Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association

Inflammatory bowel disease(IBD) could be associated with several extra-intestinal manifestations(EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa(HS) is acquiring an increasing interest. IBD, especially Crohn's disease(CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD(95%CI: 15.5%-19.1%) and in 8.5% of UC patients(95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests abacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as "the explosive mixture" at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.

Association of hidradenitis suppurativa with Crohn’s disease

Hidradenitis suppurativa(HS)is a chronic inflammatory skin disorder characterized by recurrent nodules,abscesses,and sinus tracts.Crohn’s disease(CD)is characterized by inflammation of the entire digestive tract and belongs to the group of inflammatory bowel diseases,and there are many extraintestinal manifestations,among which hidradenitis suppurativa is one of the rare extraintestinal manifestations.There appears to be a strong association between CD and HS based on clinical and histological similarities(sinus tract development,granulomatous inflammation,and scarring),intersections in pathogenesis(genetic loci,immune dysregulation mechanisms,and microbiome changes),and commonality in treatment.In this review,we summarize recent studies on the association between HS and CD.

Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis

BACKGROUND Nonalcoholic fatty liver disease(NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver(NAFL) and non-alcoholic steatohepatitis(NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease(ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern.Hidradenitis suppurativa(HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed.AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients.METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH.RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients(P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index(ADDI) was significantly higher among patients with HS/NASH(5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only(2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups.CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores.

Topical 5-aminolevulinic acid photodynamic therapy improved refractory acne conglobata and perifolliculitis capitis abscedens et suffodiens rather than hidradenitis suppurativa

Acne conglobata(AC),perifolliculitis capitis abscedens et suffodiens(PCAS)and hidradenitis suppurativa(HS)are uncommon refractory chronic,inflammatory,scarring diseases but cause serious damage to the quality of life.These three diseases are associated with follicular occlusion.Several studies indicated topical 5-aminolevulinic acid photodynamic therapy(ALA-PDT)improved follicular occlusion besides acne treatment.So we attempted to apply ALA-PDT to medicine resistant AC,PCAS and HS.Topical ALA-PDT was applied to 10 patients with AC,seven patients with PCAS and three patients with HS for more than three sessions.All the patients completed the dermatology life quality index(DLQI)questionnaire and were assessed for the efficacy at the baseline and on two weeks after each treatment.Adverse effects were recorded at each visit.The results showed 25.5%(5/20,two cases of AC and three cases of PCAS)of patients achieved excellent improvement after three sessions of PDT and another 60.0%(12/20,eight cases of AC and four cases of PCAS)of patients achieved good improvement.15.0%(3/20,three cases of HS)got poor response(<20%lesions clearance).Anotherfive cases(three cases of AC and two cases of PCAS)also achieved excellent response after 5–7 sessions of PDT.We also found that papular/nodular,cyst/abscess showed higher clearance rate than sinus/¯stula(88.5%,86.1%versus 11.1%).DLQI was reduced after three sessions of PDT in AC and PCAS patients rather than HS patients.5-ALA-PDT could improve refractory AC and PCAS but could not lead to improvement in late stage of HS.The e±cacy increased with more treatment sessions.

Mammographic Features of Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic suppurative inflammation of the apocrine sweat glands. Axillary, inframammary, intermammary, and peri-areolar apocrine gland involvement may be visualized mammographically. Characteristic lesions tend to be round or oval, lucent, and smooth-bordered, with or without central densities. While diagnosis made purely via mammography is unlikely, having an awareness of this entity may prove useful in patient care in regards to proper utilization of both imaging and consultative resources.

Efficacy of Nd:YAG Laser for the Treatment of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is an inflammatory skin disease that involves sebaceous glands and hair follicles of intertriginous areas, including axillary and inguinal regions. It is often chronic, painful, disabling, and can worsen over time. Besides surgically excising affected areas, effective treatments are currently lacking. The long-pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is a device that has traditionally been used for hair removal, but has recently shown promise in clearing old lesions of HS and preventing new eruptions. In accordance with studies in the current literature, we hypothesize that the Nd:YAG laser will significantly improve subjects with hidradenitis suppurativa compared to standard, uninvasive treatment with topical antibiotics [1,2]. Study aims include: to treat subjects with hidradenitis suppurativa with Nd:YAG laser therapy once monthly for 3 consecutive months, with a one month follow-up;to compare the effectiveness of Nd:YAG treatment on one side of the subject (e.g., right) to treatment with topical antibiotics on the subject’s other side (e.g., left);to assess treatment response using a visual analogue scale;to assess subject satisfaction with treatment using a questionnaire;and to photodocument treatment response at each visit.

Surgical Management of Severe Hidradenitis Suppurativa in Women: Outcome and Quality of Life Assessment

Background: Hidradenitis suppurativa (HS) or Acne inversa sometimes referred to as Verneuil’s disease, is a rare and debilitating condition arising in the intertriginous folds that bear apocrine glands (axillae, groin, perineum, pubis, ano-genital area). It has a deleterious impact on the life of affected persons who tend to be more depressive and poorly socially and sexually connected because of pain, malodor and stigmatization. Methods: We conducted a retrospective study in Henri Mondor Hospital in Créteil, France, in order to assess the effectiveness of surgery as a radical treatment and also assess the factors related to recurrence and the surgical and sexual satisfaction in women operated for severe HS of perineum and genitalia. Results: Fifty-five women were included. We got a recurrence rate of 23.6%. 66.7% of recurrence occurred after localized excision. 83% of patients were satisfied with surgery results and would undergo a revision surgery or recommend it. The factors significantly associated with recurrence were overweight (p = 0.0046), location in groin (p = 0.0040), localized excision (p = 0.02), total excision (p = 0.009), healing via secondary intention (p = 0.001) and disability due to HS (p = 0.006). Assessment of sexual response thanks to the FSFI showed an alteration of all the domains of sexual response but the composite index of 18.51 was below the threshold to diagnose pathologic sexual condition.

Prevalence of Acne Inversa(Hidradenitis Suppurativa)in China:A Nationwide Cross-Sectional Epidemiological Study

Objective:This study was performed to estimate the prevalence of hidradenitis suppurativa(HS)in China and describe the demographic and clinical features of HS in the Chinese population.Methods:This multicenter clinic-based cross-sectional study was conducted in dermatology clinics within 19 hospitals located in 15 cities/provinces across China from September to October 2020.The prevalence of HS was calculated as the percentage of patients with HS among all visitors at participating clinics during the 1-month study period.HS was independently diagnosed by two certified dermatologists at each site.All visitors at participating clinics were screened,and all patients with HS were invited to participate in a questionnaire survey to elucidate the demographics and clinical features of HS in the Chinese population.Results:We identified 92 patients with HS among 274,742 visitors at participating clinics.The prevalence rate was 0.03349%or 33.49 per 100,000 population(95%confidence interval,26.64–40.32),and the female:male ratio was 1.0:4.7.Conclusion:The overall prevalence of HS in China was lower than that in Western and other Asian countries with a predominance of male patients.

Diagnosis and Treatment of Acne Inversa/Hidradenitis Suppurativa in China: An Expert Consensus Statement (2021 Version)

Acne inversa/hidradenitis suppurativa is a chronic,recurrent,inflammatory skin disease that affects the pilosebaceous units,causinfollicular occlusion.The etiology and pathogenesis of acne inversa/hidradenitis suppurativa involves internal and external factors such as genetic susceptibility,inflammation and immunity,microorganisms,obesity,and smoking.acne inversa/hidradenitis suppurativa is difficult to treat,and the current aim of treatment is to control the frequency and duration of disease flares and improve the quality of life.Treatment protocols for acne inversa/hidradenitis suppurativa should be selected based on the disease severity grade.Medical treatments include antibiotics,retinoids,biologics,immunosuppressive agents,and antiandrogen agents.Adjuvant treatments include surgery and laser/light therapies.This consensus aims to further standardize the diagnosis and treatment procedures of acne inversa/hidradenitis suppurativa in China to facilitate its diagnosis and treatment.

Hidradenitis Suppurativa: An Exploration of Genetic Perturbations and Immune Dysregulation

Hidradenitis suppurativa(HS)is a chronic,inflammatory skin condition that poses a significant diagnostic and therapeutic challenge for clinicians,as the underlying etiology and pathogenesis remains unclear.The host of genetic mutations and immune dysfunction has been identified to be involved in the pathogenesis of HS during recent years.These genetic defects,including monogenetic mutations altering subunits ofγ-secretase,a protease that functions through Notch signaling to maintain skin appendages,promote epithelial stability,suppress/terminate innate immune responses(ie,Toll-receptors),further have the propensity to induce aberrant cytokine responses that create to a proinflammatory environment,consequently induce hyperkeratosis and promote expression of pro-inflammatory,locally destructive matrix metalloproteinases.Cytokine-driven inflammation propagates the disease state of HS and contributes to the formation of painful subcutaneous nodules,abscesses,and eventually,fistulas and draining sinus tracts.A closer look at genetic mutations linked to the disease may explain the immune perturbations seen in HS.An understanding of the immune cells and inflammatory markers expressed in affected individuals provides insight into disease pathogenesis and can help identify therapeutic targets.

Risk analysis of diabetes mellitus in patients with hidradenitis suppurativa: a meta-analysis

Objective The results of association studies between hidradenitis suppurativa and diabetes mellitus remain controversial.This study aimed to investigate the association between hidradenitis suppurativa and diabetes mellitus by reviewing all the available evidences comprehensively.Methods We performed a meta-analysis on observational studies that reported the odds ratio (OR) comparing diabetes mellitus risk in patients with hidradenitis suppurativa versus participants without hidradenitis suppurativa.Pooled OR and 95％ confidence intervals (95％CIs) were calculated using a random effect,generic inverse variance methods of DerSimonian and Laird.Results Four studies (two cross-sectional studies and two case-control studies) including 5,362 patients with hidradenitis suppurativa and 23,193participants without hidradenitis suppurativa were identified and coved in the meta-analysis.The pooled OR of diabetes mellitus in patients with hidradenitis suppurativa was 1.95 (95％CI:1.31-2.91).The statistical heterogeneity of this meta-analysis was I2 =63％.Conclusions This meta-analysis shows a signi ficant risk increase of diabetes mellitus incidence among patients with hidradenitis suppurativa.Patients with hidradenitis suppurativa should be regularly screened for diabetes mellitus as complication.

1例化脓性汗腺炎青少年患者双侧腋窝皮肤溃疡的护理

本文总结1例青少年化脓性汗腺炎(HS)患者双侧腋窝皮肤溃疡的护理经验。护理要点包括:医护合作控制MRSA感染;保证有效的负压封闭引流;观察皮瓣的成活情况;健康教育以提升患者主动管理伤口和预防复发的能力;减轻患者伤口的疼痛感;预防情绪障碍等。通过综合治疗和护理,患者双侧腋窝创面达到上皮化。

克罗恩病与化脓性汗腺炎发生风险的两样本孟德尔随机化研究

目的利用两样本孟德尔随机化研究克罗恩病与化脓性汗腺炎之间的因果关系。方法从IEU open GWAS数据库获得克罗恩病和化脓性汗腺炎的汇总数据集,样本量分别为212356人和211548人,利用两样本MR研究,将遗传因素作为工具变量,运用MR-Egger法、加权中位数法、逆方差加权法、简单模型和加权模型这5种方法来探讨克罗恩病和化脓性汗腺炎之间的因果关系。结果筛选出6个单核苷酸多态性作为工具变量,IVW、加权中位数和加权模式这3种方法得到的结果均支持克罗恩病与化脓性汗腺炎风险增加的因果关系。IVW结果显示OR=1.64,95%CI:1.28~2.09,P<0.001;加权中位数法显示OR=1.71,95%CI:1.24~2.35,P<0.001;加权模式显示OR=1.74,95%CI:1.21~2.50,P=0.032。Cochran’Q检验结果IVW(P=0.412)和MR-Egger(P=0.322),表明SNP之间不存在异质性。MR-Egger回归结果(P=0.607)表明研究结果不存在基因的水平多效性。结论两样本孟德尔随机化分析结果支持克罗恩病和化脓性汗腺炎发生风险增加存在因果关系。

化脓性汗腺炎4例临床分析

目的探讨化脓性汗腺炎的临床、组织病理特点。方法回顾性分析4例化脓性汗腺炎临床资料。结果本组病例表现为单发或多发紫红色或化脓性结节,有不同程度的疼痛和压痛,潜行性不规则溃疡,融合性斑块、脓肿及瘢痕形成等。组织病理表现为棘层肥厚,假上皮瘤样增生,真皮全层不等数量的中性粒细胞、浆细胞、淋巴细胞、组织细胞和少量嗜酸性粒细胞浸润,分布不均,典型的毛囊、汗腺等附属器罕见。部分见真皮中浅层血管内皮细胞增生、新生毛细血管及异物肉芽肿形成,毛囊周围炎和小汗腺周围炎,胶原纤维细胞增生和胶原化。4例抗酸染色和PAS染色均未查到结核杆菌和真菌。分泌物真菌和结核杆菌培养均阴性。4例均依据其临床特征、组织病理学表现、实验室检查及排除其他诊断证实。结论化脓性汗腺炎诊断需结合病史、临床表现、微生物学检查等,并排除结核及真菌感染等。应早发现早治疗,晚期病变对治疗反应不佳。

毛囊闭锁三联征一家系致病基因精细定位研究

目的对1例毛囊闭锁三联征家系进行连锁分析精细定位研究,确定其致病基因位点。方法应用覆盖1号染色体1p21.1～1q25.3区域的17个微卫星标记对该家系进行基因分型、连锁分析和单倍型分析。结果在1号染色体上的微卫星标记D1S2707处获得最大LOD值为2.11(重组率θ=0.00)。通过单倍型分析将该家系致病基因定位在微卫星标记D1S2715和D1S484之间的染色体1q21.3～1q23.2区域。结论该研究提示1p21.1～1q25.3(61.8cM)是毛囊闭锁三联征致病基因连锁区域,并将致病基因支持连锁范围缩小至1q21.3～1q23.2(9.8cM)区域。

毛囊闭锁三联征伴Dowling-Degos病一家系致病基因定位研究

目的:通过对一家系4代毛囊闭锁三联征患者进行致病基因连锁分析定位研究,定位毛囊闭锁三联征家系致病基因,探索毛囊闭锁三联征遗传学发病机制。方法:收集毛囊闭锁三联征伴发Dowling-Degos病家系成员血样并提取DNA,作角蛋白5基因扩增和直接测序;选取覆盖1p21.1～1q25.3区域的12个微卫星标记,应用CEQ8800测序仪对该家系个体样本进行微卫星标记的基因分型,利用Linkage软件(5.2Version)进行连锁分析。结果:该家系成员中未发现角蛋白5基因突变;在染色体1p21.1～1q25.3区域上的微卫星标记处均获得小于-2的LOD值(重组率θ=0.00)。结论:该毛囊闭锁三联征伴发Dowling-Degos病家系与1p21.1～1q25.3区域不存在连锁,毛囊闭锁三联征可能存在遗传异质性。

去顶开窗手术治疗肛周化脓性汗腺炎疗效分析(附12例报告)

目的探讨去顶开窗术治疗肛周化脓性汗腺炎的疗效。方法对12例肛周化脓性汗腺炎患者采用去顶开窗手术治疗的临床资料作回顾性分析。结果 2例患者术后平均6个月复发,再次手术后痊愈。10例患者术后平均随访33个月,治疗部位无复发。结论去顶开窗手术是一种有效、简单、微创、保留组织的外科治疗技术,适用于肛周化脓性汗腺炎的治疗。

病变区域刃厚皮片联合头皮刃厚皮片移植修复大面积顽固性Ⅲ期化脓性汗腺炎切除后创面

目的:评估利用病变区域有活力的上皮组织,回植修复化脓性汗腺炎病变组织切除后大面积皮肤缺损的临床效果。方法:将笔者科室2002年1月-2019年3月的7例顽固性Ⅲ期化脓性汗腺炎患者作为研究对象,以滚轴刀削取病变区较完整的表皮及真皮浅层皮片,清洗干净后回植到病变切除后的创面上,剩余创面以头皮刃厚皮片覆盖,加压包扎,创面规律换药,观察皮片成活情况。结果:本组共7例患者,创面植皮成活率高,创面经规律换药治疗后愈合良好。结论:利用病变区域刃厚皮片回植治疗顽固性化脓性汗腺炎切除后创面,减少了正常皮肤供皮区取皮量,可以一次性切除较大面积病变组织,有利于缩短治疗大面积顽固性化脓性汗腺炎的疗程,减少手术次数,值得临床上广泛应用。

冰-矾散耳道施药治疗急性化脓性中耳炎80例

目的观察中医验方冰-矾散治疗急性化脓性中耳炎(脓耳)临床疗效。方法对117例患者分别采用冰-矾散(治疗组)与复方氧氟沙星滴耳液(对照组)治疗,并进行临床观察。结果治疗(80例)临床有效率为91.25%,细菌清除率81.40%;对照组(37例)临床有效率为86.49%,细菌清除率为78.85%。两组疗效均明显,但对重症患者的疗效有极显著性差异(P<0.01)。结论中医验方冰-矾散协同抗生素,以外耳道施药治疗急性化脓性中耳炎,能提高疗效、缩短疗程。

阿达木单抗治疗反常性痤疮3例

患者1,男性,60岁,臀部脓肿反复发作伴疼痛20余年。患者2,男性,59岁,臀部反复皮疹、破溃伴疼痛3年。患者3,男性,18岁,头皮反复红疹破溃溢脓伴疼痛6个月。诊断:反常性痤疮。治疗上给予皮下注射阿达木单抗注射液,治疗时间分别为18月、5月及6月,治疗后观察国际化脓性汗腺炎严重程度评分(ISH4)均下降,均达到化脓性汗腺炎临床反应评价(HiSCR)临床有效。所有患者未出现严重感染、恶性肿瘤、上呼吸道感染、注射部位反应、头痛及骨骼肌疼痛等不良反应,停药后随诊6个月均未复发。