The Role of the Cutaneous Microbiome in Hidradenitis Suppurativa-Light at the End of the Microbiological Tunnel.

The development of next generation sequencing, coupled with advances in bio-informatics, has provided new insights into the role of the cutaneous microbiome in the pathophysiology of a range of inflammatory skin diseases. In fact, it has even been suggested that the identification of specific skin microbial signatures may not only be useful in terms of diagnosis of skin diseases but they may also ultimately help inform personalised treatment strategies. To date, research investigating the role of microbiota in the development of inflammatory skin diseases has largely focused on atopic eczema and psoriasis vulgaris. The role of the microbiome in Hidradenits suppurativa (HS)-also known as acne inversa-a chronic auto-inflammatory skin disease associated with significant morbidity, has received comparatively little attention. This is despite the fact that antimicrobial therapy plays a central role in the treatment of HS. After briefly outlining the clinical features of HS and current treatment strategies, we move on to review the evidence of microbial dysbiosis in HS pathophysiology. We conclude by outlining the potential for metagenomic studies to deepen our understanding of HS biology but more importantly to identify novel and much needed treatment strategies.

Comparison of Four Haemodynamic Tests that Quantify Superficial Venous Insufficiency.

OBJECTIVES: Reflux assessment with ultrasound (U/S) is usually qualitative. Quantitative measurements of superficial venous insufficiency (SVI) include the venous arterial flow index (VAFI), recirculation index (RCI), venous filling index (VFI), and the postural diameter change (PDC) of the saphenous trunk. The aim was to investigate their relationship. MATERIALS AND METHODS: This was an observational study performed on patients with varicose veins and hospital employees. Four haemodynamic parameters were measured in 21 legs from 16 subjects. Legs were divided into no reflux (n = 7) and reflux (n = 14). The VAFI is the U/S ratio of common femoral vein volume flow divided by the common femoral artery volume flow, performed supine. The RCI is the U/S ratio of reflux volume over antegrade volume within the saphenous trunk after calf compression, standing. The VFI is the rate of calf volume increase on dependency measured in mL/s, using air plethysmography. The PDC is the percentage reduction of the saphenous trunk diameter from standing to lying, using U/S. RESULTS: The clinical part of the CEAP classification was: C0 = 3, C1 = 4, C2 = 5, C3 = 1, C4a = 1, C4b = 6, C5 = 1. All four tests demonstrated significant differences between the two groups with minimal overlap (Mann Whitney U test): VAFI (p = .028), RCI (p < .0005), VFI (p = .001), and PDC (p = .014). Furthermore, significant correlations were observed with the tests: VAFI vs. RCI (r = .532, p = .015), VFI (r = .489, p = .025) and PDC (r = -.474, p = .030); RCI vs. VFI (r = .446, p = .043) and PDC (r = -.527, p = .014). CONCLUSIONS: Superficial venous drainage insufficiency should not be confined to an U/S assessment of the presence of reflux, which is qualitative. Quantitative data may be provided using the VAFI, RCI, VFI, and PDC. Understanding why there are significant correlations among these parameters and the preferred objective reference test requires further work.

Transient increased tumescence of the glans penis during penile erection after endovenous ablation of the great saphenous vein.

OBJECTIVE: The primary objective of our study was to investigate the impact of endovenous ablation of the great saphenous vein (GSV) on the degree of tumescence of the glans penis during penile erection as well as on global erectile function (EF). METHODS: We included patients scheduled for one of three different methods of endoluminal treatment. Our questionnaire was composed of the EF domain of the International Index of Erectile Function, an additional question that has been validated for assessment of swelling (tumescence) of the glans penis, and a question on the use of erectogenic medication. RESULTS: There were 62 patients enrolled in the study. Seven patients (11%) reported a postoperative enlargement of the glans penis on penile erection compared with the subjectively assessed glans tumescence before surgery. Three patients (5%) reported an increased tumescence of the glans 1 week after surgery, and four (7.4%) different patients reported the effect 3 months after surgery. Of these seven men, three had normal EF (score ≥26) at any time. One patient had mild erectile dysfunction before the operation, with an improvement to normal EF from week 1 throughout the observation in the study (3 months). CONCLUSIONS: This is the first prospective study that confirms an unexpected side effect of endoluminal treatment of the GSV occurring in approximately 10% of men. It might be of interest for insufficient responders to phosphodiesterase type 5 inhibitors with varicosis of the GSV in the future.