Are Bacteria Infectious Pathogens in Hidradenitis Suppurativa? Debate at the Symposium for Hidradenitis Suppurativa Advances Meeting, November 2017

Abstract

In November 2017, a formal debate on the role of bacteria in the pathogenesis of hidradenitis suppurativa (HS) was held at the 2nd Symposium on Hidradenitis Suppurativa Advances (SHSA) in Detroit, Michigan. In this report, we present both sides of the argument as debated at the SHSA meeting and then discuss the potential role of bacteria as classic infectious pathogens versus an alternative pathogenic role as activators of dysregulated commensal bacterial-host interactions. Although there was consensus that bacteria play a role in pathogenesis and thus are pathogenic, there was a compelling discussion about whether bacteria in HS incite an infectious disease as we classically understand it or whether bacteria might play a different role in HS pathogenesis.

Figure 1.. Proposed roles of bacteria in cutaneous health, infection, and inflammation.

(a) A range of commensal microbiota have a role in maintaining skin health. (b) Cutaneous breach can allow noncommensal pathogenic bacteria to proliferate and cause true infection. (c) An imbalance in commensal bacterial populations can allow pathobionts, or a keystone pathogen, to dominate and drive inflammation. In more advanced HS, epithelialized dermal tracts provide an ideal surface for biofilm development and act as a reservoir of bacteria, which may contribute to persistence and relapse.