Remission of hidradenitis suppurativa after bariatric surgery

Gallagher, Catriona; Kirthi, Shivashini; Burke, Teresa; O’Shea, Donal; Tobin, Anne-Marie

doi:10.1016/j.jdcr.2017.06.008

Cited by 22 publications

(26 citation statements)

References 8 publications

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“…However, the causation between disease and systemic inflammation is still a topic of contention. 64 Guidelines 65,66 and clinical evidence 67,68 suggest weight loss, smoking cessation, and dietary counseling as an integral part of hidradenitis suppurativa management 65,66 through suppression of inflammation. [69][70][71] Smoking, via polycyclic aromatic hydrocarbons, can directly alter follicular keratinocyte differentiation, resulting in comedogenesis.…”

Section: Disease Initiation Is Associated With Systemic Subclinical Imentioning

confidence: 99%

Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence

Frew

2020

JAAD International

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The pathogenic model of hidradenitis suppurativa is in the midst of a paradigm shift away from a disorder of primary follicular occlusion to an autoinflammatory keratinization disease. Observational, experimental, and therapeutic evidence supports the concept of hidradenitis suppurativa as a primarily inflammatory disorder, a disorder of autoimmunity, or both, in contrast to the current prevailing paradigm of primary follicular occlusion. The lack of reliable and high-fidelity disease models has limited the available experimental and mechanistic evidence to support or refute one pathogenic model over another. This scholarly review synthesizes the existing clinical, histologic, and molecular data to evaluate the extant evidence supporting the autoinflammatory paradigm and further informing the molecular mechanisms of hidradenitis suppurativa pathogenesis. Follicular hyperkeratosis/occlusion and perifollicular inflammation coexist in histologic specimens, with interleukin 1a demonstrated to stimulate comedogenesis in the infundibulum. pH elevation in occluded body sites alters the microbiome and amplifies existing T-helper cell type 17 immunoresponses. Known metabolic comorbidities and smoking are known to upregulate interleukin 1a in follicular keratinocytes. Identified genetic variants may alter epidermal growth factor receptor signaling, leading to upregulated keratinocyte inflammatory responses. The process of follicular rupture and dermal tunnel formation can be explained as secondary responses to inflammatory activation of fibroblasts and epithelial-mesenchymal transition, with antibody production associated with inflammatory amplification in advanced disease. This review aims to reevaluate and integrate the current clinical, histologic, and molecular data into a pathogenic model of hidradenitis suppurativa. This is essential to advance our understanding of the disease and identify novel therapeutic targets and approaches.

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Section: Disease Initiation Is Associated With Systemic Subclinical Imentioning

confidence: 99%

Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence

Frew

2020

JAAD International

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“…involving questionnaires distributed to patients who had undergone bariatric surgery 2 years prior found that ≥15% weight reduction was associated with a significant reduction in HS disease severity. Other studies have demonstrated that weight reduction after bariatric surgery resulted in decreased severity of HS as well …”

Section: Obesity and Metabolic Syndromementioning

confidence: 94%

Diet in hidradenitis suppurativa: a review of published and lay literature

Silfvast‐Kaiser

Youssef²,

Paek

2019

Int J Dermatology

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Hidradenitis suppurativa (HS) is a chronic, recurring, inflammatory skin disorder resulting in skin abscesses and sinus tracts of the skin folds. Hidradenitis suppurativa remains a disease with limited treatment options. Management of disease activity with dietary modification has been of considerable interest to the HS patient community. Limited evidence exists to support dietary changes for treatment of HS. Strategies such as eliminating dairy products, limiting simple carbohydrate and sugar intake, and avoiding nightshades (Solanaceae) and foods containing brewer's yeast have been reported to be helpful in some patients. Several supplements have also been touted as beneficial. Herein, we review the existing dietary recommendations in both peer-reviewed and lay literature in an attempt to consolidate and evaluate existing information, while stimulating further inquiry into the role of diet in HS. Although dietary modifications are often of considerable interest to HS patients, there is a paucity of data regarding diet as it relates to HS. It is unclear whether diet may prove to be of value in limiting the severity of HS. Further research is needed to determine the potential benefits of these dietary changes.

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“…7 Several case reports have demonstrated symptom improvement and even disease remission in HS patients who achieved large weight reduction following bariatric surgery. 8,9 Overall, obesity is the most frequently observed component of the MetS. 10 A 2015 study found that HS was significantly associated with each individual component of MetS, including obesity (OR 1.71; 95%CI 1.53-1.91), diabetes (OR 1.41; 95%CI 1.19-1.66), hyperlipidemia (OR 1.14; 95%CI 1.02-1.28), and hypertension (OR 1.19; 95%CI 1.03-1.38) when compared to controls.…”

Section: Introductionmentioning

confidence: 99%

Weight Gain Over Time in Hidradenitis Suppurativa Patients: Trends and Implications

et al. 2020

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Background: Hidradenitis suppurativa (HS) is often seen in overweight and obese patients. However, little is documented about weight gain over time in HS patients.Methods: From August 2009 to March 2018, all patients in the UCLA HS clinic were asked at initial examination about their weight gain since high school.Results: A cohort of 143 HS patients were found to have a significant mean BMI increase of 4.7 (25.5 to 30.2, p<0.0001) from high school until time of presentation (approximately a 15-year interval). Of the patients with ≥10 point BMI increase, 85.2% were women. 59.6% of women were normal weight in high school with an average BMI of 24.8 (SD 6.41, range 14-50) and 78.7% were overweight or obese at time of HS clinic intake. Hispanic HS patients were found to have more weight gain than other ethnic groups, (p=0.09) which may be clinically significant.Conclusions: Although many HS patients were normal weight or mildly overweight in high school, most become obese in early adulthood. Since obesity is thought to increase HS severity, weight management should be stressed in HS patients early on before weight gain occurs.

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Remission of hidradenitis suppurativa after bariatric surgery

Cited by 22 publications

References 8 publications

Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence

Hidradenitis suppurativa is an autoinflammatory keratinization disease: A review of the clinical, histologic, and molecular evidence

Diet in hidradenitis suppurativa: a review of published and lay literature

Weight Gain Over Time in Hidradenitis Suppurativa Patients: Trends and Implications

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