Hans Christian Ring
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Yiqiu Yao
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | | | - John R. Ingram
- Department of Dermatology & Academic Wound HealingInstitute of Infection & Immunity, Cardiff UniversityCardiffUK
| | - John W. Frew
- Department of DermatologyLiverpool HospitalSydneyAustralia
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte HospitalUniversity of CopenhagenDenmark
| | - Mia‐Louise Nielsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Jashin J. Wu
- Dermatology Research and Education FoundationIrvineCAUSA
| | - Jacob P. Thyssen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Simon F. Thomsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark,Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Alexander Egeberg
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| |
Collapse
|
32
|
Pham JP, Glasenhardt K, Garg A, Frew JW. Interpretation of comorbidity risk in hidradenitis suppurativa: comparing odds ratio and 'number needed to be exposed'. J Eur Acad Dermatol Venereol 2022; 36:e1004-e1006. [PMID: 35793407 DOI: 10.1111/jdv.18403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J P Pham
- St Vincent's Hospital Sydney, Victoria, NSW, Australia.,University of New South Wales Sydney, Sydney, NSW, Australia
| | - K Glasenhardt
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - A Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York, USA
| | - J W Frew
- University of New South Wales Sydney, Sydney, NSW, Australia.,Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, Sydney, Australia
| |
Collapse
|
33
|
Flora A, Frew JW. A case series of early biologic therapy in guttate psoriasis: Targeting resident memory T cell activity as a potential novel therapeutic modality. JAAD Case Rep 2022; 24:82-87. [PMID: 35647251 PMCID: PMC9136601 DOI: 10.1016/j.jdcr.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Akshay Flora
- Department of Dermatology, Liverpool Hospital, Liverpool, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Laboratory of Translational Cutaneous Research, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Liverpool, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Laboratory of Translational Cutaneous Research, Ingham Institute of Applied Medical Research, Liverpool, Australia
| |
Collapse
|
34
|
Kozera EK, Kossard S, Frew JW. Extramammary Paget's disease: Harbinger of internal malignancy. Aust J Gen Pract 2022; 51:351-352. [PMID: 35491460 DOI: 10.31128/ajgp-05-21-5981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Emily K Kozera
- BMedSc, MD, MPH, Research Registrar, Department of Dermatology, Liverpool Hospital, Liverpool, NSW
| | - Steven Kossard
- MBBS, BS, FACD, PhD, Hon FRCPA, Director of Dermatopathology, Kossard Dermatopathologists, Macquarie Park, NSW
| | - John W Frew
- MBBS (Hons), MMed (ClinEpi), FACD, Consultant Dermatologist, Department of Dermatology, Liverpool Hospital, Liverpool, NSW; Ingham Institute of Applied Medical Sciences, Liverpool, NSW; University of NSW, Sydney, NSW
| |
Collapse
|
35
|
Ring HC, Frew JW, Thyssen JP, Egeberg A, Thomsen SF. Can we increase the drug survival time of biologic therapies in hidradenitis suppurativa? Clin Exp Dermatol 2022; 47:1585-1586. [PMID: 35437813 DOI: 10.1111/ced.15232] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | - Jacob P Thyssen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
36
|
Flora A, Frew JW. Pyoderma gangrenosum: a review of the clinical, mechanistic and therapeutic landscape. WPR 2022. [DOI: 10.33235/wpr.30.1.16-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
37
|
Russell R, Slape D, McCrossin I, Frew JW. Cutaneous infection and atopic dermatitis: the importance of early intervention in Indigenous children in Australia. WPR 2022. [DOI: 10.33235/wpr.30.1.34-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
38
|
Honigman A, Kern JS, Frew JW. Pathergy: a review of potential mechanisms and novel therapeutic targets. WPR 2022. [DOI: 10.33235/wpr.30.1.55-61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
39
|
Frew JW. Dermatology and wound research: targeting inflammation through cooperation and collaboration. WPR 2022. [DOI: 10.33235/wpr.30.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
40
|
Navrazhina K, Frew JW, Grand D, Williams SC, Hur H, Gonzalez J, Garcet S, Krueger JG. IL-17RA blockade by brodalumab decreases inflammatory pathways in hidradenitis suppurativa skin and serum. Br J Dermatol 2022; 187:223-233. [PMID: 35191018 PMCID: PMC9356983 DOI: 10.1111/bjd.21060] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/26/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory skin disease with dysregulation of the IL-17 axis. Recently we reported clinical benefit of brodalumab, a human anti-IL-17 receptor A (IL-17RA) monoclonal antibody, in moderate-to-severe HS. OBJECTIVES To characterize the molecular response to brodalumab in HS skin and serum, and to identify biomarkers of treatment response. METHODS Ten participants that received 210 mg/1.5mL brodalumab subcutaneously at week 0, 1, 2, 4 and every 2 weeks after were included in this molecular profiling study (NCT03960268). RNA-sequencing and immunohistochemistry of nonlesional, perilesional and lesional HS skin biopsies, and Olink high throughput proteomics of serum at baseline, week 4 and week 12 were assessed. RESULTS At week 12, brodalumab led to a decrease of overall inflammation, and improvement of psoriasis-, keratinocyte- and neutrophil-related pathways. Despite perilesional and lesional skin having no differentially expressed genes at baseline, treatment response was best assessed in perilesional skin. In serum, brodalumab treatment decreased pathways involved in neutrophil inflammation. Patients with higher baseline expression of neutrophil-associated Lipocalin-2 (LCN2) in the skin and IL-17A in the serum demonstrated greater decreases of HS-related inflammatory cytokines as measured in skin biopsies at week 12. CONCLUSIONS IL-17RA inhibition by brodalumab impacts several pathogenic inflammatory axes in HS. Perilesional skin provides a valid and robust assessment of treatment response. Expression of LCN2 in skin and IL-17A in serum may be used as biomarkers to stratify patients that may have a superior molecular response to brodalumab =.
Collapse
Affiliation(s)
- Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA.,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD program, New York, NY, USA
| | - John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - David Grand
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Samuel C Williams
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA.,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD program, New York, NY, USA
| | - Hong Hur
- Center for Clinical and Translational Science, The Rockefeller University, New York, NY, USA
| | - Juana Gonzalez
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| |
Collapse
|
41
|
Flora A, Kozera E, Frew JW. Pyoderma Gangrenosum: A Systematic Review of the Molecular Characteristics of Disease. Exp Dermatol 2022; 31:498-515. [PMID: 35114021 DOI: 10.1111/exd.14534] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/30/2022]
Abstract
Pyoderma Gangrenosum is a painful recurrent ulcerative neutrophilic dermatosis in which the pathogenesis is incompletely defined. Current evidence suggests that PG is associated with dysregulation of components of both the innate and adaptive immune system with dysregulation of neutrophil function and contribution of the Th17 immune axis. PG can present in numerous heterogeneous clinical presentations and be associated with multiple inflammatory conditions including Rheumatoid Arthritis, inflammatory bowel disease and hidradenitis suppurativa. However, no critical evaluation of the observed molecular characteristics in PG studies in association with their clinical findings has been assessed. Additionally, emerging evidence suggests a potential role for other cell types and immune pathways including B cells, macrophages, autoantibodies, and the complement system in PG although these have not yet been integrated into the pathogenesis of disease. This systematic review aims to critically evaluate the current molecular observations regarding the pathogenesis of PG and discuss associations with clinical characteristics as well as the evidence supporting novel cell types and immune pathways in PG.
Collapse
Affiliation(s)
- Akshay Flora
- Ingham Institute for Applied Medical Research.,Department of Dermatology, Liverpool Hospital.,University of New South Wales
| | - Emily Kozera
- Ingham Institute for Applied Medical Research.,Department of Dermatology, Liverpool Hospital
| | - John W Frew
- Ingham Institute for Applied Medical Research.,Department of Dermatology, Liverpool Hospital.,University of New South Wales
| |
Collapse
|
42
|
Navrazhina K, Garcet S, Frew JW, Zheng X, Coats I, Guttman-Yassky E, Krueger JG. The inflammatory proteome of hidradenitis suppurativa skin is more expansive than that of psoriasis vulgaris. J Am Acad Dermatol 2022; 86:322-330. [PMID: 34339761 PMCID: PMC8800946 DOI: 10.1016/j.jaad.2021.07.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although hidradenitis suppurativa (HS) shares some transcriptomic and cellular infiltrate features with psoriasis, their skin proteome remains unknown. OBJECTIVE To define and compare inflammatory protein biomarkers of HS and psoriasis skin. METHODS We assessed 92 inflammatory biomarkers in HS (n = 13), psoriasis (n = 11), and control skin (n = 11) using Olink high-throughput proteomics. We also correlated HS skin and blood biomarkers using proteomics and RNA sequencing. RESULTS We identified 57 differentially expressed proteins (DEPs) in lesional psoriasis and 64 DEPs in lesional HS skin, compared to healthy controls. Both HS and psoriasis lesional skin demonstrated a significant upregulation of T helper 1 and T helper 17 proteins. Healthy-appearing perilesional HS skin had 63 DEPs compared to healthy controls. Nonlesional HS and psoriasis skin had 24 and 7 DEPs, respectively, compared to healthy controls. Tumor necrosis factor and 8 other proteins were significantly correlated with clinical severity in perilesional HS skin (2 cm from a nodule). LIMITATIONS Inclusion of only moderate-to-severe patients and the cohort size. CONCLUSION HS has a greater inflammatory profile and is more diffusely distributed compared with psoriasis. Proteins correlated with disease severity are potential disease mediators. Perilesional skin is comparably inflamed to lesional skin, suggesting the need to treat beyond skin nodules.
Collapse
Affiliation(s)
- Kristina Navrazhina
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York; Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York
| | - Sandra Garcet
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - John W Frew
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Xiuzhong Zheng
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Israel Coats
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Laboratory of Inflammatory Skin Diseases, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York.
| |
Collapse
|
43
|
Der Sarkissian S, Hessam S, Kirby JS, Lowes MA, Mintoff D, Naik HB, Ring HC, Suyien NC, Frew JW. Identification of Biomarkers and Critical Evaluation of Biomarker Validation in Hidradenitis Suppurativa: A Systematic Review. JAMA Dermatol 2022; 158:300-313. [PMID: 35044423 DOI: 10.1001/jamadermatol.2021.4926] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease. Objective To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria. Evidence Review Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Findings A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting. Conclusions and Relevance Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free "omics"-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.
Collapse
Affiliation(s)
| | - Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco.,Associate Editor, JAMA Dermatology
| | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nisha Chandran Suyien
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Sydney, Australia
| |
Collapse
|
44
|
Kozera E, Stewart T, Gill K, De La Vega MA, Frew JW. Dupilumab Associated Head and Neck Dermatitis is Associated with Elevated Pre-Treatment Serum Malassezia-Specific Immunoglobulin E: A Multicenter, Prospective Cohort Study. Br J Dermatol 2022; 186:1050-1052. [PMID: 35041759 PMCID: PMC9322676 DOI: 10.1111/bjd.21019] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/29/2021] [Accepted: 01/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Kyra Gill
- Department of Dermatology, Liverpool Hospital.,University of New South Wales, Sydney, Australia
| | | | - John W Frew
- Department of Dermatology, Liverpool Hospital.,University of New South Wales, Sydney, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Liverpool, Sydney, Australia
| |
Collapse
|
45
|
Rick JW, De DR, Shih T, Alavi A, Kirby JS, Naik HB, Frew JW, Sayed CJ, Hsiao JL, Shi VY. Guidance on COVID-19 Vaccination in Hidradenitis Suppurativa Patients: A Modified Delphi Consensus of Experts. Skin Appendage Disord 2022; 8:287-290. [PMID: 35979524 PMCID: PMC9274824 DOI: 10.1159/000521268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Hidradenitis suppurativa (HS) patients may be at increased risk of COVID-19 infection and complications from their medications and comorbidities. There is a lack of expert consensus on recommendations for the COVID-19 vaccine for HS patients. Herein, we aim to provide expert-driven consensus recommendations regarding COVID-19 vaccinations in HS patients. Methods A modified Delphi consensus survey developed by a core committee of 7 dermatologist HS experts consisting of 4 demographic questions and 12 practice statements was distributed to the US HS Foundation-sponsored provider listserv. Participants were attending physician HS experts. Survey results were to be reviewed by the core group and revised and resubmitted until consensus (≥70% agreement) was achieved. Results Among the 33 survey participants, there were 30 (87%) dermatologists, 1 general surgeon, 1 plastic surgeon, and 1 rheumatologist. Consensus for all 12 statements on vaccine counseling and HS treatment counseling was achieved after the first round. Discussion/Conclusion For now, this consensus can serve as a resource for clinicians discussing COVID-19 vaccination with their HS patients. These recommendations will need to be updated as new evidence on COVID-19 emerges.
Collapse
Affiliation(s)
- Jonathan W. Rick
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Devea R. De
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joslyn S. Kirby
- Department of Dermatology Hershey, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Christopher J. Sayed
- Department of Dermatology Chapel Hill, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer L. Hsiao
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vivian Y. Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- *Vivian Y. Shi,
| |
Collapse
|
46
|
Kozera EK, Lowes MA, Hsiao JL, Frew JW. Clinical considerations in the management of hidradenitis suppurativa in women. Int J Womens Dermatol 2021; 7:664-671. [PMID: 35028361 PMCID: PMC8714605 DOI: 10.1016/j.ijwd.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 12/20/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease of the skin with a predilection for women. The role of sex hormones, including estrogen and progesterone, is incompletely understood, but alterations in hormone levels may play a role in disease activity for many patients. Specific clinical considerations should be made for women with HS, particularly in the setting of pregnancy, childbirth, breastfeeding, and menopause. Current knowledge gaps regarding HS include the cumulative impact of disease across an individual's lifespan, as well as the mechanistic role of sex hormones in the disease. An improved understanding of the pathophysiologic role of hormones in HS would optimize our ability to use targeted therapies for hormonally driven disease. Psychological and psychosexual support for women with HS is an important facet of any holistic management strategy for the disease. This article integrates up-to-date pathogenic and mechanistic insights with evidence-based clinical management to optimize care for women with HS.
Collapse
Affiliation(s)
- Emily K. Kozera
- Liverpool Hospital Department of Dermatology, Sydney, Australia
| | | | - Jennifer L. Hsiao
- Division of Dermatology, University of California, Los Angeles, California
| | - John W. Frew
- Liverpool Hospital Department of Dermatology, Sydney, Australia
- University of New South Wales, Sydney, Australia
| |
Collapse
|
47
|
Frew JW, Grand D, Navrazhina K, Garcet S, Krueger JG. Assessing the responsiveness of sonographic biomarkers to Brodalumab therapy in Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2021; 35:e884-e887. [PMID: 34310761 PMCID: PMC8595589 DOI: 10.1111/jdv.17536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/21/2021] [Indexed: 01/24/2023]
Affiliation(s)
- J W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, NY, USA
| | - D Grand
- Laboratory of Investigative Dermatology, Rockefeller University, NY, USA
- Einstein College of Medicine, Bronx, NY, USA
| | - K Navrazhina
- Laboratory of Investigative Dermatology, Rockefeller University, NY, USA
- Tri-Institutional MD-PhD Program Weill Cornell Medical College, New York, NY, USA
| | - S Garcet
- Laboratory of Investigative Dermatology, Rockefeller University, NY, USA
| | - J G Krueger
- Laboratory of Investigative Dermatology, Rockefeller University, NY, USA
| |
Collapse
|
48
|
Frew JW. Autoantibody-Mediated Macrophage Responses Provide the Missing Link between Innate and Adaptive Immune Dysfunction in Hidradenitis Suppurativa. J Invest Dermatol 2021; 142:747-749. [PMID: 34716008 DOI: 10.1016/j.jid.2021.08.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
Hidradenitis suppurativa is considered to be a T helper 17-mediated inflammatory disorder. However, the role of prominent B-cell and plasma cell infiltrates has not been incorporated into pathogenic understanding of the disease. In their new article in the Journal of Investigative Dermatology, Carmona-Rivera et al. (2021) present new insights regarding autoantibody-mediated macrophage activation, which bridges the link between the innate and adaptive immune responses in severe hidradenitis suppurativa.
Collapse
Affiliation(s)
- John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Sydney, Australia; Department of Dermatology, Liverpool Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
| |
Collapse
|
49
|
Frew JW, Alavi A, Kirby JS. An Abscess Is Not a Descriptive Term but an Entity With a Universally Accepted Definition-A Clarification on Semantics-Reply. JAMA Dermatol 2021; 157:1245-1246. [PMID: 34431960 DOI: 10.1001/jamadermatol.2021.2495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, New York
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| |
Collapse
|
50
|
Mintoff D, Benhadou F, Pace NP, Frew JW. Metabolic syndrome and hidradenitis suppurativa: epidemiological, molecular, and therapeutic aspects. Int J Dermatol 2021; 61:1175-1186. [PMID: 34530487 DOI: 10.1111/ijd.15910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/28/2021] [Indexed: 12/12/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, suppurative condition of the pilosebaceous unit. Patients suffering from HS demonstrate a molecular profile in keeping with a state of systemic inflammation and are often found to fit the criteria for a diagnosis of metabolic syndrome (MetS). In this paper, we review the literature with regards to established data on the prevalence of MetS in HS patients and revise the odds ratio of comorbid disease. Furthermore, we attempt to draw parallels between inflammatory pathways in HS and MetS and evaluate how convergences may explain the risk of comorbid disease, necessitating the need for multidisciplinary care.
Collapse
Affiliation(s)
- Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta.,European Hidradenitis Suppurativa Foundation e.V, Dessau, Germany.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V, Dessau, Germany.,Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nikolai P Pace
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.,Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|