Acne and Inflammatory Bowel Disease: Insights from SAPHO and PAPA Syndromes?

Review Article

Acne and Inflammatory Bowel Disease: Insights from SAPHO and PAPA Syndromes?

Daniel P Gibson¹, Melissa Chan and Lawrence S Meyers^{2 3}

Affiliations: ¹Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; ²Private Practice, Westfield, New Jersey, USA and ³Robert Wood Johnson
Medical School, Piscataway, New Jersey, USA


ABSTRACT

Recent attention has been placed upon the possible role of isotretinoin in triggering inflammatory bowel disease (IBD). Less focus has been placed on the larger question of a shared pathophysiology between forms of IBD and acne, and the implications it may have for future research and treatment of both diseases. Syndromes such as SAPHO (synovitis, acne, pustolosis, hyperostosis, and osteitis) and PAPA (pyogenic sterile arthritis, pyoderma gangrenosum, and acne), despite their relative rarity, may shed light on as yet incompletely elucidated associations between acne and IBD. We hypothesize a shared pathogenesis in a subset of patients with severe acne (e.g., acne conglobata) and IBD, presumably involving a protracted and misdirected host immune response to infectious or environmental stimuli. Even the currently limited understanding of the clinical and genetic links with IBD in SAPHO and PAPA syndromes would suggest promising avenues for future research. CD2BP1/PSTPIP1, Nod, Toll‐like receptor, or other proinflammatory gene mutations may ultimately be found in a subset of patients with severe acne, which would have profound implications for the understanding of the basic pathogenesis of acne. We speculate that diseases such as SAPHO and PAPA may in fact serve as a model for a subpopulation of patients with autoinflammatory forms of acne that may benefit from treatment with tumor necrosis factor alfa‐blocking agents or other biologic immunosuppressants, ideally in a topical or other targeted formulation.

Keywords: acne, inflammatory bowel disease, SAPHO syndrome, PAPA syndrome