Łukasz Matusiak

Surgical Treatment of Hidradenitis Suppurativa: Experiences and Recommendations

OBJECTIVE To describe our own surgical techniques of wound closure in pubic and armpit areas in the treatment of hidradenitis suppurativa (HS) and to analyze surgical procedures performed with regard to complications, tolerance, and factors influencing recurrence rate. METHODS Between 1999 and 2009, 118 operations were performed on 57 patients with HS. Surgical procedures included local excision of involved tissue and different methods of wound closure, including those of our own design such as the “star‐like” technique and “pubic flaps.” Treatment tolerance was evaluated 3 months after surgery, and efficacy was evaluated after 24 months. RESULTS Forty‐four (77.2%) patients showed good tolerance of the operation and during the postoperative period, whereas only one individual (1.8%) reported unsatisfactory tolerance. Of all patients, 51 (89.5%) expressed willingness to undergo additional surgery in the event of lesion recurrence. During the 2‐year follow‐up period, complete recovery was observed in 34 (59.7%) patients, partial recovery in 18 (31.6%), and no improvement in five (8.8%). Factors influencing recurrence rate were number of skin areas affected by HS lesions and disease duration. CONCLUSION Surgical treatment of HS is effective and well tolerated. In selected cases, our own techniques of surgical wound closure accelerated healing and improved results. &NA; The authors have indicated no significant interest with commercial supporters.

Hidradenitis suppurativa and associated factors: Still unsolved problems

23 patients with tumor-stage MF treated at our dermatology tertiary care clinic in the last several years, this is the first patient in whom extracutaneous disease was detected during complete cutaneous remission. The absence of lymph node involvement, which is usually the initial manifestation of extracutaneous dissemination, is particularly noteworthy, as is the short period within which the extracutaneous disease developed after beginning bexarotene therapy. This finding and the six previously reported cases in the literature cannot be ignored. However, further examples of a possible heterogeneity in the kinetics of response to bexarotene by different tissues are needed before any conclusion can be drawn.

Soluble interleukin-2 receptor serum level is a useful marker of hidradenitis suppurativa clinical staging

Hidradenitis suppurativa (HS) is a recurrent, debilitating suppurative skin disease. The major challenge is the choice of optimal treatment. Assessment of treatment effectiveness is currently associated with clinical observations of disease activity based on Hurley’s or Sartorius’ grading system. Detailed examination of patients with HS and evaluation of disease severity is frequently time-consuming and undoubtedly subjective. With regard to these factors, there is a need for laboratory findings that will help resolve the problem. The aim of this study was to determine the usefulness of soluble interleukin-2 receptor (sIL-2R) serum concentration as a marker of HS clinical staging and comparative analysis with the commonly conducted laboratory measurements, including white blood cell count, C-reactive protein and erythrocyte sedimentation rate. The statistical analysis of all these laboratory parameters conducted within a group of 54 individuals with HS revealed that sIL-2R serum level seems to be the most sensitive measurement for evaluation of disease stage. Moreover, the existence of strong dependences between sIL-2R serum concentration and Hurley’s HS grading system were demonstrated. In conclusion, we believe that sIL-2R serum level could be used as a valuable marker for disease staging in patients with HS.

Increased interleukin (IL)-17 serum levels in patients with hidradenitis suppurativa: Implications for treatment with anti-IL-17 agents

Background Biologics seem to offer a promising nonsurgical approach in hidradenitis suppurativa (HS), especially in disease with highly pronounced inflammation. Recent studies revealed increased expression of a broad range of cytokines in lesional HS skin, including interleukin (IL)‐17. Objective This study was undertaken to determine IL‐17 serum levels in this group of patients. Methods Our study was conducted on a group of 86 patients between 16 and 72 years of age with HS. A total of 86 matched healthy volunteers constituted the control group. Enzyme‐linked immunosorbent assay kits were used to quantify IL‐17 serum concentration. Results The mean IL‐17 serum level of patients with HS was 3.68 ± 2.08 pg/mL, which was significantly elevated (P < .0001) compared with that found in healthy volunteers (2.5 ± 1.11 pg/mL). Moreover, there was a tendency toward higher serum concentrations of IL‐17 in patients with more advanced disease (P = .005). Disease duration; patient sex, age, and body mass index; and smoking habits were not determining factors for IL‐17 serum concentration. Limitations Hospital‐based study population was a limitation, as was a lack of posttreatment assessment. Conclusion In light of our findings and literature on increased expression of IL‐17 in HS lesions, evaluating the clinical effectiveness of using anti‐IL‐17 agents in the treatment of patients with HS is justified.

Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non‐melanoma skin cancers

Background  There are many situations in integument surgery in which secondary intention healing (SIH) may bring results comparable or even superior to those obtained with primary intention healing.

Expression of metallothioneins in cutaneous squamous cell carcinoma and actinic keratosis.

Metallothioneins (MT) are low-molecular weight proteins implicated in heavy metal detoxification, zinc and cooper homeostasis and cell protection against free radicals. In variety of cancers MT-overexpression was shown, but there are just a few studies on the role of MT in skin carcinogenesis. Current study was undertaken to evaluate MT and Ki-67 expression in pre-cancerous skin lesions as well as in fully developed skin cancers. 73 squamous cell carcinomas (SCC), 23 actinic keratoses (AK) and 20 normal skin samples were included in the study. In obtained paraffin sections immunohistochemical reactions were performed. MT-expression in SCC (mean 2.89 ± 1.83) was significantly higher than in AK (mean 1.69 ± 1.26)(p = 0.006) and higher than in normal skin (mean 2 ± 0.79) (p = 0.0075). The MT-expression positively correlated with Ki-67 expression (R = 0.28; p = 0.017) in SCC and in AK (R = 0.49; p = 0.018). Various clinico-pathological variables, e.g. morphology, size of lesions and the depth of neoplastic infiltration were not associated to MT-expression in both SCC and AK. The grade of histological differentiation of SCC correlated positively with Ki-67 antigen (p < 0.001) and did not correlate with MT-expression (p = 0.06). Ki-67 expression was higher in SCC and in AK than in healthy skin (p = 0,003). In SCC and in AK expression of Ki-67 antigen correlated positively with MT-expression (respectively p = 0.017 and p = 0.018). MT may serve as a good markers of proliferation in SCC and AK. MT-overexpression in SCC may suggest a potential role of MT in skin carcinogenesis.

Trichophyton rubrum autoinoculation from infected nails is not such a rare phenomenon

Kerion‐like lesions are usually caused by zoophilic dermatophytes. Here, we present a rare case report – an inflammatory tinea barbae due to an anthropophilic fungus (Trichophyton rubrum), which is the main pathogen of onychomycosis and tinea pedis. Probably the infection, in the presented case, spread from diseased fingernails. We do postulate that physicians should consider autoinoculation as a not so rare way of fungal infection transmission.

A single nucleotide polymorphism −35 kb T > C (rs9264942) is strongly associated with psoriasis vulgaris depending on HLA-Cw∗06

HLA class I molecules play a role both in viral infection control and in autoimmune diseases development. rs9264942T>C polymorphism in HLA-C gene was found to impact on HLA-C surface expression level and to be associated with HIV-1 control. It was found that these HLA alleles which protect against AIDS are associated with autoimmune disease e.g. psoriasis vulgaris (PsV). Whether rs9264942 SNP is associated with PsV was investigated here. rs9264942T>C was genotyped in 292 PsV patients, and 254 controls using TaqMan Genotyping Assay. PsV patients differed from controls in frequencies of rs9264942T>C alleles (p=3.62 × 10(-16)) and genotypes (5.67 × 10(-15)). However, rs9264942C allele was predisposing to PsV 3-fold weaker than HLA-Cw(∗)06 (OR=5.04 vs. OR=15.61, respectively). In addition, this SNP was described earlier to be in strong linkage disequilibrium (LD) with another SNP, rs67384697 ins/del, which by affecting a microRNA binding is responsible for regulating HLA-C expression. However, typing for is cheaper and simpler than that for rs67384697, therefore we think it may substitute for it to some extent.

Surgical Procedures in Hidradenitis Suppurativa

Hidradenitis suppurativa is difficult to treat owing to its complex pathomechanism; beside the extensive inflammation with abscesses and inflammatory nodules, there is also an architectural loss with sinus tract formation and in severe cases with extensive scarring. Therefore, surgery is mandatory in moderate and severe HS.

Decreased Number of Circulating Endothelial Progenitor Cells in Hidradenitis Suppurativa Patients

Background: Hidradenitis suppurativa (HS) is nowadays regarded as a systemic disease associated with metabolic syndrome. Some recent studies have also demonstrated an increased cardiovascular risk in patients with HS. Circulating endothelial progenitor cells (EPCs) play an integral role in the regulation and protection of the endothelium and in the maintenance of vascular homeostasis. Objective: This study was undertaken to determine the possible alterations in the number of EPCs in patients with HS compared to controls. Methods: The number of EPCs, identified as CD133+/KDR+ cells, was determined with flow cytometry in the peripheral blood of 25 HS patients and 31 controls. Results: The number of EPCs was significantly reduced in HS sufferers compared with controls (p < 0.0001). The mean number of EPCs was assessed as 191.3 ± 118.5/ml and 672.4 ± 343.0/ml for patients and controls, respectively. Conclusion: A decreased number of EPCs among HS sufferers may contribute to endothelial malfunction resulting in increased cardiovascular risk in this group of patients.