CLINICAL REPORT
493 ActaDV ActaDV Advances in dermatology and venereology Acta Dermato-Venereologica
Bacterial Colonization in Hidradenitis Suppurativa / Acne Inversa: A Cross-sectional Study of 50 Patients and Review of the Literature
Georgios NIKOLAKIS 1 #, Aikaterini I. LIAKOU 1 #, Stefanos BONOVAS 2, Holger SELTMANN 1, Nikolaos BONITSIS 1, Olivier JOIN-LAMBERT 3 – 6, Thomas WILD 1, 7, Ioannis KARAGIANNIDIS 1, Silvia ZOLKE-FISCHER 8, Klaus LANGNER 8 and Christos C.
ZOUBOULIS 1 1
Departments of Dermatology, Venereology, Allergology and Immunology and 8 Institute for Clinical Chemistry and Microbiology, Dessau Medical Center, Dessau, Germany, 2 Humanitas Clinical and Research Center, Milan, Italy, 3 Université Paris Descartes, Sorbonne Paris Cité,
4
Inserm U1151, équipe 11“ Physiopathologie des infections systémiques”, 5 Institut Pasteur, Centre Médical, Service de Pathologie Infectieuse et Tropicale, 6 Centre d’ Infectiologie Necker-Pasteur, Paris, France, and 7 Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg, Hamburg, Germany
#
These authors contributed equally to the study.
It is unclear whether bacterial colonization in hidradenitis suppurativa / acne inversa( HS) comprises a primary cause, triggering factor or secondary phenomenon of the disease pathogenesis. Furthermore, the connection between certain bacterial species, the disease severity and its localization is unknown. Bacterial species were isolated from HS lesions to reveal a potential correlation with localization and disease severity. Ninety swab tests were prospectively obtained from 90 HS lesions of 50 consecutive patients. The material was cultured under aerobic and anaerobic conditions. The identified species were statistically correlated with Hurley stage and localization of the lesions. The most prevalent isolates were reported. Hurley stage significantly correlated with disease localization. Particular bacterial species were associated with“ extended” disease and Hurley III stage with the detection of both aerobic and anaerobic bacteria and with a higher number of species. The presence of bacterial species is dependent on the local milieu, which correlates with the localization of the disease, its clinical manifestations and its extension.
Key words: hidradenitis suppurativa; acne inversa; bacteria; aerobic; anaerobic; microbial colonization; Hurley stage.
Accepted Nov 23, 2016; Epub ahead of print Nov 24, 2016 Acta Derm Venereol 2017; 97: 493 – 498.
Corr: Christos C. Zouboulis, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, DE- 06847 Dessau, Germany. E-mail: christos. zouboulis @ klinikum-dessau. de
Hidradenitis suppurativa / acne inversa( HS) is a chronic, inflammatory, recurrent, debilitating disease of the terminal hair follicles that usually manifests after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal and anogenital regions( Dessau definition, 1 st International Conference on hidradenitis suppurativa, 30 March – 1 April 2006, Dessau, Germany)( 1). The pathogenesis of the disease is probably multifactorial. Genetic predisposition, cellular and immunological agents, nutrition, adipositas and smoking are among the suspected factors( 2).
Bacterial colonization in HS, both aerobic and anaerobic, has only been sporadically investigated in recent years( 3, 4). Despite recent analysis of the skin microbiome( 5), there is no evidence as to how bacteria could be involved in HS pathogenesis and lesion development( 6).
In 1999, Brook & Frazier( 7) reported the isolation of aerobic and anaerobic bacteria from lesions of 17 patients with HS, claiming a possible involvement of bacteria in the occurrence of the disease. However, the study included only axillary lesions. Staphylococci and streptococci, peptostreptococci, Prevotella, Fusobacterium and Bacteroides spp. were the majority of the isolated aerobic and anaerobic bacteria( 7). In a study performed on skin cysts and abscesses without strict association with HS a strong involvement of staphylococci and streptococci, but also of Peptostreptococcus and Prevotella spp, was identified( 8).
Recently, samples of 10 patients with HS before and after treatment with carbon dioxide laser revealed coagulase-negative staphylococci, Corynebacterium spp. and alpha-haemolytic streptococci were detected at various levels among the aerobic bacteria( 8), whereas Grampositive cocci were the most common species in another study( 9). From the microbiologist’ s point of view, HS was reported as a bacterial biofilm disease, with staphylococci and streptococci being the most prevalent bacteria( 10).
In the current study, swab tests were obtained from HS lesions( axillae, inguinofemoral, submammary as well as gluteal region and, in individual cases, from the scalp, head and neck as well as the periumbilical region / lower abdomen) of a consecutive series of 50 patients in a prospective manner. The collected material was cultured under both aerobic and anaerobic conditions and the results show the colonization of aerobic and anaerobic bacteria into HS lesions.
The primary aim of this study was to elucidate a potential correlation between certain bacterial families or species with the disease localization and its severity. This information can secondarily lead to the discovery of connections between bacteria and HS manifestation patterns, as well the development of more effective therapeutic strategies.
This is an open access article under the CC BY-NC license. www. medicaljournals. se / acta Journal Compilation © 2017 Acta Dermato-Venereologica. doi: 10.2340 / 00015555-2591 Acta Derm Venereol 2017; 97: 493 – 498