Search Results (213)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a complex immune response. Given the considerable heterogeneity of the clinical phenotype of HS, this study aimed to analyse the immunohistochemical pattern of interstitial inflammation. Methods: Immunohistochemical analysis was performed on skin samples from 49 patients with HS. The immunohistochemical markers CD3, CD4 and CD8 for T-cells, CD20 for B-cells, CD138 for plasma cells and CD30, CD56, Bcl-2 and Bcl-6 were stained on lesional skin. Results: The analysis of immune cell dominance in patients with HS revealed that 33.3% of the cohort exhibited B-cell dominance, defined as a ratio of the sum of CD20+ and CD138+ cells to CD3+ cells greater than 1, while the majority (66.7%) demonstrated T-cell dominance, defined as a ratio of CD3+ cells to the sum of CD20+ and CD138+ cells greater than 1. B-cell-dominant HS is associated with a significantly elevated probability of mammary involvement (13.3% vs. 0%; p = 0.041). T-cell-dominant HS patients tended to demonstrate a higher mean tobacco consumption, but not significantly (20 vs. 5 tobacco pack-years; p = 0.06). CD4-dominant HS patients exhibited a significantly greater involvement of the mons pubis (62.5% vs. 28.6%, p = 0.023) compared to CD8-dominant patients, who demonstrated a significantly higher number of abscesses (p = 0.027). Conclusions: For the first time, we describe the clinical and immunohistochemical characteristics of T-cell- and B-cell-dominant HS. Although HS seems to be more dominated by T-cells, a B-cell dominance was found in 33% of cases. Full article

Background: Surgical excision of axillary hidradenitis suppurativa (HS) often results in challenging defects. While flap techniques offer durable coverage, they are typically invasive. We present a modified method combining peripheral defect reduction with two sliding triangular island flaps from the arm and chest, designed to optimize healing with minimal invasiveness. Methods: Twelve patients (Hurley II–III) underwent excision and dual V-Y advancement flap reconstruction. Flaps were mobilized without perforator dissection. Outcomes were assessed using patient and surgeon Likert-scale ratings at one and six months. Results: Good healing was achieved in 91.7% of cases. Both patient acceptance and cosmetic outcomes were favorable (83.3%). No major complications were noted; one recurrence (8.3%) occurred at six months. Conclusions: The described technique offers a safe, effective, and cosmetically favorable option for medium-sized axillary HS defects. It provides a less invasive alternative to conventional flaps, with high healing rates and patient acceptance. Full article

Hidradenitis suppurativa (HS) is a chronic, inflammatory, immune-mediated skin disease associated with several comorbidities and vascular risk factors. Oxidative stress, inflammation, and altered high-density lipoprotein (HDL) functions play key roles in inflammatory skin diseases. However, the relationship between these factors and HS is not fully understood. The aim of this study was to investigate the relationship between HS and oxidative stress, inflammation, and HDL functions, focusing on inflammatory markers and HDL-related antioxidant properties. We evaluated the serum levels of inflammation markers serum amyloid A (SAA) and monocyte chemoattractant protein-1 (MCP-1) in 44 HS patients and 16 healthy controls. Additionally, we assessed the activity of the antioxidant enzyme paraoxonase-1 (PON1) associated with HDL, as well as the HDL redox properties using a cell-free method. HS patients showed significantly higher serum levels of MCP-1 and SAA compared to controls. PON1 activity was considerably lower in HS patients, suggesting impaired antioxidant functions of HDL. These changes in HDL correlated with the severity of HS but occurred without significant alterations in plasma HDL levels. Our findings indicate that inflammation and oxidative stress could contribute to the dysfunction of HDL in HS patients. Identifying dysfunctional HDL could provide valuable insights into the pathogenesis of HS and its associated complications, offering potential targets for new therapeutic strategies. Full article

Shedding light on Hidradenitis Suppurativa activity: a pilot study to evaluate the potential of [^99mTc]Tc-anti-TNF-alpha scintigraphy. Background/Objectives: Hidradenitis suppurativa (HS), also known as acne inversa and Verneuil’s disease, is a chronic and non-contagious auto-inflammatory disease of pilo-sebaceous units that can lead to severe complications and sequelae. The actual prevalence of HS is unknown due to diagnostic delay and/or misdiagnosis, but it is estimated to affect 0.00033–4.1% of the general population worldwide. Only severe cases are referred for imaging assessment, and the final diagnosis is mostly established on a clinical basis. Here, we present a pilot study aiming to evaluate clinically active inflammatory disease in patients with HS using [^99mTc]Tc-anti-TNF-alpha scintigraphy. Methods: Four patients (2 male, 2 female) had their HS clinical features measured through the HS-PGA and Hurley Score and compared to [^99mTc]Tc-anti-TNF-alpha scintigraphy findings. Results: Scintigraphy with [^99mTc]Tc-anti-TNF-alpha showed abnormal uptake in clinically active lesions of HS and also detected some clinically unknown potential active lesions, later confirmed by clinical reassessment after the imaging. Conclusions: Our results suggest that scintigraphy with [^99mTc]Tc-anti-TNF-alpha may be able to detect increased radiotracer uptake in most clinically identified active lesions in this pilot cohort. While promising, due to the inherent limitations of this pilot study, more studies need to be carried out to arrive at a definitive diagnostic assessment of active inflammatory disease using this method. Full article

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory dermatosis of the pilosebaceous unit characterized by nodules, abscesses, and dermal tunnels. Recent transcriptomic studies have implicated dysregulation of innate and adaptive immune responses, epidermal barrier dysfunction, and systemic metabolic alterations. This review synthesizes findings from 16 studies investigating the HS transcriptome using bulk and single-cell RNA sequencing. Differential gene expression analyses revealed extensive upregulation of inflammatory cytokines and chemokines, particularly in lesional and perilesional skin. These changes were also mirrored in non-lesional skin, suggesting diffuse immune dysregulation beyond visibly affected areas. Downregulated pathways include those involved in lipid metabolism, muscle contraction, and neuronal signaling, potentially linking HS to obesity, metabolic syndrome, and neuropsychiatric comorbidities. Single-cell transcriptomics confirmed the enrichment of keratinocytes and immune cells (B cells, plasma cells, M1 macrophages, and T cells) with proinflammatory profiles in HS lesions. Keratinocyte dysfunction further implicated a compromised epidermal barrier in disease pathogenesis. While transcriptomic studies have advanced mechanistic understanding and highlighted therapeutic targets—such as the IL-1β–TH17 axis and B cell signaling pathways—methodological heterogeneity limits cross-study comparisons. Integration of multi-omics data and standardized phenotyping will be essential to identify robust biomarkers, stratify HS subtypes, and guide personalized therapeutic approaches. Full article

Insulin resistance (IR) plays a pivotal role in the pathogenesis of several dermatological diseases, including psoriasis, acne, acanthosis nigricans, and hidradenitis suppurativa (HS). These conditions are characterized by chronic inflammation, oxidative stress, and metabolic dysfunction, which are exacerbated by IR. This narrative review examines the emerging role of nutraceutical insulin-sensitizing agents (ISAs), including myo-inositol, alpha-lipoic acid, vitamin D, vitamin C, and folic acid, in managing IR-related dermatological disorders. A comprehensive literature search was conducted across Cochrane Library and MEDLINE (1965–May 2025), focusing on clinical trials involving nutraceutical ISAs in dermatological conditions associated with IR. Only human studies published in English were included. Evidence from randomized controlled trials (RCTs) and observational studies suggests that ISAs improve glycemic control, reduce oxidative stress, and modulate inflammatory pathways in IR-related dermatoses. Notably, myo-inositol combined with magnesium and folic acid has demonstrated significant reductions in acne severity, hirsutism, and quality-of-life impairments in women with polycystic ovary syndrome. Similar benefits have been observed in psoriasis and HS, though data remain limited. Nutraceutical ISAs offer a promising adjunctive approach for the management of IR-associated dermatological diseases, potentially addressing both metabolic dysfunction and skin inflammation. However, robust RCTs with long-term follow-up are needed to confirm these preliminary findings and to establish optimal treatment regimens. Full article

Sleep is crucial to overall health and plays a significant role in skin function. While the circadian rhythm has been extensively researched for its impact on the body’s optimal functioning, the skin also possesses an independent circadian system that serves many important functions. Sleep disruptions or deprivation can significantly affect skin conditions, by compromising the skin barrier and impairing processes such as collagen production, cellular repair, and wound healing. Given the commonality of sleep disturbances, it is crucial to understand the connection between sleep, circadian regulation, and skin health. This is particularly important in understudied populations, such as those with occupational sleep disruption and individuals with hormone-related conditions like PCOS and menopause. Bidirectional relationships have been established between sleep and several inflammatory skin conditions, including atopic dermatitis, psoriasis, rosacea, and hidradenitis suppurativa. While acne is influenced by sleep, the reverse relationship, how acne affects sleep quality, has not been well established. Chronic sleep disruption can increase cortisol levels and oxidative stress, both of which contribute to skin aging and the progression of autoimmune skin conditions, including systemic lupus erythematosus. As sleep is a modifiable risk factor, it is crucial to consider therapeutic options and interventions to prevent or alleviate skin conditions. This review discusses various therapeutic approaches, including melatonin, L-Theanine, Magnesium-L-threonate, Inositol, Cinnamomi cortex, nervous system regulation, and proper sleep hygiene. These therapeutic options have been studied for their impact on sleep, and importantly, several have been evaluated for their utility as adjuncts for treating skin conditions. Overall, the relationship between sleep and skin health is clear, and incorporating sleep-focused therapeutic interventions offers potential to improve both sleep quality and skin health in individuals with a variety of skin conditions. Full article

Hidradenitis suppurativa (HS) and inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, immune-mediated conditions with significant impact on quality of life. Emerging evidence reveals a notable epidemiological and pathogenic overlap between HS and IBD, particularly CD. Although a bidirectional association between HS and IBD has been well documented, current evidence supports a causal effect of IBD on the development of HS, while a causal relationship in the opposite direction has yet to be established. The present review explores the important association between these immune-mediated conditions and further highlights shared risk factors, genetic predispositions and immunopathogenic mechanisms, such as dysbiosis and cytokine dysregulation, involved in both HS and IBD. Diagnostic challenges, especially in differentiating perianal HS from perianal CD, are also discussed. The coexistence of HS and IBD impacts disease severity, treatment response, and overall management strategies. Shared therapeutic approaches, such as TNF-α inhibitors and JAK inhibitors, are considered promising options for effectively managing patients affected by both conditions. Nevertheless, deeper understanding of the gut–skin axis that will offer potential for more precise interventions in patients with simultaneous HS and IBD is considered imperative. Full article

Background/Objectives: Hidradenitis suppurativa (HS) is a chronic autoinflammatory skin disease characterized by recurrent, painful, and persistently draining purulent lesions. Alterations in the composition of the microbiome may be associated with immune dysregulation and HS progression. The objective of this study was to investigate the correlations between the gut microbiome and HS. Methods: A total of 80 participants (40 HS patients and 40 healthy controls [HCs]) were included in this study. Each participant filled out a specially designed questionnaire, which included demographics, HS severity, physical characteristics, dietary habits, and gastrointestinal disorders. DNA isolation and sequencing of microbiota were performed from fecal samples collected from each participant. Results: No statistically significant difference was observed in the alpha diversity between the microbiota of HS and HC. Nevertheless, HS was found to significantly decrease the chances of, among others, Collinsella, Izemoplasmatales, Clostridia, Lachnospiraceae, eligens group, xylanophilum group, and Pseudoflavonifractor occurrence. Conversely, HS significantly increased the chances of Enterorhabdus, Senegalimassilia, Gastranaerophilales, Candidatus Stoquefichus, Erysipelatoclostridiaceae, Holdemanella, Solobacterium, Ruminiclostridium, [Eubacterium] fissicatena group, Angelakisella, Comamonas, and Enterobacter occurrence. The logistic regression analysis, performed separately for each genus, showed a significant influence of disease severity (based on the Hurley scale) on the chances of occurrence for the following genera: Chloroplast (OR = 5.778), Dielma (OR = 5.75), Eisenbergiella (OR = 5.75) and Paludicola (OR = 5.778). Conclusions: In conclusion, our study adds to the growing body of literature on the gut microbiome in HS and provides valuable insights into the specific alterations in microbial occurrence and abundance associated with the disease. Full article

Background/Objectives: Hidradenitis suppurativa (HS) is a complicated chronic inflammatory skin disorder characterized by recurrent and painful deep-seated nodules, abscesses, fistulae, scarring, and sinus tracts. HS most commonly affects high-density hair follicles and apocrine gland-rich regions of the body, including the axillae, inguinal folds, breasts, and perianal areas. Although genetic predisposition and environmental factors are known to contribute to the development and the severity of HS, the molecular mechanisms of HS are largely unknown. Methods: In this study, we employed global epigenetic and genomic data analysis and single-nucleus ATAC-seq (snATAC-seq) to profile the heterogeneity of HS-associated chromatin accessibility and define the underlying disease drivers. We additionally performed high-resolution immunofluorescence staining to confirm a novel candidate regulator. Results: We found that multiple skin development modules and molecular signal pathways were epigenetically dysregulated in HS basal CD49f^high cells. Importantly, our snATAC-seq revealed a previously unraveled role for a transcription factor, ATF3, in transcriptionally regulating HS-associated genes. We also delineated the specific ATF3 expression pattern across the HS lesional skin. Conclusions: We characterize HS-specific epigenetic plasticity and chromatin state at the single-nucleus level and further underscore a possible mechanism for HS pathogenesis. Full article

Hidradenitis suppurativa (HS) and atopic dermatitis (AD) are both inflammatory dermatoses that can significantly impact patient quality of life, however, limited research exists regarding their association. The purpose of this comprehensive review is to compare the inflammatory pathogenesis of HS and AD, explore the associations between these diseases, and discuss standalone and concomitant disease treatment options. Although HS and AD are understood to be primarily driven by the Th1 and Th2 inflammation pathways, respectively, these conditions both utilize the Janus Kinase/Signal transducer and activator of transcription (JAK/STAT) pathway to promote inflammation. Newer research also suggests that IL-36 and IL-1 receptor-associated kinase 4 (IRAK4) may be two additional inflammatory signals shared between the HS and AD disease pathways. These shared mechanisms are reflected in patient presentations as HS and AD are often concomitantly present and demonstrate a bidirectional association in the current literature. Treatment options for concomitant disease are limited, but leverage the shared immune pathogenesis of both diseases. Dupilumab has been reported to improve both HS and AD symptoms in select patients. JAK inhibitors are currently FDA-approved for the treatment of AD, and early trials have suggested benefits from JAK inhibitors such as upadacitinib, povorcitinib, and topical ruxolitinib for HS. Possible future avenues for research on treating both HS and AD include IRAK-4 inhibitors such as zabedosertib and BAY1830839, and diet and gut microbiome modifications. Full article

Background/Objectives: The accurate measurement of tunnel lengths in hidradenitis suppurativa (HS) is critical for surgical planning. This study aimed to evaluate the agreement between palpation and high-frequency ultrasound (USG) for assessing tunnel lengths in HS patients. Methods: This prospective study included patients who underwent the surgical excision of tunnels between May 2024 and July 2024 at a referral dermatology clinic. Tunnel lengths were measured preoperatively using palpation and USG. Clinical and demographic data, including lesion localization and disease severity, were prospectively recorded and analyzed. Results: This study analyzed 121 lesions from patients undergoing surgical excision for HS. Tunnel lengths measured by palpation had a median of 30 mm [IQR 18–40], while USG measurements had a median of 36 mm [IQR 24–51.5], with USG identifying tunnels 10.3 mm longer on average (95% CI: 8.2–12.3). Axillary lesions were most frequent (53.7%), followed by inguinal (32.2%) and sacral regions (6.6%). Most lesions were classified as Hurley stage 2 (59.5%) and stage 3 (37.2%), with a median IHS4 score of 8 [IQR 7–11]. Conclusions: High-frequency USG offers greater precision than palpation in measuring tunnel lengths, indicating its potential to enhance disease assessments in HS. Full article

Ablative fractional CO₂ laser is an established tool for dermatologic and aesthetic indications. Non-ablative wavelengths, such as 1540 and 1570 nm, are increasingly being combined with CO₂ laser to optimise the results while reducing the recovery time. A narrative review of the literature was conducted, including ex vivo, in vivo, and in vitro studies, as well as human clinical trials that evaluated the efficacy, safety, and histological impact of dual-laser systems. Preclinical studies have shown that sequential application of fractional CO₂ followed by 1540/1570 nm expands the thermal coagulation zone without increasing the ablation depth. At the histological level, the dual protocol promotes collagen remodelling with greater thermal precision. On a clinical level, a combined treatment has shown efficacy in improving scars, striae distensae, skin laxity, and wrinkles, with reduced recovery times compared to CO₂ monotherapy. Preliminary data also suggest potential benefits in inflammatory conditions such as hidradenitis suppurativa. The sequential CO₂ + 1540/1570 nm combination represents an effective and well-tolerated approach in regenerative dermatology. Current evidence supports its use as a versatile, safe, and reproducible technique for skin rejuvenation and scar modulation; however, further comparative studies are needed to standardise protocols. Full article

Vitamin D, a hormone synthesized in the skin through ultraviolet B radiation (UVB), plays a crucial role not only in calcium and phosphate homeostasis but also in regulating skin homeostasis and modulating immune responses. In keratinocytes, vitamin D is converted to its active form, 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D), which interacts with the vitamin D receptor (VDR) to regulate gene expression involved in proliferation, differentiation, and antimicrobial defense. Dysregulation of this pathway has been implicated in inflammatory skin diseases such as psoriasis, atopic dermatitis, acne vulgaris, and hidradenitis suppurativa. These conditions are associated with altered epidermal differentiation, immune imbalance, and microbial interactions, where vitamin D plays a modulatory role by suppressing proinflammatory cytokines, enhancing antimicrobial peptide synthesis, and restoring skin barrier integrity. Topical vitamin D analogues have shown therapeutic benefits in psoriasis, while emerging evidence supports the adjunctive role of vitamin D supplementation in acne, hidradenitis suppurativa, and atopic dermatitis. Despite promising associations between low serum vitamin D levels and disease severity, a causal relationship remains uncertain. This review integrates molecular mechanisms with clinical findings, emphasizing the role of vitamin D in cutaneous physiology and pathology, and highlights the need for further research into targeted supplementation strategies in dermatological disorders. Full article

The sebaceous gland (SG) is an integral part of the pilosebaceous unit and is a very active and dynamic organ that contributes significantly to the maintenance of skin homeostasis. In addition to its primary role in sebum production, the SG is involved in the maintenance of skin barrier function, local endocrine/neuroendocrine function, the innate immune response, and the regulation of skin bacterial colonization. Structural and functional alterations of SGs leading to the dysregulation of sebum production/composition and immune response may contribute to the pathogenesis of inflammatory dermatoses. This review summarises the current knowledge on the contribution of SGs to the pathogenesis of common inflammatory skin diseases. These findings are crucial for the development of more effective therapeutic strategies for the treatment of inflammatory dermatoses. Full article