Disorders of Follicular Occlusion: Exploring Pathogenic Mechanisms to Identify Novel Therapeutic Targets
Disorders of Follicular Occlusion include the conditions Hidradenitis Suppurativa (HS), Dissecting Cellulitis of the Scalp (DCS), Acne Congolobata (AC) and Pilonidal Sinus Disease (PD). All of these disorders are chronic, burdensome diseases with few efficacious therapeutic options. The prevailing pathogenic paradigm in these disorders are follicular occlusion via a variety of endogenous and exogenous mechanisms, resulting in follicular rupture and dermal inflammatory response.
The term ‘disorders of follicular occlusion’ was first coined in 1956 by Pillsbury, Shelley and Kligman based upon commonalities in histopathological and clinical manifestations. However, since this time our understanding of follicular biology, physiology and cutaneous immunology has expanded dramatically. Paradigm shifts in our understanding of the mechanistic underpinnings of other dermatological disorders (such as psoriasis and atopic dermatitis) have led to translational revolutions and the development of novel therapeutics.
Evidence is accumulating that immunological mechanisms may have a larger role in the development of follicular occlusion disorders than previously appreciated. Successful control of HS, AC and DCS with TNF-alpha inhibitors; as well as follicular occlusion-like disorders occurring as a result of oncological therapies suggest a primary role for immune dysregulation in the development of these diseases. Although the pathogenesis remains enigmatic, the majority of evidence currently focuses upon HS, and the relevance of similar findings in DCS, AC and PD has yet to be explored.
The pathogenic paradigm is currently shifting from follicular occlusion as a primary driver of disease, to an understanding of follicular occlusion, alongside inflammation, as co-contributing mechanisms involved in intimate crosstalk and feedback in disease pathogenesis. Moreover, microbiome studies have recently demonstrated interesting disease associated findings in HS and acne patients, thus suggesting a potential role of a local dysregulated microbiome (dysbiosis) in some disorders of follicular occlusion.
Within this Research Topic, we aim to foster novel insights into disorders of follicular occlusion to provoke further basic and translational research in this area, and to ultimately improve the so far unsatisfactory treatment options for patients suffering from these disorders.
We welcome the submission of insightful Case Reports, state-of-the art Reviews and Mini-Reviews as well as Original Research articles dealing with basic, translational or clinical studies on the following sub-topics:
1. Hidradenitis Suppurativa (Acne Inversa)
2. Dissecting Cellulitis of the Scalp (Perifolliculitis Capitis Abscedens et Suffodiens)
3. Acne Congolobata
4. Autoinflammatory associated follicular occlusion disorders (PASH Syndrome, PAPASH Syndrome)
5. Pilonidal Sinus Disease
6. Drug-Induced Follicular-Occlusion Like Syndromes
9. Role of Immune Cells and Cytokines
10. New Therapeutic Approaches
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Journal of Clinical & Experimental Dermatology Research