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Alavi A, Prens EP, Kimball AB, Frew JW, Krueger JG, Mukhopadhyay S, Gao H, Ranganathan U, Ivanoff NB, Hernandez Daly AC, Zouboulis CC. Proof-of-concept study exploring the effect of spesolimab in patients with moderate-to-severe hidradenitis suppurativa: a randomized double-blind placebo-controlled clinical trial. Br J Dermatol 2024; 191:508-518. [PMID: 38576350 DOI: 10.1093/bjd/ljae144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a considerable disease burden. Existing treatment options are limited and often suboptimal; a high unmet need exists for effective targeted therapies. OBJECTIVES To explore the effects of spesolimab treatment in patients with HS. METHODS This randomized double-blind placebo-controlled proof-of-clinical-concept (PoCC) study was conducted at 25 centres across 12 countries from 3 May 2021 to 21 April 2022. Patients had moderate-to-severe HS for ≥ 1 year before enrolment. Patients were randomized (2 : 1) to receive a loading dose of 3600-mg intravenous spesolimab (1200 mg at weeks 0, 1 and 2) or matching placebo, followed by maintenance with either 1200-mg subcutaneous spesolimab every 2 weeks from weeks 4 to 10 or matching placebo. The primary endpoint was the percentage change from baseline in total abscess and inflammatory nodule (AN) count at week 12. Secondary endpoints were the absolute change from baseline in the International Hidradenitis Suppurativa Severity Score System (IHS4), percentage change from baseline in draining tunnel (dT) count, the proportion of patients achieving a dT count of 0, absolute change from baseline in the revised Hidradenitis Suppurativa Area and Severity Index (HASI-R), the proportion of patients achieving Hidradenitis Suppurativa Clinical Response (HiSCR50), the proportion of patients with ≥ 1 flare (all at week 12) and patient-reported outcomes. RESULTS In this completed trial, randomized patients (n = 52) received spesolimab (n = 35) or placebo (n = 17). The difference vs. placebo in least squares mean is reported. At week 12, the percentage change in total AN count was similar between treatment arms: -4.1% [95% confidence interval (CI) -31.7 to 23.4]. There was greater numerical improvement in the spesolimab arm, as measured by IHS4 (13.9, 95% CI -25.6 to -2.3); percentage change from baseline in dT count (-96.6%, 95% CI -154.5 to -38.8); and the proportion of patients achieving a dT count of 0 (18.3%, 95% CI -7.9 to 37.5). Spesolimab treatment also improved HASI-R and HiSCR50 vs. placebo. Spesolimab demonstrated a favourable safety profile, similar to that observed in trials in other diseases. CONCLUSIONS This exploratory PoCC study supports the development of spesolimab as a new therapeutic option in HS.
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Affiliation(s)
- Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - John W Frew
- School of Clinical Medicine, UNSW Medicine and Health, Sydney, NSW, Australia
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | | | - Heli Gao
- Boehringer Ingelheim Shanghai Pharmaceuticals Co. Ltd, Shanghai, China
| | - Usha Ranganathan
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | | | | | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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2
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Forder BH, Nistor S, Mykula R, Bignell M, Soleymani majd H. Complex hidradenitis suppurativa on a background of long-standing Crohn's disease requiring radical pelvic and perineal reconstruction: A case report. Clin Case Rep 2024; 12:e9203. [PMID: 39035118 PMCID: PMC11259511 DOI: 10.1002/ccr3.9203] [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: 02/21/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
Key Clinical Message A surgical MDT approach to high-complexity surgeries can allow maximal resection in order to achieve disease control and excellent functional outcomes, as demonstrated here for a case of hidradenitis suppurativa in a patient with Crohn's disease. Abstract Hidradenitis suppurativa is an autoimmune disease characterized by abscess and fistula formation with purulent discharge in intertriginous zones, and is associated with inflammatory bowel disease. We present the case of a patient with severe ongoing hidradenitis suppurativa causing osteomyelitis and affecting the perineum, on a background of Crohn's disease previously treated with panprotocolectomy and permanent ileostomy. The hidradenitis suppurativa was having a severe impact on the patient's quality of life, and she had failed to respond to conservative management. The patient opted for a radical two-step procedure: first her coccyx and sacrum were removed. The second step was a radical bilateral anterior vulvectomy and posterior vaginectomy, with preservation of the uterine body and cervix. An anterolateral thigh flap was used to reconstruct the perineum. This complex procedure required the expertise of multiple surgical specialties, including plastic, general, spinal, and gynecological oncology surgeons to achieve maximal disease resection, minimizing the risk of recurrence.
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Affiliation(s)
| | - Sabina Nistor
- Department of Gynaecology OncologyOxford University Hospitals Foundation TrustOxfordUK
| | - Roman Mykula
- Department of Plastic SurgeryOxford University Hospitals Foundation TrustOxfordUK
| | - Mark Bignell
- Department of Colorectal SurgeryOxford University Hospitals Foundation TrustOxfordUK
| | - Hooman Soleymani majd
- Department of Gynaecology OncologyOxford University Hospitals Foundation TrustOxfordUK
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Krajewski A, Alsayed A, Capek A, Casey K, Chandawarkar R. Surgical Management of Hidradenitis Suppurativa. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5860. [PMID: 38872991 PMCID: PMC11175856 DOI: 10.1097/gox.0000000000005860] [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: 06/15/2021] [Accepted: 03/18/2024] [Indexed: 06/15/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of the skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. Treatment for this debilitating disease has been medical management with antibiotics and immune modulators. With the advent of better reconstructive surgical techniques, the role of surgery in the treatment of HS has expanded, from being a last resort to a modality that is deployed earlier. Larger defects can be more easily reconstructed, allowing for a more radical excision of diseased areas. Locoregional flaps, perforator flaps, and propeller flaps that use the fasciocutaneous tissue allow reconstruction of defects with similar tissue, and provide better cosmetic and functional outcomes. They are easy to execute and can be performed even in resource-poor settings with concurrent use of immune modulators and postoperative antibiotics. Hidradenitis can be successfully treated with surgery in early stages as well as severe disease, due to the advances in understanding disease behavior, multidisciplinary care, and advanced reconstructive techniques. Coupled with a multidisciplinary care team, surgery offers a durable, lasting cure for HS, significantly reducing disease morbidity.
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Affiliation(s)
| | - Ahmed Alsayed
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Allison Capek
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kathleen Casey
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rajiv Chandawarkar
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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5
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Shan HD, Huffman SS, Bovill JD, Haffner ZK, Towfighi P, Benedict CD, Evans KK. Psychiatric Influences on Hidradenitis Suppurativa: A Call for Help. Arch Plast Surg 2024; 51:304-310. [PMID: 38737841 PMCID: PMC11081730 DOI: 10.1055/a-2258-2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/26/2023] [Indexed: 05/14/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. This study aimed to assess impact of a psychiatric diagnosis on patients treated for HS. Methods Patients with HS were retrospectively identified at a single institution from 2010 to 2021. Cohorts were stratified by the presence of a psychiatric disorder. Demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the procedural interventions and emergency department (ED) visits. Financial distress was assessed via the COST-FACIT Version 2 survey. Results Out of 138 patients, 40 (29.0%) completed the survey of which 19 (47.5%) had a preexisting psychiatric diagnosis. No demographic differences were found between cohorts. Mean follow-up was 16.1 ± 11.0 months. The psychiatric cohort had a higher median number of surgeries received (7.0 vs. 1.5, p < 0.001), a higher median number of ED visits (1.0 vs. 0, p = 0.006), and a similar hospital length of stay ( p = 0.456). The mean COST-FACIT score of the overall study population was 19.2 ± 10.7 (grade 1 financial toxicity). The psych cohort had a lower mean COST-FACIT score (16.8 vs. 21.3, p = 0.092) and reported greater financial hardship (3.3 vs. 1.7, p < 0.001). On multivariate analysis, a psychiatric diagnosis was predictive of lower credit scores, more ED visits, and a higher number of surgeries. Conclusion Preexisting psychiatric conditions in patients with HS are associated with increased health care utilization and surgical intervention with substantial financial distress. Plastic surgeons should be cognizant of such comorbid disorders to facilitate holistic care addressing all patient needs.
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Affiliation(s)
- Holly D. Shan
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Samuel S. Huffman
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - John D. Bovill
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Zoë K. Haffner
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Parhom Towfighi
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Carol D. Benedict
- Department of Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Vinnicombe Z, Singh GV, Spiers J, Pouncey AL, McEvoy H, Lancaster K. Comparison of Negative Pressure Wound Therapy with or without a Split-Thickness Skin Graft in the Surgical Management of Axillary Hidradenitis Suppurativa: A Retrospective Cohort Study. Plast Surg (Oakv) 2024; 32:314-320. [PMID: 38681254 PMCID: PMC11046271 DOI: 10.1177/22925503221109006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/10/2022] [Accepted: 03/19/2022] [Indexed: 05/01/2024] Open
Abstract
Introduction: Negative pressure wound therapy (NPWT) alone or with the addition of a split-thickness skin graft (STSG) are 2 reconstructive options available after surgical excision of axillary hidradenitis suppurativa (HS). The aim of this study was to retrospectively examine patients undergoing these treatments and to assess clinical and patient-related outcome measures. Methods: A single-centre, retrospective analysis was conducted, evaluating surgical excision of axillary HS, with STSG and NPWT, or NPWT alone. Data collected included No. of post-operative clinic visits, time to heal, size of wound, disease recurrence, follow-up time, Dermatology Life Quality Index (DLQI), the Generalised Anxiety Disorder Assessment (GAD-7), the Patient Health Questionnaire Depression Scale (PHQ-9), Pain Visual Analogue Scale (PAINVAS2), the Brief Illness Perception Questionnaire (BIPQ), and Dermatology Visual Analogue Scale (DERMVAS). Two-tailed t-test and Mann-Whitney Wilcoxon U-tests were used to assess for significant relationships. Results: One hundred five patients were included in the study, 44 who received NPWT alone, and 61 who received NPWT + STSG. There was no significant difference in follow-up time (P = .934) or No. of follow-up appointments between groups (P = .287). There was a significant difference in time to heal between groups, with STSG + NPWT observing a mean time of 2.77 months and NPWT alone observing a mean time of 4.40 months (P = .0006). There was no difference in patient-reported outcomes between the 2 groups. Conclusion: There is no difference in patient-reported outcomes with the addition of an STSG to NPWT after surgical excision of HS. Wide excision and use of NPWT alone is an effective procedure for the treatment of axillary HS.
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Affiliation(s)
- Z. Vinnicombe
- Department of Plastic and Reconstructive Surgery, St. Thomas’ Hospital, London, UK
| | - G. V. Singh
- GKT School of Medical Education, King’s College London, London, UK
| | - J. Spiers
- GKT School of Medical Education, King’s College London, London, UK
| | - A. L. Pouncey
- Department of Plastic and Reconstructive Surgery, St. Thomas’ Hospital, London, UK
| | - H. McEvoy
- Department of Plastic and Reconstructive Surgery, St. Thomas’ Hospital, London, UK
| | - K. Lancaster
- Department of Plastic and Reconstructive Surgery, St. Thomas’ Hospital, London, UK
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8
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Richards E, Joshi A. Psychosocial effects of hidradenitis suppurativa in the literature: A systematic review. Int J Psychiatry Med 2024:912174241249215. [PMID: 38644350 DOI: 10.1177/00912174241249215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by painful, deep follicular nodules, abscesses, sinus tracts, and scarring, most commonly presenting in the inguinal, axillary, and anogenital regions. This condition substantially decreases quality of life in affected individuals, resulting in higher rates of psychiatric disorders including depression, anxiety, suicidality, and substance use. The detrimental effects of HS are well documented by dermatologists, as individuals with HS make up a large proportion of the patients that they see daily. However, it is unclear whether psychiatrists are aware of the degree of psychosocial impairment present in HS patients. It is important that those in the field of psychiatry and behavioral medicine are aware of this condition and are comfortable managing it from a psychosocial perspective. This systematic review chronicles the existing literature on the psychosocial effects of HS and assesses the extent to which dermatology journals review these effects in comparison to psychiatry or behavioral medicine.
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Affiliation(s)
| | - Ami Joshi
- Cooper Medical School of Rowan University, Camden, NJ, USA
- Cooper University Healthcare, Camden, NJ, USA
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Salame N, Sow YN, Siira MR, Garg A, Chen SC, Patzer RE, Kavalieratos D, Orenstein LAV. Factors Affecting Treatment Selection Among Patients With Hidradenitis Suppurativa. JAMA Dermatol 2024; 160:179-186. [PMID: 38198173 PMCID: PMC10782374 DOI: 10.1001/jamadermatol.2023.5425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/03/2023] [Indexed: 01/11/2024]
Abstract
Importance Despite the US Food and Drug Administration's approval of adalimumab for the treatment of hidradenitis suppurativa (HS), prescription rates remain low, indicating a critical gap between evidence-based guidelines and clinical practice. Understanding the medical decision-making process that these patients use when considering biologic agents and other HS therapies may uncover opportunities for improved patient-physician communication and HS disease control. Objective To elucidate factors that affect the medical decision-making process for patients with HS, with an emphasis on biologic therapies. Design, Setting, and Participants Open-ended semistructured interviews were conducted with English-speaking adults with HS (aged ≥18 years) recruited from 2 dermatology clinics that are part of Emory University School of Medicine in Atlanta, Georgia. All participants had an average 7-day pain score of 1 or higher on a 0- to 10-point numeric rating scale. Surveys were conducted between November 2019 and March 2020, and data were analyzed from December 2021 to August 2022. Data collection continued until thematic saturation was reached at 21 interviews. Results A total of 21 participants (median [IQR] age, 38.5 [27.9-43.4] years; 16 females [76%]) were included in the analysis. Almost all participants (96%) had Hurley stage II or III disease, and 15 (71%) had a history of adalimumab use. Suffering threshold, perceptions of treatment risk, treatment fatigue, disease understanding, and sources of information (included dermatologists, the internet, advertisements, and friends and loved ones) were identified as factors affecting participants' decisions to initiate new treatments for HS. Conclusions and Relevance Results of this qualitative study suggest that mitigating misconceptions about treatment risk, identifying gaps in disease knowledge, and emphasizing early treatment to prevent scarring and disease progression may empower patients with HS to engage in treatment planning and to try new therapies.
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Affiliation(s)
- Nicole Salame
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Meron R. Siira
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Suephy C. Chen
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Rachel E. Patzer
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
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10
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Schofield A. Reducing the pain of hidradenitis suppurativa wounds. J Wound Care 2024; 33:39-42. [PMID: 38197276 DOI: 10.12968/jowc.2024.33.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Alison Schofield
- Independent Tissue Viability Clinical Nurse Specialist, UK
- Independent Tissue Viability Clinical Nurse Consultant, Pioneer Sussex Wound Healing and Lymphoedema Centres, UK
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11
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Kimball AB, Kirby J, Ingram JR, Tran T, Pansar I, Ciaravino V, Willems D, Lewis-Mikhael AM, Tongbram V, Garg A. Burden of Hidradenitis Suppurativa: A Systematic Literature Review of Patient Reported Outcomes. Dermatol Ther (Heidelb) 2024; 14:83-98. [PMID: 38183616 PMCID: PMC10828455 DOI: 10.1007/s13555-023-01085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/08/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) has a profound negative impact on patients' health-related quality of life (HRQoL). Here we summarize the evidence on HRQoL and Patient Reported Outcomes (PROs) in patients with HS in real-world settings by conducting a systematic literature review (SLR) of observational studies. METHODS Data sources included MEDLINE, Embase & PsycINFO between January 1, 2010 and August 29, 2021, and conference proceedings between 2019 and 2021. Identified abstracts were reviewed and screened independently by two reviewers. Eligibility criteria included patients with HS of any severity, sample size ≥ 100, reporting PROs including HRQoL measures. Included studies were critically appraised. RESULTS Fifty-eight observational studies matched inclusion criteria. Dermatology Life Quality Index (DLQI) was the most commonly utilized instrument: 57% of included studies reported mean baseline DLQI scores, ranging between 8.4 and 16.9, indicating a very large impact on the patients' HRQoL. Higher scores were reported with increasing disease severity and among female patients. Pain was assessed mostly by an 11-point (0-10) numeric rating scale (NRS) with a mean baseline score ranging from 3.6 to 7.7 indicating moderate to high pain levels. There was a negative impact of HS on patients' psychological well-being, based on PRO scores related to depression and anxiety. A high proportion of sexual dysfunction was reported, with a larger impact on women than men. Work productivity and leisure activity were consistently found to be impaired in patients with HS. CONCLUSIONS All included studies reported a negative impact of HS on patients' lives. A diverse set of disease- and non-disease-specific PRO instruments were utilized highlighting the need for more consistent use of HS-specific validated PRO instruments to assess the impact of HS on the different aspects of patients' HRQoL to allow for data to be more meaningfully interpreted and compared in real-world settings. Patients with HS need better disease management approaches that address the observed low quality of life.
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Affiliation(s)
- Alexa B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center Boston, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Amit Garg
- Northwell Health, New Hyde Park, New York, NY, USA
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12
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Bens L, Green SI, Jansen D, Hillary T, Vanhoutvin T, Matthijnssens J, Sabino J, Vermeire S, Van Laethem A, Wagemans J, Lavigne R. Phage therapy for hidradenitis suppurativa: a unique challenge and possible opportunity for personalized treatment of a complex, inflammatory disease. Clin Exp Dermatol 2023; 48:1221-1229. [PMID: 37315154 DOI: 10.1093/ced/llad207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/07/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
Phage therapy is an emerging antimicrobial treatment for critical multidrug-resistant pathogens. In this review, the specific potential and challenges of phage therapy for patients with hidradenitis suppurativa (HS) are discussed. This represents a unique challenge as HS is a chronic inflammatory disease, but presenting with acute exacerbations, which have an enormous negative impact on patient's quality of life. The therapeutic arsenal for HS has expanded in the past decade, for example, with adalimumab and several other biologicals that are currently under investigation. However, treatment of HS remains challenging for dermatologists because there are individuals who do not respond to any classes of the current treatment options when used for a first or second time. Furthermore, after several courses of treatment, a patient may lose their response to therapy, meaning long-term use is not always an option. Culturing studies and 16S ribosomal RNA profiling highlight the complex polymicrobial nature of HS lesions. Despite the detection of various bacterial species in lesion samples, several key pathogens, including Staphylococcus, Corynebacterium and Streptococcus, may be potential targets for phage therapy. Using phage therapy for the treatment of a chronic inflammatory disease could potentially provide new insights into the role of bacteria and the immune system in HS development. In addition, it is possible more details on the immunomodulatory effects of phages may come to light.
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Affiliation(s)
| | | | - Daan Jansen
- Microbiology, Immunology and Transplantation, Rega Institute, KU LeuvenBelgium
| | | | | | - Jelle Matthijnssens
- Microbiology, Immunology and Transplantation, Rega Institute, KU LeuvenBelgium
| | - João Sabino
- Gastroenterology and Hepatology, UZ Leuven, Leuven, Belgium
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13
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Behrangi E, Atefi N, Mireshghollah P, Goodarzi A, Dehghani A, Zare Dehnavi A, Roohaninasab M, Dilmaghani S, Lotfi E. The efficacy and safety of endo-radiofrequency for the treatment of hidradenitis suppurativa. Skin Res Technol 2023; 29:e13450. [PMID: 37753687 PMCID: PMC10462799 DOI: 10.1111/srt.13450] [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: 08/05/2023] [Accepted: 08/17/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic and recurrent disease of the axilla and groin with inflammatory lesions. There is no definitive medication or intervention to cure the disease. Radiofrequency (RF) is a modality to destroy the lesions by transferring heat into the skin. To date, few studies have been conducted to evaluate the efficacy and safety of RF at HS. METHODS This 9-month, prospective, nonrandomized, and single-blinded study is a clinical trial conducted in 10 patients with refractory HS. In all patients, the initial grade of HS was evaluated. The procedure involved treating HS of the axilla with a endo-RF wave device. Post-treatment evaluation included: determination of the severity of the disease by a blinded dermatologist, the degree of patient satisfaction, tolerability in each patient, and complications of the procedure. We also evaluate the recurrence of the disease during a 6-month follow-up. RESULTS The satisfaction level after the intervention among under-studied cases was excellent and good in six of cases. There was a significant difference in comparing the grading score of patients before and 3 months after receiving RF (P-value: 0.01). Regarding tolerability, eight of the patients could tolerate it. We had no complication after the intervention and four cases had not recurrence during a 6-month follow-up. CONCLUSION Endo-RF is an effective and safe modality for treating HS however to prevent the recurrence, periodic therapy sessions are needed.
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Affiliation(s)
- Elham Behrangi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Najmolsadat Atefi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Pardissadat Mireshghollah
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Azadeh Goodarzi
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Abbas Dehghani
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | | | - Masoumeh Roohaninasab
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
| | - Sara Dilmaghani
- Department of DermatologyRasool Akram Medical Complex Clinical Research Development Center (RCRDC)School of MedicineIran University of Medical Sciences (IUMS)TehranIran
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14
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Kaur AP, Laing ME, Griffin L, Carr PJ. Quality of life in Hidradenitis Suppurativa (Acne Inversa): A scoping review. SKIN HEALTH AND DISEASE 2023; 3:e214. [PMID: 37538319 PMCID: PMC10395634 DOI: 10.1002/ski2.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/23/2022] [Accepted: 01/04/2023] [Indexed: 08/05/2023]
Abstract
Background Hidradenitis Suppurativa (HS) is a chronic, relapsing, inflammatory skin condition which is physically, psychologically and socially disabling and often affects a patient's quality of life (QOL). There are numerous QOL tools used in dermatology. However, assessment of QOL in patients with HS is difficult due to the inability of generic QOL tools to specifically capture QOL in patients with HS. Numerous HS-specific QOL tools have been developed in recent years. It is important to identify evidence on full psychometric evaluation of these tools. Objectives There has been a gradual increase in the use of generic and disease-specific QOL tools in the last few decades. The aim of this scoping review (SR) is to evaluate the most widely used generic QOL tools and HS-specific QOL tools to identify the psychometric evaluation of such tools. Methods Design: An SR guided by Joanna Briggs Institute manual and Arskey O'Malley framework guidelines. Data extraction included the studies available on full psychometric evaluation of the most widely used dermatology generic QOL tools in HS and HS-specific QOL tools. Results Ten papers were included in the review, eight papers demonstrated HS-specific QOL assessment tools. The psychometric properties of these tools were underpinned by reliability, validity and sensitivity measurement. Six disease-specific tools were identified in this SR. However, they all lack full psychometric evaluation. Conclusion This review indicates that an extensive research in the field of QOL tools for HS is much needed. It is crucial to develop user-friendly and validate disease-specific tools to measure the real impact of disease on patients QOL. QOL instruments can evaluate the impact on life of an HS patient, thus helping improve intervention and management of disease. There is a necessity for more research into existing HS-specific QOL tools and they should be widely tested and fully validated.
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Affiliation(s)
- Amrit P. Kaur
- Department of DermatologyUniversity of GalwayGalwayIreland
| | - Mary E. Laing
- Department of DermatologyUniversity of GalwayGalwayIreland
| | - Laoise Griffin
- Department of DermatologyUniversity of GalwayGalwayIreland
| | - Peter J. Carr
- Department of DermatologyUniversity of GalwayGalwayIreland
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15
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Joly P, Lafon A, Houivet E, Donnadieu N, Richard MA, Dupuy A, Delaporte E, Bernard P, Machet L, Tosti A, Del Marmol V, Grimalt R, de Viragh PA, Benichou J, Chosidow O, Assouly P, Reygagne P. Efficacy of Methotrexate Alone vs Methotrexate Plus Low-Dose Prednisone in Patients With Alopecia Areata Totalis or Universalis: A 2-Step Double-Blind Randomized Clinical Trial. JAMA Dermatol 2023; 159:403-410. [PMID: 36884234 PMCID: PMC9996454 DOI: 10.1001/jamadermatol.2022.6687] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/29/2022] [Indexed: 03/09/2023]
Abstract
Importance Poor therapeutic results have been reported in patients with alopecia areata totalis (AT) or universalis (AU), the most severe and disabling types of alopecia areata (AA). Methotrexate, an inexpensive treatment, might be effective in AU and AT. Objective To evaluate the efficacy and tolerance of methotrexate alone or combined with low-dose prednisone in patients with chronic and recalcitrant AT and AU. Design, Setting, and Participants This academic, multicenter, double-blind, randomized clinical trial was conducted at 8 dermatology departments at university hospitals between March 2014 and December 2016 and included adult patients with AT or AU evolving for more than 6 months despite previous topical and systemic treatments. Data analysis was performed from October 2018 to June 2019. Interventions Patients were randomized to receive methotrexate (25 mg/wk) or placebo for 6 months. Patients with greater than 25% hair regrowth (HR) at month 6 continued their treatment until month 12. Patients with less than 25% HR were rerandomized: methotrexate plus prednisone (20 mg/d for 3 months and 15 mg/d for 3 months) or methotrexate plus placebo of prednisone. Main Outcome and Measures The primary end point assessed on photos by 4 international experts was complete or almost complete HR (Severity of Alopecia Tool [SALT] score <10) at month 12, while receiving methotrexate alone from the start of the study. Main secondary end points were the rate of major (greater than 50%) HR, quality of life, and treatment tolerance. Results A total of 89 patients (50 female, 39 male; mean [SD] age, 38.6 [14.3] years) with AT (n = 1) or AU (n = 88) were randomized: methotrexate (n = 45) or placebo (n = 44). At month 12, complete or almost complete HR (SALT score <10) was observed in 1 patient and no patient who received methotrexate alone or placebo, respectively, in 7 of 35 (20.0%; 95% CI, 8.4%-37.0%) patients who received methotrexate (for 6 or 12 months) plus prednisone, including 5 of 16 (31.2%; 95% CI, 11.0%-58.7%) who received methotrexate for 12 months and prednisone for 6 months. A greater improvement in quality of life was observed in patients who achieved a complete response compared with nonresponder patients. Two patients in the methotrexate group discontinued the study because of fatigue and nausea, which were observed in 7 (6.9%) and 14 (13.7%) patients receiving methotrexate, respectively. No severe treatment adverse effect was observed. Conclusions and Relevance In this randomized clinical trial, while methotrexate alone mainly allowed partial HR in patients with chronic AT or AU, its combination with low-dose prednisone allowed complete HR in up to 31% of patients. These results seem to be of the same order of magnitude as those recently reported with JAK inhibitors, with a much lower cost. Trial Registration ClinicalTrials.gov Identifier: NCT02037191.
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Affiliation(s)
- Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Audrey Lafon
- Department of Dermatology, Rouen University Hospital and INSERM U1234, Centre de référence des maladies bulleuses autoimmunes, Normandie University, Rouen, France
| | - Estelle Houivet
- Department of Biostatistics, Rouen University Hospital and INSERM U1219, Normandie University, Rouen, France
| | - Nathalie Donnadieu
- Department of Pharmacy, Rouen University Hospital, Normandy University, Rouen, France
| | - Marie-Aleth Richard
- Department of Dermatology, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - Alain Dupuy
- Department of Dermatology, University of Rennes, Rennes, France
| | | | | | - Laurent Machet
- Department of Dermatology, Tours University Hospital, Tours, France
| | - Antonella Tosti
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Ramon Grimalt
- Department of Dermatology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Pierre A. de Viragh
- Department of Dermatology, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Jacques Benichou
- Department of Pharmacy, Rouen University Hospital, Normandy University, Rouen, France
| | - Olivier Chosidow
- Department of Dermatology, Henri-Mondor University Hospital, Paris, France
| | - Philippe Assouly
- Department of Dermatology, Centre Sabouraud, Hopital Saint Louis, Paris, France
| | - Pascal Reygagne
- Department of Dermatology, Centre Sabouraud, Hopital Saint Louis, Paris, France
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16
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Scholl L, Schneider-Burrus S, Fritz B, Sabat R, Bechara FG. The impact of surgical interventions on the psychosocial well-being of patients with hidradenitis suppurativa. J Dtsch Dermatol Ges 2023; 21:131-139. [PMID: 36748846 DOI: 10.1111/ddg.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa is a chronic inflammatory skin disease. Depending on disease severity, a combination of conservative and surgical treatments is necessary. This analysis aimed to determine the impact of surgical interventions on patient psychosocial well-being. PATIENTS AND METHODS This is a prospective, noninterventional, multicenter study. The medical history, medical examination, and patient-reported outcomes, including the Hospital Anxiety and Depression Scale, Dermatology Life Quality Index, and the Short Form-12 Health Survey, were collected from 481 patients with hidradenitis suppurativa. RESULTS Among all patients with hidradenitis suppurativa included in this study, 74.2% reported surgery before study inclusion, of whom 92.4% could identify surgery type and location. Although adjusted for confounding factors, such as disease severity and activity, the aforementioned patient reported outcomes, did not vary significantly between groups of patients with different techniques and number of prior surgical intervention. However, patients without any prior surgical intervention yielded significantly better scores. CONCLUSIONS In patients with hidradenitis suppurativa, previous surgery was associated with worse outcomes in anxiety, depression, and quality of life, showing the apparent need of psychological support. It remains unclear whether the morbidity of surgical procedures or a possible higher severity score in patients undergoing surgery is responsible.
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Affiliation(s)
- Lisa Scholl
- Department of Dermatology, Venerology, and Allergology - St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sylke Schneider-Burrus
- Centre for Dermatosurgery, Havelklinik, Berlin, Germany.,Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Inflammation and Regeneration of Skin, BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology - St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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17
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Francois K, Moon HS, Panchal N. Cervicofacial hidradenitis suppurativa: A case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 135:e25-e31. [PMID: 36241598 DOI: 10.1016/j.oooo.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/13/2022] [Accepted: 07/23/2022] [Indexed: 12/01/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the apocrine glands primarily affecting the axillae, perineum, and inframammary regions. It is characterized by painful, inflamed cutaneous lesions causing nodules, sinus tracts, and abscesses. Cervicofacial HS is an atypical presentation of HS in the head and neck region and is scarcely reported in the literature. We present a 34-year-old male who developed a large facial swelling overlying the left inferior mandibular border. Management included surgical incision and drainage, antibiotic therapy, followed by infliximab (Remicade). The purpose of this case report was to highlight the presentation, pathophysiology, interdisciplinary approach to treatment and follow-up of patients with cervicofacial HS, and finally, review the cervicofacial HS literature.
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Affiliation(s)
- Kevin Francois
- Department of Oral and Maxillofacial Surgery, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
| | - Hwi Sean Moon
- Department of Cleft and Craniofacial Surgery, El Paso Children's Hospital, El Paso, TX, USA.
| | - Neeraj Panchal
- Department of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, Penn Presbyterian Medical Center, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA
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18
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Scholl L, Schneider-Burrus S, Fritz B, Sabat R, Bechara FG. Auswirkungen chirurgischer Eingriffe auf das psychosoziale Wohlbefinden von Patienten mit Hidradenitis suppurativa. J Dtsch Dermatol Ges 2023; 21:131-140. [PMID: 36808435 DOI: 10.1111/ddg.14934_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/15/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Lisa Scholl
- Klinik für Dermatologie, Venerologie und Allergologie - St. Josef-Hospital, Ruhr-Universität Bochum
| | - Sylke Schneider-Burrus
- Zentrum für Dermatochirurgie, Havelklinik, Berlin.,Interdisziplinäre Gruppe für Molekulare Immunpathologie, Dermatologie/Medizinische Immunologie, Charité - Universitätsmedizin Berlin
| | | | - Robert Sabat
- Interdisziplinäre Gruppe für Molekulare Immunpathologie, Dermatologie/Medizinische Immunologie, Charité - Universitätsmedizin Berlin.,Psoriasis Forschungs- und BehandlungsCentrum, Charité - Universitätsmedizin Berlin.,Entzündung und Hautregeneration, BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie - St. Josef-Hospital, Ruhr-Universität Bochum
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19
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OTTEN M, AUGUSTIN M, BLOME C, TOPP J, NIKLAUS M, HILBRING C, BECHARA FG, PINTER A, ZOUBOULIS CC, ANZENGRUBER F, KIRSTEN N. Measuring Quality of Life in Hidradenitis Suppurativa: Development and Validation of a Disease-specific Patient-reported Outcome Measure for Practice and Research. Acta Derm Venereol 2023; 103:adv00859. [PMID: 36129249 PMCID: PMC9901329 DOI: 10.2340/actadv.v102.2485] [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] [Received: 04/06/2022] [Accepted: 09/21/2022] [Indexed: 02/03/2023] Open
Abstract
Hidradenitis suppurativa is a chronic disease that disrupts patients' physical and psychological well-being. A disease-specific measure was developed and validated for assessing health-related quality of life in hidradenitis suppurativa. After qualitative item development, the quality of life in hidradenitis suppurativa instrument was tested in 101 patients, applying convergent measures and a usability questionnaire. Descriptive and validation-specific analyses were conducted. There was no ceiling, but moderate floor effects (scores between 0 and 3.13 on a scale of 0-4). Few missing values were observed (21 of 23 items < 5%). Internal consistency was satisfying: 2 subscales with 6 and 16 items were identified (Cronbach's alpha=0.95 and 0.88). The quality of life in hidradenitis suppurativa instrument correlated significantly with all convergent criteria (including change in convergent patient-reported outcomes; p < 0.05) except for Hurley stage (p = 0.490). In conclusion, the quality of life in hidradenitis suppurativa questionnaire is an internally consistent, valid, responsive, and usable instrument to assess quality of life in patients with hidradenitis suppurativa.
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Affiliation(s)
- Marina OTTEN
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Matthias AUGUSTIN
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Christine BLOME
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Janine TOPP
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Marina NIKLAUS
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Caroline HILBRING
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
| | - Falk G. BECHARA
- Dermatologic Surgery Unit, Department of Dermatology, Ruhr-University Bochum, Bochum
| | - Andreas PINTER
- Clinic for Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main
| | - Christos C. ZOUBOULIS
- Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | | | - Natalia KIRSTEN
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg
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Orenstein LAV, Salame N, Siira MR, Urbanski M, Flowers NI, Echuri H, Garg A, McKenzie-Brown AM, Curseen KA, Patzer RE, Kavalieratos D, Chen SC. Pain experiences among those living with hidradenitis suppurativa: a qualitative study. Br J Dermatol 2023; 188:41-51. [PMID: 36689519 DOI: 10.1093/bjd/ljac018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pain is rated by patients with hidradenitis suppurativa (HS) as the disease's most impactful symptom. HS therapies are often insufficient to control inflammatory disease activity and pain. A better understanding of patient experiences with pain may improve patient-provider relationships and help identify strategies for addressing HS pain. OBJECTIVES This qualitative study sought to characterize lived pain experiences of those with HS. METHODS English-speaking patients ≥ 18 years old with a dermatologist-confirmed diagnosis of HS and an average numerical rating scale pain score of ≥ 1 over the preceding week were recruited from a single academic medical centre in Atlanta, Georgia, USA. Semistructured interviews were conducted from November 2019 to March 2020 to explore participants' HS pain experiences and the subsequent impact on their lives. Thematic saturation was reached after interviewing 21 participants. Interviews were audio recorded, transcribed, and analysed using thematic analysis. RESULTS Among 21 study participants, the median 7-day average pain score was 6 (interquartile range 3-7; scale ranges from 0 to 10, with 10 being most pain). Participants' descriptions of pain were consistent with nociceptive pain, neuropathic pain and itch. Pain impacted multiple life domains, including physical limitations (decreased mobility and impaired sleep), decreased psychological wellbeing (irritability, depression, loss of control, and difficulty communicating pain experiences) and impaired social relationships (social isolation, intimacy problems and difficulty fulfilling social responsibilities). Although participants reported chronic discomfort, acutely painful and unpredictable HS disease flares caused more distress and quality-of-life (QoL) burden. Participants frequently treated their pain without input from the medical team, sometimes with unsafe medication doses or combinations. Factors contributing to self-management of pain included difficulty accessing timely outpatient care during disease flares and fear of stigma from healthcare providers. CONCLUSIONS When present, HS-related pain may impact not only physical wellbeing but also mental health and relationships. In addition to therapies that target the inflammatory disease burden, treating the symptom of pain may improve patients' QoL and wellbeing. Because patients with HS have difficulty explaining their pain, proactively asking them about pain may identify unmet needs, facilitate better pain control and improve QoL. Further, the influence of HS-related pain on numerous aspects of QoL suggests the need for multidisciplinary, patient-centred approaches to HS pain management.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nicole Salame
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Meron R Siira
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Megan Urbanski
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA
| | - Nyla I Flowers
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Harika Echuri
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | | | - Kimberly A Curseen
- Department of Family and Preventive Medicine, Division of Palliative Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA, USA
| | - Dio Kavalieratos
- Department of Family and Preventive Medicine, Division of Palliative Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Suephy C Chen
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
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Delage M, Jais JP, Lam T, Guet-Revillet H, Ungeheuer MN, Consigny PH, Nassif A, Join-Lambert O. Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley stage 1 hidradenitis suppurativa: prospective short-term trial and 1-year follow-up in 28 consecutive patients. J Am Acad Dermatol 2023; 88:94-100. [PMID: 31931082 DOI: 10.1016/j.jaad.2020.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Severe Hurley stage 1 hidradenitis suppurativa (HS1) is a difficult-to-treat form of the disease. OBJECTIVE To assess the efficacy and tolerance of the oral combination of rifampin (10 mg/kg once daily)/moxifloxacin (400 mg once daily)/metronidazole (250-500 mg 3 times daily) (RMoM) treatment strategy in patients with severe HS1. METHODS Prospective, open-label, noncomparative cohort study in 28 consecutive patients. Nineteen patients were treated for 6 weeks by RMoM, followed by 4 weeks of rifampin/moxifloxacin alone, then by cotrimoxazole after remission. Moxifloxacin was replaced by pristinamycin (1 g 3 times daily) in 9 patients because of contraindications or intolerance. The primary endpoint was a Sartorius score of 0 (clinical remission) at week 12. RESULTS The median Sartorius score dropped from 14 to 0 (P = 6 × 10-6) at week 12, with 75% of patients reaching clinical remission. A low initial Sartorius score was a prognosis factor for clinical remission (P = .049). The main adverse effects were mild gastrointestinal discomfort, mucosal candidiasis, and asthenia. At 1 year of follow-up, the median number of flares dropped from 21/year to 1 (P = 1 × 10-5). LIMITATIONS Small, monocentric, noncontrolled study. CONCLUSIONS Complete and prolonged remission can be obtained in severe HS1 by using targeted antimicrobial treatments.
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Affiliation(s)
- Maïa Delage
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Jean-Philippe Jais
- Unit of Biostatistics, Hôpital Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U1163, Institut Imagine, Paris, France; Université de Paris, Paris, France
| | - Thi Lam
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Hélène Guet-Revillet
- Department of Bacteriology, Centre Hospitalier Universitaire Purpan, Toulouse, France
| | - Marie-Noelle Ungeheuer
- Investigation Clinique et d'Accès aux Bio-ressources platform, Center for Translational Science, Institut Pasteur, Paris, France
| | - Paul-Henri Consigny
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Paris, France; Centre d'Infectiologie Necker Pasteur, Paris, France
| | - Olivier Join-Lambert
- Normandie University, UNICAEN, UNIROUEN, CHU de Caen Normandie, Department of Microbiology, Groupe de Recherche sur l'Adaptation Microbienne, Caen, France.
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22
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Schultheis M, Staubach-Renz P, Grabbe S, Hennig K, Khoury F, Nikolakis G, Kirschner U. Can hidradenitis suppurativa patients classify their lesions by means of a digital lesion identification scheme? J Dtsch Dermatol Ges 2023; 21:27-32. [PMID: 36721936 DOI: 10.1111/ddg.14926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa (HS) differs widely with respect to its clinical presentation. Literature imposes different phenotypes potentially implying different treatment modalities. The aim of this study is to develop a validated scheme that enables HS patients to identify their own lesion types. PATIENTS AND METHODS The developed schemes for physicians and patients were implemented in a specific software. Upon patient consent, the physician used the software to document the lesions identified. Patients subsequently logged into the patient-version of the software from the convenience of their home and selected the lesions they identified on themselves. Afterwards the correlation between professionals and patients was tested. RESULTS For seven lesion types, correlation coefficients were statistically significant. A large/strong correlation between patients and physicians was found for the draining fistulas (0.59) and double-ended comedones (0.50). For five other lesion types, correlation was medium/moderate, namely the inflammatory nodule (0.37), abscess (0.30), accordion like-/ bridged scar (0.45), epidermal cyst (0.33) and pilonidal sinus (0.39). CONCLUSIONS HS-patients demonstrate high willingness to share their experiences and data. Therefore, a self-assessment scheme, as the developed LISAI, can be a valuable tool to enrich patient surveys with the identification of lesion types, for instance as a basis for phenotyping.
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Affiliation(s)
- Michael Schultheis
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach-Renz
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Fareed Khoury
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - 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
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
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23
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Alotaibi HM. Incidence, Risk Factors, and Prognosis of Hidradenitis Suppurativa Across the Globe: Insights from the Literature. Clin Cosmet Investig Dermatol 2023; 16:545-552. [PMID: 36891064 PMCID: PMC9987236 DOI: 10.2147/ccid.s402453] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
Hidradenitis suppurativa, a chronic inflammatory disease of the skin, affects a patient's quality of life to a greater extent. While the disease burden, including its incidence and prevalence, has been extensively studied in the western population, there is a paucity of data from developing countries on the epidemiology of Hidradenitis suppurativa. Therefore, a general literature review was conducted to shed light on the epidemiology of Hidradenitis suppurativa across the globe. We reviewed the most recently available information on epidemiology, including incidence, prevalence, risk factors, prognosis and quality of life, complications, and associated comorbid among patients with Hidradenitis suppurativa. The estimated global prevalence of Hidradenitis suppurativa is found to be 0.00033-4.1%, with a relatively higher prevalence of 0.7-1.2% in European and US populations. Both genetic and environmental factors are associated with Hidradenitis suppurativa. Patients with Hidradenitis suppurativa have associated comorbid such as cardiovascular disease, type II diabetes mellitus, mental health issues, and sleep and sexual dysfunctions. These patients spend poor quality of life and tend to be less productive. Future studies are needed to assess the burden of Hidradenitis suppurativa in developing countries. Since the disease tends to be underdiagnosed, future studies should rely on clinical diagnosis rather than self-reporting to avoid the potential of recall bias. Attention needs to be diverted to developing countries with less amount of data on Hidradenitis suppurativa.
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Affiliation(s)
- Hend M Alotaibi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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24
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Schultheis M, Staubach-Renz P, Grabbe S, Hennig K, Khoury F, Nikolakis G, Kirschner U. Können Acne-inversa-Patienten ihre Läsionen mit Hilfe eines digitalen Läsionsidentifikationsschemas klassifizieren? J Dtsch Dermatol Ges 2023; 21:27-34. [PMID: 36721938 DOI: 10.1111/ddg.14926_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Michael Schultheis
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Stephan Grabbe
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Katharina Hennig
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | | | - Georgios Nikolakis
- Abteilungen für Dermatologie, Venerologie, Allergologie und Immunologie, Medizinisches Zentrum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
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25
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Ocker L, Abu Rached N, Seifert C, Scheel C, Bechara FG. Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:7240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed.
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Affiliation(s)
- Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | | | | | | | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
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26
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Moloney S, Fitzgerald D, Roshan D, Gethin G. Impact of hidradenitis suppurativa-specific wound dressing system on patient quality of life and dressing-related pain: pilot study. J Wound Care 2022; 31:898-906. [DOI: 10.12968/jowc.2022.31.11.898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: It is theorised that adhesive-free wound care developed specifically for patients with hidradenitis suppurativa (HS) can improve their quality of life (QoL). Our study aimed to investigate the impact of a novel wound care device on Dermatology Life Quality Index (DLQI) scores, and other factors related to experienced pain, time spent changing dressings, comfort, ease of use and body image. Method: A 21-day, single-arm, unblinded, pilot trial was conducted to assess ease of use and the impact of effective wound care on various aspects of wound management in patients with HS. Participants were provided two trial garments and trial dressings as required, to use over a 21-day period in the home setting. A seven-item questionnaire and the DLQI questionnaire was completed on days 0, 7, 14 and 21. Results: All 15 participants were female, aged >18 years old and with a diagnosis of HS. Mean DLQI score at baseline (day 0) was 19.3, which was reduced to 4.53 on day 21, a significant improvement in 100% of participants (p<0.001). High levels of dressing-related pain, assessed using an 11-point Visual Analogue Scale, reduced from 5.53 at baseline to 0.8 on day 21. Other significant improvements in terms of patient comfort, time spent on changing dressings, body confidence and the dressing's ability to retain exudate were also noted. Conclusion: The results illustrated the improvement made to study participants' day-to-day activities and QoL when effective HS-specific wound care products were provided. Wound care is an essential component in the treatment journey of patients.
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Affiliation(s)
- Suzanne Moloney
- Business and Innovation Centre, University of Galway, Galway, Ireland
| | | | - Davood Roshan
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Georgina Gethin
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
- Alliance for Research and Innovation in Wounds, University of Galway, Galway, Ireland
- School of Nursing and Midwifery, Monash University, Australia
- CÚRAM, University of Galway, Galway, Ireland
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27
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Sabat R, Tsaousi A, Ghoreschi K, Wolk K, Schneider-Burrus S. Sex-disaggregated population analysis in patients with hidradenitis suppurativa. Front Med (Lausanne) 2022; 9:1028943. [PMID: 36388895 PMCID: PMC9663462 DOI: 10.3389/fmed.2022.1028943] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/11/2022] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a common chronic inflammatory skin disease, which affects both sexes. OBJECTIVES Identification of sex-specific risk factors, comorbidity, clinical manifestations, and treatments in HS patients. METHODS A non-interventional, cross-sectional, mono-centric study with 500 HS patients. All patients were examined by dermatologists. Prospectively collected demographic, anamnestic, clinical data, and blood parameters were evaluated. RESULTS There were no significant differences in age at HS onset and in disease duration between female and male patients. Furthermore, no differences regarding the family history for HS were found between sexes. Regarding further risk factors for HS, central obesity was more frequent in women while extensive cigarette smoking and acne vulgaris were more commonly found among male patients. Regarding comorbidity, lower HDL-levels were significantly more frequent in men. Female patients were found to suffer significantly more often from back pain, especially in the neck/shoulder region and lower back. Analyzing the clinical manifestation of HS, the groin was more frequently involved in women and the axillae in men. Women showed a higher number of skin sites with inflammatory nodules, whereas fistulas were observed more frequently in men. Nevertheless, there was no difference in HS treatment applied to female vs. male patients. LIMITATIONS Data were obtained from a mono-centric study. CONCLUSION Significant differences in HS risk factors, comorbidity, and clinical manifestation exist between female and male patients. Thus, sex-specific differences should be taken into account in the prevention as well as medical and surgical treatment of HS patients.
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Affiliation(s)
- Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Athanasia Tsaousi
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kerstin Wolk
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Psoriasis Research and Treatment Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | - Sylke Schneider-Burrus
- Institute of Medical Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
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28
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Kohorst JJ, Ghanavatian S, Davis MDP, Weaver AL, Schleck CD, Swanson DL. Long-term risk of death in patients with hidradenitis suppurativa. Int J Dermatol 2022; 62:631-636. [PMID: 36097962 DOI: 10.1111/ijd.16409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is associated with substantial morbidity. Few studies have addressed the natural history and mortality rates associated with HS. A higher risk of cardiovascular death in patients with HS has been reported. We investigated whether patients with HS have an increased overall risk of death compared with age- and gender-matched referents. METHODS We performed a retrospective cohort study of residents of Olmsted County, Minnesota, with incident HS between January 1, 1980, and December 31, 2008, and age- and gender-matched referents. The main outcomes and measures were the overall and cause-specific risks of death. RESULTS We identified 226 incident cases of HS and 678 age- and gender-matched referents among Olmsted County residents during the study period. Compared to referents, patients with HS had a significantly higher risk of all-cause death (hazard ratio [HR, 2.48; 95% CI, 1.53-4.03, P < 0.001) and cardiovascular- or cerebrovascular-related death (HR, 2.85; 95% CI, 1.10-7.40, P = 0.03). However, these risks were attenuated by adjusting for smoking history: all-cause HR, 1.65 (95% CI, 0.97-2.82, P = 0.07) and cardiovascular- or cerebrovascular-related HR, 2.03 (95% CI, 0.71-5.81, P = 0.18). The 71% of patients were former or current smokers at the time of HS diagnosis. CONCLUSIONS Hidradenitis suppurativa patients have a substantially increased risk of death from any cause, including cardiovascular or cerebrovascular causes; the risk is especially dependent on smoking history.
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Affiliation(s)
- John J Kohorst
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | | | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Cathy D Schleck
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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29
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Fisher S, Kagan I, Zoller L, Cohen AD, Kridin K. Hidradenitis suppurativa: Evaluating activity patterns and predictors of recalcitrant course-A population-based study. Australas J Dermatol 2022; 63:321-327. [PMID: 35510316 DOI: 10.1111/ajd.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/06/2022] [Accepted: 04/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological evidence regarding the course and activity patterns of hidradenitis suppurativa (HS) is yet to be delineated. OBJECTIVE To identify activity patterns of HS throughout the time axis and to outline predictors of recalcitrant disease course. METHODS A population-based retrospective cohort study was performed to follow patients with HS (n = 4417) throughout the initial 10 years following their diagnosis. The disease was considered active in a certain month if one of the following criteria was fulfilled: (i) purchase of an HS-related drug, (ii) admission to a dermatological ward and (iii) referral to a dermatological consultation in an emergency room. Patients with a recalcitrant disease were defined as those with ≥5 years of follow-up with ≥6 'active months' each. Patients with an indolent course were defined as those experiencing ≥9 years of follow-up with ≤1 'active months' each. RESULTS The average (SD) number of months in which patients had an active disease was 1.37 (1.28) months per year. While 98 (2.2%) patients pursued a recalcitrant course, 1390 (31.5%) went through an indolent disease course. Older age (≥38 years; adjusted OR, 6.17; 95% CI, 3.33-11.43), Arab ethnicity (adjusted OR, 2.04; 95% CI, 1.20-3.48), low socioeconomic status (adjusted OR, 1.64; 95% CI, 1.03-2.60), obesity (adjusted OR, 3.47; 95% CI, 2.25-5.34) and smoking (adjusted OR, 2.65; 95% CI, 1.57-4.47) were found to independently predict recalcitrant course of HS. CONCLUSIONS Mild course is more frequently encountered than severe course among Israeli patients with HS. Modifiable risk factors of recalcitrant course should be carefully addressed.
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Affiliation(s)
- Shani Fisher
- Dermatology and Venereology Department, Emek Medical Center, Afula, Israel
| | - Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
| | - Lilach Zoller
- Clalit Health Services, Tel-Aviv and Haifa, Tel Aviv, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv and Haifa, 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
| | - Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Israel.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany.,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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30
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Cheong KW, Shen M, Wang DY, Tey HL, Ren EC, Oon HH. Psychosocial impact and treatment trends of hidradenitis suppurativa in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:318-320. [PMID: 35658158 DOI: 10.47102/annals-acadmedsg.2021477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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31
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Gulliver W, Alavi A, Wiseman MC, Gooderham MJ, Rao J, Shayesteh Alam M, Papp KA, Desjardins O, Jean C. Real-World Moderate-to-Severe Hidradenitis Suppurativa: Decrease in Disease Burden With Adalimumab. J Cutan Med Surg 2022; 26:361-370. [PMID: 35322692 DOI: 10.1177/12034754221088584] [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
BACKGROUND Real-world knowledge of the burden of hidradenitis suppurativa (HS) on patients remains limited. OBJECTIVES To measure the impact of adalimumab on moderate-to-severe HS patients' health-related quality of life (HRQoL) and work productivity. METHODS In 23 Canadian centres, 138 adults with moderate-to-severe HS requiring a change in ongoing therapy were treated with adalimumab for up to 52 weeks as per the physician's practice. Patient-reported outcome measures (PROMs) were obtained at baseline, weeks 24 and 52 to measure overall HRQoL, HS severity, levels of anxiety and depression, impact and symptoms of HS, work productivity and activity impairment. A post-hoc analysis further explored the PROMs by abscess and inflammatory nodule (AN) count at baseline (≤5, low; 6-10, medium; ≥11, high). RESULTS From baseline to weeks 24 and 52, all PRO overall scores improved significantly (P ≤ .0023). The number of patients reporting "good disease control" and "complete disease control" increased from 9.7% to 66.4% over 52 weeks. The score in Health Utility Index Mark 3 (HUI3) pain attribute meaningfully decreased over 52 weeks (mean difference ≥.05). The HS symptoms skin "tenderness" and "itchiness" improved the most. Work productivity loss and activity impairment improved by approximately 20% over 52 weeks. Disease burden improved more in 24 week responders with low and medium AN counts at baseline than in those with high AN count or in 24 week nonresponders. CONCLUSION At week 24 and maintained at week 52 in a real-world setting, adalimumab meaningfully improved HRQoL, work productivity, and activity impairment in moderate-to-severe HS patients.
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Affiliation(s)
- Wayne Gulliver
- NewLab Clinical Research Inc, St. John's, NL, Canada.,Faculty of Medicine, Memorial University of Newfoundland, NL, Canada
| | - Afsaneh Alavi
- 6915 Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,468790 Probity Medical Research Inc, Waterloo, ON, Canada
| | - Marni C Wiseman
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Wiseman Dermatology Research, Winnipeg, Canada
| | - Melinda J Gooderham
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,SKiN Centre for Dermatology, Peterborough, ON, Canada.,Queen's University, Kingston, ON, Canada
| | - Jaggi Rao
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Division of Dermatology, University of Alberta, Edmonton, AB, Canada
| | - Maryam Shayesteh Alam
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,SimcoMed Health Ltd, Barrie, ON, Canada
| | - Kim A Papp
- 468790 Probity Medical Research Inc, Waterloo, ON, Canada.,Kim Papp Clinical Research, Waterloo, ON, Canada
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Butt M, Chinchilli VM, Leslie DL, Khesroh E, Helm MF, Flamm A, Kirby JS, Rigby A. Internalized skin bias: Validation study to explore the impact of the internalization of social stigma on those with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2022; 36:1118-1124. [PMID: 35170818 DOI: 10.1111/jdv.18007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic auto-inflammatory disease that is highly associated with adverse psychopathology and impaired body image. Previous studies show that patients with HS are also impacted by social stigma associated with their skin disease. Over time, these experiences can influence the way in which patients feel about themselves, leading to internalized skin bias (ISB). OBJECTIVES To evaluate the validity and reliability of the Internalized Skin Bias Questionnaire (ISBQ) in an HS population, and to determine the association of this instrument with markers of HS severity. METHODS A cross-sectional survey with 72-hour retest was sent to adult patients with HS from March to November 2021. Reliability for the ISBQ was evaluated using Cronbach's alpha and the Concordance Correlation Coefficient (CCC). Construct validity was evaluated using Pearson Correlation Coefficients with similar measures. RESULTS Internal consistency for the ISBQ instrument was 0.89 with a CCC of 0.88. The ISBQ had moderate correlation (r = 0.63) with the experienced skin stigma questionnaire as well as the BDI-II (r = 0.66) and the psychosocial subscale of the HiSQOL (r = 0.65). ISBQ scores differed significantly across different stages of disease severity (p=0.04). There was no significant difference between those with different durations of disease (p=0.47). CONCLUSIONS This study shows that the ISBQ is a valid and reliable instrument that can be used to assess the psychosocial construct of ISB especially in a population of HS patients. Further, ISB places a prevalent negative impact on the psychopathology of patients with HS.
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Affiliation(s)
- Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.,Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Douglas L Leslie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Eiman Khesroh
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Matthew F Helm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexandra Flamm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Andrea Rigby
- Department of Surgery - Division of Minimally Invasive SurgeryPenn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Auffret N, Ngyen JM, Leccia MT, Claudel JP, Dréno B. TRASS: a global approach to assess the severity of truncal acne. J Eur Acad Dermatol Venereol 2022; 36:897-904. [PMID: 35170810 DOI: 10.1111/jdv.18009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/07/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Only a small amount of published data regarding truncal acne is available and no proper tool to assess its severity exists. AIM to provide dermatologists with an easy-to-use tool to assess truncal acne (TRASS, truncal acne severity scale) using a global approach. METHODS A scoring tool that assesses the severity of acne (based on GEA and ECLA scales) on the trunk using a global approach was built, including three subscores: family history, clinical signs and quality of life (QoL). In order to test TRASS, the experts used photos of 47 patients attending their clinics with truncal acne. The ROP (Regression OPtimized) model was applied to assess the diagnosis performance of TRASS and to identify items contributing to the classification of the patients. Internal testing was made to demonstrate the robustness of the model. Correlation analyses between the different items were performed to evaluate the interaction between the different items and their impact on the severity grading of truncal acne. RESULTS Patients with the most severe acne were identified by TRASS. The error level was 6.6% after internal validation and 10.4% when using the median value or the centile 75th (6.6% and 10.4%). Correlation was significant between systemic treatment and scars (p=0.0025) and nodules (p=0.01988) and between location and QoL (p=0.0095). CONCLUSION TRASS is the first global, patient-centred approach to evaluate truncal acne by scoring the importance of each factor independently from its clinical severity. TRASS may allow the practitioner to choose and validate the most suitable therapy together with the patient in order to treat his or her truncal acne successfully and to limit treatment failure.
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Affiliation(s)
| | - J M Ngyen
- Biostatistic and Epidemiology, Inserm U1232, Nantes, France
| | - Marie-Thérèse Leccia
- Department of Dermatology, Allergology and Photobiology, CHU A Michallon, Grenoble, France
| | | | - B Dréno
- UF dermato-cancérologie, CHU Nantes-Hôtel-Dieu, CIC Biothérapie Inserm 05031, Inserm, U1232, Nantes, France
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Navrazhina K, Garcet S, Zheng X, Hur HB, Frew JW, Krueger JG. High inflammation in hidradenitis suppurativa extends to perilesional skin and can be subdivided by lipocalin-2 expression. J Allergy Clin Immunol 2022; 149:135-144.e12. [PMID: 34081946 DOI: 10.1016/j.jaci.2021.05.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/14/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with diverse manifestations ranging from nodules and abscesses to draining tunnels. Whether the underlying inflammation from lesions extends to relatively healthy-appearing adjacent perilesional and distant nonlesional skin has not been systematically evaluated. OBJECTIVE We sought to characterize lesional, perilesional, and nonlesional skin in patients with HS. METHODS Skin biopsy samples were collected under ultrasound guidance from patients with active, untreated moderate-to-severe HS. Site-matched control biopsy samples from healthy volunteers were used for comparison. RESULTS RNA sequencing demonstrated that HS skin clustered separately from healthy control skin, with perilesional and lesion skin clustering together and away from nonlesional skin. Immunohistochemistry analysis identified psoriasiform hyperplasia with keratin 16 positivity in both perilesional and lesional skin, with comparable levels of CD3+, CD11c+, and neutrophil elastase-positive cellular infiltration. There was a marked upregulation of IL-17 signaling in perilesional and lesional skin. HS samples clustered on the basis of expression of lipocalin-2 (LCN2), with samples characterized by high LCN2 expression in the skin exhibiting a differing transcriptomic profile with significantly higher overall inflammation than that of skin characterized by low LCN2 levels. CONCLUSIONS Perilesional HS skin has a transcriptomic and molecular profile comparable to that of lesional skin. HS can be grouped into 2 distinct subtypes based on molecular levels of LCN2 in the skin, with the LCN2-high subtype exhibiting an overall higher inflammatory burden and an upregulation of targetable cytokines. To our knowledge, this is the first study to characterize a unique HS subtype (and a potential endotype) that may guide future therapeutic targets.
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Affiliation(s)
- Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY; Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY
| | - Sandra Garcet
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY
| | - Xiuzhong Zheng
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY
| | - Hong Beom Hur
- Research Bioinformatics, Center for Clinical and Translational Science, The Rockefeller University, New York, NY
| | - John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY
| | - James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY.
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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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Dick J, Kröhl V, Enk A, Hartschuh W, Gholam P. Improvement in Quality of Life and Pain in Patients With Hidradenitis Suppurativa After Wide Local Excision: A Prospective Study. Dermatol Surg 2021; 47:1556-1561. [PMID: 34537785 DOI: 10.1097/dss.0000000000003235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects patients' quality of life (QoL). OBJECTIVE To investigate changes in QoL in patients with HS after wide local excision (WLE) and to examine the level of pain, rate of postoperative complications, recurrences, and the time to complete wound closure. METHODS Fifty-five patients were enrolled in this prospective study. All patients underwent WLE of HS, followed by secondary wound healing. Dermatologic Life Quality Questionnaire, pain, and wound size were measured 1 day, 3 weeks, 3 months, and 6 months after surgery. RESULTS Dermatologic Life Quality Questionnaire and pain scores (mean ± SD) improved significantly (both p < .001) from 14.5 ± 7.3 and 3.7 ± 2.8 at baseline to 5.8 ± 6.9 and 0.8 ± 1.7, 6 months postoperatively, respectively. Wounds were closed completely by secondary intention after 4.4 ± 2.8 months. Sixteen patients (29.1%) experienced postoperative complications, local recurrences in the treated sites were observed in 11 patients (20%), and new lesions in untreated sites were observed in 5 cases (9.1%). CONCLUSION Wide local excision significantly improves patients' QoL and pain, and, given its low rate of recurrence and complications, should be considered as a first-line therapy, especially in patients with higher Hurley stages.
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Affiliation(s)
- Julika Dick
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Haut-und Laserzentrum Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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Orenstein LAV, Amah A, Shaw FM, Zhang C, Swerlick RA, Chen SC. Validation of the Three-Item Skindex-Mini Among Hidradenitis Suppurativa Patients With Diverse Racial Backgrounds. J Cutan Med Surg 2021; 24:457-460. [PMID: 32469259 DOI: 10.1177/1203475420930222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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 skin disease that severely impairs patients' quality of life (QoL). Instruments such as the 10-item Dermatology Life Quality Index and 16-item Skindex-16 have been used to assess QoL in HS; however, it is unknown whether the shorter 3-item Skindex-mini can also provide an accurate assessment of skin-related QoL in patients with HS. OBJECTIVES The aim was to assess how well the Skindex-16 correlates with its shorter adaptation, the Skindex-mini, in capturing QoL among patients with HS. METHODS This retrospective cross-sectional study included all HS patients seen in the HS Clinic at The Emory Clinic between January 1, 2019, and August 16, 2019. We compared the correlation between the symptom, emotion, and function domains of the Skindex-16 and Skindex-mini using Pearson correlation coefficients (CC). Secondary outcome measures included individual survey item analysis, ItchyQuant scores, and numeric rating scale of pain. RESULTS We identified 108 encounters among 75 unique hidradenitis suppurativa patients (43 black/African American, 18 white, 5 Asian/Pacific Islander, 3 Latino, 4 Other, 2 unknown). Pearson CC between the Skindex-16 and Skindex-mini domain scores for all encounters were 0.770 (P < .001), 0.787 (P < .001), and 0.801 (P < .001) for the symptom, emotion, and function domains, respectively. The mean pain and ItchyQuant scores were 4.14 (SD 3.31) and 3.55 (SD 3.34), respectively. CONCLUSIONS The Skindex-mini correlated highly with the Skindex-16 in a racially diverse group of patients with HS. The Skindex-mini is a streamlined QoL instrument that could be practically implemented into routine clinical care among diverse patients presenting to dermatology.
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Affiliation(s)
- Lauren A V Orenstein
- 12239 Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adaugo Amah
- 1374 Morehouse School of Medicine, Atlanta, GA, USA
| | - Fiona M Shaw
- 1374 Morehouse School of Medicine, Atlanta, GA, USA
| | - Chao Zhang
- 189275 Biostatistics & Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Robert A Swerlick
- 12239 Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Suephy C Chen
- 12239 Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
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Johnston DGW, Kirby B, Tobin DJ. Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction? Exp Dermatol 2021; 30:1554-1568. [PMID: 34418166 DOI: 10.1111/exd.14451] [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: 04/05/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022]
Abstract
The innate immune system of human skin consists of a multi-layered barrier consisting of cells and soluble effector molecules charged with maintaining homeostasis and responding to insults and infections. It has become increasingly clear that these barrier layers become compromised in skin diseases, especially in disorders of an (auto)inflammatory nature. In the case of hidradenitis suppurativa, great strides have been made in recent years in characterizing the underlying breakdown in homeostatic innate immunity, including an increasing understanding of the central role of the hair follicle in this process. This breakdown appears to occur at multiple levels: the pilosebaceous unit, associated epithelium, the cutaneous microbiome, alteration of immune cell function and local molecular events such as complement activation. This review seeks to summarize, contextualize and analyse critically our current understanding of how these innate immune barriers become dysregulated in the early stage(s) of hidradenitis suppurativa, and to speculate on where potential hidradenitis suppurativa research could be most fruitful.
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Affiliation(s)
- Daniel G W Johnston
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Brian Kirby
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,The Conway Institute, University College Dublin, Dublin 4, Ireland
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Recurrence Rates Following Reconstruction Strategies After Wide Excision of Hidradenitis Suppurativa: A Systematic Review and Meta-analysis. Dermatol Surg 2021; 47:e106-e110. [PMID: 33795566 DOI: 10.1097/dss.0000000000002815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wide excision (WE) is generally considered to be the most common treatment for recurrent hidradenitis suppurativa. When performed, excision is followed by decisions regarding best options for management of the surgical defect. Different reconstructive strategies (RSs) have been used, with varying rates of recurrence. OBJECTIVE To provide an up-to-date systematic review of the complete literature for different RS after WE and their recurrence rates. METHODS A systematic literature search of the complete available literature and a meta-analysis of proportions were performed on the included studies. RESULTS Of a total of 1,813 retrieved articles, 79 were included in the analysis. Most were retrospective analyses, with only one randomized controlled trial (RCT) and 7 prospective analyses. The RS described were divided into primary closure (PC), secondary intention healing (SIH), skin graft (SG), and fasciocutaneous flaps (FCF). The average estimated recurrence for PC was 22.0% (95% confidence interval [CI], 8.0%-40.0%), for SIH 11.0% (95% CI, 5.0%-20.0%), for SG 2.0% (95% CI, 0.0%-5.0%), and for FCF 2.0% (95% CI, 1.0%-5.0%) (p < .001). Hidradenitis suppurativa below the umbilicus was significantly associated with overall recurrence (p = .006). Quality of evidence was poor, and the reporting of results was mostly heterogeneous. CONCLUSION After WE, PC has the highest recurrence rates, whereas SG and FCF have the lowest rates. There is a need for more RCTs and guidelines, to be able to report uniformly on treatment outcomes.
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Hafner A, Ghislain PD, Kovács R, Batchelor R, Katoulis AC, Kirby B, Banayan H, Schonbrun M. Improvement in Hidradenitis Suppurativa and Quality of Life in Patients Treated With Adalimumab: Real-World Results From the HARMONY Study. J Eur Acad Dermatol Venereol 2021; 35:2277-2284. [PMID: 34320249 PMCID: PMC9293108 DOI: 10.1111/jdv.17551] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/05/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
Background Hidradenitis suppurativa (HS), a chronic, recurrent, debilitating skin disease, is characterized by painful, inflammatory, subcutaneous lesions of the axilla, inguinal and anogenital regions. Overall prevalence of HS is ˜1%, and the impact of disease on patient quality of life (QoL) and healthcare resource utilization (HRU) is high. Objectives To estimate the real‐world effectiveness of adalimumab (Humira®) treatment in patients with moderate‐to‐severe HS on disease severity, pain, QoL, work productivity and HRU. Methods HARMONY (Effectiveness of Adalimumab in Moderate to Severe HidrAdenitis SuppuRativa Patients – a Multi‐cOuNtry studY in Real Life Setting) is a multicentre, postmarketing observational study in adult patients with moderate‐to‐severe HS. Disease severity and QoL parameters were evaluated using validated measures at 12‐week intervals over 52 weeks of treatment. The primary endpoint was the proportion of patients achieving a Hidradenitis Suppurativa Clinical Response (HiSCR: ≥50% reduction in abscess and inflammatory nodule count, with no increase in abscess and draining fistula counts relative to baseline) at 12 weeks. Secondary endpoints were HiSCR at 24, 36 and 52 weeks and changes in QoL parameters and work productivity assessments. Analyses were conducted using as‐observed data. Results The proportion of patients reaching the primary HiSCR endpoint was 70.2% (n = 132/188 enrolled) and remained ≥70% until study completion. There were statistically significant (P < 0.0001) reductions in worst and average skin pain. All of the QoL measures evaluated improved significantly (P < 0.0001) by 12 weeks of adalimumab treatment, as did work productivity assessments (P < 0.05), and there was a ˜50% decrease in HRU between baseline and week 52. Adalimumab was well tolerated. Conclusions In this real‐world setting, adalimumab treatment of moderate‐to‐severe HS resulted in decreased disease severity and improvements in QoL and productivity. Response to adalimumab was rapid (within 12 weeks) and sustained (52 weeks). No unexpected safety signals were reported.
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Affiliation(s)
- A Hafner
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - R Kovács
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - R Batchelor
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - A C Katoulis
- Second Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, General University Hospital, Athens, Greece
| | - B Kirby
- Department of Dermatology, St Vincent's University Hospital and University College, Dublin, Ireland
| | - H Banayan
- AbbVie Biopharmaceuticals Ltd, Hod Hasharon, Israel
| | - M Schonbrun
- AbbVie Biopharmaceuticals Ltd, Hod Hasharon, Israel
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Huang CM, Kirchhof MG. Hidradenitis Suppurativa From a Patient Perspective Including Symptoms and Self-Treatment. J Cutan Med Surg 2021; 25:591-597. [PMID: 34137667 DOI: 10.1177/12034754211024157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hidradenitis Suppurativa (HS) is a chronic inflammatory disordercommonly affecting body folds. It can significantly impair quality of life due to the physical, psychological, and socialturmoil experienced by patients. Treatment remains a challenge.Limited data on the HS patient experience, such as self-treatment exists. METHODS This was a single-center cross-sectional study, utilizing a paper-based survey. Surveys were mailed out to all HS patients from the dermatology clinic and completed on a voluntary basis. Demographics, disease characteristics, medical and family history, treatments tried, and life quality were documented. RESULTS The response rate was 49.4% (41/83), with a female predominance (26/41). Eighty-five percent (35/41) were Caucasian with an average age and BMI of 39.0 ± 16.78 and 30.71 ± 7.02, respectively. In total, 24.4% (10/41), 56.0% (23/41), and 19.5% (8/41) had Hurley I, II, and III, respectively. Lesions affected the genital region (75.6%), thigh/groin (68.2%), and axilla (46.3). Almost half (49%) of patients experienced an average of 1-2 flares per month. The most bothersome symptoms were pain (92.7%), discharge (68.3%), malodor (63.4%), and itch (61%). Depression (53.7%), severe facial acne (14.6%), and hypertension (14.6%) were the most common co-morbidities. Treatments used included antibiotics (82.9%) and surgical excision (34.2%) were. Over 90% of patients reportedself-treatment of lesions by squeezing (80.5%), soaking (53.7%), and lancing (41.4%). CONCLUSIONS This study provides insight into the patient perspective of HS. We identify itch as a symptom that is not frequently associated with HS and reveal how commonly patients utilize various types of self-treatment in their experience of disease.
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Affiliation(s)
- Christina M Huang
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Canada
| | - Mark G Kirchhof
- 12365 Division of Dermatology, Department of Medicine, University of Ottawa and The Ottawa Hospital, Canada
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Zimmer S, Basien K, von Stebut E. [Impact of LAight therapy on hidradenitis suppurativa care]. Hautarzt 2021; 72:586-594. [PMID: 34125251 DOI: 10.1007/s00105-021-04843-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with high burden for patients and limited treatment options. We recently analyzed the efficacy of local treatment with LAight therapy, a combination of intense pulsed light (IPL) and radiofrequency (RF). OBJECTIVES The aim of the present survey was to compare care of HS patients under LAight with standard care prior to therapy. MATERIALS AND METHODS The retrospective study included 111 patients who were treated with LAight at least 5 times between 01/2014 and 03/2017. Primary endpoint was the change in surgical interventions. Secondary endpoints included additional patient-reported outcomes, e.g., effects on their quality of life. RESULTS In all, 50 completed surveys were available for evaluation. Under LAight therapy, the number of surgical interventions decreased from 3.2 to 0.3 per year (p < 0.001). Secondary endpoints were also significantly improved: The days of sick leave/year due to HS decreased from 30.4 to 7.2 (p = 0.002), and the number of doctor appointments due to HS flare ups was altered from 7.3 to 1.5 (p < 0.001). In line, patient-reported pain levels, general wellbeing and quality of life were also improved. CONCLUSION This retrospective assessment of patient-reported treatment outcomes of 50 HS cases after treatment with LAight revealed a significant reduction of required surgical interventions and sick-days along with improved quality of life. Thus, it appears that IPL + RF treatment not only improves disease activity, but also secondary care aspects. Future studies will need to confirm these findings in a controlled setting.
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Affiliation(s)
- Sophia Zimmer
- Klinik und Poliklinik für Dermatologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Kyra Basien
- Klinik und Poliklinik für Dermatologie, Universitätsmedizin, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Esther von Stebut
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Schneider-Burrus S, Tsaousi A, Barbus S, Huss-Marp J, Witte K, Wolk K, Fritz B, Sabat R. Features Associated With Quality of Life Impairment in Hidradenitis Suppurativa Patients. Front Med (Lausanne) 2021; 8:676241. [PMID: 33987196 PMCID: PMC8112201 DOI: 10.3389/fmed.2021.676241] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with an adverse impact on patients' quality of life (QoL). Objectives: To quantify QoL impairment in patients in Germany suffering from HS and to identify the parameters associated with QoL impairment. Methods: A non-interventional, cross-sectional, mono-centric study with 500 HS patients. QoL data (measured using the Dermatology Life Quality Index; DLQI) and demographic, anamnestic, clinical, and blood parameters were collected. All patients were examined by dermatologists that documented the skin alterations. QoL data from 462 HS patients were available and evaluated. Results: The mean (± standard deviation) DLQI score of HS patients was 13.18 ± 7.99. Approximately 40% and 20% of HS patients declared very large and extremely large QoL impairment, respectively. The degree of QoL disturbance correlated with the severity of skin alterations, blood leucocyte count and, in particular, with anogenital localization and the presence of nodules and fistulas. Furthermore, QoL impairment was associated with specific comorbidities, such as adiposity and back pain, but not with HS family history. QoL impairment was not influenced by whether or not the patients had undergone resection surgery or antibiotic treatment but was more severe in HS patients that had undergone abscess lancing compared to patients without such treatment in the past. Limitations: It was a mono-centric study and most data were obtained from self-administered patient questionnaires. The association of QoL with type of treatment was analyzed for abscess lancing, resection surgery, and antibiotic treatment. Further therapeutic modalities recommended in the guidelines were not investigated. Conclusion: A profound impairment in QoL was present in patients with HS, and this was higher than that observed in other studied dermatoses. The degree of impairment correlated with the extent of cutaneous and some extra-cutaneous alterations. Surgical and conventional medicamentous therapies of HS were not associated with long-lasting reduction of QoL impairment. Our data support the implementation of patient-reported outcome measures for the assessment of therapy responses.
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Affiliation(s)
- Sylke Schneider-Burrus
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Dermatosurgery, Havelklinik, Berlin, Germany
| | - Athanasia Tsaousi
- Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Katrin Witte
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Kerstin Wolk
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH) Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Dermatology, Venereology, and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
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44
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Tan J, Beissert S, Cook-Bolden F, Chavda R, Harper J, Hebert A, Lain E, Layton A, Rocha M, Weiss J, Dréno B. Impact of facial and truncal acne on quality of life: A multi-country population-based survey. JAAD Int 2021; 3:102-110. [PMID: 34409378 PMCID: PMC8362284 DOI: 10.1016/j.jdin.2021.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 11/26/2022] Open
Abstract
Background Acne confers an increased risk of physical, psychiatric, and psychosocial sequelae, potentially affecting multiple dimensions of health-related quality of life (HRQoL). Morbidity associated with truncal acne is poorly understood. Objective To determine how severity and location of acne lesions impact the HRQoL of those who suffer from it. Methods A total of 694 subjects with combined facial and truncal acne (F+T) and 615 with facial acne only (F) participated in an online, international survey. Participants self-graded the severity of their acne at different anatomical locations and completed the dermatology life quality index (DLQI). Results The F+T participants were twice as likely to report “very large” to “extremely large” impact on HRQoL (ie, DLQI > 10 and children's DLQI [CDLQI] > 12) as compared with the F participants (DLQI: odds ratio [OR] 1.61 [95% confidence interval {CI} 1.02-2.54]; CDLQI: OR 1.86 [95% CI 1.10-3.14]). The impact of acne on HRQoL increased with increasing acne severity on the face (DLQI and CDLQI P values = .001 and .017, respectively), chest (P = .003; P = .008), and back (P = .001; P = .028). Limitations Temporal evaluation of acne impact was not estimated. Conclusions Facial and truncal acne was associated with a greater impact on HRQoL than facial acne alone. Increasing severity of truncal acne increases the adverse impact on HRQoL irrespective of the severity of facial acne.
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Affiliation(s)
- Jerry Tan
- Schulich School of Medicine and Dentistry, Western University Canada, Windsor, Ontario, Canada
| | - Stefan Beissert
- Department of Dermatology, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | | | | | - Julie Harper
- The Dermatology and Skin Care Center of Birmingham, Birmingham, Alabama
| | - Adelaide Hebert
- The University of Texas Medical School - Houston, Houston, Texas
| | - Edward Lain
- Austin Institute for Clinical Research, Pflugerville, Texas
| | - Alison Layton
- Hull York Medical School, York University, Heslington, York, United Kingdom
| | - Marco Rocha
- Federal University of São Paulo, São Paulo, Brazil
| | - Jonathan Weiss
- Georgia Dermatology Partners (Formerly, Gwinnett Dermatology, PC), Snellville, Georgia
| | - Brigitte Dréno
- Unité Thérapie Cellulaire et Génique, Faculté de Médecine de Nantes, CHU Nantes - Place Alexis Ricordeau, Nantes, France
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45
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Cao Y, Hong F, Conlon DM, Sidur L, Smith KM, Fang Y, Cuff CA, Kaymakcalan Z, Ruzek MC. Potential predictive biomarkers of adalimumab response in patients with hidradenitis suppurativa. Br J Dermatol 2021; 185:804-814. [PMID: 33811319 DOI: 10.1111/bjd.20097] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adalimumab provides significant efficacy for patients with hidradenitis suppurativa (HS), which was demonstrated by at least 50% of patients achieving a clinical response by week 12 that was maintained through to week 168 in the PIONEER trials. OBJECTIVES To identify whether there are biomarkers that could predict adalimumab response, as well as markers that differentially respond to adalimumab in patients with HS. METHODS Baseline and week-12 plasma samples from the PIONEER studies were used to assess the levels of circulating proteins by multiplex and enzyme-linked immunosorbent assays. RESULTS Analyses revealed significantly higher high-sensitivity C-reactive protein (hs-CRP) and chemokine (C-C motif) ligand (CCL) 16 (HCC-4) levels in nonresponders at baseline and identified a multivariate response signature of calprotectin, fractalkine and HCC-4, reaching an 86% predictive accuracy rate for adalimumab response. Additionally, post-treatment reduction of plasma C-X-C motif chemokine ligand (CXCL)9, CXCL8 (interleukin-8) and CCL19 (macrophage inflammatory protein 3β) were greater in adalimumab super-responders than in nonresponders (P = 0·026, P = 0·044 and P = 0·026, respectively). These cytokines are involved in the recruitment of innate and adaptive inflammatory cells, and/or stimulation of certain inflammatory responses, suggesting that these pathways could be disease drivers in adalimumab nonresponders. CONCLUSIONS These initial results suggest HCC-4, calprotectin and fractalkine could be potential predictive biomarkers of adalimumab response in HS and identified possible tumour necrosis factor-independent disease pathways.
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Affiliation(s)
- Y Cao
- Immunology Discovery, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - F Hong
- Discovery and Early Pipeline Statistics, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - D M Conlon
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - L Sidur
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - K M Smith
- Immunology Systems Computational Biology, AbbVie Cambridge Research Center, Cambridge, MA, USA
| | - Y Fang
- DMPK-BA, AbbVie Redwood City, CA, USA
| | - C A Cuff
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - Z Kaymakcalan
- Immunology Discovery, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
| | - M C Ruzek
- Translational Research, AbbVie Bioresearch Center, Worcester, MA, 01605, USA
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46
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Yidana DB. Hidradenitis suppurativa - The role of interleukin-17, the aryl hydrocarbon receptor and the link to a possible fungal aetiology. Med Hypotheses 2021; 149:110530. [PMID: 33607406 DOI: 10.1016/j.mehy.2021.110530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
Hidradenitis Suppurativa (HS) is a chronic, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. The pathophysiology of the disease remains elusive, with newer therapies targeting various aspects of the dysregulated immune system. This presents a useful opportunity to look at the cytokine profile in HS and other inflammatory conditions that share similar patterns with the aim of teasing out less considered explanations for HS pathogenesis. It has been observed that IL-17 appears to be the most common denominator linking HS with other immune mediated diseases like Crohn, ulcerative colitis, multiple sclerosis and psoriasis. Given that IL-17 plays an important role in antifungal immunity, evidenced by the cytokine pattern in fungal disease and the bulk of data citing their potential involvement in Crohn, ulcerative colitis, multiple sclerosis and psoriasis; it is fair to suggest the need to explore the role that fungi play in the setting of HS going forward. The aryl hydrocarbon receptor (ahr) is a ubiquitous and largely conserved entity that is gaining interest in inflammatory conditions such as psoriasis and atopic dermatitis. It is well known to modulate autoimmune states. Its activation by both exogenous and endogenous agents result in secretion of IL-17 by Th17 cells. One of such agents is the tryptophan metabolite 6-formylindolo [3,2-b] carbazole (FICZ)-which can be produced by microorganisms such as fungi. It will be interesting to explore its usefulness in HS pathogenesis.
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Affiliation(s)
- Daniel B Yidana
- King's College London, St. John's Institute of Dermatology, Strand, London WC2R 2LS, United Kingdom.
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47
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Guart JA, Byers VV, Sasson DC, Bassiri-Tehrani B, Ranzer M, Purnell C. Postoperative Quality of Life in Patients with Hidradenitis Suppurativa Utilizing the Hidradenitis Suppurativa Burden of Disease Tool. Cureus 2021; 13:e13172. [PMID: 33575157 PMCID: PMC7870134 DOI: 10.7759/cureus.13172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) severely impacts patients’ quality of life (QoL). Surgery has shown potential in improving a patient's QoL in severe disease. Previous studies have evaluated QoL after surgery, but lack a disease-specific questionnaire to better evaluate the unique burden of disease that patients with HS experience. Objective To measure postoperative QoL in patients with HS using a modified version of the disease-specific questionnaire, the Hidradenitis Suppurativa Burden of Disease (HSBOD) Tool. Methods A retrospective study was conducted using 19 patients who underwent surgery for HS. A demographic form and a 19-item disease-specific questionnaire were emailed to patients who consented to complete the survey. Patient-reported outcomes were recorded on a 0-100 scale (100 representing the highest burden of disease). Results Of the 24 patients that received the survey, 19 completed it in its entirety. The mean±SD Burden of Disease (BoD) score for each of the five domains assessed by the survey were: symptoms and feelings (62±27), daily activities (65±30), leisure (57±31), work and school (48±32), and personal relationships (56±27). Pearson’s correlation between the number of surgeries each patient underwent and their reported BoD scores were not significant. BoD scores were significantly higher in the symptoms and feelings domain for complex closure compared to both secondary intention and split-thickness skin grafting (STSG). Conclusion Despite having surgery, patients with hidradenitis still report impaired QoL. Further study is ongoing to determine how these measures compare to baseline preoperative values. This instrument provides a valuable tool to determine QoL in patients with hidradenitis.
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Affiliation(s)
- Jiddu A Guart
- Plastic Surgery, University of Illinois at Chicago, Chicago, USA
| | - Victor V Byers
- Plastic Surgery, University of Illinois at Chicago, Chicago, USA
| | - Daniel C Sasson
- Plastic Surgery, Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | - Matthew Ranzer
- Plastic Surgery, University of Illinois at Chicago, Chicago, USA
| | - Chad Purnell
- Plastic Surgery, University of Illinois at Chicago, Chicago, USA
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48
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Kursawe Larsen C, Kjaersgaard Andersen R, Kirby JS, Tan J, Saunte DML, Jemec GBE. Convergent Validity of Suffering and Quality of Life as Measured by The Hidradenitis Suppurativa Quality of Life. J Eur Acad Dermatol Venereol 2021; 35:1577-1581. [PMID: 33539563 DOI: 10.1111/jdv.17148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a painful chronic, recurrent inflammatory skin disease with great impact on health-related quality of life (HRQOL). Recently, Hidradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC) established HRQOL as a core domain set for HS clinical trials and developed the Hidradenitis Suppurativa Quality of Life (HiSQOL) as a validated outcome measurement instrument. OBJECTIVES To provide further convergent validity of HiSQOL by comparing it to Dermatology Life Quality Index (DLQI) and Pictorial Representation of Illness and Self Measure-Revised 2 (PRISM-R2). METHODS In this cross-sectional study, 103 participants completed HiSQOL, PRISM-R2 and DLQI. PRISM-R2 is an instrument designed to measure suffering and reports the two measures, Illness Perception Measure (IPM) and Self-Illness Separation (SIS). Correlation analyses were performed including a sub-analysis for a subgroup of patients with high scores in the HS-specific domains of HiSQOL. RESULTS A very strong correlation was found between HiSQOL and DLQI (ρ = 0.93, P < 2.2 × 10-16 , (95% CI: 0.89;0.95)), and moderately strong correlations were found between HiSQOL and SIS (ρ = -0.73, P < 2.2 × 10-16 , (95% CI: -0.81; -0.62)) and DLQI and SIS (ρ = -0.70, P < 2.2 × 10-16 , (95% CI: -0.79; -0.59)). IPM was positively associated with HiSQOL and DLQI and negatively with SIS. CONCLUSIONS HiSQOL is a valid measure of quality of life for HS patients, and we suggest that HiSQOL can be used as a measure of suffering as well.
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Affiliation(s)
- C Kursawe Larsen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | | | - J S Kirby
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - J Tan
- University of Western Ontario, London, Canada
| | - D M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health Science, Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health Science, Institute of Clinical Medicine, University of Copenhagen, Denmark
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Self-reported pain alleviating methods in patients with hidradenitis suppurativa. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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50
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Krajewski PK, Matusiak Ł, von Stebut E, Schultheis M, Kirschner U, Nikolakis G, Szepietowski JC. Quality-of-Life Impairment among Patients with Hidradenitis Suppurativa: A Cross-Sectional Study of 1795 Patients. Life (Basel) 2021; 11:34. [PMID: 33429896 PMCID: PMC7828046 DOI: 10.3390/life11010034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
The chronic, inflammatory skin disorder hidradenitis suppurativa (HS) is associated well documented negative influences on patients' quality of life (QoL). The aim of this study was to present more robust data on patients' QoL impairment by demographic data and its correlation with well-known HS risk factors on a cohort of 1795 German patients. The instrument used for measuring QoL in this study was the Dermatology Life Quality Index (DLQI). Overall, patients reported a very large effect of HS on their QoL (mean DLQI: 13.2 ± 8.1 points), and 22% of the analyzed population even reported to consider the effect as extremely large. Women tended to experience significantly higher impairment than men (p < 0.001). QoL impairment correlated positively with pain (r = 0.581, p < 0.001), HS severity (measured by the International Hidradenitis Suppurativa Severity Score System (IHS4)) as well as Hurley. Neck involvement tended to decrease QoL significantly more than any other location (14.7 ± 8.3 points). This study confirms the enormous influence of HS on patients' QoL in a large cohort. Knowledge of QoL impairment in such patients is crucial for proper understanding and holistic management of this disease.
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Affiliation(s)
- Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, 50923 Cologne, Germany;
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, 55116 Mainz, Germany;
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, 06847 Dessau, Germany;
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
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