Multidisciplinary Update on Genital Hidradenitis Suppurativa: A Review.

Importance: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a predilection for the genital region. Genital HS requires medical and surgical management as well as close collaboration among a multidisciplinary team. Observations: Hidradenitis suppurativa is a disease of the hair follicles that results in recurrent nodules, abscesses, and tunneling sinus tracts. Medical treatment mainstays include antibiotics and retinoids, but the evolving class of biologic medications has gained traction in the treatment of moderate and severe disease. Many of the medical therapies come with adverse effects requiring clinical and laboratory monitoring over the course of treatment. When lesions are refractory to therapy or are too large for medical therapy alone, surgical intervention is required. Surgical procedures can include treatment of affected areas with deroofing or excision of affected skin. When large portions of genital skin are removed, reconstruction is necessary to restore function and aesthetics of the genitals. We describe a variety of reconstructive techniques based on the size and location of the skin deficiency. Conclusions and Relevance: Effective management of genital hidradenitis suppurativa requires a thorough understanding of medical and surgical techniques for prevention, treatment, and reconstruction of genital defects.

Obesity and altered glucose metabolism impact HDL composition in CETP transgenic mice: a role for ovarian hormones.

Mechanisms underlying changes in HDL composition caused by obesity are poorly defined, partly because mice lack expression of cholesteryl ester transfer protein (CETP), which shuttles triglyceride and cholesteryl ester between lipoproteins. Because menopause is associated with weight gain, altered glucose metabolism, and changes in HDL, we tested the effect of feeding a high-fat diet (HFD) and ovariectomy (OVX) on glucose metabolism and HDL composition in CETP transgenic mice. After OVX, female CETP-expressing mice had accelerated weight gain with HFD-feeding and impaired glucose tolerance by hyperglycemic clamp techniques, compared with OVX mice fed a low-fat diet (LFD). Sham-operated mice (SHAM) did not show HFD-induced weight gain and had less glucose intolerance than OVX mice. Using shotgun HDL proteomics, HFD-feeding in OVX mice had a large effect on HDL composition, including increased levels of apoA2, apoA4, apoC2, and apoC3, proteins involved in TG metabolism. These changes were associated with decreased hepatic expression of SR-B1, ABCA1, and LDL receptor, proteins involved in modulating the lipid content of HDL. In SHAM mice, there were minimal changes in HDL composition with HFD feeding. These studies suggest that the absence of ovarian hormones negatively influences the response to high-fat feeding in terms of glucose tolerance and HDL composition. CETP-expressing mice may represent a useful model to define how metabolic changes affect HDL composition and function.