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Đurinec P, Mokos ZB, Marinović B. THE PSYCHOSOCIAL EFFECTS OF HIDRADENITIS SUPPURATIVA. Clin Dermatol 2025:S0738-081X(25)00149-X. [PMID: 40381968 DOI: 10.1016/j.clindermatol.2025.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2025]
Abstract
Hidradenitis suppurativa (HS) is a chronic debilitating skin disease with a tremendous impact on the quality of life. Despite the development of new treatment modalities, consistent remission rates are still hard and sometimes impossible to achieve. Delayed diagnosis, misdiagnosis, and lack of access to adequate medical care are important issues. Poor Quality of Life (QoL) of HS patients, already proven in many studies, is most strongly influenced by physical factors along with depression and anxiety, negative body image, low self-esteem, sexual dysfunction, and impairment of ability to work. Targeting these psychosocial aspects has a great potential to improve care for HS patients. Only a holistic approach can lead to significant improvement, allowing people with HS to live more fulfilled lives.
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Affiliation(s)
- Paola Đurinec
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia.
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2
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Perković DT, Marinović B, Tešanović M, Mokos ZB. Biologic therapies and small molecules in the treatment of hidradenitis suppurativa. Clin Dermatol 2025:S0738-081X(25)00146-4. [PMID: 40373949 DOI: 10.1016/j.clindermatol.2025.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2025]
Abstract
Hidradenitis suppurativa (HS) is a debilitating chronic skin condition challenging to manage. Treatment options range from topical and systemic medications to various surgical procedures. With the expanding knowledge of cytokine signaling pathways, systemic treatment for hidradenitis suppurativa is entering an exciting phase, offering new opportunities to address imbalanced immune responses. The primary categories of treatment include biologics and small molecules. Currently, the only three approved biologics for HS are the anti-TNF-α antibody adalimumab, the anti-IL-17A secukinumab and the anti-IL-17A/17F, bimekizumab. While studies indicate moderate effectiveness of all three drugs, achieving adequate disease control remains challenging for many patients. Research in the field of HS is rapidly evolving, with a wide range of treatments being developed that leverage various mechanisms of action. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways show promise in ongoing and completed phase 3 studies, offering the potential for more comprehensive treatment responses.
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Affiliation(s)
| | - Branka Marinović
- University Hospital Centre Zagreb, Department of Dermatology and Venereology, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mara Tešanović
- Dubrovnik General Hospital, Department of Gynecology and Obstetrics, Dubrovnik, Croatia
| | - Zrinka Bukvić Mokos
- University Hospital Centre Zagreb, Department of Dermatology and Venereology, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia.
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Yamanaka-Takaichi M, Nadalian S, Loftus EV, Ehman EC, Todd A, Grimaldo AB, Yalon M, Matchett CL, Patel NB, Isaq NA, Raffals LE, Wetter DA, Murphree DH, Cima RR, Dozois EJ, Goldfarb N, Tizhoosh HR, Alavi A. Differentiating clinical characteristics of perianal inflammatory bowel disease from perianal hidradenitis suppurativa. Int J Dermatol 2025; 64:520-530. [PMID: 39306801 DOI: 10.1111/ijd.17498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 08/12/2024] [Accepted: 09/07/2024] [Indexed: 02/21/2025]
Abstract
BACKGROUND Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas. METHODS We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD. RESULTS A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife-cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral. CONCLUSIONS The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome.
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Affiliation(s)
| | - Soheila Nadalian
- Laboratory for Knowledge Inference in Medical Image Analysis, University of Waterloo, Waterloo, ON, Canada
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Austin Todd
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, USA
| | - Anna B Grimaldo
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mariana Yalon
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Caroline L Matchett
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nisha B Patel
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Nasro A Isaq
- Department of Dermatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Robert R Cima
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota Physicians, Minneapolis, MN, USA
| | - Hamid R Tizhoosh
- Kimia lab, Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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Alotaibi H, Madani A, AlFada M, Alluhaybi A, Alsehli T, Almuhaideb Q, Alnasser S, Aldossari A, Barakeh M, AlKanaan R. Clinical Epidemiology and Phenotypic Characteristics of Hidradenitis Suppurativa Disease in the Central Region of Saudi Arabia: Findings from a Cross-Sectional. Clin Cosmet Investig Dermatol 2025; 18:129-141. [PMID: 39839355 PMCID: PMC11748051 DOI: 10.2147/ccid.s493638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 12/22/2024] [Indexed: 01/23/2025]
Abstract
Background Hidradenitis suppurativa (HS) is a complex condition that is often misdiagnosed, and regional data on its clinical features and risk factors are limited. This study aimed to explore the clinical epidemiology and phenotypic characteristics of HS in the central region of Saudi Arabia. Materials and Methods A cross-sectional study was conducted on HS patients at King Khalid University Hospital (KKUH) in Riyadh from December 2020 to December 2021. Clinical, epidemiological, and comorbidity data were collected, and the severity of HS was categorized with the Hurley staging system. Statistical analysis was performed with SPSS, with the significance level set to p < 0.05. Results Of the patients, 54.8% were aged 15-30 years, 57.04% were female, and 95.56% were Saudi. Obesity was present in 48.89% of the patients, and 34.07% were smokers. The comorbid conditions included acne (10.37%), asthma (8.15%), mental disorders (2.22%), and endocrine or noncommunicable diseases (18.52%). Most patients (80.74%) had multiple affected sites. No significant associations were found between these factors and HS severity (p > 0.05). Conclusion In conclusion, HS primarily affects young, unmarried Saudi female patients, many of whom are smokers and have comorbid conditions such as asthma and skin disorders. Clinicians should carefully assess the risk profiles of patients, particularly those with smoking habits and comorbidities, and consider screening for HS in high-risk groups.
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Affiliation(s)
- Hend Alotaibi
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Madani
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlFada
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | | | - Turky Alsehli
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Qais Almuhaideb
- Department of Dermatology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Sultan Alnasser
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Abdulelah Aldossari
- Department of Dermatology, King Fahad Specialist Hospital, Buraydah, Saudi Arabia
| | - Maha Barakeh
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Renad AlKanaan
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Baran B, Öksüm Solak E, Yetkin NA, Rabahoğlu B, Tutar N, Gülmez İ, Oymak FS. Sleep quality and risk of obstructive sleep apnea in psoriasis and hidradenitis suppurativa patients. Arch Dermatol Res 2025; 317:185. [PMID: 39775297 DOI: 10.1007/s00403-024-03734-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 11/26/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025]
Abstract
BACKGROUND/AIM Psoriasis and Hidradenitis Suppurativa (HS) are chronic inflammatory skin conditions that significantly impact quality of life, sleep, and increase morbidity. This study aims to compare sleep quality and the risk of obstructive sleep apnea (OSA) in patients with these conditions. Additionally, it explores the relationships between sleep disorders, demographic factors, disease severity, and inflammatory markers. MATERIALS AND METHODS The study included 25 HS and 50 psoriasis patients diagnosed and followed in the Dermatology Department of a tertiary healthcare institution. Disease severity was assessed using the HURLEY score for HS patients and the Psoriasis Area and Severity Index (PASI) for psoriasis patients. Sleep quality and OSA risk were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Berlin, and STOP-Bang questionnaires. RESULTS A total of 75 patients participated, with 50 in the psoriasis group and 25 in the HS group. Of the participants, %41 were female, with a mean age of 36.4 ± 12.7 years. HS patients had significantly higher PSQI and STOP-Bang scores compared to psoriasis patients (p = 0.001 and p = 0.003, respectively). No significant associations were found between disease severity and questionnaire scores in either condition. However, the rate of high-risk OSA was higher in males (p = 0.004) and more prevalent in HS patients than in psoriasis patients (%64 vs. %26, p = 0.002). CONCLUSION HS patients face a significantly higher risk for OSA due to factors like obesity, smoking, increased neck and waist circumference, and elevated inflammation. Routine assessment of OSA risk using tools like the PSQI, Berlin, and STOP-Bang questionnaires is recommended for these patients.
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Affiliation(s)
- Burcu Baran
- Department of Respiratory Diseases, Erciyes University Medical School, Kayseri, Turkey.
| | - Eda Öksüm Solak
- Dermatology and Venereology Department, Erciyes University Medical School, Kayseri, Turkey
| | - Nur Aleyna Yetkin
- Department of Respiratory Diseases, Erciyes University Medical School, Kayseri, Turkey
| | - Bilal Rabahoğlu
- Department of Respiratory Diseases, Erciyes University Medical School, Kayseri, Turkey
| | - Nuri Tutar
- Department of Respiratory Diseases, Erciyes University Medical School, Kayseri, Turkey
| | - İnci Gülmez
- Department of Respiratory Diseases, Erciyes University Medical School, Kayseri, Turkey
| | - Fatma Sema Oymak
- Department of Respiratory Diseases, Erciyes University Medical School, Kayseri, Turkey
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6
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Nielsen VW, Thomsen SF, Naik HB. Hidradenitis suppurativa pathogenesis: Extrinsic factors. J Am Acad Dermatol 2024; 91:S17-S21. [PMID: 39626993 DOI: 10.1016/j.jaad.2024.07.1524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 07/26/2024] [Indexed: 12/31/2024]
Abstract
While genetic predisposition and immune dysregulation are recognized as key contributors to the development of hidradenitis suppurativa, accumulating research points to the influence of extrinsic factors in the pathogenesis of this condition. This review explores the roles of mechanical stress, altered skin and gut microbiome, tobacco smoking, diet, and paradoxical drug reactions as drivers of hidradenitis suppurativa onset and progression. A holistic management approach addressing these factors may be encouraged to improve disease outcomes. Further research is needed to fully determine the causal role of these extrinsic factors and their impact on treatment strategies.
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Affiliation(s)
- Valdemar Wendelboe Nielsen
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital - Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Copenhagen University Hospital - Bispebjerg & Frederiksberg, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California.
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Sun N, Ogulur I, Mitamura Y, Yazici D, Pat Y, Bu X, Li M, Zhu X, Babayev H, Ardicli S, Ardicli O, D'Avino P, Kiykim A, Sokolowska M, van de Veen W, Weidmann L, Akdis D, Ozdemir BG, Brüggen MC, Biedermann L, Straumann A, Kreienbühl A, Guttman-Yassky E, Santos AF, Del Giacco S, Traidl-Hoffmann C, Jackson DJ, Wang DY, Lauerma A, Breiteneder H, Zhang L, O'Mahony L, Pfaar O, O'Hehir R, Eiwegger T, Fokkens WJ, Cabanillas B, Ozdemir C, Kistler W, Bayik M, Nadeau KC, Torres MJ, Akdis M, Jutel M, Agache I, Akdis CA. The epithelial barrier theory and its associated diseases. Allergy 2024; 79:3192-3237. [PMID: 39370939 DOI: 10.1111/all.16318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 08/28/2024] [Accepted: 09/03/2024] [Indexed: 10/08/2024]
Abstract
The prevalence of many chronic noncommunicable diseases has been steadily rising over the past six decades. During this time, over 350,000 new chemical substances have been introduced to the lives of humans. In recent years, the epithelial barrier theory came to light explaining the growing prevalence and exacerbations of these diseases worldwide. It attributes their onset to a functionally impaired epithelial barrier triggered by the toxicity of the exposed substances, associated with microbial dysbiosis, immune system activation, and inflammation. Diseases encompassed by the epithelial barrier theory share common features such as an increased prevalence after the 1960s or 2000s that cannot (solely) be accounted for by the emergence of improved diagnostic methods. Other common traits include epithelial barrier defects, microbial dysbiosis with loss of commensals and colonization of opportunistic pathogens, and circulating inflammatory cells and cytokines. In addition, practically unrelated diseases that fulfill these criteria have started to emerge as multimorbidities during the last decades. Here, we provide a comprehensive overview of diseases encompassed by the epithelial barrier theory and discuss evidence and similarities for their epidemiology, genetic susceptibility, epithelial barrier dysfunction, microbial dysbiosis, and tissue inflammation.
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Affiliation(s)
- Na Sun
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- SKL of Marine Food Processing & Safety Control, National Engineering Research Center of Seafood, School of Food Science and Technology, Dalian Polytechnic University, Dalian, P. R. China
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Xiangting Bu
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Manru Li
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Xueyi Zhu
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Huseyn Babayev
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Sena Ardicli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Department of Genetics, Faculty of Veterinary Medicine, Bursa Uludag University, Bursa, Turkey
| | - Ozge Ardicli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Division of Food Processing, Milk and Dairy Products Technology Program, Karacabey Vocational School, Bursa Uludag University, Bursa, Turkey
| | - Paolo D'Avino
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ayca Kiykim
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Lukas Weidmann
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Marie Charlotte Brüggen
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Andrea Kreienbühl
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Emma Guttman-Yassky
- Department of Dermatology, and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexandra F Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, Guy's & St Thomas' NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King's College London, London, UK
| | - De-Yun Wang
- Department of Otolaryngology, Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore City, Singapore
| | - Antti Lauerma
- Department of Dermatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Heimo Breiteneder
- Department of Pathophysiology and Allergy Research, Medical University of Vienna, Vienna, Austria
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Laboratory of Allergic Diseases and Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, University College Cork, Cork, Ireland
- APC Microbiome Ireland, Cork, Ireland
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Robyn O'Hehir
- Allergy, Asthma & Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Immunology, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Department of Pediatric and Adolescent Medicine, University Hospital St. Pölten, St. Pölten, Austria
| | - Wytske J Fokkens
- Department of Otorhinolaryngology & Head and Neck Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Beatriz Cabanillas
- Department of Allergy, Instituto de Investigación Biosanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Cevdet Ozdemir
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Istanbul Faculty of Medicine, Department of Pediatrics, Division of Pediatric Allergy and Immunology, Istanbul University, Istanbul, Turkey
| | - Walter Kistler
- Department of Sports Medicine, Davos Hospital, Davos, Switzerland
- Swiss Research Institute for Sports Medicine (SRISM), Davos, Switzerland
- Medical Committee International Ice Hockey Federation (IIHF), Zurich, Switzerland
| | - Mahmut Bayik
- Department of Internal Medicine and Hematology, Marmara University, Istanbul, Turkey
| | - Kari C Nadeau
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Maria J Torres
- Allergy Unit, IBIMA-Hospital Regional Universitario de Málaga-ARADyAL, UMA, Málaga, Spain
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland
| | - Ioana Agache
- Faculty of Medicine, Department of Allergy and Clinical Immunology, Transylvania University, Brasov, Romania
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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8
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Marzouk S, Saleeb J, Hassan O, Alkhalili S, Hassan T, Issa R, Muttar S, Lio P. Gender, race, and economic factors influencing screening practices in hidradenitis suppurativa: a cross-sectional analysis. Arch Dermatol Res 2024; 316:746. [PMID: 39503954 DOI: 10.1007/s00403-024-03494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/08/2024] [Accepted: 10/22/2024] [Indexed: 11/22/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life. Despite its substantial burden, HS remains underdiagnosed and undertreated, particularly among marginalized populations. This study aimed to elucidate the primary social determinants of health (SDOH) and structural determinants of health (StDOH) influencing rates and patterns of screening for patients diagnosed with HS. Using data from the All of Us Research Program database, participants with HS were identified using ICD-10 codes and stratified based on various sociodemographic factors, including race, gender, and income. The primary outcome variables were participation in viral screening and disease screening among HS patients. Statistical analyses were performed to assess the relationship between sociodemographic factors and screening practices. Income and gender had significant impacts on screening practices. Higher-income patients were more likely to receive necessary disease screening and less likely to receive unnecessary disease screening compared to lower-income patients. Non-male patients had significantly higher rates of unnecessary disease and viral screening than male patients. While differences in screening practices within each income level were significant, there were no significant differences across different income brackets or racial groups. These findings suggest that subjectivity associated with individual physicians' recommendations may contribute to disparities in screening outcomes, especially in lower-income and non-male HS patients. The study highlights the need for more clearly delineated screening guidelines and continued research on the role of SDOH in improving patient health outcomes.
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Affiliation(s)
- Sammer Marzouk
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA
| | - John Saleeb
- Northwestern University, Evanston, USA, 633 Clark St, Illinois, 60208
| | - Osama Hassan
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA
| | - Sawsan Alkhalili
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA
| | - Taaha Hassan
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA
| | - Ramzy Issa
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA
| | - Sara Muttar
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA
| | - Peter Lio
- Northwestern University Feinberg School of Medicine, 363 W Erie St #350, Chicago, IL, 60654, USA.
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9
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Judge AC, Tahernia AH. Hidradenitis Suppurativa: Radical Surgical Excisions with Staged Reconstructions: A Single-Surgeon Retrospective Review of 71 Patients. Adv Skin Wound Care 2024; 37:1-8. [PMID: 39792518 DOI: 10.1097/asw.0000000000000237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2025]
Abstract
BACKGROUND Hidradenitis suppurativa is a chronic, inflammatory disease involving the pilosebaceous unit of apocrine gland-bearing skin. Wide surgical excision, wherein margins extend beyond active lesions, is considered curative. OBJECTIVE To evaluate the safety and efficacy of wide surgical excision in the treatment of hidradenitis suppurativa. METHODS This single-surgeon, single-site analysis included all patients undergoing radical surgical excision of hidradenitis suppurativa between 2015 and 2019. Using paper case notes and electronic health records, researchers identified a total of 71 patients who underwent 262 surgeries. RESULTS The mean number of surgeries per patient was 3.7, and the total number of sites addressed was 309. Wound dehiscence, infection, and flap necrosis were the most common complications. Disease recurrence in surgically treated areas was noted in two patients (3%). CONCLUSIONS For patients with failed medical management of hidradenitis suppurativa or who have otherwise developed severe disease, wide surgical excision remains a safe, effective treatment with comparatively low recurrence rates. Surgeons should consider staging surgeries, rather than performing a single-stage reconstruction, and anticipate complications.
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Affiliation(s)
- Abigail C Judge
- Abigail C. Judge, BS, is Medical Student, School of Medicine, Yale University, New Haven, Connecticut, United States. Amir H. Tahernia, MD, is Surgeon, Olympia Medical Center and Cedars-Sinai Medical Center, Los Angeles, California
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10
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Kim SR, Choi YG, Jo SJ. Smoking Cessation and Risk of Hidradenitis Suppurativa Development. JAMA Dermatol 2024; 160:1056-1065. [PMID: 39167402 PMCID: PMC11339703 DOI: 10.1001/jamadermatol.2024.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/18/2024] [Indexed: 08/23/2024]
Abstract
Importance Although tobacco smoking is established as a risk factor for hidradenitis suppurativa (HS), studies on the effects of smoking cessation on HS are limited, and evidence is lacking. Objective To examine the association between changes in smoking status and the development of HS. Design, Setting, and Participants This population-based cohort study enrolled participants from the Korean National Health Insurance Service database who had undergone 2 consecutive biennial health examinations (2004-2005 and 2006-2007) as the primary cohort. Within the primary cohort, the secondary cohort comprised individuals who underwent all biennial health examinations throughout the follow-up period and maintained the same smoking status from 2006 to 2007 to the end of the follow-up period. Data were analyzed from July to December 2023. Exposures Changes in smoking habit status. Main Outcomes and Measures Risk of HS development. The HS risk according to change in smoking status between the 2 consecutive health examinations was estimated using a Cox proportional hazards model. Results Of the 6 230 189 participants enrolled, the mean (SD) age was 47.2 (13.5) years, and 55.6% were male. During 84 457 025 person-years of follow-up, 3761 HS events occurred. In the primary cohort, compared to those who consistently reported active smoking at both checkups (ie, sustained smokers), lower HS risk was seen among those who were confirmed to smoke initially but quit by the second checkup (ie, smoking quitters) (adjusted hazard ratio [AHR], 0.68; 95% CI, 0.56-0.83), those who maintained cessation status throughout (AHR, 0.67; 95% CI, 0.57-0.77), and those who reported never smoking at either checkup (ie, never smokers) (AHR, 0.57; 95% CI, 0.52-0.63). Those who initially quit smoking but resumed by the second checkup and those who had no previous smoking history but started at the second checkup (ie, new smokers) exhibited similar HS risk as sustained smokers. The secondary cohort results aligned with those of the primary cohort, showing a more pronounced risk reduction with smoking cessation (AHR, 0.57; 95% CI, 0.39-0.83). Considering time-smoking interaction, the cumulative incidence and the risk of HS in smoking quitters were similar to those in sustained smokers in the early stages of observation. However, 3 to 4 years after smoking cessation, the rate decelerated, resembling that of never smokers, and there was a statistically significant decrease in the risk that persisted (between 3 and 6 years from the index date: AHR, 0.58; 95% CI, 0.36-0.92; and ≥12 years from the index date: AHR, 0.70; 95% CI, 0.50-0.97). New smokers initially paralleled never smokers but accelerated after 2 to 3 years, reaching sustained smokers' levels. Conclusions and Relevance In this cohort study, quitting smoking and sustaining a smoke-free status were associated with a reduced risk of HS development compared to continuous smoking. In contrast, resuming or initiating smoking may have as detrimental an effect on HS development as continual smoking.
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Affiliation(s)
- Seong Rae Kim
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Geun Choi
- Department of Mathematics Education, Sungkyunkwan University, Seoul, Republic of Korea
| | - Seong Jin Jo
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea
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11
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Martora F, Tommasino N, Brescia C, Potestio L, Battista T, Megna M. Hidradenitis Suppurativa in Elderly Patients: Clinical and Therapeutical Outcomes-A Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1465. [PMID: 39336506 PMCID: PMC11434153 DOI: 10.3390/medicina60091465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/03/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024]
Abstract
The management of hidradenitis suppurativa (HS) in elderly patients presents unique challenges due to its chronic inflammatory nature, heterogeneous clinical presentation and comorbidities. While HS typically affects the anogenital and intertriginous regions, elderly patients may exhibit atypical features such as the involvement of the neck, mammary area and gluteal region. The prevalence of HS in the elderly population is lower and the average age of disease onset is higher than in patients under 65. In contrast, it is unclear whether HS in the elderly has different clinical features. The elderly frequently present multiple comorbidities, including obesity, diabetes, and heart disease, which further complicate management decisions. Therapeutic interventions must consider the frailty and increased risk of multimorbidity and adverse events in elderly patients. While systemic antibiotics remain a mainstay of HS treatment, biologic agents such as TNFα inhibitors and secukinumab offer promising options for refractory cases. However, their safety and efficacy in elderly patients, particularly those with multiple comorbidities, require careful consideration. A comprehensive approach to managing HS in elderly patients involves not only pharmacological interventions but also lifestyle modifications and surgical options where appropriate. Multidisciplinary collaboration between dermatologists, geriatricians and other specialists is essential for tailoring treatment strategies and optimizing long-term outcomes and quality of life in special population.
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12
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Schell SL, Nelson AM. Setting the Stage for Standardized Reporting of Clinical and Demographic Information in Laboratory-Based Studies of Hidradenitis Suppurativa. J Invest Dermatol 2024; 144:1689-1695. [PMID: 38888525 DOI: 10.1016/j.jid.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 06/20/2024]
Abstract
Hidradenitis suppurativa (HS) is a complex inflammatory skin condition affecting 0.1-4% of the population that leads to permanent scarring in the axilla, inframammary region, groin, and buttocks. Its complex pathogenesis involves genetics, innate and adaptive immunity, microbiota, and environmental stimuli. Specific populations have a higher incidence of HS, including females and Black individuals and those with associated comorbidities. HS registries and biobanks have set standards for the documentation of clinical data in the context of clinical trials and outcomes research, but collection, documentation, and reporting of these important clinical and demographic variables are uncommon in HS laboratory research studies. Standardization in the laboratory setting is needed because it helps to elucidate the factors that contribute mechanistically to HS symptoms and pathophysiology. The purpose of this article is to begin to set the stage for standardized reporting in the laboratory setting. We discuss how clinical guidelines can inform laboratory research studies, and we highlight what additional information is necessary for the use of samples in the wet laboratory and interpretation of associated mechanistic data. Through standardized data collection and reporting, data harmonization between research studies will transform our understanding of HS and lead to novel discoveries that will positively impact patient care.
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Affiliation(s)
- Stephanie L Schell
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Amanda M Nelson
- Department of Dermatology, Penn State College of Medicine, Hershey, Pennsylvania, USA.
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13
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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14
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Brydges HT, Onuh OC, Friedman R, Barrett J, Betensky RA, Lu CP, Caplan AS, Alavi A, Chiu ES. Autoimmune, Autoinflammatory Disease and Cutaneous Malignancy Associations with Hidradenitis Suppurativa: A Cross-Sectional Study. Am J Clin Dermatol 2024; 25:473-484. [PMID: 38337127 DOI: 10.1007/s40257-024-00844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating cutaneous disease characterized by severe painful inflammatory nodules/abscesses. At present, data regarding the epidemiology and pathophysiology of this disease are limited. OBJECTIVE To define the prevalence and comorbidity associations of HS. METHODS This was a cross-sectional study of EPICTM Cosmos© examining over 180 million US patients. Prevalences were calculated by demographic and odds ratios (OR) and identified comorbidity correlations. RESULTS All examined metabolism-related, psychological, and autoimmune/autoinflammatory (AI) diseases correlated with HS. The strongest associations were with pyoderma gangrenosum [OR 26.56; confidence interval (CI): 24.98-28.23], Down syndrome (OR 11.31; CI 10.93-11.70), and polycystic ovarian syndrome (OR 11.24; CI 11.09-11.38). Novel AI associations were found between HS and lupus (OR 6.60; CI 6.26-6.94) and multiple sclerosis (MS; OR 2.38; CI 2.29-2.48). Cutaneous malignancies were largely not associated in the unsegmented cohort; however, among Black patients, novel associations with melanoma (OR 2.39; CI 1.86-3.08) and basal cell carcinoma (OR 2.69; CI 2.15-3.36) were identified. LIMITATIONS International Classification of Diseases (ICD)-based disease identification relies on coding fidelity and diagnostic accuracy. CONCLUSION This is the first study to identify correlations between HS with melanoma and basal cell carcinoma (BCC) among Black patients as well as MS and lupus in all patients with HS.
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Affiliation(s)
- Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Ogechukwu C Onuh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Rebecca Friedman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Joy Barrett
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | | | - Catherine P Lu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, NY, USA
| | | | - Ernest S Chiu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA.
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16
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Heudens S, Sarkis AS, Daoud M, Daxhelet M, Benhadou F, Suppa M, Nobile L, Karama J, Njimi H, White JM, Del Marmol V. Belgian Patients of the European Registry for Hidradenitis Suppurativa (ERHS-Be): Data, Scores, and Phenotypes since 2015. Dermatology 2024; 240:553-564. [PMID: 38621365 DOI: 10.1159/000538804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, characterized by painful and recurrent lesions in apocrine gland-bearing skin areas. It is a heterogeneous disease, which makes assessment and data collection difficult. Questionnaires with detailed items, such as the Belgian European Registry for Hidradenitis Suppurativa (ERHS-Be), are useful to study HS and its associated comorbidities. The aim of this registry was to uncover new factors associated with HS and understand HS patients' clinical profiles and efficacy of treatments. MATERIAL AND METHODS The ERHS-Be registry is based on questionnaires, with sections for sociodemographic data, medical and HS history, clinical examination, and treatment plan. It allows identification of different clinical phenotypes and automatic calculation of severity scores. RESULTS At present, 606 patients are included in the ERHS-Be (67% women, 33% men). The mean age at the first visit is 38.5 years. Tobacco use is present in 72.6% of patients. A family history of HS is noted in 42% of patients. Comorbidities are documented in this cohort: depression is present in 43.8% of patients, arthritis in 27.8%, obesity in 31.5%, hypertension in 10.6%, diabetes mellitus in 6.4%, and dyslipidemia in 12.4%. Moreover, 7.7% of patients suffer from IBD and 27.4% have a pilonidal sinus. History of severe acne is found in 32.1% of patients and psoriasis in 9.3%. Thirteen percent of women in our cohort suffer from polycystic ovarian syndrome. Severity of disease is quantified in 533 patients: for instance, Hurley I, II, and III scores proportions are, respectively, 32.3%, 52.7%, and 15%, while the mean IHS4 score is 5.2. This registry also enables determination of relative phenotype proportions in our cohort, according to different classifications. CONCLUSION The ERHS-Be questionnaires allow systematic and larger data collection, including detailed comorbidities, phenotypes, and severity of disease. Analysis of this large database will contribute to a better understanding and management of HS, at a time where new therapeutic options are becoming available.
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Affiliation(s)
- Stephanie Heudens
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium,
| | - Anne-Sophie Sarkis
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathieu Daoud
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mathilde Daxhelet
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Mariano Suppa
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Nobile
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jalila Karama
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Hassane Njimi
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan M White
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Veronique Del Marmol
- Dermatology Department, HUB - Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Kirby J, Kim K, Zivkovic M, Wang S, Garg V, Danavar A, Li C, Chen N, Garg A. Uncovering the burden of hidradenitis suppurativa misdiagnosis and underdiagnosis: a machine learning approach. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1200400. [PMID: 38591045 PMCID: PMC10999681 DOI: 10.3389/fmedt.2024.1200400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular skin condition that is associated with significant psychosocial and economic burden and a diminished quality of life and work productivity. Accurate diagnosis of HS is challenging due to its unknown etiology, which can lead to underdiagnosis or misdiagnosis that results in increased patient and healthcare system burden. We applied machine learning (ML) to a medical and pharmacy claims database using data from 2000 through 2018 to develop a novel model to better understand HS underdiagnosis on a healthcare system level. The primary results demonstrated that high-performing models for predicting HS diagnosis can be constructed using claims data, with an area under the curve (AUC) of 81%-82% observed among the top-performing models. The results of the models developed in this study could be input into the development of an impact of inaction model that determines the cost implications of HS diagnosis and treatment delay to the healthcare system.
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Affiliation(s)
- Joslyn Kirby
- Department of Dermatology, Penn State Health, Hershey, PA, United States
| | - Katherine Kim
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Marko Zivkovic
- Technology and Innovation, Genesis Research, Hoboken, NJ, United States
| | - Siwei Wang
- Technology and Innovation, Genesis Research, Hoboken, NJ, United States
| | - Vishvas Garg
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Akash Danavar
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Chao Li
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Naijun Chen
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Amit Garg
- Department of Dermatology, Northwell Health, New Hyde Park, NY, United States
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Verde L, Cacciapuoti S, Caiazzo G, Megna M, Martora F, Cavaliere A, Mattera M, Maisto M, Tenore GC, Colao A, Savastano S, Muscogiuri G, Barrea L. Very low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): an effective and safe tool for improvement of the clinical severity of disease. Results of a pilot study. J Transl Med 2024; 22:149. [PMID: 38350939 PMCID: PMC10863195 DOI: 10.1186/s12967-024-04853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS), an inflammatory-based dermatological condition often associated with obesity, poses significant challenges in management. The very low-calorie ketogenic diet (VLCKD) has shown efficacy in addressing obesity, related metabolic disorders, and reducing chronic inflammation. However, its effects on HS remain underexplored. In this prospective pilot study, we aimed to investigate the impact of a 28-day active phase of VLCKD on HS in a sample of treatment-naive women with HS and excess weight. METHODS Twelve women with HS and overweight or obesity (BMI 27.03 to 50.14 kg/m2), aged 21 to 54 years, meeting inclusion/exclusion criteria and agreeing to adhere to VLCKD, were included. Baseline lifestyle habits were assessed. The Sartorius score was used to evaluate the clinical severity of HS. Anthropometric parameters (waist circumference, weight, height, and body mass index), body composition via bioelectrical impedance analysis, levels of trimethylamine N-oxide (TMAO), oxidized low-density lipoprotein (oxLDL), and derivatives of reactive oxygen metabolites (dROMs) were assessed at baseline and after 28 days of the active phase of VLCKD. RESULTS VLCKD led to general improvements in anthropometric parameters and body composition. Notably, a significant reduction in the Sartorius score was observed after the intervention (Δ%: - 24.37 ± 16.64, p < 0.001). This reduction coincided with significant decreases in TMAO (p < 0.001), dROMs (p = 0.001), and oxLDL (p < 0.001) levels. Changes in the Sartorius score exhibited positive correlations with changes in TMAO (p < 0.001), dROMs (p < 0.001), and oxLDL (p = 0.002). CONCLUSION The 28-day active phase of VLCKD demonstrated notable improvements in HS severity and associated metabolic markers, highlighting the potential utility of VLCKD in managing HS and its association with metabolic derangements in women with overweight or obesity.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Giuseppina Caiazzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Annarita Cavaliere
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Mattera
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Maisto
- ChimNutra labs, Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131, Naples, Italy
| | - Gian Carlo Tenore
- ChimNutra labs, Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131, Naples, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143, Naples, Italy.
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Sinikumpu SP, Jokelainen J, Huilaja L. Prevalence and Characteristics of Hidradenitis Suppurativa in the Northern Finland Birth Cohort 1986 Study: A Cross-sectional Study of 2,775 Subjects. Acta Derm Venereol 2024; 104:adv14732. [PMID: 38197699 PMCID: PMC10795692 DOI: 10.2340/actadv.v104.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/17/2023] [Indexed: 01/11/2024] Open
Abstract
A negative stigmatization related to hidradenitis suppurativa may prevent patients from seeking care. Thus, a large proportion of patients with hidradenitis suppurativa may be missing from studies based on hospital data. The aim of this study was to examine the prevalence and characteristics of hidradenitis suppurativa among 2,775 subjects in the Northern Finland Birth Cohort 1986 Study (NFBC1986), who were in their mid-thirties. The prevalence of hidradenitis suppurativa was 4.0% (n = 110/2,775), being higher in females (4.8%) than in males (2.5%) (p < 0.01). Of those defined as having hidradenitis suppurativa in this study, only 4 cases (n = 4/110, 3.6%) were found to have a hidradenitis suppurativa diagnosis either in the hospital (Care Register for Health Care) or in the primary healthcare data. In an adjusted model in logistic regression analyses, hidradenitis suppurativa was significantly associated with obesity (body mass index 30-55 kg/m2) (odds ratio 3.81, 95% confidence interval 2.80-5.22), female sex (1.99, 1.53-2.61) and smoking (1.56, 1.21-2.00). In addition, there was an association between hidradenitis suppurativa and self-reported poor overall health status. Hidradenitis suppurativa seems to be common at the population level and only a minority of these patients seek care for the condition.
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Affiliation(s)
- Suvi-Päivikki Sinikumpu
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland; Medical Research Center, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
| | - Jari Jokelainen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Laura Huilaja
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland; Medical Research Center, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
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Cronin P, McCarthy S, Hurley C, Ghosh TS, Cooney JC, Tobin AM, Murphy M, O’Connor EM, Shanahan F, O’Toole PW. Comparative diet-gut microbiome analysis in Crohn's disease and Hidradenitis suppurativa. Front Microbiol 2023; 14:1289374. [PMID: 38029085 PMCID: PMC10667482 DOI: 10.3389/fmicb.2023.1289374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/27/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The chronic inflammatory skin disease Hidradenitis suppurativa (HS) is strongly associated with Crohn's Disease (CD). HS and CD share clinical similarities and similar inflammatory pathways are upregulated in both conditions. Increased prevalence of inflammatory disease in industrialised nations has been linked to the Western diet. However, gut microbiota composition and diet interaction have not been compared in HS and CD. Methods Here we compared the fecal microbiota (16S rRNA gene amplicon sequencing) and habitual diet of previously reported subjects with HS (n = 55), patients with CD (n = 102) and controls (n = 95). Results and discussion Patients with HS consumed a Western diet similar to patients with CD. Meanwhile, habitual diet in HS and CD was significantly different to controls. Previously, we detected differences in microbiota composition among patients with HS from that of controls. We now show that 40% of patients with HS had a microbiota configuration similar to that of CD, characterised by the enrichment of pathogenic genera (Enterococcus, Veillonella and Escherichia_Shigella) and the depletion of putatively beneficial genera (Faecalibacterium). The remaining 60% of patients with HS harboured a normal microbiota similar to that of controls. Antibiotics, which are commonly used to treat HS, were identified as a co-varying with differences in microbiota composition. We examined the levels of several inflammatory markers highlighting that growth-arrest specific 6 (Gas6), which has anti-inflammatory potential, were significantly lower in the 40% of patients with HS who had a CD microbiota configuration. Levels of the pro-inflammatory cytokine IL-12, which is a modulator of intestinal inflammation in CD, were negatively correlated with the abundance of health-associated genera in patients with HS. In conclusion, the fecal microbiota may help identify patients with HS who are at greater risk for development of CD.
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Affiliation(s)
- Peter Cronin
- Department of Biological Science, University of Limerick, Limerick, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Siobhan McCarthy
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Cian Hurley
- School of Microbiology, University College Cork, Cork, Ireland
| | - Tarini Shankar Ghosh
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi (IIIT-Delhi), Delhi, India
| | - Jakki C. Cooney
- Department of Biological Science, University of Limerick, Limerick, Ireland
| | - Ann-Marie Tobin
- Department of Dermatology, Tallaght University Hospital, Dublin, Ireland
| | - Michelle Murphy
- Department of Dermatology, South Infirmary Victoria University Hospital, Cork, Ireland
- School of Medicine, University College Cork, Cork, Ireland
| | - Eibhlís M. O’Connor
- Department of Biological Science, University of Limerick, Limerick, Ireland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fergus Shanahan
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Medicine, University College Cork, Cork, Ireland
| | - Paul W. O’Toole
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
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Garg A, Geissbühler Y, Houchen E, Choudhary N, Arora D, Vellanki V, Srivastava A, Priyanka, Darcy J, Richardson C, Kimball AB. Disease Burden and Treatment Patterns Among US Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study. Am J Clin Dermatol 2023; 24:977-990. [PMID: 37378875 PMCID: PMC10570206 DOI: 10.1007/s40257-023-00796-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval. METHODS This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12-17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018. RESULTS Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively). CONCLUSION In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 11042, USA.
| | | | | | | | - Disha Arora
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | | | | | - Priyanka
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | - John Darcy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Alexa B Kimball
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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22
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Mansilla-Polo M, Escutia-Muñoz B, Botella-Estrada R. Narrative Review and Update on Biologic and Small Molecule Drugs for Hidradenitis Suppurativa: An Entity With a Promising Future. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T772-T783. [PMID: 37541580 DOI: 10.1016/j.ad.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 08/06/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory entity characterized by the appearance of multiple nodules, abscesses, and fistulas, predominantly in apocrine regions. In addition to its dermatological involvement, it is associated with multiple systemic comorbidities. Its treatment is combined: topical pharmacological, systemic pharmacological and surgical. Regarding biologic or small molecule drugs, currently only adalimumab is approved. A narrative review of the literature on biological or small molecule drugs used in the treatment of hidradenitis suppurativa is presented. The arsenal we found is large, with multiple targets: inhibitors of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-17, IL-23, IL-1, inhibitors of the janus kinase (JAK) pathway, and multiple other drugs in study. New prospective studies and comparative trials are needed to analyze the effectiveness and safety of these treatments, in an entity with a promising future.
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Affiliation(s)
- M Mansilla-Polo
- Departmento de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España.
| | - B Escutia-Muñoz
- Departmento de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España
| | - R Botella-Estrada
- Departmento de Dermatología, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, España; Universitat de Valéncia, Valencia, España
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23
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Mansilla-Polo M, Escutia-Muñoz B, Botella-Estrada R. Narrative Review and Update on Biologic and Small Molecule Drugs for Hidradenitis Suppurativa: An Entity With a Promising Future. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:772-783. [PMID: 37211274 DOI: 10.1016/j.ad.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory entity characterized by the appearance of multiple nodules, abscesses, and fistulas, predominantly in apocrine regions. In addition to its dermatological involvement, it is associated with multiple systemic comorbidities. Its treatment is combined: topical pharmacological, systemic pharmacological and surgical. Regarding biologic or small molecule drugs, currently only adalimumab is approved. A narrative review of the literature on biological or small molecule drugs used in the treatment of hidradenitis suppurativa is presented. The arsenal we found is large, with multiple targets: inhibitors of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-17, IL-23, IL-1, inhibitors of the janus kinase (JAK) pathway, and multiple other drugs in study. New prospective studies and comparative trials are needed to analyze the effectiveness and safety of these treatments, in an entity with a promising future.
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Affiliation(s)
- M Mansilla-Polo
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain.
| | - B Escutia-Muñoz
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain
| | - R Botella-Estrada
- Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Health Research Institute (IIS) La Fe, Valencia, Spain; Departament of Dermatology. Universitat de Valéncia, Valencia, Spain; Dermatology, Valencia, Spain
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Alabdulkareem M, Berkane Y, Le Bras E, Rousson E, Chrelias T, Beaufils T, Leclere FM, Watier E, Bertheuil N. Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5301. [PMID: 37811354 PMCID: PMC10558224 DOI: 10.1097/gox.0000000000005301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023]
Abstract
Background Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS. Methods We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications. Results Although not statistically significant (P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time (P = 0.0006), defect size (P = 0.0064), and flap size (P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%). Conclusion After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment.
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Affiliation(s)
- Mohammad Alabdulkareem
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- Department of Surgery, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Yanis Berkane
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
- Shriners Children’s Boston, Harvard Medical School, Boston, Mass
| | - Enna Le Bras
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Etienne Rousson
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Theodoros Chrelias
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Tristan Beaufils
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Franck-Marie Leclere
- Department of Plastic, Reconstructive and Hand Surgery, Poitiers University Hospital, CHU de la Miletrie de Poitiers, Poitiers, France
- Laboratoire d’anatomie et de Simulation, Université de Poitiers, Poitiers, France
| | - Eric Watier
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Nicolas Bertheuil
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
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Ureña-Paniego C, Gamissans-Cañada M, Molina-Leyva A, Romaní J. Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort. Acta Derm Venereol 2023; 103:adv6569. [PMID: 37766657 PMCID: PMC10549763 DOI: 10.2340/actadv.v103.6569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
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Affiliation(s)
- Clara Ureña-Paniego
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Gamissans-Cañada
- Hidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain; European Hidradenitis Suppurativa Foundation (EHSF). Dessau-Roßlau, Germany.
| | - Jorge Romaní
- HHidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
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Bukvić Mokos Z, Markota Čagalj A, Marinović B. Epidemiology of hidradenitis suppurativa. Clin Dermatol 2023; 41:564-575. [PMID: 37696341 DOI: 10.1016/j.clindermatol.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disease affecting hair follicles in predominantly intertriginous areas, characterized by deep, painful nodules and abscesses, fistulas, sinus tracts, and scarring. The estimated global prevalence of HS is highly variable, as revealed in a growing body of published literature, and ranges from 0.053% to 4.1%. In North American and European patients, HS is three times more common in women than men, whereas in South Korea and Japan, male predominance is found. The disease most frequently manifests itself between the ages of 18 and 29. Numerous published studies have reported the association between smoking, obesity, and HS, although there are limitations in confirming the causal relationship due to the retrospective design of the available studies. Case-control studies have frequently evaluated the association between HS, metabolic syndrome, and other systemic comorbidities. Due to increased mental health problems, a higher risk of suicide in patients with HS has been reported. We provide up-to-date evidence about the epidemiology, genetic and environmental risk factors, comorbidities, and quality of life of patients with HS. The divergence in HS frequency, possibly due to differences in populations and methodologies, remains to be explained in future worldwide studies.
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Affiliation(s)
- Zrinka Bukvić Mokos
- School of Medicine University of Zagreb, University Hospital Centre Zagreb, Department of Dermatology and Venereology, European Reference Network (ERN) - Skin, Zagreb, Croatia
| | - Adela Markota Čagalj
- University Hospital Centre Split, Department of Dermatology and Venereology, School of Medicine, University of Split, Split, Croatia
| | - Branka Marinović
- School of Medicine University of Zagreb, University Hospital Centre Zagreb, Department of Dermatology and Venereology, European Reference Network (ERN) - Skin, Zagreb, Croatia.
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Molinelli E, De Simoni E, Candelora M, Sapigni C, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. Systemic Antibiotic Therapy in Hidradenitis Suppurativa: A Review on Treatment Landscape and Current Issues. Antibiotics (Basel) 2023; 12:978. [PMID: 37370297 DOI: 10.3390/antibiotics12060978] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, and inflammatory skin disease characterized by painful, deep-seated, nodules, abscesses, and sinus tracts in sensitive areas of the body, including axillary, inguinal, and anogenital regions. Antibiotics represent the first-line pharmacological treatment of HS because of their anti-inflammatory properties and antimicrobial effects. This narrative review summarizes the most significant current issues on the role of systemic antibiotics in the management of HS, critically analyzing the main limits of their use (antibiotic resistance and toxicity). Although, in the last decades, several cytokines have been implicated in the pathomechanism of HS and the research on the use of novel biologic agents in HS has been intensified, antibiotics remain a valid therapeutic approach. Future challenges regarding antibiotic therapy in HS comprise their use in association with biologics in the management of acute flare or as a bridge therapy to surgery.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Edoardo De Simoni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Matteo Candelora
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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Hambly R, Kearney N, Hughes R, Fletcher JM, Kirby B. Metformin Treatment of Hidradenitis Suppurativa: Effect on Metabolic Parameters, Inflammation, Cardiovascular Risk Biomarkers, and Immune Mediators. Int J Mol Sci 2023; 24:6969. [PMID: 37108132 PMCID: PMC10138328 DOI: 10.3390/ijms24086969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a common cutaneous and systemic inflammatory disease with a significant impact on mental health and quality of life. It is associated with obesity, insulin resistance, metabolic syndrome, cardiovascular (CV) disease, and increased all-cause mortality. Metformin is used frequently in HS treatment and is effective for some patients. The mechanism of action of metformin in HS is unknown. A case-control study of 40 patients with HS (20 on metformin and 20 controls) was conducted to assess differences in metabolic markers, inflammation (C-reactive protein [CRP], serum adipokines, and CV risk biomarkers), and serum immune mediators. Body mass index (BMI), insulin resistance (77%), and metabolic syndrome (44%) were high overall, but not significantly different between the groups. This highlights the need for co-morbidity screening and management. A significant reduction in fasting insulin and a trend towards a reduction in insulin resistance were identified in the metformin group compared with pre-treatment levels. CV risk biomarkers were significantly favourable in the metformin group (lymphocytes, monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio). CRP was lower in the metformin group but was not statistically significant. Adipokines were dysregulated overall but were not different between the two groups. Serum IFN-γ, IL-8, TNF-α, and CXCL1 trended lower in the metformin group but did not reach significance. These results suggest that metformin improves CV risk biomarkers and insulin resistance in patients with HS. When the results of this study are considered alongside other studies in HS and related conditions, it is likely that metformin also has beneficial effects on metabolic markers and systemic inflammation in HS (CRP, serum adipokines, and immune mediators), warranting further research.
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Affiliation(s)
- Roisin Hambly
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Niamh Kearney
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Rosalind Hughes
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
| | - Jean M. Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Brian Kirby
- The Charles Centre, Department of Dermatology, St Vincent’s University Hospital, D04 T6F4 Dublin, Ireland
- Charles Institute of Dermatology, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
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Gierek M, Klama-Baryła A, Łabuś W, Bergler-Czop B, Pietrauszka K, Niemiec P. Platelet-Rich Plasma and Acellular Dermal Matrix in the Surgical Treatment of Hidradenitis Suppurativa: A Comparative Retrospective Study. J Clin Med 2023; 12:jcm12062112. [PMID: 36983115 PMCID: PMC10056202 DOI: 10.3390/jcm12062112] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
(1) Introduction: Hidradenitis suppurativa (HS) is an inflammatory skin disease with recurrent, chronic, painful, and purulent skin lesions. Topical or systemic antibiotics are the most widely used treatments for the management of mild stages of the disease. In chronic cases (Hurley II/III), wide excision of lesions should be considered. During reconstructive surgery, the most problematic aspect is wound closure. Very large excisional wounds require reconstructive techniques such as skin flaps, skin grafts, or both. Surgical methods have their limitations, so reconstructive methods in HS surgery need to be continuously improved through the use of, for example, platelet-rich plasma and acellular dermal matrix; (2) Methods: The aim of this study was to evaluate the clinical outcomes and efficacy of surgical treatment of patients with HS using local skin flaps injected with PRP compared to a group of local skin flaps without platelet-rich plasma injection, an acellular dermal matrix, and split-thickness skin graft co-grafts. Sixty-one patients (29 males and 32 females) were included in the study. Most patients were characterized by Hurley grade III HS; (3) Results: The use of PRP injection in reconstructions (skin flaps) improved healing and reduced the number of complications, a notable trend in this study. A co-graft of acellular dermal matrix and split-thickness skin graft gave better therapeutic results than split-thickness skin graft alone (fewer days in hospital, fewer postoperative complications); (4) Conclusions: PRP injected into skin flaps, co-grafted acellular dermal matrix, and split-thickness skin grafts are good options for the surgical treatment of hidradenitis suppurativa.
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Affiliation(s)
- Marcin Gierek
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
- Correspondence: (M.G.); (P.N.); Tel.: +48-32-7357-465 (M.G.)
| | - Agnieszka Klama-Baryła
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Wojciech Łabuś
- Dr Sakiel Center for Burns Treatment, Jana Pawła II Street 2, 41-100 Siemianowice Śląskie, Poland
| | - Beata Bergler-Czop
- Department of Dermatology, Medical University of Silesia, Francuska Street, 40-027 Katowice, Poland
| | - Kornelia Pietrauszka
- Department of Dermatology, Medical University of Silesia, Francuska Street, 40-027 Katowice, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia, Medykow Street 18, 40-752 Katowice, Poland
- Correspondence: (M.G.); (P.N.); Tel.: +48-32-7357-465 (M.G.)
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van Straalen KR, Tzellos T, Alavi A, Benhadou F, Cuenca-Barrales C, Daxhelet M, Daoud M, Efthymiou O, Giamarellos-Bourboulis EJ, Guillem P, Gulliver W, Jemec GBE, Katoulis A, Koenig A, Lazaridou E, Lowes MA, Marzano AV, Matusiak L, Molina-Leyva A, Moltrasio C, Pinter A, Potenza C, Prens EP, Romaní J, Saunte DM, Sayed C, Skroza N, Stergianou D, Szepietowski JC, Trigoni A, Vilarrasa E, Kyrgidis A, Zouboulis CC, van der Zee HH. External Validation of the IHS4-55 in a European Antibiotic-Treated Hidradenitis Suppurativa Cohort. Dermatology 2023; 239:362-367. [PMID: 36630943 PMCID: PMC10332479 DOI: 10.1159/000528968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previously, a new dichotomous outcome was developed, calculated as 55% reduction in the International Hidradenitis Suppurativa 4 (IHS4-55) score. It was validated in datasets of adalimumab and placebo-treated HS patients. External validation is an important aspect of clinical outcomes. OBJECTIVES We aimed to externally validate the novel dichotomous IHS4-55 in a non-biologic treated dataset of HS patients. METHODS Data from a previously published European-wide prospective clinical study of antibiotic treatment of HS patients were used to assess the association of IHS4-55 achievement with individual reduction in inflammatory nodules, abscesses, and draining tunnels. Moreover, the associations between IHS4-55 positivity and achievement of the minimal clinically important differences (MCIDs) for Dermatology Life Quality Index (DLQI), Numerical Rating Scale (NRS) Pain, and NRS Pruritus were analyzed. RESULTS Data were obtained from 283 individual patients, of which 36.4% (103/283) were treated with clindamycin and rifampicin and 63.6% (180/283) with tetracyclines for 12 weeks. Achievers of the IHS4-55 demonstrated a significant reduction the counts of inflammatory nodules, abscesses, and draining tunnels (all p < 0.001). Additionally, IHS4-55 achievers had an odds ratio for achieving the MCID of DLQI, NRS Pain, and NRS Pruritus of 2.16 (95% CI 1.28-3.65, p < 0.01), 1.79 (95% CI 1.10-2.91, p < 0.05), and 1.95 (95% CI 1.18-3.22, p < 0.01), respectively. CONCLUSIONS This study shows the external validity of the novel IHS4-55 by demonstrating a significant association between IHS4-55 achievement and a reduction in inflammatory lesion counts as well as achievement of MCIDs for DLQI, NRS Pain, and NRS Pruritus in an antibiotic-treated cohort. These findings support the use of the IHS4-55 as a novel primary outcome measure in clinical trials.
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Affiliation(s)
- Kelsey R van Straalen
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
| | - Afsaneh Alavi
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Carlos Cuenca-Barrales
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- TECe19-Clinical and Translational Dermatology Investigation Group Ibs., Granada, Spain
| | - Mathilde Daxhelet
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Mathieu Daoud
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Ourania Efthymiou
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Philippe Guillem
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Surgery, Clinique du Val d'Ouest (Lyon), ResoVerneuil (Paris) and Groupe de Recherche en Proctologie de la Société Nationale Française de ColoProctologie, Paris, France
| | - Wayne Gulliver
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Gregor B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Katoulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | - Anke Koenig
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Elizabeth Lazaridou
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | | | - Angelo V Marzano
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Lukasz Matusiak
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
| | - Alejandro Molina-Leyva
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- TECe19-Clinical and Translational Dermatology Investigation Group Ibs., Granada, Spain
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andreas Pinter
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - Concetta Potenza
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Dermatology Unit 'Daniele Innocenzi', Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-Latina, Latina, Italy
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jorge Romaní
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Ditte M Saunte
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Zealand University Hospital, Roskilde and Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Christopher Sayed
- Assistant Professor, Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Nevena Skroza
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Dermatology Unit 'Daniele Innocenzi', Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino-Latina, Latina, Italy
| | - Dimitra Stergianou
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Jacek C Szepietowski
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Medical University, Wroclaw, Poland
| | - Anastasia Trigoni
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Second Department of Dermatology and Venereology, Aristotle University of Thessaloniki, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eva Vilarrasa
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Athanassios Kyrgidis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Maxillofacial Surgery, Aristotle University of Thessaloniki, Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Hessel H van der Zee
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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31
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How Adalimumab Impacts Antibiotic Prescriptions in Patients Affected by Hidradenitis Suppurativa: A 1-Year Prospective Study and Retrospective Analysis. J Clin Med 2023; 12:jcm12030837. [PMID: 36769485 PMCID: PMC9917487 DOI: 10.3390/jcm12030837] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
We conducted a one-year prospective study involving the enrollment of 58 patients with Hidradenitis Suppurativa. Through a retrospective analysis of data on the same patients, with reference to the year prior to the initiation of the anti-TNFα drug adalimumab, we aimed to show how the advent of this biologic therapy changes the number of days of antibiotic therapy, the number of flare-ups per year, and their duration in days, as well as the quality of life and perceived pain of patients.
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32
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A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med 2023; 136:42-53. [PMID: 36252715 DOI: 10.1016/j.amjmed.2022.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
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Alotaibi HM. Incidence, Risk Factors, and Prognosis of Hidradenitis Suppurativa Across the Globe: Insights from the Literature. Clin Cosmet Investig Dermatol 2023; 16:545-552. [PMID: 36891064 PMCID: PMC9987236 DOI: 10.2147/ccid.s402453] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
Hidradenitis suppurativa, a chronic inflammatory disease of the skin, affects a patient's quality of life to a greater extent. While the disease burden, including its incidence and prevalence, has been extensively studied in the western population, there is a paucity of data from developing countries on the epidemiology of Hidradenitis suppurativa. Therefore, a general literature review was conducted to shed light on the epidemiology of Hidradenitis suppurativa across the globe. We reviewed the most recently available information on epidemiology, including incidence, prevalence, risk factors, prognosis and quality of life, complications, and associated comorbid among patients with Hidradenitis suppurativa. The estimated global prevalence of Hidradenitis suppurativa is found to be 0.00033-4.1%, with a relatively higher prevalence of 0.7-1.2% in European and US populations. Both genetic and environmental factors are associated with Hidradenitis suppurativa. Patients with Hidradenitis suppurativa have associated comorbid such as cardiovascular disease, type II diabetes mellitus, mental health issues, and sleep and sexual dysfunctions. These patients spend poor quality of life and tend to be less productive. Future studies are needed to assess the burden of Hidradenitis suppurativa in developing countries. Since the disease tends to be underdiagnosed, future studies should rely on clinical diagnosis rather than self-reporting to avoid the potential of recall bias. Attention needs to be diverted to developing countries with less amount of data on Hidradenitis suppurativa.
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Affiliation(s)
- Hend M Alotaibi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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34
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Gau SY, Preclaro IAC, Wei JCC, Lee CY, Kuan YH, Hsiao YP, Juang SE, Ma KSK. Risk of psoriasis in people with hidradenitis suppurativa: A systematic review and meta-analysis. Front Immunol 2022; 13:1033844. [PMID: 36532043 PMCID: PMC9752046 DOI: 10.3389/fimmu.2022.1033844] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa were associated with comorbidities in various organ systems. Inflammatory dermatological diseases such as pyoderma gangrenosum were reported to be associated with hidradenitis suppurativa. Nevertheless, as for the association between hidradenitis suppurativa and psoriasis, evidences were insufficient. In many studies, the association between psoriasis and hidradenitis suppurativa has been reported. However, some evidence seems to be controversial. The purpose of the systematic review and meta-analysis was to assess whether there was significant association between HS and psoriasis. METHODS On June 01, 2022, we appraised 2,795 articles from databases including PubMed, Web of Science and Embase. Search syntaxes were based on 'hidradenitis suppurativa' or 'acne inversa' with "psoriasis", "comorbidities" or 'epidemiology'. Synonyms were determined based on MeSH terms and Emtree. Observational results that evaluated the odds ratio for people with hidradenitis suppurativa who had psoriasis were extracted for qualitative synthesis. RESULTS After the selection process of the initial 2,795 studies, ten observational studies, including 3 cohort studies, 1 case-control study, and 6 cross-sectional studies, were extracted for critical appraisal. Based on the integration of 7 studies (with more than 560,000 participants included), people with hidradenitis suppurativa had a higher risk of having psoriasis, with a 2.67-fold risk (95% CI, 1.84, 3.87). The association remained in the sensitivity analyses utilizing strict adjustment models. In the analysis that only included studies with a similar study design and adjustments in obesity-related factors, the risk of people with hidradenitis suppurativa having psoriasis was 3.24 (95% CI, 2.27, 4.62). In male patients with HS, the risk of having psoriasis was 4.30-fold higher than male patients without HS (95% CI, 2.37, 7.78). Likewise, in an analysis including 3 cross-sectional studies, the risk of female HS patients having psoriasis was 3.94-fold higher than female HS-free patients (95% CI, 2.34, 6.63). CONCLUSIONS The co-occurrence of hidradenitis suppurativa and psoriasis can greatly increase the burden of the disease. Psoriasis could be one of the critical comorbidities of hidradenitis suppurativa and should be recommended for future screening and follow up. The association between the two diseases should be kept in mind in managing hidradenitis suppurativa patients. More prospective studies are needed to establish the true magnitude of the association between psoriasis and hidradenitis suppurativa.
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Affiliation(s)
- Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ivan Arni C. Preclaro
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Ping Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sin-Ei Juang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Gasslitter I, Häfner HM, Kofler K, Kofler L. [Postoperative wound care with custom-made wound dressings for hidradenitis suppurativa : Wound care after radical excision with secondary wound closure]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 74:994-996. [PMID: 37910227 DOI: 10.1007/s00105-023-05247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
Hidradenitis suppurativa is a chronic, recurrent, autoinflammatory skin disease of the hair follicle and sebaceous glands in intertriginous skin areas. Treatment is based on clinical severity (typically classified according to Hurley stage). In advanced stages, radical excision of affected skin areas with secondary wound closure remains first-line treatment. Postoperative care in this setting should comprise nonadhesive wound dressings. The purpose of this article is to illustrate postoperative wound care after radical excision with secondary wound closure using nonadhesive, absorbent dressings for economical and effective care.
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Affiliation(s)
- Irina Gasslitter
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a. d. R, Deutschland
| | - Hans-Martin Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Studienzentrum für Operative Dermatologie der Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Katrin Kofler
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a. d. R, Deutschland
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Studienzentrum für Operative Dermatologie der Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Lukas Kofler
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a. d. R, Deutschland.
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
- Studienzentrum für Operative Dermatologie der Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits. Biomedicines 2022; 10:biomedicines10112973. [PMID: 36428540 PMCID: PMC9687269 DOI: 10.3390/biomedicines10112973] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.
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Geoghegan L, Rodrigues R, Harrison CJ, Rodrigues JN. The Use of Botulinum Toxin in the Management of Hidradenitis Suppurativa: A Systematic Review. Plast Reconstr Surg Glob Open 2022; 10:e4660. [PMID: 36415615 PMCID: PMC9674480 DOI: 10.1097/gox.0000000000004660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by suppurative infection, sinus tract, and abscess formation. International management guidelines are largely consensus-based. Botulinum toxin (BTX) has been widely used in the treatment of apocrine and eccrine gland disorders, such as hyperhidrosis, although the effectiveness of BTX in the treatment of HS remains unknown. The aim of this systematic review was to understand the published evidence of BTX safety and effectiveness in the management of HS. METHODS We conducted a PRISMA-compliant, prospectively registered (PROSPERO, CRD42021228732), systematic review. We devised bespoke search strategy and applied it to the Cochrane Central Register of Controlled Trials, Medline, Embase, and OpenGrey up until March 2022. We included all clinical studies that reported outcomes following BTX treatment in patients diagnosed with HS (both adult and pediatric). RESULTS A total of 4658 studies were identified, of which six met full inclusion criteria reporting data on 26 patients. The six identified studies included one randomized control trial, one case series, and four case studies. The one included randomized control trial demonstrated a significant reduction in the Dermatology Life Quality Index score at 3 months following treatment with BTX. CONCLUSIONS The effectiveness and safety of BTX in the treatment of HS remain unknown. This systematic review identified a paucity of high-quality clinical data. Evidence of treatment effectiveness is likely to come from registry-based cohort studies using established core outcome sets in the first instance.
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Affiliation(s)
- Luke Geoghegan
- From the Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Raina Rodrigues
- Department of Plastic and Reconstructive Surgery, Lister Hospital. East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Conrad J. Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Oxford, UK
| | - Jeremy N. Rodrigues
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK,Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan AM. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol 2022; 61:1372-1379. [PMID: 35485975 PMCID: PMC10835602 DOI: 10.1111/ijd.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders. OBJECTIVE Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions. METHODS From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups. RESULTS A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others. LIMITATIONS Our study was limited by its retrospective design. CONCLUSIONS Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.
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Affiliation(s)
- Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL
| | - David O. Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Sophia A. Ederaine
- Student, Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, AZ
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Ali M. Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, CA
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Ulschmid C, Serrano L, Wu R, Roth GM, Sokumbi O. African American race is a risk factor for severe hidradenitis suppurativa. Int J Dermatol 2022; 62:657-663. [PMID: 36183313 DOI: 10.1111/ijd.16428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/15/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND African Americans face a disproportionate incidence and prevalence of hidradenitis suppurativa (HS) in the United States, but HS severity and outcomes across racial and ethnic groups have not been well-established while controlling for potentially confounding factors. In this retrospective cohort study, we investigated the associations of race and ethnicity with HS severity, emergency department (ED) visits, hospitalizations, and surgeries for HS while controlling for age, sex, body mass index (BMI), tobacco use, and insurance type. METHODS We reviewed 1190 patients seen at the Medical College of Wisconsin with ≥3 encounters for HS between 1/1/2002 and 3/19/2019, excluding those without race data or an encounter in which HS was treated. RESULTS A total of 953 patients were included; 470 patients were Black or African American non-Hispanic (49%), 39 Hispanic (4%), 418 White non-Hispanic (44%), and 26 other race or ethnicity (3%). Controlling for age, sex, BMI, tobacco use, and insurance type, Black patients had 2.8 times the odds of having Hurley stage III disease (95% CI 1.76-4.45, P < 0.001), 2.86 times the risk for experiencing an ED visit for HS (95% CI 2.12-3.88, P < 0.001), 2.25 times the risk for experiencing a hospitalization for HS (95% CI 1.42-3.56, P < 0.001), and 1.61 times the risk for experiencing a surgical encounter for HS (95% CI 1.34-1.95, P < 0.001) when compared to White patients. CONCLUSIONS African Americans face significant disparities in HS severity, ED visits, hospitalizations, and surgeries. The causes of these disparities must be further investigated and addressed.
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Affiliation(s)
- Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Linda Serrano
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ruizhe Wu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gretchen M Roth
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, USA
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Bostan E, Jarbou A, Karaduman A, Gulseren D, Yalici-Armagan B, Akdogan N. Impact of COVID-19 Pandemic on Hidradenitis Suppurativa Patients: a Cross-Sectional Study From Tertiary Referral Hospital. Dermatol Pract Concept 2022; 12:e2022192. [PMID: 36534566 PMCID: PMC9681235 DOI: 10.5826/dpc.1204a192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, disabling skin disorder which is characterized by recurrent attacks of nodule, abscess, sinus tract formation and scarring. Oral/topical antibiotics, oral retinoids and TNF-alpha inhibitors are used for the treatment of HS. OBJECTIVES In the present study, we aimed to determine the prevalence of coronavirus disease 2019 (COVID-19) real-time polymerase chain reaction (real-time PCR) positivity and the presence of COVID-19 related symptoms in relation to the age, gender, body mass index, disease duration, treatment used for HS, treatment duration and smoking. METHODS We conducted a comparative, cross-sectional study of 178 patients diagnosed with HS in a referral hospital. Age, gender, smoking status, body mass index, treatment modalities used for HS, the presence of COVID-19 related symptoms, history of close contact to a person with COVID-19 and COVID-19 real time-PCR results were determined by a telephone questionnaire. RESULTS Sixty-three patients were female, whereas 115 patients were male. During COVID-19 pandemic, 94 out of 178 patients had COVID-19 related symptoms; COVID-19 real time-PCR test was performed in 109 (61.2%) patients. Thirty (27.5%) cases tested positive for COVID-19 whereas 79 (72.5%) tested negative. CONCLUSIONS Patients having COVID-19 related symptoms were shown to have statistically significantly higher mean age compared to the ones who did not have any symptoms (P = 0.031). No statistically significant relationship was found COVID-19 real time-PCR positivity and the type of treatment administered for HS when categorized as tumor necrosis factor-alpha inhibitor, oral retinoid, topical antibiotic and oral antibiotic group (P > 0.05).
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Affiliation(s)
- Ecem Bostan
- Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Adam Jarbou
- Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Aysen Karaduman
- Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Duygu Gulseren
- Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Basak Yalici-Armagan
- Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Neslihan Akdogan
- Department of Dermatology and Venereology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Kimball AB, Loesche C, Prens EP, Bechara FG, Weisman J, Rozenberg I, Jarvis P, Peters T, Roth L, Wieczorek G, Kolbinger F, Jemec GBE. IL-17A is a pertinent therapeutic target for moderate-to-severe hidradenitis suppurativa: Combined results from a pre-clinical and phase II proof-of-concept study. Exp Dermatol 2022; 31:1522-1532. [PMID: 35638561 PMCID: PMC9804780 DOI: 10.1111/exd.14619] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/12/2022] [Accepted: 05/29/2022] [Indexed: 01/09/2023]
Abstract
Hidradenitis Suppurativa (HS) is a chronic, recurrent, inflammatory, follicular skin disease whose pathology is complex and not fully understood. The objective of this study was to elucidate the role of IL-17A in moderate-to-severe HS. Transcriptomic and histological analyses were conducted on ex vivo HS (n = 19; lesional and non-lesional) and healthy control (n = 8) skin biopsies. Further, a Phase II exploratory, randomized, double-blind, placebo-controlled study was carried out in moderate-to-severe HS patients. Patients were treated with either CJM112 300 mg (n = 33), a fully human anti-IL-17A IgG1/κ monoclonal antibody, or placebo (n = 33). The main outcome of the translational analyses was to identify IL-17A-producing cells and indications of IL-17A activity in HS lesional skin. The primary objective of the clinical study was to determine the efficacy of CJM112 in moderate-to-severe HS patients by HS-Physician Global Assessment (HS-PGA) responder rate at Week 16. Transcriptomic and histopathologic analyses revealed the presence of heterogeneous cell types in HS lesional skin; IL-17A gene signatures were increased in HS lesional vs non-lesional or healthy skin. High expression of IL-17A was localized to T cells, neutrophils, and mast cells, confirming the transcriptional data. Clinically, the proportion of Week 16 HS-PGA responders was significantly higher (p = 0.03) in the CJM112 group vs placebo (32.3% vs 12.5%). This study elucidated the role of the IL-17A pathway in HS pathogenesis and clinically validated the IL-17A pathway in moderate-to-severe HS patients in a proof-of-concept study using the anti-IL-17A-specific antibody CJM112.
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Affiliation(s)
- Alexa B. Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of DermatologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Christian Loesche
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Errol P. Prens
- Department of DermatologyErasmus University Medical CentreRotterdamNetherlands
| | - Falk G. Bechara
- Department of Dermatology, Venereology and AllergologyRuhr‐University BochumBochumGermany
| | | | - Izabela Rozenberg
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Philip Jarvis
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Thomas Peters
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Lukas Roth
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Grazyna Wieczorek
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Frank Kolbinger
- Novartis Institutes for BioMedical ResearchNovartis Pharma AGBaselSwitzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zeeland University Hospital, Roskilde, Health Sciences FacultyUniversity of CopenhagenRoskildeDenmark
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Kohorst JJ, Ghanavatian S, Davis MDP, Weaver AL, Schleck CD, Swanson DL. Long-term risk of death in patients with hidradenitis suppurativa. Int J Dermatol 2022; 62:631-636. [PMID: 36097962 DOI: 10.1111/ijd.16409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is associated with substantial morbidity. Few studies have addressed the natural history and mortality rates associated with HS. A higher risk of cardiovascular death in patients with HS has been reported. We investigated whether patients with HS have an increased overall risk of death compared with age- and gender-matched referents. METHODS We performed a retrospective cohort study of residents of Olmsted County, Minnesota, with incident HS between January 1, 1980, and December 31, 2008, and age- and gender-matched referents. The main outcomes and measures were the overall and cause-specific risks of death. RESULTS We identified 226 incident cases of HS and 678 age- and gender-matched referents among Olmsted County residents during the study period. Compared to referents, patients with HS had a significantly higher risk of all-cause death (hazard ratio [HR, 2.48; 95% CI, 1.53-4.03, P < 0.001) and cardiovascular- or cerebrovascular-related death (HR, 2.85; 95% CI, 1.10-7.40, P = 0.03). However, these risks were attenuated by adjusting for smoking history: all-cause HR, 1.65 (95% CI, 0.97-2.82, P = 0.07) and cardiovascular- or cerebrovascular-related HR, 2.03 (95% CI, 0.71-5.81, P = 0.18). The 71% of patients were former or current smokers at the time of HS diagnosis. CONCLUSIONS Hidradenitis suppurativa patients have a substantially increased risk of death from any cause, including cardiovascular or cerebrovascular causes; the risk is especially dependent on smoking history.
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Affiliation(s)
- John J Kohorst
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Cathy D Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Johnston LA, Alhusayen R, Bourcier M, Delorme I, George R, O'Brien E, Wong SM, Poelman SM. Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update. J Cutan Med Surg 2022; 26:2S-24S. [PMID: 36000460 DOI: 10.1177/12034754221116115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.
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Affiliation(s)
- Leah A Johnston
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Raed Alhusayen
- 282299 Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Isabelle Delorme
- Dr Isabelle Delorme Inc, Dermatologue, Drummondville, QC, Canada
| | - Ralph George
- 7938 Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth O'Brien
- 12367 Faculty of Medicine, Dermatology, McGill University, Montreal, QC, Canada
| | - Se Mang Wong
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Susan M Poelman
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada.,Beacon Dermatology, Calgary, AB, Canada
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Gierek M, Kitala D, Łabuś W, Szyluk K, Niemiec P, Ochała-Gierek G. Impact of Hidradenitis Suppurativa Surgical Treatment on Health-Related Life Quality. J Clin Med 2022; 11:4327. [PMID: 35893421 PMCID: PMC9330903 DOI: 10.3390/jcm11154327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 02/08/2023] Open
Abstract
(1) Background: Hidradenitis suppurativa is a disease that affects the intimacy of patients. This disease reduces the quality of life and functioning of patients in everyday life. The surgical treatment of HS is one of the treatments for HS that can improve the quality of life. (2) Methods: The main goal of this study was to assess quality of life before the surgical treatment and after the surgical treatment of HS at Center for Burn Treatment in Siemianowice Śląskie, Poland, using the EQ-5D-5L survey before the operation and at follow-up (6 months after). (3) Results: The average quality of life measured with the EQ-5D-5L survey before therapy was 39.3 ± 20.1 (min., 0; max., 60; most frequent value, 50), whereas after surgical treatment, the mean quality of life was 89.5 ± 12.5 (min., 50; max., 100; most frequent value, 100). The average increase in the quality of life was 50.2 ± 19.5 (min., 30; max., 100; most frequent value, 30), and it was statistically significant (p < 0.001).
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Affiliation(s)
- Marcin Gierek
- Center for Burns Treatment im. Dr Sakiel, ul. Jana Pawła II 2, 41-100 Siemianowice Slaskie, Poland; (D.K.); (W.Ł.)
| | - Diana Kitala
- Center for Burns Treatment im. Dr Sakiel, ul. Jana Pawła II 2, 41-100 Siemianowice Slaskie, Poland; (D.K.); (W.Ł.)
| | - Wojciech Łabuś
- Center for Burns Treatment im. Dr Sakiel, ul. Jana Pawła II 2, 41-100 Siemianowice Slaskie, Poland; (D.K.); (W.Ł.)
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
- I Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, 41-940 Piekary Slaskie, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
| | - Gabriela Ochała-Gierek
- Dermatology Department, City Hospital in Sosnowiec, ul. Zegadłowicza 3, 41-200 Sosnowiec, Poland;
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Varney P, Guo W, Brown M, Usmani H, Marquez J, Ayasse M, Kaufmann T, Haughton A. A systematic review and meta-analysis of sexual dysfunction in patients with hidradenitis suppurativa. Int J Dermatol 2022; 62:737-746. [PMID: 35781695 DOI: 10.1111/ijd.16328] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/05/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with significant psychosocial comorbidity. To date, the relationship between HS and sexual dysfunction has not been assessed through meta-analysis. A systematic review was performed by OVID Medline, EMBASE, Cochrane Central, PsycINFO via EBSCO, Web of Science, and LILACS. Original English language studies assessing HS and sexual function published prior to April 2020 were screened. Scores from the Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF), Arizona Sexual Experiences Scale (ASEX), Frankfurt Self-Concept Scale for Sexuality (FKKS SEX), and Dermatology Life Quality Index (DLQI) were analyzed. Sixteen studies met inclusion criteria, and nine were eligible for meta-analysis. Pooled mean FSFI score for female HS patients met criteria for sexual dysfunction (mean = 20.32, P < 0.001). Females with HS reported worse FSFI scores than controls (pooled mean difference = -5.704, P = 0.003, I2 =0). Mean IIEF score among males with HS was 47.96 (P < 0.001). Males with HS also reported worse IIEF scores than controls (pooled mean difference = -18.77, P = 0.00, I2 = 0). Females with HS performed worse on sexual function inventories than males with HS (SMD = -0.72, P = 0.009, I2 = 0). Both male and female HS patients reported significantly more sexual impairment than same-sex controls. Female HS patients also experience more sexual impairment than males and on average meet criteria for sexual dysfunction (FSFI <26.55). Clinicians should be aware that their patients with HS, especially females, may be suffering from sexual dysfunction and treated them appropriately.
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Affiliation(s)
- Paige Varney
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - William Guo
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Mikayla Brown
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Hunya Usmani
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Jocellie Marquez
- Department of Surgery, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Marissa Ayasse
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Tara Kaufmann
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Adrienne Haughton
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
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Interviewing Women with Hidradenitis Suppurativa-Thematic and Content Analysis. Adv Skin Wound Care 2022; 35:381-384. [PMID: 35723957 DOI: 10.1097/01.asw.0000831084.75243.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hidradenitis suppurativa (HS) is a chronic autoinflammatory skin disease with a higher prevalence in women. The disease results in a low quality of life as well as physical and psychological comorbidities. The authors sought to determine the effects of HS on women's self-perception and life experiences. METHODS Semistructured interviews were conducted with 22 women of varying age and family status. The content was transcribed and subjected to both thematic and content analyses. RESULTS Five themes and a number of subthemes were revealed, involving physical, emotional, coping, and functional aspects. Somatic features, especially pain, were the most troubling issues, along with the emotional burden of shame and loss of femininity and intimacy. However, women also revealed strength and expressed optimism. CONCLUSIONS These findings reveal the inner world of women coping with HS, addressing multiple dilemmas, problems, and concerns. Healthcare providers should pay special attention to the specific needs of these patients. Additional research is needed to further shed light on the impact of HS on women.
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Breznik V, Marko PB. A Case of Overlapping Clinical Features of Idiopathic Granulomatous Mastitis, Hidradenitis Suppurativa, and Pyoderma Gangrenosum Successfully Treated with Adalimumab. Case Rep Dermatol 2022; 14:98-106. [PMID: 35702373 PMCID: PMC9149353 DOI: 10.1159/000523801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
A 36-year-old woman with a 6-month history of painful unilateral mammary nodules and abscesses was initially treated by gynecologists under the diagnosis of idiopathic granulomatous mastitis (IGM). IGM is an entity that has not been described in classical dermatological textbooks and is considered a rare inflammatory breast disease assumingly associated with trauma, infection, or autoimmune system manifestations. In this patient, the lesions were refractory to conventional treatment of IGM comprising of surgical incisions, systemic antibiotics, dexamethasone, and methotrexate. At the initial visit to the dermatology department, a working diagnosis of localized hidradenitis suppurativa (HS) of breast was established, and treatment with systemic doxycycline was initiated. After the diagnostic incisional biopsy, the inflamed nodule deteriorated into a painful ulceration, implying a pathergy phenomenon. Histopathological features were consistent with the granulomatous type of pyoderma gangrenosum (PG). Treatment with systemic methylprednisolone and mycophenolate mofetil was unsuccessful. Subsequently, the patient developed nodules in the inguinal and axillary areas, typical for HS. Finally, adalimumab treatment resulted in the complete resolution of all lesions without relapse even after the biologic therapy was discontinued. Although in this case, IGM was not confirmed histopathologically, we noted several etiopathological and therapeutic similarities between IGM, PG, and HS and summarized them in a unique table. Further observations are needed to ascertain the potential associations among the three entities.
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Affiliation(s)
- Vesna Breznik
- Department of Dermatovenerology, University Medical Centre Maribor, Maribor, Slovenia
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Barak-Levitt J, Held R, Synett Y, Kremer N, Hodak E, Sherman S. Hidradenitis Suppurativa International Online Community: Patient Characteristics and a Novel Model of Treatment Effectiveness. Acta Derm Venereol 2022; 102:adv00686. [PMID: 35312027 PMCID: PMC9558329 DOI: 10.2340/actadv.v102.1056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Treatment for hidradenitis suppurativa is diverse, yet frequently unsatisfactory. The aims of this study were to create a reproducible artificial intelligence-based patient-reported outcome platform for evaluation of the clinical characteristics and comorbidities of patients with hidradenitis suppurativa, and to use this to grade treatment effectiveness. A retrospective patient-reported outcome study was conducted, based on online questionnaires completed by English-speaking patients registered to the hidradenitis suppurativa Stuff-ThatWorks® online community. Data collected included patient characteristics, comorbidities and treatment satisfaction. These were recoded into scalable labels using a combination of machine learning algorithm, manual coding and validation. A model of treatment effectiveness was generated. The cohort included 1,050 patients of mean ± standard deviation age 34.3 ± 10.3 years. Greater severity of hidradenitis suppurativa was associated with younger age at onset (p < 0.001) and male sex (p < 0.001). The most frequent comorbidities were depression (30%), anxiety (26.4%), and polycystic ovary syndrome (16.6%). Hurley stage I patients rated topical agents, dietary changes, turmeric, and pain relief measures more effective than tetracyclines. For Hurley stage II, adalimumab was rated most effective. For Hurley stage III, adalimumab, other biologic agents, systemic steroids, and surgical treatment were rated more effective than tetracyclines. Patients with hidradenitis suppurativa often have comorbid psychiatric and endocrine diseases. This model of treatment effectiveness provides a direct comparison of standard and complementary options.
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Affiliation(s)
| | | | | | | | | | - Shany Sherman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
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Seetan K, Eldos B, Saraireh M, Omari R, Rubbai Y, Jayyusi A, Abu Jubran M. Prevalence of low vitamin D levels in patients with Hidradenitis suppurativa in Jordan: A comparative cross-sectional study. PLoS One 2022; 17:e0265672. [PMID: 35303020 PMCID: PMC8932615 DOI: 10.1371/journal.pone.0265672] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/06/2022] [Indexed: 12/26/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the apocrine gland bearing skin, presenting various stages of flexural skin pain, erythema, painful nodules, abscesses, sinuses, and fistulas. We aimed to assess serum vitamin D levels in patients with (HS) in Jordan. a cross-sectional comparative study conducted among 110 patients with HS and 110 matched controls, who didn't previously receive vitamin D therapy. Serum vitamin D was measured and classified into normal (>30 ng/ml), insufficient (20-30 ng/ml), and low (<20 ng/ml). The mean age of the cases was 43.1 ± 12.9 years and the mean disease duration was 19.4 months. The mean body mass index among patients with HS was 30 and about 34% of them were smokers. The mean Vitamin D level was 8.4 ng/ml and all HS patients were vitamin D deficient. Patients of HS were more likely to have vitamin D deficiency compared to healthy controls. Most of the study subjects and particularly all of the patients with HS have low vitamin D levels. Smoking and high BMI, were associated with HS. We suggest the implementation standard public dietary recommendations of Vitamin D supplementation, smoking cessation, and weight reduction behaviors with further assessment of disease course among HS patients.
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Affiliation(s)
- Khaled Seetan
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Batool Eldos
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Muthanna Saraireh
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Rami Omari
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Yousef Rubbai
- Princess Aisha Bint Al-Hussein College of Nursing and Health Sciences, Al-Hussein Bin Talal University, Maan, Jordan
| | - Anas Jayyusi
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Maha Abu Jubran
- Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
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