BackgroundSeveral case reports and case series have recently explored the association between hidradenitis suppurativa (HS) and inflammatory bowel disease (IBD).ObjectiveWe performed a systematic review and meta‐analysis of case‐control studies to determine (i) the pooled prevalence of IBD in HS cohorts, and (ii) whether HS is more strongly associated with Crohn’s disease or ulcerative colitis.MethodsElectronic searches were performed using five databases, from their inception to August 2018. Case‐control studies reporting the proportion of IBD cases in HS cohorts were included and meta‐analysis performed.ResultsFrom six included studies, a significant association between HS and IBD after pooling of adjusted effect sizes was identified (OR 2.12; 95% CI 1.62–2.77; P = 0.03). Subgroup analysis demonstrated a significant association between HS and Crohn’s disease (OR 2.25; 95% CI 1.52–3.32; P < 0.0001, I2 = 92%) and with ulcerative colitis (OR 1.56; 95% CI 1.26–1.94; P < 0.0001; I2 = 36%).LimitationsStudies reviewed were observational by design which are susceptible to bias and lack of randomization.ConclusionsOur results indicate a statistically significant association between HS and IBD. Our results highlight that all patients with HS should be clinically screened for symptoms of IBD and symptomatic patients referred for further investigations.
Introduction: Despite 3% of Australians identifying as Indigenous, cutaneous malignancies in these patients, including incidence, risk factors and outcomes have not been investigated. This is despite recognition that cancer outcomes in this population are significantly poorer. Methods: We undertook a retrospective case series of Indigenous Peoples who presented to two urban cancer therapy centres for the management of cutaneous malignancies from 2003 to 2017. Risk factors, tumour-specific characteristics, treatments and outcomes were reviewed. Results: Twenty-two patients identified as Aboriginal and/or Torres Strait Islander. The median age at presentation was 61 years and the majority were male (63.6%) and had skin phototype III (86.4%). Patients presented with basal cell carcinoma (50%), squamous cell carcinoma (31.8%), melanoma (9.1%) and cutaneous sarcomas (9.1%). The majority (68.2%) presented with stage II or higher disease, and there were high rates of immunosuppression (45.5%). At the time of reporting, 68.2% patients were alive, 18.2% had died from their skin cancers and 13.6% had died from unrelated causes. Conclusion: This cohort has demonstrated late-stage presentation of skin cancers, with substantial morbidity and mortality from potentially treatable cutaneous malignancies. This parallels other health conditions in Indigenous Australians and has highlighted the need for improved data collection of Indigenous status to better quantify the epidemiology of skin cancer in this population. There is an imperative to improve skin cancer awareness in this population to allow earlier detection and management to ensure better outcomes.
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.
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