Chronic Inflammatory Dermatosis Research Articles

Característica da diminuição da diversidade bacteriana na psoríase

ABSTRACT Disturbance of commensal intestinal microbiota is related to chronic inflammatory dermatosis. We analyzed the diversity of the gut microbiota to characterize the biological variation of psoriasis (Ps). Significant differences of gut microbiome profiles were revealed in murine model with psoriasis by sequencing 16S rRNA V3-V4 variable region. Group comparisons included the imiquimod cream (IMQ group, n=8), the imiquimod cream and antibiotics (ATB) (PC+IMQ group, n=8) and the healthy control (CTRL group, n=8). The gut microbiota existed in Ps groups including IMQ group and PC+IMQ group encompassed less diversity than controls, which were attributed to decreased presence of several taxa. The two Ps groups were characterized by significant reduction in firmicutes. In this study, microbiota of psoriasis was defined by an increase presence of Bacteroides. After treated with ATB, we found substantial increase of Lactobacillales but significant decrease of Clostridiales and Coriobacteriales. Relative lower abundance of multiple intestinal bacteria was observed in Ps groups. Although part of genera were concomitantly reduced in both IMQ and PC+IMQ conditions, we discovered the specialty of PC+IMQ group samples was that contained lower abundance of beneficial taxa. Characteristics of gut microbiota profiles in Ps mice were comparable to profiles in patients with Ps, which were related to alteration of specific inflammatory proteins in disease groups but were significantly different from control group. Thus, this study emphasizes the role of intestinal microbiota in the pathogenesis of Ps and provides new insight for investigating association between intestinal microbes and immune inflammation.

Analysis of acne relapses in women after systemic retinoid therapy

Objective. To analyze the conditions and factors contributing to the development of acne recurrence after therapy with systemic retinoids. Acne is a chronic inflammatory dermatosis characterized by the formation of open and closed comedones, papules, pustules, nodes on skin areas rich in sebaceous glands, significantly disrupting the quality of life of patients. The most effective drugs for its treatment are systemic retinoids. They allow one to achieve complete cleansing of the skin, but even after their use relapses of the disease are possible.
 Materials and methods. The study involved 65 women 1 year after the end of acne treatment with systemic retinoids, who were divided into two groups: group I was formed by 30 women with the development of acne relapses; group II included 35 women without acne relapses. The exclusion criteria were the following: severe endocrine pathology, the presence of cardiovascular diseases, liver disease, pregnancy and lactation, alcoholism, smoking. The study consisted of general clinical techniques and standard laboratory methods, including biochemical blood analysis with the determination of lipid and carbohydrate metabolism, the level of pituitary hormones and sex hormones. Methods of parametric and nonparametric statistics were used to account for and analyze the results.
 Results. In half of the cases, acne relapses were observed after a new coronavirus infection; much less often, in equal proportions, they developed after stress and menstrual cycle failure, there were patients who could not identify the factors preceding the recurrence of acne. The average age of patients with acne relapses after treatment with systemic retinoids was 24.6 2.4 years, patients without acne relapses after appropriate therapy 17.3 1.8 years (p = 0.028). Burdened heredity for acne, combination of acne with seborrheic dermatitis and/or menstrual dysfunction by the type of menstrual arrhythmia were significantly more often determined in patients with acne relapses after therapy with systemic retinoids. In the same group, lipid metabolism disorders and hormonal changes in the form of increased levels of progesterone and androgens were observed significantly more often.
 Conclusions. Acne, even after the therapy with systemic retinoids, can have a recurrent course. The main external factor, preceding relapse is a new coronavirus infection. Relapses after acne treatment with systemic retinoids are developed against the background of burdened heredity for acne, changes in lipid metabolism, persistent imbalance of sex hormones, as well as when acne is combined with seborrheic dermatitis. For pubertal acne without pronounced metabolic and endocrine changes, relapses after therapy with systemic retinoids are not typical.

New and Upcoming Topical Treatments for Atopic Dermatitis: A Review of the Literature.

Atopic dermatitis (AD) is a chronic inflammatory dermatosis with periods of exacerbation and remissions. AD is characterized by intense, persistent pruritus and heterogeneity in clinical symptomatology and severity. Therapeutic goals include the amelioration of cutaneous eruptions, diminishing relapses and eventually the disease burden. To date, topical corticosteroids (TCS) and calcineurin inhibitors (TCI) have yet been deemed the mainstay of topical treatments in AD management. Nevertheless, despite their indisputable efficiency, TCS and TCI are not indicated for continuous long-term use given their safety profile. While research in AD has concentrated predominantly on systemic therapies, more than 30 novel topical compounds are under development. The existing data appear encouraging, with some regimens that are already FDA-approved (ruxolitinib was the most recent in September 2021) and several pharmaceutical pipeline products for mild-to-moderate AD that are in an advanced stage of development, such as tapinarof, difamilast and roflumilast. Larger, long-term studies are still required to evaluate the efficacy and safety of these novel compounds in the long run and weigh their advantages over present treatments. In this review, we aim to provide an overview of the latest knowledge about AD topical treatments, echoing upcoming research trends.

Long-Term Effectiveness and Safety of Biologic and Small Molecule Drugs for Moderate to Severe Atopic Dermatitis: A Systematic Review.

Introduction: Atopic dermatitis (AD) is a genetically based chronic inflammatory dermatosis associated with multiple triggers and complex pathophysiological mechanisms. Nowadays, an authentic therapeutic revolution is taking place with the incorporation of biological drugs for the treatment of moderate and severe atopic dermatitis. A new systematic revision (RS) is necessary to support decision-making for specialists treating AD. Methods: A literature search of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials was performed between 1 January 2000 and 30 April 2022. Phase III randomized clinical trials (RCTs) of EMA-approved molecules were included. The main variables analyzed were a 75% improvement in the Eczema Area and Severity Index (EASI 75) and the number of patients who reached 0 in the Investigator Global Assessment (IGA) (fully cleared patients) or IGA 1 (almost cleared patients) at the end of the study period (week 48–60). The risk of bias was analyzed with the Cochrane Risk of Bias Assessment (ROB-2) tool, focused on the primary objectives. Before carrying out the study, the protocol was registered in PROSPERO with the number CRD42022331109. Results: A total of 3299 studies were systematically identified via databases and registers (442 from PubMed/MEDLINE, 2857 from Embase and 719 from CENTRAL). Finally, five publications containing seven RCTs were included in the final sample of detailed data extraction and data analyses. Regarding efficacy, the best results are obtained with Upadacitinib 30 mg (84.7% (77.3–92.1)) at 52 weeks, slightly improving its results when TCS is added (84.9% (80.3–89.5)). These results are replicated in the measurement of vIGA 0/1 for Updacitinib 30 mg + TCS, where 65.5% (55.7–75.2) of patients maintain it at 52 weeks. Of the four drugs, no long-term safety results have been reported for baricitinib. In relation to the safety findings, there were no significant differences in the dropout rates for this reason in the remaining three drugs. Discussion: Today, different therapeutic options for AD patients can be prescribed. Individualizing the treatment allows for better therapeutic consistency, in addition to being cost-efficient to avoid primary therapeutic failures. The results of the present SR may provide us with a useful basis for the preparation of management guidelines for the use of new generation therapies in moderate to severe atopic dermatitis.

Association of vulvar lichen sclerosus with endometrial and ovarian cancer

Association of vulvar lichen sclerosus with endometrial and ovarian cancer

312 Efficacy of infliximab in hidradenitis suppurativa: A meta-analysis

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that is often recalcitrant to treatments. Adalimumab is the only medication for HS that is approved by the FDA/EMA. The tumor necrosis factor inhibitor infliximab is an established treatment for HS, but its evidence is limited. Objective: Systematically conduct a meta-analysis of existing literature on the efficacy of infliximab in HS. Method: MEDLINE and EMBASE databases were systematically searched in September 2021.

Machine Learning Assisted Handheld Confocal Raman Micro-Spectroscopy for Identification of Clinically Relevant Atopic Eczema Biomarkers.

Atopic dermatitis (AD) is a common chronic inflammatory skin dermatosis condition due to skin barrier dysfunction that causes itchy, red, swollen, and cracked skin. Currently, AD severity clinical scores are subjected to intra- and inter-observer differences. There is a need for an objective scoring method that is sensitive to skin barrier differences. The aim of this study was to evaluate the relevant skin chemical biomarkers in AD patients. We used confocal Raman micro-spectroscopy and advanced machine learning methods as means to classify eczema patients and healthy controls with sufficient sensitivity and specificity. Raman spectra at different skin depths were acquired from subjects’ lower volar forearm location using an in-house developed handheld confocal Raman micro-spectroscopy system. The Raman spectra corresponding to the skin surface from all the subjects were further analyzed through partial least squares discriminant analysis, a binary classification model allowing the classification between eczema and healthy subjects with a sensitivity and specificity of 0.94 and 0.85, respectively, using stratified K-fold (K = 10) cross-validation. The variable importance in the projection score from the partial least squares discriminant analysis classification model further elucidated the role of important stratum corneum proteins and lipids in distinguishing two subject groups.

Current situation and the latest progress in the treatment of pyoderma gangrenosum

Pyoderma gangrenosum (PG) is a rare chronic inflammatory non-infectious skin dermatosis, and there is no clear treatment guideline for this disease at home and abroad. There are a variety of clinical treatment methods for PG, including local therapy and systemic application of glucocorticoids, immunosuppressants, intravenous immuno- globulin, and biologics. Glucocorticoids are the first-line drugs commonly used in clinical practice, and immunosuppressants can be used alone or in combination with glucocorticoids. In recent years, more and more evidence has shown that biologics are a new trend in the treatment of PG, mainly including tumor necrosis factor α inhibitors, interleukin-1 (IL-1) inhibitors, IL-12/23 inhibitors, IL-17 inhibitors, rituximab, and small molecular inhibitors. This article summarizes the current status and latest progress in the treatment of PG, hoping to provide clinicians with ideas for the treatment of PG.

Transcriptome Profiling and Network Analysis Provide Insights Into the Pathogenesis of Vulvar Lichen Sclerosus

Vulvar lichen sclerosus (VLS) is a chronic inflammatory dermatosis that affects female anogenital skin. Although VLS is considered a T cell-mediated autoimmune disease, the diagnosis criteria, molecular mechanism, and universally accepted therapies for this disease remain largely unresolved. To explore disease pathogenesis and potential biomarkers, we performed an RNA-Seq-based transcriptome analysis to profile the gene expression of VLS lesions. Differentially expressed gene (DEG) analysis revealed profound changes in expressions of coding genes, microRNAs, and long non-coding RNAs. Pathway and network analysis suggested that T cell activation-associated genes, including CD3G, CD3D, CD8B, LAT, LCK, ZAP70, CCR5, CXCR3, CXCL9, CXCL10, and CXCL11, were highly expressed in VLS, while NR4A family genes (NR4A1, NR4A2, NR4A3), whose coding products inhibit T cell activity, were significantly downregulated, suggesting heightened T cell response in VLS. Neutrophil chemoattractant genes CXCL1, CXCL2, CXCL3, CXCL8, and their cognate receptor CXCR2 were downregulated, suggesting dampened neutrophil activity. We also found the downregulation of genes involved in cell cycle progression, including cyclins (CCNB1, CCNB2, CCNL1, CCNE1, and CCNK) and centrosome factors (CENPA, CENPE, CENPF, and CENPN), while microRNA-203a and let-7, microRNAs known to inhibit cell growth, were found to be upregulated. These data collectively indicate that cell proliferation in VLS is compromised. In sum, these findings comprehensively deciphered key regulatory genes and networks in VLS, which could further our understanding of disease mechanisms and point toward therapeutic strategies.

Ketoconazole 2% cream alters the skin fungal microbiome in seborrhoeic dermatitis: a cohort study.

Seborrhoeic dermatitis (SD) is a common chronic inflammatory dermatosis. Current theories on the pathogenesis of SD highlight the role of microbes on the skin surface. Ketoconazole is commonly used for the treatment of SD; however, there are limited data focusing on the effects of ketoconazole in shaping the skin microbiome in patients with SD. In this prospective cohort study, we used a high-throughput DNA sequencing method to characterize the cutaneous microbial communities of patients with SD before and after topical ketoconazole treatment. In total, 30 patients with facial SD and 15 age- and sex-matched healthy controls (HCs) were enrolled in this study. Skin swabs were collected from SD lesional sites of the cheek at baseline, after ketoconazole treatment and 2 weeks post-treatment. DNA was extracted from skin samples. The bacterial 16S V3V4 rRNA and fungal internal transcribed spacer 1-5F regions were sequenced, and the microbial community compositions were analysed. Significantly lower bacterial and fungal diversities were detected at the lesional sites of facial SD compared with HCs. A decreased relative abundance of Cutibacterium and increased abundances of Malassezia and Staphylococcus were found in facial SD. Disease diversity was positively correlated with the relative abundances of Malassezia, Staphylococcus and Corynebacterium, while transepidermal water loss was negatively associated with the relative abundance of Cutibacterium. After ketoconazole treatment, fungal Shannon diversity and the relative abundances of Candida and Aspergillus were significantly increased at the lesional sites, and the relative abundance of Malassezia showed a decreasing trend. These changing trends were maintained until 2 weeks post-treatment. Facial SD showed lower fungal diversity accompanied by increased relative abundances of Malassezia and Staphylococcus and decreased relative abundance of Cutibacterium. Ketoconazole treatment reduced Malassezia and increased fungal diversity to restore skin microbial communities.

Burden of treatment in vulval lichen sclerosus.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis predominantly affecting the anogenital region, which can have significant impact on quality of life. Burden of treatment (BOT) is defined as the workload of healthcare experienced by patients and consequences on well‐being. In this prospective study, 35 women with vulval LS completed a detailed Treatment Burden Questionnaire to assess their BOT. Nineteen (54.3%) achieved a score of 35 or less, signifying low BOT; ten (28.6%) between 36 and 65, signifying moderate BOT; and six (17.1%) above 65, signifying high BOT. Seven (20%) patients reported BOT scores of greater than 59, which has been designated as a cut‐off for increased risk of treatment‐related burnout. Higher BOT scores were moderately correlated with higher DLQI scores (r = 0.47, p < 0.01). BOT in LS is low for most patients, although a minority are at risk of treatment‐related burnout. BOT should be considered when forming treatment guidelines for LS.

Hemostatic and Coagulation Profile in Psoriasis: A Hospital-Based case control Study.

Psoriasis is a chronic inflammatory dermatosis associated with an increased risk of cardiovascular disease and atherothrombosis. This study was conducted to assess the levels of various hemostatic and coagulation parameters in psoriasis and their correlation with disease severity. This was a hospital-based observational study. Seventy-five patients with psoriasis and seventy controls were included in the study. History taking, clinical examination, and calculation of Psoriasis Area and Severity Index (PASI) were done. Blood analysis for Platelet count (PC), mean platelet volume (MPV), Vitamin B12, Thrombin Time (TT), Prothrombin time (PT) and Activated partial thromboplastin time (APPT) were done in both groups. MPV which is a marker of inflammation and platelet activation was significantly increased in cases and positively correlated with the disease severity. Vitamin B12 is an important cofactor in homocysteine (Hcy) metabolism and correlates inversely with serum Hcy which is a known atherothrombotic marker. Vitamin B12 levels were significantly decreased in the cases with a significant negative correlation between Vitamin B12 level and PASI. There was also a significant decrease in serum level of PT, aPTT and TT in cases as compared to controls; however they showed no significant correlation with PASI. Inflammation in psoriasis may drive the process of abnormal platelet activation and coagulation abnormalities thus predisposing psoriatic patients to an atherothrombotic state and increasing the cardiovascular risk in psoriatic patients.

Offering an Off-Label Therapeutic Algorithm for Lichen Planus.

Lichen planus (LP) is a poorly characterized, chronic inflammatory dermatosis notable for violaceous to brown/ black polygonal pruritic papules and plaques, often with lacey scale, and reticular white erosions involving mucosal sites.

Autologous lipoaspirate as a new treatment of vulvar lichen sclerosus: A review on literature.

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that mostly affects the genital and anal skin areas. Symptoms may vary from pruritis and pain to sexual dysfunction; however, LS can also be asymptomatic. LS occurs at all ages and in both sexes. Approximately 5% of all women affected by vulvar LS will develop vulvar squamous cell carcinoma. Topical treatment is safe but less effective resulting in chronic course in most patients, who suffer from persistent itching and pain. In severe cases of therapy‐resistant LS, there is no adequate treatment. Fat grafting is a novel regenerative therapy to reduce dermal fibrosis. The therapeutic effect of adipose tissue grafts for LS is already investigated in various pioneering studies. This review provides an overview of these studies and the putative mechanisms‐of‐action of fat grafting to treat LS.

Exposome factors in the acne pathogenesis

The concept of the exposome, formulated more than fifteen years ago, is increasingly discussed in the modern scientific literature. The term “exposome” is understood as a cumulative measure of the impact of environmental factors on an individual throughout his or her life (from the prenatal period to death) and the biological response associated with it. The sum of these factors has a significant impact on the occurrence, course, and treatment efficacy of multifactorial diseases. The skin is a border organ and is constantly exposed to environmental influences, i.e., it is a target for the exposome. The influence of the latter components has been described in skin aging, atopic dermatitis, and malignant skin neoplasms. Acne is one of the most common chronic inflammatory dermatoses. Over the past decade, the worldwide increase in the incidence of acne, its early onset and a prolonged course, affecting adult men and women, has been noted. The review presents an analysis of the data on the effects of the components of the exposome – diet, medications, stress, and pollutants - on the course of acne. Particular attention is paid to the few data on the nature of interaction between the components of the exposome and the skin microbiome, which, on the one hand, is involved in the pathogenesis of dermatoses, including acne, and, on the other hand, is changed under the influence of exposome factors, acting as an intermediary between the environment and the human body. The search for environmental factors has at least two objectives: the discovery of potential pathogenetic links, the strength of their relationship with the clinical manifestations of the disease to develop new therapies aimed at new targets; and the creation and recommendation of a protective regime for factors with a proven effect on the course of the disease, for patients suffering from acne.

Management of severe vulval lichen sclerosus with adalimumab.

Vulval Lichen Sclerosus (VLS) is a chronic inflammatory dermatosis that significantly impacts the quality of life. We report 2 cases of severe treatment-resistant VLS treated with subcutaneous adalimumab. One patient showed modest clinical improvement with no significant improvement in quality-of-life measures. The second patient showed a significant improvement in both clinical and quality-of-life measures. Both patients achieved optimal control with a maintenance dosing of 40 mg subcutaneously weekly. Adalimumab may be a treatment option for recalcitrant VLS; however, clinical trials are required to confirm efficacy for this indication.

Health Related Quality of Life of Rosacea Patients in China Assessed by Dermatology Life Quality Index and Willingness to Pay.

PurposeRosacea is a chronic inflammatory dermatosis mainly involving facial skin, leading to physical and emotional problems, which greatly affect the quality of life (QoL) of patients. Dermatology Life Quality Index (DLQI) and willingness to pay (WTP) are well-established instruments assessing the health-related quality of life (HRQoL), while very few studies have been focused on this topic about rosacea in China. The present study investigated HRQoL in Chinese rosacea patients.Patients and MethodsThis cross-sectional study was conducted on 973 patients with rosacea. Sociodemographic data, clinical features and DLQI were collected, and WTP was assessed by three standardized items. Multivariable logistic analysis was performed to investigate independent factors influencing QoL.ResultsA total of 921 questionnaires were accomplished by participants. The mean DLQI score was 11.6 (median 11). Patients were willing to pay an average of € 896.2 (median € 368.1) for complete cure. 33.3% would like to pay more than 20% of their monthly income to achieve sustainable control. There were positive correlations between WTP with DLQI (P < 0.05). DLQI could be independently impacted by age (21–30 and 31–40 relative to > 50, OR = 3.242 and 3.617, respectively), the occupational requirement of appearance (high, OR = 4.410), disease duration (< 2 years, OR = 1.582), edema (OR = 1.844) and severity of flushing, burning, stinging and pruritus (severe, OR = 2.003, 1.981, 2.491, 2.249, respectively). There were no significant associations between WTP and most of the clinical factors.ConclusionThe QoL was greatly impaired and should not be ignored among rosacea patients in China. Patients aged 21–40y, having occupational requirement of appearance, with the disease duration less than 2 years, and suffering severe flushing and related sensitive symptoms were more likely to have severe or very severe limitation of QoL.

High Incidence of Metabolic Syndrome Components in Lichen Planus Patients: A Prospective Cross-Sectional Study.

Background Lichen planus (LP) is a chronic inflammatory dermatosis, involving the skin, appendages, and mucous membranes. There is a growing body of evidence about higher risk of metabolic syndrome and dyslipidemia in some dermatoses including LP. Aim To evaluate lipid profile, leptin, and CRP status among Iranian LP patients, compared to healthy controls, and peruse the relationship between abnormal values of these parameters with the disease duration and physical characteristics of patients. Methods 40 LP patients and 40 age- and sex-matched healthy controls were enrolled in the study. Data on weight, height, lipid profile, leptin, and CRP values were recorded and compared. Results The mean values for leptin, CRP, and lipid profile parameters (except for HDL) were higher in patients, compared to controls. Total cholesterol level was negatively associated with disease duration in patients (P value: 0.039, r: −0.33). Serum leptin level was positively correlated with BMI both in patients and controls (P value: 0.037 and 0.003, respectively). In the patient group, LDL level, although insignificant, was higher in men, but HDL and leptin levels were significantly higher in women in comparison with men (P value: 0.018). Conclusion Screening of LP patients in regard to their lipid profile might be more reasonable in men or those who have other cardiovascular risk factors to prevent morbidity and mortality in result of developing cardiovascular events.

Lifestyle modifications and complementary treatments for hidradenitis suppurativa

AbstractBackgroundHidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with recurrent painful nodules and abscesses affecting the intertriginous areas. Patients often experience a significant negative impact on quality of life from associated pain, discharge, odor, scarring, and social stigma. Even with complex medical regimens, patients may report inadequate disease control. Lifestyle changes and complementary and alternative medicines (CAM) are used by a majority of HS patients. Conventional medicines and lifestyle and CAM modalities strategically incorporated together can increase treatment satisfaction and success.ObjectiveWe aim to highlight lifestyle and CAM treatment modalities to use alongside conventional treatment plans for HS patients.FindingsLifestyle modifications for HS patients include weight loss, reducing skin friction, smoking cessation, and stress reduction. Dietary modifications for HS patients include limiting foods containing dairy, Brewer's yeast, and simple carbohydrates, appropriate caloric reduction, and consuming foods in the Mediterranean diet. The CAM modalities studied in HS are vitamin D, niacinamide, vitamin B12, zinc, and magnesium. Potential CAM modalities for HS include probiotics, cannabinoids, turmeric, bathing regimens, and acupuncture.ConclusionThis review is a guide for clinicians to provide evidence‐based care for HS patients seeking non‐pharmacologic treatment modalities such as weight loss, clothing choices, dietary changes, and use of supplements and complementary medicine. Lifestyle and CAM modalities may be used in parallel with conventional medicines to synergistically improve patient disease outcomes.

Biologics and small molecule inhibitors for hidradenitis suppurativa

AbstractBackgroundHidradenitis suppurativa (HS) is a debilitating, chronic inflammatory dermatosis that is often recalcitrant to first‐line treatments. Though mechanisms underlying its pathology remain unclear, a number of upregulated inflammatory cytokines (including tumor necrosis factor‐α [TNF‐α], interleukin [IL]‐1, IL‐17, IL‐12, and IL‐23) have been identified in HS, leading to a growing investigation of targeted biologic therapies in moderate‐to‐severe HS.ObjectiveWe aim to review the current literature on biologics and small molecule inhibitors that have been used to treat HS and discuss mechanisms of action, dosing, safety considerations, and recommendations for use.FindingsBiologics that have been reported to treat HS include TNF‐α inhibitors (adalimumab, infliximab, golimumab, and certolizumab), IL‐1 inhibitors (anakinra and canakinumab), IL‐12/23 inhibitor (ustekinumab), IL‐23 inhibitors (guselkumab, risankizumab, and tildrakizumab), IL‐17 inhibitors (secukinumab, ixekizumab, and brodalumab), and small molecule inhibitors (tofacitinib and sirolimus). Though adalimumab is currently the only FDA‐approved agent to treat HS, those who do not have an optimal response may still benefit from a different anti‐TNF agent, particularly high dose infliximab. A number of other targeted treatments have also shown promising results in small prospective studies for consideration in HS patients. Additional considerations in biologic therapy include mitigating patient concerns about injection reactions and choosing agents that may also treat comorbid conditions.ConclusionThis review summarizes the current literature on the use of biologics and small molecule inhibitors in HS. There remains a significant and continued need to expand the treatment armamentarium for moderate to severe HS