Hidradenitis Suppurativa Research Articles

Barriers and facilitators to quality HS biologic care and outcomes for the Medicaid population across US states

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by painful skin lesions and dermal abscesses.1 US-based patients with HS are often covered by Medicaid (21.6–31.0%)2–5 with substantial state-by-state variations in coverage. Barriers to accessing biologics for HS may delay treatment and worsen patient outcomes. Here, we report differences in Medicaid criteria to access biologic care for HS across all 50 US states. Procedure/study: A qualitative review of the Medicaid Utilization Management (UM) policies for biologic use in HS was conducted. Data were collected from the Medicaid UM policies, Medicaid websites, and Managed Medicaid UM policies of each state in February 2024. All 50 states were analyzed; barriers to access and discrepancies across state Medicaid UM policies were identified, and opportunities to address these discrepancies in the form of an HS coalition were recognized. The analysis stratified the Medicaid UM criteria for each state for treatment with a biologic (adalimumab/secukinumab) into no or low, medium, and high barrier levels. For high barrier level states, comparison with UM criteria for psoriasis was made. Results: Overall, the UM policies varied widely, and burdensome barriers to biologic care were identified in some states. In total, 40 states had no or low barrier criteria; states with low barrier criteria required an HS diagnosis and a prescription, or inadequate responses to ≥1 therapy (steroids/antibiotics). Alabama, Kentucky, Minnesota, Missouri, Ohio, Oregon, Pennsylvania, and Washington had medium barrier criteria and generally required an HS diagnosis and failure with ≥2 therapies. Here, criteria may be reduced to align with low barrier states. Iowa and Oklahoma had high barrier criteria. Both required ≥3 abscesses or inflammatory nodules, an HS diagnosis with Hurley Stage II/III, and failure with ≥2 therapies. In Iowa, eligible requests received three months treatment, with additional authorizations conditional upon ≥50% reduction in abscess and nodule count. The approval criteria of biologics for psoriasis were less stringent than HS in Iowa and Oklahoma, including fewer criteria items and therapy failures: Iowa ≥2 vs ≥3; Oklahoma ≥1 vs ≥2. Conclusion: Substantial state-by-state variations in Medicaid criteria were observed, with ten out of 50 states having medium to high barriers to accessing biologics. Large disparities in criteria for access to biologic care between psoriasis and HS were observed in two states. These barriers and discrepancies represent opportunities for an HS coalition at the state level, to improve access to care and patient outcomes.6

Microwave Energy for Managing Hidradenitis Suppurativa

Title: Microwave energy for managing Hidradenitis Suppurativa Nicole Bielecki PA-C and Aaron Hoover MD Front Range Dermatology, Greeley, CO 80634 Introduction: Treating hidradenitis suppurativa (HS) is challenging due to its chronic, recurring nature and resistance to conventional therapies like antibiotics, anti-inflammatories, and surgery. Even with new biological treatments, there are challenges with injection site reactions. The associated pain, drainage, malodor, and scarring also significantly impact patients' mental well-being, underscoring the need for novel treatments. Four cases presented here suggest that microwave energy (ME) therapy can reduce pain, erythema and inflammation in HS lesions and even assist to resolve moderate and smaller lesions. Precise and brief surface-based applications of microwave energy to HS lesions from an FDA-cleared microwave device intended for the coagulation of soft tissue were used to generate localized hyperthermic conditions in HS and pre-HS lesions. The rapid heating of the tissues led to subsequent clearance of moderate and small HS lesions. This was accompanied with a reduction in inflammation, draining and pain associated with these HS cases. While the outcomes are promising, the exact mechanism of action needs further investigation. These cases strongly support further research and demonstrate that ME holds promise as a novel, non-invasive treatment modality for the management of HS. Procedure: A total of 25 HS lesions from five patients were treated with ME energy. Five repetitive 2-second pulses of 3 to 4W of ME operating at 8GHz were applied to the full area of these lesions. Three to four treatment sessions were given ranging from 7 to 14 days apart. Two patients received ME as a monotherapy, whereas the others began regimens of isotretinoin, adalimumab, or secukinumab at the same time as the first ME treatment. Results: These five patient cases demonstrate how ME treatments can lead to a rapid reduction in reported pain and erythema as well as clinical-assessed clearance of several early and moderate state HS lesions. Two of these patients only received ME as a monotherapy. However, based on clinical experience, even patients typically on medications will not typically show improvements within 7-14 days, suggesting that ME was having a rapid impact to manage pain and inflammation associated with HS lesions and in some cases assisting to resolve these lesions entirely. Conclusions: These cases report the first step in clinical feasibility and safety of microwave energy and shows promise as a novel modality for the management of HS. Although still in the early days of feasibility work, this non-invasive, fast, well-tolerated and simple treatment of microwave energy shows promise as a novel modality for the management of HS. Financial support: This work was supported by Emblation Ltd.

Bimekizumab Efficacy and Safety Through 2 years in Patients with Hidradenitis Suppurativa: Results from the Phase 3 BE HEARD I&II trials and Open-Label Extension BE HEARD EXT

Introduction: Interleukin (IL)-17F and IL-17A play a role in the immunopathogenesis of hidradenitis suppurativa (HS).1–3 Bimekizumab (BKZ) is a humanized IgG1 monoclonal antibody that selectively inhibits IL-17F in addition to IL-17A leading to clinically meaningful improvements in patients (pts) with HS.4,5 Here, BKZ efficacy and safety data (OC) are presented over 2 years (96 weeks [wks]) for the pooled BE HEARD I&II (BHI&II) trials and BE HEARD EXT (BHEXT).5,6 Procedure/Study: In BHI&II, pts with moderate to severe HS were randomized 2:2:2:1 (16wk-initial/32wk-maintenance) to BKZ 320mg every 2 wks (Q2W)/Q2W, BKZQ2W/Q4W, BKZQ4W/Q4W or placebo/BKZQ2W.5 Wk48 completers could enroll in BHEXT and receive open-label BKZQ2W or BKZQ4W based on ≥90% HS Clinical Response (HiSCR90; averaged from Wks36/40/44). We report HiSCR50/75/90/100 rates, percentage change from baseline (%CfB, mean±SD) in International HS Severity Score System (IHS4) and draining tunnel (DT) count, and Dermatology Life Quality Index (DLQI) 0/1 achievement at Wks48/96 for patients randomized to BKZ in BHI&II and entered BHEXT (BKZ Total, observed case). Safety outcomes reported for pts who received ≥1 BKZ dose across BHI&II/BHEXT. Results: 556 pts randomized at baseline to BKZ in BHI&II completed Wk48 and entered BHEXT; 446 pts completed Wk96. At Wk48, HiSCR50/75/90/100 was achieved by 79.9/64.0/42.3/30.2% of pts; responses improved to Wk96: 85.4/77.1/57.6/44.2%. Baseline IHS4 was 35.6±31.5; %CfB at Wk48/96 was –70.3±39.6/−79.8±28.1%. Baseline DTs were 3.8±4.3; the %CfB at Wk48/96 was −57.5±72.9%/−73.7±45.7%. Baseline DLQI was 11.0±6.8; 27.4% (151/551) of pts achieved DLQI 0/1 at Wk48 and 33.9% (149/439) at Wk96. Over 2 years, 917/995 (248.9/100 pt years [PY]) pts experienced a treatment-emergent adverse event (TEAE). Serious TEAEs were reported in 122 (7.2/100 PY) pts; 109 (6.3/100 PY) pts discontinued due to a TEAE. Serious infections occurred in 33 (1.9/100 PY) pts. Safety data were comparable with BHI&II.5 Conclusion: In pts treated with BKZ, clinically meaningful improvements in efficacy outcomes observed at 1 year, including the HiSCR 75/90/100, IHS4, and DT count endpoints, were maintained to 2 years; improvements in quality of life were maintained. No new safety signals were observed; the safety profile over 2 years was consistent with BHI&II and BKZ studies in other indications.5,7–9

Bimekizumab impact on patient-reported outcomes in patients with moderate to severe hidradenitis suppurativa: Pooled Week 48 results from BE HEARD I&II

Introduction: Hidradenitis suppurativa (HS) has substantial negative effects on patients’ lives,1 with debilitating symptoms, such as intense pain/fatigue/draining and odor, which lead to overall low quality of life (QoL).1,2 Bimekizumab (BKZ) is a humanized IgG1 monoclonal antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A; clinical efficacy was previously shown in the phase 3 BE HEARD I&II trials.3 Here, the impact of BKZ on patient-reported outcomes (PROs) in patients with moderate to severe HS in BE HEARD I&II is reported. Procedure/Study: Pooled data included an initial (Weeks [Wks]0–16) and maintenance (Wks16–48) treatment period. Patients were randomized 2:2:2:1 (initial/maintenance) to BKZ 320 mg every 2 wks (Q2W)/Q2W, BKZ Q2W/ Q4W, BKZ Q4W/Q4W or placebo (PBO)/BKZ Q2W. HS Symptom Questionnaire (HSSQ; each symptom item scored 0–10) mean values are reported to Wk48 for skin pain, itch, smell/odor, and drainage/oozing. Proportions of patients achieving minimal clinically important difference (MCID) for Dermatology Life Quality Index (DLQI; scored 0–30; improvement from baseline score ≥4) were reported at Wk16 and Wk48. Data are reported as observed case. Results: Overall, 1,014 patients were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), BKZ Q4W/Q4W (N=288), PBO/BKZ Q2W (N=146). Within each HSSQ item, similar baseline scores were observed across treatment groups. At Wk16, for skin pain, itch, smell/odor and draining/oozing, greater improvements (i.e. score reduction) from baseline were seen in BKZ- vs PBO-treated patients. HSSQ item scores were substantially reduced from Wk16 to Wk48 in Wk16 PBO/BKZ switchers, further decreases were observed in those continually treated with BKZ. At Wk16, a greater proportion of BKZ- vs PBO-treated patients achieved MCID in DLQI: BKZ Q2W/Q2W, 64.6%; BKZ Q2W/Q4W, 54.9%; BKZ Q4W/Q4W, 63.5% vs PBO, 49.1%. At Wk48, a greater proportion of patients continually treated with BKZ achieved MCID in DLQI vs at Wk16; Wk16 PBO/BKZ switchers attained similar proportions (BKZ Q2W/Q2W: 73.4%; BKZ Q2W/Q4W: 63.5%; BKZ Q4W/Q4W: 74.5%; PBO/BKZ Q2W: 76.5%). Conclusion: At Wk16, BKZ-treated patients achieved a reduction from baseline of HS symptoms: skin pain, itch, smell/odor, and drainage/oozing. Clinically meaningful health-related QoL improvements from baseline were observed and maintained/slightly improved through Wk48. PBO/BKZ switchers experienced improvements in PRO responses from Wk16 to Wk48 and achieved comparable outcomes at Wk48 to patients continually treated with BKZ.

Bimekizumab impact on draining tunnels: A dynamic assessment in patients with moderate to severe HS using pooled Week 48 results from BE HEARD I&II

Introduction: Hidradenitis suppurativa (HS) is a recurrent, inflammatory skin disease characterized by painful skin lesions in the folds of the skin and deep, dermal abscesses that join to form chronically draining tunnels (DTs).1,2 Bimekizumab (BKZ) is a humanized IgG1 monoclonal antibody that selectively inhibits IL-17F in addition to IL-17A, both abundant in lesional skin.3,4 Here, we assess the effect of BKZ on DT outcomes over 48 weeks (wks) in BE HEARD I&II.5 Procedure/Study: Pooled data included an initial (Wks0–16) and maintenance (Wks16–48) treatment period. Randomization: 2:2:2:1 (initial/maintenance) to BKZ 320mg every 2 wks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W or placebo (PBO)/BKZ Q2W. Proportions of patients with ≥1/≥3 DTs at baseline achieving 0, 1–2, 3–5 or >5 DTs were analyzed to Wk48 (observed case). Results: Overall, 1,014 patients were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), BKZ Q4W/Q4W (N=288) or PBO/BKZ Q2W (N=146). At baseline, in patients with ≥1 DT, proportions with 1–2 DTs ranged from 34.2–37.4%; 3–5 DTs: 27.0–36.9%; >5 DTs: 28.8–35.5%. In patients with ≥3 DTs, proportions with 3–5 DTs ranged from 43.2–56.1%; >5 DTs: 43.9–56.8%. At Wk16, higher proportions of BKZ-treated patients with ≥1 DT at baseline achieved 0 DTs vs PBO: BKZ Q2W/Q2W, 35.4%; BKZ Q2W/Q4W, 35.4%; BKZ Q4W/Q4W, 33.1% vs PBO, 24.7%. At Wk48, the proportions of patients receiving continuous BKZ that achieved 0 DTs increased to: 45.5%, 48.8%, and 46.8% respectively; PBO/BKZ Q2W switchers showed similar trends (46.3%). For patients with ≥3 DTs at baseline, at Wk16 a higher proportion receiving BKZ achieved 0 DTs vs PBO: BKZ Q2W/Q2W, 24.6%; BKZ Q2W/Q4W, 26.8%; BKZ Q4W/Q4W, 21.7%; vs PBO, 11.5%. At Wk48, the proportions receiving continuous BKZ that achieved 0 DTs increased to 35.0%, 42.2%, and 36.0%, respectively. PBO/BKZ Q2W switchers achieved similar levels (38.0%), with a more favorable increase from Wk16 to Wk48 than PBO/BKZ Q2W switchers with ≥1 DT at baseline.Conclusion: At Wk16, a higher proportion of BKZ-treated vs PBO patients with ≥1/≥3 DTs at baseline achieved 0 or 1–2 DTs; proportions increased to Wk48 regardless of treatment arm.

Bimekizumab cumulative clinical benefit in patients with moderate to severe hidradenitis suppurativa through 1 year of the BE HEARD I&II phase 3 trials

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which significantly impacts health-related quality of life.1 Bimekizumab (BKZ) is a humanized IgG1 monoclonal antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A.2 ere, the cumulative benefit of BKZ treatment on HS clinical response (HiSCR) through 16 and 48 weeks (wks) is reported using area under the curve (AUC) analyses.Procedure/study: Pooled data from BE HEARD I&II included an initial (Wks0–16) and maintenance treatment period (Wks16–48).3 Randomization: 2:2:2:1 (initial/maintenance) BKZ 320mg every 2 wks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W, or placebo (PBO)/BKZ Q2W. HiSCR50/75/90 response was achieved at a given visit if there was ≥50/75/90% reduction in the total abscess/inflammatory nodule count with no increase from baseline in abscess or draining tunnel count. Cumulative clinical benefit estimation: total AUC through Wk48 for HiSCR50/75/90 achievers. Calculation of estimated number of days patients achieved each response: proportion of total possible AUC for each outcome multiplied by total number of days in the period (Wks0–16: 112 days, Wks0–48: 336). Data are reported as observed case, where N represents number of patients with a non-missing lesion count assessment in the given week, and percentages are calculated accordingly (i.e. where data recorded after an intercurrent event are included).Results: Overall, 1,014 patients were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), BKZ Q4W/Q4W (N=288) and PBO/BKZ Q2W (N=146). Through 16wks, the total number of days patients achieved HiSCR50 was almost double in BKZ Q2W/Q2W (47 days), BKZ Q2W/Q4W (49), and BKZ Q4W/Q4W (47) groups vs PBO (27). To Wk16, the total number of days patients achieved HiSCR75/90 was at least double in the BKZ groups vs PBO. To Wk48, total number of days with HiSCR50 achievement: BKZ Q2W/Q2W, 211; BKZ Q2W/Q4W, 212; BKZ Q4W/Q4W, 206 vs PBO/BKZ Q2W, 178. Comparable results were observed for HiSCR75/90 at Wk48, with BKZ groups maintaining higher responses vs PBO. Conclusion: High levels of cumulative clinical benefit were observed for patients on BKZ through Wk16; benefits increased substantially through Wk48. The cumulative benefit of BKZ through 48wks was evident for patients receiving continuous BKZ and PBO switchers. The total number of days of clinical outcome achievement remained higher in those on continuous BKZ vs PBO switchers. These results demonstrate the rapid, high-level and durable responses that can be obtained with BKZ.

Bimekizumab Effect on the Need for Concomitant Rescue Interventions by HiSCR Response Level in Patients with Moderate to Severe Hidradenitis Suppurativa from BE HEARD I&II

Introduction: Hidradenitis suppurativa (HS) is a chronic, systemic, inflammatory skin disease characterized by deep, painful lesions that negatively impact patients’ (pts’) quality of life.1 These lesions are difficult to treat and require multifaceted treatment, including the need for rescue interventions alongside conventional therapy.1 Bimekizumab (BKZ) is a monoclonal IgG1 antibody that inhibits interleukin (IL)-17F in addition to IL-17A.2 Here, the relationship between increasingly stringent HS Clinical Response (HiSCR) levels achieved with BKZ and the proportion of pts not requiring rescue concomitant interventions is investigated.Procedure/Study: Pooled data are presented from the phase 3 BE HEARD I&II trials maintenance treatment period (Weeks [Wks]16–48).3 Pts were randomized 2:2:2:1 (initial/maintenance treatment period) to BKZ 320 mg every 2 wks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W, or placebo (PBO)/BKZ Q2W. Data for the individual BKZ randomization arms and pooled across these arms (BKZ Total) are reported. BKZ-randomized pts were grouped by achievement of mutually exclusive HiSCR levels (<50% improvement from baseline [<HiSCR50]; HiSCR50–<75; HiSCR75–100) at Wk16. The incidence of pts not requiring any concomitant rescue interventions during the maintenance treatment period, including medical (antibiotics, analgesics) and procedural (incision/drainage, intralesional triamcinolone injection) interventions, are reported. Data reported as observed case. Results: Overall, 868 pts were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), or BKZ Q4W/Q4W (N=288). In BKZ Total, 76.0%/83.2%/89.1% of pts in the HiSCR<50/50–<75/75–100 bands did not receive rescue intervention through Wks16–48, demonstrating a numerical increase with increasing HiSCR bands. Comparable trends across HiSCR<50/50–<75/75–100 bands were observed in pts receiving BKZ Q2W/Q2W (79.8%/90.0%/90.9%), BKZ Q2W/Q4W (75.0%/78.3%/89.0%) or BKZ Q4W/Q4W (73.3%/81.4%/87.1%). Similar trends were observed from the lowest to highest HiSCR bands when separating into any medical or procedural interventions. Conclusion: Overall, the majority of BKZ-randomized pts did not require any concomitant rescue medical or procedural interventions through Wks16–48 and the proportions of these pts increased with increasingly stringent HiSCR bands. These data highlight the additional value to pts of a decreased need for concomitant rescue interventions when they achieve higher HiSCR response levels.

Skin as a mirror of metabolic syndrome: Do some dermatoses alarm internal metabolic sinister?

Metabolic syndrome is a group of abnormalities in metabolism including hypertension, central obesity, insulin resistance and dyslipidaemia. Etiopathogenesis is multifactorial including genetic and environmental factors. It is more prevalent in recent decade due to sedentary lifestyle with unhygienic food habits and cause increased prevalence in younger age group. This abnormal metabolism leads to oxidative stress in body involving multiple inflammatory pathways. There are so many dermatoses which are associated with metabolic syndrome due to common factors are involved in etiopathogenesis. These includes psoriasis, acne vulgaris, acanthosis nigricans, hidradenitis suppurativa, atopic dermatitis, androgenetic alopecia, lichen planus. There is increased risk of developing diabetes mellitus and damage to cardiovascular system. Early diagnosis and management are required to reduce risk of complications. These includes active lifestyle, dietary changes and medications.

Wound closure techniques after wide excision for hidradenitis suppurativa: a systematic review and meta-analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects intertriginous skin areas, clinically characterized by recurrent inflamed nodules, abscesses, sinus tracts, and severe scars. Systemic treatments may provide temporary relief, while wide surgical excision offers prolonged disease-free periods. We evaluated the most efficient wound closure methods following wide excision of HS lesions in terms of recurrence, functionality, and quality of life. A systematic literature search was conducted in PubMed, Embase, Cochrane, and ClinicalTrials.gov, adhering to the PRISMA 2020 criteria. We included original studies published until February 2024, focusing on wound closure methods post-wide excision for HS. Data from 121 papers were analyzed using network and direct meta-analysis methods to compare recurrence and postoperative complication rates. From 1181 articles, 121 were included in the meta-analysis after removing duplicates and excluding publications that did not meet the inclusion criteria. Recurrence rates were associated with the type of reconstruction technique as follows: primary closure, 25% (95% confidence interval [CI], 20-30%); skin grafts, 18% (95% CI, 14-22%), and flaps, 12% (95% CI, 9-15%). Secondary intention healing showed a recurrence rate of 28% (95% CI, 23-33%). Flaps were associated with the lowest recurrence rates compared to other surgery techniques.

Emergency department usage and characteristics of pediatric patients with hidradenitis suppurativa from 2006-2019.

Emergency department usage and characteristics of pediatric patients with hidradenitis suppurativa from 2006-2019.

Apocrine gland damage and the release of specific keratins in early stage indicate the crucial involvement of apocrine glands in hidradenitis suppurativa.

The apocrine glands (AGs) are not considered to be primarily involved in hidradenitis suppurativa (HS). This study investigated the potential role of AGs in HS pathogenesis using immunohistochemistry and single-cell sequencing of nonlesional skin (NLS) and early lesional skin (LS) from patients with HS (n = 12) and healthy controls (HC, n = 8). AG cell destruction was more frequent and AG size was significantly reduced in the NLS and LS. Barrier-related genes (e.g., claudin 1 and E-cadherin) were downregulated in the AGs of the NLS and LS. Damaged AGs in the LS primarily recruit and activate neutrophils via the CXCL-CXCR and SAA1-FPR2 pathways. Elevated levels of specific keratins (KRT18 and KRT19) released from damaged AGs were observed on the skin surface of patients and were associated with disease severity. KRT19 was also detected in the dermis of the NLS and LS and was surrounded by neutrophils and macrophages. Moreover, serum KRT19 levels in patients (n = 20) were significantly negatively correlated with the age at HS onset. Collectively, our findings provide previously unreported evidence that the AGs are damaged and release specific keratins in early HS lesions, indicating a crucial role of the AGs in HS pathogenesis.

The variant c.274A>G (p.Asn92Asp) in KRT17 in a patient with pachyonychia congenita and a novel clinical feature of acne inversa

IntroductionThe occurrence of pachyonychia congenita (PC) and acne inversa (AI) may be related to gene mutations. The aim of this study is to identify the genetic cause in a patient with PC and AI, and to explore the possible molecular mechanism of their co-occurrence.MethodsThe clinical data of the proband were collected, and the genomic DNA of the proband and unaffected parents were extracted. The variant sites of the proband were identified by whole-exome sequencing, and then the variant sites of the proband and his parents were verified by Sanger sequencing.ResultsA heterozygous variant in KRT17 gene was found in the patient, resulting in a missense amino acid variant (p.N92D). The variant was not found in his parents or 100 unrelated healthy controls. In addition, this variant was not found in the gnomad v4 database. The three-dimensional structure analysis of the protein suggested that the polarity of amino acids changed after the variant. After lentiviral plasmid transfection into HaCaT cells, the expression level of NOTCH signaling decreased in the constructed c.274A>G (p.Asn92Asp) of KRT-17 mutant cells compared to that in the wild-type. Subsequent verification confirmed that differences in the expression levels of p-PI3K, AKT and p-AKT between the groups were not statistically significant.DiscussionAlthough this variant has been reported previously, our findings could expand the spectrum of co-occurrence of PC and AI with KRT17 gene variants, and elucidated the possible pathogenesis at the protein level, thereby laying a foundation for the genetic diagnosis and genetic counseling provided to individuals with PC.

Safety and efficacy of IL-17 inhibitors in hidradenitis suppurativa: an updated systematic review and meta-analysis including the BE-HEARD trials.

Safety and efficacy of IL-17 inhibitors in hidradenitis suppurativa: an updated systematic review and meta-analysis including the BE-HEARD trials.

The roles of IL-17A and IL-17F in hidradenitis suppurativa pathogenesis: evidence from human in vitro preclinical experiments and clinical samples.

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease associated with significant comorbidities and poor quality of life. Despite uncertainty about pathways driving inflammation in HS lesions, the cytokines IL-17A and IL-17F have been shown to be upregulated in patients with HS. Previous studies demonstrated that the monoclonal IgG1 antibody bimekizumab selectively inhibits IL-17F in addition to IL-17A. To further investigate the roles of IL-17A and IL-17F in HS pathogenesis. RNA sequencing was conducted on skin biopsies taken at baseline and after treatment at Week 12 of the phase 2 proof of concept study of bimekizumab in patients with moderate to severe HS. Differentially expressed genes were identified between baseline lesional and non-lesional samples and between lesional samples before and after bimekizumab treatment to describe molecular disease mechanisms and treatment effect.Human hair follicular keratinocytes (HHFK) were cultured and treated with the supernatant of stimulated Th17 cells in combination with anti-IL-17A, anti-IL-17F, anti-IL-17A and anti-IL-17F, or IgG control antibodies. Total mRNA was analysed by RNA sequencing (RNAseq). Cellular supernatants from the stimulated HHFKs were used as a source of Th17-induced chemoattractants in neutrophil chemotaxis assays. RNAseq revealed that the most prominently upregulated genes within HS lesions included those associated with neutrophil biology. Bimekizumab treatment resulted in reduced expression of these genes. Extent of reduction in gene expression was dependent on HiSCR50 fulfilment. In vitro, dual inhibition of IL-17A and IL-17F had greater attenuation of Th17-induced HS-associated genes and neutrophil migration in HHFKs compared to IL-17A or IL-17F inhibition alone. In situ hybridisation revealed IL-17A and IL-17F producing cells in HS lesions can lack IL-23R and IL-1β could induce IL-23-independent IL-17F expression in vitro. Furthermore, mucosal-associated invariant cells in HS tunnels expressed IL-17F and IL-1R1. IL-1β, IL-17A and IL-17F expressing cells were found to be co-localised in HS lesions. These data support the hypothesis that IL-17A and IL-17F play central roles in HS, a neutrophilic dermatosis. The presence of IL-1β may partly explain the high expression of IL-17F in lesional HS tissue.

Laboratory and clinical haemostatic aberrations in primary dermatologic disease: A review.

Inflammatory dermatologic diseases have long been viewed as a "skin limited" disease process. Current literature on inflammatory dermatologic diseases investigates their relationship and influence on thromboembolic states and thromboembolic complications and the understanding of their pathophysiology and molecular mechanisms.Studies specifically discuss known inflammatory skin diseases including alopecia areata, vitiligo, psoriasis, hidradenitis suppurativa, atopic dermatitis, chronic spontaneous urticaria, and autoimmune bullous diseases, and their effects on systemic inflammation, associated cardiovascular comorbidities, and thromboembolic or hypercoagulable states. The limited current literature shows potential for links between inflammatory skin diseases and hypercoagulable states. Biomarkers such as F1 + 2, D-dimer, eosinophilic cationic protein, and PAI-1 are currently being studied to outline the mechanisms connecting inflammatory skin disease to the coagulation system. Further study and larger amounts of data are needed to draw definitive conclusions, especially when interpreting biomarkers alone such as PAI-1.The mechanisms, rates of systemic inflammation, and clinical outcomes of traditionally "skin limited" inflammatory diseases remain chronically understudied in dermatology. Many organ systems have well established connections between inflammatory disease and hypercoagulable states, but there are significant gaps in the literature regarding skin diseases. There is a significant need for comprehensive investigation of molecular mechanisms behind inflammatory dermatologic disease and hypercoagulability, how hypercoagulability effects clinical outcomes, and proper intervention to optimize patient outcomes.

Assessment of therapeutic response to photodynamic therapy with the Zn-Phthalocyanine RLP068/Cl versus topical Clindamycin in patients affected by Hidradenitis Suppurativa: a comparative clinical pilot study.

Hidradenitis suppurativa is a chronic skin disorder characterized by painful inflammatory nodules and abscesses, significantly impacting patients' quality of life. Current treatment strategies, including topical antibiotics, often yield limited efficacy and pose risks of antibiotic resistance. Photodynamic therapy has emerged as a potential option, with RLP068/Cl (ELKOFAST®, non-sterile formulation) showing promising efficacy due to its broad-spectrum bactericidal activity. We conducted a pilot study assessing the therapeutic response to photodynamic therapy with RLP068/Cl versus topical clindamycin gel in patients affected by hidradenitis suppurativa of Hurley score I, II, and III. Results revealed higher efficacy of photodynamic therapy in combination with RLP068/Cl, particularly in mild cases. Its efficacy remains reliable even in more severe cases when combined with adalimumab. The observed faster lesion improvement and pain relief were ascribed to the bactericidal effects of RLP068/Cl against Gram+ and Gram- bacteria. Furthermore, photoactivated RLP068/Cl was well tolerated with no adverse events reported. Therefore, photodynamic therapy following RLP068/Cl application represents a novel therapeutic option for hidradenitis suppurativa with potential implications for antibiotic stewardship in dermatology.

Stigmatization and perceived health status in patients with hidradenitis suppurativa: an observational multicenter study in Europe.

Hidradenitis suppurativa (HS) can severely affect the quality of life (QoL) and is linked to psychological distress, including anxiety, depression, and reduced self-esteem. Stigmatization due to physical appearance may significantly contribute to the psychological burden and impact on QoL for HS patients. This study investigates the association between stigmatization, depression, anxiety, and health- and disease-related variables among HS patients in Europe. This observational cross-sectional multicenter study was conducted across 22 dermatological outpatient clinics in 17 European countries. Data collected included sociodemographic variables, general health variables, disease-related variables, perceived stigmatization (PSQ), and mental health (PHQ-2, GAD-2). Of the 5487 dermatological patients, 142 (2.6%) were diagnosed with HS, and data from 135 patients (70.1% women, mean age 38.2 years) who completed the PSQ questionnaire were analyzed. Scores on the stigmatization measure indicated that significant stigmatization levels were present in the sample. Linear regression models revealed a significant relationship between stigmatization and both the duration of HS and the presence of itch. Similar findings were noted for the PSQ "confused/staring behavior" scale with depression. The PSQ "absence of friendly behavior" scale was inversely associated with general health status, whereas the "hostile behavior" scale was positively linked to depression. HS patients experience significant stigmatization linked to disease duration, itch, and depression. Comprehensive management, including screening for psychosocial co-morbidity, is essential, as is providing access to psychological interventions that support patients to both manage internal distress and the potential reactions of others.

Latent TB screening without chest x-ray: a single centre experience.

Following a previous audit of latent tuberculosis (TB) screening prior to biologic treatment in our centre, which showed that chest x-ray was not useful in screening for latent TB, we removed chest x-ray from our screening protocol. We report the results of a review of latent TB screening in 761 patients prior to commencing biologic agents for psoriasis or hidradenitis suppurativa, finding that rates of latent TB infection in this cohort (3.3%) are similar to background rates of LTBI in the Republic of Ireland.

Gender, race, and economic factors influencing screening practices in hidradenitis suppurativa: a cross-sectional analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life. Despite its substantial burden, HS remains underdiagnosed and undertreated, particularly among marginalized populations. This study aimed to elucidate the primary social determinants of health (SDOH) and structural determinants of health (StDOH) influencing rates and patterns of screening for patients diagnosed with HS. Using data from the All of Us Research Program database, participants with HS were identified using ICD-10 codes and stratified based on various sociodemographic factors, including race, gender, and income. The primary outcome variables were participation in viral screening and disease screening among HS patients. Statistical analyses were performed to assess the relationship between sociodemographic factors and screening practices. Income and gender had significant impacts on screening practices. Higher-income patients were more likely to receive necessary disease screening and less likely to receive unnecessary disease screening compared to lower-income patients. Non-male patients had significantly higher rates of unnecessary disease and viral screening than male patients. While differences in screening practices within each income level were significant, there were no significant differences across different income brackets or racial groups. These findings suggest that subjectivity associated with individual physicians' recommendations may contribute to disparities in screening outcomes, especially in lower-income and non-male HS patients. The study highlights the need for more clearly delineated screening guidelines and continued research on the role of SDOH in improving patient health outcomes.

Treatment satisfaction in patients with hidradenitis suppurativa: A real-world survey from the EU5 and US.

Introduction Hidradenitis suppurativa (HS) is a debilitating, inflammatory skin disorder. Treatment strategies in patients with HS are challenging; real-world evidence in a HS population is warranted for greater disease understanding. The objective of this analysis was to describe real-world treatment patterns and treatment satisfaction in patients with HS. Methods This was a cross-sectional market research survey with retrospective data collection in patients with HS from the United States and five European countries (France, Germany, Italy, Spain, United Kingdom) between November 2020 and April 2021, using physician- and patient-reported surveys. Eligible physicians were general dermatologists actively managing patients with HS; dermatologists were required to have consulted with ≥2 patients with HS in the previous 12 months. Adult (≥18 years) and adolescent (10‒17 years) HS patients visiting a participating dermatologist were included. Outcomes included treatment patterns, flare status, treatments prescribed in response to flares, previous surgeries, barriers to biologics, and patient- and physician-reported satisfaction with the disease control provided by treatment. Results Survey data from 1787 patients were collected from 312 dermatologists. The most frequently prescribed treatments were topicals, oral antibiotics, and antiseptic washes/creams at diagnosis and sampling. At sampling, biologics were more frequently prescribed in patients with more severe disease (prescribed in 26.6%, 31.0% and 52.4% of patients with mild, moderate, and severe disease, respectively); oral antibiotics (48.8%), topicals (37.4%), and biologics (34.3%) were the most frequently prescribed treatment classes in response to a flare. Of patients currently not receiving a biologic, dermatologists reported that 18.9% of patients' condition warranted their use. Approximately one quarter of dermatologists (24.5%) and patients (27.4%) were not satisfied with current treatment; of patients who were dissatisfied, 12.8% reported they would never raise their dissatisfaction with their doctor. Conclusion These real-world data suggest a high disease burden and potential undertreatment in patients with HS. Patients received multiple treatments, and a notable proportion underwent surgery. Robustly integrating the patient voice in HS treatment decisions may lead to better outcomes and improved treatment satisfaction.