A. Nassif

Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa.

Background: Antibiotics have been shown to improve hidradenitis suppurativa (HS) patients but complete remission is rare using these treatments. Objective: To assess the efficacy and safety of a combination of oral rifampin, moxifloxacin and metronidazole in long-lasting refractory HS. Methods: We retrospectively studied 28 consecutive HS patients including 6, 10 and 12 Hurley stage 1, 2 and 3 patients, respectively. Complete remission, defined as a clearance of all inflammatory lesions including hypertrophic scars, was the main outcome criterion of the study. Results: Complete remission was obtained in 16 patients, including 6/6, 8/10 and 2/12 patients with Hurley stage 1, 2 and 3, respectively (p = 0.0004). The median duration of treatment to obtain complete remission was 2.4 (range 0.9–6.5) and 3.8 months (range 1.6–7.4) in stage 1 and 2 patients, respectively, and 6.2 and 12 months in the 2 stage 3 patients. Main adverse events of the treatments were gastrointestinal disorders (64% of patients) and vaginal candidiasis (35% of females). Reversible tendinopathy and hepatitis occurred in 4 and 1 patient, respectively. Conclusions: Complete remission of refractory HS can be obtained using broad-spectrum antibiotics and Hurley staging is a prognostic factor of response to the treatment.

Hidradenitis Suppurativa Associated with Spondyloarthritis — Results from a Multicenter National Prospective Study

Objective. To determine the prevalence and characterize the inflammatory musculoskeletal symptoms of hidradenitis suppurativa (HS), a chronic inflammatory disease of skin appendages. Methods. Patients with HS referred to 3 dermatology university hospital centers were systematically screened for peripheral arthritis, dactylitis, inflammatory back pain, or enthesitis. After careful clinical examination, patients were further classified according to clinical and imaging criteria for spondyloarthritis (SpA) using the Amor, European Spondyloarthropathy Study Group (ESSG), and ASsessment in ankylosing spondylitis (ASAS). Results. We screened 640 patients with HS; 184 had musculoskeletal symptoms. In all, 43 (mean age 39.4 yrs, ± 8.3; 80% women) had arthritis, inflammatory back pain, or enthesitis and were investigated further. Signs of HS preceded the onset of articular symptoms in 39 patients (90%), at a mean interval of 3.6 years. A total of 18 (41%), 24 (55%), and 15 (34%) patients fulfilled the Amor, ESSG, and ASAS criteria, respectively, while synovitis, acne, pustolosis, hyperostosis, and osteitis (SAPHO) syndrome was established in 4 patients. The crude prevalence of SpA in all 640 patients with HS was 3.7% by the ESSG criteria. Conclusion. SpA may occur in patients with HS, with the prevalence in this group exceeding that in the general population. The very short time between skin and joint symptom onset in some cases suggests common pathogenic mechanisms underlying HS and SpA.

Bacterial Pathogens Associated with Hidradenitis Suppurativa, France

Staphylococcus lugdunensis and anaerobic actinomycetes are associated with this skin infection.

First nicastrin mutation in PASH (pyoderma gangrenosum, acne and suppurative hidradenitis) syndrome.

DEAR EDITOR, PASH (pyoderma gangrenosum, acne and suppurative hidradenitis) syndrome is a new clinical entity associating pyoderma gangrenosum (PG), severe acne and hidradenitis suppurativa (HS). The absence of pyogenic sterile arthritis (PA) distinguishes PASH syndrome from PAPASH (pyogenic arthritis, pyoderma gangrenosum, acne and hidradenitis suppurativa) and PAPA (pyogenic arthritis, pyoderma gangrenosum and acne) syndromes, which exhibit PA in combination with PG, severe acne with or without HS, respectively. Mutations in the coding region of the proline-serine-threonine-phosphatase interacting protein 1 gene (PSTPIP1) were identified in patients with PAPA and PAPASH syndromes, although PAPA syndrome is genetically heterogenous. HS (OMIM#142690) is a chronic skin disease characterized by nodules, cysts and abscesses in apocrine gland-bearing sites. Loss-of-function mutations in the c-secretase genes, nicastrin (NCSTN), presenilin enhancer gamma secretase subunit (PSENEN) and presenilin 1 (PSEN1), have been reported in a small number of HS cases. Furthermore, c-secretase is an intramembranous protease complex capable of cleaving transmembrane proteins, including Notch receptors. Mutations in the c-secretase genes may

Allergie de contact aux antiseptiques : 75 cas analysés par le réseau Revidal de dermato-allergovigilance

Resume Objectifs Le but de l’etude etait de determiner les caracteristiques cliniques des allergies de contact aux antiseptiques et de preciser si l’agent responsable etait le principe actif lui-meme ou un excipient. Malades et methodes Il s’agissait d’une etude multicentrique, retrospective, descriptive analysant toutes les observations declarees en 2 ans au Reseau de Vigilance en Dermato-Allergologie (Revidal). Pour chaque dossier etaient precises les caracteristiques cliniques des lesions, l’antiseptique en cause, les modalites d’exposition, les resultats detailles des tests epicutanes. Resultats Soixante-quinze malades (d’âge moyen 44 ans) etaient sensibilises aux antiseptiques suivants : chlorhexidine (14 cas), hexamidine (20 cas), povidone iodee (14 cas), mercuriels (3 cas), triclocarban (Septivon ® ) (17 cas), hexamidine-chlorhexidine-chlorocresol (Cyteal ® ) (4 cas), chlorhexidine-tensioactif (Hibiscrub ® ), cetrimide ou chlorhexidine digluconate (Diaseptyl ® ) dans 1 cas chacun. La source d’exposition etait l’application therapeutique d’un antiseptique (68 cas), professionnelle (6 cas, 5 en milieu hospitalier, 1 eleveur de bovins), aux cosmetiques (1 cas, hexamidine). L’aspect clinique etait, dans la plupart des cas, un eczema au site d’application, cependant dans 9 cas avec l’hexamidine, il s’agissait d’un eczema generalise. La sensibilisation etait liee aux molecules antiseptiques (53 cas) ou limitee aux excipients (22 cas), en particulier dans les 17 cas dus au Septivon ® . Dans 27/75 cas (35 p. 100) les malades avaient une polysensibilisation de contact a des antiseptiques de classes differentes. Conclusion La sensibilisation aux antiseptiques n’est probablement pas rare. Les sources d’exposition sont variees. Les tests epicutanes sont indispensables pour le diagnostic, pour differencier une allergie a l’antiseptique de celle liee a un excipient enfin pour rechercher une polysensibilisation aux topiques medicamenteux.

Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients

OBJECTIVES Hidradenitis suppurativa (HS) is an inflammatory skin disease typically localized in the axillae and inguinal and perineal areas. In the absence of standardized medical treatment, severe HS patients present chronic suppurative lesions with polymicrobial anaerobic abscesses. Wide surgery is the cornerstone treatment of severe HS, but surgical indications are limited by the extent of lesions. Intravenous broad-spectrum antibiotics may help control HS, but their efficacy is not documented. This study was designed to assess the efficacy of a 6 week course of ertapenem (1 g daily) and of antibiotic consolidation treatments for 6 months (M6) in severe HS. PATIENTS AND METHODS Thirty consecutive patients with severe HS were retrospectively included in this study. The clinical severity of HS was assessed using the Sartorius score, which takes into account the number and severity of lesions. RESULTS The median (IQR) Sartorius score dropped from 49.5 (28-62) at baseline to 19.0 (12-28) after ertapenem (P < 10(-4)). Five patients were lost to follow-up thereafter. At M6 the Sartorius score further decreased for the 16 patients who received continuous consolidation treatments, since 59% of HS areas reached clinical remission at M6 (i.e. absence of any inflammatory symptoms, P < 10(-4)). Nine patients interrupted or received intermittent consolidation treatments due to poor observance or irregular follow-up. Their Sartorius score stopped improving or returned to baseline. No major adverse event occurred. CONCLUSIONS Ertapenem can dramatically improve severe HS. Consolidation treatments are needed to further improve HS and are mandatory to prevent relapses. Combined with surgery, optimized antibiotic treatments may be promising in severe HS.

The Microbiological Landscape of Anaerobic Infections in Hidradenitis Suppurativa: A Prospective Metagenomic Study

Background Hidradenitis suppurativa (HS) is a frequent and severe disease of the skin, characterized by recurrent or chronic skinfold suppurative lesions with a high impact on quality of life. Although considered inflammatory, antimicrobial treatments can improve or lead to clinical remission of HS, suggesting triggering microbial factors. Indeed, mixed anaerobic microbiota are associated with a majority of HS lesions. Our aim in this study was to characterize the landscape of anaerobic infections in HS using high-throughput sequencing. Methods We sampled and cultured 149 lesions and 175 unaffected control skinfold areas from 65 adult HS patients. The microbiome of 80 anaerobic lesions was compared to that of 88 control samples by 454 high-throughput sequencing after construction of 16S ribosomal RNA gene libraries. Results Bacterial cultures detected anaerobes in 83% of lesions vs 53% of control samples, combined with milleri group streptococci and actinomycetes in 33% and 26% of cases, respectively. High-throughput sequencing identified 43 taxa associated with HS lesions. Two gram-negative anaerobic rod taxa, Prevotella and Porphyromonas, predominated, contrasting with a reduced abundance of aerobic commensals. These rare taxa of normal skinfold microbiota were associated with lesions independently of gender, duration and familial history of HS, body mass index, and location. Two main additional taxa, Fusobacterium and Parvimonas, correlated with the clinical severity of HS. Conclusions In this study we reveal the high prevalence and particular landscape of mixed anaerobic infection in HS, paving the way for rationale targeted antimicrobial treatments.

Antibiotic Treatment of Hidradenitis Suppurativa.

Although hidradenitis suppurativa (HS) is not primarily an infectious disease, antibiotics are widely used to treat HS. Recent microbiological data show that HS suppurating lesions are associated with a polymorphous anaerobic flora, including actinomycetes and milleri group streptococci, and can therefore be considered as polymicrobial soft tissue and skin infections. Analysis of the literature provides little information on the efficacy of antibiotics in HS but suggests a beneficial effect of certain antimicrobial treatments, depending on the clinical severity of the disease. Patients must be informed and should agree with the treatment strategy before starting antibiotic treatments.

A rare nail polish allergen: phthalic anhydride, trimellitic anhydride and glycols copolymer

The main allergen responsible for nail polish contact dermatitis is toluene sulfonamide formaldehyde resin (TSFR) (1). However, we observed 3 cases of allergic contact dermatitis from nail polishes due to an original compound phthalic anhydride/ trimellitic anhydride/glycols copolymer (PTGC). As this new allergen is not available from the allergens suppliers, only patch testing to the patient’s nail polish(es) and the breakdown of the positive varnishes can show the responsibility of this particular allergen.

Remission of refractory pyoderma gangrenosum, severe acne, and hidradenitis suppurativa (PASH) syndrome using targeted antibiotic therapy in 4 patients

Pyoderma gangrenosum, severe acne, and suppurative hidradenitis (PASH) syndrome can prove refractory to treatment and is characterized by relapses and recurrences. The combination of antibiotic therapy and surgery can produce success in the management of the syndrome. Acute treatment is required, but maintenance therapy is also necessary to prevent disease relapse. The response to antibiotic therapy is hypothesis generating, raising the issue of a modified host response. To date, anecdotal reports support the use of surgery and medical therapy, but controlled investigations with extended follow-up are necessary to substantiate preliminary data observed with individual cases.