Hope for Patients with Hidradenitis Suppurativa
Summary
- Researchers from the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery are testing a potential therapy for patients with hidradenitis suppurativa.
- Hidradenitis suppurativa typically begins at puberty and is characterized by painful nodules, abscesses and draining wounds or tunnels deep in the skin.
- The research team is planning a larger study with an actively controlled group, in combination with systemic therapy with biologics.
Researchers from the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine are testing a potential therapy for patients with the skin disease hidradenitis suppurativa (HS). Their research shows promising results, with the latest findings published in the Journal of the American Academy of Dermatology.
What is Hidradenitis Suppurativa?
HS typically begins at puberty and is characterized by painful nodules, abscesses and draining wounds or tunnels deep in the skin. The cause remains unknown, but it is associated with bacteria trapped under the skin. The resulting immune response forms tunnels that worsen inflammation and significantly affects quality of life, often causing chronic pain and emotional distress. The condition disproportionately impacts women and minority populations, making the Miami HS Center an ideal hub for studying HS.
“I thought it would be interesting to combine my expertise in dermatology with our amazing wound healing program to see what therapy we can come up with,” said Hadar Lev-Tov, M.D., associate professor in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, medical director of the Miami HS Center and first author on the paper. “Since we already have the expertise in treating wounds that are colonized with bacteria with advanced antimicrobial therapies and techniques, I wanted to see if we can apply a similar approach to patients with HS.”
A Minimally Invasive Approach
Current therapies for HS involve invasive surgery. An excision removes large areas of skin, allowing the wound to heal on its own. In some cases, the wound is closed with a flap of skin, resulting in scarring and limitation of movement. The risk of recurrence is often high.
“Our thinking was to treat the HS tunnels like an under-skin wound, where as long as the bacteria remain, the immune system won’t have a chance to calm down,” Dr. Lev-Tov said. “If I can restore the normal skin microbiome or even completely remove the bacteria, then I can promote normal healing and potentially resolve the HS tunnels without the scarring and other complications.”
The new approach is minimally invasive and involves creating small openings with the punch incision at the beginning and end of the tunnel. After the tunnel is probed to ensure complete accessibility, an antimicrobial gel is applied using a de-needled catheter attached to a three-millimeter syringe, allowing patients to be treated at the time of procedure and to self-apply gel at home.
“When Dr. Lev-Tov first proposed this approach, I was excited but scientifically skeptical, given the disease’s complexity,” said Irena Pastar, Ph.D., research professor in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, research director at the Miami HS Center and senior author on the paper. “That made the discovery even more thrilling. Analyzing the microbiome and tissue inflammation before and after procedure, my laboratory revealed a major drop in harmful bacteria and a shift toward a healthier, more balanced microbiome, similar to healthy skin.”
Patients Heal Faster
With the idea in place, the team enrolled 15 voluntary patients from the Miami HS Center and administered this treatment. The initial application was conducted at the center under local anesthesia, followed by same-day discharge. Patients were shown how to apply the gel themselves.
“We found that, on average, patients healed in less than 12 days,” Dr. Lev-Tov said. “Our team studied them in the beginning and then followed up in four weeks. Tunnels showed a resolution rate of 93%, with a reduced bacterial load. Patients reported an improved quality of life without significant adverse effects.”
The microbiome restoration was accompanied by marked suppression of inflammatory drivers of disease, currently targeted by systemic biologics. More importantly, many patients have opted out of excisional surgery, as their painful tunnels resolved after procedure.
“This local antimicrobial therapy is safe, as it does not pose the risk of antibiotic resistance, the raising concern in chronic skin conditions,” Dr. Pastar said. “In addition to the effect of antimicrobial gel, it is possible that ‘mechanical’ flushing of the HS tunnel removes harmful microbiome, which will be tested in our future studies.”
Although the study was effective, it is not yet ready to become the standard of care compared to traditional surgical methods. The team is planning a larger study with an actively controlled group, in combination with systemic therapy with biologics. Additionally, the gel was only tested in a single tunnel, leaving room for further insight into how it will perform in severe cases involving multiple tunnels.
Additional Miller School faculty in the study include:
• Marjana Tomic-Canic, Ph.D., the William H. Eaglstein, M.D., Chair in Wound Healing, vice chair of research, director of the Wound Healing and Regenerative Medicine Research Program and professor in the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the Miller School
• Natasa Strbo, M.D., D.Sc., assistant professor in the Department of Microbiology and Immunology
The Miami HS Center also offers a fertile ground for training, and this study involved talented dermatology research residents Tammy Gonzalez, M.D., Ph.D., and Nathan Balukoff, M.D., Ph.D.
Tags: dermatology, Dr. Hadar Lev-Tov, Dr. Irena Pastar, Dr. Marjana Tomic-Canic, Dr. Natasa Strbo, Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, hidradenitis suppurativa, wound healing, Wound Healing and Regenerative Medicine Research Program