Laboratory Research
Microbiome dysbiosis contributes to pathogenesis of Hidradenitis Suppurativa (HS), a complex inflammatory skin condition with significant impacts on quality of life. Patients affected with severe HS often undergo surgical removal of inflamed tissue requiring wound care. Bioelectric wound dressings (BEWDs) promote healing and have antimicrobial effects in chronic wounds, but the efficacy in HS post-surgical wound care remains unknown. We aimed to determine the effect of BEWD on the HS microbiome when compared to standard of care (SOC).
Patients (n=12) underwent bilateral axillary tunnel deroofing excisional procedures at initial visit. Each patient’s surgical sites were randomly assigned in a 1:1 ratio to receive the BEWD* on one side, or the standard-of-care petrolatum with gauze on the contralateral side. Wound debridement was performed at Weeks 2 and 4 and patients were followed for 8 weeks. Extracted DNA from tissue samples collected at Weeks 0, 2, and 4 was used for 16S ribosomal RNA (rRNA) PCR quantification and sequencing. Relative abundance calculated from total reads per individual were used for composition and diversity analysis using Shannon diversity index and bray-curtis dissimilarity. Genera and species abundances were compared between Weeks 0 and 4 using Wilcoxon rank sum tests.
Bacterial load was significantly decreased by Week 2 and 4 in BEWD-treated axillae (p< 0.05), while no significant difference was found in SOC-treated axillae. Microbial composition markedly shifted in BEWD-treated axillae between weeks 0 and 4 at the genus and species level. Beta diversity was statistically significant between Week 0 and Week 4 (p=0.018), demonstrating patient-to-patient variation. Alpha diversity or intra-sample diversity was not significant. Anaerobes implicated in HS, including Peptoniphilus (p=0.008), Parvimonas (p=0.038), and Clostridium (p=0.001) were initially abundant and reduced by week 4. Abundance of skin commensals, particularly Cutibacterium (p=0.023), Lactobacillus (p=0.018), and Bacillus (p=0.006), increased at week 4 vs Week 0. The restoration of the microbiome correlated with the improved clinical outcomes in BEWD-treated sites.
We demonstrate bacterial load reduction and microbiome restoration with BEWD application. Our findings are directly translatable to patients living with HS as we provide for the first time scientific and clinical proof for effective wound care management.