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Raudonis T, Šakaitytė A, Vileikis TP, Černel V, Gancevičiene R, Zouboulis CC. Demographic Data, Risk Factors, and Disease Burden of HS Patients in Lithuania at a Reference Center. Healthcare (Basel) 2024; 12:1849. [PMID: 39337190 PMCID: PMC11431364 DOI: 10.3390/healthcare12181849] [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: 06/26/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) diagnosis often faces a global delay of 7.2 years due to factors like lack of recognition, stigma, and socioeconomic barriers. Limited effective therapies and frequent exacerbations impact patients' quality of life, posing a significant burden on healthcare systems. METHODS HS patients were assessed according to European Hidradenitis Suppurativa Foundation (EHSF) Registry questionnaire guidelines at various stages of the disease and treatment. RESULTS The study included 49 patients; 57.14% (n = 28) of them were male. The average age of the subjects was 39.91 ± 13.665 years; the average BMI was 27.84 ± 7.362. A total of 59.18% (n = 29) were active or previous smokers. There were statistically more male smokers than female (p < 0.01). Average disease onset was 25.71 ± 13.743 years; the mean time to diagnosis was 5.2 ± 7.607 years. A total of 70.2% (n = 33) were previously misdiagnosed. Subjects had 6.17 ± 6.98 painful days over the preceding 4 weeks. The average intensity of pain according to the visual analogue scale (VAS) was 5.60 ± 3.36 points. The mean dermatology life quality index (DLQI) at baseline was 8.9 ± 7.436. CONCLUSIONS The research revealed delayed diagnoses, especially for females. Smoking was linked to higher Hurley stages, with a prevalence among male smokers, and HS had a substantial impact on patients' quality of life.
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Affiliation(s)
- Tadas Raudonis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Austėja Šakaitytė
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
| | - Tomas Petras Vileikis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
| | - Vitalij Černel
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania;
| | - Rūta Gancevičiene
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
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Scholl L, Abu Rached N, Stockfleth E, Cramer P, Ocker L, Stranzenbach R, Garcovich S, Hessam S, Bechara FG. Hidradenitis Suppurativa in the SARS-CoV-2 Pandemic: Investigation of Trigger Factors in a Single Center. J Clin Med 2024; 13:4074. [PMID: 39064114 PMCID: PMC11277551 DOI: 10.3390/jcm13144074] [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: 05/31/2024] [Revised: 07/03/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a debilitating, chronic inflammatory disease associated with multiple triggers. As the world struggles with the global COVID-19 pandemic, it is important to review the trigger factors for chronically ill HS patients during the COVID-19 pandemic. This work investigates the self-described trigger factors of HS patients that emerged during the COVID-19 outbreak. Methods: We anonymously surveyed 110 HS patients during the SARS-CoV-2 pandemic using a 25-question questionnaire that included trigger factors for deterioration. Demographic, personal, and HS-specific information was also collected to identify potential trigger factors for HS exacerbation. All HS patients were asked if their HS had worsened compared to the time before the pandemic. Results: Compared to before the pandemic, 20% of HS patients (n = 22) reported a worsening of HS. Patients with an HS exacerbation were significantly more likely to avoid contact with a doctor than those without an exacerbation (45.5% vs. 18.2%; p = 0.007). HS involvement, severity, exercise activity, and BMI had no association with worsening HS (p > 0.05). Interestingly, dietary changes and increased consumption of sweets and treats were associated with worsening HS (p = 0.011 and p = 0.013). Specifically, eating more sweets and treats was associated with a 6-fold increased risk of worsening HS. The results suggest that diet has an important influence on HS relapses. Further investigation is needed to determine whether diet is a triggering factor independent of the SARS-CoV-2 pandemic. In addition, gluteal HS involvement was associated with a more than 4.3-fold risk of HS exacerbation. Conclusions: In the management of HS patients, it is important to consider that gluteal involvement and the consumption of sweets are more often associated with deterioration.
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Affiliation(s)
- Lisa Scholl
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Eggert Stockfleth
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Philipp Cramer
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - René Stranzenbach
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | | | - Schapoor Hessam
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany; (E.S.); (F.G.B.)
- Skin Cancer Center, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
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3
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Alter M. [Hidradenitis suppurativa]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:497-506. [PMID: 38512397 DOI: 10.1007/s00105-024-05321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin and systemic disease that is associated with considerable discomfort and a significant reduction in the quality of life. Despite a significantly increased understanding of the disease, the diagnosis is still delayed for many years. Delayed patient access to suitable treatment often leads to disease progression with increased surgical interventions and the occurrence of possible comorbidities. In recent years, there has been an improved understanding of the pathophysiology and, as a result the authorization of modern therapeutic agents for HS. The treatment of HS is based on three treatment pillars: surgery, antibiotics and biologics. Additionally, risk factors, such as smoking and obesity should be positively influenced. Knowledge of comorbidities and their interdisciplinary treatment is important for the individualized care of patients.
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Affiliation(s)
- M Alter
- Klinik für Dermatologie, Johannes-Wesling-Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, 32429, Minden, Deutschland.
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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5
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Simon SL, Phimphasone-Brady P, McKenney KM, Gulley LD, Bonny AE, Moore JM, Torres-Zegarra C, Cree MG. Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:443-455. [PMID: 38552655 DOI: 10.1016/s2352-4642(24)00019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 05/18/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a lifelong chronic condition that affects one in ten females and can be diagnosed in adolescence. As adolescents with PCOS transition to adulthood, counselling for lifestyle management and mental health concerns often transition from involving the family unit to increasingly individual-focused approaches. PCOS is associated with a large range of comorbidities affecting reproductive, metabolic, dermatological, and psychological health. The diagnosis and comorbidities of PCOS are influenced by pubertal hormones and need to be reassessed continuously to ensure that treatment remains appropriate for age and development. As young patients grow up, personal concerns often change, especially in relation to reproductive management. In this Review, we present prevalence rates, screening tools, and treatment recommendations for PCOS-related conditions, and we consider the diagnostic and clinical elements of optimal transition of care models that ensure continuity of comprehensive care for adolescents moving from the paediatric health-care system to the adult health-care system.
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Affiliation(s)
- Stacey L Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA.
| | | | - Kathryn M McKenney
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren D Gulley
- Children's Hospital Colorado Aurora, CO, USA; Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Andrea E Bonny
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaime M Moore
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
| | - Carla Torres-Zegarra
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
| | - Melanie G Cree
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
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6
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Zouboulis CC, Prens EP, Sayed CJ, Molina-Leyva A, Bettoli V, Romanelli M, Szepietowski JC, Martinez AL, Kasparek T, Lobach I, Wozniak MB, Ortmann CE, Thomas N, Bachhuber T, Ravichandran S, Tzellos T. International Hidradenitis Suppurativa Severity Scoring System (IHS4) as a holistic measure of hidradenitis suppurativa disease severity compared with Hurley staging: A post hoc analysis of the SUNRISE and SUNSHINE phase 3 trials of secukinumab. J Eur Acad Dermatol Venereol 2024; 38:e496-e499. [PMID: 38058224 DOI: 10.1111/jdv.19681] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christopher J Sayed
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alejandro Molina-Leyva
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Hidradenitis Suppurativa Unit, Instituto de Investigación Biosanitaria ibs and Servicio de Dermatologia, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Vincenzo Bettoli
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Romanelli
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Jacek C Szepietowski
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | | | | | | | | | | | | | | | | | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
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7
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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8
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Xie H, Song C, Jian L, Guo Y, Li M, Luo J, Li Q, Tan T. A deep learning-based radiomics model for predicting lymph node status from lung adenocarcinoma. BMC Med Imaging 2024; 24:121. [PMID: 38789936 PMCID: PMC11127329 DOI: 10.1186/s12880-024-01300-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVES At present, there are many limitations in the evaluation of lymph node metastasis of lung adenocarcinoma. Currently, there is a demand for a safe and accurate method to predict lymph node metastasis of lung cancer. In this study, radiomics was used to accurately predict the lymph node status of lung adenocarcinoma patients based on contrast-enhanced CT. METHODS A total of 503 cases that fulfilled the analysis requirements were gathered from two distinct hospitals. Among these, 287 patients exhibited lymph node metastasis (LNM +) while 216 patients were confirmed to be without lymph node metastasis (LNM-). Using both traditional and deep learning methods, 22,318 features were extracted from the segmented images of each patient's enhanced CT. Then, the spearman test and the least absolute shrinkage and selection operator were used to effectively reduce the dimension of the feature data, enabling us to focus on the most pertinent features and enhance the overall analysis. Finally, the classification model of lung adenocarcinoma lymph node metastasis was constructed by machine learning algorithm. The Accuracy, AUC, Specificity, Precision, Recall and F1 were used to evaluate the efficiency of the model. RESULTS By incorporating a comprehensively selected set of features, the extreme gradient boosting method (XGBoost) effectively distinguished the status of lymph nodes in patients with lung adenocarcinoma. The Accuracy, AUC, Specificity, Precision, Recall and F1 of the prediction model performance on the external test set were 0.765, 0.845, 0.705, 0.784, 0.811 and 0.797, respectively. Moreover, the decision curve analysis, calibration curve and confusion matrix of the model on the external test set all indicated the stability and accuracy of the model. CONCLUSIONS Leveraging enhanced CT images, our study introduces a noninvasive classification prediction model based on the extreme gradient boosting method. This approach exhibits remarkable precision in identifying the lymph node status of lung adenocarcinoma patients, offering a safe and accurate alternative to invasive procedures. By providing clinicians with a reliable tool for diagnosing and assessing disease progression, our method holds the potential to significantly improve patient outcomes and enhance the overall quality of clinical practice.
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Affiliation(s)
- Hui Xie
- Department of Radiation Oncology, Affiliated Hospital (Clinical College) of Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
- Faculty of Applied Sciences, Macao Polytechnic University, Macao, 999078, People's Republic of China
| | - Chaoling Song
- School of Medical Imaging, Laboratory Science and Rehabilitation, Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
| | - Lei Jian
- School of Medical Imaging, Laboratory Science and Rehabilitation, Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
| | - Yeang Guo
- School of Medical Imaging, Laboratory Science and Rehabilitation, Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
| | - Mei Li
- School of Medical Imaging, Laboratory Science and Rehabilitation, Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
| | - Jiang Luo
- School of Medical Imaging, Laboratory Science and Rehabilitation, Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
| | - Qing Li
- Department of Radiation Oncology, Affiliated Hospital (Clinical College) of Xiangnan University, Chenzhou, Hunan province, 423000, People's Republic of China
| | - Tao Tan
- Faculty of Applied Sciences, Macao Polytechnic University, Macao, 999078, People's Republic of China.
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, Netherlands.
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9
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González-López MA. [Hidradenitis suppurativa]. Med Clin (Barc) 2024; 162:182-189. [PMID: 37968174 DOI: 10.1016/j.medcli.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.
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Affiliation(s)
- Marcos A González-López
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, España; Real Academia de Medicina de Cantabria, Santander, Cantabria, España.
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10
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Kim Y, Lee J, Kim HS, Ko HC, Kim BS, Kim MB, Shin K. Review of Scoring Systems for Hidradenitis Suppurativa. Ann Dermatol 2024; 36:9-17. [PMID: 38325429 PMCID: PMC10861310 DOI: 10.5021/ad.23.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 02/09/2024] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in apocrine gland-bearing regions. Assessing its severity is challenging because of its clinical heterogeneity, lack of a standardized tool, and increasing severity scores. This article provides a chronological overview of HS grading scales to aid in the understanding and comparison of different scoring systems. A literature review of articles published in English on PubMed was conducted searched from 1989 to 2023. The review includes 15 scores that are the most relevant and widely used and acknowledges the existence of over 30 scoring systems for HS. The expanding landscape of HS scoring systems presents challenges when patients evaluated using different systems are compared. A universally accepted scoring system is required for consistent application across diverse populations. A comprehensive assessment should balance subjective and objective items, considering observer-reported signs and patient-reported symptoms to make meaningful treatment decisions.
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Affiliation(s)
- Youngbeom Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jungsoo Lee
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
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11
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Abu Rached N, Gambichler T, Ocker L, Skrygan M, Seifert C, Scheel CH, Stockfleth E, Bechara FG. Haptoglobin is an independent marker for disease severity and risk for metabolic complications in hidradenitis suppurativa: A prospective study. J Eur Acad Dermatol Venereol 2024; 38:205-213. [PMID: 37669834 DOI: 10.1111/jdv.19495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is highly correlated with obesity. Haptoglobin serum levels have recently been recognized as an important biomarker linking obesity with chronic inflammation. OBJECTIVE To compare haptoglobin with previously proposed serum biomarkers for the determination of disease severity in HS patients. For this purpose, disease severity of HS patients was determined by a panel of clinical scores as well as several risk factors, such as weight and smoking habits. METHODS A prospective, diagnostic accuracy study was performed at the International Centre for Hidradenitis suppurativa/Acne inversa Bochum (ICH). The study included a total of 263 patients, including 131 who had a confirmed diagnosis of HS in Hurley I (n = 16), II (n = 56) and III (n = 59) HS, and 132 healthy controls. The main outcome was to identify serological inflammatory markers for HS disease severity [severe (III) vs. moderate/mild (II/I)] as assessed by Hurley classification. RESULTS The serum levels of acute phase proteins haptoglobin and CRP, as well as the number of neutrophils in peripheral blood, number of monocytes, the systemic immune-inflammation index and the pan-immune-inflammatory value correlated with disease severity according to established clinical scores (mHSS, SAHS, Hurley, DLQI). HS patients had significantly higher haptologlobin levels compared to healthy controls. Logistic regression analysis revealed haptoglobin as the only independent marker predicting severe HS. CONCLUSION In this prospective study, we discovered that the serum levels of the acute phase protein haptoglobin levels serve as an independent marker of disease severity in HS. While this presents the first study in the context of HS. Thus, the present data not only yield a highly promising serum marker to be further validated.
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Affiliation(s)
- N Abu Rached
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - L Ocker
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C Seifert
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C H Scheel
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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12
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Mastacouris N, Tannenbaum R, Strunk A, Koptyev J, Aarts P, Alhusayen R, Bechara FG, Benhadou F, Bettoli V, Brassard A, Brown D, Choon SE, Coutts P, da Silva DLF, Daveluy S, Dellavalle RP, Del Marmol V, Emtestam L, Gebauer K, George R, Giamarellos-Bourboulis EJ, Goldfarb N, Hamzavi I, Hazen PG, Horváth B, Hsiao J, Ingram JR, Jemec GBE, Kirby JS, Lowes MA, Marzano AV, Matusiak L, Naik HB, Okun MM, Oon HH, Orenstein LAV, Paek SY, Pascual JC, Fernandez-Peñas P, Resnik BI, Sayed CJ, Thorlacius L, van der Zee HH, van Straalen KR, Garg A. Outcome Measures for the Evaluation of Treatment Response in Hidradenitis Suppurativa for Clinical Practice: A HiSTORIC Consensus Statement. JAMA Dermatol 2023; 159:1258-1266. [PMID: 37755725 DOI: 10.1001/jamadermatol.2023.3282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Importance Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines. Objective To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied. Evidence Review Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice. Findings Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]). Conclusions and Relevance An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting.
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Affiliation(s)
| | | | | | | | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
| | - Farida Benhadou
- Department of Dermatology, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Vincenzo Bettoli
- Department of Medical Sciences, O.U. of Dermatology, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | | | - Debra Brown
- Medical Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Siew Eng Choon
- Hospital Sultanah Aminah and Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia
| | | | | | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz School of Medicine, Aurora, Colorado
- Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Aurora, Colorado
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Lennart Emtestam
- Section of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Noah Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Paul G Hazen
- Case-Western Reserve University School of Medicine, Cleveland, Ohio
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Joslyn S Kirby
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | | | - Hazel H Oon
- National Skin Centre, Singapore, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Singapore City, Singapore
| | - Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - So Yeon Paek
- Baylor University Medical Center, Dallas, Texas A&M University School of Medicine, Dallas
| | - José C Pascual
- Dermatology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Pablo Fernandez-Peñas
- Department of Dermatology, Westmead Hospital, The University of Sydney, Westmead, New South Wales, Australia
| | - Barry I Resnik
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amit Garg
- Northwell Health, New Hyde Park, New York
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Radhakrishna U, Ratnamala U, Jhala DD, Uppala LV, Vedangi A, Patel M, Vadsaria N, Shah S, Saiyed N, Rawal RM, Mercuri SR, Jemec GBE, Damiani G. Hidradenitis suppurativa presents a methylome dysregulation capable to explain the pro-inflammatory microenvironment: Are these DNA methylations potential therapeutic targets? J Eur Acad Dermatol Venereol 2023; 37:2109-2123. [PMID: 37338327 DOI: 10.1111/jdv.19286] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/27/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, systemic, inflammatory skin condition with elusive pathogenesis that affects therapeutic intervention directly. OBJECTIVE To characterize epigenetic variations in cytokines genes contributing to HS. METHODS Epigenome-wide DNA methylation profiling with the Illumina Epic array was performed on blood DNA samples from 24 HS patients and 24 age- and sex-matched controls to explore DNA methylation changes in cytokine genes. RESULTS We identified 170 cytokine genes including 27 hypermethylated CpG sites and 143 genes with hypomethylated sites respectively. Hypermethylated genes, including LIF, HLA-DRB1, HLA-G, MTOR, FADD, TGFB3, MALAT1 and CCL28; hypomethylated genes, including NCSTN, SMAD3, IGF1R, IL1F9, NOD2, NOD1, YY1, DLL1 and BCL2 may contribute to the pathogenesis of HS. These genes were enriched in the 117 different pathways (FDR p-values ≤ 0.05), including IL-4/IL-13 pathways and Wnt/β-catenin signalling. CONCLUSIONS The lack of wound healing, microbiome dysbiosis and increased tumour susceptibility are all sustained by these dysfunctional methylomes, hopefully, capable to be targeted in the next future. Since methylome describes and summarizes genetic and environmental contributions, these data may represent a further step towards a feasible precision medicine also for HS patients.
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Affiliation(s)
- Uppala Radhakrishna
- Department of Obstetrics and Gynaecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Uppala Ratnamala
- Department of Life Sciences, School of Sciences, Gujarat University, Ahmedabad, India
| | - Devendrasinh D Jhala
- Department of Life Sciences, School of Sciences, Gujarat University, Ahmedabad, India
- Department of Zoology, School of Sciences, Gujarat University, Ahmedabad, India
| | - Lavanya V Uppala
- College of Information Science & Technology, The University of Nebraska at Omaha, Peter Kiewit Institute, Omaha, Nebraska, USA
| | - Aaren Vedangi
- Department of Clinical Research, KIMS ICON Hospital, A Unit of ICON Krishi Institute Medical Sciences, Visakhapatnam, India
| | | | | | - Sushma Shah
- Department of Obstetrics and Gynaecology, B.J. Medical College, Ahmedabad, India
| | - Nazia Saiyed
- Department of Life Sciences, School of Sciences, Gujarat University, Ahmedabad, India
| | - Rakesh M Rawal
- College of Information Science & Technology, The University of Nebraska at Omaha, Peter Kiewit Institute, Omaha, Nebraska, USA
| | - Santo Raffaele Mercuri
- Unit of Clinical Dermatology, Università Vita-Salute San Raffaele, Milan, Italy
- Italian Center of Precisione Medicine and Chronic Inflammation, Milan, Italy
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Giovanni Damiani
- Unit of Clinical Dermatology, Università Vita-Salute San Raffaele, Milan, Italy
- Italian Center of Precisione Medicine and Chronic Inflammation, Milan, Italy
- Clinical Dermatology, Case Western Reserve University, Cleveland, Ohio, USA
- Young Dermatologists Italian Network, Milan, Italy
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14
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Cai P, Lin Q, Lv D, Zhang J, Wang Y, Wang X. Establishment of a scoring model for the differential diagnosis of white coat hypertension and sustained hypertension. Blood Press Monit 2023; 28:185-192. [PMID: 37115849 PMCID: PMC10309104 DOI: 10.1097/mbp.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This study aimed to establish a scoring model for the differential diagnosis of white coat hypertension (WCH) and sustained hypertension (SHT). METHODS This study comprised 553 adults with elevated office blood pressure, normal renal function, and no antihypertensive medications. Through questionnaire investigation and biochemical detection, 17 parameters, such as gender and age, were acquired. WCH and SHT were distinguished by 24 h ambulatory blood pressure monitoring. The participants were randomly divided into a training set (445 cases) and a validation set (108 cases). The above parameters were screened using least absolute shrinkage and selection operator regression and univariate logistic regression analysis in the training set. Afterward, a scoring model was constructed through multivariate logistic regression analysis. RESULTS Finally, six parameters were selected, including isolated systolic hypertension, office systolic blood pressure, office diastolic blood pressure, triglyceride, serum creatinine, and cardiovascular and cerebrovascular diseases. Multivariate logistic regression was used to establish a scoring model. The R2 and area under the ROC curve (AUC) of the scoring model in the training set were 0.163 and 0.705, respectively. In the validation set, the R2 of the scoring model was 0.206, and AUC was 0.718. The calibration test results revealed that the scoring model had good stability in both the training and validation sets (mean square error = 0.001, mean absolute error = 0.014; mean square error = 0.001, mean absolute error = 0.025). CONCLUSION A stable scoring model for distinguishing WCH was established, which can assist clinicians in identifying WCH at the first diagnosis.
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Affiliation(s)
- Peng Cai
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Qingshu Lin
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Dan Lv
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Jing Zhang
- Department of Intensive Care Medicine, PLA 80th Group Army Hospital, Weifang
| | - Yan Wang
- Department of Pharmacy, Key Laboratory of Basic Pharmacology of Ministry of Education Joint International Research Laboratory of Ministry Education, Zunyi Medical University, Zunyi
| | - Xukai Wang
- Department of Cardiology, Institute of Field Surgery, Daping Hospital, Army Medical University, Chongqing
- Department of Cardiology, Chongqing Hygeia Hospital, Chongqing, China
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15
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Ng-Wong YK, Alexander B, Bartl M, Loftis CE, Hammad D, Dulgheru EC, De La Garza M, Nunez AC. Deeper Seated Than Skin Deep: Report of a Rare Case of Follicular Occlusion Tetrad and a Literature Review. Cureus 2023; 15:e39474. [PMID: 37362514 PMCID: PMC10290440 DOI: 10.7759/cureus.39474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Follicular occlusion tetrad (FOT) is a clinical syndrome consisting of hidradenitis suppurativa (HS), acne conglobata (AC), dissecting cellulitis of the scalp (DCS), and pilonidal cyst (PC). These entities typically occur independently, but occasionally present simultaneously comprising FOT. The four components share similar pathophysiology affecting the apocrine glands, follicular hyperkeratinization being the hallmark of each entity. Understanding shared similarities of each disease is paramount for the treatment approach as the relapsing and chronic nature of this syndrome can be burdening to patients. We present the case of a 22-year-old obese Hispanic man with a history of tobacco use who presented with worsening skin lesions. The patient developed extensive facial cystic acne 5 years before presentation, followed by left axillary hidradenitis suppurativa lesions two years before the presentation and right axillary involvement one year after. Skin manifestations then expanded to include the lower back, gluteal and perineal areas. The patient was diagnosed with FOT and despite conservative medical management, his lesions failed to improve. He ultimately underwent multiple staged excisional debridement surgeries and skin grafts. Our case underlines the presence of a syndromic association of cutaneous lesions that share a common pathogenesis and emphasizes that this entity requires a multidisciplinary approach. New biologic therapies continue to emerge and may potentially prevent the need for surgical intervention and the burden associated with it.
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Affiliation(s)
- Yilen K Ng-Wong
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Blesset Alexander
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Mery Bartl
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Christine E Loftis
- Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA
| | - Dina Hammad
- Rheumatology, University of Florida, Gainesville, USA
| | | | - Mauricio De La Garza
- Plastic and Reconstructive Surgery Institute, Doctors Hospital at Renaissance, Edinburg, USA
| | - Aidee C Nunez
- Plastic Surgery, Doctors Hospital at Renaissance, Edinburg, USA
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16
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Kridin K, Valido K, Cohen JM, Cohen AD. Hidradenitis suppurativa and the risk of myocardial infarction, cerebrovascular accident, and peripheral vascular disease: a population-based study. Arch Dermatol Res 2023; 315:429-435. [PMID: 35871185 DOI: 10.1007/s00403-022-02369-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/06/2022] [Accepted: 07/02/2022] [Indexed: 11/02/2022]
Abstract
Previous studies have identified an association between myocardial infarction (MI), cerebrovascular accident (CVA), and peripheral vascular disease (PVD) in patients with hidradenitis suppurativa (HS). To evaluate the risk and prognostic outcomes of MI, CVA, and PVD in patients with HS. A population-based retrospective cohort study using the computerized database of Clalit Health Services (CHS), the largest managed care organization in Israel, was conducted to compare the incidence of MI, CVA, and PVD among patients with HS (N = 6779) with age-, sex- and ethnicity-matched control subjects (N = 33,260). Adjusted hazard ratios (HRs) were estimated by multivariate Cox regression analysis. The overall incidence rates of MI, CVA, and PVD were estimated at 2.9 (2.3-3.4), 1.3 (0.9-1.7), and 0.8 (0.6-1.1) per 1000 person-year, respectively. Patients with HS were at an increased risk of developing MI (fully-adjusted HR 1.33; 95% CI 1.04-1.68; P = 0.021), but the risk of CVA (fully-adjusted HR 0.82; 95% CI 0.59-1.14; P = 0.245) and PVD (fully-adjusted HR 1.22; 95% CI 0.80-1.87; P = 0.355) was comparable relative to controls. Compared to other patients with HS, increased risk of all-cause mortality was observed among patients with HS and comorbid MI (HR 12.56; 95% CI 7.59-20.80; P < 0.001), CVA (HR 13.33; 95% CI 7.29-24.37; P < 0.001), and PVD (HR 7.11; 95% CI 2.61-19.32; P < 0.001). Patients with HS are at an increased risk of MI, but not CVA and PVD. Awareness of these epidemiological findings is of importance for clinicians managing patients with HS.
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Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Poria Medical Center, Poriya, Israel
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | | | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, 15 York St, New Haven, CT, 06510, USA.
| | - Arnon D Cohen
- Department of Quality Measures and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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17
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Daoud M, Benhadou F, Njimi H, Jemec GBE, Daxhelet M, White J, Heudens S, Karama J, Suppa M, Del Marmol V. Scoring hidradenitis suppurativa: How to simplify data collection? J Eur Acad Dermatol Venereol 2023; 37:e562-e564. [PMID: 36308053 DOI: 10.1111/jdv.18707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mathieu Daoud
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Hassane Njimi
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, København, Denmark
| | - Mathilde Daxhelet
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Jonathan White
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Stéphanie Heudens
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Jalila Karama
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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18
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Daoud M, Suppa M, Benhadou F, Daxhelet M, Njimi H, White J, Jemec G, del Marmol V. Overview and comparison of the clinical scores in hidradenitis suppurativa: A real-life clinical data. Front Med (Lausanne) 2023; 10:1145152. [PMID: 37138732 PMCID: PMC10149852 DOI: 10.3389/fmed.2023.1145152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Partly due to its clinical heterogeneity, hidradenitis suppurativa (HS) is difficult to score accurately; illustrated by the large number of disease scores. In 2016, a systematic review by Ingram et al. reported the use of about thirty scores, and since then, this number has increased further. Our aim is twofold: to provide a succinct but detailed narrative review of the scores used to date, and to compare these scores with each other for individual patients. Materials and methods The review of the literature was done among articles in English and French, on Google, Google scholar, Pubmed, ScienceDirect and Cochrane. To illustrate the differences between scores, data from some Belgian patients included in the European Registry for HS were selected. A first series of patients compares the severity of the following scores: Hurley, Hurley Staging refined, three versions of Sartorius score (2003, 2007, 2009), Hidradenitis Suppurativa Physician Global Assessment (HS-PGA), International Hidradenitis Suppurativa Severity Scoring System (IHS4), Severity Assessment of Hidradenitis Suppurativa (SAHS), Hidradenitis Suppurativa Severity Index (HSSI), Acne Inversa Severity Index (AISI), the Static Metascore, and one score that is not specific to HS: Dermatology Life Quality Index (DLQI). A second set of patients illustrates how some scores change over time and with treatment: Hurley, Hurley Staging refined, Sartorius 2003, Sartorius 2007, HS-PGA, IHS4, SAHS, AISI, Hidradenitis Suppurativa Clinical Response (HiSCR), the very new iHS4-55, the Dynamic Metascore, and DLQI. Results Nineteen scores are detailed in this overview. We illustrate that for some patients, the scores do not predictably and consistently correlate with each other, either in an evaluation of the severity at a time-point t, or in the evaluation of the response to a treatment. Some patients in this cohort may be considered responders according to some scores, but non-responders according to others. The clinical heterogeneity of the disease, represented by its many phenotypes, seems partly to explain this difference. Conclusion These examples illustrate how the choice of a score can lead to different interpretations of the response to a treatment, or even potentially change the results of a randomized clinical trial.
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Affiliation(s)
- Mathieu Daoud
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- *Correspondence: Mathieu Daoud,
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mathilde Daxhelet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hassane Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jonathan White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, København, Denmark
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
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19
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Ocker L, Abu Rached N, Seifert C, Scheel C, Bechara FG. Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:7240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed.
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Affiliation(s)
- Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | | | | | | | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
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20
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Gambichler T, Hessam S, Cramer P, Abu Rached N, Bechara G. Complete blood collection‐based systemic inflammation biomarkers for patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022; 36:1593-1596. [DOI: 10.1111/jdv.18175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/05/2022] [Indexed: 11/27/2022]
Affiliation(s)
- T. Gambichler
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - S. Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - P. Cramer
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - N. Abu Rached
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
| | - G. Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr‐University Bochum Bochum Germany
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21
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Wound Closure with Transcutaneous Absorbable Polyglactin Sutures after Hidradenitis Suppurativa Excision. Adv Skin Wound Care 2022; 35:1-4. [PMID: 35050922 DOI: 10.1097/01.asw.0000805360.14633.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Wide surgical excision is the standard treatment for severe hidradenitis suppurativa (HS). Because of the nature of HS, these wounds are often nonsterile, located in moist intertriginous regions, and closed under tension, increasing the risk for surgical site complications. Although uncommon, absorbable sutures may confer benefits over nonabsorbable material for skin closure. Accordingly, the authors evaluated the use of absorbable, braided, transcutaneous polyglactin sutures after wide surgical excision of HS. METHODS The authors performed a retrospective chart review for all consecutive patients who underwent wide surgical excision of HS at a tertiary university hospital between January 2009 and March 2020. RESULTS Sixty consecutive patients with 174 operative sites were included in the study. The surgical site complication rate was 17.8%. Postoperative complications included wound dehiscence (n = 18), surgical site infection (n = 2), and scar contracture (n = 1). Sutures were removed from 12 (6.9%) operative sites. Factors influencing complications were Hurley grade and area of excision. Complications did not differ significantly among disease locations (P = .6417). CONCLUSIONS The results support the growing evidence that absorbable sutures are an appropriate option after wide surgical excision of HS.
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22
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Barmatz S, Fisch-Gilad S, Hackett A, Barak Levitt J, Dalal A, Taieb Y, Kremer N, Levi A, Pavlovsky L, Hodak E, Yahav D, Sherman S. The Bacteriology of Skin Lesions in Patients with Hidradenitis Suppurativa Is Associated with Previous Antibiotic Treatment in the Community Setting: A Referral Center Experience. Dermatology 2022; 238:772-784. [PMID: 35086093 DOI: 10.1159/000520288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory nodules and abscesses. The pathogenic role of bacteria is not fully understood. As the diagnosis is usually delayed, patients are often treated with several lines of antibiotics in a nonstandardized fashion. The aim of the study was to investigate and compare the bacteriology of active HS lesions in patients treated or not treated with antibiotics in the community setting before referral to a dedicated HS clinic. METHODS Purulent skin lesions of patients with HS referred to the HS Clinic of Rabin Medical Center in 2009-2020 were cultured. Data were collected from the patients' medical files and microbiology reports. The correlation between the location of the skin lesion and the bacteriologic profile was analyzed, and the effects of previous antibiotic treatment on the bacteriologic profile of the lesions and susceptibility patterns of the cultured bacteria were evaluated. RESULTS Pus (or tissue) from inflammatory lesions of 97 patients with HS was cultured. Mean (SD) patient age was 39.5 (13.0) years, and mean delay in diagnosis was 7.3 (8.3) years. Most patients (57.7%) had dominant involvement of one location, with the most active lesions concentrated in the genitalia, gluteal/perineal area, and axilla. Enterobacterales species were the most frequent isolates detected in all locations except the face and scalp. Seventy-eight patients (80.4%) had been treated in the community setting prior to referral with a median (range) of 2 (1-8) lines of antibiotics. The most commonly prescribed antibiotics were amoxicillin/clavulanate (22.0%), doxycycline/minocycline (16.8%), clindamycin (16.2%; monotherapy 8.1%, clindamycin with rifampicin 8.1%), and cephalexin (13.9%). Compared to the previously untreated patients, cultures of lesions from the previously treated patients yielded a higher percentage of gram-negative Enterobacterales (the most common isolates in this group) (31.3% vs. 10.3%) and a significantly higher median number of isolates per culture (2 vs. 1, p < 0.0001). Gram-positive bacteria, usually considered contaminants (mainly coagulase-negative staphylococci) accounted for 31.0% of the isolates in the previously treated group. Susceptibility testing for the entire cohort revealed 100% bacterial sensitivity to ciprofloxacin. Staphylococcus spp. were 100% sensitive to rifampicin. Both gram-positive and gram-negative bacteria had high sensitivity to trimethoprim and sulfamethoxazole. CONCLUSION Nonstandardized antibiotic treatment of HS in the community setting can skew the microbiology of skin lesions toward gram-negative bacteria. Therefore, treatment with trimethoprim and sulfamethoxazole or ciprofloxacin, either alone or combined with rifampicin, may be considered.
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Affiliation(s)
- Shira Barmatz
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Fisch-Gilad
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asher Hackett
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jen Barak Levitt
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Dalal
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Taieb
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Kremer
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Levi
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Pavlovsky
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Shany Sherman
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Der Sarkissian S, Hessam S, Kirby JS, Lowes MA, Mintoff D, Naik HB, Ring HC, Suyien NC, Frew JW. Identification of Biomarkers and Critical Evaluation of Biomarker Validation in Hidradenitis Suppurativa: A Systematic Review. JAMA Dermatol 2022; 158:300-313. [PMID: 35044423 DOI: 10.1001/jamadermatol.2021.4926] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease. Objective To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria. Evidence Review Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Findings A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting. Conclusions and Relevance Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free "omics"-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.
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Affiliation(s)
| | - Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco.,Associate Editor, JAMA Dermatology
| | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nisha Chandran Suyien
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Sydney, Australia
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Gajanin V, Baroš N, Marošević G, Ninković-Baroš Đ, Balaban J. New approaches in management and treatment of 'Hidradenitis suppurativa'. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-36048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background / Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that most often affects apocrine gland-bearing areas of the skin. The treatment depends on the severity of the clinical presentation. The paper objective was to present new modalities in management and treatment of HS. Methods: The subjects in this research included the patients suffering from the severe form of HS, who were treated in the University Clinical Centre of the Republic of Srpska for the past three years. The effect of treatment of HS were monitored. In four patients, biologic therapy with adalimumab or adalimumab biosimilars was administered, while four patients received radiotherapy and 17 of them, were treated surgically. Depending on the type of treatment, the effects of therapy were monitored after 6-12 weeks by using clinical examination and by assessing the disease stage according to the Hurley staging. Due to a small number of subjects, especially in patients treated with biologic and radiotherapy, it was not possible to perform any statistical analysis and the results were presented by description, in tables and photographs. Results: Biologic therapy: Adalimumab was administered subcutaneously 80 mg, twice a month. After 12 weeks, in 4 patients was observed a regression of changes by 60-70 % when compared to previous skin changes. Radiotherapy: the total radiation dose was 5 Gy, distributed in 5 or 10 fractions. After 12 weeks an improvement by 60-70 % was observed. Surgical treatment: after 6-8 weeks, the patients were fully recovered. Conclusions: Application of biologic and radiotherapy after 12 weeks had similar results, ie it brought to regression of changes by 60-70 %. The best results were achieved after surgical treatment of HS.
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25
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Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells 2021; 10:cells10082094. [PMID: 34440863 PMCID: PMC8392140 DOI: 10.3390/cells10082094] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.
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Lu JW, Huang YW, Chen TL. Efficacy and safety of adalimumab in hidradenitis suppurativa: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e26190. [PMID: 34087885 PMCID: PMC8183777 DOI: 10.1097/md.0000000000026190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adalimumab is used as a first-line biologic agent in the management of moderate-to-severe hidradenitis suppurativa (HS). The objective of the present study was to evaluate the efficacy and safety of adalimumab in patients with moderate-to-severe HS. METHODS We performed a systematic review and meta-analysis according to Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. Pooled estimates, namely standardized mean difference (SMD) and relative risk (RR), were calculated using random-effect model with trial sequential analysis. Small study effects were examined using the Doi plot. Certainty of evidence (CoE) was assessed using "The Grading of Recommendations Assessment, Development, and Evaluation" approach, and number-needed-to-treat (NNT) was calculated. RESULTS Five randomized controlled trials, involving 1014 patients, were included. We performed subgroup analysis of adalimumab administered subcutaneously both weekly and every other week. Adalimumab administered weekly was associated with better clinical response achievement (RR 1.76, 95% confidence interval [95% CI] 1.35-2.29; trial sequential analysis TSA-adjusted CI 1.01-3.08; CoE: low; NNT = 5) and a significant improvement in modified Sartorius score (SMD = -0.45, 95% CI = -0.76 to -0.13; CoE: very low; NNT = 10) and dermatology life quality index (DLQI) (SMD -0.47, 95% CI -0.61 to -0.32; CoE: low; NNT = 10). Nevertheless, adalimumab administered every other week showed an improvement only in modified Sartorius score. The pooled RRs of adverse events in both groups revealed no statistical significance when compared with the placebo. CONCLUSIONS Adalimumab administered weekly resulted in not only better clinical responses than placebo but also significantly improved disease severity and quality of life of patients with moderate-to-severe HS. Our study provides supporting evidence to the current guidelines and aids decision-making in the application of adalimumab in HS management.
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Affiliation(s)
- Jing-Wun Lu
- Department of Medical Education, Hualien Tzu Chi Hospital, Hualien
| | - Yu-Wen Huang
- Department of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
| | - Tai-Li Chen
- Department of Medical Education, Hualien Tzu Chi Hospital, Hualien
- School of Medicine, Tzu Chi University, Hualien, Taiwan
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Preda-Naumescu A, Ahmed HN, Mayo TT, Yusuf N. Hidradenitis suppurativa: pathogenesis, clinical presentation, epidemiology, and comorbid associations. Int J Dermatol 2021; 60:e449-e458. [PMID: 33890304 DOI: 10.1111/ijd.15579] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/08/2021] [Indexed: 02/06/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is clinically defined by lesions ranging from painful, deep seated nodules to abscesses, draining sinus tracts, and ultimately, irreversible fibrotic scars. While the etiology remains unclear, a number of mechanisms ranging from genetics to aberrations of the immune system have been proposed. In addition, HS has a number of associations and may occur in conjunction with several diseases that span a host of medical specialties. The estimated prevalence ranges are from 1% to 4%; however, a large degree of under-reporting and misdiagnosis of this condition likely underestimates its true clinical significance. The debilitating consequences of missed diagnoses or improper management leads to severe pain and irreversible cutaneous manifestations (i.e., fistulae, sinus tracts, disfiguring scarring). HS has been found to significantly impair patients' quality of life to a greater degree when compared with other skin conditions. Early recognition and treatment are critical for a favorable prognosis, and diagnostic delays may be related to variable presentations within numerous comorbidities. Here we provide an in-depth, clinical-based review of HS, highlighting the clinical presentation, pathophysiology, grading systems, epidemiology, and comorbidities, in hopes of shedding light on an often misunderstood disease and ultimately moving closer to a more conclusive understanding of its various presentations and association.
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Affiliation(s)
- Ana Preda-Naumescu
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Hana N Ahmed
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tiffany T Mayo
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nabiha Yusuf
- Department of Dermatology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Kjærsgaard Andersen R, Saunte D, Jemec G. What counts? The relationship between patient estimated numbers of painful hidradenitis suppurativa lesions over 4 weeks compared with clinician's lesion count at the time of examination. J Eur Acad Dermatol Venereol 2020; 34:e827-e830. [DOI: 10.1111/jdv.16704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Kjærsgaard Andersen
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - D.M.L. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - G.B.E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
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Daoud M, Njimi H, Benhadou F, Suppa M, Daxhelet M, Karama J, White J, Jemec GBE, Del Marmol V. Metascoring Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 35:e272-e274. [PMID: 33131129 DOI: 10.1111/jdv.17022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Daoud
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - H Njimi
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - F Benhadou
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - M Suppa
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium.,Institut Jules Bordet, Brussels, Belgium
| | - M Daxhelet
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - J Karama
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - J White
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Denmark
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme, Université libre de Bruxelles (ULB), Brussels, Belgium
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30
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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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31
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Dubois A, Meggitt S, Hampton PJ. Description of a disease activity proforma for documentation of hidradenitis suppurativa severity and distribution, and suggestions for use as a patient‐reported outcome measure. Clin Exp Dermatol 2020; 45:598-599. [DOI: 10.1111/ced.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2019] [Indexed: 12/01/2022]
Affiliation(s)
- A. Dubois
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
| | - S. Meggitt
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - P. J. Hampton
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
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Pinter A, Kokolakis G, Rech J, Biermann MHC, Häberle BM, Multmeier J, Reinhardt M. Hidradenitis Suppurativa and Concurrent Psoriasis: Comparison of Epidemiology, Comorbidity Profiles, and Risk Factors. Dermatol Ther (Heidelb) 2020; 10:721-734. [PMID: 32500484 PMCID: PMC7367943 DOI: 10.1007/s13555-020-00401-y] [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: 04/22/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Hidradenitis suppurativa (HS) is a chronic, debilitating, and inflammatory skin disease. The epidemiology of HS varies greatly, with an estimated prevalence ranging from 0.03% to 4% worldwide. Similar to psoriasis (PsO), HS also exhibits a systemic inflammatory nature with a spectrum of systemic comorbidities. A large health insurance claims (HICs) database is analyzed to determine the demography and epidemiology of HS, PsO, and HS with concurrent PsO (HS-PsO) patients. Furthermore, the comorbidity profiles, including the comorbidity risk of these patient populations, are analyzed. Methods This is a noninterventional retrospective analysis of anonymized HICs data using a subset of the Institute of Applied Health Research Berlin (InGef) database. The primary outcome is the prevalence and incidence of HS, PsO, and HS-PsO. Secondary outcomes include comorbidity profiles and a comorbidity risk analysis. Results The prevalence and incidence of HS were 0.0681% and 0.0101%, respectively. The prevalence of HS-PsO was 0.004% (6% of the total HS population). HS patients frequently suffered from arterial hypertension (45%), nicotine dependence (46%), obesity (41%), and depression (36%), which were more common in HS-PsO patients compared with HS alone. HS patients had an increased prevalence of metabolic, psychiatric, immune-mediated, and cardiovascular diseases, e.g., overweight/obesity [odds ratio (OR): 2.65, 95% confidence interval (CI) 2.37–2.96], depression (OR: 1.55, 95% CI 1.42–1.76), or seronegative rheumatoid arthritis (OR: 2.82, 95% CI 1.61–4.94) compared with the overall population. The increased risk of myocardial infarction in HS patients (OR: 4.1, 95% CI 3.5–4.8, adjusting for age/sex) was largely attributed to patient’s current smoking status (OR: 1.1, 95% CI 0.8–1.5, adjusting for smoking/age/sex). Conclusions HS patients show a broad spectrum of inflammatory and metabolic syndrome-related comorbidities, with an increased risk by concurrent PsO. Important for clinical practice, the elevated cardiovascular risk of HS patients can be largely attributed to smoking. Electronic supplementary material The online version of this article (10.1007/s13555-020-00401-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andreas Pinter
- Clinic for Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany.
| | - Georgios Kokolakis
- Psoriasis Research and Treatment Center, Clinic of Dermatology, Venereology, and Allergology and Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Juergen Rech
- Department of Internal Medicine, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
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33
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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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Abstract
Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease. Several studies showed that perianal, perineal and gluteal involvement is more common in men. Axillary, submammary and inguinal localizations seem to be more prevalent in women. Involvement of the genitoanal region is associated with a higher reduced quality of live and sexual health compared to other locations. Moreover HS/AI in the genitoanal region can lead to serious complications. The knowledge of perianal fistula formation, pubogenital lymphedema and squamous cell carcinoma, which are three of the most severe complications, is critical for adequate treatment.
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Affiliation(s)
- S Hessam
- Klinik für Dermatologie und Phlebologie, Katharinen-Hospital Unna, Unna, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Klinik der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - F G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Klinik der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
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35
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Abstract
Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. The estimated prevalence of HS is ~1% in most studied countries. Typically starting in early adulthood, cutaneous inflamed nodules, abscesses and pus-discharging tunnels develop in axillary, inguinal, gluteal and perianal body sites. The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1β and IL-17. The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients' quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.
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36
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Marzano AV, Chiricozzi A, Giovanardi G, Argenziano G, Bettoli V, Bianchi L, Dapavo P, Dini V, Fabbrocini G, Micali G, Offidani AM, Potenza C, Prignano F, Gualberti G, Saragaglia V, Rongioletti F. Creation of a severity index for hidradenitis suppurativa that includes a validated quality-of-life measure: the HIDRAscore. J Eur Acad Dermatol Venereol 2020; 34:1815-1821. [PMID: 32119143 PMCID: PMC7607398 DOI: 10.1111/jdv.16328] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/11/2020] [Indexed: 01/19/2023]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, debilitating disease with a considerable effect on patient quality of life. Its clinical severity can be measured using different scoring systems; however, few of them include patient‐centred parameters. Objective To create a new scoring system for HS that includes a quality‐of‐life instrument, the HIDRAdisk. Methods This post hoc analysis was carried out within the framework of a multicentre, longitudinal, epidemiologic study conducted over 9 months on quality‐of‐life aspects of HS. The new severity score was created using as reference a question from the Subject Satisfaction Questionnaire (SSQ) concerning the severity of HS as evaluated by the patient. Associated variables were selected using univariable and multivariable logistic regression models. The discriminant capabilities of the final model and of the final score were evaluated by the area under the receiver operating characteristic curve and the Hosmer–Lemeshow test. Results The study population included 308 patients with HS of any severity grade. According to the results of the regression models, the variables associated with the reference SSQ measure were number of inflammatory nodules, abscesses and draining fistulas; the HIDRAdisk score; and the number of subumbilical lesions. The HIDRAscore is obtained by the sum of the scores associated with the number of these parameters. Possible scores range from 0 to 10. Conclusion The HIDRAscore is a new scoring system for HS severity which, in addition to the clinical evaluation by the physician, includes a validated patient‐reported outcome measure, the HIDRAdisk.
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Affiliation(s)
- A 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
| | - A Chiricozzi
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Giovanardi
- Institute of Dermatology, Catholic University - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - V Bettoli
- Dermatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | - L Bianchi
- Department of Dermatology, Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - P Dapavo
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - V Dini
- U.O. Dermatologia, Università di Pisa, Pisa, Italy
| | - G Fabbrocini
- U.O.C. di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - G Micali
- Dermatology Clinic, P.O.G. Rodolico, A.O.U. Policlinico, Vittorio Emanuele, Catania, Italy
| | - A M Offidani
- Dermatology Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - C Potenza
- Dermatology Operational Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and medicine, Sapienza University of Rome - Polo Pontino- Latina, Italy
| | - F Prignano
- Clinica Dermatologica, ASF Dipartimento di Chirurgia e Medicina Translazionale, Università di Firenze, Ospedale Piero Palagi, Florence, Italy
| | | | | | - F Rongioletti
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Oranges T, Vitali S, Benincasa B, Izzetti R, Lencioni R, Caramella D, Romanelli M, Dini V. Advanced evaluation of hidradenitis suppurativa with ultra‐high frequency ultrasound: A promising tool for the diagnosis and monitoring of disease progression. Skin Res Technol 2019; 26:513-519. [DOI: 10.1111/srt.12823] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 11/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Teresa Oranges
- Department of Dermatology University of Pisa Pisa Italy
- Department of Health Sciences Anna Meyer Children's University Hospital University of Florence Florence Italy
| | - Saverio Vitali
- Department of Diagnostic and Interventional Radiology University of Pisa Pisa Italy
| | | | - Rossana Izzetti
- Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa Italy
| | - Riccardo Lencioni
- Department of Diagnostic and Interventional Radiology University of Pisa Pisa Italy
| | - Davide Caramella
- Department of Diagnostic and Interventional Radiology University of Pisa Pisa Italy
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Ngaage LM, Wu Y, Ge S, Gebran S, Liang F, Rada EM, Nam AJ, Silverman RP, Rasko YM. Factors influencing the local cure rate of hidradenitis suppurativa following wide local excision. Int Wound J 2019; 17:117-123. [PMID: 31680472 DOI: 10.1111/iwj.13241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/17/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
Wide local excision is the gold standard and only potential curative therapy for recalcitrant hidradenitis suppurativa. However, high recurrence rates persist even post-surgery with little known on the influencing factors for remission. We evaluated the effect of patient, disease, and operative factors on local cure rate of moderate to severe hidradenitis following wide local excision. We performed a retrospective chart review for all patients who had undergone surgical excision of hidradenitis at a university hospital from 2012 to 2018. We identified 79 patients with a total of 220 operative sites. The majority were obese (mean body mass index [BMI] 32.5), female (71%), African-American (84%), and had a mean age of 31 years. A quarter of operative sites experienced a recurrence (n = 56). Patients who achieved remission had a significantly lower number of affected regions than those who experienced a recurrence (2.3 vs 3.6, P = .0023). Additionally, recurrence rate differed significantly between body locations (P = .0440). Smoking, BMI, Hurley grade, closure method, and excision size did not influence local cure rate. Surgical excision remains a worthy management option for hidradenitis patients with three quarters achieving remission after a single operation. Number of affected regions and location of hidradenitis may play a factor in recurrence.
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Affiliation(s)
- Ledibabari M Ngaage
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Yinglun Wu
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shealinna Ge
- Division of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Selim Gebran
- Division of Plastic and Reconstructive Surgery, R Adams Shock Trauma Center, Baltimore, Maryland
| | - Fan Liang
- Division of Plastic and Reconstructive Surgery, R Adams Shock Trauma Center, Baltimore, Maryland
| | - Erin M Rada
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Arthur J Nam
- Division of Plastic and Reconstructive Surgery, R Adams Shock Trauma Center, Baltimore, Maryland
| | - Ronald P Silverman
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.,Acelity Corporation, San Antonio, Texas
| | - Yvonne M Rasko
- Division of Plastic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
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Goldfarb N, Ingram JR, Jemec GBE, Naik HB, Piguet V, Hyde MJ, Freese R, Lowes MA, Alavi A. Hidradenitis Suppurativa Area and Severity Index (HASI): a pilot study to develop a novel instrument to measure the physical signs of hidradenitis suppurativa. Br J Dermatol 2019; 182:240-242. [PMID: 31286486 DOI: 10.1111/bjd.18335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, U.S.A.,Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, U.S.A
| | - J R Ingram
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Dermatology, University of Copenhagen, Copenhagen, Denmark
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - V Piguet
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M J Hyde
- The Rockefeller University, New York, NY, U.S.A
| | - R Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, U.S.A
| | - M A Lowes
- The Rockefeller University, New York, NY, U.S.A
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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40
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Prouteau C, Dinulescu M, Oger E, Pruvost-Balland C, Buche S, Cogrel O, Delage M, Maruani A, Nicol I, Sbidian E, Villani AP, Viguier M, Chastagner M, Grodner C, Kaoutar J, Laurent C, Leducq S, Dupuy A, Droitcourt C. Concordance of severity scores for photographic assessment of hidradenitis suppurativa. Br J Dermatol 2019; 182:515-516. [PMID: 31494929 DOI: 10.1111/bjd.18480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Prouteau
- Department of Dermatology, CHU Rennes, F35000, Rennes, France.,University of Rennes, F35000, Rennes, France
| | - M Dinulescu
- Department of Dermatology, CHU Rennes, F35000, Rennes, France
| | - E Oger
- EA 7449 REPERES Pharmacoepidemiology and Health Services Research, F35000, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, F35000, Rennes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | - C Laurent
- Department of Dermatology, CHU Rennes, F35000, Rennes, France.,University of Rennes, F35000, Rennes, France
| | | | - A Dupuy
- Department of Dermatology, CHU Rennes, F35000, Rennes, France.,University of Rennes, F35000, Rennes, France.,EA 7449 REPERES Pharmacoepidemiology and Health Services Research, F35000, Rennes, France
| | - C Droitcourt
- Department of Dermatology, CHU Rennes, F35000, Rennes, France.,University of Rennes, F35000, Rennes, France.,EA 7449 REPERES Pharmacoepidemiology and Health Services Research, F35000, Rennes, France.,Pharmacovigilance, Pharmacoepidemiology and Drug Information Departments, PEPS Research Consortium, F35000, Rennes, France
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Kokolakis G, Sabat R. Distinguishing Mild, Moderate, and Severe Hidradenitis Suppurativa. JAMA Dermatol 2019; 154:971-972. [PMID: 29926079 DOI: 10.1001/jamadermatol.2018.1599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Georgios Kokolakis
- Psoriasis Research and Treatment Center, Clinic of Dermatology, Venereology, and Allergology and Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Center, Clinic of Dermatology, Venereology, and Allergology and Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG. Distinguishing Mild, Moderate, and Severe Hidradenitis Suppurativa-Reply. JAMA Dermatol 2019; 154:972. [PMID: 30090941 DOI: 10.1001/jamadermatol.2018.1600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Lisa Scholl
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Michael Sand
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Lutz Schmitz
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Sarah Reitenbach
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
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Kirby JS, Butt M, King T. Severity and Area Score for Hidradenitis (SASH): a novel outcome measurement for hidradenitis suppurativa. Br J Dermatol 2019; 182:940-948. [PMID: 31233623 DOI: 10.1111/bjd.18244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with a large impact on patients' health-related quality of life. However, reliable and consistent outcome measures to assess body surface area (BSA) of HS have not been established. OBJECTIVES To develop and assess the reliability and validity of a novel outcome instrument for assessment of HS BSA in a clinical trial setting. METHODS Qualitative interviews and focus groups were conducted from July to August 2015 and October 2017 to January 2018. Evaluation of the measurement was assessed during a single-day grading session with patients in April 2018. Participants, who included clinicians or patients, were recruited from academic medical centres in the U.S. mid-Atlantic region. RESULTS Concept elicitation included input from 10 providers, of which 60% (n = 6) were female, 80% (n = 8) dermatology specialists and 20% (n = 2) gynaecology specialists. Cognitive debriefing was conducted with 11 providers, of which 82% (n = 9) were dermatologists and 18% (n = 2) gynaecologists. The evaluation stage included 10 clinicians and 23 patients. The intraclass correlation coefficient (ICC) for inter-rater reliability was 0·60 [95% confidence interval (CI) 0·44-0·74]. The ICC for intrarater reliability was 0·98 (95% CI 0·94-1·00). Transformation of the BSA score resulted in an increase in inter-rater reliability to 0·75 (95% CI 0·62-0·85) or 0·76 (95% CI 0·62-0·85). Scores all demonstrated concurrent validity, with statistically significant correlations with extant scoring methods. CONCLUSIONS This novel scale is a reliable and valid HS outcome instrument and may capture a wide range of patients by assessing BSA. Future research is necessary to demonstrate its responsiveness. What's already known about this topic? The major HS disease activity scales rely on lesions counts and have moderate-to-good reliability. Body surface area (BSA) is one of the physical signs included in the Core Outcome Set for HS, but is not a part of existing HS disease activity scales. What does this study add? A novel disease severity scale, the Severity and Area Score for Hidradenitis (SASH), was developed and the psychometric properties assessed. There was high inter-rater reliability of 0·75 and 0·76 when BSA was scored on an ordinal scale, and an excellent intrarater reliability of 0·98. The SASH score also demonstrated convergent validity with extant instruments. What are the clinical implications of this work? The ability of clinicians to accurately assess disease status will be improved. Implementation of the SASH score will help guide and assess the effectiveness of appropriate treatment choice.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - T King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, U.S.A
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Ovadja ZN, Schuit MM, van der Horst CMAM, Lapid O. Inter- and intrarater reliability of Hurley staging for hidradenitis suppurativa. Br J Dermatol 2019; 181:344-349. [PMID: 30585304 PMCID: PMC6850108 DOI: 10.1111/bjd.17588] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 12/12/2022]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, inflammatory and recurrent skin disease. Different staging instruments have been suggested, but none has achieved universal acceptance. Despite the fact that Hurley staging is one of the most widely applied HS disease severity staging instruments, it has not been validated. Objectives To determine the inter‐ and intrarater reliability of the Hurley staging system. Methods Fifteen raters (five plastic surgeons, five general surgeons and five dermatologists) independently staged 30 photos of patients with HS according to Hurley staging at two time points. Reliability was assessed using kappa (&kgr;) statistics, and multivariable logistic regressions were used to determine independent risk factors for photos with discordant staging. Results Inter‐rater reliability was moderate for the three stages of HS [κ = 0·59, 95% confidence interval (CI) 0·48–0·70]. It was moderate for Hurley stage I (κ = 0·45, 95% CI 0·32–0·55) and stage II (κ = 0·51, 95% CI 0·31–0·71) and it was almost perfect for stage III (κ = 0·81, 95% CI 0·62–1·00). The intrarater reliability was substantial for all stages and all raters (κ = 0·65, 95% CI 0·58–0·72). For stage I it was moderate (κ = 0·50, 95% CI 0·38–0·62), for stage II it was substantial (κ = 0·62, 95% CI 0·51–0·73) and for stage III it was almost perfect (κ = 0·82, 95% CI 0·77–0·87). Hurley stages II and III were less likely to result in discordant staging than Hurley stage I (odds ratios 0·47, 95% CI 0·29–0·77 and 0·21, 95% CI 0·12–0·38, respectively). The mean time spent on staging a photo was 14 s. Conclusions Hurley staging is reliable for rapid severity assessment of HS, with moderate inter‐rater and substantial intrarater reliability for all stages. It is best for assessing Hurley stage III HS, which is an indication for surgery. What's already known about this topic? Hidradenitis suppurativa is a relatively common disease without a universally accepted disease severity staging instrument. Hurley staging is one of the most widely applied disease severity staging instruments.
What does this study add? This study is the first to determine the inter‐ and intrarater reliability of Hurley staging. Hurley staging is reliable for rapid severity assessment of hidradenitis suppurativa. It is best for assessing Hurley stage III disease, which is an indication for surgery.
Linked Comment: https://doi.org/10.1111/bjd.18158. https://doi.org/10.1111/bjd.18188 available online https://www.bjdonline.com/article/inter-and-intrarater-reliability-of-the-hurley-staging-for-hidradenitis-suppurativa/
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Affiliation(s)
- Z N Ovadja
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, OLVG, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands
| | - M M Schuit
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - O Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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Peris K, Lo Schiavo A, Fabbrocini G, Dini V, Patrizi A, Fusano M, Bianchi L, Guanziroli E, Guarneri C, Parodi A, Bertoldi A, Musumeci ML, Offidani A, Rongioletti F, Pistone G, Malara G, Potenza C, Casari A, Franchi C, Ardigò M, Cusano F, Stingeni L, Amerio P, Mancini LL, Prignano F, Deboli T, Gualberti G, Saragaglia V, Bettoli V. HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2019; 33:766-773. [PMID: 30633405 PMCID: PMC6593467 DOI: 10.1111/jdv.15425] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland-bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used. OBJECTIVE The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome. METHODS A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex-16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment-General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS-PGA). RESULTS A total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex-16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS-PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test-retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated. CONCLUSION Our study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice.
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Affiliation(s)
- K Peris
- Istituto di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Lo Schiavo
- Unità di Dermatologia, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - G Fabbrocini
- U.O.C. di Dermatologia- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy
| | - V Dini
- U.O. Dermatologia, Università di Pisa, Pisa, Italy
| | - A Patrizi
- Dermatologia, DIMES (Dipartimento di Medicina clinica Specialistica e Sperimentale), Università di Bologna, Bologna, Italy
| | - M Fusano
- ASST Spedali Civili of Brescia, U.O. Dermatologia e Venereologia, Università di Brescia, Brescia, Italy
| | - L Bianchi
- Unità Operativa di Dermatologia, Policlinico Tor Vergata, Università degli studi di Roma Tor Vergata, Rome, Italy
| | - E Guanziroli
- Dipartimento di Fisiopatologia, IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - C Guarneri
- Dipartimento di Scienze Biomediche e Dentali e Imaging Morfofunzionale, Unità di Dermatologia, Università di Messina, Messina, Italy
| | - A Parodi
- DiSSal Sezione di Dermatologia, Università di Genova, Ospedale-Policlinico San Martino, Genoa, Italy
| | - A Bertoldi
- Dipartimento di Dermatologia, Ospedale "Santi Giovanni e Paolo", Venice, Italy
| | - M L Musumeci
- Dermatology Clinic, P.O. G. Rodolico, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - A Offidani
- SOD Clinica di Dermatologia, Università Politecnica delle Marche, Azienda Ospedaliera Universitaria, Ancona, Italy
| | - F Rongioletti
- Clinica Dermatologica, Dipartimento di scienze Mediche e Salute Pubblica, Università di Cagliari, Cagliari, Italy
| | - G Pistone
- Dipartimento Di.Bi. MIS, U.O.C. di Dermatologia e MTS, A.O.U.P "Paolo Giaccone", Palermo, Italy
| | - G Malara
- Struttura Complessa presso la UOC di Dermatologia GOM "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - C Potenza
- Facoltà di Farmacia e Medicina, U.O.C. di Dermatologia "Daniele Innocenzi", Università degli Studi di Roma "Sapienza", Polo Pontino, Italy
| | - A Casari
- Clinica Dermatologica, Policlinico di Modena, Modena, Italy
| | - C Franchi
- UO dermatologia, IRCCS Galeazzi, Milan, Italy
| | - M Ardigò
- U.O.C. di Dermatologia Clinica, IFO-San Gallicano, IRCCS, Rome, Italy
| | - F Cusano
- U.O.C. di Dermatologia, A.O. Gaetano Rummo, Benevento, Italy
| | - L Stingeni
- Sezione di Dermatologia Clinica, Allergologica e Venereologica, Dipartimento di Medicina, Università di Perugia, Perugia, Italy
| | - P Amerio
- Dipartimento di Medicina e Scienze dell'Invecchiamento, Università G. d'Annunzio, Chieti, Italy
| | - L L Mancini
- Unità di Dermatologia, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - F Prignano
- Clinica Dermatologica - ASF Dipartimento di Chirurgia e Medicina Translazionale, Ospedale Piero Palagi, Università di Firenze, Florence, Italy
| | - T Deboli
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | - V Bettoli
- Dipartimento di Medicina Clinica e Specialistica, U.O. di Dermatologia, A.O.U. di Ferrara, Ferrara, Italy
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