Academic literature on the topic 'Hidradenitis suppurativa (HS)'

Hidradenitis suppurativa is a rare chronic / recurrent, infl ammatory and suppurative disease that affects apocrine gland-bearing areas of the skin, including the axillae, inframammary fold, inguinal and anogenital regions. Few reports have described the co-occurrence of Hidradenitis suppurativa and Crohn’s disease and the challenge in managing patients with both conditions. We describe two cases in which HS developed during the course of Crohn’s disease in one patient, while it preceded the onset of Crohn’s disease in the other case. Both patients showed poor response to biological therapy although one case initially responded well to induction therapy with infliximab.

Hidradenitis suppurativa (HS) is a pathology characterized by chronic inflammation and skin lesions. The molecular basis of the inflammatory network remains unclear; however, since microRNAs (miRNAs) are involved in the modulation of inflammation, the composition of a micro-transcriptome RNA library using the blood of HS patients was analysed here. The total miRNA expression profiles of miRNAs from HS patients was assayed by real-time qPCR. Here, compared to healthy controls, miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p expression was found significantly different in HS. Knowing the significance of the miRNA mechanism in inflammatory and immune progression, we suggest that miRNA profiles found in HS patients can be significant in understanding the pathogenesis modality and establishing efficient biomarkers for HS early diagnosis. In particular, miR-338-5p was closely related to HS invasiveness and production of cytokines and was atypically overexpressed. miR-338-5p may represent a good promise as a non-invasive clinical biomarker for HS.

INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory and suppurative disorder of skin bearing apocrine glands. The most severe complication is squamous cell carcinoma (SCC) and we here present three cases, all of which proved fatal, and review the past 40 years of published cases. PATIENTS AND METHODS Three advanced cases of SCC arising in chronic HS have been referred for reconstructive surgery over the past 8 years. Another 28 cases published over the past 40 years were identified using a Medline search (search items in combination: hidradenitis, squamous, carcinoma). RESULTS The male:female ratio was 4:1, most (61%) were perineal or buttock. We found no reports of SCC arising in axillary disease. The symptomatic history of HS prior to SCC diagnosis ranged from 3–50 years with a mean of 25 years. Age at diagnosis of SCC ranged from 27–71 years, and 15 patients (48%) died within 2 years of SCC diagnosis. CONCLUSIONS We advocate that hidradenitis suppurativa arising in extra-axillary sites is a pre-malignant condition, and should not be treated conservatively; curative resection is the mainstay of management.

Hidradenitis suppurativa (HS), or still known under the name Acne Inversa is a multifactor disease that has a chronic flow and starts with the capture of follicles of fibers located in intertriginous regions or anogenital regions. It is followed by recurrent, deep, sub connected and painful nodes, connected intertriginous sinus tracts and hypertrophic scars. Women are more versatile from men, according to 3:1 and more likely to develop axillary and genitofemoral lesions than a male population that develops changes that are localized in the perineal region. The disease itself is unpredictable flow and cannot be certain whether the period of menstruation, pregnancy or menopause may affect the deterioration of the patient’s condition. Usually, the bacterial infection that builds on the state itself is like a secondary phenomenon and most often isolate beta hemolytic streptococcus or staphylococcus. The pathogenesis of the disease is still unclear, but it is thought that the primary event that occurs is follicular occlusion occurring as a result of infundibular keratosis and epithelial hyperplasia. Features show that patients say that the same changes occur in other members of the family. Some genes from Secretase G family are thought to be responsible for the disease itself. On the other hand, there are autoimmune reasons for the very disease, both of the innate and the acquired immunity. However, this disease is classified as neutrophilic restriction. The simplest and most widely used instrument for HS classification in routine clinical practice. It classifies HS into three stages: Stage I: isolated, single or more painful abscesses, no scars and occurrence of cicatrix. Stage II: recurrent pain abscesses with scars, single or multiple but not so extensive. Stage III: diffuse, similar to plates, inflammatory, sick infiltrates or more mutual abscesses. Contracts of joints as a result of limited mobility associated with pain. Because the disease has more stages and treatment itself will be correlated with the stage of the disease. We should emphasize that the disease can also be worsened by some accompanying diseases from which the type 2 diabetes or some other endocrine and metabolic diseases should be distinguished in the first place. Always put the lifestyle and change in everyday habits as it is in the first place to reduce weight if it is increased as well as the cancellation of cigarette smoking. Primary in treatment is maintaining good personal hygiene with soaps that are antibacterial and pastures with mild disinfection. At the beginning of the disease, antibiotics are usually attached as local and systemic administration, most often from the group of tetracyclines. Anti-inflammatory preparations are given in order to reduce inflammation and drug reduction drugs. As antiseptics use salicylic solution, alcohol pine, camphor, ethyl alcohol or iodine. More recently, it goes to make drinks from iodine and potassium hypermangan. If it is not contraindicated, corticosteroid creams and gels as well as a local anesthetic can be reduced. Surgical intervention can be applied to make an incision of a nodule or an apex to be easier drainage and thus reduced the pain of the region concerned. It should be noted that this disease affects the whole family. In the first place, it is necessary to accept the patient’s patient in order not to isolate it from the rest and to participate in social life as before the disease itself. A conversation is necessary by a psychologist with the whole family in order to facilitate life and improve the quality of it.

Abstract: Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicles, usually presenting after puberty on the apocrine gland-bearing areas of the body. It usually flares up periodically and can lead to a severe condition affecting the 20–40-year-old childbearing age group. HS occurs more commonly in women. The main clinical features consist of painful, cicatrizing nodules and abscesses which develop mostly in the axillary, inguinal, genital and perianal regions and also on the breasts. HS is often accompanied by severe pain and malodorous discharge, both of which cause significant psychological stress and social stigma. Our main aim with this review paper is to highlight the gynecological aspects of this disease, as many times – due to the typical localization of the disease – patients seek gynecological care first when they experience the first symptoms of this disease. The most important classification of HS is the Hurley scale, which is based on the severity of the clinical symptoms. In recent years, numerous clinical trials have been conducted to seek optimized care of HS patients. Several drugs are used for the treatment of HS, but in most cases, the treatment has to be switched many times. It is of great importance to carefully follow comorbidities and possible pregnancies as in these cases, careful selection of treatment is required. Thus, HS is not only a dermatological, but also a gynecological disease. With an appropriate treatment and follow-up, the disease can be effectively handled. Orv Hetil. 2019; 160(8): 291–299.

Complex multifactorial pathogenesis of hidradenitis suppurativa eventually results in chronic inflammation of the apocrine gland-bearing areas of the skin. However, the pathogenesis is not fully understood, there are many immune cells and inflammatory pathways of which role is clearly defined in the last years in HS, such as interleukin 1β (IL-1β), tumour necrosis factor alpha (TNFα), IL-17, IL-12 and IL-23. These pathways provide multiple targets for medical treatment. Currently, only adalimumab is licenced in HS, but the numerous ongoing clinical trials promise huge potential therapeutic options in this debilitating disease.

A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.

Hintergrund: Hidradenitis suppurativa (HS) ist eine chronisch-entzündliche Hauterkrankung. Die Evidenzlage spricht zunehmend dafür, dass dysfunktionelle Immunreaktionen sowohl der adaptiven als auch der angeborenen Immunität an HS beteiligt sind. Die kürzlich postulierte Assoziation der HS mit dem metabolischen Syndrom könnte zusätzlich zum Entzündungsgeschehen bei HS beitragen. Ziel: Untersuchung des Entzündungsstatus und des Leukozytenprofils im peripheren Blut von HS-Patienten. Material und Methoden: In einer komparativ aufgebauten Querschnittstudie untersuchten wir hochsensitives C-reaktives Protein (hs-CRP) und das Leukozytenprofil in Blutproben von stationär behandelten HS-Patienten (HS-HOSP), laut Selbstauskunft an HS leidenden Patienten aus der Allgemeinbevölkerung (HS-POP) sowie Populationskontrollen. Ergebnisse: Unsere Studie umfasste 32 Personen in der HS-HOSP-Gruppe, 430 in der HS-POP-Gruppe und 20 780 Kontrollen. Der mediane hs-CRP-Wert betrug in der HS-HOSP Gruppe 5,1 mg/l (Quartilsabstand 2,6-8,2), in der HS-POP-Gruppe 2,2 mg/l (1,0-4,3) und bei den Kontrollen 1,3 mg/l (0,7-2,9). Eine nach Lebensalter und Geschlecht adjustierte Analyse ergab ei- nen signifikant höheren hs-CRP-Wert für beide HS-Gruppen im Vergleich zur Kontrollgruppe (p < 0,0001). In der nach Alter und Geschlecht adjustierten Analyse war in beiden HS-Gruppen die Wahrscheinlichkeit einer Leukozytose im Vergleich zur Kontrolle signifikant erhöht; die Odds Ratio lag für die HS-HOSP-Gruppe bei 4,38 (95-%-KI = 2,18-8,80; p < 0,0001) und für die HS-POP-Gruppe bei 1,95 (95-%-KI = 1,58-2,42; p < 0,0001). Das nach Lebensalter und Geschlecht adjustierte Leukozyten-Differentialblutbild ergab signifikant höhere Werte für neutrophile Granulozyten (p < 0,0001) und Monozyten (p = 0,0014; p = 0,0004) in den HS-Gruppen im Vergleich zu den Kontrollen. Schlussfolgerung: Die mit HS assoziierten hs-CRP-Werte scheinen im intermediären Bereich zu liegen (2,2-5,1 mg/l), was eher auf eine systemische Inflammation als auf eine Infektion hindeutet. Bei der Leukozytose im peripheren Blut bei HS standen neutrophile Granulozyten und Monozyten im Mittelpunkt.

AbstractPanton-Valentine leukocidin (PVL) appears to be a virulence factor which, among others, can exacerbate the pathogenicity of Staphylococcus aureus infections, especially inducing severe necrotic, deep-seated skin infections, abscesses, and recurrences. These peculiarities have some overlaps with hidradenitis suppurativa (HS). Our main aim was to assess if S. aureus producing PVL could have some role in influencing clinical features and/or course of HS, specifically in the suppuration and recurrence of lesions. This pilot, mono-centric, observational study included all adult subjects affected with HS consecutively referring to our HS clinic over a 3-month period. Clinically evident suppuration and at least 2 weeks wash out from any antibiotic were the main inclusion criteria. Purulent material from HS skin lesions was collected with swabs in order to isolate micro-organisms, with specific regard to S. aureus. Detection of PVL was performed by real-time quantitative PCR (RT-qPCR). We also analyzed purulent material from suppurative skin lesions other than HS, as a control. Thirty HS patients were included; 29 purulent lesions (96.7%) harbored at least one bacterial species. Five (16.7%) swab samples were positive for S. aureus, none of which was positive for PVL genes. Among the 30 purulent disorders included as controls, 8 (26.3%) were positive for S. aureus; of these, 4 strains (50%) expressed LPV. The study results seem to exclude the pathogenetic involvement of S. aureus producing PVL in HS; as a result, PVL does not seem to represent a potential target in the future development of HS treatments.

Mucocutaneous adverse events are commonly observed under immune checkpoint inhibitors (ICIs) therapy. Here, we report the case of a 43-year-old male patient with a stage IIIC melanoma disease who developed hidradenitis suppurativa (HS) three months after the beginning of an anti-PD-1 (nivolumab) adjuvant therapy. The patient had no comorbidities other than obesity and severe acne during adolescence. After an unsuccessful course of lymecycline while he was still treated with nivolumab, he gradually improved under zinc gluconate therapy and, more importantly, after nivolumab cessation. HS is a recurrent follicular inflammatory disease in the apocrine gland-bearing areas of the body often associated with obesity, metabolic syndrome, tobacco smoking, inflammatory bowel diseases, psoriasis, and arthritis. In our patient, the latency period between drug initiation and onset of HS symptoms and the improvement after immunotherapy discontinuation, argued strongly in favor of an anti-PD-1-induced HS. Anti-PD-1 therapies often trigger T cells-mediated adverse events that mimic Th17-mediated inflammatory and neutrophilic diseases. We suggest that HS, as other pustular skin reactions and ICIs-induced neutrophilic colitis, can be part of the anti-PD-1 mucocutaneous adverse event spectrum.

This chapter provides an evidence-based approach to the condition known as hidradenitis suppurativa (HS), covering the symptoms, diagnosis, and management of the painful spots caused by HS. HS is a complex condition, and the causes are not completely understood. As with other inflammatory skin conditions, both genes and environment play a role. It gives an explanation of the apocrine glands, and the process by which they become blocked and inflamed in HS, before then moving on to the potential triggers—in particular smoking and weight—associated with the condition. Treatment of HS, including preventative steps, tablet options, and surgical management, are also evaluated in detail.

Hidradenitis suppurativa (HS) is a chronic inflammatory, recurrent, and a debilitating skin disorder that affects the follicular epithelium, specifically of apocrine-gland-bearing regions (such as axillae, inframammary folds, groin, perineal, and/or perigenital). HS prevalence is around 1–4%, and the perineal disease is more common in males. HS is initially characterized by perifollicular lymphocytic infiltrate, which causes glands’ duct occlusion, dilation, rupture of the follicle, and increased inflammation. The result is the formation of tunnels (fistulas) connecting the glands to the skin’s surface. Secondary bacterial infections may occur. The etiological factors are obesity, smoking, and hormones, with a genetic predisposition of up to 40% of patients. HS usually occurs in early adulthood, with inflamed skin nodules, abscesses, pus discharge tunnels, and scarring developed in axillary, inguinal, gluteal, and perineal body sites. The diagnosis is made clinically based on typical lesions, affected regions, and progression (chronicity, persistent lesions, and recurrence). The therapy for HS must be individualized and guided by severity. They range from topical and systemic antibiotics, retinoids, immunosuppressive drugs, local therapies such as laser, phototherapy, hyperbaric, and even regulated and extensive surgical resections, which may be associated with skin grafts.