Microbiome characterization of biopsies from lesional skin in Spanish patients with hidradenitis suppurativa shows an abundance of Mycoplasma and a decrease in Cutibacterium species

Abstract

Abstract Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by nodules, abscesses, and tunnels. Understanding the role of the skin microbiome in HS pathogenesis is crucial for developing targeted therapies. Previous studies have reported dysbiosis in HS-affected skin. This study aimed to investigate the microbiome in lesional skin biopsies of HS patients compared to perilesional healthy skin and healthy controls. Additionally, we sought to identify potential differences in the microbiome based on disease endotype, clinical variables, and lesion type. We collected skin samples from 30 HS patients and 20 healthy controls. Participants were categorized into follicular and inflammatory endotypes. Skin biopsies were obtained from lesional and perilesional areas of patients, and from anatomically matched areas in healthy controls. The microbiome was characterized using 16S rRNA gene sequencing. Clinical variables were recorded, including age, sex, body mass index, smoking habit, age of disease onset, family history, and lesion type. The microbiome composition differed significantly between lesional, perilesional, and healthy skin. Lesional skin showed higher abundance of Mycoplasma (P = 0,013) and Bacillus (p < 0,01), while Propionibacterium was more prevalent in healthy controls (p < 0,01). No significant differences were observed in the microbiome composition based on endotypes or lesion types. However, the severity of HS was associated with decreased Propionibacterium abundance. Our study provides novel insights into the microbiome variations in HS-affected skin in a Mediterranean population. The dysbiosis observed, particularly the higher abundance of Mycoplasma, may play a role in the inflammatory process of HS. Understanding the microbiome's impact on HS pathogenesis could lead to innovative treatments aimed at restoring microbiological balance and controlling inflammation. Propionibacterium's lower abundance in severe HS suggests its potential as a therapeutic target. Further investigations into microbiome manipulation as a potential therapeutic approach are warranted, particularly in early-stage lesions with potential for reversibility.