Tumour Necrosis Factor-alpha and Matrix Metalloproteinase-2 are Expressed Strongly in Hidradenitis Suppurativa

Abstract

Hidradenitis suppurativa is a chronic skin condition, characterized clinically by painful, recurrent, deep- seated nodules and suppuration, and histologically by hyper-trophic scarring of apocrine gland bearing skin and sinus tracts. The overall consequence of the disease is considerable tissue remodelling and the underlying alterations in innate immunity are poorly understood. The aim of this study was to evaluate the expression of human beta-defensin 2, tumour necrosis factor (TNF)-α and matrix metalloproteinase-2 in skin lesions of patients with hidradenitis suppurativa. A total of 14 skin samples from patients and 2 skin samples from healthy volunteers were evaluated by immunohistochemistry. Human beta-defensin 2 was negative in 12/14 specimens. Elevated expression of metalloproteinase-2 was observed in keratinocytes, fibroblasts and inflammatory cells in dermis, sweat glands, hair follicles and sinus tracts, suggesting a key role for hidradenitis suppurativa pathogenesis. Decreased human beta-defensin 2 in the presence of inflammatory (TNF-α-containing) cells suggests a decreased innate immunity in hidradenitis suppurativa-affected skin.

Use of biological treatments in patients with hidradenitis suppurativa

“…Serum TNF-alpha levels are higher in patients with HS when compared with healthy controls 11 as well as levels in lesional and perilesional skin. 12,13 In our series, biological drugs are indicated in cases of severe disease. The definition of severe HS includes: high Hurley stage, multiple lesions, severe pain and concomitant comorbidities.…”

South Italy: A Privileged Perspective to Understand the Relationship between Hidradenitis Suppurativa and Overweight/Obesity

“…TNF-α is a pro-inflammatory cytokine that plays an important role in the control of lipid metabolism and interferes with the signaling of insulin, whose circulating levels are increased with obesity and decreased with weight loss. An increase in TNF-α in skin lesions of patients with HS has been demonstrated and suggests a key role of this cytokine in the pathogenesis of HS [7]. …”

Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review

“…In this context, TNF-α is considered as one of the major actors in TLR-activated innate immunity in HS. Indeed, its overexpression has been observed in lesional and perilesional skin of HS together with a positive correlation with disease severity, providing a rationale for HS treatment with biologic drugs such as inhibitors of TNF-α [48,49] whose use, particularly adalimumab, has been shown to suppress the overexpression of most of the upregulated cytokines in HS such as IL-1β, CXCL9, B-lymphocyte chemoattractant, as well as the number of inflammatory CD11c+ DCs in HS lesional skin [41]. Hence, it is clear that HS is a follicular disease showing some defect in keratin clearance with resultant follicular occlusion, where defective innate cellular immunity plays an important role [24,44].…”