The Role of Gram - Negative Anaerobes in Hidradenitis Suppurativa

Samuel Clay Williams

A Thesis Presented to the Faculty of The Rockefeller University in Partial Fulfillment of the Requirements for the degree of Doctor of Philosophy

Abstract

Hidradenitis Suppurativa is a chronic autoinflammatory disease with unknown triggers.New evidence in the last five years has begun to clarify two parts of the pathogenesis of the disease. These two parts are the fundamental role of keratinocyte inflammation from early through late-stage disease and the role of the microbiome as an antigenic and infectious trigger of pathogenesis. Gram-negative anaerobic bacteria (GNA) such as Prevotella, Porphyromonas, and Fusobacterium are commonly identified in HS lesions, and their prevalence in lesions is associated with HS disease severity. Additionally, newly epithelialized structurescalled “dermal tunnels” are found in severe disease and are associated with biofilm as well as the production of keratinocyte inflammatory cytokines.