Tuesday, March 21, 2017

Recent Research in Hidradenitis Suppuritiva


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Antibiotic Therapy for HS Can Induce Antibiotic Resistance
A cross-sectional analysis of 239 patients with HS evaluated from 2010 to 2015 compared use of antibiotics to no antibiotics with respect to the development of bacterial resistance to antibiotics.
Tetracyclines and oral clindamycin were not associated with any significant antimicrobial resistance. Therefore they should be used in preference to Bactrim, Ciprofloxacin and topical Clindamycin to treat HS related infections.
Fischer AH, Haskin A, Okoye GA. Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa. JAAD. 2017;76(2)309-213.e2

Skin Microbiota is Altered in Preclinical Hidradenitis Suppurativa
Researchers compared armpit skin not involved with HS in 24 patients with HS to 24 people without HS. 50% of the samples from HS participants showed signs of low-grade inflammation compared with only 16% of controls but there were fewer bacteria and less biofilm on the skin of the HS participants not visibly affected by HS. Therefore the inciting factor of HS is likely autoimmune not bacterial infection from the outside and antibiotic use to prevent HS flare ups is not recommended.
Ring HC, Bay L, Kallenbach K, et al. Normal skin microbiota is altered in pre-clinical hidradenitis suppurativa. Acta Derm Venereol. 2017;97(2):208-213.

Ultrasound Evaluation May Assist in Staging HS Severity
Researchers examined 20 individuals with HS diagnosed lesions between January and September 2016 using high frequency ultrasound systems (UHF48 and UHF70 transducers with M-mode and Color Doppler mode). The ultrasounds showed widening of the hair follicles, thickening and/or abnormal echogenicity of the dermis, dermal pseudocystic nodules, fluid collections, fistulas and dermal sinus tracts connected to the base of hair follicles. They concluded that high frequency ultrasound can help to confirm HS diagnosis, assess the severity of the disease, improve the management of the patients and evaluate the therapeutic effects of systemic and local treatments.
Oranges T, Chiricozzi A, Dini V, et al. High frequency ultrasound in Hidradenitis Suppurativa [presented at the 75th Annual Meeting of the American Academy of Dermatology]. Orlando, Florida. March 3, 2016.

HS Flares Are Often Heralded by Prodromal Symptoms
Researchers administered an extensive questionnaire including questions on the frequency, type and time of occurrence of the prodromal symptoms, and the degree of certainty of the perceived association to 72 patients with HS. 83.3% (60 out of 72) reported experiencing 1 or more prodromal symptoms prior to the development of inflamed nodules or abscesses. 45% indicated that the prodromes occurred more than 24 hours before eruption, while 20% indicated that they occurred 12-24 hours before eruption. In over half of these patients the symptom was fatigue or malaise which is likely related to immune system downgrading or upgrading.
Ring HC, Theut Riis P, Zarchi K, Miller IM, Saunte DM, Jemec GB. Prodromal symptoms in hidradenitis suppurativa [published online February 14, 2017]. Clin Exp Dermatol. doi: 10.1111/ced.13025.

Age of HS onset has no bearing on HS severity
A retrospective review of HS patients 12 to 64 years old, defining early age onset as under 18, revealed no significant differences in gender, body mass index, or family history of HS between early onset and later onset HS. Also early onset HS was not associated with disease severity or with the number of anatomic areas affected.
Dessinioti C, Antoniou C, Tzanetakou V, Zisimou C. A retrospective study of the characteristics of patients with early onset hidradenitis suppurativa [Presented at the 75th Annual Meeting of the American Academy of Dermatology. Orlando, Florida. March 2017. https://www.aad.org/eposters/Submissions/getFile.aspx?id=4187&type=sub.

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