101
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Arenbergerova M, Gkalpakiotis S, Marques E, Arenberger P, Dahmen R, Smetanova A. Corticosteroid rescue therapy in relapsing hidradenitis suppurativa treated with adalimumab. J Eur Acad Dermatol Venereol 2021; 35:e381-e383. [DOI: 10.1111/jdv.17151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 01/24/2023]
Affiliation(s)
- M. Arenbergerova
- Department of Dermatovenereology Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
| | - S. Gkalpakiotis
- Department of Dermatovenereology Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
| | - E. Marques
- Department of Dermatovenereology Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
| | - P. Arenberger
- Department of Dermatovenereology Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
| | - R.A. Dahmen
- Department of Dermatovenereology Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
| | - A. Smetanova
- Department of Dermatovenereology Third Faculty of Medicine Charles University and Kralovske Vinohrady University Hospital Prague Czech Republic
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102
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López-Llunell C, Romaní J, Garbayo-Salmons P, Agut-Busquet E. Vulvar hidradenitis suppurativa: Clinical cross-sectional study of 25 patients. J Dermatol 2021; 48:457-463. [PMID: 33547675 DOI: 10.1111/1346-8138.15728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
Hidradenitis suppurativa (HS) involving the vulva is seldom reported in the gynecological or dermatological literature. The aim of this study was to describe the clinical characteristics of HS with vulvar affectation (VHS) and to compare it with patients without vulvar involvement. A cross-sectional study was conducted in a tertiary academic referral centre in Spain from May 1, 2015 to October 1, 2019. This study included 230 women with HS diagnosed in our hospital, 25 of them had vulvar involvement. In order to clinically characterize patients, demographic factors, comorbidities, clinical features, prescribed treatments and complications were recorded. The VHS group presented later median age of onset and lower body mass index (BMI) (P = 0.048), they mainly belonged to latent class 2 (LC2) and LC3 phenotypes involving groins, perineal and pubic area. A higher incidence of psychiatric disease was found in VHS (32% vs 10.7%). Significant positive association with fistula (P < 0.001), LC2 phenotype (P = 0.014), acne (P = 0.021) and thyroid disease (P = 0.006), and negative association with axillar lesions (P = 0.001) were noted. Ultrasonographical study of vulvar lesions demonstrated that most of them were fistulas with high Doppler signal suggestive of high inflammatory load. In conclusion, VHS is mostly seen in women with later onset and lower BMI and higher incidence of psychiatric disease compared to those without vulvar involvement. It is clinically characterized by the presence of fistulas and barely absent axillary involvement. Early diagnosis and treatment could be essential to prevent complications and quality of life impairment.
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Affiliation(s)
- Cristina López-Llunell
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
| | - Jorge Romaní
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
| | - Patricia Garbayo-Salmons
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
| | - Eugènia Agut-Busquet
- Department of Dermatology, Hospital de la Santa Creu i de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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103
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Condamina M, Penso L, Tran VT, Hotz C, Guillem P, Villani AP, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts. Dermatology 2021; 237:748-758. [PMID: 33503635 DOI: 10.1159/000513447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in "real-life" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in "real-life" interventions.
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Affiliation(s)
- Morgane Condamina
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Laetitia Penso
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Claire Hotz
- Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Philippe Guillem
- Department of Visceral and Digestive Surgery, Val d'Ouest Clinic, Écully, France.,RésoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation, Dessau, Germany.,Groupe de Recherche en Proctologie de la Société Nationale Française de Coloproctologie, Paris, France
| | | | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - Marie-France Bru
- Patient Member of the Scientific Committee of ComPaRe Verneuil Disease, Paris, France
| | - Eric Jacquet
- Department of Visceral Surgery, Beau Soleil Clinic, Montpellier, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Hervé Bachelez
- Department of Dermatology-Venereology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM U1163, Imagine Institute, Paris, France
| | - Pierre Wolkenstein
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France.,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Marie Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Dermatology Department, University Hospital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Emilie Sbidian
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France, .,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France, .,INSERM, Centre d'Investigation Clinique 1430, Créteil, France,
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104
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Cuenca-Barrales C, Montero-Vilchez T, Salvador-Rodríguez L, Sánchez-Díaz M, Arias-Santiago S, Molina-Leyva A. Implications of Hidradenitis Suppurativa Phenotypes in Cardiovascular Risk and Treatment Decisions: A Retrospective Cohort Study. Dermatology 2021; 237:727-732. [PMID: 33477150 DOI: 10.1159/000513044] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND New integrative hidradenitis suppurativa (HS) lesion pattern phenotypes have been proposed, an inflammatory phenotype (IP) and a follicular phenotype (FP). They are characterized by different lesion patterns, symptoms, and risks of disease progression. OBJECTIVES To evaluate whether lesion pattern phenotypes (1) have a different cardiovascular risk factor profile, and (2) are associated with a different therapeutic approach in the setting of an HS clinic. METHODS A retrospective cohort study was conducted on 233 patients with HS. They were classified according to lesion pattern phenotype criteria. Data regarding cardiovascular risk factors and treatment decisions were gathered. RESULTS One hundred and seventeen HS patients (50.21%) were classified as FP and 112 (48.07%) as IP. IP was associated with more severe disease and greater impairment of quality of life. Regardless of disease severity, patients with IP may have a higher cardiovascular risk, assessed according to higher C-reactive protein (CRP) levels (12.75 vs. 5.89, p = 0.059). The lesion pattern phenotype also influenced treatment decisions regardless of disease severity. Patients with IP were more likely to be treated with systemic corticosteroids and adalimumab, showing that lesion pattern phenotypes are associated with different therapeutic approaches. CONCLUSIONS IP is associated with higher CRP values, suggesting a greater cardiovascular risk in these patients and also a different therapeutic approach. This information could help guide dermatologists in the management of HS patients and help to determine future treatment recommendations.
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Affiliation(s)
- Carlos Cuenca-Barrales
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Trinidad Montero-Vilchez
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Luis Salvador-Rodríguez
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Manuel Sánchez-Díaz
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain, .,Instituto de Investigación Biosanitaria Granada, Granada, Spain,
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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105
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Dahmen RA, Lautenschlager S. [CME Dermatology 23: Hidradenitis suppurativa]. PRAXIS 2021; 110:363-372. [PMID: 34019444 DOI: 10.1024/1661-8157/a003693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME Dermatology 23: Hidradenitis suppurativa Abstract. Hidradenitis suppurativa (Acne inversa) is a chronic skin disease characterized by recurrent inflammatory nodules, abscesses, and scarring mainly in the intertriginous areas. The prevalence is estimated to be 0.05 to 4.1 % worldwide, with women being more commonly affected. The exact pathogenesis remains unknown, but hair follicle occlusion and inflammation seem to be the initiating events. Several epidemiological correlations with smoking and obesity as well as mutations in gamma secretase genes were described. The therapy depends on the extension of the disorder and should respect the current guidelines. Topical clindamycin is suitable for mild forms of the disease whereas moderate to severe disease requires systemic anti-inflammatory treatment. Surgical intervention is currently the only definitive treatment for hidradenitis suppurativa.
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Affiliation(s)
- Robert A Dahmen
- Institut für Dermatologie und Venerologie, Stadtspital Waid und Triemli, Zürich
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106
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Karvar M, Panayi AC, Alavi A, Baziar Z, Orgill DP. Trends in the management of hidradenitis suppurativa in the Middle East region: a systematic review. Int J Dermatol 2020; 60:e440-e448. [PMID: 33615455 DOI: 10.1111/ijd.15293] [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: 07/23/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, painful, and severely debilitating inflammatory disease that affects apocrine gland-bearing skin. There is no universal consensus on the management of hidradenitis suppurativa (HS). Current available guidelines are from western countries, which may be of limited use in other parts of the world. In this study, we aim to identify trends in the management of HS in the Middle East (ME) and its differences with the West. METHODS A systematic literature review was performed to identify all studies in HS management performed by experts in the ME from database inception to June 2020 using PubMed, EMBASE, and Cochrane Library databases. Only original articles published in English language were included. Guidelines from western countries were used for comparison. RESULTS Fifty-four eligible studies comprising 7649 HS patients from the ME region and nine guidelines from the West were included. No established guidelines were found for the management of HS in the ME. Sex ratio of HS patients in the ME is different in that men reported to be affected at a higher rate than in the West. Different antibiotic regimens were recommended in the ME, and the experts in the ME tend to be more procedure intensive than experts in the West. CONCLUSIONS Establishing a guideline for HS management in the ME is recommended to address unique considerations in the countries in this region.
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Affiliation(s)
- Mehran Karvar
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Adriana C Panayi
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Afsaneh Alavi
- Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Zahra Baziar
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dennis P Orgill
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
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107
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Holm JG, Jørgensen AR, Yao Y, Thomsen SF. Certolizumab pegol for hidradenitis suppurativa: Case report and literature review. Dermatol Ther 2020; 33:e14494. [DOI: 10.1111/dth.14494] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Jesper Grønlund Holm
- Department of Dermato‐Venereology and Wound Healing Center Bispebjerg Hospital Copenhagen Denmark
| | | | - Yiqiu Yao
- Department of Dermato‐Venereology and Wound Healing Center Bispebjerg Hospital Copenhagen Denmark
| | - Simon Francis Thomsen
- Department of Dermato‐Venereology and Wound Healing Center Bispebjerg Hospital Copenhagen Denmark
- Department of Biomedical Sciences University of Copenhagen Copenhagen Denmark
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108
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Montero‐Vilchez T, Martinez‐Lopez A, Salvador‐Rodriguez L, Molina‐Leyva A, Arias‐Santiago S. Management of patients with hidradenitis suppurativa during the
COVID
‐19 pandemic. Dermatol Ther 2020; 33:e13875. [PMID: 32558071 PMCID: PMC7323050 DOI: 10.1111/dth.13875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 01/10/2023]
Affiliation(s)
| | - Antonio Martinez‐Lopez
- Department of Dermatology, Hospital Universitario Virgen de las Nieves Granada Spain
- Instituto de Investigación Biosanitaria (ibs.Granada) Granada Spain
| | | | - Alejandro Molina‐Leyva
- Department of Dermatology, Hospital Universitario Virgen de las Nieves Granada Spain
- Instituto de Investigación Biosanitaria (ibs.Granada) Granada Spain
| | - Salvador Arias‐Santiago
- Department of Dermatology, Hospital Universitario Virgen de las Nieves Granada Spain
- Instituto de Investigación Biosanitaria (ibs.Granada) Granada Spain
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109
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Zouboulis C, Nogueira da Costa A. Drug repurposing through drug–gene interaction profiles for hidradenitis suppurativa/acne inversa treatment. J Eur Acad Dermatol Venereol 2020; 35:e251-e254. [DOI: 10.1111/jdv.16976] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
| | - A. Nogueira da Costa
- Translational Science and Experimental Medicine Early Respiratory and Immunology Biopharmaceuticals R&D AstraZeneca Gothenburg Sweden
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110
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Treatment strategies for hidradenitis suppurativa: real-life data from a tertiary Greek hospital. Arch Dermatol Res 2020; 314:301-305. [PMID: 33094412 DOI: 10.1007/s00403-020-02150-6] [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: 05/02/2020] [Revised: 08/17/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
Hidradenitis suppurativa (HS) is a difficult-to-treat chronic relapsing skin disease, which greatly impacts the quality of life. To bring forward real-life challenges in the decision-making process regarding HS treatment. A retrospective observational study was performed with treatment-related data derived from the HS archive of tertiary hospital-based First Department of Dermatology and Venereology of Aristotle University, Greece. Data were available for 121 patients, 63 men (52.7%) and 58 women (47.93%) with a mean age of 38 years. Doxycycline 100 mg twice daily for 1-2 weeks and then once daily for up to a total of 12 weeks was the most popular treatment choice (80 patients, 66.12%), administered for mild-to-moderate disease. Biologics were the second most frequently prescribed treatment, reserved for moderate-to-severe disease (adalimumab: 26 patients, 14.88%, infliximab: 2 patients, 1.65%). All in all, a wide variety of treatment regimens were implemented, with various combinations of topical and systemic agents. Real-life practice reflects the relative paucity of high-quality evidence regarding HS treatment and the absence of a unanimously preferable therapeutic option, leaving both dermatologists and patients defenceless against disease progress and sequelae.
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111
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Caposiena Caro RD, Molinelli E, Brisigotti V, Offidani A, Bianchi L. Lymecycline vs. clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasonography evaluation. Clin Exp Dermatol 2020; 46:96-102. [PMID: 32683727 DOI: 10.1111/ced.14388] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antibiotic therapy remains the first-line treatment for hidradenitis suppurativa (HS). However, literature data on its comparative clinical efficacy and safety are limited. AIM To investigate the efficacy of tetracycline (lymecycline 300 mg daily) vs. the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) by evaluating and comparing the clinical response at the end of antibiotic treatment (10 weeks). METHODS The study retrospectively analysed 52 patients divided in two groups of 26 patients: Group A received lymecycline and Group B received clindamycin plus rifampicin for 10 weeks. Subjects had mild, moderate and severe HS. The clinical and ultrasonography extent of disease was measured by the Hurley Score, Sonographic Score of Hidradenitis Suppurativa, International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (pain VAS) and Dermatology Life Quality Index (DLQI). The primary outcome was the clinical response at the end of the antibiotic treatment period, according to the Hidradenitis Suppurativa Clinical Response measure. RESULTS Both groups showed a significant improvement in IHS4, pain VAS and DLQI from baseline, but this was more marked in Group A. Reductions in nodule counts were similar between the two groups, whereas the number of abscesses and draining tunnels decreased more in Group B. Disease-free survival was similar between the two groups. CONCLUSION Lymecycline monotherapy and clindamycin plus rifampicin combination are both effective treatments for patients with moderate-severe HS. Nodular-type HS seems to respond better to lymecycline, whereas the abscess/tunnel type seems to respond better to clindamycin plus rifampicin.
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Affiliation(s)
- R D Caposiena Caro
- Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - E Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - V Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - A Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - L Bianchi
- Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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112
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Savage KT, Singh V, Patel ZS, Yannuzzi CA, McKenzie-Brown AM, Lowes MA, Orenstein LAV. Pain management in hidradenitis suppurativa and a proposed treatment algorithm. J Am Acad Dermatol 2020; 85:187-199. [PMID: 32950543 DOI: 10.1016/j.jaad.2020.09.039] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/23/2022]
Abstract
Pain contributes substantially to reduced quality of life in individuals living with hidradenitis suppurativa (HS). Although improved understanding of HS pathogenesis and treatment has resulted in improved evidence-based HS management guidelines, comprehensive pain management guidelines have yet to be developed. Few HS-specific data exist to guide pharmacologic analgesia; however, recognizing HS pain as either acute or chronic and predominantly nociceptive (aching and gnawing pain due to tissue damage) versus neuropathic (burning-type pain due to somatosensory nervous system dysfunction) provides a conceptual framework for applying outside pain management practices to HS management. This article incorporates the best available evidence from the HS and pain literature to propose an HS pain algorithm that integrates psychological, pharmacologic, and complementary and alternative treatment modalities.
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Affiliation(s)
- Kevin T Savage
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Vinita Singh
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia
| | - Zarine S Patel
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | | | | | | | - Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
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113
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Montero-Vilchez T, Salvador-Rodriguez L, Sanchez-Diaz M, Cuenca-Barrales C, Martinez-Lopez A, Arias-Santiago S, Molina-Leyva A. Clinical selection criteria in new clinical trials of hidradenitis suppurativa: External validity and implications on the daily clinical practice. Dermatol Ther 2020; 33:e14254. [PMID: 32860480 DOI: 10.1111/dth.14254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There are an increasing number of biologic drugs in the pipeline for treating hidradenitis suppurativa (HS). Clinical trials for these drugs usually share the same clinical selection criteria. OBJECTIVES (a) To describe the clinical profile of HS patients receiving first-line biologic treatment in an HS clinic setting, (b) to assess how this population would meet clinical criteria to participate in a clinical trial, and (c) to assess treatment effectiveness at week 16 in eligible vs non-eligible patients. METHODS Prospective observational study. Patients were grouped according to their eligibility for clinical trials. The effectiveness of adalimumab was assessed by HiSCR, IHS4-category-change and a-50%-reduction on IHS4 at week 16. RESULTS Thirty-eight patients were included in the study: eight (21.05%) were eligible for clinical trials and 30 (78.95%) were not. The main reason for non-eligibility was not having an AN count ≥5. Both groups presented similar number of draining tunnels. Effectiveness at week 16 was lower in non-eligible than eligible patients when evaluated by HiSCR-response but similar if evaluated by the IHS4-category-change or the 50%-reduction in IHS4. CONCLUSION In our population, the external validity of current eligibility criteria for clinical trials is low. Most patients receiving adalimumab in real-life setting would not be eligible for clinical trials.
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Affiliation(s)
- Trinidad Montero-Vilchez
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Luis Salvador-Rodriguez
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Manuel Sanchez-Diaz
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Carlos Cuenca-Barrales
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Antonio Martinez-Lopez
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain.,Department of Medicine, Granada School of Medicine, Granada University, Granada, Spain
| | - Alejandro Molina-Leyva
- Department of Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria Granada, Granada, Spain.,European Hidradenitis Suppurativa Foundation, Dessau-Roßlau, Germany
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115
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Salvador-Rodríguez L, Arias-Santiago S, Molina-Leyva A. Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa. Sci Rep 2020; 10:13363. [PMID: 32770058 PMCID: PMC7414138 DOI: 10.1038/s41598-020-70176-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022] Open
Abstract
Corticosteroid infiltrations of lesions in hidradenitis suppurativa (HS) appear to be beneficial to acute flares. The aim of this study is to evaluate the effectiveness and safety of ultrasound-assisted intralesional corticosteroid infiltrations to HS lesions. Prospective cohort study between February 2017 and February 2019 on patients with mild to severe HS and one or more inflammatory lesions. The study intervention was ultrasound-assisted intralesional infiltration of triamcinolone acetonide 40 mg/ml. The main outcome was the complete response rate of infiltrated lesions versus non-infiltrated lesions. Two hundred and forty-seven infiltrated inflammatory lesions and 172 non-infiltrated lesions were included. At week 12, 81.1% (30/37) of nodules, 72.0% (108/150) of abscesses and 53.33% (32/60) of draining fistulas presented complete response versus 69.1% (47/68), 54.3% (38/70) and 35.3% (12/34) respectively for the non-infiltrated lesions. The Hurley stage negatively correlated with complete response for abscesses and draining fistulas at - 0.17 (SD 0.06) p < 0.01 and - 0.30 (SD 0.13) p < 0.02 respectively. Ultrasound-assisted corticosteroid infiltration is a useful technique for the treatment of inflammatory HS lesions, with high and sustained response rates, especially for abscesses and small to medium-size simple draining fistulas. The likelihood of response correlates negatively with the Hurley stage.
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Affiliation(s)
- Luis Salvador-Rodríguez
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain
- Instituto de Investigación Sanitaria IBS Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain.
- Instituto de Investigación Sanitaria IBS Granada, Granada, Spain.
| | - Alejandro Molina-Leyva
- Dermatology Department, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de Las Nieves, Avenida de Las Fuerzas Armadas 2, 18014, Granada, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
- Instituto de Investigación Sanitaria IBS Granada, Granada, Spain
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116
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Irrelevance of Panton-Valentine leukocidin in hidradenitis suppurativa: results from a pilot, observational study. Eur J Clin Microbiol Infect Dis 2020; 40:77-83. [PMID: 32767177 PMCID: PMC7782376 DOI: 10.1007/s10096-020-04002-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/30/2020] [Indexed: 12/13/2022]
Abstract
Panton-Valentine leukocidin (PVL) appears to be a virulence factor which, among others, can exacerbate the pathogenicity of Staphylococcus aureus infections, especially inducing severe necrotic, deep-seated skin infections, abscesses, and recurrences. These peculiarities have some overlaps with hidradenitis suppurativa (HS). Our main aim was to assess if S. aureus producing PVL could have some role in influencing clinical features and/or course of HS, specifically in the suppuration and recurrence of lesions. This pilot, mono-centric, observational study included all adult subjects affected with HS consecutively referring to our HS clinic over a 3-month period. Clinically evident suppuration and at least 2 weeks wash out from any antibiotic were the main inclusion criteria. Purulent material from HS skin lesions was collected with swabs in order to isolate micro-organisms, with specific regard to S. aureus. Detection of PVL was performed by real-time quantitative PCR (RT-qPCR). We also analyzed purulent material from suppurative skin lesions other than HS, as a control. Thirty HS patients were included; 29 purulent lesions (96.7%) harbored at least one bacterial species. Five (16.7%) swab samples were positive for S. aureus, none of which was positive for PVL genes. Among the 30 purulent disorders included as controls, 8 (26.3%) were positive for S. aureus; of these, 4 strains (50%) expressed LPV. The study results seem to exclude the pathogenetic involvement of S. aureus producing PVL in HS; as a result, PVL does not seem to represent a potential target in the future development of HS treatments.
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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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Impact of 970 nm photobiomodulation therapy on wound healing in cellular models of hidradenitis suppurativa. Lasers Med Sci 2020; 36:691-698. [PMID: 32647934 DOI: 10.1007/s10103-020-03097-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
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119
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Marasca C, Tranchini P, Marino V, Annunziata MC, Napolitano M, Fattore D, Fabbrocini G. The pharmacology of antibiotic therapy in hidradenitis suppurativa. Expert Rev Clin Pharmacol 2020; 13:521-530. [DOI: 10.1080/17512433.2020.1762571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Tranchini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Vincenzo Marino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maria Carmela Annunziata
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Davide Fattore
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Hidradenitis suppurativa management using tumor necrosis factor inhibitors in patients younger than 18 years: A series of 12 cases. J Am Acad Dermatol 2020; 83:199-201. [DOI: 10.1016/j.jaad.2020.02.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 11/18/2022]
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Molina-Leyva A. Smart wound closure: A novel technique for the surgical treatment of hidradenitis suppurativa. Dermatol Ther 2020; 33:e13596. [PMID: 32484585 DOI: 10.1111/dth.13596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany.,TECe19-Clinical and Translational Dermatology Investigation Group, Instituto de Investigación Biosanitaria Granada, Granada, Spain
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122
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Hidradenitis Suppurativa: Our Experience with a Surgical Case Management Team. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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123
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Saylor DK, Brownstone ND, Naik HB. Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists. Dermatol Ther (Heidelb) 2020; 10:529-549. [PMID: 32435998 PMCID: PMC7367977 DOI: 10.1007/s13555-020-00391-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 12/28/2022] Open
Abstract
Easily accessible office-based procedures that require minimal resources may facilitate timely surgical management of hidradenitis suppurativa (HS). This review focuses on excision and unroofing as two surgical HS treatments that can be tailored to the outpatient setting. Fifty-five articles were included in our review, representing 3914 patients. The majority were retrospective studies (58%, n = 32), and the studies reported data both across patients and by number of treated lesions. Recurrence rates for unroofing (14.5%) were found to be half that of excision (30%) across patients (p = 0.015) and slightly lower across lesions [20% recurrence vs 26% for excision (p = 0.023)]. Complication rates at the lesion level were also significantly associated with procedure, with rates after excision more than double those after roofing (26% vs. 12%, p < 0.001). The complication rate after combined medical and surgical therapy did not differ between procedures. Studies also suggest that continuing medical therapy in the perioperative period may be associated with improved recurrence rates, although delayed wound healing with biologic therapy has been reported. The existing data are limited by low-quality uncontrolled studies with small sample sizes, variable reporting of outcomes, and lack of uniform definitions for recurrence and remission. Further systematic prospective studies are needed to better compare complication and recurrence rates across these procedures in HS, especially in the context of concomitant medical therapy.
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Affiliation(s)
- Drew K Saylor
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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Hidradenitis Suppurative: Our Experience with a Surgical Case Management Team. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:408-412. [PMID: 32408974 DOI: 10.1016/j.ad.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/23/2019] [Accepted: 12/02/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The complexity of hidradenitis suppurativa (HS) treatment calls for a multidisciplinary approach. We therefore created a multidisciplinary team to manage surgical care. This study aimed to describe the clinical characteristics of the patients we evaluated and the outcomes of the surgical techniques used. MATERIAL AND METHODS Descriptive cross-sectional study of 104 patients evaluated by our surgical case management team between September 2015 and July 2018. RESULTS Surgery was used to treat 46% of the patients with HS who were evaluated. Most were men (73%) with no family history of HS (63%) and smokers or former smokers (76%). Gluteal HS comprised the largest phenotype group (41%) and the majority of cases were serious (Hurley stage II, 36%; stage III, 46%). The anatomical regions with the largest number of lesions were the axillae (51.9%) and the groin (41.3%). Surgery was most often performed in the axilla (38.3%), followed by the gluteus (23.4%). The most common drug treatment was a combination of rifampicin and clindamycin, Deroofing was the technique used most often (in 48% of the patients who underwent surgery). Postoperative outcomes were assessed as satisfactory overall in 63.4% of the cases. The HS lesion recurred in 20% and 12% developed wound dehiscence. CONCLUSIONS Our experience leads us to recommend forming multidisciplinary teams to improve communication between specialists, provide tailored treatment for the patient with HS, and improve follow-up.
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125
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Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I. Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice. Dermatology 2020; 236:393-412. [PMID: 32408306 PMCID: PMC8177083 DOI: 10.1159/000507323] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS. SUMMARY This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,
| | - Tien V Nguyen
- Bellevue Dermatology Clinic and Research Center, Bellevue, Washington, USA
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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126
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Penno CA, Jäger P, Laguerre C, Hasler F, Hofmann A, Gass SK, Wettstein-Ling B, Schaefer DJ, Avrameas A, Raulf F, Wieczorek G, Lehmann JCU, Loesche C, Roth L, Röhn TA. Lipidomics Profiling of Hidradenitis Suppurativa Skin Lesions Reveals Lipoxygenase Pathway Dysregulation and Accumulation of Proinflammatory Leukotriene B4. J Invest Dermatol 2020; 140:2421-2432.e10. [PMID: 32387270 DOI: 10.1016/j.jid.2020.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/07/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurring inflammatory dermatosis characterized by abscesses, deep-seated nodules, sinus tracts, and fibrosis in skin lesions around hair follicles of the axillary, inguinal, and anogenital regions. Whereas the exact pathogenesis remains poorly defined, clear evidence suggests that HS is a multifactorial inflammatory disease characterized by innate and adaptive immune components. Bioactive lipids are important regulators of cutaneous homeostasis, inflammation, and resolution of inflammation. Alterations in the lipid mediator profile can lead to malfunction and cutaneous inflammation. We used targeted lipidomics to analyze selected omega-3 and omega-6 polyunsaturated fatty acids in skin of patients with HS and of healthy volunteers. Lesional HS skin displayed enrichment of 5-lipoxygenase (LO)‒derived metabolites, especially leukotriene B4. In addition, 15-LO‒derived metabolites were underrepresented in HS lesions. Changes in the lipid mediator profile were accompanied by transcriptomic dysregulation of the 5-LO and 15-LO pathways. Hyperactivation of the 5-LO pathway in lesional macrophages identified these cells as potential sources of leukotriene B4, which may cause neutrophil influx and activation. Furthermore, leukotriene B4-induced mediators and pathways were elevated in HS lesions, suggesting a contribution of this proinflammatory lipid meditator to the pathophysiology of HS.
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Affiliation(s)
- Carlos A Penno
- Analytical Sciences & Imaging, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Petra Jäger
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Claire Laguerre
- Analytical Sciences & Imaging, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Franziska Hasler
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Andreas Hofmann
- Analytical Sciences & Imaging, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Stephanie K Gass
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, and University of Basel, Basel, Switzerland
| | - Barbara Wettstein-Ling
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, and University of Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, and University of Basel, Basel, Switzerland
| | - Alexandre Avrameas
- Biomarker Development, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Friedrich Raulf
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Grazyna Wieczorek
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Joachim C U Lehmann
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Christian Loesche
- Translational Medicine, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Lukas Roth
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Till A Röhn
- Autoimmunity, Transplantation and Inflammation, Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland.
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127
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Hidradenitis suppurativa. J Am Acad Dermatol 2020; 82:1045-1058. [DOI: 10.1016/j.jaad.2019.08.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
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128
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Montero-Vilchez T, Pozo-Román T, Sánchez-Velicia L, Vega-Gutiérrez J, Arias-Santiago S, Molina-Leyva A. Ustekinumab in the treatment of patients with hidradenitis suppurativa: multicenter case series and systematic review. J DERMATOL TREAT 2020; 33:348-353. [PMID: 32279593 DOI: 10.1080/09546634.2020.1755008] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic debilitating autoinflammatory skin disease. Adalimumab is the only biologic agent available to treat HS, but lack of response is observed in some patients. Ustekinumab may be useful to treat patients with HS who do not respond to adalimumab.Objective: The objectives of this study were: (1) to retrospectively evaluate the therapeutic outcomes of ustekinumab in a multicenter series of patients with HS and (2) to assess all published scientific evidence on its utilization in patients with HS.Methods: We evaluated the therapeutic outcomes of 10 patients with HS treated with ustekinumab and conducted a systematic review of published epidemiological studies on ustekinumab-treated patients with HS.Results: In the case series, an improvement in the Physician Global Assessment score was observed in 70% (7/10) patients and an improvement in the Numerical Pain Rating Scale in 80% (8/10). In the systematic review, clinical improvement in disease severity was reported in 76% (34/45) patients and symptomatic improvement in 84% (38/45). No severe ustekinumab-related adverse event was recorded.Conclusion: These findings suggest that ustekinumab may be an effective and safe option for patients with HS who fail to respond to first-line therapies.
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Affiliation(s)
- T Montero-Vilchez
- Hidradenitis Suppurativa Clinic, Dermatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - T Pozo-Román
- Servicio de Dermatología, Hospital Universitario Rio Ortega, Valladolid, Spain
| | - L Sánchez-Velicia
- Servicio de Dermatología, Hospital Universitario Rio Ortega, Valladolid, Spain
| | - J Vega-Gutiérrez
- Servicio de Dermatología, Hospital Universitario Rio Ortega, Valladolid, Spain
| | - S Arias-Santiago
- Hidradenitis Suppurativa Clinic, Dermatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - A Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain.,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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129
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Salvador-Rodriguez L, Montero-Vílchez T, Arias-Santiago S, Molina-Leyva A. Paradoxical Hidradenitis Suppurativa in Patients Receiving TNF-α Inhibitors: Case Series, Systematic Review, and Case Meta-Analysis. Dermatology 2020; 236:307-313. [PMID: 32135533 DOI: 10.1159/000506074] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 01/17/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIMS TNF-α inhibitors represent the most advanced approved therapeutic option for moderate and severe forms of hidradenitis suppurativa (HS). However, in recent years, cases of paradoxical HS secondary to the use of these biological drugs have been described, with very few cases reported in the literature. The aims of this study are (1) to present 2 new cases of paradoxical HS and (2) to perform a systematic review of scientific evidence regarding paradoxical HS with TNF-α inhibitors. MATERIAL AND METHODS This is a retrospective study in which we searched all the cases of paradoxical HS secondary to the use of TNF-α inhibitors published in the literature and included two additional cases observed in our clinical practice. RESULTS A total of 34 patients under TNF-α inhibitor treatment were included (adalimumab = 21; infliximab = 9; etanercept = 4). The median delay from exposure to TNF-α inhibitor and the development of paradoxical HS was 12 months (range 1-72). The majority of patients were Hurley stage II (58.8%). Clinical improvement and complete remission were more frequent when the TNF-α inhibitor was stopped or switched to another biological agent with a different therapeutic target rather than maintenance or change to another TNF-α inhibitor. CONCLUSIONS Paradoxical HS is an unusual adverse effect of TNF-α inhibitors. When this adverse effect appears, interruption or substitution of treatment is associated with a better clinical outcome.
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Affiliation(s)
- Luis Salvador-Rodriguez
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain
| | - Trinidad Montero-Vílchez
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain.,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain
| | - Salvador Arias-Santiago
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain, .,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, 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.,Instituto de Investigación Biosanitaria, Ibs Granada, Granada, Spain
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130
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Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis Suppurativa: Current Understanding of Pathogenic Mechanisms and Suggestion for Treatment Algorithm. Front Med (Lausanne) 2020; 7:68. [PMID: 32195261 PMCID: PMC7064439 DOI: 10.3389/fmed.2020.00068] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/14/2020] [Indexed: 12/18/2022] Open
Abstract
Hidradenitis suppurativa is one of the most distressing dermatological conditions and has a significant negative impact on patients' quality of life. However, the exact pathogenic mechanisms remain incompletely understood and-therefore-efficient therapies are still lacking. The current manuscript focuses on new findings on its pathogenic mechanisms and aims to provide practical therapy recommendations.
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131
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Chiricozzi A, Micali G, Veraldi S. The patient journey: a voyage from diagnosis to hidradenitis suppurativa multidisciplinary unit. J Eur Acad Dermatol Venereol 2020; 33 Suppl 6:15-20. [PMID: 31535760 DOI: 10.1111/jdv.15850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory, recurrent and debilitating chronic skin disease that is often worsened by comorbidities, with a destructive impact on the social and working life of the patient. The low awareness of patients and clinicians regarding HS, together with weak coordination between specialists who manage the clinical care of these patients, may result in a burdening diagnostic and therapeutic delay, lowering efficacy of therapies and worsening prognosis and patients' QoL. OBJECTIVES To rule out these critical aspects, a HS-Multidisciplinary Unit with a hierarchical organization is proposed. METHODS Based on previously published models of a multidisciplinary unit, a hierarchical structure of a HS-dedicated multidisciplinary unit was designed. RESULTS In this model, an operational core constituted by four healthcare professionals constantly working as team, is supported by a large panel of consultants, local dermatologists and general practitioners, helping in HS patient management. CONCLUSIONS This standardization would imply an optimization of professional resources, an amelioration of patient's quality of life, and a shortening of patient journey.
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Affiliation(s)
- A Chiricozzi
- Institute of Dermatology, Catholic University, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - S Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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132
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Prignano F, Pescitelli L, Giani I, Dini V, Romanelli M. Tuscan consensus on the diagnosis and treatment of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 33 Suppl 6:21-24. [PMID: 31535762 DOI: 10.1111/jdv.15825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND A rationalized model of clinical and therapeutic management of hidradenitis suppurativa (HS) should place the patients at the heart of the process, facilitating their access to diagnostic tests and treatments, providing the appropriate care for each grade of disease severity and optimizing the use of healthcare resources, both in economic and human terms. MATERIAL AND METHODS This paper reports the results of a Consensus of the Tuscany HS working group for a rationalized model of diagnosis and management of HS. RESULTS The diagnostic and therapeutic protocols, the available technological equipments and the management models, are presented in the light of today's scientific evidence. CONCLUSION The goal of the Consensus is to bring the issue of HS management to the attention of the Tuscan regional government, in order to create unanimously accepted diagnostic and therapeutic protocols.
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Affiliation(s)
- F Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - L Pescitelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - I Giani
- Proctologic Unit, Department of General Surgery, Santo Stefano Hospital, Prato, Italy
| | - V Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M Romanelli
- Department of Dermatology, University of Pisa, Pisa, Italy
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133
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Kucinskiene V, Jariene V, Valiukeviciene S. Clinical Characteristics of Hidradenitis Suppurativa Patients from a Reference Centre in Kaunas, Lithuania. Dermatology 2020; 236:66-70. [PMID: 31940646 DOI: 10.1159/000505742] [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: 06/01/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Clinical data on hidradenitis suppurativa (HS) derived mainly from studies in Western Europe and the USA, raising the risk of potential selection bias. According to the official data, during 2006-2015 the incidence of HS in Lithuania was 23.5 cases per 100,000 population with a female-to-male ratio of 2:1. A more fine-grained data set would however be of great relevance to further understanding this disease. Collection of standardized data enables the comparison of populations of patients across samples. OBJECTIVES To present a cohort of HS patients with uniformly collected data according to European Hidradenitis Suppurativa Foundation/European Reference Network-Skin recommendations. METHODS The demographic and clinical data of a total of 37 HS patients, included over a 3-year period (from 2016 to January 2019) in a local database of the reference centre of Rare Skin Diseases in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos, were analysed. Non-parametric tests such as χ2 and Mann-Whitney were used for assessing interdependence between qualitative data. Logistic regression analysis was performed to find out the factors statistically related with significant diagnostic delay. RESULTS The mean duration of diagnosis delay was 5.5 (±5.9) years in females and 6.6 (±8.2) years in males. A significant delay (>2 years) was reported in 29/37 (78.4%) cases and was not related with sex, age at HS diagnosis or disease severity. The groin area was more affected in females than in males. There was no statistically significant difference between sex and Hurley stage, HS Physician Global Assessment, International Hidradenitis Suppurativa Severity Score System, visual analogue scale and Dermatology Life Quality Index scores. Combined (medical and surgery) HS treatment was applied to 46.0% and monotherapy (medical or surgery) to 54.0% of patients. CONCLUSIONS Standardized collection of epidemiological and clinical data is required to improve the quality of HS patient data and allow for international comparisons and pooling of data for research purposes.
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Affiliation(s)
- Vesta Kucinskiene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) member, Kaunas, Lithuania
| | - Vaiva Jariene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) member, Kaunas, Lithuania,
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) member, Kaunas, Lithuania
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134
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Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab. Clin Exp Dermatol 2019; 45:438-444. [DOI: 10.1111/ced.14127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 01/03/2023]
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135
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Atzori L, Bonato F, Pilloni L, Rongioletti F. Hidradenitis suppurativa in a patient with Warkany syndrome: Sustainability of adalimumab treatment. Dermatol Ther 2019; 33:e13160. [PMID: 31705612 DOI: 10.1111/dth.13160] [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: 08/21/2019] [Revised: 10/18/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
Mental retardation is a potential limitation to self-administration of innovative biologic treatment, which is otherwise very effective for devastating chronic inflammatory conditions, such as hidradenitis suppurativa (HS). We report our successful experience with a 34-year-old woman, who was genetically affected by Warkany syndrome, which causes intellectual disability. This patient was unable to maintain long-term antibiotic regimen and was disappointed by the limited results in her 12 years' history of painful draining fistulae and abscesses; however, she enthusiastically adhered to adalimumab 40 mg/once weekly treatment. After 52 weeks, treatment compliance is excellent, the patient is satisfied with the HS improvements, and no adverse effects have been reported.
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Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Filippo Bonato
- Dermatology Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Pilloni
- Pathology Unit, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
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136
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Hidradenitis Suppurativa—Diagnosis and Management. J Nurse Pract 2019. [DOI: 10.1016/j.nurpra.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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137
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Hendricks AJ, Hsiao JL, Lowes MA, Shi VY. A Comparison of International Management Guidelines for Hidradenitis Suppurativa. Dermatology 2019; 237:81-96. [PMID: 31645040 DOI: 10.1159/000503605] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that imparts a significant burden on patients and presents a management challenge for healthcare providers. As attention to this debilitating condition has grown over recent years, our understanding of HS pathogenesis and optimal treatment approaches continues to evolve. Nine HS treatment guidelines developed by various expert organizations have been published, encompassing therapeutic modalities ranging from topical agents to systemic therapies to procedural interventions. These guidelines demonstrate significant overlap in treatment recommendations and have all been published within the last 5 years. Therefore, we aim to compare and synthesize the recommendations of international HS treatment guidelines and to encourage inter-organizational communication for the development of consensus or staggered publication of recommendations for HS management.
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Affiliation(s)
| | - Jennifer L Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, California, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Vivian Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona, USA,
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138
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Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Current and emerging treatments. J Am Acad Dermatol 2019; 82:1061-1082. [PMID: 31604100 DOI: 10.1016/j.jaad.2019.08.089] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 12/27/2022]
Abstract
The treatment of hidradenitis suppurativa (HS) has remained challenging because of the many knowledge gaps regarding etiology. However, recent studies into the pathogenesis of HS have enabled the investigation of newer therapies. The second article in this continuing medical education series reviews the evidence for established therapies for HS, including anti-inflammatories, antibiotics, and surgery. New and emerging therapies that specifically target cytokines involved in HS pathogenesis will be covered. The potential therapeutic roles of anticytokine therapies, including both the expanded application of existing molecules as well as the specific development of novel therapies for HS are discussed. With increased attention on HS and with numerous clinical trials currently underway, we hope that the variety of treatment options for HS will be expanded.
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Affiliation(s)
| | - Bruce E Strober
- Central Connecticut Dermatology Research, Cromwell, Connecticut; Yale University, New Haven, Connecticut
| | - Michael J Payette
- University of Connecticut School of Medicine, Farmington, Connecticut; Central Connecticut Dermatology Research, Cromwell, Connecticut; Dermatology Department, Farmington, Connecticut
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139
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Włodarek K, Stefaniak A, Matusiak Ł, Szepietowski J. Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems. Dermatology 2019; 236:8-14. [DOI: 10.1159/000501771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022] Open
Abstract
A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.
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140
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Loh TY, Hendricks AJ, Hsiao JL, Shi VY. Undergarment and Fabric Selection in the Management of Hidradenitis Suppurativa. Dermatology 2019; 237:119-124. [PMID: 31466052 DOI: 10.1159/000501611] [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: 05/14/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory condition manifesting as recurrent and exquisitely painful nodules in intertriginous regions. The role of mechanical stress in HS pathogenesis is gaining attention, as factors including intertriginous distribution of lesions, obesity, sweating, and suboptimal clothing contribute to increased friction and exacerbation of disease. Undergarment and clothing selection are often-overlooked components of HS management and should be addressed with patients as practical lifestyle changes that can decrease the frequency of disease flares and reduce symptoms of pain and irritation at involved sites. Selection of breathable and absorbent fabrics can also aid in reducing microbial colonization, sweat retention, and odor. This discussion is based on expert recommendations and aims to provide practitioners with the rationale for appropriate undergarment and clothing selection for HS patients. We propose practical principles for choosing undergarment design and fabrics for breathability, absorbency, and skin pressure reduction.
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Affiliation(s)
- Tiffany Y Loh
- Division of Dermatology, University of Arizona, Tucson, Arizona, USA
| | | | - Jennifer L Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, California, USA
| | - Vivian Yan Shi
- Division of Dermatology, University of Arizona, Tucson, Arizona, USA,
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141
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Vural S, Gündoğdu M, Akay BN, Boyvat A, Erdem C, Koçyiğit P, Bostancı S, Sanli H, Kundakci N. Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatol Ther 2019; 32:e13003. [DOI: 10.1111/dth.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/08/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Secil Vural
- Koç University School of Medicine, Dermatology Department İstanbul Turkey
| | | | - Bengu N. Akay
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Ayşe Boyvat
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Cengizhan Erdem
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Pelin Koçyiğit
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Seher Bostancı
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Hatice Sanli
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Nihal Kundakci
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
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142
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Romaní J, Vilarrasa E, Martorell A, Fuertes I, Ciudad C, Molina-Leyva A. Ustekinumab with Intravenous Infusion: Results in Hidradenitis Suppurativa. Dermatology 2019; 236:21-24. [PMID: 31288233 DOI: 10.1159/000501075] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022] Open
Abstract
Adalimumab is the only approved biological therapy for hidradenitis suppurativa (HS). The last published recommendations support the use of other off-label biologic therapies. We report on a multicentric retrospective review of patients with HS treated with an ustekinumab dosing schedule of intravenous infusion adjusted by weight, followed by a subcutaneous maintenance dose of 90 mg every 8 weeks, as recently approved for Crohn's disease. The minimal follow-up period required for inclusion was 16 weeks. A total of 14 patients from six hospitals were included. In 50% of the treated patients, therapeutic outcomes, measured by means of the Hidradenitis Suppurativa Clinical Response (HiSCR) and decrease of Dermatology Life Quality Index (DLQI) and visual analog scale (VAS) of pain, were reached at week 16. In 71.42% of patients DLQI and VAS of pain improved, irrespective of achievement of HiSCR. Two patients abandoned treatment due to lack of efficacy or patient preferences. No ustekinumab-related adverse effects were reported. The results are limited by the retrospective nature of the study, the short follow-up period, and the small patient number. This therapeutic regime proved to be safe and showed moderate efficacy in treating HS with failure to previous biologic therapy. Ideally, the efficacy of ustekinumab in HS should be tested in randomized and controlled clinical trials.
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Affiliation(s)
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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143
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Tricarico PM, Boniotto M, Genovese G, Zouboulis CC, Marzano AV, Crovella S. An Integrated Approach to Unravel Hidradenitis Suppurativa Etiopathogenesis. Front Immunol 2019; 10:892. [PMID: 31105704 PMCID: PMC6494959 DOI: 10.3389/fimmu.2019.00892] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022] Open
Abstract
Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory disease involving hair follicles that presents with painful nodules, abscesses, fistulae, and hypertrophic scars, typically occurring in apocrine gland bearing skin. Establishing a diagnosis of HS may take up to 7 years after disease onset. HS severely impairs the quality of life of patients and its high frequency causes significant costs for health care system. HS patients have an increased risk of developing associated diseases, such as inflammatory bowel diseases and spondyloarthropathies, thereby suggesting a common pathophysiological mechanism. Familial cases, which are around 35% of HS patients, have allowed the identification of susceptibility genes. HS is perceived as a complex disease where environmental factors trigger chronic inflammation in the skin of genetically predisposed individuals. Despite the efforts made to understand HS etiopathogenesis, the exact mechanisms at the basis of the disease need to be still unraveled. In this review, we considered all OMICs studies performed on HS and observed that OMICs contribution in the context of HS appeared as not clear enough and/or rich of useful clinical information. Indeed, most studies focused only on one aspect—genome, transcriptome, or proteome—of the disease, enrolling small numbers of patients. This is quite limiting for the genetic studies, from different geographical areas and looking at a few aspects of HS pathogenesis without any integration of the findings obtained or a comparison among different studies. A strong need for an integrated approach using OMICs tools is required to discover novel actors involved in HS etiopathogenesis. Moreover, we suggest the constitution of consortia to enroll a higher number of patients to be analyzed following common and consensus OMICs strategies. Comparison and integration with the findings present in the OMICs repositories are mandatory. In a theoretic pipeline, the Skin-OMICs profile obtained from each HS patient should be compared and integrated with repositories and literature data by using appropriate InterOMICs approach. The final goal is not only to improve the knowledge of HS etiopathogenesis but also to provide novel tools to the clinicians with the eventual aim of offering a tailored treatment for HS patients.
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Affiliation(s)
- Paola M Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Michele Boniotto
- University of Paris Est-Créteil and INSERM U955/IMRB-Team 16, Créteil, France
| | - Giovanni Genovese
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e Dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Angelo V Marzano
- UOC Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e Dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Sergio Crovella
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
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144
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Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, Hirata SH, Ramos AMC. Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:7-19. [PMID: 31166401 PMCID: PMC6544037 DOI: 10.1590/abd1806-4841.20198607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.
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Affiliation(s)
- Renata Ferreira Magalhães
- Discipline of Dermatology, Department of Internal Medicine,
Universidade Estadual de Campinas, Campinas (SP), Brazil
| | | | | | - Roberto Souto
- Dermatology Service, Hospital Universitário Pedro Ernesto,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | - Daniel Holthausen Nunes
- Dermatology Service, Hospital Universitário, Universidade
Federal de Santa Catarina, Florianópolis (SC), Brazil
| | - Mario Chaves
- Dermatology Service, Hospital Universitário Pedro Ernesto,
Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | | | - Andrea Machado Coelho Ramos
- Dermatology Service, Hospital de Clínicas, Universidade
Federal de Minas Gerais, Belo Horizonte (MG), Brazil
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145
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Frew JW, Hawkes JE, Krueger JG. Topical, systemic and biologic therapies in hidradenitis suppurativa: pathogenic insights by examining therapeutic mechanisms. Ther Adv Chronic Dis 2019; 10:2040622319830646. [PMID: 30854183 PMCID: PMC6399757 DOI: 10.1177/2040622319830646] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/16/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin, manifesting in chronic, recurrent painful pustules, nodules, boils and purulent draining abscesses. Our current understanding of the pathogenesis of the disease is incomplete. This review aims to identify available treatment options in HS and discuss the pharmacological mechanisms through which such agents function. Identifying common pathways may inform our understanding of the pathogenesis of HS as well as identify future therapeutic targets. The pharmacological mechanisms implicated in topical therapies, antibiotic, hormonal, systemic immunomodulatory and biologic therapies for HS are discussed. Significant differences exist between agents and implicated pathways in therapy for mild and severe disease. This is an expression of the possible dichotomy in inflammatory pathways (and treatment responses) in HS. Studies involving monoclonal antibodies provide the greatest insight into what these specific mechanisms may be. Their variable levels of clinical efficacy compared with placebo bolsters the suggestion that differential inflammatory pathways may be involved in different presentations and severity of disease. Nuclear factor kappa B (NF-κB), tumor necrosis factor (TNF)-α and other innate immune mechanisms are strongly represented in treatments which are effective in mild to moderate disease in the absence of scarring or draining fistulae, however complex feed-forward mechanisms in severe disease respond to interleukin (IL)-1 inhibition but are less likely to respond to innate immune inhibition (through NF-κB or TNF-α) alone. It is unclear whether IL-17 inhibition will parallel TNF-α or IL-1 inhibition in effect, however it is plausible that small molecule targets (Janus kinase1 and phosphodiesterase 4) may provide effective new strategies for treatment of HS.
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Affiliation(s)
- John W. Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Jason E. Hawkes
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - James G. Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Vossen ARJV, van der Zee HH, Davelaar N, Mus AMC, van Doorn MBA, Prens EP. Apremilast for moderate hidradenitis suppurativa: no significant change in lesional skin inflammatory biomarkers. J Eur Acad Dermatol Venereol 2018; 33:761-765. [PMID: 30451329 PMCID: PMC6590194 DOI: 10.1111/jdv.15354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 01/20/2023]
Abstract
Background Treatment with apremilast has recently demonstrated clinically meaningful improvement in moderate hidradenitis suppurativa (HS). Objective To evaluate the change in expression of inflammatory markers in lesional skin of HS patients receiving apremilast 30 mg twice daily (n = 15) for 16 weeks compared with placebo (n = 5). Methods At baseline, 5‐mm punch biopsies were obtained from an index lesion (HSL) and non‐lesional (HSN) skin in the same anatomical area. Subsequent HSL samples were taken as close as possible to the previously biopsied site at week 4 and week 16. After sampling, biopsies were split; one half was processed for in vivo mRNA analysis using real‐time quantitative PCR; the other half was cultured for ex vivo protein analysis using a proximity extension assay (Olink). Linear mixed effects models were calculated to compare the levels of inflammatory markers in HSL skin between apremilast and placebo over time. Results At baseline, 17 proteins with a fold change >2 in HSL vs. HSN skin were identified in 20 patients. The top five were IL‐17A (5), S100A12, CST5, IL‐12/23p40, CD6 (1) with fold changes ranging from 6.6 to 1638, respectively (FDR <0.044). Linear mixed effects models for 75 assays were calculated. Protein levels of S100A12 decreased during treatment in the apremilast group compared with the placebo group (p = 0.014, FDR = 0.186). None of the 14 genes exhibited significant changes in expression over time. However, an evident downward trend in relative mRNA expression of IL‐17A and IL‐17F was demonstrated in patients receiving apremilast. Conclusion We did not detect statistically significant changes in inflammatory markers in HSL skin of HS patients receiving apremilast compared with placebo, despite clinical improvement in the apremilast group. Nonetheless, S100A12 and IL‐17A were significantly elevated in HSL skin and showed a decrease in response to apremilast. The translational model in clinical trials involving HS clearly needs further improvement.
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Affiliation(s)
- A R J V Vossen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N Davelaar
- Laboratory of Rheumatology & Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A M C Mus
- Laboratory of Rheumatology & Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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