Normal Skin Microbiota is Altered in Pre-clinical Hidradenitis Suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined by recurrent nodules, tunnels (sinus tracts) and scarring involving the intertriginous regions. The clinical course of HS is compatible with a biofilm-driven disease, and biofilm has been described in lesional HS skin. We therefore hypothesized that clinically unaffected HS skin would also have an increased presence of biofilm compared with that of healthy controls. We conducted a case-control study, investigating the morphology of the axillary skin microbiota. Peptide nucleic acid - fluorescence in situ hybridization probes were used in combination with confocal laser scanning microscopy. Significant differences were found in both distribution and quantity of the cutaneous microbiota in clinically non-affected axillary skin of patients with HS compared with healthy controls. Surprisingly, we detected fewer bacteria and less biofilm in patients with HS. The reduced microbiota in patients with HS may play an important role in the early course of the disease.

The microbiome of tunnels in hidradenitis suppurativa patients

“…As previously suggested, this lack of Propionibacterium spp. may potentially provide a cutaneous dysbiosis in the early stages of the pathogenesis in HS . The potential reduced number of sebaceous glands and subsequent reduced secretion of sebum in intertriginous HS regions may potentially lead to a shift in the local microbial community of hair follicles .…”

Burden, predictors and temporal relationships of comorbidities in patients with hidradenitis suppurativa: a hospital‐based cohort study

“…Studies report prevalence rates of HS from 1% to 4% in European populations, with females more frequently affected than males . Although the pathogenesis remains enigmatic, studies have suggested the combination of occlusion of the hair follicles and a dysfunctional immune response leading to chronic inflammation, with a presumed contribution of the intertriginous bacterial microbiome …”

Biofilm production and antibiotic susceptibility of Staphylococcus epidermidis strains from Hidradenitis Suppurativa lesions

“…Microbiological studies in HS patients have shown primarily skin or intestinal (especially in the anogenital area), anaerobic commensals in lesional HS tissue . Data suggest a shift in microbiota from preclinical paucity to an abundance in chronic lesions . An aberrant interaction between the commensal skin bacteria and the skin immune system has been suggested to play a role in HS.…”

“…Hidradenitis Suppurativa (HS) is a chronic, debilitating skin disease characterized by recurrent abscesses, nodules, sinuses and scarring involving the intertriginous areas of the body . Although HS is not considered to be a simple infection, bacteria are thought to play a role in the pathogenesis and an aberrant interaction of commensal skin bacteria with the innate skin immune system in patients with HS has been suggested as a central element of the pathogenesis of the disease . This implies that both immune system and the commensal flora of HS patients may have functional characteristics which influence the pathogenesis of HS.…”

“…The chronic and recurrent course of HS, the slow wound healing process and the relative resistance towards conventional antibiotic therapy are compatible with a pathogenic role for biofilms in HS . In contrast to HS‐prone skin where biofilm appears to be absent, the presence of biofilm in chronic HS lesions has recently been described …”