Hidradenitis suppurativa still a hot topic

<p class="article-intro">The 6^th Conference of the European Hidradenitis Suppurativa Foundation (EHSF) was held in Copenhagen from February 8^th to 10^th 2017. In the course of the two days, participants from 28 countries presented a total of 75 scientific communications, mostly as oral communications, on a wide range of topics. Judging by the active interest by the many participants Hidradenitis suppurativa (HS) remains a hot topic.</p> <hr /> <p class="article-content"><p>The etiology was studied in several manuscripts. Dr van Straalen (NL) and co-workers presented results of a twin study backing the search for a gene in HS, and Dr Vossen (NL) and co-workers from the same group of Professor Errol Prens presented data on a new nicastrin mutation. The discoverer of mutations of the gammasecretase complex, Professor Wang (CN) and Professor Radhakrishna (US), explored possible genetic and epigenetic factors of importance to the manifestations of the disease and suggesting new possible inflammatory pathways of importance. The other hot topic regarding etiology of HS is the role of bacteria. Although it is acknowledged that HS is not a simple infectious disease, bacteria are none the less thought to play a role in the disease. Dr Riverain- Gillet (FR) was reporting on the dysbiosis found in HS lesions, and Dr Ring (DK) on the surprising lack of follicular biofilm in areas of healthy looking skin where HS flares occur. The induction of antibiotic resistance has been demonstrated by Professor Schneider-Burrus (DE), which naturally linked with the reporting by Dr Delaunay (FR) of other combinations of antibiotics (oxofloxacin &amp; clindamycin) as alternatives to guideline recommended treatment with clindamycin &amp; rifampicin.<br /><br /> On a protein level Dr Witte (DE) presented data implicating the activation of IL-36, while Dr Thomi (CH) presented a poster exploring the role of IL-32 in active lesions, while Dr Theut Riis (DK) reported the absence of anticytokine antibodies in a bid to characterise one possible cause of the dysregulated inflammation in this group of patients. Genetic co-morbidities provide another hint on the underlying causes of HS and Dr Delage&rsquo;s (FR) report on a possible association between Down syndrome and HS was therefore of general interest. HS occurs in the context of several clinical syndromes as reviewed by Dr Gasparic (DK) and exemplified by specific case reports. In one of these Dr Rivitti Machado (BR) described the successful treatment of PASH syndrome with adalimumab. Disease management was the topic of several presentations, ranging from the study of the benefits of topical resorcinol for prolonged treatment of single lesions by Dr Pasqual (SP) to the real-world study of adalimumab indicating that the results of the licensing trials may have been a conservative estimate of the real effect, reported by Dr Martorell (SP).<br /><br /> A range of other co-morbidities were reported, and discussed, the distinction between co-morbidities and risk factors often being difficult to make. Sometimes different studies of the same phenomenon may therefore reach different conclusions, e.g. associated renal disease reported by Jemec (DK) based on a registry study being contrasted by the opposite findings in a clinical study by Jenenings (IR). Providing another clue to a possible mechanistic link between co-morbidities and HS Dr Malara (IE) reported the finding of dysregulated adipokines in HS patients. Other co-morbidities are more clearly associated with HS, e.g. the presence of joint involvement in the form of spondylarthropathies as reported by Rondags (NL).<br /><br /> Quality of life issues were reported from several countries, but most convincingly and engagingly by the patient forum headed by Mrs Willumsen (DK). Patients were also strongly involved in the work to develop a core outcome set for future studies of HS. Dr Thorlacious (DK) and Dr Ingram (GB) presented data on the ongoing process to develop these &lsquo;measuring points&rsquo; within the HISTORIC collaboration.<br /> The setting in central Copenhagen was very conducive to the exchange of ideas and setting up of collaborative studies in among the very active and engaged participants. Many new contacts were made, and many old ones were renewed. The Faster-and-Better (FAB) Investigators group met to discuss new initiatives on a global scale and throughout the sessions and interested and constructive atmosphere prevailed, to the point where four cities have made a bid for the 2018 EHSF Conference. The members of the society are voting to decide if this year&rsquo;s success from Copenhagen will be repeated in Barcelona, Lyon, Rotterdam or Wroclaw. Prepare to join &ndash; you will be welcome.</p></p>