Synovitis, Acne, Pustulosis, Hyperostosis, and Osteitis - SAPHO
SAPHO syndrome is a rare and complex condition that combines skin and musculoskeletal symptoms. The name is an acronym for Synovitis, Acne, Pustulosis (of the palms and soles), Hyperostosis (excess bone formation), and Osteitis (bone inflammation).
At Haute-Derma, we treat SAPHO as a chronic autoinflammatory disorder. Rather than tackling each symptom separately, we target the underlying systemic inflammation to relieve bone pain and control pustules, helping patients avoid permanent structural bone damage and improving the appearance of their skin.
Our Approach to Treating SAPHO
Our specialists understand that people with SAPHO suffer both from deep bone pain and from the self-consciousness that visible skin lesions bring. We start with accurate imaging to define the extent of bone inflammation before beginning immunomodulatory treatment.
We use cytokine inhibitors (such as anti-TNF-alpha or IL-17 agents) together with targeted bone-modifying drugs. At Haute-Derma, the goal is to bring patients into remission, prevent bone sclerosis, and restore flexible movement.
Our SAPHO care pathway includes:
- Advanced imaging (X-ray, MRI, or bone scintigraphy) to assess osteitis.
- Targeted biologic therapy to control skin and joint symptoms together.
- Dermatologic and cosmetic management of severe acne and persistent pustulosis.
How We Diagnose SAPHO Syndrome at Haute-Derma
Because skin and bone symptoms can appear months or years apart, Haute-Derma follows patients comprehensively so the diagnosis is not missed:
- Identifying skin lesions: We look especially for palmoplantar pustulosis or severe acne (acne conglobata/fulminans).
- Assessing bone and joint inflammation: We examine typical pain sites such as the sternoclavicular joints, spine, and pelvis.
- Targeted imaging:
- X-ray/CT: To look for hyperostosis and bone sclerosis.
- Bone scintigraphy: To detect the characteristic "bull's head" sign at the sternoclavicular region.
- Inflammatory markers: CRP and erythrocyte sedimentation rate (ESR), which are often raised during acute flares.
- Ruling out infection: Specialized microbiology tests confirm that the areas of osteitis are sterile.
How Is SAPHO Syndrome Treated at Haute-Derma?
Our treatment plan addresses both the skeleton and the skin:
- Bisphosphonates: Beyond their effect on bone, these drugs have strong anti-inflammatory properties and can relieve bone pain quickly in SAPHO.
- Anti-TNF-alpha biologics (etanercept, adalimumab): Our preferred option when standard treatments fail, helping clear pustules and calm joint inflammation.
- IL-17 or IL-23 inhibitors: Used for patients whose skin symptoms dominate, often producing clear improvement in the skin.
- Acne and pustule management at Haute-Derma: Oral isotretinoin combined with blue-light therapy and targeted topical treatments to control pustular lesions.
- NSAIDs and corticosteroids: Short courses to relieve pain and inflammation during acute flares.
