Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities

Hidradenitis suppurativa in children and adolescents: a review of treatment options

Hidradenitis suppurativa (HS) is a burdensome disease and has the potential to affect the life course of patients. It is a rare disease in children, and the recorded literature is correspondingly scarce. This article reviews the therapeutic options for HS in children and adolescents, and highlights particular differences or challenges with treating patients in this age group compared with adults. The work-up of paediatric patients with HS should include considerations of possible endocrine co-morbidities and obesity. Medical therapy of lesions may include topical clindamycin. Systemic therapy may include analgesics, clindamycin and rifampicin, finasteride, corticosteroids or tumour necrosis factor alpha (TNFα) blockers. Superinfections should be appropriately treated. Scarring lesions generally require surgery.

Bariatric surgery - a dermatologic perspective

Bariatric surgery has become a standard option in morbid obesity for patients not responding to conventional treatment. A major and stable weight loss can be achieved. Since obesity and weight loss may affect skin diseases, we performed this review to analyse the impact of bariatric surgery on a number of skin diseases. We categorized the skin diseases into three main groups: (i) diseases with a possible benefit from bariatric surgery, (ii) diseases that may develop after bariatric surgery and (iii) diseases that may persist. We hope that dermatologists will achieve an updated knowledge of benefits and possible hazards of this type of surgically induced weight loss.

Successful treatment of PASH syndrome with infliximab, cyclosporine and dapsone

BACKGROUND

The group of autoinflammatory syndromes associated with Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis are poorly defined and difficult to control with currently available treatment modalities.

OBJECTIVES

We describe a patient with PASH syndrome and report about the successful multimodal treatment with infliximab, cyclosporine, and dapsone.

METHODS

A review of the available literature to date about this group of autoinflammatory diseases was performed. We performed genetic analysis for PSTPIP1 mutations associated with PAPA syndrome.

RESULTS

A 22-year-old woman presented to our department with pyoderma gangrenosum, concomitant acne, and suppurative hidradenitis. She had previously been treated unsuccessfully with etanercept, adalimumab, fumaric acid and the IL-1 receptor antagonist (IL-1RA) anakinra without prolonged remission. Treatment with intravenous infliximab in combination with cyclosporine and dapsone lead to sudden and prolonged improvement of the clinical symptoms that we classified as PASH syndrome. We review the literature about this group of diseases and report the third case of PASH syndrome to date.

CONCLUSION

PASH syndrome and associated diseases should be considered whenever hidradenitis suppurativa is found in association with pyoderma gangrenosum. We provide a systematic overview about PASH syndrome and suggest a novel multimodal therapeutic regimen beyond isolated inhibition of TNF or IL-1.