Carlos Cuenca-Barrales

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the pilosebaceous units, particularly in large skin folds. The pathophysiology of HS is multifactorial, with evidence suggesting that the microbiome plays a crucial role in perpetuating inflammation. The persistent nature of HS tunnels, coupled with potential dysbiosis in these lesions, may help explain the recurrent episodes of HS, even with systemic treatment. To explore this further, a literature search was conducted on June 20, 2024. A total of eight studies, involving 418 patients, 632 HS lesions, 360 HS tunnels, and 300 controls, were included. The findings from these studies suggested that HS tunnels are characterized by a polymicrobial microbiome, predominantly dominated by anaerobic bacteria such as Porphyromonas , Parvimonas , Fusobacterium , and Prevotella . In contrast, HS tunnels exhibit a notable reduction in saprophytic species like Cutibacterium acnes and Staphylococcus epidermidis , which are commonly found in healthy skin. Disease stage, as classified by the Hurley system, is the most significant factor influencing the microbiome composition of HS tunnels, with advanced lesions showing a greater presence of dysbiotic and pathogenic flora. Interestingly, no significant differences in bacterial colonization were observed based on variables such as sex, age, smoking status, body mass index (BMI), or anatomical location. Larger biofilms with active bacteria were found in tunnels and anaerobic regions of hair follicles. Overall, these results highlight the distinct polymicrobial, predominantly anaerobic bacterial flora of HS tunnels and the significant reduction in commensal bacteria typically found in healthy skin. This specific microbiome may help explain both the pathogenic characteristics and therapeutic challenges associated with HS tunnels.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease for which several phenotypic classifications have been proposed in recent years to optimize medical care. The aim of this study was to define a new classification of HS based on the anatomical distribution of lesions, serving as a tool for therapeutic decision‐making. Methods: This cross‐sectional study with consecutive sampling included patients attending their first medical consultation at the Hidradenitis Suppurativa Unit of Virgen de las Nieves University Hospital in Granada, Spain, between January 1, 2017, and March 1, 2024. Patients were classified into four groups based on the anatomical distribution of HS: Upper, Atypical, Lower, and Progressor HS. Sociodemographic variables, personal history, and HS‐related variables were collected. Results: A total of 557 patients were included, with a similar proportion of men and women. Patients with the Upper type exhibited milder forms of HS and underwent surgical treatment more frequently. In contrast, those with the Progressor type presented more severe forms of HS and required more immunomodulatory treatment. Patients in the Atypical and Lower groups showed more heterogeneity in therapeutic approaches, although the presence of lesions in specific locations may help predict the need for early initiation of more aggressive treatments. Conclusions: We propose a new HS classification based on the location of lesions. This classification can be used alone or in conjunction with previous ones to identify patients at higher risk of progression and to guide therapeutic decision‐making.

Introduction: Therapeutic burden (TB) has been identified as a potential predictor of response to biologic therapy in hidradenitis suppurativa (HS). We aim to analyze the determinants of TB in real‐world clinical settings among HS patients to explain this concept and its utility as an additional tool for guiding therapeutic decision‐making.Methods: We conducted a cross‐sectional study including all consecutive HS patients attending a specialized HS clinic between 2017 and 2024. The primary variable was TB, defined as the cumulative sum of prior systemic treatment cycles and surgical interventions for HS. We analyzed whether sociodemographic or clinical factors were associated with a higher TB.Results: We included 557 HS patients. Of these, 50.81% were women, and the mean age was 41.87 (14.19) years. Most patients (62.30%) were referred from general dermatology consultations. The mean disease duration was 17.52 (11.51) years. Regarding disease severity, 46.50% presented with Hurley II, and 42.19% had an IHS‐4 score between 4 and 10. Before their baseline visit, 9.70% of patients had received biological therapy, mostly adalimumab (88.89%). The mean TB was 2.42 (2.25) systemic medical and/or surgical interventions. Referral from general dermatology or other hospital departments, older age, longer disease duration, greater HS severity, presence of pilonidal sinus, and prior biological therapy were significantly associated with higher TB.Conclusions: Our findings suggest that TB comprehensively captures HS severity and progression factors. This metric could prove valuable in aiding decision‐making for HS patients by indicating when a change in therapy might be necessary.

In this original research, we present the results in terms of effectiveness and safety of bimekizumab for hidradenitis suppurativa in real clinical practice. Results indicated significant improvement in all activity scores and patient‐reported outcomes at week 16, including a notable decrease in mean IHS4 from 27.1 to 15.6 (p < 0.001), HS‐PGA from 5.1 to 3.2 (p < 0.001), VAS pain from 8.3 to 4.7 (p < 0.001) and DLQI from 21.6 to 12.6 (p < 0.001). Bimekizumab, administered every 2 or 4 weeks, was well‐tolerated with no discontinuations and no new safety concerns identified. These findings corroborate the drug's effectiveness and favourable safety profile observed in phase 3 clinical trials, supporting its use in real‐world clinical practice for treating HS.

Introducion The concept of a window of opportunity in hidradenitis suppurativa (HS) management suggests that early initiation of biological therapy leads to better outcomes, though its timing remains uncertain. Methods We conducted a retrospective observational multicenter study, including consecutive patients with moderate to severe HS who initiated secukinumab treatment following prior failure with systemic antibiotics or adalimumab. Therapeutic burden was defined as the sum of previous systemic treatment cycles and previous major surgical interventions for HS. Patients were followed up for 24 weeks. Main outcomes were safety and effectiveness, assessed through the proportion of patients achieving HS Clinical Response (HiSCR) and a 55% reduction in International HS Severity Score System (IHS4-55). Additionally, potential predictors of response to secukinumab were studied. Analysis was performed on an intention-to-treat basis. Results A total of 67 patients (33 men, 34 women) were included, with a mean age of 41.55 (11.94) years and a mean baseline IHS4 of 17.88 (11.13). The mean therapeutic burden was 6.06 (3.49). At week 24, 10.45% (7/67) of patients experienced adverse events, with three leading to treatment discontinuation. At week 24, 41.79% (28/67) of patients achieved HiSCR, and 44.78% (30/67) of patients achieved IHS4-55. HiSCR could not be calculated in 12 patients with a baseline AN count < 3. A lower therapeutic burden was significantly associated with a higher likelihood of achieving HiSCR and IHS4-55 at week 24. Conclusions Secukinumab showed safety and efficacy in real-world patients with HS, and the inverse correlation found between therapeutic burden and treatment response supports the concept of a window of opportunity, offering insights into its timing.

Introduction The recurrent nature of hidradenitis suppurativa (HS), even under maintained systemic treatment, makes it necessary to have effective local treatments; however, the response to these therapies is variable (44–81%). The application of galvanic current (GC) has demonstrated its utility in humans in treating lesions structurally similar to those of HS. With this background, the main objective of this study was to evaluate the efficacy and safety of ultrasound-guided percutaneous GC in inflamed and/or draining tunnels of HS. Methods This was an open study (one-way repeated measures design over time). Patients were evaluated at 4 and 12 weeks after receiving GC. A combined clinical response at week 12 (absence of suppuration/inflammation on examination and clinical interview) was considered the principal variable of efficacy. Adverse effects potentially associated with GC were reported by telephone and at each visit. Results Twenty-six patients were included, with a male/female ratio of 5:8. The mean age was 35.84 (13.14) years. At 12 weeks after the administration of GC, a complete response was achieved in 77% (20/26) of the treated lesions. No serious adverse effects were observed, and the mean procedural pain assessed by the numeric rating scale was 0.03 (0.2). Conclusion GC has proven to be effective and well tolerated in inflamed and draining tunnels of patients with HS.

Hidradenitis suppurativa (HS) is a chronic skin disease that profoundly affects patients’ quality of life (QoL) and sexuality. Few data are available on the impact of HS on patients’ partners. We aimed to explore the QoL and sexual function of patients’ partners and the factors associated with their impairment and to compare the QoL and sexual function of single patients and those in a stable relationship. We conducted a cross-sectional study at Hospital Universitario Virgen de las Nieves (Granada, Spain) and at the Wroclaw Medical University (Wroclaw, Poland). Patients over the age of 16 years attending their scheduled follow-up and their partners, if any, were included. The Dermatology Life Quality Index (DLQI) and the Family Dermatology Life Quality Index (FDLQI) were used to estimate the QoL of patients and partners, respectively. The FSFI-6 was used to determine sexual dysfunction in women and the IIEF-5 for erectile dysfunction in men. Thirty-four single patients and twenty-eight patients in a stable relationship and their partners were included. Patients had a very large impact (DLQI 12.5 ± 7.5) and their partners a moderate impact (FDLQI 10.3 ± 7.1) in their QoL due to HS. Women with HS had a high prevalence of sexual dysfunction (13/32, 40.6%) and men of erectile dysfunction (19/30, 63.3%). Male partners also had a high prevalence of erectile dysfunction (10/17, 58.8%), while only one female partner had sexual dysfunction (1/11, 9.1%). Factors related to disease severity, intensity of symptoms and body mass index were associated with poorer QoL in partners and time of disease evolution with greater erectile dysfunction in male partners. In conclusion, HS not only profoundly affects the QoL and sexuality of patients but also of their partners. Several risk factors have been identified, which should be taken into account in the holistic approach of the disease.

IntroductionDistressed personality (or Type D personality, TDp) is a personality trait that has been associated with poor quality of life in patients suffering from a variety of skin diseases such as psoriasis or urticaria. To date the potential association between Alopecia areata (AA) and TDp has not been studied. The aim of this study was to compare the prevalence of TDp between patients with AA and controls, and to analyse the impact of TDp on patients with AA regarding mood status disturbances, quality of life and sexuality. MethodsCross-sectional study includes patients suffering from mild-to-severe AA and sex- and age-matched healthy controls. Socio-demographic and clinical variables, quality of life, sexual disfunction, anxiety, depression and TDp were collected using validated questionnaires. ResultsA total of 120 participants (60 patients and 60 controls) were included. Patients with AA showed higher prevalence of TDp than controls (35% vs. 15% p = 0.01), as well as higher rates of anxiety, depression and sexual dysfunction (p < 0.05). TDp was found to be linked to disease severity (p = 0.04), anxiety and depression scores (p < 0.001) and worse quality of life (p = 0.001). No relationship was found between TDp and sexual dysfunction. DiscussionType D personality prevalence is higher in patients with AA than in controls. It is associated with higher rates of anxiety, depression and worse quality of life. Screening for this type of personality could be useful to detect patients who could benefit from additional psychological support as a complement to their medical treatment.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle that has previously been associated with a higher cardiovascular risk (CVR). Although different methods have been described for CVR stratification in HS, there is little evidence about the role of hemogram indexes in CVR in HS. Given its potential convenience, the aim of this study was to assess the role of the hemogram indexes systemic immune-inflammation index (SII) and neutrophil-lymphocyte ratio (NLR) in CVR stratification for patients with HS. A cross-sectional study was performed to assess the role of SII and NLR in CVR stratification in patients with moderate to severe HS who were candidates for biologic therapy. SII, NLR, carotid intima-media thickness, and other clinical and biochemical CVR factors were assessed before the start of the treatment. Fifty patients were included. The male:female ratio was 3:2, and the mean International Hidradenitis Suppurativa Severity Score System score was 21.6. After multivariate analysis, SII correlated with higher values of systolic blood pressure, metabolic syndrome, and higher risk of insulin resistance (p < 0.05). NLR was associated with insulin resistance (p < 0.05). These associations were independent of age, sex, body mass index, severity of the disease, and tobacco consumption. The implementation of SII and NLR in daily practice may be of benefit for identifying patients with HS at higher risk of high blood pressure, insulin resistance, or metabolic syndrome. Since these indexes are simple to calculate, they could be used as a screening tool in HS-specific units.