The bacteriology of hidradenitis suppurativa: a systematic review

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disabling skin disease consisting of recurrent nodules, sinuses, fistulas and scarring involving the intertriginous regions. HS is often a therapeutic challenge and most treatments are off-label. A better understanding of aetiology and pathogenesis of HS may facilitate the development of effective treatment. Although the clinical presentation is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacteria specimens. Consistent findings of Gram-positive cocci and Gram-positive rods including Staphylococus aureus, coagulase-negative staphylococci (CoNS) and Corynebacterium species in deep tissue samples have been demonstrated in HS and may constitute a central target for the immune system. Efficacy of antibiotics, that is rifampicin, clindamycin or tetracycline, supports a microbial role in disease pathogenesis. However, these antibiotics also work as immunomodulators of especially T cells, and the underlying mechanisms may therefore be more complex. We performed a systematic review of previous studies investigating the bacterial flora in hidradenitis suppurativa. We searched PubMed, EMBASE, Royal Danish Library and Cochrane library (search date 11 December 2014). A total of 66 papers were identified and nine papers published between 1988 and 2014 matched our inclusion criteria, yielding bacteriological data of a total of 324 patients with HS (mean age 36.8 years and female/male ratio 215/109). This overview of the bacteriology may aid researchers and physicians exploring the potential role of bacteria in HS. Furthermore, to stimulate a broader debate, we also present different viewpoints on the possible role of bacteria in HS.

Hidradenitis Suppurativa in General Practice: A Pilot Study

“…HS is a complex disease with various phenotypic expressions and the diagnosis could be easily missed or confused with common infectious skin diseases [1]. Indeed, numerous elements like the common use of antibiotics in HS and the suggested hypothesis of an altered innate and adaptive immunity for its pathogenesis may reinforce the confusion with a skin infection [17]. Interestingly, HS is often classified in the skin bacterial infection chapter of some handbooks [18].…”

Update on Hidradenitis Suppurativa (Part I): Epidemiology, Pathogenesis, Severity assessment and Comorbidities

“…55 However, these antibiotics also have anti-inflammatory activity. 55 Therefore, the underlying mechanisms may be more complex.…”

“…55 However, these antibiotics also have anti-inflammatory activity. 55 Therefore, the underlying mechanisms may be more complex. 55,56 Bacterial collection from superficial lesions has frequently shown negative results or a mixed growth of commensal microbes.…”

“…55 Therefore, the underlying mechanisms may be more complex. 55,56 Bacterial collection from superficial lesions has frequently shown negative results or a mixed growth of commensal microbes. 33,57,58 Studies using CO2 laser vaporization of lesional skin level by level or aspirating pus from the deeper parts of HS lesions to prevent contamination by the normal skin microflora, found Gram-positive cocci and rods including Staphylococus aureus, coagulase-negative staphylococci (CoNS) as S. epidermidis, Corynebacterium species and anaerobes of the commensal flora.…”

“…33,57,58 Studies using CO2 laser vaporization of lesional skin level by level or aspirating pus from the deeper parts of HS lesions to prevent contamination by the normal skin microflora, found Gram-positive cocci and rods including Staphylococus aureus, coagulase-negative staphylococci (CoNS) as S. epidermidis, Corynebacterium species and anaerobes of the commensal flora. 1,55 Biofilm formation can also have a role in HS. 56 A retrospective study of 27 patients using histopathology found biofilm-like structures in one-fifth of the samples.…”