To identify the underlying subtypes of hidradenitis suppurativa (HS), we performed latent class analysis on prospective clinical data of 618 consecutive patients seen between 2002 and 2010. The ...median patient age was 31 years (Q1=26; Q3=38), median age at HS onset was 20 years (16–25), and median Sartorius score was 18 (11–19); 34.4% of patients were of Hurley stage II or III. A three-class model showed the best fit. Latent class 1 (LC1) patients (48%) had a high probability of breast and armpit lesions (0.74) and hypertrophic scars (0.41). LC2 patients (26%) had a high probability not only of breast and armpit lesions (0.96) but also of lesions in the ears, chest, back, or legs (0.55); follicular lesions (pilonidal sinus: 0.48; comedones: 0.74); severe acne (0.47); and a family history of HS (0.44). Compared with LC1 patients, LC2 patients were more often male (odds ratio, 4.6; 95% confidence interval, 3–7; P<0.001) and current smokers (2.2; 1.3–3.9; P=0.005), and had greater disease severity (odds ratio, 1.6; 1.3–1.9; P<0.001). LC3 was characterized by gluteal involvement (0.54), papules, and folliculitis (0.71). LC3 patients were less often obese (0.6; 0.3–0.95; P=0.03) and had less severe disease (0.9; 0.7–1.1; P<0.001). These three phenotypes (“axillary–mammary”, “follicular”, and “gluteal”) may help stratify patients for clinical trials.
Cutibacterium acnes has been identified as one of the main triggers of acne. However, increasing knowledge of the human skin microbiome raises questions about the role of other skin commensals, such ...as Staphylococcus epidermidis, in the physiopathology of this skin disease.
This review provides an overview of current knowledge of the potential role of S. epidermidis in the physiopathology of acne. Recent research indicates that acne might be the result of an unbalanced equilibrium between C. acnes and S. epidermidis,according to dedicated interactions. Current treatments act on C. acnesonly. Other treatment options may be considered, such as probiotics derived from S. epidermidis to restore the naturally balanced microbiota or through targeting the regulation of the host's AMP mediators. Key Messages: Research seems to confirm the beneficial role of S. epidermidis in acne by limiting C. acnes over-colonisation and inflammation.
Background Conflicting opinions have been reported regarding the epidemiology of hidradenitis suppurativa. Objective We sought to evaluate the prevalence of hidradenitis suppurativa and to identify ...associated factors. Methodology Prevalence was evaluated using a representative sample of the French population (n = 10,000). Associated risk factors were assessed using two case-control studies, one population-based with 67 self-reported patients and 200 control subjects, and the other clinic-based with 302 medically assessed patients and 906 control subjects. Results The prevalence was 1% of the French population. Multivariate analyses showed a strong association with current smoking in self-reported (odds ratio = 4.16, 95% confidence interval 2.99-8.69) and in medically assessed (odds ratio = 12.55 8.58-18.38) populations. Association with body mass index was significant in medically assessed patients (odds ratio = 1.12 1.08-1.15) for each increase of 1 U of BMI. Limitations A causal relationship could not be established with such a cross-sectional study. Conclusion Hidradenitis suppurativa is a common disease, frequently associated with smoking and being overweight.
Background Factors associated with the severity of hidradenitis suppurativa (HS) are not known. Objective We sought to identify factors associated with the severity of HS. Methodology The severity of ...disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. Results Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index ( P < .001), atypical locations ( P = .002), a personal history of severe acne ( P = .04), and absence of a family history of HS ( P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). Limitations The referral center base of the study may have biased recruitment. Conclusion Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.
The diagnosis of acne is usually easy, but there are some pitfalls to be avoided. ‘Keloid acne of the neck’ and beard folliculitis are not acnes in the usual sense: both are inflammatory and fibrous ...reactions of the hair follicles and frizzy hair; no retentional lesions, blackheads and microcysts – are visible. Gram negative folliculitis classically occurs in acneic male subjects who have undergone extensive treatment with general antibiotics or local antiseptics, but ‘de novo’ cases do exist. On black skin, this condition is not exceptional, it occurs in both sexes and usually takes the nodular form. The diagnosis should be considered if there is any aggravation of acne which is resistant to classic treatment, with painful nodules on the cheeks. Treatment is based on appropriate antibiotherapy for several weeks and possibly, in a second phase, on Isotretinoin. Pityrosporum folliculitis occurs mainly on the trunk. More frequent in men than in women, it is chiefly observed in subjects living in a hot, humid climate. Demodicidosis is manifested by outbreaks of papular or papulopustular lesions of the face. On black skin the principal differential diagnosis is acne. The presence of numerous parasites is necessary for diagnosis. Clinically speaking, an important sign is when the eyelids are affected. Ivermectin is effective. Acneiform dermatitis may be induced by depigmenting preparations containing powerful dermocorticoids. It is therefore important, in cases of very inflammatory acne, to look for the other clinical signs of voluntary depigmentation. In countries where it is endemic, lepromatous leprosy should be considered. Other common dermatitis may simulate acne or else be associated with it, such as eruptive hidradenoma or molluscum contagiosum. Analysis of the different elementary lesions and the absence of retentional lesions generally enable a diagnosis to be established.
Résumé
Le diagnostic d’acné est habituellement facile, certains pièges sont néanmoins àéviter. « L’ acné chéloïdienne de la nuque » et la folliculite de la barbe ne sont pas des acnés au sens propre: ...ce sont toutes deux des réactions inflammatoires puis fibreuses des follicules porteurs de cheveux et poils crépus, il n’y a pas de lésions rétentionnelles – comédons et microkystes‐ visibles. Les folliculites à gram négatifs surviennent classiquement chez les sujets masculins acnéiques traités de façon prolongée par antibiothérapie générales ou antiseptiques locaux, mais il existe des cas « de novo ». Sur peau noire, cette affection n’est pas exceptionnelle, elle survient dans les deux sexes et prend habituellement la forme nodulaire. Devant toute aggravation d’une acné, résistante au traitement classique, comportant des nodules douloureux des joues, le diagnostic est àévoquer. Le traitement repose sur une antibiothérapie adaptée pendant plusieurs semaines et éventuellement dans un deuxième temps sur l’Isotrétinoïne. Les folliculites pityrosporiques sont localisées principalement sur le tronc. Plus fréquente chez l’homme que chez la femme, elles s’observent sur‐tout chez les sujets vivants en climat chaud et humide. La démodécie se manifeste par des poussées de lésions papuleuses ou papulo‐pustuleuses du visage. Sur peau noire, le principal diagnostic différentiel est l’acné. La présence de nombreux parasites est nécessaire au diagnostic. Cliniquement, un signe important est l’atteinte des paupières. L’Ivermectine est efficace. Une dermatose acnéiforme peut être induite par les préparations dépigmentantes contenant des dermocorticoïdes puissants. Il est donc important, devant une acné très inflammatoire, de rechercher les autres signes cliniques de la dépigmentation volontaire. L’hydradénite du visage et du dos peut être confondue avec une acné nodulaire. En pays d’endémie, il faut penser à la lèpre lépromateuse. D’autres dermatoses courantes peuvent simuler une acné ou bien lui être associées, comme les hidradénomes éruptifs ou les molluscum contagiosum, L’analyse des différentes lésions élémentaires et l’absence de lésions rétentionnelles permet en général de rétablir le diagnostic.
Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating, follicular disease of the skin. Despite a high prevalence in the general population, the physiopathology of HS remains poorly ...understood. The use of antibiotics and immunosuppressive agents for therapy suggests a deregulated immune response to microflora. Using cellular and gene expression analyses, we found an increased number of infiltrating CD4+ T cells secreting IL-17 and IFN-γ in perilesional and lesional skin of patients with HS. By contrast, IL-22-secreting CD4+ T cells are not enriched in HS lesions contrasting with increased number of those cells in the blood of patients with HS. We showed that keratinocytes isolated from hair follicles of patients with HS secreted significantly more IL-1β, IP-10, and chemokine (C-C motif) ligand 5 (RANTES) either constitutively or on pattern recognition receptor stimulations. In addition, they displayed a distinct pattern of antimicrobial peptide production. These findings point out a functional defect of keratinocytes in HS leading to a balance prone to inflammatory responses. This is likely to favor a permissive environment for bacterial infections and chronic inflammation characterizing clinical outcomes in patients with HS.
Acne on pigmented skin Poli, Florence
International journal of dermatology,
October 2007, Letnik:
46, Številka:
s1
Journal Article, Conference Proceeding
Recenzirano
Acne on pigmented skin occurs in Africans and their descendants, as well as in patients with a skin phototype above IV. Acne is common in Africans and is often the primary reason for consulting a ...dermatologist. Acne on pigmented skin is principally inflammatory acne. The sequelae in terms of pigmentation are often the main reason for consulting a dermatologist, and take precedence over the acne itself. Research is needed into cosmetic acne and steroid‐induced dermatitis, which are common in users of skin bleaching products.
The treatment for acne in pigmented skin involves the same medicines as used in acne in white skin. Of the available topical treatments, benzoyl peroxide is particularly effective for the inflammatory component. Retinoids act on both the retentional and inflammatory components of acne and have skin bleaching properties. Tetracyclines are essential on initiation of treatment, regardless of severity. They prevent an inflammatory episode at the onset of acne and rapidly improve the inflammatory component. Minocycline should not be prescribed in African patients. Fatal cases of hypersensitivity have been described, with a particular frequency in this population. Doxycycline is effective, but has photosensitizing properties. Lymecycline is well tolerated. Isotretinoin is indicated for nodular acne. The same precautions for use should be followed as in all cases of acne. The skin bleaching effects are considerable. Photoprotection should generally be imposed, but, in patients with black skin, photoprotective agents are often not applied. The administration of a cosmetic containing a skin bleaching agent combined with a photoprotective agent for application in the morning, instead of hydrating cream, is acceptable to patients, improves compliance, and is effective.
Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne.
To describe the skin lesions of a group of patients with HS.
Twelve patients were selected ...from a series of 648 patients on the basis of their specific skin lesions.
The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, 'worm-eaten scars' and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect.
Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.
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