elastin and Hidradenitis-Suppurativa

A previous study has found an association between chronic inflammatory disorders e.g. psoriasis, rheumatoid arthritis, and inflammatory bowel disease and increased vascular stiffness(1). Psoriasis and hidradenitis suppurativa (HS) are believed to have shared comorbidities and pathophysiology despite their morphologically different manifestations in the skin. In order to evaluate a putative association between the chronic inflammatory skin disease HS and arterial stiffness, an observational cross-sectional retrospective study was carried out as part of the Danish General Suburban Population Study (GESUS) (1), in which 430 patients with HS from the general population (representing mild HS; Table 1), 32 patients with HS from a hospital-based out-patient clinic (representing severe HS, Table 1), and 20,780 controls underwent measurements of arterial vascular tone and stiffness using photoplethysmography (Pulse Trace PCA2®; Micro Medical Ltd, Kent, UK). The method of Pulse Trace has been validated by correlation with intra-arterial sensing techniques, and is a simple cost-effective screening method[2]. All analyses were performed using SAS 9.3. This study was accepted by the ethics committee of Region Zealand (project number SJ-191, SJ-113, SJ-114) in Denmark (2,3). RESULTS Reflection index (RI) is an expression of arterial vascular tone and stiffness of small arteries. The raw data showed a significantly lower RI for both HS groups groups, compared to controls. The results remained significant when adjusting for confounders (age, sex, smoking and metabolic syndrome) in the out-patient clinic HS group (-11.26 (-17.75- -4.76), P=0.0002*), but not in the population HS group (Table 2). Stiffness index (SI) expresses arterial stiffness in large arteries. Both HS groups showed no significant difference in either SI or vascular age in multivariate analysis, when compared with controls (Table 2). DISCUSSION This study suggests that decreased vascular tone and stiffness of small arteries may be associated with severe HS, and at the same time found no difference in arterial stiffness in large arteries. The significance for the out-patient clinic HS group, but not the population HS group may reflect a dose-response relationship. Vascular tone in vascular smooth muscle cells of small arteries depends on competing vasodilators and vasoconstrictors. We speculate that the inflammation of HS may induce a dysfunctional balance e.g. through increased TNF-alpha with subsequent

Topics: Arteries; Cicatrix; Cross-Sectional Studies; Elastin; Hidradenitis Suppurativa; Histamine; Humans; Hydrocortisone; Inflammation; Myocardial Infarction; Nitric Oxide; Psoriasis; Retrospective Studies; Stroke; Tumor Necrosis Factor-alpha; Vasoconstrictor Agents; Vasodilator Agents

Hidradenitis suppurativa (HS) is a dermatological condition characterized by ruptured hair follicles inducing a localized, but massive chronic inflammatory response. Analysis of 104 HS lesions in formalin-fixed paraffin-embedded tissues identified the most common histologic features found associated with HS were migrating epithelial sheets, acute and chronic inflammation, perivascular chronic inflammation in regions adjacent to active lesions, and granulation tissue. Additionally, using a modified Masson's trichrome stain principally for collagen, Verhoeff van Gieson elastic stain, and CD34 immunohistochemistry assay for endothelium, lesional areas in the dermis with chronic inflammation exhibited a significant decrease in collagen and elastin, and an increase in neovascularization.

Topics: Collagen; Elastin; Hair Follicle; Hidradenitis Suppurativa; Humans; Inflammation; Neovascularization, Pathologic