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Demir O, Yondem OZ, Doganay M. A Neglected Disease: Hidradenitis Suppurativa a Rare Cause of Amyloidosis Complicated With Sepsis and Renal Failure: A Case Report. Case Rep Crit Care 2024; 2024:4893040. [PMID: 39229360 PMCID: PMC11371454 DOI: 10.1155/2024/4893040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/08/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a painful relapsing inflammatory disease characterized with subcutaneous nodules, abscesses, tunnels, and deforming scars. We present a case of HS complicated with amyloidosis who was admitted with sepsis and acute renal failure. Case Report: A 53-year-old male patient with a history of HS and amyloidosis was accepted to the intensive care unit suffering from acute kidney failure and sepsis symptoms. He was receiving adalimumab during admission. He received hemodialysis and piperacillin-tazobactam antibiotherapy. After 15 days of hospitalization, his sepsis was treated, but he was taken to a routine hemodialysis programme. Conclusion: In the presence of amyloidosis with intervenient infections, the risk of chronic renal failure in HS cases can be kept in mind even if the patient is receiving TNF inhibitors.
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Affiliation(s)
- Orhun Demir
- Department of AnesthesiologyFaculty of MedicineLokman Hekim University, Ankara, Türkiye
| | - Omer Zuhtu Yondem
- Department of AnesthesiologyFaculty of MedicineLokman Hekim University, Ankara, Türkiye
| | - Mehmet Doganay
- Department of Infectious DiseasesFaculty of MedicineLokman Hekim University, Ankara, Türkiye
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Almuhanna N, Aljughayman M, Fidler L, Alhusayen R. Risk of respiratory diseases among hospitalized patients with hidradenitis suppurativa. Int J Dermatol 2024. [PMID: 38634645 DOI: 10.1111/ijd.17182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease. METHODS This is a cross-sectional, case-control, population-based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD-9-CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls. RESULTS Twenty-three thousand seven hundred and sixty-seven hospital admissions for HS were compared with 95,068 age- and sex-matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170-1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419-1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157-2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182-1.374]; P < 0.001). CONCLUSION HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients.
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Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Lee Fidler
- Division of Respirology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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3
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Kurokawa I, Kita K, Hashimoto T. Successful treatment of ulceration in hidradenitis suppurativa with topical bucladesine: A case report. SKIN HEALTH AND DISEASE 2024; 4:e321. [PMID: 38312248 PMCID: PMC10831532 DOI: 10.1002/ski2.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024]
Abstract
We report a case of hidradenitis suppurativa (HS) with skin ulceration in a 19-year-old man. He was successfully treated with topical bucladesine ointment treatment, resulting in a hypertrophic scar 2 months after the treatment. Bucladesine can be an alternative treatment option for ulceration in HS.
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Affiliation(s)
- Ichiro Kurokawa
- Department of DermatologyMeiwa HospitalNishinomiyaHyogoJapan
| | - Kanako Kita
- Department of DermatologyMeiwa HospitalNishinomiyaHyogoJapan
| | - Takashi Hashimoto
- Department of DermatologyOsaka Metropolitan University, Graduate School of MedicineOsakaJapan
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Zeiner KN, Schreckenbach T, Gruber-Rouh T, Roos F, Frank J, Kaufmann R, Meissner M, Valesky EM. Hidradenitis suppurativa - pitfalls of long-term immunosuppressive treatment with TNF inhibitors. Dermatol Ther 2022; 35:e15597. [PMID: 35614570 DOI: 10.1111/dth.15597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/17/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Kim Nikola Zeiner
- Department of Dermatology, Venereology and Allergology, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Teresa Schreckenbach
- Department of General, Visceral and Transplantation Surgery, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Frederik Roos
- Department of Urology, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Goethe-University Frankfurt, University Hospital Frankfurt/Main
| | - Eva Maria Valesky
- Department of Dermatology, Venereology and Allergology, Goethe-University Frankfurt, University Hospital Frankfurt/Main
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Yang K, Shi M, Fu C, Huo R. Comprehensive Treatment of Severe Follicular Occlusion Triad: A Case Report. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:541-546. [PMID: 35387202 PMCID: PMC8978351 DOI: 10.2147/ccid.s351522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
Follicular occlusion triad (FOT) is a chronic inflammatory skin disease that comprises hidradenitis suppurativa, acne conglobata, and perifolliculitis capitis abscedens et suffodiens and can seriously affect a patient’s quality of life. Currently, there is no consensus on the treatment plan for FOT. There are also only a few reports on the treatment of severe FOT. In July 2020, a male patient who was diagnosed with severe FOT was treated in our hospital and received comprehensive surgical treatment for 2 months. This treatment strategy was effective and the patient had no recurrence during a follow-up period of >1 year. By retrospectively analyzing the clinical data of the patient, recording the patient’s condition during postoperative recovery, and reviewing relevant literatures, the clinical manifestations, diagnosis, choice of treatment methods, and prognosis of FOT were evaluated.
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Affiliation(s)
- Kun Yang
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Mengdong Shi
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Cong Fu
- Department of Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Ran Huo
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People's Republic of China
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6
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An JH, Moon SJ, Shin JU, Kim DH, Yoon MS, Lee HJ. Clindamycin Mono-Therapy of Hidradenitis Suppurativa Patients: A Single-Center Retrospective Study. Ann Dermatol 2021; 33:515-521. [PMID: 34858002 PMCID: PMC8577909 DOI: 10.5021/ad.2021.33.6.515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/12/2021] [Accepted: 04/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background A rifampicin (RF)-clindamycin (CL) combination therapy is recommended as the first-line treatment for moderate to severe hidradenitis suppurativa (HS). Although the long-term use of RF requires caution due to the possibility of developing resistant bacteria, only a few studies have investigated alternatives for this combination therapy. Objective To evaluate the efficacy of systemic CL mono-therapy and assess the prevalence and CL resistance of bacterial growth in HS patients. Methods A total of 53 HS patients treated with CL mono-therapy were included. The efficacy was evaluated by identifying the rate of HS Clinical Response (Hi-SCR) achievers and comparing HS Physician’s Global Assessment (HS-PGA) before (W0) and after (W8) the treatment. Purulent material from HS skin lesions was collected on the W0. Bacterial flora and antibiotic sensitivity were determined by bacterial cultures. Results Of 53 HS patients, 34 were eligible for evaluation of the efficacy of the therapy. Twenty-one patients (61.76%) achieved Hi-SCR. The mean scoring of HS-PGA had significantly decreased from 3.24 to 2.15 (p=0.001). The prevalence of CL resistance was 15.00%. No significant differences in the efficacy of the therapy according to the presence of CL-resistant bacteria on the W0 were observed (p=0.906). Adverse events occurred in 26.42% of patients. Conclusion Systemic CL mono-therapy may be a safe and useful alternative to RF-CL combination therapy, and no significant difference in the efficacy of the therapy depending on the presence of CL-resistant bacteria was observed.
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Affiliation(s)
- Ji Hae An
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Su Jin Moon
- Department of Medicine, CHA University School of Medicine, Pocheon, Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Moon Soo Yoon
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hee Jung Lee
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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El-Shebly AM, El-Hadidy MR, Shehabeldin SA, El Din AB, Zeina AM, Zayed AE, El Fahar MH. Outcome comparison between thoracodorsal artery perforator flap and muscle-sparing latissimus dorsi flap in axillary reconstruction after hidradenitis suppurativa excision. Microsurgery 2021; 42:143-149. [PMID: 34783373 DOI: 10.1002/micr.30837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/28/2021] [Accepted: 10/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thoracodorsal artery perforator (TDAP) flap and muscle-sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results. METHODS A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm-chest interval. RESULTS The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p = .009), respectively. Flap complications were significantly higher in the TDAP group (p = .034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm-chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p = .001). CONCLUSIONS TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.
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Affiliation(s)
- Ahmed M El-Shebly
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed R El-Hadidy
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samy A Shehabeldin
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Bahaa El Din
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed M Zeina
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed E Zayed
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed H El Fahar
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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8
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Qian YT, Xiao M, Liu K, Ma DL, Zhang X. Two novel mutations of the γ-secretase genes in Chinese acne inversa (hidradenitis suppurativa). Exp Dermatol 2021; 31:643-644. [PMID: 34748240 DOI: 10.1111/exd.14496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yue-Tong Qian
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Xiao
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Keqiang Liu
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Dong-Lai Ma
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue Zhang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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9
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Glatt S, Jemec GBE, Forman S, Sayed C, Schmieder G, Weisman J, Rolleri R, Seegobin S, Baeten D, Ionescu L, Zouboulis CC, Shaw S. Efficacy and Safety of Bimekizumab in Moderate to Severe Hidradenitis Suppurativa: A Phase 2, Double-blind, Placebo-Controlled Randomized Clinical Trial. JAMA Dermatol 2021; 157:1279-1288. [PMID: 34406364 PMCID: PMC8374742 DOI: 10.1001/jamadermatol.2021.2905] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Question What is the efficacy and safety of bimekizumab in individuals with moderate to severe hidradenitis suppurativa (HS)? Findings In this double-blind, placebo-controlled, phase 2 randomized clinical trial including 90 randomized patients with HS (73 completed the trial), bimekizumab demonstrated clinically meaningful and consistent improvements in participants with HS vs placebo across all assessed outcome measures. Serious adverse events occurred in 2 of 46 bimekizumab-treated participants (4%) and 2 of 21 placebo-treated participants (10%). Meaning These initial clinical efficacy and safety data suggest that dual inhibition of interleukin 17A and 17F by bimekizumab may be a viable treatment approach for HS, with the potential to achieve deep responses in clinical outcome measures, and support further evaluation. Importance Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a high burden for patients and limited existing therapeutic options. Objective To evaluate the efficacy and safety of bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin 17A and 17F in individuals with moderate to severe HS. Design, Setting, and Participants This phase 2, double-blind, placebo-controlled randomized clinical trial with an active reference arm was performed from September 22, 2017, to February 21, 2019. The study included a 2- to 4-week screening period, a 12-week treatment period, and a 20-week safety follow-up. Of 167 participants screened at multiple centers, 90 were enrolled. Eligible participants were 18 to 70 years of age with a diagnosis of moderate to severe HS 12 months or more before baseline. Interventions Participants with HS were randomized 2:1:1 to receive bimekizumab (640 mg at week 0, 320 mg every 2 weeks), placebo, or reference arm adalimumab (160 mg at week 0, 80 mg at week 2, and 40 mg every week for weeks 4-10). Main Outcomes and Measures The prespecified primary efficacy variable was the proportion of participants with a 50% or greater reduction from baseline in the total abscess and inflammatory nodule count with no increase in abscess or draining fistula count (Hidradenitis Suppurativa Clinical Response [HiSCR] at week 12. Exploratory variables included proportion achieving a modified HiSCR with 75% reduction of HiSCR criteria (HiSCR75) or a modified HiSCR with 90% reduction of HiSCR criteria (HiSCR90), change in Patient’s Global Assessment of Pain, and Dermatology Life Quality Index total scores. Results Eighty-eight participants received at least 1 dose of study medication (61 [69%] female; median age, 36 years; range, 18-69 years). Seventy-three participants completed the study, including safety follow-up. Bimekizumab demonstrated a higher HiSCR rate vs placebo at week 12 (57.3% vs 26.1%; posterior probability of superiority equaled 0.998, calculated using bayesian analysis). Bimekizumab demonstrated greater clinical improvements compared with placebo. Improvements in the International Hidradenitis Suppurativa Severity Score (IHS4) were seen at week 12 with bimekizumab (mean [SD] IHS4, 16.0 [18.0]) compared with placebo (mean [SD] IHS4, 40.2 [32.6]). More bimekizumab-treated participants achieved positive results on stringent outcome measures compared with placebo. At week 12, 46% of bimekizumab-treated participants achieved HiSCR75 and 32% achieved HiSCR90, whereas 10% of placebo-treated participants achieved HiSCR75 and none achieved HiSCR90; in adalimumab-treated participants, 35% achieved HiSCR75 and 15% achieved HiSCR90. One participant withdrew because of adverse events. Serious adverse events occurred in 2 of 46 bimekizumab-treated participants (4%), 2 of 21 placebo-treated participants (10%), and 1 of 21 adalimumab-treated participants (5%). Conclusions and Relevance In this phase 2 randomized clinical trial, bimekizumab demonstrated clinically meaningful improvements across all outcome measures, including stringent outcomes. Bimekizumab’s safety profile was consistent with studies of other indications, supporting further evaluation in participants with HS. Trial Registration ClinicalTrials.gov Identifier: NCT03248531
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Affiliation(s)
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | | | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill
| | | | - Jamie Weisman
- Medical Dermatology Specialists Inc, Atlanta, Georgia
| | | | | | | | | | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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Anduquia-Garay F, Rodríguez-Gutiérrez MM, Poveda-Castillo IT, Valdes-Moreno PL, Agudelo-Rios DA, Benavides-Moreno JS, Lozada-Martínez ID, Bolaño-Romero MP, Borraez-Segura B, Rahman S. Hidradenitis suppurativa: Basic considerations for its approach: A narrative review. Ann Med Surg (Lond) 2021; 68:102679. [PMID: 34401142 PMCID: PMC8353381 DOI: 10.1016/j.amsu.2021.102679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
Hidradenitis suppurativa is a chronic and debilitating skin disease, whose lesions can range from inflammatory nodules to abscesses and fistulas in the armpits, groin, perineum, inframammary region. Diagnosis can be confused with a large number of clinical pictures, and although studies on hidradenitis suppurativa are not so scarce in the literature, doctors are often unaware of this disease and therefore its diagnosis is often late. Pharmacological treatment ranges from retinoids to immunosuppression and radiation therapy, and surgical treatment ranges from incision and drainage to more complete excisions and laser therapies. Hidradenitis suppurativa is a disease seen and treated mainly by dermatologists and general surgeons, however, it is necessary for general practitioners to have basic knowledge about this entity, as they are the first line of care in the health system. Hidradenitis suppurativa is an entity of necessary recognition by the surgeon. It is a preventable and treatable condition with a good prognosis. This condition should be managed by a multidisciplinary team.
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Affiliation(s)
- Felipe Anduquia-Garay
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- School of Medicine, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - María Manuela Rodríguez-Gutiérrez
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Medical and Surgical Research Center, School of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Colombia
| | | | | | | | | | - Ivan David Lozada-Martínez
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia
| | | | | | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
- Corresponding author.
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11
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Yee D, Collier EK, Atluri S, Jaros J, Shi VY, Hsiao JL. Gender differences in sexual health impairment in hidradenitis suppurativa: A systematic review. Int J Womens Dermatol 2020; 7:259-264. [PMID: 34222580 PMCID: PMC8243154 DOI: 10.1016/j.ijwd.2020.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/13/2020] [Accepted: 10/23/2020] [Indexed: 01/01/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by painful nodules, sinus tracts, and scarring, with a predilection for intertriginous areas. HS is particularly prevalent in women of childbearing age and can have varying psychological and physical consequences. The chronic and debilitating nature of this disease can lead to significant impairments in patients' sexual health and overall quality of life. This systematic review examines gender differences in the impact of HS on sexual health. In addition, we review gaps in the management of sexual health for patients with HS and outline recommendations to adequately address sexual concerns and optimize care.
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Affiliation(s)
- Danielle Yee
- University of California, Los Angeles-Olive View, Sylmar, CA, United States
| | - Erin K Collier
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Swetha Atluri
- College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Joanna Jaros
- Department of Dermatology, Cook County Hospital and Health System, Chicago, IL, United States
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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12
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Morita A, Takahashi H, Ozawa K, Imafuku S, Takekuni N, Takahashi K, Matsuyama T, Okubo Y, Zhao Y, Kitamura S, Takei K, Yokoyama M, Hayashi N, Terui T. Long-term analysis of adalimumab in Japanese patients with moderate to severe hidradenitis suppurativa: Open-label phase 3 results. J Dermatol 2020; 48:3-13. [PMID: 33029861 PMCID: PMC7821142 DOI: 10.1111/1346-8138.15605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/17/2020] [Indexed: 11/29/2022]
Abstract
This phase 3, multicenter, open-label single-arm study evaluated adalimumab (ADA) in Japanese patients with moderate to severe hidradenitis suppurativa (HS). Fifteen patients received ADA 160 mg s.c. at week 0, 80 mg at week 2 and 40 mg at week 4 and every week thereafter. At any time after week 52, patients were given the option to receive 80 mg ADA every other week or remain on 40 mg every week. The primary end-point (achievement of HS Clinical Response [HiSCR] at week 24) and results up to week 24 were published previously. Secondary end-points included total abscess and inflammatory nodule (AN) count, 30% or more and 1 unit or more reduction in Patient's Global Assessment of Skin Pain Numeric Rating Scale (NRS30), modified Sartorius score and quality of life (QoL). After 12 weeks of ADA treatment, the achievement rate in HiSCR was 86.7%; HiSCR achievement rate was sustained through week 52 at 66.7%. Improvements at week 12 were also seen in the proportion of patients achieving an AN count of 0-2; NRS30 response rate among the nine patients with a baseline NRS of 3 or more; mean decrease in modified Sartorius score (61.4); and QoL as assessed by Dermatology Life Quality Index and Treatment Satisfaction Questionnaire; these improvements were maintained through 52 weeks. Similar efficacy was observed when patients switched dosing from ADA 40 mg every week to ADA 80 mg every other week. There were no new safety findings with ADA 40 mg weekly dosing during the study, and no differences in safety were found between patients who switched to 80 mg ADA every other week and patients who remained on 40 mg every week. The results of this study indicate that long-term ADA treatment is effective and well tolerated in Japanese patients with moderate to severe HS.
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Affiliation(s)
- Akimichi Morita
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Kentaro Ozawa
- National Hospital Organization Osaka National Hospital, Osaka, Japan
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van der Zee H, Longcore M, Geng Z, Garg A. Weekly adalimumab treatment decreased disease flare in hidradenitis suppurativa over 36 weeks: integrated results from the phase 3 PIONEER trials. J Eur Acad Dermatol Venereol 2020; 34:1050-1056. [PMID: 31630445 PMCID: PMC7318582 DOI: 10.1111/jdv.16023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/25/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory lesions that flare unpredictably. The impact of weekly adalimumab (ADAew) on HS flare is not well-characterized. OBJECTIVE To evaluate the impact of disease flare on health-related quality of life (HRQOL) in moderate-to-severe HS patients and to determine the effect of ADAew on disease flare using integrated data from two phase 3 trials over 36 weeks. METHODS In period A (12 weeks), Dermatology Life Quality Index (DLQI) score change from baseline was compared in patients who flared and those who did not, regardless of treatment. The proportion of patients experiencing flare, duration of flare and time to flare was evaluated for ADAew vs. placebo (PBO). In period B (24 weeks), proportion of patients experiencing flare who received continuous ADAew treatment through 36 weeks was assessed. RESULTS HRQOL was markedly improved among those who did not experience flare. In period A, the proportion of patients who experienced flare was significantly lower with ADAew vs. PBO (12.3% vs. 35.3%, P < 0.001). ADAew patients also had longer time to first flare (101 days vs. 57 days; P < 0.001) and shorter flare duration (18.9 days vs. 32.0 days, respectively; P = 0.001) vs. PBO. Through 36 weeks of treatment, 20.2% of ADAew patients flared, and for those who achieved at least a partial clinical response to ADAew at 12 weeks, only 5.7% flared. CONCLUSIONS Flare reduction is an important measure in HS that correlates with clinically meaningful improvement in HRQOL. ADAew reduces HS flare through 12 and subsequent 36 weeks of treatment.
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Affiliation(s)
- H.H. van der Zee
- Department of DermatologyErasmus Medical CenterRotterdamThe Netherlands
| | | | - Z. Geng
- AbbVie IncNorth ChicagoILUSA
| | - A. Garg
- Department of DermatologyZucker School of Medicine at Hofstra/NorthwellNew Hyde ParkNYUSA
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Hong JS, Kim JH, Jung GY, Lee JH, Jang TJ, Shin HK. A case report of hidradenitis suppurativa after subdermal excision for axillary osmidrosis. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2020. [DOI: 10.14730/aaps.2019.01998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Wu J, Ge H, Fan Y, Zhen Q, Tang L, Sun L. Novel Mutation of the NCSTN Gene Identified in a Chinese Acne Inversa Family. Ann Dermatol 2020; 32:237-242. [PMID: 33911744 PMCID: PMC7992621 DOI: 10.5021/ad.2020.32.3.237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
Acne inversa is a chronic inflammatory follicular disease with autosomal dominant inheritance. In recent years, many functional mutations in the NCSTN genes have been identified as the cause of familial acne inversa. Herein, we recruited four patients and seven unaffected individuals from a Chinese family and performed Sanger sequencing of the NCSTN gene. One novel frameshift mutation, c.450_459del (p.Ser 151GlnfsX48), was identified in exon 5 of the NCSTN gene. Three normal-looking children carrying the mutation were proven to be patients. We also presented a literature review from previous studies of acne inversa, suggesting that NCSTN is a hotspot gene for acne inversa. Most affected individuals experienced onset in adolescence. We confirmed the diagnosis in this family based on the mutation. This finding will help expound the relationship between the NCSTN gene and the pathogenesis of acne inversa and emphasize the value of genetic diagnosis in monogenic disorder.
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Affiliation(s)
- Jing Wu
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Huiyao Ge
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Yiming Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qi Zhen
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Lili Tang
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China
| | - Liangdan Sun
- Department of Dermatology of First Affiliated Hospital, Anhui Medical University, Hefei, China.,Key Laboratory of Dermatology, Ministry of Education, Anhui Medical University, Hefei, China.,Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China
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16
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Lee DJ, Desai S, Laurent E, Kopplin LJ. Characterization and Management of Inflammatory Eye Disease in Patients with Hidradenitis Suppurativa. Ocul Immunol Inflamm 2020; 29:1318-1323. [PMID: 32255701 DOI: 10.1080/09273948.2020.1739718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To assess the spectrum and treatment outcomes of inflammatory eye disease (IED) in subjects with hidradenitis suppurativa (HS).Methods: We conducted a single center retrospective chart review of 236 patients with HS seen for ophthalmic examination between 2013 and 2018.Results: Of 236 subjects with HS, 22 subjects (9.3%) were found to have IED. Seven of 22 subjects had more than one IED diagnosis. Anterior uveitis was the most common type of IED (40.9% of subjects with IED). Episcleritis, optic neuritis, keratitis, scleritis, intermediate and posterior uveitis, trochleitis, and dacryoadenitis were also observed. Of subjects with HS and IED, 59.1% did not have any other inflammatory or autoimmune disease that could explain the etiology of their IED. Eleven patients with IED were treated with systemic immunosuppression, with IED as the principal factor directing treatment in three patients.Conclusions: IED may be independently associated with HS and may benefit from systemic immunosuppression.
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Affiliation(s)
- Daniel J Lee
- Amita Health Resurrection Medical Center, Chicago, Illinois, USA
| | - Sapna Desai
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emily Laurent
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laura J Kopplin
- Department of Ophthalmology & Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Ophthalmology and Visual Sciences, University of Wisconsin - Madison, Madison, Wisconsin, USA
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17
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Earwax of patients with hidradenitis suppurativa: A retrospective study. Arch Plast Surg 2019; 46:566-571. [PMID: 31775210 PMCID: PMC6882705 DOI: 10.5999/aps.2019.00290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 09/19/2019] [Indexed: 11/08/2022] Open
Abstract
Background In Western nations, hidradenitis suppurativa (HS) typically affects the apocrine gland-bearing skin of people of African origin, women, smokers, and individuals with obesity. The clinical characteristics of HS in Korea and Japan, however, are reportedly different from those in the West. We therefore hypothesized that wet earwax is associated with HS because most East Asian people are genetically predisposed to produce dry earwax. Methods The medical charts of 53 Japanese patients with HS were reviewed retrospectively. Results Unlike the results of surveys conducted in Western nations, most of our patients were men (72%), whose buttocks were the most commonly affected site. Apocrine gland-bearing areas, such as the axilla, were affected less often. The proportion of HS patients with wet earwax was 51%, which was substantially higher than that found in the general Japanese population. Moreover, when patients with gluteal HS were excluded, the proportion of patients with wet earwax became even higher (68%). Conclusions Although the etiology of HS is unknown, our survey indicated that HS in apocrine gland-bearing skin, such as the axillary and anogenital areas, may be associated with wet earwax. As this study was conducted in a limited clinical setting, a nationwide, multicenter survey is warranted to clarify the clinical characteristics of HS in Japan.
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18
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Tzur Bitan D, Berzin D, Cohen A. Hidradenitis suppurativa and schizophrenia: a nationwide cohort study. J Eur Acad Dermatol Venereol 2019; 34:574-579. [DOI: 10.1111/jdv.15997] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022]
Affiliation(s)
- D. Tzur Bitan
- Department of Behavioral Sciences Ariel University Ariel Israel
- Shalvata Mental Health Center Affiliated with the Sackler School of Medicine Tel Aviv University Tel Aviv Israel
| | - D. Berzin
- School of Medicine Ben‐Gurion University of the Negev Be'er Sheva Israel
| | - A.D. Cohen
- 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 Be'er Sheva Israel
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19
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Jemec GBE, Okun MM, Forman SB, Gulliver WPF, Prens EP, Mrowietz U, Armstrong AW, Geng Z, Gu Y, Williams DA, Teixeira HD, Kimball AB. Adalimumab medium-term dosing strategy in moderate-to-severe hidradenitis suppurativa: integrated results from the phase III randomized placebo-controlled PIONEER trials. Br J Dermatol 2019; 181:967-975. [PMID: 30916379 PMCID: PMC6899827 DOI: 10.1111/bjd.17919] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2019] [Indexed: 12/29/2022]
Abstract
Background Weekly adalimumab (Humira®) is approved for the treatment of hidradenitis suppurativa (HS) based on the 12‐week placebo‐controlled periods of the two phase III PIONEER trials. Objectives Using PIONEER integrated trial results, we aimed to evaluate the optimal medium‐term adalimumab maintenance dosing strategy for moderate‐to‐severe HS. Methods Each trial had two double‐blind periods; 12‐week Period A and 24‐week Period B. Patients randomized to adalimumab 40 mg every week (ADAew) (Period A), were rerandomized in Period B to ADAew (ADAew/ew), ADA every other week (ADAew/eow), or placebo (ADAew/pbo). Placebo‐randomized patients were reassigned in Period B to ADAew (PIONEER I) or placebo (PIONEER II). The primary outcome was HS Clinical Response (HiSCR). Patients who lost response during Period B were discontinued from the study and offered an option to enter the open‐label extension (OLE) to receive ADAew. Results are reported across the two study periods, and data were combined from the two study periods and the OLE. Results For week‐12 HiSCR achievers, the HiSCR week‐36 rate was 48·1% (ADAew/ew) vs. 46·2% (ADAew/eow) and 32·1% (ADAew/pbo). Combining (post hoc) these patients with week‐12 partial responders further differentiated outcomes in Period B (ADAew/ew 55·7% vs. ADAew/eow 40·0% and ADAew/pbo 30·1%). Period‐B adverse‐event rates were ADAew/ew 59·6% vs. ADAew/eow 57·4% and ADAew/pbo 65·0%. One patient (ADAew/ew) reported a serious infection. Conclusions Weekly adalimumab treatment, effective throughout 36 weeks, was the optimal maintenance medium‐term dosing regimen for this population. At least partial response after 12 weeks with continued weekly dosing had better outcomes than dose reduction or interruption. Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy. No new safety risks were identified. What's already known about this topic? Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly misinterpreted as an infection and treated with long‐term antibiotic regimens or surgical incisions. Based on the chronicity of HS and the lack of evidence for efficacious and safe long‐term HS treatments, it is important to evaluate medium‐ to long‐term therapies for HS. Weekly adalimumab (Humira®) is approved for the treatment of moderate‐to‐severe HS based on the two phase III PIONEER trials.
What does this study add? This study pooled data from the two PIONEER trials, providing a more robust assessment of outcomes. After at least partial treatment success with weekly adalimumab short‐term therapy (12 weeks), continuing weekly dosing during the subsequent 24 weeks had better outcomes than dose reduction or treatment interruption. Patients who do not show at least a partial response to weekly adalimumab by week 12 are unlikely to benefit from continued therapy.
Linked Comment: https://doi.org/10.1111/bjd.18437. https://www.bjdonline.com/article/adalimumab-medium-term-dosing-strategy-in-moderate-to-severe-hidradenitis-suppurativa-integrated-results-from-the-phase-iii-randomized-placebo-controlled-pioneer-t/
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Affiliation(s)
- G B E Jemec
- Department of Dermatology Zealand University Hospital, Health Sciences Faculty University of Copenhagen, Roskilde, Denmark
| | - M M Okun
- Fort HealthCare, Fort Atkinson, WI, U.S.A
| | - S B Forman
- Forward Clinical Trials, Tampa, FL, U.S.A
| | - W P F Gulliver
- Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - E P Prens
- Erasmus University Medical Center, Rotterdam, the Netherlands.,CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims Cedex, France
| | - U Mrowietz
- Department of Dermatology, Venereology, and Allergology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - A W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, U.S.A
| | - Z Geng
- AbbVie Inc., North Chicago, IL, U.S.A
| | - Y Gu
- AbbVie Inc., North Chicago, IL, U.S.A
| | | | | | - A B Kimball
- Harvard Medical School and Beth Israel Deaconess Hospital, Boston, MA, U.S.A
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20
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Abstract
BACKGROUND Although treatment recommendations for hidradenitis suppurativa (HS) are well known, practical experience implementing them in Lithuania has not been reported yet. OBJECTIVE To review clinical findings and treatment options used in patients with HS in the largest center of dermatology and venereology in Lithuania from 2005 to 2016. METHODS A retrospective single-center medical file analysis was conducted on 46 patients with HS. Demographic information, patient history, and treatment results were included in the final analysis. χ Tests were used. Statistical significance was set at P ≤ .05. MAIN RESULTS Of the 46 patients, 52.2% were male. Percentages of patients with Hurley stages I, II, and III were 41.3%, 30.4%, and 28.3%, respectively. Patients with Hurley III HS were more likely to be smokers and obese. The most commonly prescribed medications were systemic antibiotics (76.1%) and systemic retinoids (37.0%). Systemic corticosteroids (19.6%) were more often prescribed to patients with Hurley III. Surgical procedures were performed in 54.3% of patients. The most common complication of the disease was contracture (13.0%). CONCLUSIONS This study revealed an association between smoking and obesity and the most severe stage of HS. Results showed that traditional medications used in this study were not effective for severe HS.
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Tugnoli S, Agnoli C, Silvestri A, Giari S, Bettoli V, Caracciolo S. Anger, Emotional Fragility, Self-esteem, and Psychiatric Comorbidity in Patients with Hidradenitis Suppurativa/Acne Inversa. J Clin Psychol Med Settings 2019; 27:527-540. [DOI: 10.1007/s10880-019-09640-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: Clinical and ultrasound observations. J Am Acad Dermatol 2019; 80:1314-1321. [DOI: 10.1016/j.jaad.2018.11.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/13/2018] [Accepted: 11/18/2018] [Indexed: 01/18/2023]
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23
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Silfvast-Kaiser A, Youssef R, Paek SY. Diet in hidradenitis suppurativa: a review of published and lay literature. Int J Dermatol 2019; 58:1225-1230. [PMID: 31006861 DOI: 10.1111/ijd.14465] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurring, inflammatory skin disorder resulting in skin abscesses and sinus tracts of the skin folds. Hidradenitis suppurativa remains a disease with limited treatment options. Management of disease activity with dietary modification has been of considerable interest to the HS patient community. Limited evidence exists to support dietary changes for treatment of HS. Strategies such as eliminating dairy products, limiting simple carbohydrate and sugar intake, and avoiding nightshades (Solanaceae) and foods containing brewer's yeast have been reported to be helpful in some patients. Several supplements have also been touted as beneficial. Herein, we review the existing dietary recommendations in both peer-reviewed and lay literature in an attempt to consolidate and evaluate existing information, while stimulating further inquiry into the role of diet in HS. Although dietary modifications are often of considerable interest to HS patients, there is a paucity of data regarding diet as it relates to HS. It is unclear whether diet may prove to be of value in limiting the severity of HS. Further research is needed to determine the potential benefits of these dietary changes.
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Affiliation(s)
| | | | - So Yeon Paek
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA.,Texas A&M College of Medicine, Dallas, TX, USA
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24
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Kimball AB, Sundaram M, Gauthier G, Guérin A, Pivneva I, Singh R, Ganguli A. The Comorbidity Burden of Hidradenitis Suppurativa in the United States: A Claims Data Analysis. Dermatol Ther (Heidelb) 2018; 8:557-569. [PMID: 30306395 PMCID: PMC6261111 DOI: 10.1007/s13555-018-0264-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Prior studies have reported that hidradenitis suppurativa (HS) is accompanied by a myriad of physical and mental conditions. However, given the small sample sizes and the limited number of pre-selected comorbidities, these studies do not provide a complete picture of the comorbidity burden of HS in the USA. Moreover, the relationship between HS severity and comorbidity burden has yet to be characterized. Using a large US claims database, we estimated the comorbidity burden associated with HS, stratified by disease severity. METHODS A retrospective matched cohort design was used. Patients with HS were classified into two severity cohorts (milder and more severe) using an empirical algorithm based on treatments received. The comorbidity burden was compared between each HS cohort and their matched HS-free cohort, and between patients with milder vs. those with more severe forms of HS. RESULTS Several physical and mental comorbidities were found to be more prevalent in both cohorts of patients with milder and more severe forms of HS than in their matched HS-free cohorts. The comorbidity burden also increased greatly as the disease progressed to more severe forms. CONCLUSIONS The results of this study highlight the complexity of the comorbidity burden of HS patients and the need for a multidisciplinary approach to optimize the management of HS and its numerous associated comorbidities. FUNDING AbbVie, Inc.
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Affiliation(s)
- Alexandra B Kimball
- Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Murali Sundaram
- AbbVie Inc, North Chicago, IL, USA
- Janssen Scientific Affairs, Horsham, PA, USA
| | | | | | | | - Rakesh Singh
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, IL, USA
| | - Arijit Ganguli
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, IL, USA
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Michel C, DiBianco JM, Sabarwal V, Stein DM. The Treatment of Genitoperineal Hidradenitis Suppurativa: A Review of the Literature. Urology 2018; 124:1-5. [PMID: 30391681 DOI: 10.1016/j.urology.2018.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
Hidradenitis suppurativa is a chronic inflammatory condition affecting the axilla, genitals, perineum, and perianal regions. The pathophysiology of hidradenitis suppurativa is complex and requires a multidisciplinary approach to treatment involving medical and surgical management when indicated. We describe our multidisciplinary protocol for treatment, which includes rheumatology-monitored immunotherapy, medical management, wide surgical resection, wound care, and reconstruction. The multidisciplinary care team includes rheumatology, wound care, and reconstructive urologic surgery. Surgical management includes wide local surgical resection, negative pressure dressing, delayed reconstruction, and perioperative immunotherapy. Multimodal treatment with surgical, medical, wound, and immunotherapy care is vital to successful treatment.
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Affiliation(s)
- Chloe Michel
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - John Michael DiBianco
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Vikram Sabarwal
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Daniel M Stein
- Department of Urology, The George Washington University School of Medicine and Health Sciences, Washington, DC
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26
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Surgical management of hidradenitis suppurativa: procedural trends and risk factors. J Surg Res 2018; 229:200-207. [DOI: 10.1016/j.jss.2018.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022]
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Caposiena Caro R, Solivetti F, Bianchi L. Power Doppler ultrasound assessment of vascularization in hidradenitis suppurativa lesions. J Eur Acad Dermatol Venereol 2018; 32:1360-1367. [DOI: 10.1111/jdv.14745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- R.D. Caposiena Caro
- Dermatology Department; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
| | - F.M. Solivetti
- Radiodiagnostic Service; Dermatologic Institute San Gallicano; Rome Italy
| | - L. Bianchi
- Dermatology Department; Department of Systems Medicine; University of Rome Tor Vergata; Rome Italy
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Suárez Valladares MJ, Eiris Salvado N, Rodríguez Prieto MA. Treatment of hidradenitis suppurativa with intralesional photodynamic therapy with 5-aminolevulinic acid and 630nm laser beam. J Dermatol Sci 2017; 85:241-246. [DOI: 10.1016/j.jdermsci.2016.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/11/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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30
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Jemec GBE, Guérin A, Kaminsky M, Okun M, Sundaram M. What happens after a single surgical intervention for hidradenitis suppurativa? A retrospective claims-based analysis. J Med Econ 2016; 19:710-7. [PMID: 26938967 DOI: 10.3111/13696998.2016.1161636] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective Hidradenitis suppurativa (HS) is often treated by surgery. The risk of recurrence after surgery is common and the consequences are substantial, but neither has been quantified using a claims database. This study aimed to estimate the burden associated with non-curative surgery in HS patients. Methods A retrospective analysis was performed of health insurance claims data from Q1 1999 to Q2 2011 in a US claims database. The analysis included 2668 adults with ≥1 diagnosis of HS and ≥1 claim for skin surgery within 6 months after diagnosis. Healthcare resource utilization and medical costs were compared using multivariate regressions. Results Overall, 46% of HS patients had ≥1 indicator of non-curative surgery. The incidences of inpatient, emergency department, and outpatient visits were 88%, 40%, and 30% higher, respectively, for patients with non-curative surgery vs patients without indicator of non-curative surgery (all p < 0.001). Average medical costs were $11,858 and $6427 for patients with and without indicators of non-curative surgery, respectively. The difference of $4185 (p < 0.001) was mainly driven by inpatient costs (difference = $2685; p < 0.001). Limitations Indicators of non-curative HS surgery were defined based on an empirical algorithm. Conclusions Non-curative HS surgery occurred in almost half of all cases and represents a significant burden on patients and payers in terms of resource utilization and costs.
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Affiliation(s)
- Gregor B E Jemec
- a Department of Dermatology , Roskilde Hospital , Roskilde , Denmark
- e Health Sciences Faculty , University of Copenhagen , Copenhagen , Denmark
| | | | | | - Martin Okun
- c Fort HealthCare , Fort Atkinson , WI , USA
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31
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Principi M, Cassano N, Contaldo A, Iannone A, Losurdo G, Barone M, Mastrolonardo M, Vena GA, Ierardi E, Di Leo A. Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association. World J Gastroenterol 2016; 22:4802-4811. [PMID: 27239107 PMCID: PMC4873873 DOI: 10.3748/wjg.v22.i20.4802] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/11/2016] [Accepted: 05/04/2016] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn’s disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as “the explosive mixture” at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.
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Harvin G, Kasarala G. Two Cases of Paradoxical Hidradenitis Suppurativa while on Adalimumab. Case Rep Gastroenterol 2016; 10:88-94. [PMID: 27403108 PMCID: PMC4929363 DOI: 10.1159/000444442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 12/26/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by recurring abscesses, nodules, and fistulas predominantly in the groin and axillae. The association between HS and Crohn's disease (CD) has been well documented. Tumor necrosis factor (TNF) inhibitors have shown to be effective in treating both HS and CD. We report 2 patients who developed HS while on TNF inhibitor treatment for CD.
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Affiliation(s)
- Glenn Harvin
- Department of Gastroenterology, Hepatology and Nutrition, Brody School of Medicine at East Carolina University, Greenville, N.C., USA
| | - George Kasarala
- Department of Gastroenterology, Hepatology and Nutrition, Brody School of Medicine at East Carolina University, Greenville, N.C., USA
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Silva-Feistner M, Salomone C, Silva S, Vial-Letelier V. Hidradenitis supurativa prepuberal: presentación de 2 casos clínicos. ACTA ACUST UNITED AC 2016; 87:193-8. [DOI: 10.1016/j.rchipe.2015.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/25/2015] [Accepted: 10/06/2015] [Indexed: 02/07/2023]
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Affiliation(s)
- Maeve Maher
- Ohio State University College of Medicine, Columbus, Ohio
| | - Larissa Larsen
- Department of Dermatology, University of California, Davis, Sacramento, California
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Thomas C, Rodby KA, Thomas J, Shay E, Antony AK. Recalcitrant Hidradenitis Suppurativa: An Investigation of Demographics, Surgical Management, Bacterial Isolates, Pharmacologic Intervention, and Patient-reported Health Outcomes. Am Surg 2016. [DOI: 10.1177/000313481608200423] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hidradenitis suppurativa (HS) is characterized by chronic inflammation, recurrent abscesses, and scarring. Surgery is performed when medical management and antibiotic therapy fails. This study sought to evaluate the demographics, surgical procedures, bacteriology, pharmacologic intervention, and quality of life of patients with recalcitrant HS requiring surgical intervention. A retrospective chart review was performed of 76 recalcitrant HS patients at the University of Illinois Medical Center. Patient demographics, bacterial culture, and surgery data were reviewed. Quality of life was assessed using the 36-item short-form health survey. Patients were mostly female (73.7%) and African American (81.6%) with a mean duration of symptoms of 8.6 years before surgery. Patients underwent at least one surgical procedure, most often to the axillae (57.6%) and 73.7 per cent received antibiotics. The most common culture isolates were Corynebacterium species (14.0%), Staphylococcus epidermidis (13.1%), and Staphylococcus aureus (10.4%) with varying resistance patterns. Surveyed patients had depressed 36-item short-form health survey physical functioning and social functioning scores. Recalcitrant HS patients with progressive symptomology over approximately nine years before surgical intervention were more likely to be African American women with axillary HS. Quality of life was diminished. We recommend initial treatment of HS with clindamycin and trimethoprim–sulfamethoxazole in clindamycin refractory cases.
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Affiliation(s)
- Cristina Thomas
- Northwestern University Feinberg School of Medicine, Illinois
| | | | - Jessina Thomas
- Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
| | - Elizabeth Shay
- Department of Plastic Surgery, University of Illinois at Chicago
| | - Anuja K. Antony
- Department of Plastic and Reconstructive Surgery, Rush University Medical Center, Chicago, Illinois
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Rekawek P, Mehta S, Andikyan V, Harmaty M, Zakashansky K. Squamous cell carcinoma of the vulva arising in the setting of chronic hidradenitis suppurativa: A case report. Gynecol Oncol Rep 2016; 16:28-30. [PMID: 27331133 PMCID: PMC4899419 DOI: 10.1016/j.gore.2016.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/16/2016] [Accepted: 03/15/2016] [Indexed: 11/17/2022] Open
Abstract
Highlights the sheer mass of tumor encountered with hidradenitis suppurativa. Reviews the complexity of wound healing with hidradenitis suppurativa. Overview of multi-team approach to a vulvar cancer.
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Affiliation(s)
- Patricia Rekawek
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shailja Mehta
- Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Vaagn Andikyan
- Department of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marco Harmaty
- Department of Plastic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Konstantin Zakashansky
- Department of Gynecologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Anderson MD, Zauli S, Bettoli V, Boer J, Jemec GBE. Cyclosporine treatment of severe Hidradenitis suppurativa--A case series. J DERMATOL TREAT 2015; 27:247-50. [PMID: 26406923 DOI: 10.3109/09546634.2015.1088128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an overlooked but common disease severely affecting both genders. HS is generally perceived as difficult to treat and although a number of treatments are available, the need for more effective treatment is apparent. OBJECTIVES Cyclosporine A (CsA) has been suggested as an effective treatment in four smaller case series. It was therefore decided to review a larger series of cases, reporting all outcomes in order to provide a less biased base for evaluating the potential of CsA for use in HS. METHODS An exploratory retrospective review of case notes was performed at three departments of dermatology with a special interest in HS, where HS had been treated with CsA in the period 2009-2012. RESULTS In total, 18 HS patients treated with CsA were identified and analysed and 50% reported some benefit. All patients had previously been treated with multiple various other modalities. LIMITATIONS This is an exploratory retrospective review with a limited number of patients. CONCLUSIONS This retrospective review found some effect of CsA in the recalcitrant cases studied, mainly reported as "slight improvement". This may be due to a number of factors which may have overestimated (e.g., concommitant therapy) or underestimated (e.g., case selection of recalcitrant cases) the effect, and indicates the need for prospective evaluation of the claims. The present data provide a basis for power calculations in future studies investigating the potential for treating HS with CsA in a randomised controlled trial.
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Affiliation(s)
- Marianne D Anderson
- a Department of Dermatology , Health Sciences Faculty, Roskilde Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Stefania Zauli
- b Section of Dermatology, Department of Clinical and Experimental Medicine , University of Ferrara , Arcispedale S. Anna , Ferrara , Italy , and
| | - Vincenzo Bettoli
- b Section of Dermatology, Department of Clinical and Experimental Medicine , University of Ferrara , Arcispedale S. Anna , Ferrara , Italy , and
| | - Jurr Boer
- c Department of Dermatology , Deventer Hospital , Deventer , The Netherlands
| | - Gregor B E Jemec
- a Department of Dermatology , Health Sciences Faculty, Roskilde Hospital, University of Copenhagen , Copenhagen , Denmark
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McMillan K. Diagnoses of Hidradenitis Suppurativa in the United States, 1979-2012. Skin Appendage Disord 2015; 1:117-22. [PMID: 27171648 DOI: 10.1159/000439438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/14/2015] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is rarely diagnosed in the United States. Delayed diagnosis is a significant problem in the management of HS. In the past decade, there has been an increase in HS research. To determine whether those efforts have led to an increase in diagnoses, an analysis of visits to physicians in the United States from 1979 to 2012 was performed, using National Center for Health Statistics (NCHS) databases. Patient visits to private physician offices, hospital outpatient departments, and emergency rooms were analyzed. An increase in visit rates at outpatient departments from 2003-2007 [6.3/100,000, 95% confidence interval (CI) 2.9-9.8] to 2008-2010 (30.4/100,000, 95% CI 13.9-46.9; p = 0.017) was found. Converting the data to estimated numbers of patients, a 7-fold increase in patients from 2002-2007 (2.5/100,000, 95% CI 1.4-3.6) to 2008-2010 (16.9/100,000, 95% CI 7.8-26.1; p = 0.003) was found. No significant increase in patient or patient visit rates were found when analyzing visits in the physician office setting or combined office and hospital settings. Localization of increased diagnosis to outpatient departments may reflect the recent increase in clinical research. NCHS data can be useful in monitoring rates of HS diagnosis as an outcome of increased awareness of the disease.
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Hidradenitis Suppurativa: A Frequently Missed Diagnosis, Part 2: Treatment Options. Adv Skin Wound Care 2015; 28:372-80; quiz 381-2. [PMID: 26181861 DOI: 10.1097/01.asw.0000466712.21948.8a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the intertriginous area. Patients with HS have several challenges to their quality of life and activities of everyday living, including malodor, purulent discharge, and discomfort. There is often a delay in diagnosis and appropriate treatment. The need for cosmetically acceptable local treatments and dressing application makes this disease an important challenge for wound care specialists. The choice of optimal treatment varies depending on the disease severity, expert knowledge, the availability of an interprofessional team, and patient factors.
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Shlyankevich J, Chen AJ, Kim GE, Kimball AB. Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis. J Am Acad Dermatol 2014; 71:1144-50. [PMID: 25440440 DOI: 10.1016/j.jaad.2014.09.012] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/01/2014] [Accepted: 09/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving intertriginous skin. Previous epidemiologic studies have been limited by small sample size. OBJECTIVE We sought to describe the prevalence and comorbidities of HS in a large patient care database. METHODS In this retrospective case-control study, we chart-validated all patients within a hospital database who received at least 1 billing code for HS between 1980 and 2013. Verified cases were matched with controls based on age, gender, and race. Prevalences of a priori selected comorbidities were compared between HS and control groups. RESULTS A total of 2292 patients at Massachusetts General Hospital received at least 1 code for HS. A total of 1776 cases had a validated diagnosis of HS, yielding a prevalence of 0.08%. In unadjusted analysis, all comorbidities were diagnosed significantly more in HS compared with control including (in rank order of likelihood): smoking, arthropathies, dyslipidemia, polycystic ovarian syndrome, psychiatric disorders, obesity, drug dependence, hypertension, diabetes, thyroid disease, alcohol dependence, and lymphoma (all P < .01). LIMITATIONS Control subjects were not validated for absence of HS and comorbidity validation was not performed for either group. CONCLUSIONS Our results highlights the high comorbidity burden of patients with HS compared with matched control subjects.
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Affiliation(s)
- Julia Shlyankevich
- Clinical Unit for Research Trials and Outcomes in Skin, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Alpert Medical School, Brown University, Providence, Rhode Island
| | - Allison J Chen
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Grace E Kim
- Clinical Unit for Research Trials and Outcomes in Skin, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Alexandra B Kimball
- Clinical Unit for Research Trials and Outcomes in Skin, Massachusetts General Hospital, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Andino Navarrete R, Hasson Nisis A, Parra Cares J. Efectividad de la terapia fotodinámica con ácido 5-aminolevulínico en el tratamiento de la hidrosadenitis supurativa. Serie de 5 casos. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:614-7. [DOI: 10.1016/j.ad.2013.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/14/2013] [Accepted: 10/19/2013] [Indexed: 01/27/2023] Open
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Effectiveness of 5-Aminolevulinic Acid Photodynamic Therapy in the Treatment of Hidradenitis Suppurativa: A Report of 5 Cases. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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44
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McMillan K. Hidradenitis suppurativa: number of diagnosed patients, demographic characteristics, and treatment patterns in the United States. Am J Epidemiol 2014; 179:1477-83. [PMID: 24812161 DOI: 10.1093/aje/kwu078] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recent regional and insurance database studies indicate that diagnoses of hidradenitis suppurativa (HS) are rare, with fewer than 200,000 affected patients in the United States. These findings are at odds with the generally accepted prevalence of approximately 1%. To estimate the number of patients diagnosed with HS, including patients enrolled in public health plans and the uninsured, we performed an investigation using National Center for Health Statistics databases of visits to health care providers. Survey data from physician offices and clinics, hospital outpatient departments, and emergency departments in the United States were analyzed. There were 254,000 (95% confidence interval: 180,000, 328,000) health care visits by patients with HS per year from 2002 to 2010. An annualized estimate of 118,000 (95% confidence interval: 83,000, 152,000) patients with HS diagnoses was determined. Excluding emergency department data, the annualized estimate was 100,000 (95% confidence interval: 67,000, 134,000) patients. Adults between 18 and 64 years of age comprised 92.8% (standard error, 2.6%) of HS patients. Of that working-age population, 31.5% (standard error, 5.6%) were enrolled in Medicare or Medicaid, which is a significantly higher proportion than for those in the same age group in the general population. A review of earlier surveys of HS prevalence was performed. HS is a rarely diagnosed disease, and epidemiologic data to support undiagnosed HS as a common disease are lacking.
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Dufour DN, Esmann S, Jemec GBE. Improving quality of life in patients with hidradenitis suppurativa: a therapeutic view. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.12.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bahillo Monné C, Honorato Guerra S, Schoendorff Ortega C, Gargallo Quintero AB. Management of Hidradenitis Suppurativa with Biological Therapy: Report of Four Cases and Review of the Literature. Dermatology 2014; 229:279-87. [DOI: 10.1159/000365076] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 06/04/2014] [Indexed: 11/19/2022] Open
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Slominski A, Zbytek B, Nikolakis G, Manna PR, Skobowiat C, Zmijewski M, Li W, Janjetovic Z, Postlethwaite A, Zouboulis CC, Tuckey RC. Steroidogenesis in the skin: implications for local immune functions. J Steroid Biochem Mol Biol 2013; 137:107-23. [PMID: 23435015 PMCID: PMC3674137 DOI: 10.1016/j.jsbmb.2013.02.006] [Citation(s) in RCA: 249] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/07/2013] [Accepted: 02/08/2013] [Indexed: 12/13/2022]
Abstract
The skin has developed a hierarchy of systems that encompasses the skin immune and local steroidogenic activities in order to protect the body against the external environment and biological factors and to maintain local homeostasis. Most recently it has been established that skin cells contain the entire biochemical apparatus necessary for production of glucocorticoids, androgens and estrogens either from precursors of systemic origin or, alternatively, through the conversion of cholesterol to pregnenolone and its subsequent transformation to biologically active steroids. Examples of these products are corticosterone, cortisol, testosterone, dihydrotesterone and estradiol. Their local production can be regulated by locally produced corticotropin releasing hormone (CRH), adrenocorticotropic hormone (ACTH) or cytokines. Furthermore the production of glucocorticoids is affected by ultraviolet B radiation. The level of production and nature of the final steroid products are dependent on the cell type or cutaneous compartment, e.g., epidermis, dermis, adnexal structures or adipose tissue. Locally produced glucocorticoids, androgens and estrogens affect functions of the epidermis and adnexal structures as well as local immune activity. Malfunction of these steroidogenic activities can lead to inflammatory disorders or autoimmune diseases. The cutaneous steroidogenic system can also have systemic effects, which are emphasized by significant skin contribution to circulating androgens and/or estrogens. Furthermore, local activity of CYP11A1 can produce novel 7Δ-steroids and secosteroids that are biologically active. Therefore, modulation of local steroidogenic activity may serve as a new therapeutic approach for treatment of inflammatory disorders, autoimmune processes or other skin disorders. In conclusion, the skin can be defined as an independent steroidogenic organ, whose activity can affect its functions and the development of local or systemic inflammatory or autoimmune diseases. This article is part of a Special Issue entitled 'CSR 2013'.
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Affiliation(s)
- Andrzej Slominski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA; Center for Cancer Research, University of Tennessee Health Science Center, Memphis, TN 38163, USA; Department of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Wollina U, Koch A, Heinig B, Kittner T, Nowak A. Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment. Indian Dermatol Online J 2013; 4:2-11. [PMID: 23439959 PMCID: PMC3573446 DOI: 10.4103/2229-5178.105454] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Dresden, Germany
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Thoracodorsal Artery Perforator Flaps and Muscle-Sparing Latissimus Dorsi Myocutaneous Flaps for the Treatment of Axillary Hidradenitis. Ann Plast Surg 2012; 69:371-5. [DOI: 10.1097/sap.0b013e31824b3d4a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Zhang C, Wang L, Chen L, Ren W, Mei A, Chen X, Deng Y. Two novel mutations of the NCSTN gene in Chinese familial acne inverse. J Eur Acad Dermatol Venereol 2012; 27:1571-4. [PMID: 22759192 DOI: 10.1111/j.1468-3083.2012.04627.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acne inversa (AI; MIM 142690), or hidradenitis suppurativa (HS), is a type of autosomal-dominant genodermatosis caused by mutations in γ-secretase. The complex of γ-secretase is a transmembrane protease that catalyses the cleavage of a set of membrane proteins and is comprised of four subunits encoded by four genes, including PSEN1, PSENEN, NCSTN and APH1. However, mutations associated with AI vary significantly, and it is important to define the specific mutation with a particular AI patient. OBJECTIVE To determine specific mutations in the γ-secretase gene associated with two Chinese AI families. METHODS Two families of three generations with apparent AI symptoms were examined through proband analysis. Genomic DNAs of the family members and a cohort of 100 healthy individuals were isolated and subjected to polymerase chain reaction (PCR) and direct DNA sequencing. RESULTS Two heterozygous missense mutations, c.647A>C (p.Q216P) in the exon 6, and c.223G>A (p.V75I) in the exon 3 of the NCSTN gene, were identified in the two families respectively. No mutations were found in 100 healthy individuals. CONCLUSIONS We have identified two novel mutations within the NCSTN gene associated with AI.
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Affiliation(s)
- C Zhang
- Core Laboratory, Department of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, ChinaDepartment of Dermatology, Qichun County Renmin Hospital, Qichun, Hubei 435300, ChinaDepartment of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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