Farida Benhadou

Inflammatory bowel disease is associated with hidradenitis suppurativa: Results from a multicenter cross-sectional study

Background: Hidradenitis suppurativa (HS) is often associated with inflammatory bowel disease (IBD; Crohns disease or ulcerative colitis). However, the prevalence of IBD in HS patients is unknown. Objective: To determine the prevalence of IBD in HS patients, and determine if patients with HS and IBD have a distinct HS phenotype. Methods: For this multicenter, cross‐sectional study, HS patients were asked during their first consultation if they had IBD. The diagnosis of IBD was checked in the medical files, and clinical characteristics were collected. Results: IBD had a prevalence of 3.3% (95% CI 2.3‐4.4) in 1076 HS patients. The prevalence of Crohns disease was 2.5% (95% CI 1.6‐3.4) and the prevalence of ulcerative colitis was 0.8% (95% CI 0.3‐1.4). HS‐IBD patients were less frequently obese (13.9% vs 31.2%, P = .04) than HS‐only patients, but there were no differences in gender, family history of HS, disease severity, body areas affected by HS, or smoking status. Limitations: The prevalence might be underestimated since HS patients might still develop IBD. Conclusion: The prevalence of IBD in HS patients (3.3%) is 4‐8 times higher than the prevalence in the general northern European population (0.41%‐0.74%), however HS‐IBD patients do not have a distinct HS phenotype.

Low and high body mass index in hidradenitis suppurativa patients-different subtypes?

Overweight is a well‐established risk factor for hidradenitis suppurativa (HS). In this cross‐sectional study, we compare HS patients with a high body mass index (BMI) with HS patients with a low BMI to investigate differences in disease characteristics.

Transgenic Mouse Technology in Skin Biology : Generation of Knockin Mice

INTRODUCTION Genetic modification of model organisms is a powerful tool to study human diseases in vivo. Mice have become the main subject of interest for basic researchers because they share a broad spectrum of physiological and pathological similarities with humans. These similarities, genetic accessibility, and a defined genetic background within the laboratory mouse strains provide the basis to analyze in vivo cellular and molecular pathways that are altered in human diseases. Knockout and knockin mice have become valuable tools to investigate the role of certain proteins and thereby have helped researchers to overcome cause and consequence problems arising from biochemical data (Hacking, 2008). For biomedical research, the knockin mouse opened the possibility of studying the in vivo pathological consequences of gene mutations associated with human disease and examining their similarity to human pathologies. Whereas knockout technology aims to delete a gene or part of a gene, knockin technology introduces specific mutations or cDNAs into a known locus of the genome. The altered mice can then be used to study the molecular mechanisms by which specific mutations can contribute to human diseases. Examples of the potential of knockin technology are the introduction into mice of human orthologs—the human equivalent of the mouse gene—and investigation into how either single-point mutations or gene insertions/deletions/inversions observed in human disease affect gene function. In addition, knockin technology can be used to introduce reporter genes under the control of a cell type–specific promoter to follow their fate over time in a defined location within the genome (Vorhagen et al., in press). An important advantage of knockin technology as compared with integration by chance (random integration) is its directed integration into a known locus in the genome. By contrast, random integration can result in multiple-copy integration and/or disturbance of genes where the transgene was inserted. For example, random integration may occur in the promoter of another gene, resulting in disturbed transcription of that gene.

Establishment of a European Registry for hidradenitis suppurativa/acne inversa by using an open source software

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Occurrence of an invasive cervical epidermoid carcinoma in a patient receiving TNF-α blocking therapy for hidradenitis suppurativa

HPV: human papilloma virus HS: hidradenitis suppurativa RA: rheumatoid arthritis TNF: tumor necrosis factor INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting apocrine gland areas leading to recurrent abscesses and nodules, forming scars and sinus tracts. Adalimumab, a tumor necrosis factor (TNF)-a monoclonal antibody is the first treatment approved by the US Food and Drug Administration for HS. TNF-a plays a primary and critical role in themechanism of autoimmune disease by binding to TNF-a receptors, and initiating the immune response. Biological therapies have dramatically changed the management of chronic inflammatory skin disorders. The association between cervical dysplasia and TNF-a blocking therapy is well documented. TNF-a plays a critical role in the control of viral infection, including human papilloma virus (HPV). Therefore, the therapeutic TNF-a inhibition may increase the risk of HPV reactivation and lead to cervical dysplasia and carcinoma. We report, for the first time to our knowledge, the impressive case of an HS patient who went on to have a cervical epidermoid carcinoma 6 months after starting adalimumab therapy.

Low Back Pain in Hidradenitis Suppurativa: A Diagnosis Not to Miss!

We report the case of a patient suffering from hidradenitis suppurativa since puberty and complaining of chronic low back pain associated to altered sensitivity and muscular weakness in the right leg. A diagnosis of lumbosciatica was confirmed. Symptoms were not relieved after the use of nonsteroidal anti-inflammatory drugs and analgesics. A surgical decompression was then indicated but heavily debated. Indeed, extended inflammatory and fibrotic hidradenitis suppurativa lesions were located regarding the skin area eligible for the proposed surgery. A combined therapy with clindamycine/rifampicin was started and the surgery was postponed. A complete remission of the articular symptoms was observed 1 month after the start of the antibiotherapy and the inflammatory skin lesions were greatly improved. With the presentation of this clinical case, we would like to discuss the spectrum of rheumatic disorders associated to hidradenitis suppurativa that needs to be correctly diagnosed and taken into consideration in the therapeutic management of the patient.

Acute Erythroderma in a Patient Receiving TNF-α-Blocking Therapy for Hidradenitis Suppurativa

Tumor necrosis factor-α (TNF-α) normally binds to TNF-α receptors, leading to the inflammatory response of autoimmune diseases. Adalimumab is a TNF-inhibiting, anti-inflammatory, biological medication which binds to TNF-α, thus reducing this inflammatory response. The use of TNF-α-inhibiting medication, such as adalimumab, being the first FDA-approved treatment for hidradenitis suppurativa, has drastically changed the management of dermatological diseases. One rarely reported manifestation that occurs as a side effect associated with the use of TNF-α-blocking agents is erythroderma. This study, for the first time, reports the case of a patient suffering from hidradenitis suppurativa with concomitant psoriasis, who developed a severe and acute erythrodermic rash after the start of adalimumab therapy.

Necrosis and Infection

Skin infection leading to cutaneous necrosis is a rare condition. The presence of an immunosuppressant state or an impaired vascular network is a risk factor associated with infection spreading and skin necrosis.

Livedo(id) Vasculitis

Livedoid vasculitis (LV) is a rare vasculopathic disorder. Different names are used in the literature to define LV and one of them is “atrophie blanche.” Atrophie blanche is a confusing term because it is a sign that is frequently observed in chronic venous insufficiency and not specific for LV.

Hidradenitis Suppurativa in General Practice: A Pilot Study

Background: Hidradenitis suppurativa (HS) is a chronic debilitating skin disease with a diagnostic delay of 7 years. The general practitioner (GP) is often the first physician consulted by the HS patients, and often provide the initial treatment. Early diagnosis by GP is of major importance and may help to better control the course of the disease. Aim: To describe GP’s recognition and management of HS. Methods: GPs in Belgium and Denmark were invited to complete a questionnaire constructed to describe general knowledge about HS. Results: 103 Belgian and 51 Danish participated. Demographic characteristics were similar in both groups. Danish GPs estimated the disease to be more common: 0%/21.6% Belgian/Danish GPs seeing more than 20 patients with HS per week and conversely 28.2%/3.9% seeing no patients with HS per week. Belgian GPs were less likely to consider HS a chronic disease than the Danish GPs (41.7%/84.3%), and antibiotics were more commonly associated with HS by Danish GPs (31.4% versus 3.9%). Interestingly, Belgian and Danish GPs consider HS as an inflammatory (respectively 44.7%/58.8%) but also as an infectious disease (respectively 62.1%/64.7%). Conclusions: The early diagnosis and a correct management is a crucial step to improve the prognosis of the disease. This pilot study has attempted to assess the general knowledge about HS of Belgian and Danish GPs. Important differences have appeared, suggesting a need for more information to facilitate the management of the patients. A multidisciplinary approach is suggested for the management of this often debilitating disease. Our pilot study evaluates for the first time the knowledge of GPs about Hidradenitis Suppurativa. Unfortunately the disease is often misdiagnosed and we have reported a mean diagnosis delay of 7 years. An early diagnosis by GPs could greatly improve the course and the management of the disease.