RARE DISEASE
Autoinflammatory syndrome with acne and/or hidradenitis suppurativa
Autoinflammatory syndrome with acne and/or hidradenitis suppurativa
Autoinflammatory syndrome with acne and/or hidradenitis suppurativa
Drug discovery
1,330
papers
On emerging therapies
Overview
Autoinflammatory Syndromes with Acne/Hidradenitis Suppurativa (HS) are rare disorders characterized by dysregulated innate immunity, manifesting as chronic neutrophilic inflammation. Key features include recurrent HS (painful nodules, abscesses, scarring), acne, and pyoderma gangrenosum, often forming syndromes like PASH (pyoderma gangrenosum, acne, HS) or PAPASH (adding pyogenic arthritis). These conditions are linked to IL-1β pathway overactivation and polygenic factors, with symptoms persisting for decades without targeted treatment [3][6][9].
Burden
Chronic pain, disfiguring scars, and recurrent infections lead to impaired quality of life, with 40–60% reporting depression/anxiety [9][12][19].
Diagnostic delays average 4–6 years, increasing risks of amyloidosis, arthritis, and secondary infections [1][6][17].
High healthcare utilization due to frequent flares and multidisciplinary care needs [3][6][12].
Therapies
Biologics: IL-1 inhibitors (anakinra, canakinumab), TNF-α blockers (adalimumab, infliximab), and IL-17 antagonists (secukinumab) for moderate-severe cases [6][9][18].
Immunosuppressants: Colchicine, corticosteroids, or JAK inhibitors as adjuncts [3][6].
Surgical interventions: Incision/drainage or laser therapy for refractory HS lesions [9][12].
Categories: rare skin diseases, rare systemic and rheumatological diseases
Research Papers
1,330 drug discovery papers about Autoinflammatory syndrome with acne and/or hidradenitis suppurativa, with 2 first-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
1,330 drug discovery papers about Autoinflammatory syndrome with acne and/or hidradenitis suppurativa, with 2 first-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
categories:
Small molecules
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.
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.
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.
2026-09-13 | Lesional hair lipidomic signatures reveal ARA-LTB4 pathway activation and NETs formation in hidradenitis suppurativa.
Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease originating from the folliculosebaceous unit (FPSU), characterized by abundant neutrophil infiltration in the skin. We aimed to address the lack of systemic evidence regarding lipid metabolic dysregulation within the FPSU in disease pathogenesis. By integrating the lipidomic features of lesional hair, skin tissue, and pus, we found prominent dysregulation of arachidonic acid (ARA) and leukotriene B4 (LTB4) across all specimens. Notably, the lipidomic features in lesional hair directly correlated with disease severity. Mechanistically, HS lesions exhibited activation of a bacterial-keratinocyte-neutrophil cascade, in which sustained exposure to lipopolysaccharide (LPS) derived from Gram-negative bacteria induced phosphorylation of cytosolic phospholipase A2α (cPLA2α) in keratinocytes. This response was further amplified by recruited neutrophils through 5-lipoxygenase (5-LO) activation, resulting in increased production of LTB4 and extensive neutrophil extracellular traps (NETs) formation. These findings were further validated in NcstnΔCKO mice, where lipid profiles in lesional hair mirrored those of HS patients. Our study provided evidence that lipid mediators in HS lesional hair served as sensitive markers for disease activity, suggesting that targeting Gram-negative colonization or the ARA-LTB4 pathway represented a promising therapeutic intervention for HS.
2026-09-08 | Resorcinol in Dermatology: Reassessing a Legacy Topical Therapy for Contemporary Clinical Use.
Resorcinol is a phenolic topical agent (Figure 1) with a long history in dermatology, but its role in contemporary practice has narrowed substantially. This review summarizes the mechanism, formulation considerations, clinical applications, safety profile, and future relevance of topical resorcinol. Resorcinol has keratolytic, antiseptic, antifungal, anti-inflammatory, and tyrosinase-inhibitory properties that support its use in acne, hidradenitis suppurativa, chemical peels, hyperkeratotic disorders, and pigmentary conditions. Despite historical use in acne, current evidence and guideline support are limited, and resorcinol remains largely absent from routine acne management. In contrast, topical resorcinol has a more defined role in mild to moderate hidradenitis suppurativa, particularly as a nonantibiotic option for localized inflammatory lesions. Safety concerns, especially thyroid toxicity, have contributed to its decline. However, reported systemic toxicity largely involved prolonged high-dose application to ulcerated or compromised skin, which differs from limited modern dermatologic use. Practical barriers, including lack of commercial availability at clinically relevant concentrations and dependence on compounding, also limit adoption. Resorcinol may be better viewed as an underused legacy compound rather than an obsolete therapy.
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.
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.
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.
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.
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. [...].
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.
2026-04-14 | Multidisciplinary Approach to Complex Lower Extremity Limb Salvage in Pyogenic Arthritis, Pyoderma Gangrenosum, and Acne (PAPA) Syndrome: A Case Report.
Limb salvage using free tissue transfer in patients with rare autoinflammatory syndromes is poorly described, and the safety of microvascular reconstruction in this population remains uncertain. Hereditary pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome is characterized by dysregulated inflammation, pathergy, and impaired wound healing, raising concern for flap compromise and postoperative complications. We report a rare case of lower extremity free tissue transfer in a patient with PAPA syndrome. A 66-year-old woman with rheumatoid arthritis and PAPA syndrome presented with rapid wound breakdown, violaceous ulceration, exposed hardware, and periprosthetic joint infection following left total knee arthroplasty (TKA). Examination revealed an approximately 9 × 7 cm anterior knee defect with subtotal patellar tendon necrosis. After multidisciplinary optimization, she underwent single-stage irrigation and debridement, hardware removal, revision TKA with patellar tendon reconstruction using gracilis autograft, and immediate coverage with a 22 × 14 cm free latissimus dorsi (LD) muscle flap. The flap was anastomosed end-to-side to the anterior tibial artery with venous outflow via the venae comitantes and loosely inset to preserve future surgical access. The donor site was closed primarily. A 21 × 13 cm staged split-thickness skin graft was performed 1 week later, with adjunctive postoperative hyperbaric oxygen therapy (HBOT). Initial healing was uncomplicated, with complete graft take and donor-site healing. Four months postoperatively, the patient developed chronic sinus tracts and recurrent periprosthetic infection requiring flap re-elevation, debridement, and hardware exchange; the flap pedicle was preserved, and coverage maintained. At one-year follow-up, all wounds had healed; flap coverage was durable with acceptable cosmesis, and the patient was ambulatory for short distances without assistance. She was last seen infection-free and full-weightbearing 4 months later. This case demonstrates that microvascular limb salvage is feasible in PAPA syndrome when guided by multidisciplinary planning and strategic flap design.
2026-03-26 | Two-Stage Surgical Management of Anogenital Hidradenitis Suppurativa in Patients on Biologic Therapy: A Retrospective Case Series.
Hidradenitis suppurativa is a chronic inflammatory skin disorder causing painful nodules, abscesses and scarring, with the anogenital region presenting particular functional and reconstructive challenges. Although biologic therapy is commonly used in moderate to severe disease, its limitations highlight the role of surgery in advanced cases. This single-centre retrospective case series included five male patients with Hurley stage III perineal, anorectal, genital or gluteal disease treated surgically between 2021 and 2023 following failure of biologic therapy. Management consisted of two-stage radical excision, negative-pressure wound therapy and reconstruction with meshed split-thickness skin grafts. All patients achieved more than 90% graft take and complete wound healing. No recurrence occurred during a median follow-up of 19.2 months. One patient developed a keloid scar at the donor site, and one experienced delayed healing. Functional and aesthetic results were satisfactory in all cases. Two-stage surgical excision with split-thickness skin graft reconstruction was associated with sustained wound healing and favourable functional outcomes in selected patients with severe anogenital hidradenitis suppurativa refractory to biologic therapy.
2026-03-06 | Intact Fish Skin Grafting in a Patient With Hidradenitis Suppurativa.
Wound management in hidradenitis suppurativa (HS) patients is often challenging due to worsening infections and impaired circulation, which can lead to prolonged hospitalization and poorer quality of life. Traditionally, autografting-a leading option in skin grafting-exhibits risks, including donor site morbidity. However, xenograft products, such as KerecisTM, derived from North Atlantic Cod fish, offer a novel solution for conditions with chronic wounds by promoting natural tissue regeneration. This case report presents a 35-year-old woman with HS who presented with persistent abscesses and fistulas in bilateral axillary regions. Following multiple surgical incisions and drainage procedures, the patient was treated with intact fish skin grafting, which resulted in significant granulation tissue deposition and wound edge approximation. The successful outcome in this case suggests that intact fish skin grafting is a viable option for non-healing wounds, particularly HS wounds, and can be integrated into surgical and wound care practices.
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.
proteins
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.
2026-09-15 | Glucagon-like peptide-1 receptor agonists and tirzepatide are associated with reduced mortality, cardiovascular, and psychiatric risks in patients with hidradenitis suppurativa and type 2 diabetes and/or obesity: a retrospective cohort study.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease strongly associated with obesity and diabetes mellitus type 2 (T2D). GLP-1 receptor agonists (GLP-1RAs) and tirzepatide are increasingly used for metabolic control, but their systemic effects in HS remain poorly characterized. To compare all-cause mortality, cardiovascular, rheumatologic, metabolic, psychiatric, and non-communicable inflammatory outcomes in HS patients with T2D or obesity treated with GLP-1RAs/tirzepatide vs. alternative metabolic medications. This retrospective cohort study used the US Collaborative Network in TriNetX. Adults (≥18 years) with HS and T2D or obesity were included, excluding prior bariatric surgery. Exposed patients received a GLP-1RA or tirzepatide for at least one year, controls received other systemic antidiabetic or anti-obesity agents. Outcomes over a 2-year follow-up were assessed using 1:1 propensity score matching (PSM) for each outcome category. Outcomes included all-cause mortality, cardiovascular, rheumatologic, metabolic, psychiatric, and non-communicable inflammatory events. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and Cox regression was used to confirm significant findings. Sensitivity analyses and benchmark comparisons were performed. Before matching, 8,564 patients received GLP-1RA/tirzepatide and 6,299 alternative therapies. After matching, GLP-1RA/tirzepatide use was associated with reduced all-cause mortality (HR: 0.24, 95% CI: 0.145-0.395; p < 0.0001) and major adverse cardiovascular events (MACE) (HR: 0.61, 95% CI: 0.500-0.749; p < 0.0001). Risks of stroke and heart failure were also reduced (both p < 0.05). Psychiatric outcomes, including depression (HR: 0.78), suicidal ideation (HR: 0.38), and substance use disorder (HR: 0.58), were significantly reduced (all p < 0.05). Risks for rheumatologic and non-communicable chronic inflammatory outcomes were similar among groups. A modest increase in the risk of hyperlipidemia (HR: 1.25), metabolic dysfunction-associated steatotic liver disease (MASLD) (HR: 1.37), and nausea/vomiting (HR: 1.31) was observed in the GLP-1RA/tirzepatide group compared with alternative therapies (all p < 0.05). GLP-1RAs and tirzepatide are associated with reduced mortality, cardiovascular and psychiatric morbidity in HS patients with obesity or T2D, without increasing rheumatologic or inflammatory risk. These results extend the systemic benefits of GLP-1RAs and tirzepatide beyond metabolic control and suggest potential therapeutic value in HS.
2026-09-13 | The Expanding Role of GLP-1 Receptor Agonists and Dual GIP/GLP-1 Agonists in Dermatology: From Immunometabolism to Clinical Practice.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (dual GIP/GLP-1 agonists) have rapidly changed the management of obesity and type 2 diabetes mellitus. Beyond their effects on weight reduction and glycemic control, these agents exert pleiotropic effects on inflammation, adipose tissue biology, endothelial function and tissue repair, properties of growing relevance to dermatology, where several chronic inflammatory diseases are closely linked to obesity, insulin resistance and systemic low-grade inflammation. Current evidence suggests potential clinical benefit in psoriasis and hidradenitis suppurativa, encouraging signals regarding wound healing and a generally favorable cutaneous safety profile, although cutaneous adverse events, including injection site reactions, hypersensitivity, alopecia and rare autoimmune eruptions, have been increasingly reported. This review summarizes the immunometabolic rationale, current clinical evidence, the dermatologic safety profile and future perspectives of GLP-1RAs and dual GIP/GLP-1 agonists in dermatology. Although available data remain heterogeneous and largely observational outside psoriasis and hidradenitis suppurativa, these therapies may represent a new class of systemic immunometabolic modulators with practical implications for inflammatory, surgical and aesthetic dermatology.
2026-09-03 | Where the future lies: GLP-1 receptor agonists as therapeutics for dermatologic comorbidities.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity, type 2 diabetes mellitus, and cardiometabolic disease through effects on weight reduction, glycemic control, and systemic inflammation. Their varied immunometabolic actions have generated increasing interest in dermatology, where chronic inflammatory skin diseases frequently coexist with obesity, insulin resistance, metabolic syndrome, and cardiovascular disease. Emerging evidence from clinical trials, observational studies, and real-world analyses suggests that GLP-1RAs may improve outcomes in psoriasis and hidradenitis suppurativa while simultaneously reducing the burden of associated metabolic and cardiovascular comorbidities. In psoriasis, combination therapy with tirzepatide has demonstrated enhanced skin clearance, substantial weight loss, and reduced risk of psoriatic arthritis. In hidradenitis suppurativa, GLP-1RAs have been associated with improvements in cardiometabolic outcomes and reductions in systemic complications. Collectively, these findings support an evolving paradigm in which the greatest therapeutic utility of GLP-1RAs in dermatology may lie not in direct modulation of cutaneous inflammation but in addressing the metabolic dysfunction and chronic systemic inflammation that drive disease severity and multimorbidity. We review the current clinical evidence and propose a conceptual framework positioning GLP-1RAs as immune-metabolic therapies that target the systemic comorbidities of inflammatory skin disease, which may provide future opportunities for cutaneous disease modification and integrated dermatologic care.
2026-08-13 | The Metabolic Revolution in Dermatology: Obesity, Insulin Resistance, and Ultra-Processed Diets as Drivers of Skin Inflammation.
Inflammatory dermatoses are increasingly linked to systemic metabolic factors. Obesity and insulin resistance create a pro-inflammatory milieu that affects the skin. Adipose tissue functions as an endocrine organ secreting adipokines and cytokines that drive chronic inflammation with notable skewing toward T-helper 1 (Th1)/Th17 signaling. Hyperinsulinemia, elevated insulin-like growth factor-1 promote keratinocyte proliferation, sebum production, and autoinflammation, contributing to a multitude of skin diseases including hidradenitis suppurativa, acne, psoriasis, atopic dermatitis (AD), acanthosis nigricans, hirsutism, scarring alopecias, intertrigo, and chronic idiopathic urticaria. Concomitantly, ultra-processed diets low in fiber and high in additives detrimentally affect the gut-skin axis. Diets rich in emulsifiers, sugars, and fructose alter the gut microbiome and increase intestinal permeability, leading to metabolic endotoxemia and increased systemic inflammation. High-fructose corn syrup in sweetened beverages is metabolized via hepatic fructokinase, promoting de novo lipogenesis and excess uric acid, a cascade implicated in metabolic fatty liver disease and heightened inflammation. These dietary factors have been correlated with aggravated skin diseases, where fast-food intake (≥3× weekly) is associated with increased risk of severe AD in children. Emerging evidence suggests that dietary modifications may help mitigate skin inflammation in select patients. At the same time, the advent of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists may improve metabolic parameters and could represent promising adjunctive therapies in select inflammatory dermatoses. Dermatologists can serve as sentinels, identifying cutaneous signs of insulin resistance (eg, acanthosis nigricans, acrochordons, and other skin diseases driven by insulin resistance) and addressing lifestyle factors as part of routine care.
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.
2024-12-16 | Unlocking the Mechanisms of Hidradenitis Suppurativa: Inflammation and miRNA Insights.
Inflammatory skin diseases impose a significant burden on patients and healthcare systems worldwide. Among these, hidradenitis suppurativa (HS) is particularly notable for its chronic and recurrent nature. Recurrent nodules, abscesses, and scarring in apocrine gland-rich areas characterize the disease, including the groin, axillae, and perianal regions. Despite its considerable physical and psychological impact, the precise mechanisms driving HS remain elusive. Recent advancements in understanding the inflammatory processes involved in HS have highlighted the TNF-alpha, IL-1β, and IL-17/IL-23 pathways, which play crucial roles in initiating and perpetuating the disease. Moreover, specific microRNAs (miRNAs), such as miR-24-1-5p, miR146a-5p, mirR-26a-5p, miR-206, miR-338-3p, and miR-338-5p, are involved in these inflammatory processes. Dysregulation of these miRNAs contributes to aberrant cytokine expression and persistent inflammation, foreseeably exacerbating HS disease progression. This narrative review hypothesizes that miRNA dysregulation triggers aberrant expression in specific inflammatory pathways, contributing to HS's clinical manifestations and progression. We explore the implicated miRNAs' potential as biomarkers for earlier disease detection and as novel therapeutic targets. Identifying miRNA dysregulation offers new opportunities for earlier and more accurate diagnosis, potentially allowing clinicians to intervene before severe disease manifestations occur. Furthermore, therapeutic strategies to modulate miRNA expression could target the inflammatory pathways driving HS, leading to more personalized and effective treatments. This review also discusses future research directions to enhance the clinical management of HS. A better understanding of miRNA involvement in HS offers new avenues for research and management, ultimately improving patient outcomes and quality of life.
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.
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.
2022-10-14 | Methylated miRNAs may serve as potential biomarkers and therapeutic targets for hidradenitis suppurativa.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease influenced by genetics, non-genetic and environmental factors that modulate miRNA expression. Currently, no miRNA data are available for HS. In this study, we profiled DNA methylation patterns of miRNA genes associated with HS susceptibility. Identify miRNA gene methylation profiles associated with HS susceptibility. This study examined the methylation patterns of DNAs from 24 healthy controls and 24 patients with HS using Illumina Infinium MethylationEPIC BeadChip array analysis. Methylation patterns of miRNA genes were analysed using KEGG pathway analysis to explore the inversely correlated pathways regulated by miRNAs. We identified 60 CpG sites representing 65 unique microRNA genes including 54 hypomethylated and 6 hypermethylated CpGs as potentially associated with HS. Some of these CpGs were found to be critical for skin function, such as miR-29, miR-200, miR-205, miR-548 and miR-132. The miR-192 is implicated in non-alcoholic fatty liver disease. The miR-200c gene was identified as a vital determinant in regulating skin repair after injury and may contribute to age-associated alterations in wound repair. miR-132 was significantly upregulated during the inflammation phase of wound repair, enhancing the activity of STAT3 and ERK pathways that promote keratinocyte proliferation. Epigenetically altered microRNA genes are implicated in wound healing, inflammation, keratinocyte proliferation and wound modulation. This is the first study to analyse methylation profiles of miRNA genes in the HS population, highlighting the unique role that miRNAs might play in diagnosing and treating HS.
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.
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.
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.
2026-09-13 | Lesional hair lipidomic signatures reveal ARA-LTB4 pathway activation and NETs formation in hidradenitis suppurativa.
Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease originating from the folliculosebaceous unit (FPSU), characterized by abundant neutrophil infiltration in the skin. We aimed to address the lack of systemic evidence regarding lipid metabolic dysregulation within the FPSU in disease pathogenesis. By integrating the lipidomic features of lesional hair, skin tissue, and pus, we found prominent dysregulation of arachidonic acid (ARA) and leukotriene B4 (LTB4) across all specimens. Notably, the lipidomic features in lesional hair directly correlated with disease severity. Mechanistically, HS lesions exhibited activation of a bacterial-keratinocyte-neutrophil cascade, in which sustained exposure to lipopolysaccharide (LPS) derived from Gram-negative bacteria induced phosphorylation of cytosolic phospholipase A2α (cPLA2α) in keratinocytes. This response was further amplified by recruited neutrophils through 5-lipoxygenase (5-LO) activation, resulting in increased production of LTB4 and extensive neutrophil extracellular traps (NETs) formation. These findings were further validated in NcstnΔCKO mice, where lipid profiles in lesional hair mirrored those of HS patients. Our study provided evidence that lipid mediators in HS lesional hair served as sensitive markers for disease activity, suggesting that targeting Gram-negative colonization or the ARA-LTB4 pathway represented a promising therapeutic intervention for HS.
2026-09-08 | Resorcinol in Dermatology: Reassessing a Legacy Topical Therapy for Contemporary Clinical Use.
Resorcinol is a phenolic topical agent (Figure 1) with a long history in dermatology, but its role in contemporary practice has narrowed substantially. This review summarizes the mechanism, formulation considerations, clinical applications, safety profile, and future relevance of topical resorcinol. Resorcinol has keratolytic, antiseptic, antifungal, anti-inflammatory, and tyrosinase-inhibitory properties that support its use in acne, hidradenitis suppurativa, chemical peels, hyperkeratotic disorders, and pigmentary conditions. Despite historical use in acne, current evidence and guideline support are limited, and resorcinol remains largely absent from routine acne management. In contrast, topical resorcinol has a more defined role in mild to moderate hidradenitis suppurativa, particularly as a nonantibiotic option for localized inflammatory lesions. Safety concerns, especially thyroid toxicity, have contributed to its decline. However, reported systemic toxicity largely involved prolonged high-dose application to ulcerated or compromised skin, which differs from limited modern dermatologic use. Practical barriers, including lack of commercial availability at clinically relevant concentrations and dependence on compounding, also limit adoption. Resorcinol may be better viewed as an underused legacy compound rather than an obsolete therapy.
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.
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.
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.
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.
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. [...].
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.
2026-04-14 | Multidisciplinary Approach to Complex Lower Extremity Limb Salvage in Pyogenic Arthritis, Pyoderma Gangrenosum, and Acne (PAPA) Syndrome: A Case Report.
Limb salvage using free tissue transfer in patients with rare autoinflammatory syndromes is poorly described, and the safety of microvascular reconstruction in this population remains uncertain. Hereditary pyogenic arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome is characterized by dysregulated inflammation, pathergy, and impaired wound healing, raising concern for flap compromise and postoperative complications. We report a rare case of lower extremity free tissue transfer in a patient with PAPA syndrome. A 66-year-old woman with rheumatoid arthritis and PAPA syndrome presented with rapid wound breakdown, violaceous ulceration, exposed hardware, and periprosthetic joint infection following left total knee arthroplasty (TKA). Examination revealed an approximately 9 × 7 cm anterior knee defect with subtotal patellar tendon necrosis. After multidisciplinary optimization, she underwent single-stage irrigation and debridement, hardware removal, revision TKA with patellar tendon reconstruction using gracilis autograft, and immediate coverage with a 22 × 14 cm free latissimus dorsi (LD) muscle flap. The flap was anastomosed end-to-side to the anterior tibial artery with venous outflow via the venae comitantes and loosely inset to preserve future surgical access. The donor site was closed primarily. A 21 × 13 cm staged split-thickness skin graft was performed 1 week later, with adjunctive postoperative hyperbaric oxygen therapy (HBOT). Initial healing was uncomplicated, with complete graft take and donor-site healing. Four months postoperatively, the patient developed chronic sinus tracts and recurrent periprosthetic infection requiring flap re-elevation, debridement, and hardware exchange; the flap pedicle was preserved, and coverage maintained. At one-year follow-up, all wounds had healed; flap coverage was durable with acceptable cosmesis, and the patient was ambulatory for short distances without assistance. She was last seen infection-free and full-weightbearing 4 months later. This case demonstrates that microvascular limb salvage is feasible in PAPA syndrome when guided by multidisciplinary planning and strategic flap design.
2026-03-26 | Two-Stage Surgical Management of Anogenital Hidradenitis Suppurativa in Patients on Biologic Therapy: A Retrospective Case Series.
Hidradenitis suppurativa is a chronic inflammatory skin disorder causing painful nodules, abscesses and scarring, with the anogenital region presenting particular functional and reconstructive challenges. Although biologic therapy is commonly used in moderate to severe disease, its limitations highlight the role of surgery in advanced cases. This single-centre retrospective case series included five male patients with Hurley stage III perineal, anorectal, genital or gluteal disease treated surgically between 2021 and 2023 following failure of biologic therapy. Management consisted of two-stage radical excision, negative-pressure wound therapy and reconstruction with meshed split-thickness skin grafts. All patients achieved more than 90% graft take and complete wound healing. No recurrence occurred during a median follow-up of 19.2 months. One patient developed a keloid scar at the donor site, and one experienced delayed healing. Functional and aesthetic results were satisfactory in all cases. Two-stage surgical excision with split-thickness skin graft reconstruction was associated with sustained wound healing and favourable functional outcomes in selected patients with severe anogenital hidradenitis suppurativa refractory to biologic therapy.
2026-03-06 | Intact Fish Skin Grafting in a Patient With Hidradenitis Suppurativa.
Wound management in hidradenitis suppurativa (HS) patients is often challenging due to worsening infections and impaired circulation, which can lead to prolonged hospitalization and poorer quality of life. Traditionally, autografting-a leading option in skin grafting-exhibits risks, including donor site morbidity. However, xenograft products, such as KerecisTM, derived from North Atlantic Cod fish, offer a novel solution for conditions with chronic wounds by promoting natural tissue regeneration. This case report presents a 35-year-old woman with HS who presented with persistent abscesses and fistulas in bilateral axillary regions. Following multiple surgical incisions and drainage procedures, the patient was treated with intact fish skin grafting, which resulted in significant granulation tissue deposition and wound edge approximation. The successful outcome in this case suggests that intact fish skin grafting is a viable option for non-healing wounds, particularly HS wounds, and can be integrated into surgical and wound care practices.
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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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.
2026-09-15 | Glucagon-like peptide-1 receptor agonists and tirzepatide are associated with reduced mortality, cardiovascular, and psychiatric risks in patients with hidradenitis suppurativa and type 2 diabetes and/or obesity: a retrospective cohort study.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease strongly associated with obesity and diabetes mellitus type 2 (T2D). GLP-1 receptor agonists (GLP-1RAs) and tirzepatide are increasingly used for metabolic control, but their systemic effects in HS remain poorly characterized. To compare all-cause mortality, cardiovascular, rheumatologic, metabolic, psychiatric, and non-communicable inflammatory outcomes in HS patients with T2D or obesity treated with GLP-1RAs/tirzepatide vs. alternative metabolic medications. This retrospective cohort study used the US Collaborative Network in TriNetX. Adults (≥18 years) with HS and T2D or obesity were included, excluding prior bariatric surgery. Exposed patients received a GLP-1RA or tirzepatide for at least one year, controls received other systemic antidiabetic or anti-obesity agents. Outcomes over a 2-year follow-up were assessed using 1:1 propensity score matching (PSM) for each outcome category. Outcomes included all-cause mortality, cardiovascular, rheumatologic, metabolic, psychiatric, and non-communicable inflammatory events. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and Cox regression was used to confirm significant findings. Sensitivity analyses and benchmark comparisons were performed. Before matching, 8,564 patients received GLP-1RA/tirzepatide and 6,299 alternative therapies. After matching, GLP-1RA/tirzepatide use was associated with reduced all-cause mortality (HR: 0.24, 95% CI: 0.145-0.395; p < 0.0001) and major adverse cardiovascular events (MACE) (HR: 0.61, 95% CI: 0.500-0.749; p < 0.0001). Risks of stroke and heart failure were also reduced (both p < 0.05). Psychiatric outcomes, including depression (HR: 0.78), suicidal ideation (HR: 0.38), and substance use disorder (HR: 0.58), were significantly reduced (all p < 0.05). Risks for rheumatologic and non-communicable chronic inflammatory outcomes were similar among groups. A modest increase in the risk of hyperlipidemia (HR: 1.25), metabolic dysfunction-associated steatotic liver disease (MASLD) (HR: 1.37), and nausea/vomiting (HR: 1.31) was observed in the GLP-1RA/tirzepatide group compared with alternative therapies (all p < 0.05). GLP-1RAs and tirzepatide are associated with reduced mortality, cardiovascular and psychiatric morbidity in HS patients with obesity or T2D, without increasing rheumatologic or inflammatory risk. These results extend the systemic benefits of GLP-1RAs and tirzepatide beyond metabolic control and suggest potential therapeutic value in HS.
2026-09-13 | The Expanding Role of GLP-1 Receptor Agonists and Dual GIP/GLP-1 Agonists in Dermatology: From Immunometabolism to Clinical Practice.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonists (dual GIP/GLP-1 agonists) have rapidly changed the management of obesity and type 2 diabetes mellitus. Beyond their effects on weight reduction and glycemic control, these agents exert pleiotropic effects on inflammation, adipose tissue biology, endothelial function and tissue repair, properties of growing relevance to dermatology, where several chronic inflammatory diseases are closely linked to obesity, insulin resistance and systemic low-grade inflammation. Current evidence suggests potential clinical benefit in psoriasis and hidradenitis suppurativa, encouraging signals regarding wound healing and a generally favorable cutaneous safety profile, although cutaneous adverse events, including injection site reactions, hypersensitivity, alopecia and rare autoimmune eruptions, have been increasingly reported. This review summarizes the immunometabolic rationale, current clinical evidence, the dermatologic safety profile and future perspectives of GLP-1RAs and dual GIP/GLP-1 agonists in dermatology. Although available data remain heterogeneous and largely observational outside psoriasis and hidradenitis suppurativa, these therapies may represent a new class of systemic immunometabolic modulators with practical implications for inflammatory, surgical and aesthetic dermatology.
2026-09-03 | Where the future lies: GLP-1 receptor agonists as therapeutics for dermatologic comorbidities.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity, type 2 diabetes mellitus, and cardiometabolic disease through effects on weight reduction, glycemic control, and systemic inflammation. Their varied immunometabolic actions have generated increasing interest in dermatology, where chronic inflammatory skin diseases frequently coexist with obesity, insulin resistance, metabolic syndrome, and cardiovascular disease. Emerging evidence from clinical trials, observational studies, and real-world analyses suggests that GLP-1RAs may improve outcomes in psoriasis and hidradenitis suppurativa while simultaneously reducing the burden of associated metabolic and cardiovascular comorbidities. In psoriasis, combination therapy with tirzepatide has demonstrated enhanced skin clearance, substantial weight loss, and reduced risk of psoriatic arthritis. In hidradenitis suppurativa, GLP-1RAs have been associated with improvements in cardiometabolic outcomes and reductions in systemic complications. Collectively, these findings support an evolving paradigm in which the greatest therapeutic utility of GLP-1RAs in dermatology may lie not in direct modulation of cutaneous inflammation but in addressing the metabolic dysfunction and chronic systemic inflammation that drive disease severity and multimorbidity. We review the current clinical evidence and propose a conceptual framework positioning GLP-1RAs as immune-metabolic therapies that target the systemic comorbidities of inflammatory skin disease, which may provide future opportunities for cutaneous disease modification and integrated dermatologic care.
2026-08-13 | The Metabolic Revolution in Dermatology: Obesity, Insulin Resistance, and Ultra-Processed Diets as Drivers of Skin Inflammation.
Inflammatory dermatoses are increasingly linked to systemic metabolic factors. Obesity and insulin resistance create a pro-inflammatory milieu that affects the skin. Adipose tissue functions as an endocrine organ secreting adipokines and cytokines that drive chronic inflammation with notable skewing toward T-helper 1 (Th1)/Th17 signaling. Hyperinsulinemia, elevated insulin-like growth factor-1 promote keratinocyte proliferation, sebum production, and autoinflammation, contributing to a multitude of skin diseases including hidradenitis suppurativa, acne, psoriasis, atopic dermatitis (AD), acanthosis nigricans, hirsutism, scarring alopecias, intertrigo, and chronic idiopathic urticaria. Concomitantly, ultra-processed diets low in fiber and high in additives detrimentally affect the gut-skin axis. Diets rich in emulsifiers, sugars, and fructose alter the gut microbiome and increase intestinal permeability, leading to metabolic endotoxemia and increased systemic inflammation. High-fructose corn syrup in sweetened beverages is metabolized via hepatic fructokinase, promoting de novo lipogenesis and excess uric acid, a cascade implicated in metabolic fatty liver disease and heightened inflammation. These dietary factors have been correlated with aggravated skin diseases, where fast-food intake (≥3× weekly) is associated with increased risk of severe AD in children. Emerging evidence suggests that dietary modifications may help mitigate skin inflammation in select patients. At the same time, the advent of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonists may improve metabolic parameters and could represent promising adjunctive therapies in select inflammatory dermatoses. Dermatologists can serve as sentinels, identifying cutaneous signs of insulin resistance (eg, acanthosis nigricans, acrochordons, and other skin diseases driven by insulin resistance) and addressing lifestyle factors as part of routine care.
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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.
2024-12-16 | Unlocking the Mechanisms of Hidradenitis Suppurativa: Inflammation and miRNA Insights.
Inflammatory skin diseases impose a significant burden on patients and healthcare systems worldwide. Among these, hidradenitis suppurativa (HS) is particularly notable for its chronic and recurrent nature. Recurrent nodules, abscesses, and scarring in apocrine gland-rich areas characterize the disease, including the groin, axillae, and perianal regions. Despite its considerable physical and psychological impact, the precise mechanisms driving HS remain elusive. Recent advancements in understanding the inflammatory processes involved in HS have highlighted the TNF-alpha, IL-1β, and IL-17/IL-23 pathways, which play crucial roles in initiating and perpetuating the disease. Moreover, specific microRNAs (miRNAs), such as miR-24-1-5p, miR146a-5p, mirR-26a-5p, miR-206, miR-338-3p, and miR-338-5p, are involved in these inflammatory processes. Dysregulation of these miRNAs contributes to aberrant cytokine expression and persistent inflammation, foreseeably exacerbating HS disease progression. This narrative review hypothesizes that miRNA dysregulation triggers aberrant expression in specific inflammatory pathways, contributing to HS's clinical manifestations and progression. We explore the implicated miRNAs' potential as biomarkers for earlier disease detection and as novel therapeutic targets. Identifying miRNA dysregulation offers new opportunities for earlier and more accurate diagnosis, potentially allowing clinicians to intervene before severe disease manifestations occur. Furthermore, therapeutic strategies to modulate miRNA expression could target the inflammatory pathways driving HS, leading to more personalized and effective treatments. This review also discusses future research directions to enhance the clinical management of HS. A better understanding of miRNA involvement in HS offers new avenues for research and management, ultimately improving patient outcomes and quality of life.
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.
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.
2022-10-14 | Methylated miRNAs may serve as potential biomarkers and therapeutic targets for hidradenitis suppurativa.
Hidradenitis suppurativa (HS) is a chronic inflammatory disease influenced by genetics, non-genetic and environmental factors that modulate miRNA expression. Currently, no miRNA data are available for HS. In this study, we profiled DNA methylation patterns of miRNA genes associated with HS susceptibility. Identify miRNA gene methylation profiles associated with HS susceptibility. This study examined the methylation patterns of DNAs from 24 healthy controls and 24 patients with HS using Illumina Infinium MethylationEPIC BeadChip array analysis. Methylation patterns of miRNA genes were analysed using KEGG pathway analysis to explore the inversely correlated pathways regulated by miRNAs. We identified 60 CpG sites representing 65 unique microRNA genes including 54 hypomethylated and 6 hypermethylated CpGs as potentially associated with HS. Some of these CpGs were found to be critical for skin function, such as miR-29, miR-200, miR-205, miR-548 and miR-132. The miR-192 is implicated in non-alcoholic fatty liver disease. The miR-200c gene was identified as a vital determinant in regulating skin repair after injury and may contribute to age-associated alterations in wound repair. miR-132 was significantly upregulated during the inflammation phase of wound repair, enhancing the activity of STAT3 and ERK pathways that promote keratinocyte proliferation. Epigenetically altered microRNA genes are implicated in wound healing, inflammation, keratinocyte proliferation and wound modulation. This is the first study to analyse methylation profiles of miRNA genes in the HS population, highlighting the unique role that miRNAs might play in diagnosing and treating HS.
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