51
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Yang CC, Tsai SJ, Chu CB, Li WL, Lin SH, Hsu CK. The influence of gender and smoking on hidradenitis suppurativa: A retrospective study of 161 patients in Taiwan. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_32_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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52
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Meier K, Schloegl A, Poddubnyy D, Ghoreschi K. Skin manifestations in spondyloarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20975915. [PMID: 33343725 PMCID: PMC7727049 DOI: 10.1177/1759720x20975915] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/03/2020] [Indexed: 12/30/2022] Open
Abstract
Spondyloarthritides (SpA) like psoriatic arthritis, axial spondyloarthritis/ankylosing spondylitis, reactive arthritis and inflammatory bowel disease (IBD)-associated SpA can present with characteristic skin manifestations. These SpA-associated skin disorders may precede joint involvement, reflect a loss of efficacy of a current systemic treatment or can even be treatment associated. Cutaneous manifestations in SpA not only add additional morbidity with physical impact but also impose a psychosocial burden on affected patients. Psoriasis (PsO) - the main skin disease in SpA - has a variety of clinical presentations, including plaque-type PsO, inverse PsO, guttate PsO, erythrodermic PsO, nail PsO and pustular types. SpA associated with IBD presents with neutrophilic and granulomatous skin disorders, including pyoderma gangrenosum, hidradenitis suppurativa and cutaneous Crohn's disease. Reactive arthritides has a favourable prognosis and may feature keratoderma blenorrhagicum or balanitis circinatum as typical skin manifestations. Immunologically, SpA-associated skin diseases share interleukin (IL)-17 and IL-23 dysregulation but show distinctive genetic and immunological profiles. Therefore, they vary in their treatment responses to targeted therapies with biologicals or small molecules. In this review, we highlight the clinical presentation of skin manifestations in SpA and discuss therapeutic approaches in this interdisciplinary field.
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Affiliation(s)
- Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | | | - Denis Poddubnyy
- Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Kamran Ghoreschi
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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53
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Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos‐Bourboulis EJ, Fabbrocini G, Frew JW, Fujita H, González‐López MA, Guillem P, Gulliver WPF, Hamzavi I, Hayran Y, Hórvath B, Hüe S, Hunger RE, Ingram JR, Jemec GB, Ju Q, Kimball AB, Kirby JS, Konstantinou MP, Lowes MA, MacLeod AS, Martorell A, Marzano AV, Matusiak Ł, Nassif A, Nikiphorou E, Nikolakis G, Nogueira da Costa A, Okun MM, Orenstein LA, Pascual JC, Paus R, Perin B, Prens EP, Röhn TA, Szegedi A, Szepietowski JC, Tzellos T, Wang B, van der Zee HH. What causes hidradenitis suppurativa ?—15 years after. Exp Dermatol 2020; 29:1154-1170. [DOI: 10.1111/exd.14214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Affiliation(s)
- 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
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hôpital Erasme Universite Libre de Bruxelles Bruxelles Belgium
| | - Angel S. Byrd
- Department of Dermatology Howard University College of Medicine Washington DC USA
| | - Nisha S. Chandran
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Department of Medicine National University Hospital Singapore
| | - Evangelos J. Giamarellos‐Bourboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Medical School Athens Greece
| | - Gabriella Fabbrocini
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | | | - Hideki Fujita
- Division of Cutaneous Science Department of Dermatology Nihon University School of Medicine Tokyo Japan
| | - Marcos A. González‐López
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Hospital Universitario Marqués de Valdecilla University of Cantabria IDIVAL Santander Spain
| | - 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 P. F. Gulliver
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Faculty of Medicine Memorial University of Newfoundland, and NewLab Clinical Research Inc St. John's Canada
| | - Iltefat Hamzavi
- Department of Dermatology Henry Ford Hospital Wayne State University Detroit MI USA
| | - Yildiz Hayran
- Department of Dermatology Ankara Numune Training and Research Hospital Ankara Turkey
| | - Barbara Hórvath
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology University Medical Centre Groningen University of Groningen Groningen The Netherlands
| | | | - Robert E. Hunger
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - John R. Ingram
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology & Academic Wound Healing Division of Infection and Immunity Cardiff University Cardiff UK
| | - Gregor B.E. Jemec
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Qiang Ju
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology RenJi Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - Alexa B. Kimball
- Department of Dermatology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Joslyn S. Kirby
- Department of Dermatology Penn State Milton S. Hershey Medical Center Hershey PA USA
| | - Maria P. Konstantinou
- Dermatology Department Paul Sabatier University University Hospital of Toulouse Toulouse France
| | | | - Amanda S. MacLeod
- Department of Dermatology Department of Immunology Department of Molecular Genetics and Microbiology Duke University Durham NC USA
| | - Antonio Martorell
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hospital of Manises Valencia Spain
| | - 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
| | - Łukasz Matusiak
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Aude Nassif
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Institut Pasteur Paris France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases King’s College London, and Department of Rheumatology King’s College Hospital London UK
| | - Georgios Nikolakis
- 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
| | - André Nogueira da Costa
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Translational Science and Experimental Medicine Early Respiratory and Immunology Biopharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | | | | | - José Carlos Pascual
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Alicante University General Hospital Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
| | - Ralf Paus
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - Benjamin Perin
- Division of Dermatology University of Washington Seattle WA USA
| | - Errol P. Prens
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
| | - Till A. Röhn
- Autoimmunity, Transplantation and Inflammation Novartis Institutes for BioMedical Research Novartis Pharma AG Basel Switzerland
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Jacek C. Szepietowski
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Nordland Hospital Trust Bodø Norway
| | - Baoxi Wang
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hessel H. van der Zee
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
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54
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Sherman S, Tzur Bitan D, Kridin K, Pavlovsky L, Hodak E, Cohen AD. Hidradenitis suppurativa is associated with hypothyroidism and hyperthyroidism: a large-scale population-based study. Int J Dermatol 2020; 60:321-326. [PMID: 33241580 DOI: 10.1111/ijd.15319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/07/2020] [Accepted: 10/29/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the skin bearing apocrine glands. There are numerous comorbidities and associated diseases among patients with HS. The association of HS and thyroid abnormalities is equivocal. We aimed to explore whether HS is associated with thyroid disorders. METHODS In this cross-sectional large-scale population-based study in Israel, patients with a validated diagnosis of HS were matched at a proportion of 1:5 with age- and gender-matched healthy controls without HS. A cross-checking for HS diagnosis by International Classification of Diseases, ninth revision (ICD-9) coding, and hyperthyroidism and hypothyroidism by ICD-9 coding was performed. Demographic and exposure covariates were identified. Univariate and multivariate logistic regressions were utilized to establish the association of HS with thyroid disorders. RESULTS Study participants included 4,191 HS patients and 20,941 controls. The average age of patients was 39.7 years old, and 61.8% were female. 53.4% of HS patients and 13.5% of controls (P < 0.001) were smokers. Odds ratios (ORs) for hypothyroidism and hyperthyroidism in HS were 2.91 (95% confidence interval [CI] 2.48-3.40) and 2.25 (95% CI 1.55-3.28), respectively (P < 0.001 for both). While the association of HS with hypothyroidism was maintained across genders and all age groups, and remained positive after controlling for smoking status, the association with hyperthyroidism remained positive only among females, middle-aged patients, and nonsmokers. CONCLUSION HS is independently associated with hypothyroidism. The association of HS with hyperthyroidism held significance only in limited subgroups. Smoking status is a major modifier, mainly in the association of HS with hyperthyroidism.
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Affiliation(s)
- Shany Sherman
- Division of Dermatology, Rabin Medical Center (Beilinson Hospital), Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel.,Shalvata Mental Health Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Hod Hasharon, Israel
| | - Khalaf Kridin
- Lubeck Institute of Experimental Dermatology, Lubeck, Germany
| | - Lev Pavlovsky
- Division of Dermatology, Rabin Medical Center (Beilinson Hospital), Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center (Beilinson Hospital), Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon D Cohen
- Department of Quality Measurements and Research, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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55
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Ingram JR. The epidemiology of hidradenitis suppurativa. Br J Dermatol 2020; 183:990-998. [PMID: 32880911 DOI: 10.1111/bjd.19435] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease defined clinically by multiple, painful inflammatory lesions occurring predominantly in flexural sites. Onset is typically soon after puberty; however, it remains unknown whether the menopause induces remission. In North American and European patients with HS the female-to-male ratio is approximately 3 : 1 but the ratio is 1 : 2 in South Korean patients. It may be that some elements of HS epidemiology cannot be generalized across all populations. Elements of HS epidemiology in the USA and Europe are well established, including strong associations with obesity and smoking, which may increase disease severity. There are associations between HS and other cardiovascular disease (CVD) risk factors, including type 2 diabetes and metabolic syndrome. People with HS have double the risk of death from CVD compared with those without HS and 1·5 times the risk compared with patients with psoriasis. Depression and anxiety are associated with HS and completed suicide rates in those with HS are more than double the rates in controls. Associations exist between HS and other chronic inflammatory conditions, particularly inflammatory bowel disease and inflammatory arthritis. Case-control studies demonstrate associations with pilonidal sinus, polycystic ovary syndrome, Down syndrome, obstructive sleep apnoea and pyoderma gangrenosum. Population-based studies using routinely collected healthcare data from the USA estimate a prevalence of 0·1%, suggesting HS is relatively uncommon. European studies include undiagnosed patients and typically estimate prevalence of 1% or more, suggesting a common condition. Resolving the controversy surrounding a greater than 10-fold difference in HS prevalence estimates remains a high priority.
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Affiliation(s)
- John R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, CF14 4XN, UK
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56
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Hidradenitis suppurativa in pediatric patients. J Am Acad Dermatol 2020; 86:140-147. [PMID: 32822788 DOI: 10.1016/j.jaad.2020.08.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
Interest in and research on hidradenitis suppurativa (HS) have increased during the past decade, resulting in expanded knowledge about associated comorbidities and treatment efficacy. Knowledge about pediatric-onset HS is still limited, based on case studies, small case series, and extrapolation from adult studies. With increasing prevalence of childhood obesity, decreasing pubertal age, and increasing awareness of HS, physicians may start encountering younger HS patients. This review presents an updated discussion on the epidemiology, pathophysiology, and associated comorbidities in HS, with a focus on pediatric and adolescent patients. It also suggests recommendations for investigation and treatment based on current evidence.
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57
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Nguyen T, Damiani G, Orenstein L, Hamzavi I, Jemec G. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol 2020; 35:50-61. [DOI: 10.1111/jdv.16677] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T.V. Nguyen
- Bellevue Dermatology Clinic & Clinical Research Center Bellevue WA USA
| | - G. Damiani
- Department of Dermatology Emory University School of Medicine Atlanta GA USA
| | - L.A.V. Orenstein
- Dipartimento di Fisiopatologia Medico‐Chirurgica e dei Trapianti Università degli Studi di Milano Unità Operativa di Dermatologia IRCCS Fondazione Ca' GrandaOspedale Maggiore Policlinico Milano Italy
| | - I. Hamzavi
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - G.B. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
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58
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Lu CY, Hsieh MS, Wei KC, Ezmerli M, Kuo CH, Chen W. Gastrointestinal involvement of primary skin diseases. J Eur Acad Dermatol Venereol 2020; 34:2766-2774. [PMID: 32455473 DOI: 10.1111/jdv.16676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/11/2020] [Indexed: 12/14/2022]
Abstract
Less is known about gastrointestinal (GI) involvement of primary skin diseases due to the difference in embryology, histology, microbiology and physiology between integument and alimentary tract. Oesophagus, following the oropharyngeal mucosa, is the most common GI segment affected by primary skin diseases, especially by eosinophilic oesophagitis, lichen planus and autoimmune bullous dermatoses like pemphigus vulgaris, mucosal membrane pemphigoid and epidermolysis bullosa acquisita. Eosinophilic oesophagitis is an emerging chronic atopic disease with oesophageal dysfunction as the typical presentation, and oesophageal narrowing, rings and stricture as late complications. Oesophageal lichen planus mainly involves the proximal to mid-oesophagus in elderly aged women with long-term oral mucosal lesions. In acute attack of pemphigus vulgaris, oesophageal involvement is not uncommon but often neglected and may cause sloughing oesophagitis (oesophagitis dissecans superficialis) with acute GI bleeding in rare cases. GI manifestation of hereditary bradykininergic angio-oedema with colicky acute abdomen mostly affects small intestine, usually in the absence of pruritus or urticaria, and is more severe and long-lasting than the acquired histaminergic form. Strong evidence supports association between inflammatory bowel disease, especially Crohn disease, and hidradenitis suppurativa/acne inversa. Patients with vitiligo need surveillance of autoimmune liver disease, autoimmune atrophic gastritis or coeliac disease when corresponding symptoms become suspect. Melanoma is the most common primary tumour metastatic to the GI tract, with small intestine predominantly targeted. Gastrointestinal involvement is not uncommon in disseminated mycosis fungoides. Extramammary Paget's disease is an intraepidermal adenocarcinoma of controversial origin, and a high association between the anogenital occurrence and colorectal adenocarcinoma has been reported. As GI tract is the largest organ system with multidimensional functions, dermatologists in daily practice should be aware of the gastrointestinal morbidities related to primary skin diseases for an early diagnosis and treatment.
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Affiliation(s)
- C-Y Lu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - M-S Hsieh
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - K-C Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - M Ezmerli
- Department of Dermatology, Faculty of Medicine in Rabigh, Kingdom of Saudi Arabia, King Abdulaziz University, Jeddah, Saudi Arabia
| | - C-H Kuo
- Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - W Chen
- Center for Research & Development, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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59
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Hayama K, Fujita H, Hashimoto T, Terui T. Questionnaire-based epidemiological study of hidradenitis suppurativa in Japan revealing characteristics different from those in Western countries. J Dermatol 2020; 47:743-748. [PMID: 32441411 PMCID: PMC7818453 DOI: 10.1111/1346-8138.15378] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/07/2020] [Indexed: 01/14/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic relapsing skin disease localized mainly on the apocrine gland‐bearing areas. In Japan, HS is yet to be fully understood, and no criteria have been established for its diagnosis or severity assessment. The purpose of this study was to investigate and characterize HS in Japan. We conducted a nationwide questionnaire‐based study, in which Japanese diagnostic criteria were proposed. Question items included age, sex, disease duration, past history, family history, smoking status, disease severity scores (Hurley stage, modified Sartorius score and Physician Global Assessment [PGA] score), treatments, comorbidities and prognosis. We analyzed 300 patients (219 males and 81 females) diagnosed with HS based on our criteria. Average disease duration was 92.3 ± 6.82 months. Only 12 (4%) patients had a family history of HS. Disease severity was classified by PGA score (mild, 100 [33.3%]; moderate, 133 [44.3%]; severe, 34 [11.3%]; most severe, 29 [9.7%]) and Hurley stage (I, 69 [23%]; II, 109 [36.3%]; III, 121 [40.3%]). Disease severities based on PGA score and Hurley stage were positively correlated to modified Sartorius score using the Kruskal–Wallis test (P < 0.001, respectively). Patients with diabetes mellitus showed higher PGA scores (χ2 = 10.977, P = 0.01185). Presence of axillary lesions related to higher PGA scores (χ2 = 8.6378, P = 0.03452). The results in this study and previous studies indicate that Japanese HS patients have different backgrounds from those in Western countries, and are characterized by male predominance, higher incidence of Hurley stages II and III, higher PGA scores in patients with axillary lesions and much fewer familial cases.
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Affiliation(s)
- Koremasa Hayama
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Fujita
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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60
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Wu J, Ge H, Fan Y, Zhen Q, Tang L, Sun L. Novel Mutation of the NCSTN Gene Identified in a Chinese Acne Inversa Family. Ann Dermatol 2020; 32:237-242. [PMID: 33911744 PMCID: PMC7992621 DOI: 10.5021/ad.2020.32.3.237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
Acne inversa is a chronic inflammatory follicular disease with autosomal dominant inheritance. In recent years, many functional mutations in the NCSTN genes have been identified as the cause of familial acne inversa. Herein, we recruited four patients and seven unaffected individuals from a Chinese family and performed Sanger sequencing of the NCSTN gene. One novel frameshift mutation, c.450_459del (p.Ser 151GlnfsX48), was identified in exon 5 of the NCSTN gene. Three normal-looking children carrying the mutation were proven to be patients. We also presented a literature review from previous studies of acne inversa, suggesting that NCSTN is a hotspot gene for acne inversa. Most affected individuals experienced onset in adolescence. We confirmed the diagnosis in this family based on the mutation. This finding will help expound the relationship between the NCSTN gene and the pathogenesis of acne inversa and emphasize the value of genetic diagnosis in monogenic disorder.
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Affiliation(s)
- Jing Wu
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Huiyao Ge
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Yiming Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qi Zhen
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Lili Tang
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Liangdan Sun
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
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61
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Prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Arch Dermatol Res 2020; 313:95-99. [PMID: 32322958 PMCID: PMC7864810 DOI: 10.1007/s00403-020-02065-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/03/2020] [Accepted: 03/28/2020] [Indexed: 12/26/2022]
Abstract
The association of hidradenitis suppurativa with other skin diseases has not yet been investigated in larger studies based on dermatological exams. The objectives of this study are to determine the prevalence and cutaneous comorbidities of hidradenitis suppurativa in the German working population. Between 2014 and 2017, 20,112 people in 343 German companies were examined for the presence of clinical features of hidradenitis suppurativa within the framework of a cross-sectional epidemiological study based on whole-body examinations. In addition, all cutaneous comorbidities were recorded. Point prevalence was calculated and the differences between individuals with and without hidradenitis suppurativa were determined by bivariate analysis. All statistical procedures were performed using SPSS 23.0 for Windows. Of 20,112 people examined, mean age was 43.6 ± 10.5 years; 52.3% were male. In total, n = 57 people (0.3%) with hidradenitis suppurativa were identified; 61.4% (n = 35) being male. In addition, non-inflammatory hidradenitis suppurativa-related lesions were found in 674 other individuals. In a bivariate comparison, patients with hidradenitis suppurativa showed significantly more frequently the following cutaneous comorbidities: acne vulgaris, psoriasis, seborrhoeic dermatitis, excoriations, and folliculitis. We determined a point prevalence of hidradenitis suppurativa of 0.3%. Since we have examined the working population, the healthy worker effect, which could have led to underestimation of prevalence, cannot be ruled out. The point prevalence of 0.3% for employed people in Germany and a prevalence of 3.0% for inflammatory and non-inflammatory hidradenitis suppurativa-related lesions show that hidradenitis suppurativa is an important disease for the whole health system.
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Kim HB, Lim SY, Yoon CS, Kim KN. Reconstruction of bilateral inferomedial gluteal defects after resection of hidradenitis suppurativa with symmetrical keystone flaps designed parallel to relaxed skin-tension lines: A case report. Medicine (Baltimore) 2020; 99:e19779. [PMID: 32243413 PMCID: PMC7220192 DOI: 10.1097/md.0000000000019779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Surgical treatment of hidradenitis suppurativa (HS) is challenging. Wide excision of affected lesions followed by skin graft or flap coverage has been recommended to achieve remission and prevent recurrence. Herein, we present our experience of bilateral inferomedial gluteal defects coverage using symmetrical keystone flaps (KFs) designed parallel to relaxed skin-tension lines (RSTLs). PATIENT CONCERNS An 18-year-old man was admitted for chronic inflammatory lesions in both inferomedial gluteal areas. DIAGNOSES Physical examination revealed multiple sinuses with broad surrounding scars in both inferomedial gluteal areas, which led to a diagnosis of HS. INTERVENTIONS We performed wide excision on all affected lesions. The size of the final defects was 6 × 10 cm on the right side, and 5 × 9 cm on the left side. We covered the defects with KFs 9 × 15 cm (right) and 8 × 12 cm (left), which were based on the hotspots of the interior gluteal artery and internal pudendal artery perforators, and parallel to RSTLs. OUTCOMES The flaps were inset without tension on each side, and the donor sites were closed primarily. All flaps fully survived and there were no postoperative complications. The patient was satisfied with the final outcome after 6 months of follow-up. LESSONS Successful reconstruction of bilateral inferomedial gluteal defects was achieved after resection of HS using symmetrical KFs designed parallel to RSTLs. The KF technique considering RSTLs could be a good reconstructive option for gluteal HS.
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Affiliation(s)
- Hyo Bong Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon
| | - Soo Yeon Lim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon
| | - Chi Sun Yoon
- Department of Plastic and Reconstructive Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Kyu Nam Kim
- Department of Plastic and Reconstructive Surgery, Konyang University Hospital, University of Konyang College of Medicine, Myunggok Medical Research Center, Daejeon
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Abstract
Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. The estimated prevalence of HS is ~1% in most studied countries. Typically starting in early adulthood, cutaneous inflamed nodules, abscesses and pus-discharging tunnels develop in axillary, inguinal, gluteal and perianal body sites. The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1β and IL-17. The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients' quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.
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Kluger N, Nuutinen P, Lybeck E, Ruohoalho T, Salava A. Type 2 diabetes mellitus in a cohort of Finnish patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34:e98-e100. [DOI: 10.1111/jdv.16010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- N. Kluger
- Department of Dermatology, Allergology and Venereology Helsinki University Hospital Helsinki Finland
| | - P. Nuutinen
- Department of Dermatology, Allergology and Venereology Helsinki University Hospital Helsinki Finland
| | - E. Lybeck
- Department of Dermatology, Allergology and Venereology Helsinki University Hospital Helsinki Finland
| | - T. Ruohoalho
- Department of Dermatology, Allergology and Venereology Helsinki University Hospital Helsinki Finland
| | - A. Salava
- Department of Dermatology, Allergology and Venereology Helsinki University Hospital Helsinki Finland
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Tzellos T, Zouboulis CC. Review of Comorbidities of Hidradenitis Suppurativa: Implications for Daily Clinical Practice. Dermatol Ther (Heidelb) 2020; 10:63-71. [PMID: 31955366 PMCID: PMC6994573 DOI: 10.1007/s13555-020-00354-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent skin inflammatory disease associated with a variety of comorbidities, like reduced quality of life, metabolic syndrome, sexual dysfunction, working disability, axial spondyloarthritis, inflammatory bowel disease, depression, and anxiety. Like psoriasis, HS patients have been found to have higher risk of cardiovascular death and suicide risk. Clinicians should be informed about these comorbidities so that appropriate screening is implemented. All this evidence suggests that for such a chronic, multi-comorbid disease, the use of validated outcomes to assess severity and effect of treatment, along with the use of clinically important patient reported outcomes, is essential. The potential of available treatments to negatively and positively affect these comorbidities should also be taken into account when designing treatment strategies. This review provides an outline of important HS comorbidities with emphasis on possible implications for daily clinical practice.
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Affiliation(s)
- Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway.
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School, Theodor Fontane, Dessau, Germany
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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Phan K, Charlton O, Smith SD. Global prevalence of hidradenitis suppurativa and geographical variation—systematic review and meta-analysis. BIOMEDICAL DERMATOLOGY 2020. [DOI: 10.1186/s41702-019-0052-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Background
There is a significant variation in the reported prevalence of hidradenitis suppurativa (HS), ranging from 0.03–4%. We hypothesized that this significant variation may be due to different prevalence rates of HS according to geographical location as well as sex.
Objective
We aimed to perform a meta-analysis to determine pooled overall prevalence of HS, prevalence stratified according to geographical region and sex.
Materials and methods
A systematic review was performed by searching Ovid Medline, PubMed, Cochrane Library, DARE, and Embase, from inception to August 2018. A systematic review and meta-analysis was performed according to PRISMA guidelines. A meta-analysis of proportions was performed to determined pooled prevalence rates, with meta-regression based on geographic region. Prevalence in males versus females was also performed according to region.
Results
The overall pooled prevalence rate was 0.3% (0.2–0.6%) based on 118,760,093 HS cases available. Subgroup analysis demonstrated prevalence differences, with the highest being in Europe 0.8% (0.5–1.3%), compared to the USA 0.2% (0.1–0.4%), Asia-Pacific 0.2% (0.01–2.2%), and South America 0.2% (0.01–0.9%). Prevalence in males was lower compared to females in the USA (OR 0.403, 95% CI 0.37–0.439, P < 0.001) as well as in Europe (OR 0.635, 95% CI 0.397–1.015, P = 0.08) but not in the Asia-Pacific region (OR 0.936, 95% CI 0.319–2.751, P = 0.78).
Conclusion
Prevalence of HS varies significantly according to the geographical population. This variation is likely attributed to different ethnicity distributions amongst different continents.
Level of evidence
III
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Epicardial fat thickness is ıncreased and associated with disease severity in hidradenitis suppurativa. Arch Dermatol Res 2020; 312:467-472. [DOI: 10.1007/s00403-019-02032-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022]
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and acne vulgaris and conglobata—systematic review and meta-analysis. BIOMEDICAL DERMATOLOGY 2019. [DOI: 10.1186/s41702-019-0045-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder which involves painful nodules and draining abscesses in flexural areas. Acne vulgaris and its more severe variants including acne conglobata and acne fulminans are also disorders involving the follicular unit. Given that follicular obstruction, dilatation and inflammation feature in both HS and acne vulgaris/conglobata, it has been suggested that HS is associated with acne vulgaris/conglobata.
Methods
The present systematic review and meta-analysis was performed according to recommended PRISMA guidelines. All eligible case-control studies comparing patients with HS vs non-HS were included in the present review. All studies must have included either the proportion of patients with acne vulgaris/conglobata in each group, or the summary effect size for association between HS and acne vulgaris/conglobata. The odds ratio (OR) was used as a summary statistic.
Results
From pooled unadjusted meta-analysis, we found a significantly higher proportion of patients with acne vulgaris/conglobata in HS cases compared to controls (OR 3.44, 95% CI 1.95–6.07, P < 0.0001, I2 = 100%). Pooled meta-analysis was also performed with adjusted effect sizes. This demonstrated that HS was significantly associated with acne vulgaris/conglobata after adjustment for potential confounders (OR 3.44, 95% CI 2.43–4.87, P < 0.00001, I2 = 99%).
Conclusions
In summary, a significant association was found between HS and acne vulgaris/conglobata. This has implications in terms of understanding the burden of disease on patient quality of life as well as consideration of optimal management strategies to target both disorders. Physicians taking care of patients with HS should be aware of this association.
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69
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Horissian M, Maczuga S, Kirby JS, Nelson AM. Increased risk of alopecia areata for people with hidradenitis suppurativa in a cross-sectional study. J Am Acad Dermatol 2019; 81:1431-1432. [DOI: 10.1016/j.jaad.2019.05.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022]
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70
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Earwax of patients with hidradenitis suppurativa: A retrospective study. Arch Plast Surg 2019; 46:566-571. [PMID: 31775210 PMCID: PMC6882705 DOI: 10.5999/aps.2019.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/19/2019] [Indexed: 11/08/2022] Open
Abstract
Background In Western nations, hidradenitis suppurativa (HS) typically affects the apocrine gland-bearing skin of people of African origin, women, smokers, and individuals with obesity. The clinical characteristics of HS in Korea and Japan, however, are reportedly different from those in the West. We therefore hypothesized that wet earwax is associated with HS because most East Asian people are genetically predisposed to produce dry earwax. Methods The medical charts of 53 Japanese patients with HS were reviewed retrospectively. Results Unlike the results of surveys conducted in Western nations, most of our patients were men (72%), whose buttocks were the most commonly affected site. Apocrine gland-bearing areas, such as the axilla, were affected less often. The proportion of HS patients with wet earwax was 51%, which was substantially higher than that found in the general Japanese population. Moreover, when patients with gluteal HS were excluded, the proportion of patients with wet earwax became even higher (68%). Conclusions Although the etiology of HS is unknown, our survey indicated that HS in apocrine gland-bearing skin, such as the axillary and anogenital areas, may be associated with wet earwax. As this study was conducted in a limited clinical setting, a nationwide, multicenter survey is warranted to clarify the clinical characteristics of HS in Japan.
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71
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Phan K, Tatian A, Woods J, Cains G, Frew JW. Prevalence of inflammatory bowel disease (IBD) in hidradenitis suppurativa (HS): systematic review and adjusted meta‐analysis. Int J Dermatol 2019; 59:221-228. [DOI: 10.1111/ijd.14697] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/07/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Kevin Phan
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
- Faculty of Medicine University of New South Wales Sydney Australia
| | - Artiene Tatian
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
| | - Jane Woods
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
| | - Geoffrey Cains
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
| | - John W. Frew
- Department of Dermatology Liverpool Hospital Liverpool Sydney Australia
- Faculty of Medicine University of New South Wales Sydney Australia
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Kjærsgaard Andersen R, Saunte SK, Jemec GBE, Saunte DM. Psoriasis as a comorbidity of hidradenitis suppurativa. Int J Dermatol 2019; 59:216-220. [DOI: 10.1111/ijd.14651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Rune Kjærsgaard Andersen
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - Sara K. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Gregor B. E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - Ditte M. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
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73
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Phan K, Huo YR, Charlton O, Smith SD. Hidradenitis Suppurativa and Thyroid Disease: Systematic Review and Meta-Analysis. J Cutan Med Surg 2019; 24:23-27. [DOI: 10.1177/1203475419874411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful nodules, sinus tracts, and significant scarring. Although the pathogenesis of this disease is not well established, there is increasing evidence to suggest that it is an immune-mediated disorder. Previous studies have suggested a relationship between HS and thyroid disease, which is also driven by an autoimmune process. We sought to assess whether an association exists between HS and thyroid disease. Objectives: To determine whether HS is associated with thyroid disease via meta-analysis of case-control studies. Methods: A systematic review and meta-analysis was performed according to recommended PRISMA guidelines. Electronic searches were performed using 6 electronic databases from their inception until August 2018. Data were extracted and analyzed according to predefined clinical endpoints. Odds ratio (OR) was used as the summary effect size. Results: We identified 5 case-controls studies included for meta-analysis. There were a total of 36 103 HS cases compared with 170 517 control cases. We found a significant association between HS and thyroid disease (OR 1.36, 95% CI 1.13-1.64, I 2 = 78%, P = .001). Conclusions: This pooled analysis of existing case-control studies to date supports an association between HS and any thyroid disease. Clinicians treating patients with HS should be aware of this potential association with thyroid disease.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ya Ruth Huo
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Olivia Charlton
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Saxon D. Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Australia
- The Dermatology and Skin Cancer Centre, Gosford and St Leonards, Sydney, Australia
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Morita A, Takahashi H, Ozawa K, Imafuku S, Nakama T, Takahashi K, Matsuyama T, Okubo Y, Kitamura S, Matsuda N, Zhao Y, Yokoyama M, Hayashi N, Terui T. Twenty-four-week interim analysis from a phase 3 open-label trial of adalimumab in Japanese patients with moderate to severe hidradenitis suppurativa. J Dermatol 2019; 46:745-751. [PMID: 31282051 PMCID: PMC6771639 DOI: 10.1111/1346-8138.14997] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 05/23/2019] [Indexed: 12/30/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent painful inflamed nodules/abscesses and draining fistulas that negatively impact quality of life. Adalimumab, a monoclonal antibody against tumor necrosis factor‐α, has been approved in the EU, USA and Japan for the treatment of moderate to severe HS. This is an interim analysis of an ongoing phase 3, multicenter, open‐label, single‐arm study of the safety and efficacy of adalimumab weekly dosing in Japanese patients with moderate to severe HS. Fifteen patients received adalimumab 160 mg at week 0, 80 mg at week 2 and 40 mg every week thereafter starting at week 4. The fulfillment of Hidradenitis Suppurativa Clinical Response was assessed under adalimumab treatment; clinical response was assessed by skin pain, total abscess and inflammatory nodule count and modified Sartorius score; and quality of life and safety were assessed. At week 12, 86.7% of patients achieved clinical response, with improvements at week 12 across the primary and secondary end points generally sustained through week 24. Adalimumab weekly dosing was generally safe and well tolerated with no new safety findings through week 24. These results suggest that adalimumab is effective and well tolerated in Japanese patients with moderate to severe HS.
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Affiliation(s)
- Akimichi Morita
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Kentaro Ozawa
- National Hospital Organization Osaka National Hospital, Osaka, Japan
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75
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Lee J, Bae J. Response to ‘Korean gender differences in hidradenitis suppurativa: nature or nurture?’. J Eur Acad Dermatol Venereol 2019; 33:e257. [DOI: 10.1111/jdv.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J.H. Lee
- Department of Dermatology St. Vincent's Hospital College of Medicine The Catholic University of Korea 93, Jungbu‐daero Paldal‐gu, Suwon 16247 Korea
| | - J.M. Bae
- Department of Dermatology St. Vincent's Hospital College of Medicine The Catholic University of Korea 93, Jungbu‐daero Paldal‐gu, Suwon 16247 Korea
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76
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and metabolic syndrome - systematic review and adjusted meta-analysis. Int J Dermatol 2019; 58:1112-1117. [PMID: 31148159 DOI: 10.1111/ijd.14500] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/06/2019] [Accepted: 04/28/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating and distressing chronic systemic inflammatory skin disease. There have been several prior observational studies which reported a possibility link between HS and metabolic syndrome, however the current evidence is not definitive. It is unclear in HS whether this possible relationship is independent or driven by underlying risk factors and comorbidities. OBJECTIVE To determine whether HS is independently associated with metabolic syndrome via adjusted meta-analysis of case-control studies. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. Electronic searches were performed using six electronic databases (Ovid Medline, PubMed, CCTR, CDSR, ACP Journal Club, and DARE) from their inception until September 2018. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS We identified six case-control studies included for meta-analysis. Based on unadjusted analysis, we found a significant association between adult cases of HS and metabolic syndrome (OR 1.95, 95% CI 1.31-2.89, P = 0.001). Adjusted meta-analysis, after adjustment for age, sex, other cardiovascular risk factors, and comorbidities, found a significant association (OR 2.19, 95% CI 1.70-2.81, I2 = 32%, P < 0.00001). LIMITATIONS Studies reviewed were observational by design which are susceptible to bias, and there was lack of randomization. The quality of the current systematic review is also limited by the quality of available evidence which was predominantly observational in nature. CONCLUSIONS This pooled analysis of existing case-control studies supports an association between HS and metabolic syndrome. Clinicians treating patients with HS should be aware of this potential association.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Olivia Charlton
- Department of Dermatology, Royal North Shore Hospital, Saint Leonards, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, Saint Leonards, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Gosford, Australia
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Happle R. Korean gender differences in hidradenitis suppurativa: nature or nurture? J Eur Acad Dermatol Venereol 2019; 33:e256. [DOI: 10.1111/jdv.15507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- R. Happle
- Universitaets‐Hautklinik Hauptstr. 7 79104 Freiburg Germany
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Patel K, Rastogi S, Singam V, Lee H, Amin A, Silverberg J. Association between hidradenitis suppurativa and hospitalization for psychiatric disorders: a cross‐sectional analysis of the National Inpatient Sample. Br J Dermatol 2019; 181:275-281. [DOI: 10.1111/bjd.17416] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 01/05/2023]
Affiliation(s)
- K.R. Patel
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611U.S.A
| | - S. Rastogi
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611U.S.A
| | - V. Singam
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611U.S.A
| | - H.H. Lee
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611U.S.A
| | - A.Z. Amin
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL 60611U.S.A
| | - J.I. Silverberg
- Department of Dermatology, Preventive Medicine and Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL 60611 U.S.A
- Northwestern Medicine Multidisciplinary Eczema Center Chicago IL U.S.A
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79
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and diabetes mellitus: updated systematic review and adjusted meta-analysis. Clin Exp Dermatol 2019; 44:e126-e132. [PMID: 30730068 DOI: 10.1111/ced.13922] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating and distressing chronic inflammatory skin disease. There is also evolving evidence supporting the association between HS and cardiovascular risk factors, including smoking, obesity, hyperlipidaemia and metabolic syndrome. Notably, these are clinical features and risk factors that are closely associated with type 2 diabetes mellitus (DM). AIMS We performed a pooled adjusted meta-analysis of comparative studies to investigate the relationship between HS and DM. METHODS A systematic review and meta-analysis was performed according to recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OR was used as the summary effect size. RESULTS From pooled analysis of unadjusted data from 12 studies, we found a significantly higher proportion of DM in HS cases compared with non-HS healthy controls (16.1% vs. 15.7%; OR = 2.17; 95% CI 1.85-2.55; P < 0.001). Adjusted effect sizes from five studies were also pooled. A significantly higher proportion of DM was found for HS compared with healthy controls, although the effect size was attenuated compared with unadjusted analyses (OR 1.69; 95% CI 1.50-1.91; P < 0.001). CONCLUSIONS To our knowledge, our systematic review and meta-analysis is the first to pool adjusted effect sizes. We found that HS was associated with a 1.69-fold increased odds of diabetes; however, the absolute risk difference was small (16.1% vs. 15.7%) and is probably not clinically relevant. Treating clinicians should be aware of this association, but there may not be an urgent need to perform screening for impaired glucose tolerance or diabetes.
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Affiliation(s)
- K Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - O Charlton
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - S D Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Gosford and St Leonards, Sydney, Australia
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80
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Tannenbaum R, Strunk A, Garg A. Overall and subgroup prevalence of pyoderma gangrenosum among patients with hidradenitis suppurativa: A population-based analysis in the United States. J Am Acad Dermatol 2019; 80:1533-1537. [PMID: 30738122 DOI: 10.1016/j.jaad.2019.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 01/30/2019] [Accepted: 02/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) and pyoderma gangrenosum (PG) are reported to coexist, although the prevalence of PG among patients with HS has not been systematically evaluated. OBJECTIVE To evaluate PG prevalence among patients with HS. METHODS Cross-sectional analysis of adults with PG among patients with HS and patients without HS through use of electronic health records data from a population-based sample of 55 million patients. RESULTS The prevalence of PG among 68,232 patients with HS was 0.18% (125 of 68,232), compared with 0.01% (1835 of 31,435,166) among those without HS (P < .0001). Prevalence was markedly higher among patients with HS and Crohn's disease (CD) (3.68%) than among patients with HS but without CD (0.12%). The odds of having PG were 21.14 (95% confidence interval [CI], 17.51-25.51) times greater among patients with HS than among those without HS. Patients with HS with CD had 12.38 (95% CI, 9.15-16.74) times the odds of having PG than did patients without HS but with CD. Among patients without CD, compared with patients without HS, those with HS had 26.51 (95% CI, 21.07-33.36) times the odds of having PG. LIMITATIONS We could not establish HS phenotype among those having coexistent PG, nor could we distinguish syndromic from nonsyndromic cases. CONCLUSION Patients with HS have an increased prevalence of PG, regardless of CD status. Painful ulcerations among patients with HS warrant additional evaluation for PG.
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Affiliation(s)
- Rachel Tannenbaum
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, New York.
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81
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Affiliation(s)
- Ellie Choi
- Division of Dermatology; Department of Medicine; National University Health System; Singapore Singapore
| | - Nisha S. Chandran
- Division of Dermatology; Department of Medicine; National University Health System; Singapore Singapore
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82
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Affiliation(s)
- G B E Jemec
- Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
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