small molecules

2026-09-30 | 'My HS is significantly impacted by my cycle': a cross-sectional study exploring the impact of menstruation and pregnancy on hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic skin condition that causes painful abscesses, nodules and tunnelling in the skin folds. HS disproportionately affects women, and androgenic hormones are implicated in its pathophysiology. To explore the impact of menstruation and pregnancy on HS. Two anonymous online surveys were created on Microsoft Forms and distributed via social media platforms (Facebook, Instagram, X and LinkedIn). The surveys were also shared via the HS Support Network UK and Ireland and HS Ireland's mailing lists. The first survey explored the impact of menstruation on HS (open from 16 December 2024 to 18 January 2025); the second survey explored the impact of pregnancy on HS (open from 6 June to 20 August 2025). Survey data were analysed using descriptive statistics and free-text responses were coded, categorized into themes and analysed manually. Of 255 participants who responded to the first survey, 96.1% (n = 245/255) noticed changes in their HS during their menstrual cycle. Of these, 99.6% (n = 244/245) experienced worsening symptoms. Of 43 respondents to the second survey, 58% (n = 25/43) reported HS worsening during pregnancy. Flare-ups typically occurred during the premenstrual phase and the second trimester of pregnancy. Respondents reported variable disease improvement with the antiandrogenic drugs metformin and spironolactone. Some respondents reported difficulty in caring for their newborn babies during the postpartum period, primarily because of pain caused by their HS. This study demonstrates a strong association between hormonal fluctuations and HS symptom deterioration. Clinicians should proactively assess menstrual patterns in HS management and provide support during the pregnancy and postpartum periods. Coordinated multidisciplinary care is essential. Further research is needed to evaluate antiandrogenic therapies for hormonally triggered HS exacerbations.

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2026-09-24 | Molecular insights into GLP-1 receptor agonists and emerging metabolic-inflammatory targets in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is increasingly recognized as a systemic immunometabolic disease associated with obesity, insulin resistance, and metabolic syndrome (MetS). A metabolically unhealthy lean phenotype indicates that metabolic dysfunction and chronic low-grade inflammation may occur independently of increased body mass index (BMI) in patients with HS. Reduced effectiveness of biologic therapies in patients with obesity further supports targeting the upstream metabolic drivers of inflammation. This review outlines metabolic-inflammatory pathways proposed to contribute to HS, including insulin/insulin-like growth factor 1 (IGF-1) signaling, mechanistic target of rapamycin complex 1 (mTORC1) overactivation, adipokine dysregulation, and gut-skin interactions. Building on this framework, this review evaluates evidence on glucagon-like peptide-1 receptor agonists (GLP-1RAs), dual incretin agonists, and other metabolic interventions, including metformin is evaluated. GLP-1RAs may serve as adjunctive metabolic therapies for selected patients with HS and obesity or MetS. By promoting weight loss and metabolic improvement, they may reduce systemic inflammation, perioperative risk, and improve responses to weight-based biologics. However, current evidence remains mainly observational and is confounded by concomitant therapies. Randomized controlled trials using well-defined dermatological and metabolic endpoints are needed before routine implementation.

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2026-09-24 | Dietary Modulation of microRNAs as a Potential Nutritional Strategy in Inflammatory and Autoimmune Skin Diseases: A Narrative Review.

Inflammatory and autoimmune skin diseases like psoriasis, atopic dermatitis, and hidradenitis suppurativa present significant therapeutic challenges due to their complex immunological and environmental pathogenesis. This review highlights the critical role of microRNAs (miRNAs) as epigenetic regulators of inflammatory processes and investigates the potential of nutrigenomics to modulate their expression. Bioactive dietary components-including polyphenols such as quercetin, resveratrol, and curcumin, alongside vitamins C and D, selenium, and omega-3 fatty acids-demonstrate the ability to alter miRNA profiles like miR-21, miR-146a, and miR-155. These miRNA alterations may contribute to the regulation of key inflammatory pathways, including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and mitogen-activated protein kinase (MAPK), thereby potentially influencing pro-inflammatory cytokine production and keratinocyte proliferation. However, the extent to which individual dietary compounds directly mediate effects on these pathways through miRNA regulation varies and is often supported mainly by preclinical evidence. Clinical data suggests that dietary interventions, such as weight loss and the Mediterranean diet alleviate skin symptoms and lower systemic inflammatory markers. Identifying disease-specific miRNA expression profiles represents an emerging research avenue that may, following analytical and clinical validation, inform future approaches in dermatology.

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2026-09-18 | Hidradenitis Suppurativa: Part of a Tetrad of Follicular Occlusion Disorders.

Follicular occlusion disorders (FOD) represent a tetrad of chronic, recurrent inflammatory conditions united by a common pathophysiologic mechanism: follicular hyperkeratosis leading to occlusion, rupture, and subsequent abscess or sinus tract formation. First conceptualized as a triad in the 1950s and later expanded to a tetrad in the 1970s, this grouping includes hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal sinus (PS). Despite their shared pathogenesis, each condition carries distinct clinical features, epidemiological profiles, and management considerations. This article aims to provide a comprehensive review of FOD, with a primary emphasis on HS (the most prevalent of the disorders). Hidradenitis suppurativa is a debilitating disease affecting ∼1% of the global population, predominantly in females, and the diagnosis is often delayed by 7 or more years. Multiple genes are linked to FOD patients with a positive familial history in 35% to 40%, along with lifestyle factors (smoking, alcohol consumption, and obesity). Key inflammatory mediators, including TNF-α, IL-1β, and IL-17, drive the chronic tissue destruction characteristic of FOD, frequently resulting in scarring, lymphedema, and significant psychosocial impairment. Wound care is critical and often underemphasized in disease management. This article outlines evidence-informed wound care strategies for both nonsurgical and postsurgical presentations, including dressing selection, exudate and odor management, pain and itch control, infection management, and the emerging role of intravenous ertapenem as rescue therapy. An interprofessional approach, integrating dermatology, surgery, wound care nursing, and psychosocial support, is emphasized throughout as essential to improving patient outcomes and quality of life. To increase clinicians' understanding of follicular occlusion disorders including the associated risk factors, clinical manifestations, and evidence-based approaches for management. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will: Assess clinical characteristics of each follicular occlusion disorderEvaluate the basic disease mechanisms for follicular occlusion disordersDescribe principal disease burdens that require wound care attentionIdentify the unique wound care strategies and follicular occlusion disorder challenges JOURNAL/aswca/04.03/00129334-202610000-00004/figure1/v/2026-09-18T181327Z/r/image-jpeg.

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2026-09-15 | Oral Zinc Supplementation in Acne Vulgaris and Hidradenitis Suppurativa: An Updated Comprehensive Review.

Oral zinc supplementation has emerged as a potential ⁠adjunctive strategy in inflammatory follicular disorders, including ⁠acne vulgaris and hidradenitis suppurativa. Beyond its role as an essential micronutrient, zinc modulates several pathways and biological processes directly ⁠relevant to these diseases, including innate immunity, oxidative stress, neutrophil-driven inflammation, antimicrobial defense, wound repair, and possibly sebaceous gland activity and androgen metabolism. In acne, available data support a potential clinical benefit, mainly on inflammatory lesions, with ⁠potential relevance in antibiotic-sparing approaches. In hidradenitis suppurativa, the evidence remains more limited and is largely based on small observational or uncontrolled studies, although a possible adjunctive role has been suggested in mild-to-moderate disease and maintenance therapy. However, differences across studies in zinc formulation, ⁠dose, treatment duration, baseline zinc assessment, and outcome measures make it difficult to draw firm conclusions, and further randomized controlled trials are needed to identify which patients are most likely to benefit. Considering the available evidence, zinc represents an accessible and clinically attractive adjunct in acne vulgaris and hidradenitis suppurativa. This review critically appraises the evidence ⁠on oral zinc in acne vulgaris and hidradenitis suppurativa, with particular attention to biological plausibility, clinical effectiveness, dosing and safety.

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antibodies

2026-09-30 | Efficacy and safety of two interleukin-17 inhibitors (bimekizumab and secukinumab) in the management of hidradenitis suppurativa: a systematic review and meta-analysis of randomized controlled trials.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that primarily affects the intertriginous regions, causing manifestations such as inflammatory nodules, abscesses and scarring. To systematically evaluate the efficacy and safety of interleukin (IL)-17 inhibitors, including bimekizumab and secukinumab, for the treatment of moderate-to-severe HS based on evidence from randomized controlled trials (RCTs). We searched various electronic databases, including MEDLINE (via PubMed), Embase and CENTRAL to retrieve RCTs on the use of two IL-17 inhibitors (bimekizumab and secukinumab) for the management of HS. Dichotomous outcomes were reported as relative risk (RR) with 95% confidence intervals (CIs), and continuous outcomes were reported as mean difference (MD) with 95% CIs. Our meta-analysis included 5 RCTs with a total of 2188 patients. According to our analysis, IL-17 inhibitors significantly increased the proportion of patients with HiSCR50 (Hidradenitis Suppurativa Clinical Response) (RR 1.45, 95% CI 1.26-1.66) and HiSCR75 (RR 2.03, 95% CI 1.42-2.90). IL-17 inhibitors significantly increased the proportion of patients with Hidradenitis Suppurativa Symptom Daily Diary (HSSDD) worst skin pain response (RR 2.46, 95% CI 1.41-4.30). The IL-17 inhibitor group was associated with a statistically significant decrease in HSSDD worst skin pain score from baseline compared with the placebo group (MD -1.02, 95% CI -1.44 to -0.60). The intervention group was also associated with a statistically significant decrease in Dermatology Life Quality Index score from baseline compared with the placebo group (MD -1.77, 95% CI -2.54 to -0.99). The treatment-emergent adverse events were similar in both groups. IL-17 inhibitors are associated with an improvement in clinical response and pain outcomes in patients with moderate-to-severe HS, with an acceptable safety profile in the available studies. Given the limited number of trials with no head-to-head comparisons, further large-scale and independent studies are required to clarify their long-term role, particularly in patients whose HS is refractory to conventional and biologic therapies.

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2026-09-29 | Management Considerations for Patients with Hidradenitis Suppurativa and Lupus Spectrum Disease: A Narrative Review.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that carries a high burden of comorbidities, including various autoimmune conditions. Emerging population-level data indicate a significant association between HS and lupus spectrum diseases, including systemic lupus erythematosus (SLE), cutaneous lupus erythematosus (CLE), and drug-induced lupus erythematosus (DILE), with studies demonstrating an elevated risk of SLE among patients with HS compared with non-HS controls. Despite shared immunological mechanisms, including overlapping cytokine signaling and pathways such as the Janus kinase/signal transducers and activators of transcription (JAK/STAT) cascade, co-managing HS and lupus presents major clinical challenges. Guidance on how to manage patients with both HS and varying presentations of lupus is limited in the literature. A primary management challenge is the risk of DILE or inducing flares of preexisting SLE. Tumor necrosis factor (TNF)-α inhibitors (e.g., adalimumab, infliximab), which are mainstays of treatment for moderate-to-severe HS, can induce autoantibodies and trigger DILE. Other common medications used for HS, such as minocycline, have also been associated with reports of drug-induced lupus. Managing patients with concurrent HS and lupus should balance adequate HS disease control while avoiding therapies capable of inducing or exacerbating lupus flares. Other treatment options, such as anifrolumab, interleukin (IL)-1 inhibitors, and JAK/tyrosine kinase (TYK)2 inhibitors are currently under investigation, with preliminary data supporting their role in managing both HS and lupus spectrum diseases. Herein, we propose a clinical decision framework to guide safe, individualized therapeutic strategies for clinicians treating this complex patient population.

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2026-09-18 | Real-World Treatment Response to Adalimumab and Secukinumab in Chinese Adults with Hidradenitis Suppurativa: A Retrospective Cohort Study.

Biologic therapies have transformed the management of moderate-to-severe hidradenitis suppurativa (HS). However, real-world comparative data between tumor necrosis factor-alpha (TNF-α) inhibitors and interleukin-17 (IL-17) inhibitors in Chinese populations remain limited. To compare the short- and mid-term effectiveness and safety of TNF-α versus IL-17 inhibitors in adult Chinese patients with HS. This single-center retrospective cohort study included adult patients (≥18 years) with moderate-to-severe HS treated with biologics. Patients were stratified into TNF-α inhibitor and IL-17 inhibitor groups. The primary endpoint was achievement of Hidradenitis Suppurativa Clinical Response (HiSCR50) at week 16. Secondary endpoints included HiSCR50 at weeks 12, and safety outcomes. A total of 79 adult patients were included (TNF-α: n=25; IL-17: n=54). At week 12, response rates remained similar (72.0% vs. 63.0%). By week 16, a decline in response was observed in the TNF-α group (56.0%), whereas the IL-17 group maintained a stable response (66.7%). Safety profiles were acceptable in both groups, with one discontinuation due to fungal infection in the IL-17 group. Both TNF-α and IL-17 inhibitors demonstrate rapid onset of action in HS. However, IL-17 inhibitors may offer superior mid-term durability of response, supporting their role as a preferred option for sustained disease control.

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2026-09-15 | Efficacy of Secukinumab in Chinese Patients with Moderate-to-Severe Hidradenitis Suppurativa: A 16-Week, Single-Center, Prospective, Real-World Study.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease in which interleukin-17A (IL-17A) is an important therapeutic target. However, prospective real-world data on secukinumab (IL-17A inhibitor) safety and efficacy in Chinese patients with HS remain limited. To evaluate the 16-week efficacy and safety of secukinumab in Chinese patients with moderate-to-severe HS and explore potential treatment response predictors. This single-center, prospective, real-world cohort study included 31 patients with moderate-to-severe HS. The patients received subcutaneous secukinumab 300 mg weekly for 5 weeks, followed by administration either every 2 (1 patient [3.23%]) or 4 (30 patients [96.77%]) weeks. Concomitant therapies were allowed when clinically indicated. The primary endpoint was Hidradenitis Suppurativa Clinical Response (HiSCR) at week 16. Secondary endpoints included changes in inflammatory nodule, abscess, and draining tunnel counts, International Hidradenitis Suppurativa Severity Score System (IHS4), Numeric Rating Scale (NRS) for pain, Dermatology Life Quality Index (DLQI), adverse events, and exploratory predictors of HiSCR. The cohort was predominantly male (77.42%). Ten patients (32.26%) were classified as Hurley stage II and 21 (67.74%) as Hurley stage III. During treatment, 74.19% of patients received concomitant therapies. At week 16, HiSCR was achieved by 17/31 patients (54.84%). Inflammatory nodule counts, draining tunnel counts, IHS4, and DLQI significantly decreased. In the adjusted multivariate logistic regression model, after adjustment for prior biologic use, decreased high-density lipoprotein cholesterol, and dyslipidemia, elevated triglyceride was independently associated with HiSCR achievement (β= 3.246, p = 0.037). Adverse events were mild, including acne in two patients (6.45%), facial allergic dermatitis in one (3.23%), fever in two (6.45%), and fatigue in one (3.23%). None discontinued treatment because of adverse events. Secukinumab demonstrated meaningful 16-week efficacy and favorable safety in Chinese patients with moderate-to-severe HS. Elevated triglyceride was associated with treatment response in this exploratory analysis; however, further validation in larger cohorts is required.

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2026-09-14 | When anti-tumor necrosis factor-α backfires: paradoxical psoriasis and psoriatic arthritis in a patient with hidradenitis suppurativa.

Dear Editor, Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the folliculoapocrine units. Biological therapies, historically led by the anti-tumor necrosis factor (TNF)-α antibody adalimumab, have transformed severe HS management. Recently, interleukin (IL)-17 inhibitors (secukinumab, bimekizumab) were also approved in Europe for moderate-to-severe HS. However, TNF-α blockade can paradoxically induce or exacerbate inflammatory skin and joint conditions, including psoriasis (incidence 1-5%) and psoriatic arthritis. We report a case of paradoxical inverse psoriasis and suspected early psoriatic arthritis induced by adalimumab in an HS patient, successfully managed by switching to secukinumab. [...].

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proteins

2026-08-13 | Autoinflammatory Syndromes of Hidradenitis Suppurativa: Updates in Clinical Features, Emerging Associations, and Management.

To summarize and critically evaluate recent literature on autoinflammatory syndromes of hidradenitis suppurativa (HS). HS-associated autoinflammatory syndromes traditionally encompass pyoderma gangrenosum (PG), acne, and HS (PASH); pyogenic arthritis, PG, acne, and HS (PAPASH); psoriatic arthritis, PG acne, and HS (PsAPASH); and PG, acne, HS and ankylosing spondylitis (PASS). However, this spectrum continues to expand, with recent literature considering the inclusion of additional autoinflammatory diseases such as HS associated with SAPHO, including synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO); and Hyperimmunoglobulin D Syndrome (HIDS). HS-associated autoinflammatory syndromes are thought to be driven by dysregulation of the innate immune system and the subsequent overexpression of key inflammatory cytokines such as IL-1, and targeted IL-1 therapies have demonstrated particularly brisk and efficacious response. Multiple genes related to follicular keratinization or inflammatory regulation have been implicated, and sequencing methods such as whole-exome sequencing and variant enrichment analysis continue to identify novel genetic variants and are being used to further elucidate genotype-phenotype correlations. HS-associated autoinflammatory syndromes are an evolving spectrum of rare, severe, diseases in which HS coexists with other autoinflammatory conditions, most commonly PASH and related syndromes. They are driven by innate immune dysregulation and pathogenic genetic variants, with whole-exome sequencing aiding diagnosis and genotype-phenotype correlation. Management is often challenging and highly individualized, with targeted biologic therapies such as IL-1 inhibitors showing the most consistent and rapid clinical benefit.

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2026-07-25 | Integrated Proteogenomics and Single-Cell Transcriptomics Prioritize Putative Protective Plasma Proteins for Hidradenitis Suppurativa.

Translating hidradenitis suppurativa (HS) genetic susceptibility into actionable targets remains challenging, as most genome-wide association study loci lie in non-coding regions and tissue-level transcriptomics cannot easily distinguish causal drivers from secondary inflammation. In this study, we aimed to prioritize plasma proteins whose genetically predicted levels are causally associated with HS risk and to localize them within human skin at single-cell resolution. We performed two-sample Mendelian randomization (MR) using cis-pQTL instruments for 2923 plasma proteins from the UK Biobank Pharma Proteomics Project against HS summary statistics from FinnGen R12. Following multiple-testing correction and Bayesian colocalization with a prior-sensitivity grid, the intersection of false-discovery rate (FDR)-significant MR with colocalization evidence (PP.H4 ≥ 0.5) yielded three putative protective candidates: TNFRSF6B (OR = 0.748, 95% CI 0.666-0.840; PP.H4 = 0.648), FCRL2 (OR = 0.896, 95% CI 0.819-0.979; PP.H4 = 0.550), and APOD (OR = 0.789, 95% CI 0.647-0.963; PP.H4 = 0.503). All sensitivity MR tests were concordant. Single-cell transcriptomic analysis localized FCRL2 and APOD to specific cell populations. FCRL2 was predominantly expressed in B cells and NK cells, while APOD showed multi-cellular expression across cornified keratinocytes, macrophages, and dendritic cells. Furthermore, TNFRSF6B was below the skin detection threshold, supporting its biological role as a circulating decoy receptor. Together, our integrated proteogenomic and single-cell approach prioritizes TNFRSF6B, FCRL2, and APOD as putative protective plasma proteins for HS, with TNFRSF6B emerging as the most genetically robust candidate for future translational follow-up.

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2026-07-02 | Clinical and mechanistic effects of GLP-1 receptor agonists in hidradenitis suppurativa and comorbidities.

Hidradenitis suppurativa (HS) is a painful inflammatory skin disease within the pilosebaceous unit associated with numerous comorbidities, including obesity type-2-diabetes (T2DM), and a general meta-inflammatory state. This narrative review explores the therapeutic potential of GLP-1-receptor-agonists (GLP-1RAs) in treating HS by analyzing mechanisms of action and clinical outcomes. Based on a literature search, encompassing 12 cohorts and 4 case-based reports, current evidence demonstrates significant improvements in both clinical and patient-reported outcomes in patients with HS treated with GLP-1RAs. Treatment consistently resulted in reduced body mass index (BMI) and disease activity, measured by Hurley-staging and the number of nodules and abscesses. Patients across studies experienced fewer flares and less pain, supporting improvements in dermatology quality of life (DLQI) scores. Studies observed reductions in systemic inflammatory markers and improved glycemic control. The beneficial effects of GLP-1RAs in HS are attributed to the reduction in mechanical friction and metabolic improvements from weight loss. Suggestively, concurrent and direct anti-inflammatory mechanisms, including inhibition of the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling pathway and modulation of cytokines, occur independently of weight-reduction. Results from cohorts and cases supported this theory, showing significant improvements in HS and metabolic markers independent of weight-related outcomes. Four supplementary cohorts found GLP-1RAs beneficial for cardiovascular comorbidities in patients with HS. Additionally, studies suggest that GLP-1RAs enhance the efficacy of biologic therapies used for HS and reduce the need for adjunctive treatment. In conclusion, GLP-1RAs represent a promising pleiotropic treatment within a multimodal therapy strategy for HS and comorbidities.

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2026-02-11 | The Impact of Glucagon-Like Peptide-1 (GLP-1) Agonists on Acne, Hidradenitis, and Sebaceous Activity.

Background and objective Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), especially semaglutide, are commonly used to treat obesity and diabetes. They may influence sebaceous gland activity, hidradenitis suppurativa (HS), and acne via metabolic and anti-inflammatory pathways. This study aimed to assess the effects of semaglutide on acne severity, HS activity, and sebaceous gland function, and to evaluate associations with metabolic improvements. Materials and methods This prospective, observational, single-arm study was conducted at the Department of Dermatology, Hayatabad Medical Complex, Peshawar, from January 2023 to December 2024. Adults with acne, HS, or increased sebaceous gland activity who initiated semaglutide therapy between the ages of 18 and 65 years were included. Sebumetry, HS severity using the Hidradenitis Suppurativa Area and Severity Index - Revised (HASI-R), and acne grading using the Investigator's Global Assessment (IGA) were evaluated at baseline and at three, six, 12, 18, and 24 months. Concurrent measurements of metabolic markers, including BMI, HbA1c, fasting glucose, and insulin, were also obtained. Statistical analyses included Pearson and Spearman correlations, multivariate regression to adjust for confounders, and paired t-tests for pre- and post-treatment comparisons. P-values below 0.05 were considered statistically significant. Results Of the 120 enrolled participants, 110 completed the follow-up (91.7%). Over 24 months, acne severity decreased from 1.92 ± 0.78 to 1.21 ± 0.63, HS activity declined from 11.34 ± 4.56 to 7.45 ± 3.21, and sebaceous gland activity was reduced from 186.45 ± 52.34 to 138.56 ± 42.78 µg/cm². Improvements in BMI, HbA1c, fasting glucose, and insulin were significantly associated with dermatologic improvement (p < 0.05). Adverse events were mild and transient and occurred in 17 participants (15.45%). Conclusions Semaglutide therapy was significantly associated with improvement in acne, HS activity, and sebaceous gland function, independently correlated with metabolic enhancements. These findings indicate a potential dermatologic benefit of GLP-1 agonists, supporting the need for further controlled studies.

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2026-01-03 | Tirzepatide in dermatology: cutaneous adverse events, emerging therapeutic roles, and cosmetic implications - A comprehensive review.

Tirzepatide, a dual Glucose-dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide-1 (GLP-1) receptor agonist. Tirzepatide was first approved by the FDA for type 2 diabetes in May 2022 and subsequently for obesity in November 2023, and has demonstrated significant efficacy in glycemic control and weight reduction. Beyond its metabolic benefits, recent evidence highlights its relevance in dermatology. This review explores the dermatologic implications of tirzepatide, including its cutaneous adverse effects, therapeutic potential in inflammatory skin diseases, and cosmetic benefits. Cutaneous side effects such as hypersensitivity reactions, injection-site reactions, and rare severe dermatologic events have been documented. Across the SURPASS clinical trials, injection-site reactions occurred slightly more frequently, comparable to other GLP-1 receptor agonists as semaglutide. Meanwhile, tirzepatide's immunomodulatory properties suggest potential therapeutic roles in conditions like psoriasis and hidradenitis suppurativa; however, current evidence is limited to case reports and small studies. Additionally, its profound effects on fat distribution raise interest in its cosmetic implications. Tirzepatide's induced rapid weight loss may lead to aesthetic changes, including facial volume loss, which warrants cautious interpretation. This narrative review summarizes current data from clinical trials, case reports, and pharmacovigilance sources, based on a literature search of PubMed, Scopus, and Google Scholar up to May 2025, focusing on skin-related adverse events, therapeutic effects, and cosmetic outcomes of tirzepatide.

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cell therapies

2026-08-07 | Reused skin grafts for treating hidradenitis suppurativa: A systematic review.

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease in which wide excision remains the most reliable option for durable disease control in moderate to severe cases. Reconstruction after excision is challenging. Reused or recycled split-thickness skin grafts, harvested from excised HS tissue and reapplied after processing, have been proposed to reduce donor-site morbidity, but their clinical value remains uncertain. To systematically evaluate the outcomes of reused skin grafts following surgical excision of HS, with emphasis on recurrence, graft take and procedure-related morbidity. A PRISMA-compliant systematic review was conducted using PubMed, Web of Science and Google Scholar from inception to the final search date. Studies reporting HS excision followed by reused or recycled skin grafting were included. Outcomes of interest were recurrence, graft survival, complications and follow-up duration. Given heterogeneity, a narrative synthesis was performed. Risk of bias was assessed using design-appropriate tools. Sixteen studies met inclusion criteria, including five systematic reviews, two retrospective cohorts and nine case reports or small case series. Primary reused-graft reports comprised approximately 41 patients with follow-up ranging from 6 to 113 months. Across these series, no surgical-site recurrences were reported (0/41), corresponding to an exact 95% confidence interval of 0-7.0%. Complications were generally minor. However, in the largest reused-graft series, which included 18 patients, 8 (44%) required supplemental conventional donor grafts. Broader pooled estimates from conventional graft literature reported recurrence rates ranging from 2% to 18%, reflecting substantial heterogeneity. Reused skin grafting appears feasible and safe in selected HS patients, with encouraging short- to medium-term durability. Current evidence supports feasibility rather than definitive comparative effectiveness, underscoring the need for well-designed prospective studies.

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2026-07-01 | Reconstruction of extensive gluteal defect following excision of hidradenitis suppurativa using a combined lumbar artery perforator and split superior gluteus maximus musculocutaneous flap: A case report.

Hidradenitis suppurativa is a chronic, inflammatory, recurrent, debilitating, skin follicular disease characterized by painful nodules and recurrent persistent drainage. Severe hidradenitis suppurativa not only reduces quality of life but also serves as a precursor to squamous cell carcinoma and can cause sepsis; therefore, complete excision of the lesion is recommended. We report a case of extensive hidradenitis suppurativa affecting most of the bilateral buttocks. Since it was determined that the extensive lesion in this case could not be covered in a single stage using any known single flap, we decided to perform reconstruction using a newly devised combined flap. For the area cephalad of the iliac crest, a large rotation flap centered on a lumbar artery perforator was designed. For the area caudal to the iliac crest, the superficial layer of the cephalic portion of the gluteus maximus muscle was split, and a musculocutaneous flap was designed to be elevated to include the perforating branch of the superior gluteal artery. These flaps were elevated as a single combined flap. Postoperatively, the flap blood flow was stable and the graft took well. There was no longer any persistent discharge from the lesion, and no functional impairment was observed following the elevation of the gluteus maximus musculocutaneous flap. Reconstruction using a combined lumbar artery perforator and split superior gluteus maximus musculocutaneous flap was considered a useful method, as the technique is simple and can cover extensive gluteal defects.

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2025-11-26 | Beyond excision: modern plastic surgery techniques for hidradenitis suppurativa reconstruction.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent abscesses, sinus tract formation and extensive scarring. In severe cases, surgical excision and complex reconstruction are often required. This case report aims to highlight the role of modern plastic surgical techniques, including regenerative technologies, in managing severe HS. A 37-year-old Hispanic male with a 17-year history of HS presented with extensive lesions involving the buttocks, groin, genitalia, thighs and perianal region. He underwent staged wide excisions totaling over 2,400 cm2. Reconstruction included split-thickness skin grafts (STSG), NovoSorb® BTM (Biodegradable Temporizing Matrix) and RECELL® autologous skin cell suspension. Postoperative recovery was marked by successful graft take, wound healing and return to normal function, including physical activity and sexual function, by postoperative day 69. This case underscores both the complexity of managing stage III HS and the evolving role of regenerative technologies in improving outcomes. While wide local excision remains the cornerstone of treatment for extensive disease, adjunctive use of BTM and RECELL enhances dermal regeneration, reduces donor-site morbidity and optimizes aesthetic and functional results. These innovations reflect a shift in reconstructive strategy, emphasizing a more tailored, patient-centered approach. The integration of regenerative modalities such as Biodegradable Temporizing Matrix (BTM) and RECELL autologous cell suspension technology into contemporary plastic surgical reconstruction offers significant benefits in treating severe hidradenitis suppurativa. By complementing traditional excisional techniques, these technologies contribute to improved healing, minimized morbidity and restored function, aligning with the goals of modern, multidisciplinary HS management.

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2025-09-15 | Staged Surgical Treatment of Hidradenitis Suppurativa of the Axilla and Groin Using Lateral Thoracic and Anterolateral Thigh Flaps.

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of the follicular epithelium that commonly affects apocrine gland-bearing areas such as the axillae, groin, and perineum. In advanced cases (Hurley Stage III), it is characterized by sinus tract formation, fibrosis, scarring, and recurrent abscesses. We present a case of a 20-year-old male patient with long-standing, treatment-resistant HS involving the bilateral axillae and groin. After failing multiple medical therapies over six years, he underwent staged surgical management with reconstruction using lateral thoracic fasciocutaneous flaps for axilla HS and with anterolateral thigh (ALT) perforator flaps for groin HS. Both procedures were successful with no flap loss or major complications, and the patient achieved full range of motion, excellent functional and cosmetic outcomes, and no recurrence at the six-month follow-up. This case highlights the effectiveness of wide excision with immediate regional flap reconstruction in advanced HS.

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2025-09-13 | Surgical Treatment of Axillary Hidradenitis Suppurativa Using Preliminary Defect Closure and Two Sliding Island Triangular Skin-Subcutaneous Flaps from the Arm and Chest.

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.

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other

2026-08-31 | Post-Transcriptional Regulators of Inflammation: The Role of microRNAs in Acne Inversa Pathogenesis.

Acne inversa (AI) or Hidradenitis suppurativa is a chronic, inflammatory disorder characterized by painful nodules, abscesses, and scarring, primarily affecting apocrine gland-rich areas. Despite advances in understanding its clinical features, the molecular mechanisms driving AI remain incompletely defined. Emerging evidence highlights the critical role of microRNAs (miRNAs), small non-coding RNAs that regulate gene expression post-transcriptionally, in modulating inflammatory and immune pathways implicated in AI pathogenesis. Specific miRNAs are dysregulated in AI lesional skin and systemic circulation, influencing cytokine production, immune cell recruitment, and keratinocyte activation. These findings position miRNAs as promising non-invasive biomarkers for early diagnosis and disease monitoring. Furthermore, targeting miRNA expression offers a novel therapeutic strategy to restore immune homeostasis and prevent disease progression. This review synthesizes current knowledge on miRNA involvement in AI, underscoring their potential to revolutionize personalized diagnosis and treatment approaches for this complex inflammatory disease.

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2025-12-03 | Prolonged disease remission of the chronic immunological skin disorder hidradenitis suppurativa with adjunctive bacteriophage therapy.

Hidradenitis suppurativa (HS) is a chronic skin disease in which the acute development of noduli, abscesses and in a later stage fistulas remains difficult to control, despite a wide range of recommended treatment options including immunomodulatory biologicals, surgical intervention and antibiotics. Besides being painful, associated lesions have an extensive impact on the quality of life. While HS is primarily an immune-mediated inflammatory disease, the skin microbiota plays a key role in its pathogenesis with pathogenic bacterial colonization of lesions observed. Bacteriophages, the viruses of bacteria, are used to treat a 52-year-old female HS patient with re-current colonization of lesions with Staphylococcus aureus. Phage therapy results in complete removal of lesions with a flare-free period of six months, along with a substantial improvement in the patient's quality of life. The deployed experimental framework and the gained clinical experience will be valuable for future HS phage therapy research.

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2024-05-17 | LncRNA microarray profiling identifies novel circulating lncRNAs in hidradenitis suppurativa.

Long noncoding RNAs (lncRNAs) have been demonstrated to be involved in biological processes, both physiological and pathological, including cancer, cardiovascular diseases, multiple sclerosis, autoimmune hepatitis and types I and II diabetes. LncRNAs are also known to have a critical role in the physiology of skin, and in the pathology of cutaneous diseases. LncRNAs are involved in a wide range of biological activities, including transcriptional post‑transcriptional processes, epigenetics, RNA splicing, gene activation and or silencing, modifications and/or editing; therefore, lncRNAs may be useful as potential targets for disease treatment. Hidradenitis suppurativa (HS), also termed acne inversa, is a major skin disease, being an inflammatory disorder that affects ~1% of global population in a chronic manner. Its pathogenesis, however, is only partly understood, although immune dysregulation is known to have an important role. To investigate the biological relevance of lncRNAs with HS, the most differentially expressed lncRNAs and mRNAs were first compared. Furthermore, the lncRNA‑microRNA regulatory network was also defined via reverse transcription‑quantitative PCR analysis, whereby a trio of lncRNA expression signatures, lncRNA‑TINCR, lncRNA‑RBM5‑ASI1 and lncRNA‑MRPL23‑AS1, were found to be significantly overexpressed in patients with HS compared with healthy controls. In conclusion, the three lncRNAs isolated in the present study may be useful for improving the prognostic prediction of HS, as well as contributing towards an improved understanding of the underlying pathogenic mechanisms, thereby potentially providing new therapeutic targets.

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2023-11-29 | Epigenetic switch reshapes epithelial progenitor cell signatures and drives inflammatory pathogenesis in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a complex inflammatory skin disease with undefined mechanistic underpinnings. Here, we investigated HS epithelial cells and demonstrated that HS basal progenitors modulate their lineage restriction and give rise to pathogenic keratinocyte clones, resulting in epidermal hyperproliferation and dysregulated inflammation in HS. When comparing to healthy epithelial stem/progenitor cells, in HS, we identified changes in gene signatures that revolve around the mitotic cell cycle, DNA damage response and repair, as well as cell-cell adhesion and chromatin remodeling. By reconstructing cell differentiation trajectory and CellChat modeling, we identified a keratinocyte population specific to HS. This population is marked by S100A7/8/9 and KRT6 family members, triggering IL1, IL10, and complement inflammatory cascades. These signals, along with HS-specific proinflammatory cytokines and chemokines, contribute to the recruitment of certain immune cells during the disease progression. Furthermore, we revealed a previously uncharacterized role of S100A8 in regulating the local chromatin environment of target loci in HS keratinocytes. Through the integration of genomic and epigenomic datasets, we identified genome-wide chromatin rewiring alongside the switch of transcription factors (TFs), which mediated HS transcriptional profiles. Importantly, we identified numerous clinically relevant inflammatory enhancers and their coordinated TFs in HS basal CD49fhigh cells. The disruption of the S100A enhancer using the CRISPR/Cas9-mediated approach or the pharmacological inhibition of the interferon regulatory transcription factor 3 (IRF3) efficiently reduced the production of HS-associated inflammatory regulators. Our study not only uncovers the plasticity of epidermal progenitor cells in HS but also elucidates the epigenetic mechanisms underlying HS pathogenesis.

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2023-10-27 | Phage therapy for hidradenitis suppurativa: a unique challenge and possible opportunity for personalized treatment of a complex, inflammatory disease.

Phage therapy is an emerging antimicrobial treatment for critical multidrug-resistant pathogens. In this review, the specific potential and challenges of phage therapy for patients with hidradenitis suppurativa (HS) are discussed. This represents a unique challenge as HS is a chronic inflammatory disease, but presenting with acute exacerbations, which have an enormous negative impact on patient's quality of life. The therapeutic arsenal for HS has expanded in the past decade, for example, with adalimumab and several other biologicals that are currently under investigation. However, treatment of HS remains challenging for dermatologists because there are individuals who do not respond to any classes of the current treatment options when used for a first or second time. Furthermore, after several courses of treatment, a patient may lose their response to therapy, meaning long-term use is not always an option. Culturing studies and 16S ribosomal RNA profiling highlight the complex polymicrobial nature of HS lesions. Despite the detection of various bacterial species in lesion samples, several key pathogens, including Staphylococcus, Corynebacterium and Streptococcus, may be potential targets for phage therapy. Using phage therapy for the treatment of a chronic inflammatory disease could potentially provide new insights into the role of bacteria and the immune system in HS development. In addition, it is possible more details on the immunomodulatory effects of phages may come to light.

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