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Marzano AV, Magnoni C, Micali G, De Magnis A, Pintori G, Fiorini S, Simonella V, Bastioli L, Nappi F, Pappagallo G, Prignano F. Improving hidradenitis suppurativa management: consensus statements from physicians and patients' perspectives. Arch Dermatol Res 2024; 316:577. [PMID: 39180694 DOI: 10.1007/s00403-024-03316-2] [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: 06/05/2024] [Revised: 06/05/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024]
Abstract
Hidradenitis suppurativa (HS) is a frequent chronic inflammatory skin condition primarily affecting areas rich in apocrine sweat glands, presenting with comedones, papules, nodules, and abscesses, as well as tunnels and hypertrophic scarring. Despite its prevalence and impact on quality of life, the pathogenesis of HS remains incompletely understood. Notably, its diagnosis often suffers from delays and misidentification, therefore an improved education for healthcare providers is mandatory. Moreover, HS is frequently associated with systemic comorbidities and a multidisciplinary approach is suggested for its management. Recognizing these challenges, a group of Italian HS experts and patients convened to develop consensus guidelines via the Nominal Group Technique. Through iterative meetings and remote collaboration, they identified key areas for improvement and formulated consensus statements to guide healthcare providers in delivering optimal care. This collaborative effort highlights the importance of standardized approaches and interdisciplinary collaboration in managing HS effectively.
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Affiliation(s)
- Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Via Pace, 9, 20122, Milan, Italy.
| | - Cristina Magnoni
- Università Degli Studi Di Modena E Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Giuseppe Micali
- Università Di Catania, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | | | - Linda Bastioli
- AISI-Associazione Italiana Sostegno Idrosadenite, Viterbo, Italy
| | - Francesca Nappi
- AISI-Associazione Italiana Sostegno Idrosadenite, Viterbo, Italy
| | - Giovanni Pappagallo
- Scuola Di Metodologia Clinica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Verona, Italy
| | - Francesca Prignano
- Dipartimento Di Scienze Della Salute, Sezione Di Dermatologia, Università Di Firenze, Florence, Italy
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Kridin K, Shihade W, Weinstein O, Zoller L, Onn E, Cohen A, Solomon-Cohen E. A history of asthma is associated with susceptibility to hidradenitis suppurativa: a population-based longitudinal study. Arch Dermatol Res 2023; 315:2845-2851. [PMID: 37642698 PMCID: PMC10615903 DOI: 10.1007/s00403-023-02693-4] [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: 06/20/2022] [Revised: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
The association of hidradenitis suppurativa (HS) and asthma remains to be investigated. To assess the bidirectional association between HS and asthma. A population-based study was conducted to compare HS patients (n = 6779) with age-, sex-, and ethnicity-matched control subjects (n = 33,259) with regard to the incidence of new onset and the prevalence of preexisting asthma. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were calculated. The prevalence of preexisting asthma was higher in patients with HS relative to controls (9.6% vs. 6.9%, respectively; P < 0.001). The odds of HS were 1.4-fold greater in patients with a history of asthma (fully adjusted OR 1.41; 95% CI 1.27-1.55; P < 0.001). The incidence rate of new-onset asthma was estimated at 9.0 (95% CI 6.3-12.7) and 6.2 (95% CI 5.1-7.5) cases per 10,000 person-years among patients with HS and controls, respectively. The risk of asthma was not statistically different in patients with HS and controls (fully adjusted HR 1.53; 95% CI 0.98-2.38; P = 0.062). Relative to other patients with HS, those with HS and comorbid asthma were younger at the onset of HS (30.7 [14.7] vs. 33.3 [15.1], respectively; P < 0.001) and had a comparable risk of all-cause mortality (adjusted HR 0.86; 95% CI 0.44-1.68; P = 0.660). A history of asthma confers susceptibility to subsequent development of HS. This observation is of importance for clinicians managing both patients with HS and asthma. Further research is warranted to elucidate the pathomechanism underlying this finding.
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Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
- Lübeck Institute of Experimental Dermatology, University of Lübeck, University of Lübeck, Ratzeburger Allee 160, 23562, LübeckLübeck, Germany.
| | - Wesal Shihade
- School of Public Health, University of Haifa, Haifa, Israel
| | - Orly Weinstein
- 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
| | | | - Erez Onn
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Baruch Padeh Medical Center, Poriya, Israel
| | - Arnon Cohen
- 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
| | - Efrat Solomon-Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Division of Dermatology, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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McCormack S, Tazudeen N, Garden BC. Is Exploration of Alternate Immune Pathways Needed in Hidradenitis Suppurativa? A Case of Atopic Dermatitis and Concurrent Hidradenitis Suppurativa Responding to Dupilumab. Case Rep Dermatol Med 2023; 2023:5189034. [PMID: 37908412 PMCID: PMC10615576 DOI: 10.1155/2023/5189034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/04/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory dermatosis associated with overactive T helper 1/T helper 17 (Th1/Th17) cells. HS has been effectively treated with biologic medications; however, many such biologics lack large randomized controlled trials. Only one such biologic, adalimumab, has been approved by the US Food and Drug Administration (FDA) for the treatment of HS. Other such biologics currently being studied for HS downregulate Th1/Th17 inflammatory pathways. We describe a patient with atopic dermatitis (AD) and comorbid HS, both of which improved several months into treatment with dupilumab. Interestingly enough, dupilumab targets Th2-mediated inflammatory skin conditions through the inhibition of IL-4/IL-13 cytokines. While dupilumab is known for its success in treating Th2-mediated inflammation, this presents a paradox as HS is a Th1/Th17 inflammatory condition. This case highlights how the inflammatory process of HS is not fully understood and how biologic pharmacologic interventions need to be further studied to determine their efficacy in treating HS.
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Affiliation(s)
- Sean McCormack
- Saint James School of Medicine, Cane Hall Road, Arnos Vale, Saint Vincent and the Grenadines
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Alabdulkareem M, Berkane Y, Le Bras E, Rousson E, Chrelias T, Beaufils T, Leclere FM, Watier E, Bertheuil N. Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5301. [PMID: 37811354 PMCID: PMC10558224 DOI: 10.1097/gox.0000000000005301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023]
Abstract
Background Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS. Methods We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications. Results Although not statistically significant (P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time (P = 0.0006), defect size (P = 0.0064), and flap size (P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%). Conclusion After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment.
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Affiliation(s)
- Mohammad Alabdulkareem
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- Department of Surgery, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Yanis Berkane
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
- Shriners Children’s Boston, Harvard Medical School, Boston, Mass
| | - Enna Le Bras
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Etienne Rousson
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Theodoros Chrelias
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Tristan Beaufils
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Franck-Marie Leclere
- Department of Plastic, Reconstructive and Hand Surgery, Poitiers University Hospital, CHU de la Miletrie de Poitiers, Poitiers, France
- Laboratoire d’anatomie et de Simulation, Université de Poitiers, Poitiers, France
| | - Eric Watier
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Nicolas Bertheuil
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
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Ureña-Paniego C, Gamissans-Cañada M, Molina-Leyva A, Romaní J. Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort. Acta Derm Venereol 2023; 103:adv6569. [PMID: 37766657 PMCID: PMC10549763 DOI: 10.2340/actadv.v103.6569] [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: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
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Affiliation(s)
- Clara Ureña-Paniego
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Gamissans-Cañada
- Hidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain; European Hidradenitis Suppurativa Foundation (EHSF). Dessau-Roßlau, Germany.
| | - Jorge Romaní
- HHidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
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Mandour MO, Al-Musawi S, Idowu E, Long PF, Rashidghamat E, Oben JA. Metabolic endoscopy and a simplified low-carbohydrate-high-dietary fiber template as novel treatments for hidradenitis suppurativa - A case series. JAAD Case Rep 2023; 34:23-26. [PMID: 36941875 PMCID: PMC10023847 DOI: 10.1016/j.jdcr.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- Mandour O. Mandour
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Safa Al-Musawi
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Esther Idowu
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Paul F. Long
- Institute of Cancer and Pharmaceutical Science, King’s College, London, United Kingdom
| | - Ellie Rashidghamat
- Department of Dermatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Jude A. Oben
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
- Faculty of Life Sciences & Medicine, Guy’s and St Thomas’ Hospital, United Kingdom
- Correspondence: Jude A Oben, MD, Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH.
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Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits. Biomedicines 2022; 10:biomedicines10112973. [PMID: 36428540 PMCID: PMC9687269 DOI: 10.3390/biomedicines10112973] [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] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.
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Hengy MH, Cevigney R, Tur K, Hewitt M, Ivey M. Five-Year Remission of Hidradenitis Suppurativa Following the Removal of a Levonorgestrel Intrauterine Device and Disease Overview for Obstetrics and Gynecology Providers. Cureus 2022; 14:e28937. [PMID: 36105898 PMCID: PMC9455079 DOI: 10.7759/cureus.28937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
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9
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Teng Y, Li S, Fan Y, Tao X, Huang Y. Top 100 most-cited publications in hidradenitis suppurativa: An updated bibliometric analysis. Front Med (Lausanne) 2022; 9:995873. [PMID: 36160144 PMCID: PMC9493351 DOI: 10.3389/fmed.2022.995873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background Over the last several decades, our understanding of hidradenitis suppurativa (HS) has improved considerably, thereby enhancing our ability to clinically diagnose and treat the disease. Objective The purpose of this study was to identify and analyze the top 100 most-cited publications related to HS to update bibliometric information on HS. Materials and methods We used the Web of Science database to identify reports on hidradenitis suppurativa. Data from the 100 most-cited publications were extracted and analyzed. Results The citation number of the top 100 most-cited articles was 89–532 (mean, 153.51), with the most productive periods being from years 2007 to 2016. Most publications originated from the British Journal of Dermatology and the Journal of the American Academy of Dermatology. The 100 articles originated from 18 countries, with Denmark being the most productive country, followed by the United States (17), England (14), and Germany (12). Jemec GB, from the University of Copenhagen, had 32 citations and was the most frequently identified author. The 100 articles encompassed several fields of research as follows: pathogenesis (18%), pathophysiology (7%), epidemiology (14%), clinical diagnosis and features (16%), treatment (25%), comorbidity (10%), and others (10%). In total, 11 reviews, three guidelines, and 86 original articles (nine randomized clinical trials) were included. Conclusion Through this bibliometric analysis, we aimed to indicate a series of intellectual landmark publications that offer us critical reviews, guidelines, and original articles, which highlight the immense level of progress achieved in the field of HS.
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Affiliation(s)
- Yan Teng
- Department of Dermatology, Health Management Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Sujing Li
- Bengbu Medical College, Bengbu, China
| | - Yibin Fan
- Department of Dermatology, Health Management Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiaohua Tao
- Department of Dermatology, Health Management Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- Xiaohua Tao,
| | - Youming Huang
- Department of Dermatology, Health Management Center, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
- *Correspondence: Youming Huang,
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Varney P, Guo W, Brown M, Usmani H, Marquez J, Ayasse M, Kaufmann T, Haughton A. A systematic review and meta-analysis of sexual dysfunction in patients with hidradenitis suppurativa. Int J Dermatol 2022; 62:737-746. [PMID: 35781695 DOI: 10.1111/ijd.16328] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/05/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with significant psychosocial comorbidity. To date, the relationship between HS and sexual dysfunction has not been assessed through meta-analysis. A systematic review was performed by OVID Medline, EMBASE, Cochrane Central, PsycINFO via EBSCO, Web of Science, and LILACS. Original English language studies assessing HS and sexual function published prior to April 2020 were screened. Scores from the Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF), Arizona Sexual Experiences Scale (ASEX), Frankfurt Self-Concept Scale for Sexuality (FKKS SEX), and Dermatology Life Quality Index (DLQI) were analyzed. Sixteen studies met inclusion criteria, and nine were eligible for meta-analysis. Pooled mean FSFI score for female HS patients met criteria for sexual dysfunction (mean = 20.32, P < 0.001). Females with HS reported worse FSFI scores than controls (pooled mean difference = -5.704, P = 0.003, I2 =0). Mean IIEF score among males with HS was 47.96 (P < 0.001). Males with HS also reported worse IIEF scores than controls (pooled mean difference = -18.77, P = 0.00, I2 = 0). Females with HS performed worse on sexual function inventories than males with HS (SMD = -0.72, P = 0.009, I2 = 0). Both male and female HS patients reported significantly more sexual impairment than same-sex controls. Female HS patients also experience more sexual impairment than males and on average meet criteria for sexual dysfunction (FSFI <26.55). Clinicians should be aware that their patients with HS, especially females, may be suffering from sexual dysfunction and treated them appropriately.
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Affiliation(s)
- Paige Varney
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - William Guo
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Mikayla Brown
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Hunya Usmani
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Jocellie Marquez
- Department of Surgery, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Marissa Ayasse
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Tara Kaufmann
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
| | - Adrienne Haughton
- Department of Dermatology, Renaissance School of Medicine, Stony Brook, New York, USA
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12
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Alamri AM, Alzahrani AA, Aldakhil AM, Alharbi HE, Yahya FA. Quality of Life of Patients With Hidradenitis Suppurativa in Jeddah, Saudi Arabia. Cureus 2021; 13:e20234. [PMID: 34909350 PMCID: PMC8653957 DOI: 10.7759/cureus.20234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects the apocrine gland-bearing areas of the body. It initially presents as painful nodules that eventually develop into abscesses, draining sinuses, and scarring. These manifestations have physical and psychological impacts, which lead to poor quality of life. This study examined the association between quality of life and disease severity, as well as identified the areas of the body most affected by HS among patients in Saudi Arabia. Methods This cross-sectional study examined patients with HS who were seen at two dermatology outpatient clinics between December 2018 and March 2019. The patients completed a self-administered standardized questionnaire on the Dermatology Life Quality Index (DLQI). Results The average DLQI score was 15.39 ± 8.37. The majority of patients were classified as stage 3, which indicated that HS has a very large effect on quality of life. The right and left axillae were the most commonly affected areas of the body, with 80.6% of patients noting involvement. While the mean DLQI score was higher in males compared to females, there was no significant difference between the two groups (16.44 ± 9.01 vs. 13.08 ± 6.65; P = 0.248). Conclusion HS caused significant impairment in the quality of life of patients with HS in Saudi Arabia. The mean DLQI score in our study was higher than the score previously reported in the literature. Further studies may identify opportunities to provide additional awareness, care, and support for patients with HS in Saudi Arabia.
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Affiliation(s)
- Awadh M Alamri
- Dermatology, King Abdualziz Medical City, Ministry of National Guards - Health Affairs, Jeddah, SAU
| | - Abeer A Alzahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Anan M Aldakhil
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Heba E Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Farah A Yahya
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Abtahi-Naeini B, Dehghani S. Fractionated microneedle radiofrequency as a potential novel procedure for treatment of hidradenitis suppurativa: A medical hypothesis. J Cosmet Dermatol 2021; 21:410-411. [PMID: 34837442 DOI: 10.1111/jocd.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Bahareh Abtahi-Naeini
- Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Pediatric Dermatology Division of Department of Pediatrics, Imam Hossein Children's Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shakiba Dehghani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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14
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Clinical Epidemiology and Management of Hidradenitis Suppurativa. Obstet Gynecol 2021; 137:731-746. [PMID: 33706337 PMCID: PMC7984767 DOI: 10.1097/aog.0000000000004321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1-1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18-40 years, obstetrician-gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.
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Kaleta KP, Nikolakis G, Hossini AM, Balthasar O, Almansouri D, Vaiopoulos A, Knolle J, Boguslawska A, Wojas-Pelc A, Zouboulis CC. Metabolic Disorders/Obesity Is a Primary Risk Factor in Hidradenitis Suppurativa: An Immunohistochemical Real-World Approach. Dermatology 2021; 238:251-259. [PMID: 34293747 DOI: 10.1159/000517017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory, potentially scarring disease of the hair follicle, affecting the apocrine gland-bearing skin areas. The major comorbid disorders associated with the occurrence or the aggravation of the disease are obesity and smoking. Numerous efforts to dissociate these factors led to controversial results. OBJECTIVES To assess the importance of metabolic disorders/obesity, smoking/environmental toxins, and inflammation in HS by utilizing the differential expression of major relevant protein markers in lesional skin of obese/smoking versus non-obese/non-smoking HS patients. METHODS Lesional skin specimens deriving from two groups of HS patients (BMI >30 and smokers, n = 12 vs. BMI <30 and non-smokers, n = 10) were stained with antibodies raised against irisin, PPARγ, and IGF-1R, which correlate with metabolic disorders/obesity, EGFR and AhR, associated with smoking, and IL-17, IL-17R, and S100A8, as markers of inflammation. RESULTS Metabolic disorders/obesity-related markers exhibited marked differential expression between the two groups, while smoking-associated markers a limited one. IL-17R expression was stronger in obese/smokers, and S100A8 staining exhibited intense strong immunoreactivity in both groups without significant difference. CONCLUSIONS The notion that obesity plays a role in HS development appears to be supported by the prominent regulation of the associated lesional biomarkers. Tobacco smoking might contribute less to HS than previously suspected.
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Affiliation(s)
- Katarzyna P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Amir M Hossini
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Ottfried Balthasar
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Daifallah Almansouri
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Aristeidis Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Jürgen Knolle
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Anna Boguslawska
- Department of Paediatric and Adolescence Endocrinology, Paediatric Institute, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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16
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Prens LM, Porter ML, Savage KT, Salian P, Horváth B, Kimball AB. Hidradenitis suppurativa disease course during pregnancy and postpartum: a retrospective survey study. Br J Dermatol 2021; 185:1072-1074. [PMID: 33760224 DOI: 10.1111/bjd.20078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Affiliation(s)
- L M Prens
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M L Porter
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02215, USA
| | - K T Savage
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - P Salian
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - B Horváth
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A B Kimball
- Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, 02215, USA
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Condamina M, Penso L, Tran VT, Hotz C, Guillem P, Villani AP, Perrot P, Bru MF, Jacquet E, Nassif A, Bachelez H, Wolkenstein P, Beylot-Barry M, Richard MA, Ravaud P, Viguier M, Sbidian E. Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts. Dermatology 2021; 237:748-758. [PMID: 33503635 DOI: 10.1159/000513447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in "real-life" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in "real-life" interventions.
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Affiliation(s)
- Morgane Condamina
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Laetitia Penso
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Claire Hotz
- Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Philippe Guillem
- Department of Visceral and Digestive Surgery, Val d'Ouest Clinic, Écully, France.,RésoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation, Dessau, Germany.,Groupe de Recherche en Proctologie de la Société Nationale Française de Coloproctologie, Paris, France
| | | | - Pierre Perrot
- Department of Plastic and Reconstructive Surgery, Hôtel-Dieu Hospital, Nantes, France
| | - Marie-France Bru
- Patient Member of the Scientific Committee of ComPaRe Verneuil Disease, Paris, France
| | - Eric Jacquet
- Department of Visceral Surgery, Beau Soleil Clinic, Montpellier, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Hervé Bachelez
- Department of Dermatology-Venereology, Saint Louis Hospital (AP-HP), Sorbonne Paris Cité University Paris Diderot, Paris, France.,Laboratory of Genetics of Skin Diseases, INSERM U1163, Imagine Institute, Paris, France
| | - Pierre Wolkenstein
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France.,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France
| | - Marie Beylot-Barry
- Department of Dermatology, INSERM 1053, CHU Bordeaux, Bordeaux University, Bordeaux, France
| | - Marie-Aleth Richard
- CEReSS-EA 3279, Research Center in Health Services and Quality of Life, Aix Marseille University, Dermatology Department, University Hospital La Timone, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Philippe Ravaud
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France.,Centre de Recherche Épidémiologie et StatistiqueS (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Robert-Debré Hospital, Reims, France
| | - Emilie Sbidian
- Paris-Est University, UPEC, EA 7379 EpiDermE (Epidemiologie En Dermatologie et Evaluation des Thérapeutiques), Créteil, France, .,Department of Dermatology-Venereology, Henri Mondor Hospital (AP-HP), Paris Est Créteil University, Créteil, France, .,INSERM, Centre d'Investigation Clinique 1430, Créteil, France,
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Williams NM, Randolph M, Rajabi-Estarabadi A, Keri J, Tosti A. Hormonal Contraceptives and Dermatology. Am J Clin Dermatol 2021; 22:69-80. [PMID: 32894455 DOI: 10.1007/s40257-020-00557-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Hormones play a significant role in normal skin physiology and many dermatologic conditions. As contraceptives and hormonal therapies continue to advance and increase in popularity, it is important for dermatologists to understand their mechanisms and dermatologic effects given the intricate interplay between hormones and the skin. This article reviews the dermatologic effects, both adverse and beneficial, of combined oral contraceptives (COCs), hormonal intrauterine devices (IUDs), implants, injections, and vaginal rings. Overall, the literature suggests that progesterone-only methods, such as implants and hormonal IUDs, tend to trigger or worsen many conditions, including acne, hirsutism, alopecia, and even rosacea. Therefore, it is worthwhile to obtain detailed medication and contraceptive histories on patients with these conditions. There is sufficient evidence that hormonal contraceptives, particularly COCs and vaginal rings, may effectively treat acne and hirsutism. While there are less data to support the role of hormonal contraceptives in other dermatologic disorders, they demonstrate potential in improving androgenetic alopecia and hidradenitis suppurativa.
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Dahmen RA, Lautenschlager S. [CME Dermatology 23: Hidradenitis suppurativa]. PRAXIS 2021; 110:363-372. [PMID: 34019444 DOI: 10.1024/1661-8157/a003693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME Dermatology 23: Hidradenitis suppurativa Abstract. Hidradenitis suppurativa (Acne inversa) is a chronic skin disease characterized by recurrent inflammatory nodules, abscesses, and scarring mainly in the intertriginous areas. The prevalence is estimated to be 0.05 to 4.1 % worldwide, with women being more commonly affected. The exact pathogenesis remains unknown, but hair follicle occlusion and inflammation seem to be the initiating events. Several epidemiological correlations with smoking and obesity as well as mutations in gamma secretase genes were described. The therapy depends on the extension of the disorder and should respect the current guidelines. Topical clindamycin is suitable for mild forms of the disease whereas moderate to severe disease requires systemic anti-inflammatory treatment. Surgical intervention is currently the only definitive treatment for hidradenitis suppurativa.
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Affiliation(s)
- Robert A Dahmen
- Institut für Dermatologie und Venerologie, Stadtspital Waid und Triemli, Zürich
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20
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Colosimo C, Yon JR, Fredericks C, Kingsley S, Gupta S, Mentzer CJ, Bokhari F, Poulakidas S. Obesity is Not Associated With Need for Skin Grafting After Hidradenitis Excision. Am Surg 2020; 87:458-462. [PMID: 33047967 DOI: 10.1177/0003134820950686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating disease associated with inflammation, recurrent abscesses, and fistulae of skin containing apocrine sweat glands. We hypothesize that the need for skin grafting after vacuum-assisted closure was decreased with increasing body mass index (BMI). METHODS Seventy-one consecutive patients with excisions for HS were retrospectively evaluated for demographic data, number of excisions, the total area of excised skin, need for skin grafting, and BMI. Patients were stratified for BMI and underwent logistic regression to compare all other variables. RESULTS Average for BMI was 30.8 ± 7.72, age was 36.89 ±13.52, area excised was 743 cm2 ± 774 cm2, mean operating room trips were 2.62 ± 1.59, and skin grafting was 0.52 ± 0.55. Patients were 60% male. Forty out of 71 patients were obese. There was no correlation between age, BMI, sex, thenumber of excisions, amount of skin excised, or need for a skin graft. There was a statistically significant relationship between the amount of skin excised and the need for skin grafting (P = .006). CONCLUSIONS The amount of skin affected by HS appears to be independent of patient BMI. The need for skin grafting is solely dependent upon the amount of tissue excised. APPLICABILITY OF RESEARCH TO PRACTICE This knowledge will help preoperative planning for all patients with HS, regardless of BMI.
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Affiliation(s)
| | - James R Yon
- Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, CO, USA
| | - Charles Fredericks
- Division of Trauma, Acute Care, and General Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Samuel Kingsley
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Sameer Gupta
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Caleb J Mentzer
- Division of Trauma, Critical Care & Acute Care Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
| | - Faran Bokhari
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
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21
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Riverain-Gillet É, Guet-Revillet H, Jais JP, Ungeheuer MN, Duchatelet S, Delage M, Lam T, Hovnanian A, Nassif A, Join-Lambert O. The Surface Microbiome of Clinically Unaffected Skinfolds in Hidradenitis Suppurativa: A Cross-Sectional Culture-Based and 16S rRNA Gene Amplicon Sequencing Study in 60 Patients. J Invest Dermatol 2020; 140:1847-1855.e6. [DOI: 10.1016/j.jid.2020.02.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 02/05/2020] [Accepted: 02/16/2020] [Indexed: 12/20/2022]
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22
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Chiricozzi A, Giovanardi G, Caposiena Caro DR, Iannone M, De Simone C, Cannizzaro MV, Oranges T, Fossati B, Di Matteo E, Dini V, Bianchi L, Peris K. Characterization of comorbid conditions burdening hidradenitis suppurativa: a multicentric observational study. GIORN ITAL DERMAT V 2020; 155:335-340. [DOI: 10.23736/s0392-0488.18.06165-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Nesbitt E, Clements S, Driscoll M. A concise clinician's guide to therapy for hidradenitis suppurativa. Int J Womens Dermatol 2020; 6:80-84. [PMID: 32258336 PMCID: PMC7105662 DOI: 10.1016/j.ijwd.2019.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, often debilitating, skin condition that historically does not respond well to treatment. Although there is no cure for HS, symptoms can be managed if the appropriate diagnosis is made. HS most commonly develops in postpubertal women and manifests as painful, deep-seated, inflamed lesions, including nodules, sinus tracts, and abscesses. HS flares are marked by increased pain and suppuration at varying intervals and can occur in women before menstruation. HS is commonly misdiagnosed; physicians might mistake a lesion for an infection, abscess, or sexually transmitted infection. Incision and drainage of these lesions often leads to recurrence. Given that management of this chronic disease is often difficult, we sought to outline current diagnosis and management strategies for HS.
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Affiliation(s)
- Emily Nesbitt
- University of Maryland School of Medicine, United States
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24
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Abstract
Hidradenitis suppurativa is a chronic skin condition characterized by recurrent painful abscesses usually limited to the intertriginous areas. Global prevalence has been estimated at up to 4% of the population. The exact pathogenesis of hidradenitis suppurativa is yet to be elucidated; however, recent research has shown that the disease occurs under the influence of multiple genetic, environmental, and lifestyle factors. Repeated insults result in sinus tract formation and disfigurement, which can have a significant psychosocial effect on patients. A wide range of treatments are available but none are curative. A combination antibiotic regimen is considered first line, and research into the use of biologics has been promising. Early recognition and treatment is paramount to achieving a better prognosis and improving patient quality of life.
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25
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Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Skin changes in the obese patient. J Am Acad Dermatol 2019; 81:1037-1057. [DOI: 10.1016/j.jaad.2018.12.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
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26
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Garg A, Hundal J, Strunk A. Overall and Subgroup Prevalence of Crohn Disease Among Patients With Hidradenitis Suppurativa: A Population-Based Analysis in the United States. JAMA Dermatol 2019; 154:814-818. [PMID: 29800049 DOI: 10.1001/jamadermatol.2018.0878] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Limited evidence supports a link between hidradenitis suppurativa (HS) and Crohn disease (CD), and this relationship has not been established in the United States. Objective To evaluate the prevalence of CD among patients with HS in the United States and to determine the strength of association between the 2 conditions. Design, Setting, and Participants Cross-sectional analysis of data from 51 340 patients with HS identified using electronic health records data in the Explorys multiple health system data analytics and research platform, which includes data from more than 50 million unique patients across all US census regions. Main Outcomes and Measures Primary outcome was diagnosis of CD. Results Of the 18 455 660 total population considered, 51 340 had HS (35 000 women). Of these patients with HS, 29 010 (56.5%) were aged 18 to 44 years; 17 580 (34,2%), 45 to 64 years; and 4750 (9.3%), 65 years or older. Prevalence of CD among patients with HS was 2.0% (1025/51 340), compared with 0.6% (113 360/18 404 260) among those without HS (P < .001). Prevalence of CD was greatest among patients with HS who were white (2.3%), aged 45 to 64 years (2.4%), nonobese (2.8%), and tobacco smokers (2.3%). In univariable and multivariable analyses, patients with HS had 3.29 (95% CI, 3.09-3.50) and 3.05 (95% CI, 2.87-3.25) times the odds of having CD, respectively, compared with patients without HS. Crohn disease was associated with HS across all patient subgroups. The association was strongest for men (OR, 3.61; 95% CI, 3.24-4.03), patients aged 45 to 64 years (OR, 3.49; 95% CI, 3.16-3.85), nonobese patients (OR, 4.09; 95% CI, 3.69-4.54), and nonsmokers (OR, 3.44; 95% CI, 3.10-3.82). Conclusions and Relevance These data suggest that patients with HS are at risk for CD. Gastrointestinal symptoms or signs suggestive of CD warrant additional evaluation by a gastroenterologist.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Jessica Hundal
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
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Jørgensen A, Yao Y, Ghazanfar M, Ring H, Thomsen S. Burden, predictors and temporal relationships of comorbidities in patients with hidradenitis suppurativa: a hospital‐based cohort study. J Eur Acad Dermatol Venereol 2019; 34:565-573. [DOI: 10.1111/jdv.15904] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022]
Affiliation(s)
- A.‐H.R. Jørgensen
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - Y. Yao
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - M.N. Ghazanfar
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - H.C. Ring
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
| | - S.F. Thomsen
- Department of Dermato‐Venereology & Wound Healing Centre Bispebjerg Hospital Copenhagen Denmark
- Department of Biomedical Sciences University of Copenhagen Copenhagen Denmark
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28
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Hagerman GF, Silva-Velazco J, Molina-Lopez JF. Miscellaneous Perianal Afflictions. Clin Colon Rectal Surg 2019; 32:394-402. [PMID: 31507350 DOI: 10.1055/s-0039-1687836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article provides an overview of hidradenitis suppurativa, lichen planus, lichen sclerosis, calcinosis cuti, pyogenic granuloma, intertrigo, and seborrheic keratosis. This article also focuses on recognition and management of these pleomorphic afflictions of the perianal region.
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29
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Chen WT, Chi CC. Association of Hidradenitis Suppurativa With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. JAMA Dermatol 2019; 155:1022-1027. [PMID: 31290938 DOI: 10.1001/jamadermatol.2019.0891] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Hidradenitis suppurativa (HS) and inflammatory bowel disease (IBD) are inflammatory diseases that share common genetic susceptibility and immunologic features. However, the link between HS and IBD has been largely unclear. Objective To conduct a meta-analysis to investigate the association between HS and IBD. Data Sources A search of the MEDLINE, Cochrane Central Register of Controlled Trials, and Embase databases yielded 397 relevant studies from inception to June 10, 2018. Two additional studies were supplied by one of the investigators. Study Selection Case-control, cross-sectional, or cohort studies that examined the odds or risk of IBD in patients with HS were included. No geographic or language limitations were imposed. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The Newcastle-Ottawa Scale was used to assess the risk of bias of included studies. Crohn disease and ulcerative colitis were analyzed separately, and a random-effects model meta-analysis was conducted. Main Outcomes and Measures The odds ratios (ORs) and hazard ratios (HRs) of IBD, Crohn disease, and ulcerative colitis in association with HS. Results Five case-control studies, 2 cross-sectional studies, and 1 cohort study with a total of 93 601 unique participants were included. The meta-analysis of case-control and cross-sectional studies showed significant associations of HS with Crohn disease (pooled OR, 2.12; 95% CI, 1.46-3.08) and ulcerative colitis (pooled OR, 1.51; 95% CI, 1.25-1.82). Two case-control studies found significant association of HS with IBD (ORs, 2.16 [95% CI, 1.40-3.34] and 10.00 [95% CI, 1.94-51.50]). One cohort study found an increased risk of IBD in patients with HS (HR, 5.6; 95% CI not reported; P < .002). Conclusions and Relevance The evidence to date supports an association of HS with IBD. These results suggest that consultation with gastroenterologists should be sought when patients with HS present with recurrent abdominal pain, chronic diarrhea, bloody stool, and body weight loss.
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Affiliation(s)
- Wei-Ti Chen
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan , Taiwan.,Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol 2019; 81:91-101. [PMID: 30872149 PMCID: PMC9131892 DOI: 10.1016/j.jaad.2019.02.068] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniel B Eisen
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada
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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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32
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Ingram JR, Collier F, Brown D, Burton T, Burton J, Chin MF, Desai N, Goodacre TEE, Piguet V, Pink AE, Exton LS, Mohd Mustapa MF. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol 2019; 180:1009-1017. [PMID: 30552762 DOI: 10.1111/bjd.17537] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Affiliation(s)
- J R Ingram
- Division of Infection & Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, U.K
| | - F Collier
- Alva Medical Practice, West Johnstone Street, Alva, FK12 5BD, U.K.,Dermatology Department, Stirling Community Hospital, Stirling, FK8 2AU, U.K
| | - D Brown
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, U.K
| | - T Burton
- The Hidradenitis Suppurativa Trust, Rochester ME2 4DY, U.K
| | - J Burton
- The Hidradenitis Suppurativa Trust, Rochester ME2 4DY, U.K
| | - M F Chin
- Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, Wiltshire, SN3 6BB, U.K
| | - N Desai
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, U.K
| | - T E E Goodacre
- Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, U.K
| | - V Piguet
- Division of Infection & Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, U.K.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - A E Pink
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, SE1 7EH, U.K
| | - L S Exton
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, 4 Fitzroy Square, London, W1T 5HQ, U.K
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Scheufele C, Ezaldein HH, Rothbaum R, Delost GR. Multiple self-healing palmoplantar carcinoma: An aberrance of the inflammasome. JAAD Case Rep 2019; 5:261-263. [PMID: 30891475 PMCID: PMC6403110 DOI: 10.1016/j.jdcr.2019.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Harib H Ezaldein
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Robert Rothbaum
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Gregory R Delost
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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34
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Tzellos T, Yang H, Mu F, Calimlim B, Signorovitch J. Impact of hidradenitis suppurativa on work loss, indirect costs and income. Br J Dermatol 2018; 181:147-154. [PMID: 30120887 PMCID: PMC7379487 DOI: 10.1111/bjd.17101] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 12/02/2022]
Abstract
Background Hidradenitis suppurativa (HS), a chronic cutaneous disease, can negatively affect work life. Objectives This retrospective cohort study evaluates the indirect burden among employed patients with HS in the U.S.A. Methods Newly diagnosed and general patients with HS, who were employees (age 18–64 years) from a large claims database (Q1 1999 to Q1 2015), were matched 1 : 5 to controls. Income growth and risk of leaving the workforce were assessed among the newly diagnosed HS and control cohorts in the 5‐year study period. Income, work loss days and indirect costs (absenteeism and disability) were assessed among the general HS and control cohorts in the 1‐year study period. Results Newly diagnosed (n = 1003, mean age 39·5 years, 66·3% female) and general patients with HS (n = 1204, mean age 39·9 years, 69·1% female) were matched to 5015 and 6020 controls, respectively. Newly diagnosed patients with HS had significantly slower income growth ($324 per year) and higher risk of leaving the workforce (adjusted hazard ratio 1·65, 95% confidence interval 1·45–1·88) compared with controls (all P < 0·05). General patients with HS had more total days of work loss (18·4 vs. 7·7), higher annual total indirect costs ($2925 vs. $1483) and lower annual income ($54 925 vs. $62 357) than controls (all P < 0·001). Conclusions Patients with newly diagnosed HS and general patients with HS experienced a greater indirect burden than matched controls. What's already known about this topic? Hidradenitis suppurativa (HS), a chronic inflammatory disease, can negatively affect work life.
What does this study add? This retrospective claims analysis found that HS is associated with high indirect burden, in terms of slower income growth, higher risk of leaving the workforce and higher indirect costs. These results indicate that patients with HS have unmet disease management needs.
Linked Editorial: Zouboulis. Br J Dermatol 2019; 181:7–8. Plain language summary available online Respond to this article
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Affiliation(s)
- T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, Arctic University, Tromsø, Norway
| | - H Yang
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, 02199, U.S.A
| | - F Mu
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, 02199, U.S.A
| | - B Calimlim
- AbbVie, Inc., 1 N. Waukegan Road, North Chicago, IL, 60064, U.S.A
| | - J Signorovitch
- Analysis Group, Inc., 111 Huntington Ave, Floor 14, Boston, MA, 02199, U.S.A
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35
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Zhang Y, Yang Y, Zou X. Photodynamic therapy for Hidradenitis Suppurativa/acne inversa: Case report. Photodiagnosis Photodyn Ther 2018; 22:251-252. [PMID: 29709603 DOI: 10.1016/j.pdpdt.2018.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/17/2018] [Accepted: 04/20/2018] [Indexed: 01/21/2023]
Abstract
Hidradenitis suppurativa/acne inversa (HS/AI) is a type of chronic suppurative inflammatory reaction of the hair follicles characterized by recurrent dermal abscesses, sinus tracts and scars. So far, there has not been any prospective study proving the efficacy and safety of photodynamic therapy for the disease. In this report, one case of HS/AI achieved resolution of skin lesions, ulcer healing and disappearance of symptoms after nine treatments with 5-aminolevulinic acid photodynamic therapy (ALA-PDT).
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Affiliation(s)
- Yunjie Zhang
- First Affiliated Hospital of PLA General Hospital, China
| | - Yuguang Yang
- First Affiliated Hospital of PLA General Hospital, China
| | - Xianbiao Zou
- First Affiliated Hospital of PLA General Hospital, China.
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36
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Giang J, Seelen MAJ, van Doorn MBA, Rissmann R, Prens EP, Damman J. Complement Activation in Inflammatory Skin Diseases. Front Immunol 2018; 9:639. [PMID: 29713318 PMCID: PMC5911619 DOI: 10.3389/fimmu.2018.00639] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/14/2018] [Indexed: 01/02/2023] Open
Abstract
The complement system is a fundamental part of the innate immune system, playing a crucial role in host defense against various pathogens, such as bacteria, viruses, and fungi. Activation of complement results in production of several molecules mediating chemotaxis, opsonization, and mast cell degranulation, which can contribute to the elimination of pathogenic organisms and inflammation. Furthermore, the complement system also has regulating properties in inflammatory and immune responses. Complement activity in diseases is rather complex and may involve both aberrant expression of complement and genetic deficiencies of complement components or regulators. The skin represents an active immune organ with complex interactions between cellular components and various mediators. Complement involvement has been associated with several skin diseases, such as psoriasis, lupus erythematosus, cutaneous vasculitis, urticaria, and bullous dermatoses. Several triggers including auto-antibodies and micro-organisms can activate complement, while on the other hand complement deficiencies can contribute to impaired immune complex clearance, leading to disease. This review provides an overview of the role of complement in inflammatory skin diseases and discusses complement factors as potential new targets for therapeutic intervention.
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Affiliation(s)
- Jenny Giang
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marc A J Seelen
- Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | | | | | - Errol P Prens
- Department of Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jeffrey Damman
- Department of Pathology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
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37
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Liu M, Degner J, Davis JW, Idler KB, Nader A, Mostafa NM, Waring JF. Identification of HLA-DRB1 association to adalimumab immunogenicity. PLoS One 2018; 13:e0195325. [PMID: 29614084 PMCID: PMC5882140 DOI: 10.1371/journal.pone.0195325] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/20/2018] [Indexed: 02/07/2023] Open
Abstract
Anti-drug antibody formation occurs with most biological agents across disease states, but the mechanism by which they are formed is unknown. The formation of anti-drug antibodies to adalimumab (AAA) may decrease its therapeutic effects in some patients. HLA alleles have been reported to be associated with autoantibody formation against interferons and other TNF inhibitors, but not adalimumab. We analyzed samples from 634 subjects with either rheumatoid arthritis (RA) or hidradenitis suppurativa (HS): 37 subjects (17 RA and 20 HS) developed AAA (AAA+) during adalimumab treatment and 597 subjects (348 RA, 249 HS) did not develop AAA (AAA-) during the clinical trials. Using next-generation sequencing-based HLA typing, we identified three protective HLA alleles (HLA-DQB1*05, HLA-DRB1*01,and HLA-DRB1*07) that were less prevalent in AAA+ than AAA-subjects (ORs: 0.4, 0.25 and 0.28, respectively; and P values: 0.012, 0.012 and 0.018, respectively) and two risk HLA alleles (HLA-DRB1*03 and HLA-DRB1*011) that were more abundant in AAA+ than AAA-subjects (ORs: 2.52, and 2.64, respectively; and P values: 0.006 and 0.019). Similar to the finding of Billiet et al. who found that carriage of the HLA-DRB1*03 allele was more prevalent in those with anti-infliximab antibodies (OR = 3.6, p = 0.002, 95% CI: [1.5,8.6]).), we found HLA-DRB1*03 allele was also more prevalent in anti-adalimumab positive (OR = 2.52, p = 0.006, 95% CI: [1.37,4.63]). The results suggest that specific HLA alleles may play a key role in developing AAAs in RA and HS patients treated with adalimumab.
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Affiliation(s)
- Mohan Liu
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Jacob Degner
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Justin Wade Davis
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Kenneth B Idler
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
| | - Ahmed Nader
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, United States of America
| | - Nael M Mostafa
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, United States of America
| | - Jeffrey F Waring
- Pharmacogenetics and Human Genetics, Genomics Research Center, AbbVie Inc., North Chicago, IL, United States of America
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Ben David C, Bragazzi NL, Watad A, Sharif K, Whitby A, Amital H, Adawi M. Hidradenitis suppurativa associated with systemic lupus erythematosus: A case report. Medicine (Baltimore) 2018; 97:e0186. [PMID: 29561436 PMCID: PMC5895357 DOI: 10.1097/md.0000000000010186] [Citation(s) in RCA: 10] [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] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by recurrent swollen, deep, and painful abscesses. Several autoimmune conditions have been shown to be associated with HS including inflammatory bowel disease and spondyloarthropathies. PATIENT CONCERNS 40-year-old female with systemic lupus erythematous (SLE) presented with recurrent abscesses and nodules on her extremities. DIAGNOSIS Early considerations related the described dermatologic findings to the dermatologic manifestations of SLE, however findings from lesion biopsy were suggestive of HS. INTERVENTIONS Prednisone and antibiotic therapy with clindamycin were started. Subsequently upon discharge, the patient was also treated with rifampicin and azathioprine. OUTCOME In this communication, we demonstrate a case of HS in a patient with SLE that significantly improved under antibiotic and immunosuppressant therapy. LESSONS HS can coexist in patients with SLE. Evidence pertinent to the etiology of HS and its association with other autoimmune conditions implies a possible denominator in the disease etiopathogenesis. Increased awareness of the co-occurrence of the two conditions calls for increased efforts to devise better treatment modalities.
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Affiliation(s)
- Chen Ben David
- Rheumatology Unit, Ziv and Padeh Medical Centers
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Nicola L. Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Medicine ‘B’
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Kassem Sharif
- Department of Medicine ‘B’
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Aaron Whitby
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer
| | - Howard Amital
- Department of Medicine ‘B’
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mohammad Adawi
- Rheumatology Unit, Ziv and Padeh Medical Centers
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Ramos-Rodriguez AJ, Timerman D, Khan A, Bonomo L, Hunjan MK, Lemor A. The in-hospital burden of hidradenitis suppurativa in patients with inflammatory bowel disease: a decade nationwide analysis from 2004 to 2014. Int J Dermatol 2018; 57:547-552. [PMID: 29431201 DOI: 10.1111/ijd.13932] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 01/08/2018] [Indexed: 01/01/2023]
Affiliation(s)
| | - Dmitriy Timerman
- Department of Medicine; Icahn School of Medicine at Mount Sinai West; New York NY USA
| | - Ali Khan
- Department of Medicine; Icahn School of Medicine at Mount Sinai West; New York NY USA
| | - Lauren Bonomo
- Department of Medicine; Icahn School of Medicine at Mount Sinai West; New York NY USA
| | - Manrup K. Hunjan
- Department of Medicine; Icahn School of Medicine at Mount Sinai West; New York NY USA
| | - Alejandro Lemor
- Department of Medicine; Icahn School of Medicine at Mount Sinai West; New York NY USA
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40
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Pink A, Anzengruber F, Navarini A. Acne and hidradenitis suppurativa. Br J Dermatol 2018; 178:619-631. [DOI: 10.1111/bjd.16231] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 02/06/2023]
Affiliation(s)
- A. Pink
- St John's Institute of Dermatology; Division of Genetics and Molecular Medicine; Guy's Hospital; King's College; London SE1 9RT U.K
| | - F. Anzengruber
- Department of Dermatology; University Hospital Zurich; Zurich 8091 Switzerland
| | - A.A. Navarini
- Department of Dermatology; University Hospital Zurich; Zurich 8091 Switzerland
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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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42
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Boer J. Does obesity cause a distinct phenotype of hidradenitis suppurativa? J Eur Acad Dermatol Venereol 2017; 32:e195-e196. [DOI: 10.1111/jdv.14707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Boer
- Department of Dermatology; Deventer Hospital; N. Bolkesteinlaan 75 7416 SE Deventer The Netherlands
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Khobeish MM, Shustov DV, Sokolovsky EV. Hidradenitis Suppurativa: Modern Concepts of Pathogenesis and Therapy; Successful Experience of Adalimumab Therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-5-70-81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that mainly affects the sites of the apocrine glands; HS is characterised by relapsing painful knots and abscesses, leading to the formation of fistulas and scarring. Modern ideas about the pathogenesis of HS allow us to consider it as a kind of inverse acne, since the mechanism of development of HS and inverse acne does not differ. Detailed studies of patients with HS in recent years have provided the basis for several authors to suggest that HS is a systemic, chronic, immune-mediated progressive disease. The key role of the proinflammatory cytokine tumor necrosis factor Į (TNF-Į) in the development of the inflammatory process during HS was determined. Elevated TNF-Į levels are found in the blood and HS lesions, having a positive correlation of the TNF-Į level with the severity of the disease. At the present time, the treatment with a TNF-Į blocker, adalimumab (the only one genetically engineered biological preparation approved for treatment of HS/inverse acne in the world and in Russia), is recommended as a first-line therapy in the absence of an adequate response to standard systemic therapy in the case of active HS of moderate or utmost severity. The presented clinical case confirms the fact that for HS patients it is very important to determine the correct diagnosis as quickly as possible and to prescribe the appropriate treatment according to the developed recommendations. Erroneous diagnoses, inadequate therapy (surgical treatment, short courses of antibiotics, etc.) contribute to the progression of the disease, to the appearance of common symptoms due to the attachment of secondary infection and increase in general intoxication, to limited working capacity, to the emergence of persistent and gross scars, as well as to the deformations of affected skin. Our clinical case of adalimumab (Humira) treatment of a patient with an extremely severe HS form demonstrated that the application of this medication can be effective and well tolerated.
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45
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Shah A, Alhusayen R, Amini-Nik S. The critical role of macrophages in the pathogenesis of hidradenitis suppurativa. Inflamm Res 2017; 66:931-945. [PMID: 28656364 DOI: 10.1007/s00011-017-1074-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a painful chronic inflammatory disease with a prevalence between 1 and 4% of general population. The pathogenesis of HS long eluded scientists, but growing evidence suggests that it is a consequence of inflammatory dysregulation. FINDINGS Recent studies suggest that dysregulated immune response to skin flora and overexpression of inflammatory cytokines leads to chronic skin inflammation seen in HS. Macrophages are the most numerous inflammatory cells found in HS infiltrates and release numerous pro-inflammatory cytokines such as IL-23, and IL-1β and TNF-α, exacerbating the inflammation and contributing to the pathogenesis of HS. Furthermore, in HS, there is dysregulated function of other immune players closely associated with macrophage function including: matrix metalloproteases (MMP) 2 and 9 overexpression, toll-like receptor upregulation, impaired Notch signalling, NLRP3 inflammasome upregulation, and dysregulated keratinocyte function. Lifestyle factors including obesity and smoking also contribute to macrophage dysfunction and correlate with HS incidence. CONCLUSIONS The overexpression of pro-inflammatory cytokines and subsequent efficacy of anti-cytokine biologic therapies highlights the importance of managing macrophage dysfunction. Future therapies should target key molecular drivers of macrophage dysfunction such as TLR2 and NLRP3 overexpression.
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Affiliation(s)
- Ahmed Shah
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Raed Alhusayen
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, University of Toronto, Toronto, Canada.,Sunnybrook Health Science Center, Sunnybrook Research Institute, Toronto, Canada
| | - Saeid Amini-Nik
- Faculty of Medicine, University of Toronto, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada. .,Department of Laboratory Medicine and Pathobiology (LMP), University of Toronto, Toronto, Canada. .,Sunnybrook Health Science Center, Sunnybrook Research Institute, Toronto, Canada.
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Prevalence and Risk of Inflammatory Bowel Disease in Patients with Hidradenitis Suppurativa. J Invest Dermatol 2017; 137:1060-1064. [PMID: 28089682 DOI: 10.1016/j.jid.2016.11.040] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 11/23/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. In small studies, inflammatory bowel disease has been associated with the increased prevalence of HS, but the data on the concurrence of inflammatory bowel disease in patients with HS are limited. We therefore investigated the prevalence and risk of inflammatory bowel disease in patients with HS compared with the general population. The study linked all Danish individuals aged ≥18 years in nationwide registers. Adjusted odds ratios and adjusted hazard ratios were estimated by logistic regression and Cox regression, respectively. The study comprised 7,732 patients with HS and 4,354,137 subjects from the general population. The prevalence (HS vs. general population) was 0.8% and 0.3% (odds ratio 2.04; 1.59-2.62) for Crohn's disease and 1.3% and 0.7% (odds ratio 1.75; 1.44-2.13) for ulcerative colitis. The risk of new-onset Crohn's disease (hazard ratio 2.19; 1.44-3.34) and ulcerative colitis (hazard ratio 1.63; 1.18-2.27) was significantly increased among patients with HS. In conclusion, HS was significantly associated with the presence and risk of new-onset inflammatory bowel disease, although the prevalence remained low. Gastrointestinal complaints in patients with HS should warrant further clinical examination.
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Hessam S, Sand M, Meier NM, Gambichler T, Scholl L, Bechara FG. Combination of oral zinc gluconate and topical triclosan: An anti-inflammatory treatment modality for initial hidradenitis suppurativa. J Dermatol Sci 2016; 84:197-202. [DOI: 10.1016/j.jdermsci.2016.08.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/31/2016] [Accepted: 08/10/2016] [Indexed: 01/19/2023]
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Denny G, Anadkat MJ. The effect of smoking and age on the response to first-line therapy of hidradenitis suppurativa: An institutional retrospective cohort study. J Am Acad Dermatol 2016; 76:54-59. [PMID: 27692736 DOI: 10.1016/j.jaad.2016.07.041] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 06/28/2016] [Accepted: 07/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Treatment for hidradenitis suppurativa is often empiric and inadequate, and determining which patients will respond is difficult. OBJECTIVE We sought to determine which patient factors are associated with a positive response to first-line medical therapy. METHODS A single-center retrospective cohort study of all patients with hidradenitis suppurativa seen between January 1, 1992, and October 1, 2014, was conducted. Response to first-line medical therapy (oral/topical antibiotics, intralesional corticosteroids, and topical washes) was examined at follow-up within 6 months of initiating therapy. A multivariate binary logistic regression model was built examining response to treatment and the interplay of patient factors and treatment initiated. RESULTS In all, 198 patients were included in the final model. Nonsmokers (odds ratio 2.634, 95% confidence interval 1.301-5.332, P = .007) and older individuals (odds ratio 1.046 for each additional year, 95% confidence interval 1.020-1.072, P < .001) were more likely to have improvement at follow-up. In addition, current smokers differed significantly from nonsmokers in several regards. LIMITATIONS The retrospective nature of this study is a limitation, as is relying on classification of disease severity from physical examination findings in some patients. CONCLUSIONS The results of this study suggest that clinicians may be able to more accurately predict which patients with hidradenitis suppurativa will respond to first-line medical therapy, and which patients may require therapy escalation.
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Affiliation(s)
- George Denny
- Washington University School of Medicine, St Louis, Missouri.
| | - Milan J Anadkat
- Division of Dermatology, St Louis, Missouri; Washington University School of Medicine, St Louis, Missouri
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Sotoodian B, Abbas M, Brassard A. Hidradenitis Suppurativa and the Association With Hematological Malignancies. J Cutan Med Surg 2016; 21:158-161. [PMID: 27573126 DOI: 10.1177/1203475416668161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting skin sites with a high density of apocrine glands. HS commonly presents after puberty, with most patients diagnosed in the second decade of their life. Several studies have investigated smoking, obesity, hypertension, diabetes, and dyslipidemia as possible underlying risk factors for HS. However, we encountered 2 patients with a long-standing history of untreated leukemia who developed late-onset HS. OBJECTIVE To investigate the presence of malignancy as an underlying risk factor for development of HS. METHOD The PubMed and Scopus databases were searched for keywords such as hidradenitis suppurativa, malignancy, cancer, and epidemiology. OBSERVATION Only 1 retrospective Swedish study with 2119 patients investigated the prevalence of cancer, including 6 hematopoietic malignancies, in HS patients. However, the study did not assess the timeline of developing HS in relation to the cancer diagnosis. We report 2 patients with a long-standing history of hematopoietic cancers who received no continuous treatments for their malignancies and developed late-onset HS: a 60-year-old male patient with hairy cell leukemia and a 68-year-old male patient with chronic lymphocytic leukemia who developed HS later in life. CONCLUSION Multiple epidemiologic studies found the average age of HS diagnosis to be well prior to the fourth decade of life. The latency of the HS diagnosis as well as the presence of long-standing leukemia in both of our patients raises the necessity for assessing the possibility of malignancy, especially hematopoietic cancer, as a risk factor for HS. LIMITATION This is a small retrospective analysis including only 2 patients. Larger studies would better assess the role of malignancy, leukemia in particular, as a possible risk factor for development of HS.
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Affiliation(s)
- Bahman Sotoodian
- 1 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mariam Abbas
- 1 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Alain Brassard
- 1 Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Hessam S, Sand M, Georgas D, Anders A, Bechara FG. Microbial Profile and Antimicrobial Susceptibility of Bacteria Found in Inflammatory Hidradenitis Suppurativa Lesions. Skin Pharmacol Physiol 2016; 29:161-7. [DOI: 10.1159/000446812] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/11/2016] [Indexed: 11/19/2022]
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