Haematoxylin and eosin staining identifies medium to large bacterial aggregates with a reliable specificity: A comparative analysis of follicular bacterial aggregates in axillary biopsies using peptide nucleic acid-fluorescence in situ hybridization and haematoxylin and eosin staining.

Although peptide nucleic acid (PNA), fluorescence in situ hybridization (FISH) and confocal laser scanning microscopy (CLSM) are the reference tools in the study of bacterial aggregates/biofilms, it may also be rather time-consuming. This study aimed to investigate the sensitivity and specificity between bacterial aggregates identified by haematoxylin and eosin (HE) staining vs bacterial aggregates in corresponding PNA-FISH samples. Axillary biopsies were obtained in 24 healthy controls. HE-stained and PNA-FISH samples were investigated using traditional light microscopy and CLSM, respectively. The data demonstrate that HE staining identifies large bacterial aggregates (>10 µm) with a sensitivity of 0.43 and specificity of 1. The methods, however, are not equivalent as demonstrated by a McNemar's test (P=.04). Where bacterial aggregates >10 µm in diameter, HE staining may offer a rapid and practical low-cost tool to evaluate bacterial aggregates.

Serum Anticytokine Autoantibody Levels Are Not Increased in Hidradenitis Suppurativa: A Case-Control Pilot Study.

BACKGROUND: Hidradenitis suppurativa is a skin disease of recurrent episodes of inflammatory nodules, abscesses, and scarring of the intertriginous regions, e.g. the axillae and groin. A dysregulated immune response to one or more unknown antigens in hidradenitis suppurativa has been suggested. One hypothetical element of this dysregulation may be the functionality of the cytokines. This study examines the serum level of anticytokine autoantibodies for interleukin (IL)-1α, IL-6, IL-10, IL-17A, IL-17E, IL-17F, and interferon-α. METHOD: Recombinant, carrier-free cytokines were coupled to microspheres. The coupled beads were incubated for 1 h in the dark with assay buffer-diluted sera, and subsequently for 30 min with polyclonal goat F(ab')2 anti-human IgG phycoerythrin-conjugated antibody. Data are presented as the median fluorescence intensity of samples. RESULTS: No difference in levels of anticytokine autoantibodies was demonstrated for any of the autoantibodies studied. DISCUSSION: The data suggest that endogenously produced autoantibodies only play a minor role, if any, in hidradenitis suppurativa.

Hidradenitis suppurativa in a cohort of overweight and obese children and adolescents.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurring disease mainly observed in adults. Obesity is considered an important independent factor in HS development and is associated with a higher prevalence of HS in children. We aimed to characterize the clinical presentation of HS in overweight and obese children and adolescents. METHODS: We performed a cross-sectional observational study during January 2007-April 2015. Overweight and obese patients (5-17 years of age, BMI> 90th percentile) referred to The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Denmark, underwent screening for dermatological conditions. A dermatologist ascertained the diagnosis of HS, and disease severity was assessed using Hurley staging and Sartorius score. Tobacco smoke exposure, body mass index (BMI) standard deviation score (SDS), and psychiatric comorbidities were recorded. Our cohort was compared with a reference cohort recruited in a previous study. RESULTS: A total of 195 children and adolescents underwent screening for dermatological conditions. Nine patients screened positive, and six of these patients were available for examination of whom five presented with HS. All HS cases were mild (median Sartorius score of 9). Four of the five patients (with varying constellations) reported tobacco exposure, a positive family history of HS, and exhibited psychiatric comorbidities. CONCLUSION: Our findings support that the presence of pediatric HS is correlated with familial disposition to HS and psychiatric comorbidities.

Arguments for a national questionnaire-based screening for hidradenitis suppurativa in Denmark.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease. HS patients develop painful subcutaneous nodules, primarily in the intertriginous regions. Early diagnosis is crucial to initiate appropriate treatment, which may prevent disease progression. The cost of treatment increases with disease severity. Studies have found a considerable diagnostic delay in HS. Screening programs may reduce diagnostic delay and allow for better utilization of resources. METHODS: Arguments for implementing an HS screening program were explored based on the 10 WHO criteria for implementing screening programs. RESULTS: HS is an important health problem due to its prevalence and the adverse effects of the disease. Facilities for treatment and diagnosis exist, and the validated screening questionnaire is considered acceptable to the population. HS patients should be seen by a dermatologist and treated accordingly. Medical expenses increase with disease severity, and finding patients with early-stage HS is considered cost-effective. CONCLUSIONS: We consider a screening program as valuable for public healthcare. Patients can avoid extensive surgery or treatment with biologics if disease progression is prevented, and this will reduce medical expenses for the public healthcare system. Politicians should consider implementing a screening program for HS.

Investigational drugs in clinical trials for Hidradenitis Suppurativa.

INTRODUCTION: Hidradenitis suppurativa is a chronic skin disease with a significant unmet need for treatment options. Randomized controlled trials are few and only a single drug (adalimumab) has Hidradenitis as a registered indication. AREAS COVERED: The clinicaltrials.gov and the EudraCT clinical trials register for reported trials on Hidradenitis Suppurativa was searched on the 22-06-2017. Trials for upcoming new drugs for HS are reported focusing on drugs in phase I and II trials.The clinicaltrials.gov and the EudraCT clinical trials register for reported trials on Hidradenitis Suppurativa was searched on the 22-06-2017. Trials for upcoming new drugs for HS are reported focusing on drugs in phase I and II trials. EXPERT OPINION: Currently, MABp1, Secukinumab, CJM112, Apremilast and IFX-1 are being investigated in Phase I and II trials and offer theoretical and promising new treatment options. A trial with the drug MEDI8968 has been terminated with disappointing results. Metformin, Botulinum Toxin B, Provodine, Benzoyl Peroxide and intralesional triamcinolone are being tested as well. Treatment of Hidradenitis remains a challenge and quality RTCs are needed. Studies indicates a range of potential targets for therapy such as interleukin-1 and interleukin-17, but 'broad-spectrum' immunosuppressants like phosphodiesterase-4 inhibitors are being examined as well. A range of outcomes, including Physician Global Assessment, Sartorius scores and hidradenitis suppurativa clinical response are used in these trials, making future meta-analysis of the data difficult.

Validation of a Screening Questionnaire for Chronic Leg Ulcers.

The use of a validated screening questionnaire to identify individuals with chronic leg ulcers allows large-scale population-based studies to be conducted that measure and monitor the prevalence of the disease. The aim of this study was to design and validate such a screening questionnaire to identify patients with chronic leg ulcers. A simple 3-item questionnaire was developed at the Department of Dermatology, University Hospital of Zealand, Denmark. In total, 90 patients attending the department's outpatient clinic for dermatological diseases and chronic wounds were included in this study. All included participants completed the questionnaire and were subsequently examined by dermatologists. We found that the constructed 3-item questionnaire in this study had a sensitivity and specificity of 95% and 93% and a positive predictive value and negative predictive value of 78% and 95%, respectively. Moreover, we found that the use of the 3-item questionnaire, as compared with a single question, in which the participants were asked whether they currently have a leg ulcer, resulted in significantly higher positive predictive value (+11.6%, P = .035) and specificity (+5.6%, P = .046) of the diagnostic test. Future studies are merited to investigate the diagnostic accuracy of the questionnaire in other populations and settings.