Background: People with hidradenitis suppurativa (HS) are interested in dietary alterations to manage the condition. However, there are few data on the prevalence of this or the impact on HS activity. The objective of this study was to investigate the prevalence and impact of dietary alterations made by people with HS. Methods: A cross-sectional survey was sent to people with HS through multiple sources. Participants reported food alterations in the prior 6 months. ­Results: Overall, 242 complete surveys were included in this analysis; the mean age was 35.8 years, and most (87.5%) were women. The majority (75.8%, n = 182) altered at least one food from their diet. Within this group, 154 (84.6%) made changes to multiple food groups. The top 5 food groups that were altered were gluten (48.8%), dairy (44.2%), refined sugars (40.0%), tomatoes (36.7%), and alcohol (37.1%). Smoking was eliminated in 27.5% of participants. Some participants (30.9%) reported the change made the HS “much better.” Conclusions: Dietary alteration to manage HS was common among participants in this study. Some people reported improvement in HS activity, but some noted worsening. Additional research is needed to evaluate the efficacy of dietary alteration to manage HS and to better understand the underlying pathomechanisms.

IMPORTANCE Up to 50% of patients may have hidradenitis suppurativa (HS) onset between age 10 and 21 years. To our knowledge, little is known about how adolescents with HS utilize health care during their journey to receiving a diagnosis. OBJECTIVE To assess the clinical characteristics and health care utilization patterns of pediatric vs adult patients with HS.

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the Republic of) Antimalarials are the first-line therapy for cutaneous lupus erythematosus (CLE). While some of the patients that do not initially respond to hydroxychloroquine (HCQ) benefit from the addition of quinacrine (QC), there is a subset of patients that are refractory to both antimalarials. We investigated the immunologic characteristics of patients that respond to antimalarials versus nonresponders. CLE patients were classified as HCQ-responders, HCQ/QCresponders, or HCQ/QC-nonresponders. Immunohistochemistry and qRT-PCR for gene expression were used to characterize the inflammatory cell composition and cytokine expression in lesional skin biopsies from patients. Immunohistochemistry showed that tissueresident memory T (T RM ) cells were significantly higher in HCQ/QC-nonresponders compared to HCQ-and HCQ/QC-responders (p<0.05). While myeloid DCs were significantly higher in HCQ/QC-responders compared to HCQ-and HCQ/QC-nonresponders, plasmacytoid DCs, neutrophils, macrophages, and autoreactive T cells did not differ significantly among the three groups. The HCQ/QC-nonresponder group was distinct from the other groups in that their CLASI scores did correlate positively with the number of T RM cells (r¼0.6335, p<0.05) and macrophages (r¼0.5726, p<0.05). Analyzing the mRNA expression demonstrated a high STAT3 expression in HCQ/QC-nonresponders. Staining also showed IL-22 expression was significantly higher in HCQ/QC-nonresponders versus the HCQ-or HCQ/ QC-responders while IL-17 expression was not significantly different between groups. In conclusion, an increased number of T RM cells and correlation between T RM cells and macrophages with CLASI scores in the HCQ/QC-nonresponders, a finding not seen in either HCQ or HCQ/QC-responders, may indicate that T RM cells and macrophages are more involved in antimalarial-refractory skin disease.

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