Dynamic Leukocyte Populations Are Associated With Early- and Late-stage Lesions in Hidradenitis Suppurativa

Altman, Savanna R; Criswell, Sheila

doi:10.1369/0022155420978535

Cited by 6 publications

(4 citation statements)

References 39 publications

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“…Moreover, this downregulation was more pronounced in lesional skin compared to normal skin, except for TNFα 45 . Leukocyte populations seem to be dynamic in HS: in early-stage HS lesions, plasma cells are predominant, whereas in late stages, the main players are granulocytes 46 .…”

Section: Hla-ii Alleles (mentioning

confidence: 99%

Pathophysiology of hidradenitis suppurativa: a systematic review of the literature

Mendes‐Bastos¹,

Andrade²,

Cabete³

et al. 2022

PJDV

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Hidradenitis suppurative (HS) is a multifactorial, recurrent, chronic inflammatory disease with a significant impact on patient's quality of life. The etiopathogenesis of this complex condition is not fully understood. In this systematic review, we aimed to address and clarify the role of genetics, immunity, endocrinology, and skin microbiome together with risk factors in HS etiopathogenesis. A systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed using PubMed ® and Web of Science TM databases on December 3rd, 2021, using patient/population, intervention, comparison and outcomes (PICO) criteria, limited to the last 10 years and English. Reports were analyzed by two independent reviewers. A total of 123 reports were included and divided into five sections: genetics, immunity, endocrinology, microbiome, and risk factors. Regarding genetics, up to 30-40% of patients have a positive family history of HS but only a small subset of these harbor genetic variants in components of the gamma-secretase complex. In fact, in more than 90% of HS patients, the genetic features contributing to disease development remain largely unknown. The immune response is also crucial for HS; it is characterized by antimicrobial peptide and proinflammatory cytokine dysregulation, namely interleukin (IL)-IL-23, IL-12, and Th17 immune response. This immune response in local and, consequently, systemic inflammation is amplified in patients with metabolic syndrome. The relationship between metabolic syndrome and HS is clear, and patients with metabolic syndrome have a higher risk of developing HS. The most recent evidence also associates skin microbiota dysbiosis with HS pathogenesis, contributing to local and systemic inflammation. Besides these intrinsic factors, the role of lifestyle in the development of HS is well accepted. Tobacco smoking and obesity are the main risk factors identified as contributing to HS pathogenesis. Chronic inflammation characterizes HS, a debilitating condition with a complex and multifactorial etiopathogenesis. The current model integrates genetics, immunity, endocrinology, and skin microbiome. Notwithstanding, efforts should be made to improve our comprehension of HS etiopathogenesis, hopefully leading to the development of more effective treatments.

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Section: Hla-ii Alleles (mentioning

confidence: 99%

Pathophysiology of hidradenitis suppurativa: a systematic review of the literature

Mendes‐Bastos¹,

Andrade²,

Cabete³

et al. 2022

PJDV

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“…29,35 The presence of these large, digestionresistant entities in the dermis may generate a foreign body response and explain the increased frequency of giant cells observed in these lesions. 29,[34][35][36] Immune cells then release cytokines and chemoattractants that activate the surrounding stroma and epithelia, including the epidermis, as well as recruiting further leukocytes, especially neutrophils.…”

Section: Hair Follicles the Origin Of Hs?mentioning

confidence: 99%

“…The localization of keratinaceous material in HS tissues (using pan-keratin as well as HF-specific keratin antibodies) will also be important, as it supports the hypothesis that these proteins are potent immunogenic stimulators. 29,[34][35][36] A summary of the CKs altered in HS is presented in Table 1. Keratinocyte function is altered in several other ways in both lesional and perilesional HS skin, including via inflammatory cytokine signalling, wound healing and antimicrobial peptide (AMP) secretion.…”

Section: Keratinocytesmentioning

confidence: 99%

Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction?

Johnston

Kirby

Tobin

2021

Experimental Dermatology

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Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease affecting the axillae, perineum and inframammary regions, among other body sites. Accumulating evidence indicates a hair follicle (HF) focus to this disease, as it is characterized by an early occlusion, followed by rupture of the HF and more generalized skin inflammation. 1 HS is part of the follicular occlusion tetrad of disorders (HS, acne conglobata, dissecting cellulitis of the scalp and pilonidal sinus).It results in painful local nodules and abscesses that can develop into pus-filled malodorous sinus tracts, also known as tunnels, that may result in extensive scarring. 2,3 In addition to cutaneous inflammation, patients with moderate-to-severe HS have evidence of systemic inflammation, as measured by C-reactive protein (CRP) and highsensitivity CRP. 1,4-8 Thus, it is unsurprising that HS is associated with significant psychosocial morbidity and profoundly impaired patient quality of life, when compared to other inflammatory skin diseases such as psoriasis. [9][10][11][12] Aside from the obvious pain and discomfort of HS lesions, patients commonly experience mood disorders (eg depression), altered body image, stigmatization, social isolation and sexual dysfunction. 9,[12][13][14][15][16] Approximately 35% of HS cases in northwestern European cohorts display a positive family history which suggests a genetic component. 17 This is less in some Asian populations at approximately 5% of patients. 18,19 Environmental factors,

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“…Exuberant inflammation observed during acute flares typically parallels elevated serum biomarkers of HS severity. 11 -14 Adoption of intralesional triamcinolone acetonide (ILTAC), a widely used injectable corticosteroid, is effective in mitigating acute inflammation and improving quality of life measures. 15,16 Despite the efficacy of ILTAC for acute HS flares, intralesional administration is unworkable for extensive disease.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Patient Satisfaction Associated With Intramuscular Triamcinolone Therapy for Acute Flares of Hidradenitis Suppurativa

et al. 2023

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Background A lack of consensus exists regarding acute flare management in hidradenitis suppurativa (HS). Intramuscular triamcinolone (IMTAC) therapy is useful in numerous inflammatory conditions; however, it has not been investigated for acute HS flares. Objective To evaluate the efficacy and patient experience associated with IMTAC therapy for acute, severe HS flares. Methods Retrospective analysis and surveys of 45 HS patients were conducted at Albert Einstein College of Medicine/ Montefiore HS Center, Bronx, NY, USA. Results Follow-up visits 6.77 (4.45) weeks after IMTAC therapy revealed significant reductions in mean HS-Physician Global Assessment (PGA) ( P < .001), C-Reactive Protein (CRP) ( P = .03), increased hemoglobin ( P = .004), and improved pain scores ( P < .001). Adjusting for age, sex and concomitant medications, multivariate analysis yielded significantly reduced pain ( P = .02) and increased hemoglobin ( P = .03). Patient surveys indicate that IMTAC was well-tolerated, as reflected in positive mean responses for satisfaction (29 [64%]) and willingness to receive IMTAC injections again (42 [93%]). Conclusions These novel findings demonstrate that IMTAC is a safe, effective, and well accepted adjunct for acute HS management.

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Dynamic Leukocyte Populations Are Associated With Early- and Late-stage Lesions in Hidradenitis Suppurativa

Cited by 6 publications

References 39 publications

Pathophysiology of hidradenitis suppurativa: a systematic review of the literature

Pathophysiology of hidradenitis suppurativa: a systematic review of the literature

Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction?

Efficacy and Patient Satisfaction Associated With Intramuscular Triamcinolone Therapy for Acute Flares of Hidradenitis Suppurativa

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