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Background: The hidradenitis suppurativa (HS) clinical response (HiSCR) has come under scrutiny as several HS clinical trials failed to meet primary endpoints with high placebo responses. This may be due to limitations of the tool and raters' ability to accurately characterize and count lesions, rather than lack of efficacy of the studied drug. Due to HS lesion complexity and potential differences in rater training, it was hypothesized that there would be discrepancies in how providers characterize and count lesions for HS clinical trials. Objective: To evaluate how HS providers and patients name and count HS lesions and to identify discrepancies among providers to initiate the development of consensus‐driven guidance for HS rater training. Methods: An online survey was distributed to the members of HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Respondents were asked to classify lesion images composed of multiple and different morphology types and answer questions regarding inclusion of associated dermatological conditions. Results: Forty‐seven HISTORIC members responded (29 providers; 18 patients). There was variability in how respondents classified HS lesions. Of 12 questions containing images, four had ≥50% of respondents choosing the same answer. With an image of a lesion composed of different morphologies, 45% of providers counted it as a single lesion and 45% counted it as multiple distinct lesions. With an image of multiple interconnected draining tunnels, 7% of providers classified it as a single draining tunnel while 79% categorized it as multiple draining tunnels with the number estimated by visual inspection. There was also variability in deciding whether lesions occurring in associated conditions should be considered separately or included in HS lesion counts. Patient responses were also variable. Conclusions: The result of the current study reaffirms the gap in how providers characterize and count HS lesions for clinical trials and the need to develop consensus‐driven rater training related to HS outcome measures. [ABSTRACT FROM AUTHOR]

Background/Objectives: Surgical deroofing is an essential part of ongoing management of Hidradenitis Suppurativa, including persistent lesions non‐responsive to medical therapy. The variables associated with delayed wound healing after surgical deroofing are contradictory within the literature due to the inclusion of heterogeneous surgical intervention methods. We aimed to assess the predictors of time to wound healing after surgical deroofing in HS. Methods: Patients who underwent in‐office surgical deroofing between 2020 and 2024 at a single tertiary HS referral centre were included in analysis. Demographic, disease and blood variables were collected as per standard of care. Statistical analysis was performed using univariate correlation, with multiple regression performed to explore the interactions between variables and identify variables predictive of time to wound healing. Results: A total of 270 individuals were included in the analysis. The median time to wound healing was 9.6 weeks with a range from 4 to 22 weeks. Kaplan–Meier curves demonstrated significant differences with the log rank test when comparing biologic use versus no use, normal versus abnormal CRP and normal versus abnormal haemoglobin. Cox regression analysis identified biologic use with a significant hazard ratio compared to no biologic therapy (HR = 2.512, p < 0.0001) along with baseline CRP (HR = 0.968, p < 0.0001) and baseline haemoglobin (HR = 1.052, p < 0.001). Conclusions: Time to wound healing after in‐office deroofing can be decreased with prior biologic therapy and markers of systemic inflammation in blood are also significantly associated with delays in healing. This correlates well with the existing literature promoting concurrent medical and surgical therapy to improve patient outcomes in HS. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory disease with significant impact upon quality of life. Generic quality‐of‐life measures suffer from decreased face validity and content validity, leading to the development of disease‐specific quality‐of‐life measures such as the Hidradenitis Suppurativa Quality of Life (HiSQOL) outcome measure. The aim of this study was to validate the use of the HiSQOL in the Australian population and evaluate the quality‐of‐life impact in HS patients in Australia. Methods: A total of 301 patients were recruited and consented to be involved in this study. All participants were invited to complete the HiSQOL questionnaire along with basic demographic and disease information, the DLQI and HADS anxiety and depression scale. Participants were then asked to repeat the questionnaires 14 days later to assess test–retest reliability. Results: The mean HiSQOL score was 46.5 out of a possible total score of 76 (SD = 24.2) indicating a very large impact on quality of life. Based upon the published validity bands this corresponds to a very large impact on quality of life. Validation statistics indicated a high degree of internal consistency (Cronbach's alpha = 0.956) with expected levels of convergent validity and excellent test–retest reliability (p = 0.95). Multiple regression analysis indicated individuals with a younger age of onset and positive family history had significantly greater quality‐of‐life impact as measured by the HiSQOL. Conclusions: The HiSQOL is a valid, reliable measure for assessing the quality‐of‐life impact of HS. Significant factors influencing quality of life include age of onset and family history. Longitudinal measurements will enable evaluation of the impact of therapy upon QOL in the Australian context. [ABSTRACT FROM AUTHOR]

Background/Objectives: Caucasian and Asian patients with hidradenitis suppurativa demonstrate significant differences with regard to age, gender and body mass index. Demographic characteristics are known to influence the efficacy and drug survival of hidradenitis suppurativa therapeutics including biologic therapies. What remains unknown is the impact of ethnicity upon the efficacy of therapeutics once demographic and disease characteristics have been taken into account. This is an important question given the expansion of biologic therapies for HS into the global patient community. Methods: We assessed 170 patients from a single HS specialist centre in Australia stratified by patient‐identified ethnicity including those identifying as either Caucasian or Asian. Results: Asian patients demonstrated lower BMI, higher rates of smoking and greater odds of Hurley stage 3 disease with tunnels than Caucasian patients in line with the reported literature. There was no significant difference between percentage of individuals achieving HiSCR50 or IHS4‐55 at Week 16. Significant differences were seen in median time to secondary loss of response, and Kaplan–Meier curve analysis showed a significant difference between curves when stratified by patient‐reported ethnicity. Cox regression analysis demonstrated after accounting for age, gender, BMI, smoking and Hurley stage, the significance of ethnicity in influencing time to secondary loss of response disappears. Conclusions: Caucasian or Asian ethnicity does not influence response to adalimumab treatment on patients with hidradenitis suppurativa. [ABSTRACT FROM AUTHOR]

The article discusses the understanding of the skin condition pyoderma gangrenosum (PG) and its association with multi-kinase inhibitors (MKIs). PG is a chronic ulcerative skin condition characterized by dysregulated immune responses. The lack of validated animal models has hindered the understanding of PG's etiology, but drug-induced PG can provide insights into the molecular actions of causative medications. The article reports a case of MKI-associated PG-like ulcers and discusses the spectrum of cutaneous side effects of MKIs. The study suggests that clinicians should consider PG or PG-like ulcers as a differential diagnosis in MKI-treated patients and highlights the need for further research to understand the molecular mechanisms of PG. [Extracted from the article]

Melanoma accounts for the majority of skin cancer‐related mortality, highlighting the need to better understand melanoma initiation and progression. In‐depth molecular analysis of neoplastic melanocytes in whole tissue biopsies may be diluted by inflammatory infiltration, which may obscure gene signatures specific to neoplastic cells. Thus, a method is needed to precisely uncover molecular changes specific to tumor cells from a limited sample of primary melanomas. Here, we performed laser capture microdissection (LCM) and gene expression profiling of patient‐derived frozen sections of pigmented lesions and primary cutaneous melanoma. Compared to bulk tissue analysis, analysis of LCM‐derived samples identified 9528 additional differentially expressed genes (DEGs) including melanocyte‐specific genes like PMEL and TYR, with enriched of pathways related to cell proliferation. LCM methodology also identified potentially targetable kinases specific to melanoma cells that were not detected by bulk tissue analysis. Taken together, our data demonstrate that there are marked differences in gene expression profiles depending on the method of sample isolation. We found that LCM captured higher expression of melanoma‐related genes while whole tissue biopsy identified a wider range of inflammatory markers. Taken together, our data demonstrate that LCM is a valid approach to identify melanoma‐specific changes using a relatively small amount of primary patient‐derived melanoma sample. [ABSTRACT FROM AUTHOR]

A study by Kridin et al. compared infection rates between psoriasis patients treated with different biologics using the global TriNetX database. After adjusting for demographic variables, body mass index, and comorbidities, the study found higher rates of certain infections, such as hepatitis B, cytomegalovirus, and influenza, in patients treated with tumor necrosis factor-¿ inhibitors (TNFis) compared to interleukin-17/23 inhibitors (IL-17/23is). However, tuberculosis infection rates were similar between the two groups, likely due to effective pre-biologic screening. The study emphasizes the importance of considering both relative and absolute risk differences when evaluating the safety of different biologics. It suggests using the "number needed to be exposed" (NNE) as a measure of absolute risk, which takes into account both the adjusted hazard ratio and the incidence of the outcomes of interest. The study also highlights the need for further research on clinically relevant outcomes, such as hospitalization or mortality, particularly in high-risk populations. [Extracted from the article]

This article discusses a study that aimed to compare the serum proteome (the complete set of proteins present in the blood serum) of patients with pyoderma gangrenosum (PG) and hidradenitis suppurativa (HS) in order to identify differences and potential biomarkers for future research. The study analyzed serum samples from 33 patients with HS, 7 patients with PG, and 6 healthy controls. The results showed significant differentiation between the serum proteomes of HS, PG, and healthy controls, with PG demonstrating a greater inflammatory burden compared to HS. The study identified several proteins and pathways that differentiate PG from HS, including dendritic cell-associated proteins, neutrophil-associated proteins, and proteins involved in tissue remodeling. These findings provide valuable insights into the pathogenesis of PG and may contribute to the development of targeted therapies. [Extracted from the article]

Background: Psoriasis is a chronic immune‐mediated inflammatory disorder that also occurs in the setting of human immunodeficiency virus (HIV). Biological therapy has transformed the treatment landscape for psoriasis; however, individuals with HIV are excluded from clinical trials. The impact of biological therapy on blood parameters in HIV is unclear and is only observed in small case series. Objective: The aim of this study was to assess the effect of biological therapy in psoriasis vulgaris in individuals with well‐controlled HIV on CD4+ cell counts, CD4+ proportion and HIV viral load over 12 months. Methods: This retrospective cohort study was conducted at a tertiary referral centre in Sydney, Australia and included 36 HIV‐positive individuals with psoriasis treated with biological therapy, compared with 144 age‐, gender‐ and HAART‐matched individuals without psoriasis seen between 2010 and 2022. Outcomes of interest included HIV viral load, CD4+ cell count and incidence of infections. Results: No statistically significant difference was seen in baseline HIV viral load and CD4+ count between individuals with and without psoriasis. No significant change in CD4+ count or HIV viral load was seen over the 12‐month period of analysis in the HIV cohort without psoriasis. The HIV cohort treated with biological therapy for psoriasis also did not demonstrate any significant change in HIV viral load and CD4+ counts over the 12‐month period examined. Stratification by type of biological therapy used did not identify any significant changes in these parameters. Rates of infections and adverse events were also not significantly different between cohorts. It is possible that minor blips seen in the biologics cohort may be a risk factor for future virological failure, and future prospective longitudinal studies are required. Conclusions: In individuals with well‐controlled HIV, the use of biological therapy for psoriasis does not significantly impact HIV viral load, CD4+ cell count, CD4+ proportion and rates of infection over the first 12 months of therapy. [ABSTRACT FROM AUTHOR]

Introduction: Academic dermatologists in Australia and New Zealand provide high‐quality and meaningful contributions to the understanding of disease and therapeutic translational research. Concerns have been raised by the Australian Medical Association regarding the decline of clinical academics in Australia as a whole, however, such trends in scholarly output have not previously been analysed for Australasian dermatologists. Methods: A bibliometric analysis of dermatologists in Australia and New Zealand was conducted in January and February 2023. Available Scopus profiles for all dermatologists were used to measure lifetime H index, scholarly output, citation counts and field‐weighted citation impact (FWCI) in the last 5 years (2017–2022). Trends in output over time were measured using non‐parametric tests. Differences in output between subgroups stratified by gender and academic leadership positions (associate professor or professor) were measured using Wilcoxon rank‐sum and one‐way ANOVA tests. The scholarly output of recent College graduates was also analysed as a subgroup, comparing the same bibliographic variables in the 5 years preceding and 5 years following awarding of their fellowships. Results: From the 463 practising dermatologists in Australia and New Zealand, 372 (80%) were successfully matched to Scopus researcher profiles. Of these dermatologists, 167 were male (45%) and 205 (55%) were female, and 31 (8%) held academic leadership positions. Most dermatologists (67%) published at least one paper in the last 5 years. The median lifetime H index was 4, and between 2017 and 2022 median scholarly output was 3, the median citations were 14 and the median FWCI was 0.64. There was a non‐significant trend towards fewer publications per year, however, citation count and FWCI decreased significantly. By subgroups, female dermatologists published significantly more papers between 2017 and 2022, and other bibliographic variables were comparable to male dermatologists. However, women were underrepresented in positions of academic leadership—comprising only 32% of this cohort despite representing 55% of dermatologists. Professors were also significantly more likely to have higher bibliographic outcomes than associate professors. Finally, analysis of recent College graduates highlighted a significant decline in bibliometric outcomes pre‐ and post‐fellowship. Conclusion: Overall, our analysis identifies a trend towards decreased research output by dermatologists in Australia and New Zealand in the last 5 years. Strategies to support dermatologists in research endeavours, particularly women and recent graduates, will be essential in maintaining strong scholarly output among Australasian dermatologists and thereby sustaining optimal evidence‐based patient care. [ABSTRACT FROM AUTHOR]

Altered gut microbiota composition has been observed in individuals with hidradenitis suppurutiva (HS) and many other inflammatory diseases, including obesity, type 1 and type 2 diabetes. Here, we addressed whether adalimumab, a systemic anti‐inflammatory therapy, may impact the microbiota biochemical profile, particularly on beneficial metabolites such as short‐chain fatty acids (SCFAs). We conducted an observational single‐arm pilot trial to assess gut microbiota composition by 16S rRNA gene sequence analysis and to detect metabolite signatures by gas chromatography in stool samples from participants with HS prior to and 12 weeks after commencing adalimumab therapy. HS individuals that better responded to adalimumab treatment showed a shift in the composition and function of the gut microbiota with significantly increased SCFA acetate and propionate compared to age, gender and BMI‐matched healthy controls. A positive correlation was observed between propionate with Prevotella sp and Faecalibacterium prausnitsii. Increased SCFAs, changes in gut microbiota composition, function and metabolic profile following 12 weeks of adalimumab suggest that targeting SCFAs may be considered a potential biomarker to be evaluated as a complementary protective factor or as a diagnostically relevant signal in HS. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic, suppurative condition of the pilosebaceous unit. Patients suffering from HS demonstrate a molecular profile in keeping with a state of systemic inflammation and are often found to fit the criteria for a diagnosis of metabolic syndrome (MetS). In this paper, we review the literature with regards to established data on the prevalence of MetS in HS patients and revise the odds ratio of comorbid disease. Furthermore, we attempt to draw parallels between inflammatory pathways in HS and MetS and evaluate how convergences may explain the risk of comorbid disease, necessitating the need for multidisciplinary care. [ABSTRACT FROM AUTHOR]

Angiotensin-converting enzyme 2 expression is elevated in tissue of hidradenitis suppurativa and pyoderma gangrenousm and demonstrates a different pattern of expression to psoriasis vulgaris Dear Editor, Angiotensin-converting enzyme 2 (ACE2) is a ubiquitous receptor on epithelial tissues and lymphocytes involved in regulation of inflammation through downstream interferon-gamma responses.[1] It has been previously demonstrated to be upregulated in psoriasis vulgaris and responsive to therapy with IL-17 inhibition.[2] It has been proposed that it may be upregulated in other inflammatory dermatoses, but the evidence is scarce. ACE2 expression between healthy controls and PG tissue was significant by one-way ANOVA (Figure 1b); however, the difference between lesional and non-lesional PG tissue did not reach statistical significance. [Extracted from the article]

Pyoderma gangrenosum is a painful recurrent ulcerative neutrophilic dermatosis in which the pathogenesis is incompletely defined. Current evidence suggests that PG is associated with dysregulation of components of both the innate and adaptive immune system with dysregulation of neutrophil function and contribution of the Th17 immune axis. PG can be present in numerous heterogeneous clinical presentations and be associated with multiple inflammatory conditions including rheumatoid arthritis, inflammatory bowel disease and hidradenitis suppurativa. However, no critical evaluation of the observed molecular characteristics in PG studies in association with their clinical findings has been assessed. Additionally, emerging evidence suggests a potential role for other cell types and immune pathways including B cells, macrophages, autoantibodies and the complement system in PG, although these have not yet been integrated into the pathogenesis of disease. This systematic review aims to critically evaluate the current molecular observations regarding the pathogenesis of PG and discuss associations with clinical characteristics as well as the evidence supporting novel cell types and immune pathways in PG. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease with still largely unknown pathogenesis. While infectious organisms have been identified in lesions of the disease since the 1980s, questions remain over the role that bacteria and microbiome play. Recent studies using 16S ribosomal RNA gene sequencing and larger culture‐based studies have begun to paint a clearer picture of the microbial world of HS. With this systematic review, we summarize all the work that has been done to date in HS bacteriology, analyse potential pitfalls and limitations of the current studies, and address future directions of investigation. This systematic review attempted to collate and analyse all bacteriology studies done to date. This review was prospectively registered with PROSPERO (1670769) performed in line with the PRISMA checklist. Twenty two studies were identified comprising 862 individual HS patients for culture studies and 206 HS patients for 16S rRNA gene sequencing studies. Methodology tended to be varied, with different sampling, culturing and sequencing methods as well as amount of analysis and stratification of patients. Bacteria identified as elevated in HS lesions in sequencing studies as well as grown from HS lesions in culture studies are identified and discussed. These primarily included the anerobic Gram‐negative bacilli Prevotella, Porphyromonas and Fusibacterium, the Gram‐positive bacilli Corynebacterium, and the Gram‐positive cocci Staphylococcus, Streptococcus and Parvimonas. Potential interactions, as well as work in other disease models with related bacteria are also discussed. Areas of further investigation include in vitro studies of interactions between bacteria and keratinocytes, gut and oral microbiome studies and deep sequencing studies for virulence and phage factors. [ABSTRACT FROM AUTHOR]

Hidradenitis Suppurativa is a chronic inflammatory disease manifesting in painful nodules, abscesses and malodorous draining tunnels with a pre‐disposition to flexural regions of skin. Traditional surgical interventions include excision of clinically visible lesions and in severe cases – excision down to fascia of entire anatomical regions (axilla, groin) and repair with split‐thickness grafting or skin substitutes. However, such techniques are plagued by long healing times (up to several months), extensive tissue loss and high recurrence rates given that a large proportion of disease is not clinically visible. Deroofing is a tissue‐saving surgical technique, ideal for Hurley Stage 2 disease, which when combined with bedside pre‐operative sonography can allow for the accurate identification and removal of occult dermal tunnels whilst minimising the risks of pain, infection, minimising healing times and can be safely conducted in the setting of immunomodulatory therapy. [ABSTRACT FROM AUTHOR]

The registration of the tumour necrosis factor‐α inhibitor adalimumab in 2015 was a major step forward in the treatment of hidradenitis suppurativa/acne inversa (HS). However, it soon became evident that the effectiveness of adalimumab in daily practice was highly variable. A significant unmet medical need of HS patients remained, and the search for novel therapeutic targets was intensified. During the 10th European Hidradenitis Suppurativa Foundation (EHSF) e.V. Conference, reknown international HS investigators virtually presented and discussed the published data on these potential target molecules for future HS treatment. This article addresses the most promising molecules currently under investigation from a pathophysiological and clinical point of view. With phase III trials ongoing, the anti‐ interleukin (IL)‐17 biologics bimekizumab and secukinumab are in the most advanced stage of clinical development showing promising results. In addition, targeting IL‐1α with bermekimab has shown encouraging results in two clinical trials. Directing treatment at neutrophil recruitment and activation by targeting IL‐36 with spesolimab fits well in the pathogenic concept of HS and clinical phase II trial results are pending. In contrast to in situ evidence, Complement 5a (C5a) and C5a receptor blockade have only shown greater clinical benefit in patients with severe HS. Inhibition of Janus kinase (JAK) 1 signalling in HS showed clinical efficacy only in the highest dosage, highlighting that careful surveillance of the balance between safety and efficacy of JAK inhibition is warranted. Overall, clinical efficacies of all novel treatments reported so far are modest. To guide drug development, more and better‐defined translational data on the pathogenesis of this severe and enigmatic inflammatory skin disease are required. [ABSTRACT FROM AUTHOR]

The 14 authors of the first review article on hidradenitis suppurativa (HS) pathogenesis published 2008 in EXPERIMENTAL DERMATOLOGY cumulating from the 1st International Hidradenitis Suppurativa Research Symposium held March 30–April 2, 2006 in Dessau, Germany with 33 participants were prophetic when they wrote "Hopefully, this heralds a welcome new tradition: to get to the molecular heart of HS pathogenesis, which can only be achieved by a renaissance of solid basic HS research, as the key to developing more effective HS therapy." (Kurzen et al. What causes hidradenitis suppurativa? Exp Dermatol 2008;17:455). Fifteen years later, there is no doubt that the desired renaissance of solid basic HS research is progressing with rapid steps and that HS has developed deep roots among inflammatory diseases in Dermatology and beyond, recognized as "the only inflammatory skin disease than can be healed". This anniversary article of 43 research‐performing authors from all around the globe in the official journal of the European Hidradenitis Suppurativa Foundation e.V. (EHSF e.V.) and the Hidradenitis Suppurativa Foundation, Inc (HSF USA) summarizes the evidence of the intense HS clinical and experimental research during the last 15 years in all aspects of the disease and provides information of the developments to come in the near future. [ABSTRACT FROM AUTHOR]

Hidradenitis Suppurativa (HS) is a chronic inflammatory dermatosis in which B cells play a prominent but unclear role. Our understanding of the role of B cells in innate and adaptive immunity (including antibody production, antigen presentation and effector functions) is rapidly evolving; and these novel findings require integration into the pathophysiologic model of HS. B cells are transiently present in normal human skin and have functions in the maintenance of innate cutaneous immunity. Recruitment and trafficking of B cells in significant numbers to skin is mediated via B cell‐specific chemokines as well as shared signalling with T‐cells. The evidence suggests that the presence of antibody‐secreting B cells is not sufficient to induce clinical disease and T‐cell interaction is required to induce clinical disease. Such interactions can occur in secondary lymphoid organs adjacent to involved tissue or in tertiary lymphoid organs which develop in response to the HS inflammatory milieu. This milieu directly mediates the types of antibodies produced by B cells, given the role of cytokines in B‐cell class switching. Identified antibodies in HS (IgG, IgM, ASCA, ACPA) currently demonstrate no evidence of pathogenicity, but may be novel biomarkers for disease severity. B cells also have anti‐inflammatory properties through production of IL‐10 and IL‐35 which require experimental validation. Overall, B cells in HS are likely to be involved in amplification of a pre‐existing inflammatory response; but it remains unclear whether they may be directly pathogenic. [ABSTRACT FROM AUTHOR]

Background: Several case reports and case series have recently explored the association between hidradenitis suppurativa (HS) and inflammatory bowel disease (IBD). Objective: We performed a systematic review and meta‐analysis of case‐control studies to determine (i) the pooled prevalence of IBD in HS cohorts, and (ii) whether HS is more strongly associated with Crohn's disease or ulcerative colitis. Methods: Electronic searches were performed using five databases, from their inception to August 2018. Case‐control studies reporting the proportion of IBD cases in HS cohorts were included and meta‐analysis performed. Results: From six included studies, a significant association between HS and IBD after pooling of adjusted effect sizes was identified (OR 2.12; 95% CI 1.62–2.77; P = 0.03). Subgroup analysis demonstrated a significant association between HS and Crohn's disease (OR 2.25; 95% CI 1.52–3.32; P < 0.0001, I2 = 92%) and with ulcerative colitis (OR 1.56; 95% CI 1.26–1.94; P < 0.0001; I2 = 36%). Limitations: Studies reviewed were observational by design which are susceptible to bias and lack of randomization. Conclusions: Our results indicate a statistically significant association between HS and IBD. Our results highlight that all patients with HS should be clinically screened for symptoms of IBD and symptomatic patients referred for further investigations. [ABSTRACT FROM AUTHOR]

Complement inhibition has been identified as a potential therapeutic target for multiple inflammatory disorders including Hidradenitis Suppurativa (HS). It is currently unclear how complement integrates into our current model of molecular pathogenesis in HS and whether it represents a central component of pathogenesis, or a neutrophil‐associated bystander. Levels of C5a in serum and tissue correlate with disease activity and degree of neutrophilic infiltrates in HS. C5a has been associated with Th17 immune axis activation in psoriasis, rheumatoid arthritis and Crohn's disease with strong similarities to TH17 activation in HS. Porphyromonas species (which are identified in the HS microbiome) are able to cleave inactive C5 into C5a implicating the cutaneous microbiome as an activator of complement. C3a and C5a are associated with activation of the NLRP3 inflammasome, implicated in the inflammatory drive in HS. Complement receptors are present upon dendritic cells, monocytes, fibroblasts and adipocytes, which may broaden the potential contribution of complement to multiple aspects of HS pathogenesis. Dysregulation of complement receptor pathways has been documented in obesity, insulin resistance and polycystic ovarian syndrome leading to the possibility that complement may explain the epidemiological associations between these conditions and HS. The therapeutic potential of complement inhibitors in HS may be related to the therapeutic target (complement receptor or complement subunit) and the presence of alternate receptors (such as C5aR2) or ligands (including C3a, PAMPs and DAMPs). Integrating complement into the known pathogenesis of HS may aid in explaining the contradictory results between Phase 2 studies of C5a antagonists. It also allows for the identification of existing knowledge gaps to target further clinical investigation and research. [ABSTRACT FROM AUTHOR]

The precise pathogenic mechanisms in the development, persistence and worsening of hidradenitis suppurativa (HS) remain ill‐defined. This chronic inflammatory dermatosis displays a strong Th1 and Th17 inflammatory signature with elevated levels of TNF‐α, IL‐1β, IL‐17 and IFNγ in lesional and perilesional tissue. HS significantly differs to other chronic inflammatory dermatoses due to the development of hypertrophic scarring and dermal tunnels. The development of scarring and tunnels suggests that fibroblastic stromal cells (including myofibroblasts, fibroblasts, pericytes etc) may be involved in the development and progression of disease. Heterogeneous populations of fibroblasts have been identified in other inflammatory disorders and malignancy which contribute to inflammation and present novel therapeutic targets for fibrotic disorders. Findings in HS are consistent with these fibroblast subpopulations and may contribute to tunnel formation, aggressive squamous cell carcinoma and the phenotypic presentation of familial HS variants. We describe the existing knowledge regarding these mechanistic pathways and methods to confirm their involvement in the pathogenesis of HS. [ABSTRACT FROM AUTHOR]

Summary: Background: Australia has the highest incidence of cutaneous melanoma worldwide. Previous studies have identified some body areas (forearms and dorsal hands) have lower rates of melanoma than expected when compared with other similarly exposed areas, leading to the suggestion that endogenous immunological protective mechanisms in certain body sites may exist. Aims and Methods: We hypothesise that examination of melanoma by body site in a regional Australian setting would demonstrate no significant variation in the incidence of melanoma across highly sun exposed areas including the head and neck and upper limbs. Results were stratified by body site and further examined by univariate correlation analysis by gender, age, body site, Breslow thickness and subtype. Polytomous logistic regression was used to test the difference in risk factors by location of melanoma. Results: A total of 772 melanomas were included in the analysis. Melanomas of the upper limb were more likely to affect females (OR = 2.415 95%CI: 1.433‐4.072) and more likely to be thinner than other body sites. Compared to other international studies, statistically significant decreased rates of melanoma were seen on the upper limb compared to other areas of the body (X2 = 16.29, P < 0.001). Examination of sites of melanoma on the upper limb showed significantly decreased rate on the distal upper limb given relative body surface areas (X2 = 6.30 P = 0.04). Discussion and Conclusions: Our study was limited by its retrospective nature, and the findings require validation in a larger prospective cohort. Further exploration of such mechanisms may lead to new insights into the immunological mechanisms surrounding cutaneous melanoma. [ABSTRACT FROM AUTHOR]

The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03‐05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease. [ABSTRACT FROM AUTHOR]

The xanthodermatoses consist of a heterogeneous group of cutaneous disorders characterized by the macroscopic yellow hue seen on examination. This hue is attributable to the chemical structure of the accumulating substances within the skin or surrounding tissues. The most common culprits are lipids (cholesterol and triglycerides), elastin, and bilirubin. Exogenous sources of yellow pigment include yellow dyes (including hennas) and metal salts. This article will focus on recognition of these entities, classified in terms of morphology and the site of initial eruption, in order to support the recognition and diagnosis of these widely variable conditions. [ABSTRACT FROM AUTHOR]

Dermatological disease is commonly associated with psychological morbidity because of its visible nature. The burden of living with a chronic dermatological illness can contribute to the development of psychiatric illness and conversely, such conditions can result in the exacerbation of preexisting dermatological disease. It may also reduce a patient's compliance to treatment, result in loss to follow-up and a decreased level of functioning and quality of life. In dermatological patients who suffer from psychiatric symptoms, medical management used in their treatment may have significant interactions with systemic medications used to treat their dermatological condition. A well-known example of this is lithium's ability to exacerbate psoriasis. Such interactions can result in suboptimal treatment of their psychiatric and/or dermatological condition. The present paper aimed to review the literature for documented interactions and the level of clinical significance between dermatological and psychoactive medications. Such information is clinically relevant to the practicing dermatologist in order to minimize adverse effects and drug-drug interactions in dermatological patients. [ABSTRACT FROM AUTHOR]

The Asia Pacific Hidradenitis Suppurativa (APHiS) foundation: promoting hidradenitis suppurativa research in the Asia Pacific Dear Editor, Hidradenitis suppurativa (HS) is a global disease, but our understanding of pathogenesis is incomplete and largely based upon studies of Caucasian patients. To this end, the Asia Pacific Hidradenitis Suppurativa (APHiS) Foundation has been established as an education, research, and networking hub for HS patients, clinicians, and researchers across the Asia Pacific region (http://aphisfoundation.org). [Extracted from the article]

Epidermolysis bullosa with pyloric atresia is a form of junctional epidermolysis bullosa associated with gastrointestinal abnormalities, which may include pyloric atresia. Genotype phenotype correlation is poorly understood and prognosis is difficult, if not impossible, to predict. Immunoflourescence mapping is an ideal candidate for developing a broad prognostic indicator for epidermolysis bullosa with pyloric atresia without the need for genetic mutation analysis. However, the tool developed in this paper does have limitations due to the small number of cases available and the effects of deleterious mutations in highly conserved cysteine residues on the predicted length of survival. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the importance of recognising hidradenitis suppurativa as a systemic autoinflammatory disease.

A letter to the editor is presented regarding the case of a 29-year-old man who was diagnosed with parakeratosis associated with adalimumab.

The article analyses how phenotypic heterogeneity expresses heterogeneous pathogenic pathways in hidradenitis suppurativa (HS). Topics discussed include HS as an autoinflammatory disease with dysregulation of the Notch pathway, comorbidities including insulin resistance and glucose intolerance, and association between metabolic syndrome and HS.

The article presents a case study of a 36-year-old man who has developed cercarial dermatitis and was presented in dermatology department with intensely pruritic papular eruption on the dorsum of his feet associated with swelling. Topics discussed include the administration of intravenous cefazolin, the histopathological diagnosis which reveals dermal oedema and epidermal spongiosis, and efficacy of the treatment through oral prednisolone.

The article presents a case study of three aged 21-24 men who were presented to the dermatology clinic with pruritic erythematosquamous papules resulting into plaque within the recent tattoo for two weeks. Topics mentioned include the tattoos were made in Thailand, the perform of skin biopsies which showed Mycobacterium mucogenicum and fortuitum, and the commence of the antibiotic therapy with intravenous amikacin and oral clarithromycin. It also dicussed mycobacterial infection.

The article discusses a real-world cohort analysis that quantifies the time to medical and surgical therapy after the diagnosis of hidradenitis suppurativa (HS) and pilonidal sinus disease (PSD). The study found that individuals with HS were more likely to receive biologics, while those with PSD were more likely to undergo surgical intervention. The results suggest the benefits of early biologic intervention and the integration of these findings into guidelines and models of care. Further research is needed to establish the efficacy of biologic therapy in PSD, especially when combined with surgical therapy. [Extracted from the article]