Histologische, elektronenmikroskopische, immunhistologische und IR-spektroskopische Untersuchungen an der Haut 2000 Jahre alter Moorleichen

Haut- und Haarproben von Moorleichen wurden histologisch, elektronenmikroskopisch, immunhistologisch und IR-spektroskopisch untersucht. Histologisch konnten bei allen Hautproben die Kollagenbündel des Koriums nachgewiesen werden. Epidermis war nicht erhalten. Elektronenoptisch waren bei allen Moorleichen Kollagenfasern mit einem Durchmesser von 45 - 110 nm und der typischen Periodizität zu erkennen. Bakteriensporen mit einem Durchmesser von 0,83 $\pm$ 0,051 $\mu$m waren sichtbar. Keine der Hautproben zeigte eine Reaktivität mit den verwendeten Antikörpern. Spektroskopisch konnten Kollagen Typ-I und Typ-III in den Hautproben nachgewiesen werden. Anhand der IR-Spektren wurden äußerliche Veränderungen an Haut und Haaren der Moorleichen dokumentiert. Histologie, Elektronenmikroskopie und IR-Spektroskopie demonstrieren die guten Konservierungseigenschaften des Moores für den Kollagen-Anteil der Haut. Nur der äußere Teil von Haut und Haaren wurde durch Gerbungsprozesse verändert

Hidradenitis suppurativa/Acne inversa in der Genitoanalregion

Die Hidradenitis suppurativa/Acne inversa (HS/AI) ist eine chronisch rezidivierende inflammatorische Hauterkrankung. Erhebungen zeigen, dass bevorzugt Männer einen perianalen, perinealen und glutealen Befall aufweisen, wohingegen bei Frauen die Axillen sowie die submammäre und inguinale Region vermehrt betroffen sind. Der Befall der Genitoanalregion ist mit einer stärkeren Einschränkung der Lebensqualität und einer größeren Belastung der sexuellen Gesundheit assoziiert als andere Lokalisationen. Darüber hinaus kann die HS/AI in der Genitoanalregion zu schwerwiegenden Komplikationen führen. Die perianale Fistelbildung, das pubogenitale Lymphödem und das Plattenepithelkarzinom zählen zu den 3 schwersten Komplikationen, deren Kenntnis entscheidend für ein adäquates Therapiemanagement ist.Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease. Several studies showed that perianal, perineal and gluteal involvement is more common in men. Axillary, submammary and inguinal localizations seem to be more prevalent in women. Involvement of the genitoanal region is associated with a higher reduced quality of live and sexual health compared to other locations. Moreover HS/AI in the genitoanal region can lead to serious complications. The knowledge of perianal fistula formation, pubogenital lymphedema and squamous cell carcinoma, which are three of the most severe complications, is critical for adequate treatment

Multivariate analysis of prognostic factors in patients with nodular melanoma

$\bf Purpose$ Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients. $\bf Methods$ We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann–Whitney test, Chi-square test, Kaplan–Meier curves including the log-rank test, and logistic regression model. $\bf Results$ When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death. $\bf Conclusions$ We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression

Current medical and surgical treatment of hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed

The role of hormones in hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease manifesting in inverse body regions. In a systematic review, the role of hormones in HS will be presented to better understand the pathomechanisms of HS. The review is based on the PRISMA criteria. Systematic research was carried out using keywords. Subsequently, the data were analyzed based on the clinical response and other relevant information. The main focus of our systematic review was on HS manifestation, exacerbation, sex hormones, antiandrogen therapy, thyroid function, polycystic ovary syndrome, insulin resistance, and adipokines. In HS, there appears to be a dysregulated adipokine release that is shifted towards pro-inflammatory adipokines. Insulin resistance is significantly more common in HS than in healthy patients regardless of BMI, age, and gender. Insulin resistance in HS patients leads to further cardiovascular disease. The mechanism of insulin resistance and role of adipokines should be investigated in future studies to better provide the pathomechanisms of HS. The role of androgens seems to be important in a certain subgroup of female patients. Anti-androgenic therapy can be useful and helpful in some patients. However, further studies are needed to better understand the hormonal relationship in HS

Waiving subsequent complete lymph node dissection in melanoma patients with positive sentinel lymph node does not result in worse outcome on 20-year analysis

The aim of the present study was to investigate long-term outcomes of melanoma patients who had micrometastasis on sentinel lymph node (SLN) biopsy. We focused on the comparison between melanoma patients with and without complete lymph node dissection (CLND) following a positive SLN biopsy result. Patients without CLND did not significantly differ from patients with CLND in regard to age, gender, tumor thickness, tumor ulceration, capsule infiltration of SLN, and invasion level of SLN. On 10-year analysis, we did not observe a significantly increased risk for melanoma relapse or melanoma-specific death in patients who did not undergo CLND after the detection of micrometastases on SLN biopsy. On 20-year analysis, again, the patients without CLND had no significantly increased risk of melanoma relapse and worse melanoma-specific survival. Hence, our 10-year survival data confirm the current notion that waiving CLND in SLN-positive patients does not result in clinical disadvantages with respect to melanoma-specific survival. For the first time, we demonstrate on 20-year survival analysis that relapse rates and melanoma-specific survival does not significantly differ between patients with or without CLND on long-term follow-up

Microbial profile and antimicrobial susceptibility of bacteria found in inflammatory hidradenitis suppurativa lesions

$\textit {Background:}$ The role of bacterial colonization in hidradenitis suppurativa (HS) lesions is poorly understood. To date, data on the related microbial profile and especially on bacterial resistance rates are scarce. $\textit {Methods:}$ The results of bacterial cultures and susceptibility patterns of the isolated microorganisms obtained from deep portions of HS lesions from patients who underwent surgery at our HS Centre between 2010 and 2015 were retrospectively evaluated. $\textit {Results:}$ Analyses of 113 bacterial samples from 113 HS patients revealed bacterial growth in 95 samples (84.1%). Polymicrobial growth was found in 51 samples (45.1%). Coagulase-negative $\it staphylococci$ and $\textit {Staphylococcus aureus}$ were the most commonly isolated bacteria, followed by $\textit {Proteus mirabilis}$ and $\textit {Escherichia coli}$. Data on susceptibility testing were available for 68 samples, which yielded 129 isolates. The isolated strains were primarily resistant to penicillin G, followed by erythromycin, clindamycin and ampicillin. The highest effectiveness against isolates was observed for fosfomycin, imipenem, fluoroquinolones (moxifloxacin, ciprofloxacin, levofloxacin), and cotrimoxazole. $\textit {Conclusions:}$ Our findings on bacterial species and their topographical distribution revealed that the microbial flora in HS lesions reflects commensal flora of the skin. Due to the susceptibility rate and immunomodulatory and anti-inflammatory properties, cotrimoxazole may represent an alternative antibiotic agent and should be considered for therapy in HS patients

Primary thyroid dysfunction is prevalent in hidradenitis suppurativa and marked by a signature of Hhypothyroid graves’ disease

Hidradenitis suppurativa (HS) is a chronic skin disease that can have an association with endocrine disorders. There is conflicting information in the literature regarding the role of the thyroid gland in HS. This study aimed to close this knowledge gap and investigate how thyroid disease is involved in patients with HS. We carried out a case–control study with a total of 160 patients, of whom 108 were patients with HS and 52 were controls matched for age and sex. Parametric and non-parametric methods were used to analyze the results. We calculated structural parameters of thyroid homeostasis to detect subclinical thyroid disease, non-thyroid disease syndrome and other forms. The severity of HS was not associated with thyroid hormone levels and antibodies ($\it p$ > 0.05). HS patients with or without hypothyroidism had decreased FT4 levels and a decreased thyroid secretory capacity (SPINA-GT). Titers of TSH receptor autoantibodies (TRAb) were significantly higher in smoking HS patients compared to non-smokers (median: 1.18 vs. 1.08; $\it p$ = 0.042). The rate of subclinical hypothyroidism was significantly higher in HS patients; thus, subclinical hypothyroidism is an important comorbidity of HS ($\it p$ < 0.05). Further studies are needed to investigate whether the chronic inflammation of HS is a cause of increased rates of (subclinical) hypothyroidism

Increased expression profile of NCSTN, Notch and PI3K/AKT3 in hidradenitis suppurativa

$\bf Background$ In a small number of kindreds with familial hidradenitis suppurativa (HS) different mutations of NCSTN (nicastrin) have been identified. Blocking of NCSTN leads to impairment of the Notch and PI3K/AKT signalling pathway, which is assumed to play a pathogenic role in HS. However, very limited data are available concerning expression levels of these pathway components in HS skin. $\bf Objectives$ To analyse the mRNA and protein expression of NCSTN, Notch1–3, PIK3R3 and AKT3 in HS. $\bf Methods$ Skin samples from healthy controls, lesional and perilesional skin of HS patients with and without a positive family history were analysed by quantitative real-time RT-PCR and immunohistochemistry. Univariate statistical analyses were conducted regarding association between expression levels and patient's characteristics. $\bf Results$ Expression levels of all investigated genes showed significantly higher levels in lesional HS skin compared with healthy controls. Univariate analysis showed no association between a positive family history and mRNA expression levels. Perilesional HS skin of patients with mild disease severity (Hurley I) showed significant higher mRNA expression levels of the investigated pathway components compared to moderate (Hurley II) and severe disease (Hurley III). $\bf Conclusion$ We found no evidence for diminished expression levels of the Notch signalling. In contrast, the NCSTN, Notch and PI3K/AKT signalling components are overexpressed in HS. Future research is needed to investigate a possible pathogenetic role or to reveal a coactivation of these overexpressed components during inflammatory response in HS