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Nazary M, van der Zee HH, Prens EP, Folkerts G, Boer J. Pathogenesis and pharmacotherapy of Hidradenitis suppurativa. Eur J Pharmacol 2011; 672:1-8. [PMID: 21930119 DOI: 10.1016/j.ejphar.2011.08.047] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/17/2011] [Accepted: 08/26/2011] [Indexed: 12/14/2022]
Abstract
The focus of this review is to discuss the pathogenesis and the pharmacotherapy of Hidradenitis suppurativa (HS). HS is a distressing chronic skin disorder characterized by abscesses, boils, fistulas and scarring, generally affecting the groins, anogenital area and axillae. It is a common disease with an estimated prevalence of 1%. The etiology is unknown. HS was thought to be a disease of the apocrine sweat glands, but histological findings indicate that HS is a disease arising from the hair follicles. Several pathogenic factors seem important including genetic predisposition, smoking, obesity and an aberrant immune response to commensal flora. The management of HS is tremendously challenging because effective therapies are lacking. Nevertheless, HS has been treated with topical and systemic antibiotics, retinoids and immunosuppressive drugs such as anti-TNF-α biologics with partial success. In this review we will also discuss a potential new therapy for HS with the anti-psoriases agent acitretin.
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Affiliation(s)
- Maiwand Nazary
- Division of Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, P.O. Box 80.082, 3508 TB Utrecht, The Netherlands.
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202
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Unal C, Yirmibesoglu OA, Ozdemir J, Hasdemir M. Superior and inferior gluteal artery perforator flaps in reconstruction of gluteal and perianal/perineal hidradenitis suppurativa lesions. Microsurgery 2011; 31:539-44. [DOI: 10.1002/micr.20918] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2010] [Accepted: 04/22/2011] [Indexed: 11/09/2022]
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van Rappard D, Mooij J, Mekkes J. Mild to moderate hidradenitis suppurativa treated with local excision and primary closure. J Eur Acad Dermatol Venereol 2011; 26:898-902. [DOI: 10.1111/j.1468-3083.2011.04203.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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204
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van Rappard DC, Leenarts MFE, Meijerink-van 't Oost L, Mekkes JR. Comparing treatment outcome of infliximab and adalimumab in patients with severe hidradenitis suppurativa. J DERMATOL TREAT 2011; 23:284-9. [PMID: 21756155 DOI: 10.3109/09546634.2011.571657] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic relapsing skin disease. Recent studies have shown promising results of anti-tumor necrosis factor-alpha treatment. OBJECTIVE To compare the efficacy and safety of infliximab and adalimumab in the treatment of HS. METHODS A retrospective study was performed to compare 2 cohorts of 10 adult patients suffering from severe, recalcitrant HS. In 2005, 10 patients were treated with infliximab intravenous (i.v.) (3 infusions of 5 mg/kg at weeks 0, 2, and 6). In 2009, 10 other patients were treated in the same hospital with adalimumab subcutaneous (s.c.) 40 mg every other week. Both cohorts were followed up for 1 year using identical evaluation methods [Sartorius score, quality of life index, reduction of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), patient and doctor global assessment, and duration of efficacy]. RESULTS Nineteen patients completed the study. In both groups, the severity of the HS diminished. Infliximab performed better in all aspects. The average Sartorius score was reduced to 54% of baseline for the infliximab group and 66% of baseline for the adalimumab group. CONCLUSIONS Adalimumab s.c. 40 mg every other week is less effective than infliximab i.v. 5 mg/kg at weeks 0, 2, and 6.
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Affiliation(s)
- Dominique C van Rappard
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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205
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Miller I, Lynggaard CD, Lophaven S, Zachariae C, Dufour DN, Jemec GBE. A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa. Br J Dermatol 2011; 165:391-8. [PMID: 21457202 DOI: 10.1111/j.1365-2133.2011.10339.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES To test the efficacy of adalimumab in HS. METHODS This was a prospective, randomized, double-blinded, placebo-controlled, two-centre clinical trial conducted in Denmark. Inclusion criteria were age above 18 years and a clinical diagnosis of moderate to severe HS defined as Hurley stage II or III for at least 6 months. The patients were randomized 1:2 (placebo/active). Actively treated patients received adalimumab 80 mg subcutaneously (s.c.) at baseline followed by 40 mg s.c. every other week for 12 weeks. Placebo-treated patients received identical-looking injections with no active ingredient. The medicine was dispensed in sequentially numbered computer-randomized containers. Participants, care givers and those assessing the outcomes were blinded to group assignment. The primary efficacy endpoints were changes in the HS scores (Sartorius and Hurley scoring systems). Secondary efficacy endpoints included changes in pain (visual analogue scale), days with lesions and Dermatology Life Quality Index, and evaluation of scarring. Recruitment was terminated early due to expiry date of trial medication. RESULTS Twenty-one patients were included, of whom 15 received adalimumab and six received placebo. All participants were analysed according to the intention to treat principle. A significant reduction was seen in Sartorius score after 6 weeks and an almost significant reduction was seen after 12 weeks of active treatment (-10·7 vs. 7·5, P = 0·024 and -11·3 vs. 5·8, P = 0·07) when compared with the placebo group. CONCLUSIONS A significant reduction in HS severity was gained after 6 weeks. No long-term curative effect was uniformly seen.
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Affiliation(s)
- I Miller
- Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde 4000, Denmark.
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Gulliver W, Jemec G, Baker K. Experience with ustekinumab for the treatment of moderate to severe Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2011; 26:911-4. [DOI: 10.1111/j.1468-3083.2011.04123.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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207
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van der Zee HH, de Ruiter L, van den Broecke DG, Dik WA, Laman JD, Prens EP. Elevated levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-α and IL-1β. Br J Dermatol 2011; 164:1292-8. [PMID: 21332464 DOI: 10.1111/j.1365-2133.2011.10254.x] [Citation(s) in RCA: 333] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The pathogenesis of hidradenitis suppurativa (HS) is largely unknown and the disease is difficult to treat. Patients are in high need of an effective treatment. Although it is not known whether the levels of tumour necrosis factor (TNF)-α are aberrant in HS skin, anti-TNF-α biologics are used, with variable clinical efficacy. OBJECTIVES To determine the cytokine profile in lesional and perilesional HS skin. METHODS We cultured 20 lesional and 10 normal-appearing perilesional HS skin samples, seven psoriasis and six healthy control skin samples in a transwell culture system. Two distinct cytokine bead arrays were used to measure the spectrum of inflammatory cytokines in the culture supernatant. Results from HS skin samples were compared with those of healthy and psoriasis skin. RESULTS The proinflammatory cytokines interleukin (IL)-1β and TNF-α as well as the anti-inflammatory cytokine IL-10 were significantly elevated in HS skin. Elevated levels of these cytokines were also found in perilesional HS skin. Fold increases relative to control skin of IL-1β, TNF-α and IL-10 in HS were 31, 5 and 34, compared with psoriasis: 4, 1 and 2, respectively. Levels of all three cytokines showed a trend towards a positive correlation with disease severity. IL-2, IL-4, IL-5 and interferon-γ were hardly detectable in HS or healthy control skin. CONCLUSIONS This study shows for the first time that IL-1β, TNF-α and IL-10 levels are elevated in HS skin. These data provide a rationale for therapies with biologics targeting cytokines such as TNF-α and IL-1.
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Affiliation(s)
- H H van der Zee
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Abstract
PURPOSE OF REVIEW Hidradenitis suppurativa is a chronic or relapsing inflammatory cutaneous disorder manifested by recurrent formation of abscesses, fistulating sinus and scarring in the apocrine-gland-bearing skin. This review discusses the different aetiological theories and management opportunities. RECENT FINDINGS Current understanding of the pathogenesis suggests that hyperkeratosis of the infundibulum, leading to follicular occlusion of the pilosebaceous unit plays a role. Bacterial infection with staphylococci, Escherichia coli and streptococcus is considered as a secondary event in the pathogenesis. Smoking and obesity are both known as risk factors and are associated with more severe disease course. Recently, more attention has been put into the understanding of the immunopathology of the skin and the results indicate that hidradenitis suppurativa may be considered as an inflammatory disease of unknown cause based on a defect in the hair follicle immunity. The treatments are most appropriately chosen on the basis of disease severity and the existence of any associated risk factors or comorbidities. There are three levels in the management of hidradenitis suppurativa: topical options, systemic options and surgical methods including laser therapy. At each level several treatment principles have shown themselves to be efficient, and may therefore be used either alone or in combination. Therapies are generally effective against microorganisms, inflammation or infundibular hyperkeratosis. Where an antimicrobial therapy is used, the drugs used often have significant additional immunomodulatory effects. SUMMARY The recent studies give us a better insight into the pathogenesis of hidradenitis suppurativa and should translate into improved therapies.
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Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, scarring condition involving the intertriginous skin of the axillary, inguinal, inframammary, genital, and perineal areas of the body. It is also referred to as acne inversa and Verneuil disease. Follicular occlusion is the primary event in HS. It is now accepted that the first pathogenetic change is in the pilosebaceous follicular ducts, like acne, and so there has been a move to rename this disorder acne inversa. Despite the legitimate argument that hidradenitis suppurativa is a misnomer, the term has become generally accepted.
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Happle R, König A. Smoker’s Boils. Dermatology 2011; 222:282-4. [DOI: 10.1159/000327923] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 03/23/2011] [Indexed: 11/19/2022] Open
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Yazdanyar S, Boer J, Ingvarsson G, Szepietowski JC, Jemec GB. Dapsone Therapy for Hidradenitis Suppurativa: A Series of 24 Patients. Dermatology 2011; 222:342-6. [DOI: 10.1159/000329023] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/16/2011] [Indexed: 11/19/2022] Open
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212
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Revuz J. Hidradenitis suppurativa. Presse Med 2010; 39:1254-64. [DOI: 10.1016/j.lpm.2010.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/23/2010] [Accepted: 08/31/2010] [Indexed: 11/30/2022] Open
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Miller IM, Dufour DN, Jemec GBE. Treatment of hidradenitis suppurativa: Is oral isoniazid an option? J DERMATOL TREAT 2010; 23:128-30. [DOI: 10.3109/09546634.2010.509383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van der Zee HH, Prens EP, Boer J. Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions. J Am Acad Dermatol 2010; 63:475-80. [PMID: 20708472 DOI: 10.1016/j.jaad.2009.12.018] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/01/2009] [Accepted: 12/09/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, often refractory to treatment. Patients with HS and dermatologists are in need of an effective, fast surgical intervention technique. Deroofing is a tissue-saving technique, whereby the "roof" of an abscess, cyst, or sinus tract is electrosurgically removed. The use of a probe is mandatory to explore the full extent of a lesion. OBJECTIVE We sought to evaluate the efficacy and patient satisfaction of the deroofing technique for recurrent Hurley I (mild) or II (moderate) graded HS lesions at fixed locations. METHODS An open study consisted of 88 deroofed lesions in 44 consecutive patients with HS, treated by a single clinician with a follow-up time of up to 5 years. RESULTS Fifteen of 88 (17%) treated lesions showed a recurrence after a median of 4.6 months. In all, 73 treated lesions (83%) did not show a recurrence after a median follow-up of 34 months. The median patient satisfaction with the procedure rated 8 on a scale from 0 to 10. Of the treated patients, 90% would recommend the deroofing technique to other patients with HS. One side effect occurred in the form of postoperative bleeding. LIMITATIONS Some patients were lost to follow-up. CONCLUSIONS The deroofing technique is an effective, simple, minimally invasive, tissue-saving surgical intervention for the treatment of mild to moderate HS lesions at fixed locations and it is suitable as an office procedure.
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Affiliation(s)
- Hessel H van der Zee
- Departments of Dermatology and Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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216
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Affiliation(s)
- Marcia Spear
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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218
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Matusiak Ł, Bieniek A, Szepietowski JC. Hidradenitis suppurativa markedly decreases quality of life and professional activity. J Am Acad Dermatol 2010; 62:706-8, 708.e1. [PMID: 20227585 DOI: 10.1016/j.jaad.2009.09.021] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Revised: 09/04/2009] [Accepted: 09/14/2009] [Indexed: 12/30/2022]
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219
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Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol 2010; 62:637-45. [PMID: 20227579 DOI: 10.1016/j.jaad.2009.07.048] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 07/08/2009] [Accepted: 07/08/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving the intertriginous areas. OBJECTIVE We sought to conduct clinical and histopathologic evaluation of the efficacy of long-pulsed neodymium:yttrium-aluminium-garnet laser treatment for HS. METHODS We conducted a prospective, randomized, right-left within-patient controlled trial for HS (n = 22). Four monthly laser sessions were performed. Disease activity was measured at baseline, and treatment response was assessed before each laser session and monthly for 2 months after the completion of laser treatment, using a modified scoring system based on Sartorius score. Histologic examination was performed at baseline, immediately after laser treatment, and at 1 and 4 weeks after treatment. A patient questionnaire was circulated on the last visit to assess patients' level of satisfaction. RESULTS There was progressive improvement in disease activity, most significantly during the 4 months of treatment, which was maintained during the 2-month posttreatment follow-up period. Averaged over all anatomic sites, the percent improvement was 72.7% on the laser treated side, and 22.9% on the control side (P < .05). Histologic examination showed an initial acute neutrophilic infiltrate. Granulomatous inflammation was present on follow-up biopsy specimens 4 weeks later. An inflammatory infiltrate surrounded the hair shaft remnants, denoting destruction of hair follicles. LIMITATIONS Small sample size was a limitation. CONCLUSIONS Long-pulsed neodymium:yttrium-aluminium-garnet laser, together with topical benzoyl peroxide and clindamycin, is significantly more effective than topical benzoyl peroxide and clindamycin alone for the treatment of HS. Preliminary review of histopathology suggests the mechanism of action is destruction of the hair follicle. The overall success of the treatment in both clearing pre-existing lesions and preventing new eruptions, coupled with high patient satisfaction, makes the neodymium:yttrium-aluminium-garnet laser a promising treatment advance for this highly disabling condition.
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Affiliation(s)
- Bassel H Mahmoud
- Mulitcultural Dermatology Center, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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220
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Lasocki A, Sinclair R, Foley P, Saunders H. Hidradenitis suppurativa responding to treatment with infliximab. Australas J Dermatol 2010; 51:186-90. [DOI: 10.1111/j.1440-0960.2010.00623.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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221
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Grant A, Gonzalez T, Montgomery MO, Cardenas V, Kerdel FA. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial. J Am Acad Dermatol 2010; 62:205-17. [PMID: 20115947 DOI: 10.1016/j.jaad.2009.06.050] [Citation(s) in RCA: 267] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND Biologic therapies with anti-tumor necrosis factor agents are promising treatments for hidradenitis suppurativa (HS). OBJECTIVE We assessed the efficacy and safety of infliximab (IFX) for the treatment of moderate to severe HS. METHODS A prospective double-blind treatment phase of 8 weeks where patients received IFX or placebo was followed by an open-label phase where patients taking placebo were given the opportunity to cross over to IFX, and an observational phase. Primary treatment efficacy was based on HS Severity Index. Secondary end points included Dermatology Life Quality Index, visual analog scale, and Physician Global Assessment scores. Inflammatory markers erythrocyte sedimentation rate and C-reactive protein were also assessed. RESULTS More patients in the IFX than in the placebo group showed a 50% or greater decrease from baseline HS Severity Index score. In addition, statistically and clinically significant improvement from baseline was observed at week 8 in Dermatology Life Quality Index score, visual analog scale score, erythrocyte sedimentation rate, and C-reactive protein compared with placebo. Patients in the placebo group treated with IFX after week 8 (crossover) responded similarly to the original IFX group. Many patients withdrew during the observational phase to continue anti-tumor necrosis factor-alfa therapy. No unexpected serious adverse events were observed. LIMITATIONS Results are representative of a single center, patients were treated by a single physician, some patients did not return after their last infusion, and the HS Severity Index requires validation. CONCLUSIONS This clinical study represents the first formal assessment of IFX for treatment of moderate to severe HS. IFX was well tolerated, no unexpected safety issues were identified, and improvements in pain intensity, disease severity, and quality of life were demonstrated with concomitant reduction in clinical markers of inflammation.
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Affiliation(s)
- Annika Grant
- Florida Academic Dermatology Centers, Miami, Florida 33136, USA
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222
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Sartorius K, Killasli H, Heilborn J, Jemec G, Lapins J, Emtestam L. Interobserver variability of clinical scores in hidradenitis suppurativa is low. Br J Dermatol 2010; 162:1261-8. [DOI: 10.1111/j.1365-2133.2010.09715.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Hidradenitis suppurativa is a chronic disease characterized by recurrent, painful, deep-seated, rounded nodules and abscesses of apocrine gland-bearing skin. Subsequent suppuration, sinus tracts and hypertrophic scarring are its main features. Onset is usually after puberty, although it is most common during the third decade and may persist in old age. The disease tends to be chronic and may develop to subcutaneous extension leading to indurations, sinus, and fistula having a profound impact on the quality of life. The prevalence is 1% in several studies. Axillary and inguinal involvement is more common in females; peri-anal and buttocks localizations are prevalent in males. The exact aetiology remains unknown. The primary event is a follicular occlusion with secondary inflammation, infection and destruction of the pilo-sebaceo-apocrine apparatus and extension to the adjacent sub-cutaneous tissue. Infection is common. Smoking may be a triggering factor. Obesity aggravates the discomfort. Differential diagnostic includes Crohn's disease, nodular acne and furonculosis. The main complications are arthropathy, carcinoma. Treatment depends upon the stage of the disease. Early nodular lesions may be treated by antibiotics for acute stage; long-term antibiotics, zinc salts may be useful as maintenance treatment; anti-TNF drugs have been used in severe cases; systemic steroids, estrogens, anti-androgens, retinoids have been used as options with limited success. Surgical treatment includes incision with or without drainage for limited abscesses; limited excisions are used for locally recurring draining sinuses. Total wide excision and healing with secondary intention or flaps and grafts is the only curative procedure in case of advanced disease.
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224
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van der Zee HH, van der Woude CJ, Florencia EF, Prens EP. Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study. Br J Dermatol 2009; 162:195-7. [PMID: 19681876 DOI: 10.1111/j.1365-2133.2009.09430.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The co-occurrence of hidradenitis suppurativa (HS) and Crohn disease (CD) published in a few case reports resulted in the wide acceptance of an association between these two diseases. However, the combined prevalence of these diseases is currently unknown; furthermore, it is unknown whether this co-occurrence also applies for ulcerative colitis (UC). Objectives To estimate the prevalence of HS in patients with inflammatory bowel disease (IBD) living in the Southwest of the Netherlands. Methods During an IBD patient information meeting, randomly, 158 patients with IBD were interviewed about recurrent painful boils in the axillae and/or groin and were shown illustrative clinical pictures of the appearance of HS. Results Of the 158 patients interviewed, 102 (65%) had CD and 56 (35%) had UC. Twenty-five people (16%) responded that they had had or still experienced painful boils in the axillae and/or groin, of whom 17 were patients with CD (17%) and eight had UC (14%). Conclusions This pilot study shows for the first time that HS occurs in patients with CD or UC. More prospective studies are warranted to establish the association between HS and IBD and its underlying pathogenesis.
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Affiliation(s)
- H H van der Zee
- Department of Dermatology and Immunology, Erasmus MC, University Medical Centre, 3015 GE Rotterdam, the Netherlands.
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225
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Tolaas E, Knudsen CW, Sviland L, Tønseth KA. [Hidradenitis suppurativa]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:992-6. [PMID: 19448752 DOI: 10.4045/tidsskr.08.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by recurrent tender nodules and boils, usually in the armpits and groins. Draining fistulas and hypertrophic scarring are hallmarks of more severe disease. The objective of this article is to review the clinical presentation, diagnostic considerations and treatment of the disease. MATERIAL AND METHODS The article is based on a non-systematic literature search in PubMed, review of dermatology textbooks and the author's personal clinical experience. RESULTS Hidradenitis suppurativa, also known as acne inversa, is a follicular occlusion disease that can severely reduce quality of life. Staphylococci and other pathogenic bacteria frequently colonize the lesions, but the disease is not primarily a bacterial infection. Smoking and obesity can worsen disease activity. Moderate and severe disease is usually treated with excisional surgery. Antibiotics, often tetracyclines, are indicated for mild disease and as an adjunct to surgery in more severe disease. Antibiotics, however, are not curative. New treatment options, such as TNF-alpha inhibitors and zinc gluconate should still be considered experimental. INTERPRETATION Hidradenitis suppurativa is probably underdiagnosed. The disease is often recalcitrant to treatment. The effect of medical treatment is not supported by high quality evidence.
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Affiliation(s)
- Erlend Tolaas
- Hudavdelingen, Haukeland universitetssykehus, 5021 Bergen.
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226
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Tierney E, Mahmoud BH, Hexsel C, Ozog D, Hamzavi I. Randomized control trial for the treatment of hidradenitis suppurativa with a neodymium-doped yttrium aluminium garnet laser. Dermatol Surg 2009; 35:1188-98. [PMID: 19438670 DOI: 10.1111/j.1524-4725.2009.01214.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic suppurative condition for which there is limited efficacy of medical and surgical treatments. OBJECTIVE To assess whether the 1,064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser is an effective treatment for HS. MATERIALS AND METHODS Prospective, randomized, controlled study for patients with stage II to III HS disease (n=22). A series of 3 monthly laser sessions were performed. Treatment response was measured before each laser session and 1 month after the completion of laser treatment (HS Lesion, Area, and Severity Index (HS-LASI) scale). A modification was made to include symptoms (erythema, edema, pain, and purulent discharge; modified HS-LASI, 0-3 scale). RESULTS The percentage change in HS severity after 3 months of treatment was -65.3% over all anatomic sites, -73.4% inguinal, -62.0% axillary, and -53.1% inframammary. For all anatomic sites combined and each individual anatomic site, the change in HS severity from baseline to month 3 was statistically significant at the treated sites (p<.02 for modified HS-LASI and HS-LASI) but not at the control sites (p>.05 for modified HS-LASI and HS-LASI). CONCLUSIONS The long-pulse Nd:YAG laser is effective for treatment of HS. The effectiveness of Nd:YAG laser, a hair epilation device, supports the primary follicular pathogenesis of the condition.
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Affiliation(s)
- Emily Tierney
- Center for Multicultural Dermatology, Department of Dermatology, Henry Ford Hospital, Detroit, MI 48202, USA
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Canoui-Poitrine F, Revuz JE, Wolkenstein P, Viallette C, Gabison G, Pouget F, Poli F, Faye O, Bastuji-Garin S. Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity. J Am Acad Dermatol 2009; 61:51-7. [PMID: 19406505 DOI: 10.1016/j.jaad.2009.02.013] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 02/08/2009] [Accepted: 02/08/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Factors associated with the severity of hidradenitis suppurativa (HS) are not known. OBJECTIVE We sought to identify factors associated with the severity of HS. METHODOLOGY The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. RESULTS Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). LIMITATIONS The referral center base of the study may have biased recruitment. CONCLUSION Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.
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Sartorius K, Emtestam L, Jemec GBE, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol 2009; 161:831-9. [PMID: 19438453 DOI: 10.1111/j.1365-2133.2009.09198.x] [Citation(s) in RCA: 341] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a long-standing disease with abscess and often fistula formation, predominantly in the axillae and groins. The disease is difficult to treat and has a severe impact on quality of life. A clinically relevant system for scoring disease severity is lacking in HS. OBJECTIVES To evaluate the modified Hidradenitis Suppurativa Score (HSS) and to study the impact of body mass index (BMI) and smoking habits on disease severity. METHODS Two hundred and fifty-one consecutive patients with HS referred to a clinic with special interest in the disease were included, of whom 115 were scored. Points were given for regions involved, types of lesion (nodules, fistulas), total area involved and whether lesions were separated by normal skin. Background characteristics included BMI and smoking habits. Two hundred and forty-six patients completed the Dermatology Life Quality Index (DLQI). RESULTS The median (interquartile range, IQR) HSS for all patients was 38 (18-66): women 38 (18-71) and men 37 (19-51). Median (IQR) HSS for smokers was 41 (22-75.5), former smokers 27 (16-53) and nonsmokers 22 (10-57). Median (IQR) HSS for patients with BMI < 25 kg m(-2) was 32 (12-54), BMI 25-30 kg m(-2) 44 (22-56) and BMI > or = 30 kg m(-2) 50 (18-86). Mean +/- SD DLQI for the whole group of patients was 10.3 +/- 7.5, median 9, and showed no significant differences between the groups studied. There was a significant positive correlation of fair degree between HSS and DLQI. There were significant differences in HSS between nonsmokers and smokers as well as between women of normal weight compared with obese women. CONCLUSIONS The modified HSS is simple and practical and it extracts important clinical information. A connection between disease severity and BMI as well as smoking habits in patients with HS is presented. The results suggest that the HSS may be a relevant outcome measure in future therapeutic trials in HS.
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Affiliation(s)
- K Sartorius
- Section of Dermatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
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Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol 2009; 60:539-61; quiz 562-3. [PMID: 19293006 DOI: 10.1016/j.jaad.2008.11.911] [Citation(s) in RCA: 395] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 10/10/2008] [Accepted: 11/17/2008] [Indexed: 12/14/2022]
Abstract
Hidradenitis suppurativa, also known as acne inversa, is a chronic, often debilitating disease primarily affecting the axillae, perineum, and inframammary regions. Prevalence rates of up to 4% have been estimated. Our understanding of the disease has changed over time. It is now considered a disease of follicular occlusion rather than an inflammatory or infectious process of the apocrine glands. Clinically, the disease often presents with tender subcutaneous nodules beginning around puberty. The nodules may spontaneously rupture or coalesce, forming painful, deep dermal abscesses. Eventually, fibrosis and the formation of extensive sinus tracts may result. The location of the lesions may lead to social embarrassment and the failure to seek medical treatment. Therapies in the past have consisted of long-term antibiotics, antiandrogens, and surgery. New treatments like tumor necrosis factor-alfa inhibitors have given clinicians more options against this difficult disease.
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Affiliation(s)
- Ali Alikhan
- University of California-Davis School of Medicine, Sacramento, California 95816, USA
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Abstract
Abstract
Background
Hidradenitis suppurativa is a chronic, recurrent, suppurative cutaneous disease. Despite its incidence, optimal medical or surgical treatment remains unclear. This review describes the disease, ranging from pathogenesis to treatment and prognosis.
Methods
Articles were sourced from PubMed and Medline, using the MeSH terms ‘hidradenitis suppurativa’ and ‘acne inversa’. Selection of articles was based on peer review, journal, relevance and English language.
Results and conclusion
On the basis of histological findings, the disease is now considered inflammatory and originating from the hair follicle; therefore, the term ‘acne inversa’ is favoured by some experts. The exact aetiology remains obscure but smoking seems to be a major triggering factor. Treatment should be individualized according to the site and extent of the disease. Absolute cessation of smoking is essential in the treatment of hidradenitis. Management with antibiotics or other medications may relieve early symptoms, but radical surgery may be necessary for control and to prevent recurrence.
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Affiliation(s)
- M G Buimer
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - T Wobbes
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J H G Klinkenbijl
- Department of Surgery, Rijnstate Hospital, Arnhem, and Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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Madan V, Hindle E, Hussain W, August PJ. Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser. Br J Dermatol 2009; 159:1309-14. [PMID: 19036028 DOI: 10.1111/j.1365-2133.2008.08932.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic and often a recalcitrant inflammatory skin condition. OBJECTIVES To present the results of carbon dioxide (CO2) laser treatment of recalcitrant HS in nine patients who had failed to improve on medical and other surgical treatments. METHODS HS lesions consisting of abscesses, sinuses and granulation tissue were completely excised using the cutting mode of a CO2 laser, leaving only healthy residual subcutaneous fat. The wounds were closed by primary intention where possible and left to granulate otherwise. Outcomes were determined by clinical review and questionnaire. RESULTS Twenty-seven sites were treated in 19 sessions on nine patients. Seven procedures were performed under general anaesthesia and 12 under local. All patients rated their postoperative discomfort as less or equal to their preoperative state. Seven of the nine patients had complete remission for 12 months or longer after their last laser treatment and ceased all medications. High levels of patient satisfaction were reported with CO2 laser treatment. The main complication was axillary scar contracture in two patients but this was insufficient to limit limb movement. CONCLUSIONS CO2 laser treatment should be considered as a treatment option in recalcitrant HS, where multiple medical treatments have been ineffective.
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Affiliation(s)
- V Madan
- Laser Division, The Dermatology Centre, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Salford, Manchester M6 8HD, UK.
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A prospective clinical trial of open-label etanercept for the treatment of hidradenitis suppurativa. J Am Acad Dermatol 2009; 60:565-73. [PMID: 19185954 DOI: 10.1016/j.jaad.2008.11.898] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 11/18/2008] [Accepted: 11/20/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND Medical therapies for hidradenitis suppurativa (HS) are often ineffective. Tumor necrosis factor-alpha inhibitors may be a potential treatment for patients with moderate to severe HS. OBJECTIVES We sought to evaluate the safety and efficacy of etanercept for patients with severe HS. METHODS We conducted a phase II clinical trial of etanercept (50 mg/wk subcutaneously) in patients with moderate to severe HS. Efficacy was measured using a Physician Global Assessment and several secondary physician- and patient-reported outcome measures. Responders were classified as those achieving at least a 50% reduction on the Physician Global Assessment score at week 12 compared with baseline. RESULTS Only 3 of the 15 patients who entered the study were classified as responders (response rate of 20%; 95% confidence interval: 4.3-48.1) based on the intention-to-treat analysis. Dermatology Life Quality Index scores improved slightly from a median of 19 to 15 (P = .02). Comparison of baseline with week-12 Physician Global Assessment scores, and secondary outcome measures of lesion counts and patient pain scores, failed to show statistically significant improvement. Etanercept was generally well tolerated; however, two patients discontinued the study as a result of skin infections at the site of hidradenitis lesions requiring oral antibiotics. LIMITATIONS Lack of a control group and a small number of participants are limitations. CONCLUSIONS Our study demonstrated minimal evidence of clinically significant efficacy of etanercept (50 mg/wk subcutaneously) in the treatment of hidradenitis. Future studies using higher doses of etanercept are indicated; however, patients need to be carefully monitored for infection and other adverse events. Randomized, controlled trials will be necessary to demonstrate the risk-to-benefit ratio of tumor necrosis factor-alpha inhibitors in the treatment of hidradenitis.
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Happle R, König A. A lesson to be learned from Karl Marx: smoking triggers hidradenitis suppurativa. Br J Dermatol 2008; 159:255-6; author reply 256-7. [PMID: 18489595 DOI: 10.1111/j.1365-2133.2008.08604.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ralf Paus L, Kurzen H, Kurokawa I, Jemec GBE, Emtestam L, Sellheyer K, Giamarellos-Bourboulis EJ, Nagy I, Bechara FG, Sartorius K, Lapins J, Krahl D, Altmeyer P, Revuz J, Zouboulis CC. What causes hidradenitis suppurativa? Exp Dermatol 2008. [DOI: 10.1111/j.1600-0625.2008.00712.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bordier-Lamy F, Palot JP, Vitry F, Bernard P, Grange F. Maladie de Verneuil : étude rétrospective chez 93 malades traités chirurgicalement. Ann Dermatol Venereol 2008; 135:373-9. [DOI: 10.1016/j.annder.2008.02.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 02/29/2008] [Indexed: 10/22/2022]
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Hunger R, Surovy A, Hassan A, Braathen L, Yawalkar N. Toll-like receptor 2 is highly expressed in lesions of acne inversa and colocalizes with C-type lectin receptor. Br J Dermatol 2008; 158:691-7. [DOI: 10.1111/j.1365-2133.2007.08425.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Affiliation(s)
- Judith Hong
- Department of Dermatology, University of California, San Francisco, California 94118-2616, USA.
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Mekkes J, Bos J. Long-term efficacy of a single course of infliximab in hidradenitis suppurativa. Br J Dermatol 2007; 158:370-4. [DOI: 10.1111/j.1365-2133.2007.08332.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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