Hidradenitis Suppurativa: Insights from pathogenesis to treatment
Hidradenitis suppurativa (HS) is an inflammatory disorder that is characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in the axilla, inguinal area, submammary folds, and perianal area. This disfiguring condition is accompanied by pain, embarrassment, and a significantly decreased quality of life. Although the mechanism of HS has not been entirely elucidated, lesion formation is believed to center around follicular hyperkeratosis within the pilosebaceous-apocrine unit. Recent research has provided new insight into the role of cytokines in the pathogenesis of HS, helping close some existing knowledge gaps in the development of this condition. Immune cells and keratinocyte-mediated products are widely accepted as key players in HS pathogenesis. Indeed, both pro-inflammatory (e.g., IL-1β, TNF-α, IL-23, and IL-17) and anti-inflammatory cytokines (e.g., IL-10) are found to be increased in HS lesional and perilesional skin. The identification of predictive biomarkers of therapeutic response is one of the greatest challenges of modern medicine, particularly in a pathology as HS with a high percentage of therapeutic failures. Although several studies have shown that anti-TNF-α agents clinically reduce the disease activity in HS, the efficacy of these agents is inconstant in some cases. Identifying predictive markers of response is, thus, of strong interest. Several small molecules and biologics are under investigation, for moderate-to-severe HS therapy. With phase III trials ongoing, the anti-IL-17 agents bimekizumab (which blocks IL-17 A and F) and secukinumab (which blocks IL17A) are in the most advanced stage of clinical development showing promising results, based on the extensive evidence of the activation and upregulation of the IL-17 pathway in HS inflammation. Other molecules and biologics are under investigation such as jak inhibitors and IL-23 drugs. New studies are needed to identify biomarkers. The Article Collection entitled: “Hidradenitis Suppurativa: Insights from pathogenesis to treatment” aims to bring together the most important recent findings on pathogenesis and treatments for this disease.
Guest advisors
Fabrizio Martora(University of Naples, Italy)
Matteo Megna(University of Naples, Italy)
Luca Potestio(University of Naples, Italy)