Axillary Skin Research Articles

Effect of “HuChou San” on ABCC11 mRNA levels and MRP8 protein expression in skin tissue from bilateral axilla of axillary osmidrosis patients

Purpose: To investigate the effect of “HuChou San” on axillary osmidrosis (AO) by measuring ABCC11 mRNA levels and MRP8 protein expression in axillary skin tissues from “HuChou San”-treated AO patients.Methods: Forty AO patients undergoing treatment at Shanghai Ninth People’s Hospital were enrolled in the study. Tissues from axillary regions were initially treated for 10 min with a solution of copper sulphate and zinc sulphate, followed by treatment with gentle application of “HuChou San” once daily for 3 months. Ten healthy individuals served as untreated control. Axillary skin tissue was surgically collected at 0, 1, 2, and 3 months of treatment. The expressions of ABCC11 mRNA and MRP8 protein in axillary skin samples were determined using qPCR and Western blot, respectively.Results: The qPCR and Western blot results showed higher levels of ABCC11 mRNA and MRP8 protein in AO patient tissues than in healthy controls. However, “HuChou San” treatment markedly reduced tissue levels of ABCC11 mRNA and MRP8 protein (p < 0.05), when compared to tissues extracted prior to treatment. These effects were time-dependent and increased as treatment duration increased (p < 0.05).Conclusion: “HuChou San” powder significantly and time-dependently reduced ABCC11 mRNA and MRP8 protein expressions in AO axillary tissue of AO patients. It is known that ABCC11 mRNA and MRP8 protein are two important indices of AO. Therefore, the findings of this study suggest that“HuChou San” has potentials for use as a novel alternative therapy for AO.
 Keywords: ABCC11 mRNA, MRP8 protein, Axillary osmidrosis, HuChou San

A puzzling diagnosis: mycosis fungoides masquerading as pyoderma gangrenosum

<p class="abstract">Mycosis fungoides (MF) is a form of cutaneous T cell lymphoma that initially affects the epidermis, and is characterized by the clonal proliferation of mature cluster of differentiation (CD4)+T cells. We report a 73-year old male presenting with chin and right axillary skin lesions that had ulceration and granulating areas. Initial biopsy revealed mixed inflammatory cell infiltrate, which suggested an initial diagnosis of pyoderma gangrenosum. Despite treatment, the progressive worsening of the skin lesions prompted multiple repeat biopsies, which eventually revealed a predominance of T cells within the infiltrate. A T cell receptor rearrangement resulted in elevated monoclonal T cell populations, confirming a diagnosis of MF. Subsequent positron emission tomography (PET) scans revealed metastatic involvement of the disease, which ultimately led to the patient’s death. Clinical presentations of MF can mimic several different clinical entities, including pyoderma gangrenosum. This report highlights the importance of a multimodal approach to the diagnosis of unidentified skin lesions.</p>

Variables Affecting Delivery of Glycopyrronium Tosylate Through Human Skin In Vitro.

Hyperhidrosis is a condition characterized by excessive sweating beyond what is required for normal thermal regulation. It can involve multiple body areas including the axillae, palms, soles, or craniofacial regions. Glycopyrronium tosylate (GT) is a topical anticholinergic approved by the FDA (2018) for treatment of primary axillary hyperhidrosis in patients 9 years and older. Gain insight into variables (anatomical sites, occlusion, exposure time) affecting GT delivery into human skin. Human skin from different anatomical regions (palmar, plantar, axillary, and abdominal skin) was mounted into flow-through diffusion cells (MedFlux-HT®). GT solution (2.4%) was applied at 10 mg/cm2 and the receiving fluid was collected every 2 hours, for 24 hours. GT penetration was determined using LC/MS/MS. The effect of occlusion was assessed by covering the skin with either parafilm or saran wrap, and the effect of exposure time was assessed by incubating the skin for 5, 15, or 60 minutes before washing off the GT from the surface. GT delivery through palmar and plantar skin was up to 40-fold lower compared to delivery through axillary or abdominal skin. Occlusion increased GT delivery up to 10-fold. Reducing exposure time from 24 hours to either 5, 15, or 60 minutes, decreased GT flux by 90%. However, occlusion during these varied exposure times was able to restore GT delivery to levels found in the 24-hour exposed, non-occluded control group. These in vitro skin penetration studies showed that skin thickness, exposure time, and occlusion substantially influenced GT delivery, potentially impacting clinical trial design. J Drugs Dermatol. 2020;19(11): doi:10.36849/JDD.2020.5062.

Mupirocin and Chlorhexidine Genotypic Resistance Found in Staphylococcus aureus Isolated From Young Infants Below 90 Days Old: A Genetic Basis for Eradication Failure.

To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old. S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin. During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072). Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.

The impact of different hair-removal behaviours on the biophysical and biochemical characteristics of female axillary skin.

ObjectiveThe impact of hair removal on the biophysical and biochemical characteristics of human axillary skin is not fully understood. This study investigated the effect of different hair‐removal techniques on biophysical parameters and the concentrations of key inflammatory biomarkers in the axillae of female Thai subjects. Axillary hair was removed by shaving, plucking or waxing.MethodsFollowing a 2‐week washout phase without hair removal, subjects underwent visual assessment for erythema and skin dryness in one (randomized) axilla, then, hair was removed from the axilla by shaving, plucking or waxing according to each subject’s established habit. Erythema and dryness were assessed again 30 min after hair removal, and buffer scrubs collected from depilated and non‐depilated axillae and analysed for inflammatory cytokines; after a further 48 h, erythema, dryness and post‐inflammatory hyperpigmentation (PIHP) were assessed in the depilated axilla. Biophysical assessments (skin hydration, barrier integrity, elasticity and roughness) were made in depilated and non‐depilated axillae.ResultsAll three hair‐removal techniques induced an increase in axillary erythema and skin dryness. Shaving was associated with significantly less erythema (P < 0.01), but significantly greater skin dryness (P < 0.05) versus the other techniques 30 min after hair removal. There were no between‐technique differences in PIHP or biophysical parameters. Interleukins IL‐1α and IL‐1RA concentrations increased, and IL‐8 concentration decreased following hair removal by each technique.ConclusionThis is the first study to identify the principal cytokines associated with the inflammatory process triggered by axillary hair removal. A single hair‐removal treatment did not appear to induce PIHP or further biophysical changes to the skin.

Transcriptomes from German shepherd dogs reveal differences in immune activity between atopic dermatitis affected and control skin

Canine atopic dermatitis (CAD) is an inflammatory and pruritic allergic skin disease with both genetic and environmental risk factors described. We performed mRNA sequencing of non-lesional axillary skin biopsies from nine German shepherd dogs. Obtained RNA sequences were mapped to the dog genome (CanFam3.1) and a high-quality skin transcriptome was generated with 23,510 expressed gene transcripts. Differentially expressed genes (DEGs) were defined by comparing three controls to five treated CAD cases. Using a leave-one-out analysis, we identified seven DEGs: five known to encode proteins with functions related to an activated immune system (CD209, CLEC4G, LOC102156842 (lipopolysaccharide-binding protein-like), LOC480601 (regakine-1-like), LOC479668 (haptoglobin-like)), one (OBP) encoding an odorant-binding protein potentially connected to rhinitis, and the last (LOC607095) encoding a novel long non-coding RNA. Furthermore, high mRNA expression of inflammatory genes was found in axillary skin from an untreated mild CAD case compared with healthy skin. In conclusion, we define genes with different expression patterns in CAD case skin helping us understand post-treatment atopic skin. Further studies in larger sample sets are warranted to confirm and to transfer these results into clinical practice.

062 Hidradenitis suppurativa RNA-seq skin transcriptome overlaps with psoriasis vulgaris and reveals a marked upregulation of multiple targetable cytokines

Hidradenitis Suppurativa (HS) is a chronic inflammatory dermatosis of inguinal, axillary, and submammary skin. Using established consensus definitions, unaffected, perilesional and lesional HS skin samples were collected and RNA-sequencing performed. A mixed-effect model was estimated. Hypotheses were tested under the general framework for linear models in the R limma package. P values from t-tests were adjusted for multiple hypotheses using the Benjamini–Hochberg procedure. Statistical analysis revealed a HS transcriptome of approximately 5000 genes (FCH>1.5; fdr<0.05), with HS samples clustering distinctly away from control skin.

Primary Breast Augmentation Using Axillary Skin Incision, Submuscular Implants, and Intraoperative Tissue Expansion

Background:Primary breast augmentation in small, pointed, or tubular breasts using axillary skin incision, submuscular cohesive gel implants, and intraoperative tissue expansion dramatically reduces complications.Methods:A 2.5- to 3.5-cm-long incision is made in the hair-bearing part of the axillae beside a natural fold. Incisions are opened using dissection away from the axillae, and an opening is made underneath the muscle on top of the thoracic cage. Blunt finger dissection is performed, and temporary breast expanders and special dissectors are inserted. The expanders create volume and desired breast shape. Sterility is ensured by entering implant pockets only with expanders and elevators and changing gloves before placing implants. No irrigation or antibiotic solution is used on implants or in the pockets. One thousand three hundred ten breast augmentations were performed between 2004 and 2019 (including a 2-year follow-up) using textured, cohesive round implants. Patients were followed up 3–4 months postoperatively. The parameters analyzed were size, shape, firmness, scars, and sensation in the nipple areola complexes. Patients contacted the clinic if problems occurred.Results:Of the 1,310 patients, only 2 had a Baker grade 3–4 capsular contraction. We also found 2 cases of implant rupture at the end of the 10-year guarantee period. Implants were replaced with identical ones. No infections were seen. Six cases of implant malposition were corrected by surgery. The total number of reoperations was 10 (0.8%).Conclusions:The axillary skin incision is an extremely efficient technique with few complications. The lymphatic drainage system is preserved, and implant pockets are left in a virgin state.

Risk factors for Staphylococcus capitis pulsotype NRCS-A colonisation among premature neonates in the neonatal intensive care unit of a tertiary-care hospital: a retrospective case-control study

SummaryBackgroundA S. capitis strain called NRCS-A (S. capitis NRCS-A) has emerged as a cause of bloodstream infections and sepsis in neonatal intensive care units (NICUs) worldwide.AimTo identify risk factors for S. capitis NRCS-A colonisation among neonates, Dunedin Hospital NICU, Dunedin, New Zealand, from September 2013 through March 2015.MethodsWeekly axillary swabs categorised eligible neonates as a case or a control. A case was defined as a week ending with a neonate's first positive swab for S. capitis NRCS-A and a control as a week in which a neonate remained negative. Weekly exposures were abstracted from hospital medical records. Analyses were performed using conditional logistic regression.FindingsThe median (range) gestational age at birth of participants was 32.7 (23.1–41.3) weeks. Participants contributed 26 weeks of case data and 177 weeks of control data. On adjusted analysis compared with matched controls, cases had higher odds of requiring invasive mechanical ventilation (OR 3.6, 95% CI: 1.1–11.6, p=0.035) and of a patent ductus arteriosus (PDA) (OR 3.0, 95% CI: 1.0–9.0, p=0.044). Cases had lower odds of being part of a multiple birth (OR 0.24, 95% CI 0.08–0.73, p=0.001), having an area of inflamed skin (OR 0.31, 95% CI: 0.13–0.75, p=0.009), and specifically an area of inflamed axillary skin (OR 0.08, 95% CI: 0.01–0.50, p=0.006).ConclusionsWe found that premature neonates with invasive mechanical ventilation and PDA had greater odds for S. capitis NRCS-A colonisation. Transmission may be mediated by increased staff contact, but prospective research is needed to confirm this.

Angioid streaks and obstructive sleep apnea syndrome: are they related?

Sleep apnea syndrome (OSAS) has been associated with different ocular manifestations including glaucoma, floppy eye syndrome, punctate keratitis, keratoconus, and optic neuropathy. Angioid streaks are mainly associated with pseudoxanthoma elasticum (PXE) although they can appear in other systemic conditions affecting the elastic fibers. This is a prospective, cross-sectional study. A complete ophthalmic examination was performed in 92 patients undergoing overnight polysomnography for suspicion of OSAS. Diagnosis and classification of OSAS were made based on apnea-hypopnea index (AHI). Stereoscopic optic disc photographs were taken in all patients and independently evaluated by two ophthalmologists. Patients with angioid streaks were referred to a dermatologist for axillary skin biopsy in order to rule out pseudoxanthoma elasticum or other skin abnormalities. Bilateral angioid streaks were observed in three patients who had been diagnosed with severe OSAS (AHI > 30/h). No clinical features characteristic of pseudoxanthoma elasticum or other pathological skin signs were observed. Skin biopsies were normal for all three patients, supporting the diagnosis of idiopathic angioid streaks. One of the patients developed bilateral choroidal neovascularization secondary to the angioid streaks over subsequent years. In view of the low prevalence of idiopathic angioid streaks in the general population, the finding of angioid streaks in patients with severe OSAS suggests OSAS as a possible risk factor for its development. The hypothesis of a connective tissue abnormality that could explain an association between both entities deserves further elucidation.

Candida auris Forms High-Burden Biofilms in Skin Niche Conditions and on Porcine Skin.

Emerging pathogen Candida auris causes nosocomial outbreaks of life-threatening invasive candidiasis. It is unclear how this species colonizes skin and spreads in health care facilities. Here, we analyzed C. auris growth in synthetic sweat medium designed to mimic axillary skin conditions. We show that C. auris demonstrates a high capacity for biofilm formation in this milieu, well beyond that observed for the most commonly isolated Candida sp., Candida albicans The C. auris biofilms persist in environmental conditions expected in the hospital setting. To model C. auris skin colonization, we designed an ex vivo porcine skin model. We show that C. auris proliferates on porcine skin in multilayer biofilms. This capacity to thrive in skin niche conditions helps explain the propensity of C. auris to colonize skin, persist on medical devices, and rapidly spread in hospitals. These studies provide clinically relevant tools to further characterize this important growth modality.IMPORTANCE The emerging fungal pathogen Candida auris causes invasive infections and is spreading in hospitals worldwide. Why this species exhibits the capacity to transfer efficiently among patients is unknown. Our findings reveal that C. auris forms high-burden biofilms in conditions mimicking sweat on the skin surface. These adherent biofilm communities persist in environmental conditions expected in the hospital setting. Using a pig skin model, we show that C. auris also forms high-burden biofilm structures on the skin surface. Identification of this mode of growth sheds light on how this recently described pathogen persists in hospital settings and spreads among patients.

Pressure-and dose-controlled, needle-free, transcutaneous pneumatic injection of botulinum neurotoxin-A for the treatment of primary axillary and palmoplantar hyperhidrosis.

Botulinum neurotoxin (BoNT) effectively downregulates the secretion of eccrine sweat glands in patients with axillary and palmoplantar primary hyperhidrosis (PH). To demonstrate the efficacy and safety of pressure- and dose-controlled, needle-free, transcutaneous pneumatic injection (TPI) of BoNT-A for treating axillary and palmoplantar PH. Needleless TPI-BoNT-A treatments were delivered on the axillary or palmoplantar skin at a pneumatic pressure of 2.05 bars and an injection volume of 0.08mL/shot. The efficacy thereof was assessed by evaluating starch-iodine test results and Hyperhidrosis Disease Severity Scale (HDSS) scores. At baseline, median HDSS scores were 3 (IQR, 3-4) for axillary lesions and 4 (IQR, 3.5-4) for palmoplantar lesions. Median HDSS scores at 1month after TPI-BoNT-A treatment significantly decreased to 1 (IQR, 1-1.75) for axillary lesions (P<.001) and 1 (IQR, 1-2) for palmoplantar lesions (P<.001). Median global improvement scale scores were 4 (IQR, 3.25-4) for axillary PH and 3 (IQR, 2.5-4) for palmoplantar PH (P>.05). In all patients, pain was tolerable during treatments for both axillary and palmoplantar PH after the application of topical anesthetic cream. Pressure- and dose-controlled, needle-free, BoNT delivery effectively and safely decreased sweating in axillary and palmoplantar skin.

CADASIL and Cavernomas: A Common Mechanism.

CADASIL and Cavernomas: A Common Mechanism.

Contribution to characterization of skin field cancerization activity: morphometric, chromatin texture, proliferation, and apoptosis aspects

BackgroundA skin field cancerization is a cutaneous area with subclinical changes resultant from chronic sun exposure, with a higher predisposition to development of pre-neoplastic and neoplastic lesions. So far, there are no well-defined objective parameters that can indicate their degree of activity. ObjectivesTo describe and compare morphometric aspects and expression of factors related to apoptosis and cell proliferation in actinic keratosis (AK), in both photoexposed and photoprotected epidermis. MethodsA cross-sectional study of patients with actinic keratosis in the forearms, biopsied at two points: the actinic keratosis and the axillary region. The biopsies of the actinic keratosis, perilesional area, and axilla were evaluated through keratinocyte intraepithelial neoplasia (KIN), and immunohistochemistry of p53, survivin, and Ki67. Nuclear morphometry of basal layer cells was performed through digital image analysis: entropy, area, perimeter, Ra, fractal dimension, circularity, color intensity, and largest diameter. ResultsThere were 13 patients included and 38 actinic keratosis biopsied. In morphometry, 1039 nuclei were analyzed, of which 228 represented axillary skin, 396 demonstrated actinic keratosis, and 415 represented the perilesional area to the actinic keratosis. There was a significant difference (p<0.05) in all variables tested for the topographies evaluated. A significant correlation was identified between nucellar morphometric elements, KIN, proliferation markers, and apoptosis. Joint patterns of p53, Ki67, and KIN discriminated the topographies sampled. Study limitationsThis was a cross-sectional study with a small number of patients. ConclusionsThere are patterns of proliferation, resistance to apoptosis, and different cellular morphometrics between photoprotected skin and photoexposed skin. The joint expression of p53, Ki67, and KIN can characterize skin field cancerization activity.

Pre-Paget cells: Evidence of keratinocyte origin of extramammary Paget's disease.

Extramammary Paget's disease (EMPD) is a carcinoma of the genital, perianal, and, rarely, axillary skin. The malignant Paget cells migrate extensively in the epidermis before invading the underlying dermis. Toker cells and keratinocytes have both been suggested as the cells of origin of EMPD. Paraffin sections of eight cases of EMPD were immunohistochemically stained for carcinoembryonic antigen, a known marker for Paget cells. The presence of carcinoembryonic antigen in some keratinocytes in all of the observed cases of EMPD suggests that EMPD originates from keratinocytes. Thus, keratinocytes containing carcinoembryonic antigen are pre-Paget cells.

A Multicenter Comparison of Reconstruction Strategies after Wide Excision for Severe Axillary Hidradenitis Suppurativa.

Evaluate which reconstruction strategy after wide excision in patients with severe axillary HS is associated with improved outcomes in terms of recurrence rate, complications, post-reconstruction limb function, aesthetics, and patient satisfaction. Retrospective analysis between 2008 and 2018 of wide excision and reconstruction by primary closure (PC), secondary intention healing (SIH), split thickness skin grafts (STSG), or fasciocutaneous flaps (FCF). The primary endpoint was the rate of recurrence during follow-up. A total of 107 surgical interventions were performed on 54 patients. The overall recurrence rate was 31.8% after a median follow-up of 30 months, with a significant difference between PC (48%), SIH (16%), STSG (29%), and FCF (10%) (P = 0.03). Surgical complications requiring reoperation occurred in 2% after PC, 0% after SIH, 13% after STSG, and 15% after FCF (P = 0.11). The median score regarding function, aesthetics, and satisfaction after all interventions was 17 out of 20 points, but the score was lower after FCF than PC, SIH, and STSG (P = 0.03). Reconstruction by PC should be reserved for patients with limited HS lesions, whereas FCF was most effective in avoiding recurrence, but was associated with unfavorable short-term results and patient-reported outcomes regarding function and aesthetics. FCF should generally be reserved for patients with recurrent, severe HS comprising an extensive surface of the axillary skin.

The value of axillary skin electron microscopic analysis in the diagnosis of lysosomal storage disorders

Both lysosomal storage diseases and mitochondrial diseases are a group of genetic-inherited metabolic disorders. In an era, where “old fashioned methods” are apparently being replaced by evolving molecular techniques (i.e. exome and whole genome sequencing), the “old fashioned methods” might help to characterise and thus narrow down the potential differential diagnosis. Therefore, we retrospectively evaluated the relevance of electron microscopy of axillary skin for the diagnosis of lysosomal storage or mitochondrial diseases (=inherited metabolic disorders of energy metabolism). Methods and patients: We included 74 patients with developmental delay with regression or neurodegeneration who underwent an axillary skin biopsy for both fibroblast culture and electron microscopy. Because of insufficient skin biopsy quality, for 8 patients no electron microscopy result was obtained. The electron microscopy biopsies revealed abnormalities in 37/66 (56.1%) patients. 29/66 electron microscopy biopsies showed normal results. A definite diagnosis was established in 21/66 (31.8%) patients with a pathological results of axillary skin electron microscopy analysis. In total, in 25/66 (37.8%) of the patients who underwent an axillary skin electron microscopy analysis, a definite diagnosis was finally established. Taking an axillary skin biopsy during anaesthesia or with use of local intradermal lidocaine application is an inexpensive alternative and useful to establish a diagnosis in patients suspected to have a lysosomal storage disease (or inherited metabolic disorder of energy metabolism).

Expression of PD-1 and PD-L1 in Extramammary Paget Disease: Implications for Immune-Targeted Therapy.

Extramammary Paget disease (EMPD) is a locally aggressive cutaneous malignancy that usually arises in anogenital or axillary skin. Immune checkpoint inhibitors targeting programmed cell death receptor (PD-1) and/or its ligand (PD-L1) are approved for the treatment of several types of cancer, and response to these generally correlates with increased PD-L1 expression by tumor cells. The expression of PD-L1 and composition and density of the tumor-associated immune infiltrate in EMPD have been little studied. To determine whether EMPD might be amenable to immune checkpoint blockade, we analyzed the expression of PD-1 and PD-L1 and the composition and density of the tumor-associated immune infiltrate in EMPD and evaluated associations between biomarker expression and clinicopathologic parameters. Twenty-one EMPD tumors were evaluated for tumor cell PD-L1 expression and for relative expression and distribution of CD3, CD8, PD-1, and PD-L1 in the tumor-associated immune infiltrate by using a combination of visual and image analysis (Aperio ImageScope). In addition, PD-L1 expression was assessed in 10 cases of mammary Paget disease (MPD). In EMPD cases, PD-L1 was expressed by tumor cells (3/21; 14%) and the tumor-associated immune infiltrate (15/21; 71%), and PD-1 was expressed by the tumor-associated immune infiltrate in all cases analyzed (18/18). However, PD-L1 expression by EMPD tumor cells did not correlate with the density of CD3-, CD8-, or PD-1-positive cells in the tumor-associated immune infiltrate or other clinicopathologic parameters. Furthermore, the density of CD3, CD8, PD-1, and PD-L1 in the tumor-associated immune infiltrate did not correlate with any clinicopathologic parameters evaluated with the exception that CD3 positive values were significantly higher in patients who were still alive (median, 1310 cells/mm2; range, 543–2115;) than in those who died (median, 611 cells/mm2; range, 481–908; p = 0.049). In all MPD cases, PD-L1 was absent in tumor cells but present in the tumor-associated immune infiltrate, and PD-L1 expression in lymphocytes was lower in patients with HER2/neu-positive than in those with HER2/neu-negative disease (p = 0.07). Our findings raise the possibility of therapeutic targeting of the PD-1/PD-L1 axis in EMPD.

Variables Affecting Delivery of Glycopyrronium Tosylate Through Human Skin In Vitro

Abstract not available. Disclosures: Study sponsored by Dermira.

Bacterial biofilm is associated with higher levels of regulatory T cells in unaffected hidradenitis suppurativa skin.

The role of bacterial biofilm in hidradenitis suppurativa (HS) is highly debated. Less biofilm is found in clinically unaffected axillary perilesional skin of HS patients compared with healthy controls. To study the correlation between biofilm and the phenotypical characterization of the preclinical inflammatory infiltrate. An exploratory comparative study of punch biopsies from unaffected axillary HS skin compared to similarly biopsies from healthy controls underwent standard staining procedures for CD4, CD8, CD25, FoxP3 and IL17. Standard-sized inflammatory histological hotspots were identified manually. Slides were scanned into Leica Biosystems' Digital Image Hub. Number of stained cells per slide and hotspot was found using an algorithm. 12.5% of HS had biofilm compared to 85% of controls. For full slides, HS patients had more CD4+ cells than controls; HS patients with biofilm had higher CD4+ cell number than controls with or without biofilm and HS patients without biofilm. For hotspots, HS patients with biofilm had higher number of CD4+FoxP3+ cells than HS patients without biofilm and controls with biofilm. The association between biofilm and the number of regulatory T cells in HS patients supports the concept of dysbiosis as a factor in the preclinical HS lesions.