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Abu Rached N, Rüth J, Gambichler T, Ocker L, Bechara FG. A state-of-the-art systematic review of cancer in hidradenitis suppurativa. Ann Med 2024; 56:2382372. [PMID: 39046819 PMCID: PMC11271124 DOI: 10.1080/07853890.2024.2382372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/10/2024] [Accepted: 05/12/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Hidradenitis suppurativa (HS) is a chronic inflammatory disease associated with an increased risk of malignancy. The aim of this systematic review was to investigate the prevalence of different malignancies in HS. METHODS This review meets the PRISMA criteria. A data-driven approach was used to conduct the research, which involved a detailed keyword search. The study considered meta-analyses, experimental studies, case-control studies, cross-sectional studies, cohort studies, and recently published cases, published in English or German. Excluded were reviews, summaries, and letters to the editor, as well as studies, which are not based on the human population. RESULTS Out of the initial 443 publications found, 25 met the inclusion criteria for this systematic review. Patients with HS have a significantly increased risk of cancer, up to 50%. Additionally, the risk of oropharyngeal, central nervous system, colorectal, prostate, vulvar and non-melanocytic skin cancers increase with the severity of HS. The likelihood of comorbid lymphoma in patients with HS is significantly higher compared to healthy controls. In severe cases of HS, malignant degeneration of lesions in the groin, perianal, perineal, and gluteal region can occur in up to 4.6% of cases. This leads to the development of cSCC, which often have a complicated course, are more refractory to treatment and associated with a poorer outcome. The pathogenic mechanisms responsible for the malignant transformation of HS are currently unknown. CONCLUSIONS Patients with HS have a higher risk of cancer compared to the general population. Untreated, long-standing HS lesions can lead to complicated malignant degeneration resulting in cutaneous squamous cell carcinoma. The mechanisms underlying this malignant degeneration are not fully understood. HS patients also have an increased risk of developing other cancers, including prostate, oral, pharyngeal and colorectal cancers of the central nervous system and lymphomas.
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Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
- Skin Cancer Centre, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Jonas Rüth
- International Centre for Hidradenitis suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
- Skin Cancer Centre, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Thilo Gambichler
- Skin Cancer Centre, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
- Department of Dermatology, Dortmund Hospital gGmbH and Faculty of Health, Witten/Herdecke University, Dortmund, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
- Skin Cancer Centre, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis suppurativa/Acne inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
- Skin Cancer Centre, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
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Köktürk U, Güdül NE, Erbay İ, Doğan PE, Hazinedar E, Kısa F, Koca R, Avcı A. A marker of systemic inflammation in hidradenitis suppurativa patients without cardiovascular disease: aortic arch calcification. Arch Dermatol Res 2024; 316:709. [PMID: 39460803 DOI: 10.1007/s00403-024-03461-8] [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: 08/02/2024] [Revised: 10/01/2024] [Accepted: 10/16/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND In this study, we aimed to investigate whether there is a relationship between aortic arch calcification (AAC) and hidradenitis suppurativa (HS) in HS patients without cardiovascular disease. METHODS In this study, patients over 18 years of age who applied to the dermatology outpatient clinic between January 2023 and February 2024 were followed up with the diagnosis of HS without cardiovascular disease, and a healthy control group matched in terms of age and gender were included retrospectively. RESULTS In total, 130 patients with HS without cardiovascular disease and 130 control patients were included in the study. AAC was significantly higher in the HS group compared to the control group (p = 0.028). In the multivariate analysis, we found that age and HS were independent predictors of AAC (OR: 1.048 (1.009-1.089); p = 0.015, OR: 3.158 (1.181-8.445); p = 0.022, respectively). When we divided the groups as having AAC (grade 1-3) and not having AAC (grade 0), the rate of HS disease was significantly higher in the group with AAC compared to the group without AAC (75.0% vs. 47.5% p = 0.010). CONCLUSIONS AAC is observed more frequently in patients with HS without cardiovascular disease than in healthy individuals. Moreover, HS can be considered as an independent predictor of AAC. AAC may contribute to developing treatment strategies in HS patients without cardiovascular disease.
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Affiliation(s)
- Uğur Köktürk
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey.
| | - Naile Eriş Güdül
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| | - İlke Erbay
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| | - Pelin Ertop Doğan
- Department of Dermatology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Emel Hazinedar
- Department of Dermatology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Furkan Kısa
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| | - Rafet Koca
- Department of Dermatology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Ahmet Avcı
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
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Lu W, Liu WW, Foolad N, Kwock JT, Jaleel T. Clinical characteristics associated with joint pain in hidradenitis suppurativa. Br J Dermatol 2024; 191:839-841. [PMID: 38874343 PMCID: PMC11486588 DOI: 10.1093/bjd/ljae251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/28/2024] [Indexed: 06/15/2024]
Abstract
Although patients with hidradenitis suppurativa (HS) report comorbid arthropathy, clinical characteristics associated with joint pain surrounding HS flares still remain obscure. We found that about one in five patients in our HS cohort reported peri-flare joint pain during their initial visit and that peri-flare joint pain was significantly associated with pain medication prescription (aOR 2.15, P = 0.02) and diagnosis of inflammatory arthritis (aOR 4.14, P < 0.001). Given the debilitating nature of HS flares, the addition of joint pain can further limit daily activities, underscoring the importance of a comprehensive approach to the management of patients with HS.
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Affiliation(s)
- Weiying Lu
- Department of Dermatology, Duke Health, Durham, NC, 27710
| | - Winston W. Liu
- Department of Dermatology, Duke Health, Durham, NC, 27710
- Duke University School of Medicine, Durham, NC, 27710
| | - Negar Foolad
- Department of Dermatology, Duke Health, Durham, NC, 27710
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Daoud M, Suppa M, Benhadou F, Heudens S, Sarkis AS, Njimi H, Saunte SK, Desmarest L, Orte Cano C, Dandoy C, Nobile L, Fontaine M, Daxhelet M, Karama J, White JM, Jemec GBE, Del Marmol V. Factors Associated with Severe Hidradenitis Suppurativa, Using Hurley Staging and Metascore. Dermatology 2024:1-19. [PMID: 39396514 DOI: 10.1159/000541052] [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: 02/09/2024] [Accepted: 08/16/2024] [Indexed: 10/15/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease for which certain risk factors are well known: obesity and smoking (in particular). However, the factors associated with more severe conditions, and therefore potential aggravators of the disease, remain a matter of debate. Our study aims to determine the clinical factors associated with severe HS using several severity scores. METHODS The data were obtained via the ERHS questionnaire from patients exclusively recruited at Erasme Hospital in Brussels. The severity of HS was firstly estimated by the Hurley score, and secondly by a metascore, a system combining the iHS4, HS-PGA, SAHS, and DLQI. Univariable and multivariable analyses were performed. RESULTS Six hundred and forty-seven patients were included in the Hurley analysis, and 456 patients in the metascore analysis. In multivariable analysis, men have a more severe metascore than women (odds ratio [OR] = 1.89, p = 0.022), smoking was associated with a more severe disease according to metascore, especially in mild cases (OR = 0.76, p = 0.043), and an elevated body mass index was associated with having Hurley stage III disease compared to Hurley I or II disease (OR = 1.09, p = 0.001). A significant association is also shown between blood pressure and Hurley stage (OR = 0.97, p = 0.025). Self-reports of nonsteroidal anti-inflammatory drugs aggravating the disease is also a factor associated with greater severity according to the metascore (OR = 0.12, p = 0.008). Finally, several locations of HS lesions were associated with greater severity, in particular the armpits according to the metascore (OR = 0.29, p < 0.001), and the perianal area according to the Hurley score (OR = 0.15, p < 0.001). CONCLUSION HS seems to be more severe in men; smoking seems to aggravate mild cases of HS, while increased body mass index plays a major role in the transition from Hurley II to Hurley III.
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Affiliation(s)
- Mathieu Daoud
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Mariano Suppa
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphanie Heudens
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Sophie Sarkis
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Hassane Njimi
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Sara K Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Lila Desmarest
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Orte Cano
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Céline Dandoy
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Nobile
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Margot Fontaine
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Mathilde Daxhelet
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Jalila Karama
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan M White
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Véronique Del Marmol
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
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Nielsen VW, Bundgaard Vad O, Holgersen N, Paludan-Müller C, Meseguer Monfort L, Beyer AF, Jemec GBE, Kjærsgaard Andersen R, Egeberg A, Thyssen JP, Svendsen JH, Rosenø NAL, Hansen PR, Thomsen SF, Salling Olesen M. Genetic Susceptibility to Hidradenitis Suppurativa and Predisposition to Cardiometabolic Disease. JAMA Dermatol 2024:2824562. [PMID: 39382891 PMCID: PMC11465120 DOI: 10.1001/jamadermatol.2024.3779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/06/2024] [Indexed: 10/10/2024]
Abstract
Importance Hidradenitis suppurativa (HS) is associated with an increased prevalence of cardiovascular diseases compared with the general population. Any association between polygenic risk for HS, risk of incident cardiometabolic outcomes, and the plasma proteome is unclear. Objective To investigate the genetic correlation between HS and cardiometabolic disease. Design, Setting, and Participants This cohort study used a polygenic risk score (PRS) for HS to examine the risks of coronary artery disease (CAD) and diabetes and identify changes in the plasma proteome in individuals of European ancestry from the UK Biobank. Participants were enrolled from January 1, 2006, to December 31, 2010. End of follow-up was January 1, 2023. Correlations were assessed between HS susceptibility and cardiometabolic traits using linkage disequilibrium score regression. Odds ratios were assessed in logistic regressions. The risk of incident CAD and diabetes was estimated in cause-specific survival models designed as time-to-event analyses. Exposure The PRS for HS. Main Outcomes and Measures Main outcomes were CAD and diabetes diagnosis measured by logistic regressions and incident disease measured by Cox proportional hazards regression models adjusted for sex, age, body mass index, and smoking status. Results The study included 391 481 individuals (median [IQR] age, 58 [51-64] years; 209 235 [53%] female). Genetic variants for HS correlated significantly with variants associated with CAD, diabetes, and plasma levels of high-density lipoprotein cholesterol, triglycerides, and C-reactive protein. Compared with the low-risk group, a high PRS for HS (≥75th percentile) conferred odds ratios of 1.09 (95% CI, 1.06-1.12; P < .001) for CAD and 1.13 (95% CI, 1.10-1.17; P < .001) for diabetes. Estimates remained consistent when examining only incident CAD and diabetes. The PRS for HS was significantly associated with altered expression of 58 plasma proteins. Integrating this proteomic profile and the PRS for HS in a machine learning model improved prediction of CAD and diabetes compared with a reference model based on sex, age, and body mass index. Conclusions and Relevance These findings suggest that a high genetic risk of HS is associated with increased risk of subsequent CAD and diabetes and altered composition of the plasma proteome. Additional investigation into the identified proteins and their potential roles as drug targets is warranted.
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Affiliation(s)
- Valdemar Wendelboe Nielsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Oliver Bundgaard Vad
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nikolaj Holgersen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Paludan-Müller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Laia Meseguer Monfort
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Astrid Filt Beyer
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rune Kjærsgaard Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
- LEO Pharma, Ballerup, Denmark
| | - Jacob P. Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
- LEO Pharma, Ballerup, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nana Aviaaja Lippert Rosenø
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Peter Riis Hansen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital–Herlev and Gentofte, Hellerup, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital–Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Salling Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Gangidi SV, Greene RK, Olsen E, Jackson S, Nakamura M. Efficacy of spironolactone in treating hidradenitis suppurativa in women of childbearing age: a single-center retrospective analysis. Int J Womens Dermatol 2024; 10:e159. [PMID: 38957411 PMCID: PMC11216665 DOI: 10.1097/jw9.0000000000000159] [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: 01/22/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic skin disease characterized by recurrent nodules that affect areas with a high density of apocrine sweat glands, such as the axillae and groin. Androgens are implicated in the pathophysiology of HS. Therefore, spironolactone, an antiandrogen therapy, is recommended. However, data on its use in women of childbearing age are limited, especially since its antiandrogenic effects may affect menstruation, fertility, and pubertal development. Objective To evaluate the efficacy and safety of spironolactone in the treatment of hidradenitis suppurativa in women of childbearing age and to identify factors associated with treatment response. Methods A retrospective analysis was conducted on female patients aged 12 to 50 with HS treated with spironolactone at Michigan Medicine dermatology clinics from 2000 to 2021. The patients' demographic data, HS characteristics, and spironolactone responses were examined. Statistical assessments were performed to determine the efficacy indicators. Results Of the 157 patients reviewed, 31 showed an improvement in treatment. Variables such as axillary involvement, previous treatment failures, and use of intralesional steroids were linked to a lack of improvement in spironolactone. Through adjusted multiple logistic regression analysis, a significant association was observed between improvement status and Hurley stage 3 (odds ratio = 0.15 [95% CI: 0.02-0.79], P = .036), suggesting that patients with Hurley stage 3 were 85% less likely to exhibit improvement in spironolactone therapy. Limitations The study's retrospective nature and reliance on single-center data can limit generalizability. The sample size is limited and therefore affects the study's statistical power. Conclusion Thus, spironolactone may offer therapeutic benefits for HS in women of childbearing age. However, patients with severe disease (Hurley stage 3) had reduced response rates. Further prospective studies are recommended to validate these findings and determine the most suitable patient profile for spironolactone therapy for HS.
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Affiliation(s)
- Suma V. Gangidi
- Department of Clinical Sciences, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Urbana, Illinois
| | - Rachel K. Greene
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Eric Olsen
- Department of Medicine, Wellstar Health System, Kennestone Hospital Graduate Medical Education, Marietta, Georgia
| | - Shanelle Jackson
- Department of Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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Klufas DM, Ojute F, Shochat G, Naik HB. Diagnosis and management of hidradenitis suppurativa: a review for the emergency clinician. Emerg Med J 2024:emermed-2024-213949. [PMID: 39251339 DOI: 10.1136/emermed-2024-213949] [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: 02/24/2024] [Accepted: 07/26/2024] [Indexed: 09/11/2024]
Abstract
Hidradenitis suppurativa (HS) is a complex, chronic skin disease characterised by painful inflammatory nodules, abscesses, dermal tunnels, sinus tracts and fistulae with a predilection for intertriginous skin. HS carries a substantial disease burden due to its prevalence, associated comorbidities and quality of life impacts and is associated with high healthcare resource utilisation. Clarity regarding the prevalence and pathogenesis of HS has led to improved therapies and more patients seeking care in both outpatient and acute care settings, including the emergency department. Emergency medicine providers play a critical role in HS diagnosis, management of acute flares and connection of HS patients with long-term dermatologic care, which can in turn help manage utilisation of acute care resources.
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Affiliation(s)
- Daniel M Klufas
- Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Feyisayo Ojute
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Guy Shochat
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Haley B Naik
- Dermatology, University of California San Francisco, San Francisco, California, USA
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Elzawawi KE, Elmakaty I, Habibullah M, Ahmed MB, Al Lahham S, Al Harami S, Albasti H, Alsherawi A. Hidradenitis suppurativa and its association with obesity, smoking, and diabetes mellitus: A systematic review and meta-analysis. Int Wound J 2024; 21:e70035. [PMID: 39267324 PMCID: PMC11393007 DOI: 10.1111/iwj.70035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 09/17/2024] Open
Abstract
Our meta-analysis aimed to quantify the association between Hidradenitis suppurativa (HS) and several risk factors including obesity, smoking, and type 2 diabetes mellitus (T2DM). We searched PubMed, Scopus, Embase, Web of Science, and cumulative index to nursing and allied health literature for articles reporting either the odds ratio (OR) or the numbers of HS cases associated with obesity, smoking, or T2DM, and including HS negative controls. Risk of bias was assessed against the risk of bias in non-randomized studies of interventions tool. Data synthesis was done using the random effects model with heterogeneity being evaluated with I2 statistic. Twenty-three studies with a total of 29 562 087 patients (average age of 36.6 years) were included. Ten studies relied on country-level data, while six studies collected their data from HS clinics. The analysis showed a significant association between HS and female sex (OR 2.34, 95% CI 1.89-2.90, I2 = 98.6%), DM (OR 2.78, 95% CI 2.23-3.47, I2 = 98.9%), obesity (OR 2.48, 95% CI 1.64-3.74, I2 = 99.9%), and smoking (OR 3.10 95% CI 2.60-3.69, I2 = 97.1%). Our meta-analysis highlights HS links to sex, DM, obesity, and smoking, with emphasis on holistic management approach. Further research is needed on molecular mechanisms and additional risk factors for improved patient care.
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Affiliation(s)
- Khaled E Elzawawi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ibrahim Elmakaty
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohammad Habibullah
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohamed Badie Ahmed
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salim Al Lahham
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sara Al Harami
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Habib Albasti
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abeer Alsherawi
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Vural S, Baskurt D, Yıldırıcı Ş, Rasulova G, Danacı S, Botsalı A. Evaluating dietary considerations in hidradenitis suppurativa: a critical examination of existing knowledge. Int J Dermatol 2024; 63:987-998. [PMID: 38406977 DOI: 10.1111/ijd.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic condition that can overwhelm patients, and the effectiveness of supplementary dietary treatments remains uncertain. The primary aim of this review is to explore the connection between diet and HS progression. However, it is imperative to note that the evidence supporting a substantial role of the diet in HS remains weak. Dietary alterations alone should not be considered independent solutions for managing HS. Medical therapy continues to be indispensable for adequate treatment. Research indicates that the Mediterranean lifestyle and diet may provide cost-effective and beneficial adjustments when combined with traditional therapies. Conversely, foods with a high glycemic index and dairy could worsen HS symptoms, conceivably through mechanisms linked to insulin resistance and inflammation. Zinc, known for its antioxidant properties, shows promise as an adjunct therapy. Moreover, evidence suggests a connection between vitamin D deficiency and HS severity, although the findings are inconclusive. Brewer's yeast-free diet, B12 supplementation, intermittent fasting, and reducing the intake of refined sugar and dairy merit further investigation. In conclusion, this review highlights the need for additional research because of the lack of standardized reporting of clinical effects in the studies under scrutiny. A deeper exploration of the pathophysiology focusing on dietary modifications and their potential associations with HS severity is essential. Furthermore, it is crucial to recognize that patients' willingness to experiment with new diets makes them vulnerable to fraudulent interventions, highlighting the importance of evidence-based dietary guidance.
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Affiliation(s)
- Seçil Vural
- Department of Dermatology and Venereology, Koç University School of Medicine, Istanbul, Turkey
| | - Defne Baskurt
- School of Medicine, Koç University, Istanbul, Turkey
| | | | - Gunel Rasulova
- Department of Dermatology and Venereology, Koç University School of Medicine, Istanbul, Turkey
| | - Senem Danacı
- Department of Medical Pharmacology, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Aysenur Botsalı
- Department of Dermatology and Venereology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
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10
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Raudonis T, Šakaitytė A, Vileikis TP, Černel V, Gancevičienė R, Zouboulis CC. Comorbidities, Clinical Presentation, Subtypes, and Treatment of HS Patients in Lithuania. J Clin Med 2024; 13:3900. [PMID: 38999466 PMCID: PMC11242771 DOI: 10.3390/jcm13133900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a persistent, recurring skin inflammatory condition linked to various comorbidities. Management involves antibiotics, hormone therapy, immune-modulating drugs, surgery, and treatment of comorbidities. The objectives of the study were to assess the comorbidities, clinical presentation subtypes, and applied treatment of patients with HS. Methods: Patients with HS who visited the Centre of Dermatovenereology at Vilnius University Hospital Santaros Klinikos in Lithuania underwent evaluation based on the guidelines of the European Hidradenitis Suppurativa Foundation Registry questionnaire. Results: The study included 49 patients, and 61.22% (n = 30) had comorbidities. A strong positive correlation was found between a family history of inflammatory diseases (69.38% (n = 34)) and the severity of HS according to Hurley stage (r = 0.71 p < 0.05). A statistically significant correlation (r = 0.944, p = 0.02) was found between metabolic comorbidities and Hurley stage. Patients on biologic treatment had a mean IHS4 of 7.38 at the beginning of treatment and 3.22 at follow-up (p < 0.05). For patients not on biologics, the initial IHS4 score was 6.21 and 5.42 at follow-up (p > 0.05). Conclusions: A family history of inflammatory diseases and metabolic comorbidities showed a strong correlation with HS severity. Treatment with biologics showed significant improvement in HS scores compared to systemic antibiotics.
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Affiliation(s)
- Tadas Raudonis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Austėja Šakaitytė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (V.Č.)
| | - Tomas Petras Vileikis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
| | - Vitalij Černel
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (V.Č.)
| | - Rūta Gancevičienė
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
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11
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Brydges HT, Onuh OC, Friedman R, Barrett J, Betensky RA, Lu CP, Caplan AS, Alavi A, Chiu ES. Autoimmune, Autoinflammatory Disease and Cutaneous Malignancy Associations with Hidradenitis Suppurativa: A Cross-Sectional Study. Am J Clin Dermatol 2024; 25:473-484. [PMID: 38337127 DOI: 10.1007/s40257-024-00844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating cutaneous disease characterized by severe painful inflammatory nodules/abscesses. At present, data regarding the epidemiology and pathophysiology of this disease are limited. OBJECTIVE To define the prevalence and comorbidity associations of HS. METHODS This was a cross-sectional study of EPICTM Cosmos© examining over 180 million US patients. Prevalences were calculated by demographic and odds ratios (OR) and identified comorbidity correlations. RESULTS All examined metabolism-related, psychological, and autoimmune/autoinflammatory (AI) diseases correlated with HS. The strongest associations were with pyoderma gangrenosum [OR 26.56; confidence interval (CI): 24.98-28.23], Down syndrome (OR 11.31; CI 10.93-11.70), and polycystic ovarian syndrome (OR 11.24; CI 11.09-11.38). Novel AI associations were found between HS and lupus (OR 6.60; CI 6.26-6.94) and multiple sclerosis (MS; OR 2.38; CI 2.29-2.48). Cutaneous malignancies were largely not associated in the unsegmented cohort; however, among Black patients, novel associations with melanoma (OR 2.39; CI 1.86-3.08) and basal cell carcinoma (OR 2.69; CI 2.15-3.36) were identified. LIMITATIONS International Classification of Diseases (ICD)-based disease identification relies on coding fidelity and diagnostic accuracy. CONCLUSION This is the first study to identify correlations between HS with melanoma and basal cell carcinoma (BCC) among Black patients as well as MS and lupus in all patients with HS.
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Affiliation(s)
- Hilliard T Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Ogechukwu C Onuh
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Rebecca Friedman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Joy Barrett
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | | | - Catherine P Lu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA
| | - Avrom S Caplan
- Ronald O. Perelman Department of Dermatology at NYU Grossman School of Medicine, New York, NY, USA
| | | | - Ernest S Chiu
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, 240 E 38th Street, 13th Floor, New York, NY, 10016, USA.
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12
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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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13
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Wainman HE, Chandran NS, Frew JW, Garg A, Gibbons A, Gierbolini A, Horvath B, Jemec GB, Kirby B, Kirby J, Lowes MA, Martorell A, McGrath BM, Naik HB, Oon HH, Prens E, Sayed CJ, Thorlacius L, Van der Zee HH, Villumsen B, Ingram JR. Global consensus process to establish a core dataset for hidradenitis suppurativa registries. Br J Dermatol 2024; 190:510-518. [PMID: 37976235 DOI: 10.1093/bjd/ljad454] [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: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Several registries for hidradenitis suppurativa (HS) already exist in Europe and the USA. There is currently no global consensus on a core dataset (CDS) for these registries. Creating a global HS registry is challenging, owing to logistical and regulatory constraints, which could limit opportunities for global collaboration as a result of differences in the dataset collected. The solution is to encourage all HS registries to collect the same CDS of information, allowing registries to collaborate. OBJECTIVES To establish a core set of items to be collected by all HS registries globally. The core set will cover demographic details, comorbidities, clinical examination findings, patient-reported outcome measures and treatments. METHODS Beginning in September 2022, 20 participants - including both clinicians with expertise in HS and patient advocates - from eight countries across three continents participated in a Delphi process consisting of four rounds of voting, with all participants completing each round. A list of potential items for inclusion in the core set was generated from the relevant published literature, including systematic reviews of comorbidities in HS, clinical and examination findings, and epidemiology. For disease severity and progression items, the Hidradenitis SuppuraTiva Core outcome set International Collaboration (HiSTORIC) core set and other relevant instruments were considered for inclusion. This resulted in 47 initial items. Participants were invited to suggest additional items to include during the first round. Anonymous feedback was provided to inform each subsequent round of voting to encourage consensus. RESULTS The eDelphi process established a CDS of 48 items recommended for inclusion in all HS registries globally. CONCLUSIONS The routine adoption of this CDS in current and future HS registries should allow registries in different parts of the world to collaborate, enabling research requiring large numbers of participants.
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Affiliation(s)
- Hannah E Wainman
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nisha S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - Angela Gibbons
- Patient Representative, The HS Support Network UK and Ireland, UK
| | | | - Barbara Horvath
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Brian Kirby
- Charles Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Joselyn Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | | | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Hazel H Oon
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H Van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bente Villumsen
- Patient Representative, The Patients' Association HS Denmark, Denmark
| | - John R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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14
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Saraiva RO, Saunders C, Varela dos Santos M, Carvalho D, Loureiro R, Ramos J. Refractory Hidradenitis Suppurativa: A Diagnosis to Consider. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:60-64. [PMID: 38476303 PMCID: PMC10928865 DOI: 10.1159/000528432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/04/2022] [Indexed: 03/14/2024]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease associated with multiple comorbidities, and its association with lymphoma has recently been a topic of debate. However, it is still controversial whether this risk can be attributed to the disease itself or whether it has any relationship with immunosuppressive treatment. Here, we describe the case of a patient with severe perianal hidradenitis suppurativa treated with methotrexate and infliximab, whose exacerbation with persistence of severe symptoms refractory to adequate treatment led to the diagnosis of diffuse large non-Hodgkin B-cell lymphoma. It was decided to perform a colostomy to improve perianal sepsis, and immunochemotherapy was proposed.
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Affiliation(s)
- Rita Ornelas Saraiva
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Christopher Saunders
- Department of Hematology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Rafaela Loureiro
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Jaime Ramos
- Department of Gastroenterology, Hospital Universitário de Lisboa Central, Lisbon, Portugal
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15
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Yang B, Man MQ. Improvement in Cutaneous Conditions Can Benefit Some Health Conditions in the Elderly. Clin Interv Aging 2023; 18:2031-2040. [PMID: 38058550 PMCID: PMC10697145 DOI: 10.2147/cia.s430552] [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: 07/14/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023] Open
Abstract
As we are aging, a number of cutaneous and extracutaneous disorders will be developed. Although the pathogenesis of these aging-associated disorders is not clear yet, abnormalities in the skin are linked to some aging-associated disorders at least to some extent. Inflammatory dermatoses such as psoriasis and atopic dermatitis predispose to the development of cardiovascular diseases, obesity and type 2 diabetes. In addition, both chronologically aged skin and individuals with some aging-associated systemic conditions display altered epidermal function, such as reduced stratum corneum hydration levels, which can provoke cutaneous inflammation. Because aged skin exhibits higher expression levels of inflammatory cytokines, which play a pathogenic role in a variety of aging-associated health condition, the association of the skin with some aging-associated disorders is likely mediated by inflammation. This postulation is supported by the evidence that improvement in either epidermal function or inflammatory dermatoses can mitigate some aging-associated disorders such as mild cognitive impairment and insulin sensitivity. This perspective discusses the association of the skin with aging-associated disorders and highlights the potential of improvement in cutaneous conditions in the management of some health conditions in the elderly.
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Affiliation(s)
- Bin Yang
- Dermatology Hospital of Southern Medical University, Guangzhou, 510091, People’s Republic of China
| | - Mao-Qiang Man
- Dermatology Hospital of Southern Medical University, Guangzhou, 510091, People’s Republic of China
- Dermatology Services, Veterans Affairs Medical Center and University of California, San Francisco, CA, 94121, USA
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16
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Ezanno AC, Guillem P, Gorin C, Gabison G, Malgras B, Fougerousse AC. What should a surgeon know about hidradenitis suppurativa? J Visc Surg 2023; 160:444-455. [PMID: 37722942 DOI: 10.1016/j.jviscsurg.2023.07.008] [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] [Indexed: 09/20/2023]
Abstract
Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
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Affiliation(s)
- Anne Cecile Ezanno
- Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - Philippe Guillem
- Val d'Ouest Clinic, 39, chemin de la Vernique, 69130 Écully, France
| | - Cécile Gorin
- Psychiatry Department, HIA Sainte-Anne, 2, boulevard Sainte-Anne BP600, 83000 Toulon, France
| | - Germaine Gabison
- Dermatology, 32, avenue du Maréchal-de-Lattre-de-Tassigny, 94410 Saint-Maurice, France
| | - Brice Malgras
- Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Val de Grâce School, Army Health Service, 75005 Paris, France
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17
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Colvin A, Petukhova L. Inborn Errors of Immunity in Hidradenitis Suppurativa Pathogenesis and Disease Burden. J Clin Immunol 2023; 43:1040-1051. [PMID: 37204644 DOI: 10.1007/s10875-023-01518-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Hidradenitis suppurativa (HS), also known as Verneuil's disease and acne inversa, is a prevalent, debilitating, and understudied inflammatory skin disease. It is marked by repeated bouts of pathological inflammation causing pain, hyperplasia, aberrant healing, and fibrosis. HS is difficult to manage and has many unmet medical needs. There is clinical and pharmacological evidence for extensive etiological heterogeneity with HS, suggesting that this clinical diagnosis is capturing a spectrum of disease entities. Human genetic studies provide robust insight into disease pathogenesis. They also can be used to resolve etiological heterogeneity and to identify drug targets. However, HS has not been extensively investigated with well-powered genetic studies. Here, we review what is known about its genetic architecture. We identify overlap in molecular, cellular, and clinical features between HS and inborn errors of immunity (IEI). This evidence indicates that HS may be an underrecognized component of IEI and suggests that undiagnosed IEI are present in HS cohorts. Inborn errors of immunity represent a salient opportunity for rapidly resolving the immunological landscape of HS pathogenesis, for prioritizing drug repurposing studies, and for improving the clinical management of HS.
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Affiliation(s)
- Annelise Colvin
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Lynn Petukhova
- Department of Dermatology, Vagelos College of Physicians & Surgeons, Columbia University, New York City, NY, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, #527, York City, NY, USA.
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18
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Mintoff D, Agius R, Fava S, Pace NP. Investigating Adiposity-Related Metabolic Health Phenotypes in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study. J Clin Med 2023; 12:4847. [PMID: 37510962 PMCID: PMC10381271 DOI: 10.3390/jcm12144847] [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: 07/07/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Obesity and hidradenitis suppurativa (HS) are related through meta-inflammation and are both associated with increased cardiometabolic risk. Notwithstanding, cardiometabolic pathology is not uniform in obesity and a subset of individuals with excess adiposity exhibit a healthy metabolic profile. Whilst the incidence of cardiometabolic endpoints and transitions across different adiposity-related body composition phenotypes within several populations and across different ethnicities have been investigated, data regarding metabolic health (MetH) and body composition phenotypes in individuals with HS are lacking. The objective of this study was to evaluate the relationship between different body composition phenotypes in individuals with HS. METHODS This was a cross-sectional study of 632 individuals with and without HS from a population with a high prevalence of both obesity and HS. A total of four body composition phenotypes were generated based on BMI and metabolic status (defined using either the metabolic syndrome definition or the homeostasis model of insulin resistance (HOMA-IR)): metabolically healthy overweight/obese (MHOWOB), metabolically unhealthy overweight/obese (MUOWOB), metabolically healthy normal weight (MHNW), and metabolically unhealthy normal weight (MUNW). RESULTS Generally, subjects with HS exhibited a worse metabolic profile with higher levels of indices of central adiposity measures (including Visceral Adiposity Index and waist circumference), systolic blood pressure and markers of insulin resistance, as well as a higher prevalence of the metabolic syndrome. Moreover, when sub-stratified into the different body composition phenotypes, individuals with HS typically also demonstrated adverse metabolic characteristics relative to controls matched for both adiposity and metabolic health, particularly in the normal weight category and despite being classified as metabolically healthy. Being metabolically unhealthy in addition to being overweight/obese increases an individual's risk of HS. CONCLUSIONS Metabolic risk-assessment should be prioritized in the clinical management of individuals with HS even in those who are lean. Patients attending HS clinics provide a valuable opportunity for targeted cardiovascular risk reduction with respect to the management of both obesity and metabolic health.
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Affiliation(s)
- Dillon Mintoff
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
- Department of Dermatology, Mater Dei Hospital, MSD2090 Msida, Malta
| | - Rachel Agius
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
- Department of Medicine, Mater Dei Hospital, MSD2090 Msida, Malta
| | - Stephen Fava
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
- Department of Medicine, Mater Dei Hospital, MSD2090 Msida, Malta
| | - Nikolai P Pace
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
- Centre for Molecular Medicine and Biobanking, University of Malta, MSD2080 Msida, Malta
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19
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Molinelli E, Gioacchini H, Sapigni C, Diotallevi F, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. New Insight into the Molecular Pathomechanism and Immunomodulatory Treatments of Hidradenitis Suppurativa. Int J Mol Sci 2023; 24:ijms24098428. [PMID: 37176138 PMCID: PMC10179439 DOI: 10.3390/ijms24098428] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Hidradenitis suppurativa (HS) is an immune-mediated inflammatory disorder characterized by deep-seated nodules, abscesses, sinus tracts and scars localized in the intertriginous areas. It is accompanied by pain, malodourous secretion and a dramatically decreased quality of life. Although the pathogenesis has not been entirely elucidated, the primary event is follicular hyperkeratosis of the pilosebaceous apocrine unit. Since the registration of the tumor necrosis factor-alpha inhibitor Adalimumab in 2015, several cytokines have been implicated in the pathomechanism of HS and the research of novel therapeutic targets has been intensified. We provide an update on the inflammatory cytokines with a central role in HS pathogenesis and the most promising target molecules of future HS management.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Helena Gioacchini
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Federico Diotallevi
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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20
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Lee JW, Heo YW, Lee JH, Lee S. Epidemiology and comorbidity of hidradenitis suppurativa in Korea for 17 years: A nationwide population-based cohort study. J Dermatol 2023. [PMID: 36806098 DOI: 10.1111/1346-8138.16747] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023]
Abstract
Hidradenitis suppurativa (HS) is associated with various metabolic and autoimmune diseases. The epidemiology has been analyzed in various studies worldwide. However, epidemiological data on HS for Asian populations are limited. This study aimed to analyze the change in the prevalence and incidence of HS over 17 years in South Korea using the Korean National Health Insurance Service (NHIS) database. This study also evaluated the comorbidities in patients with HS. Population-based data from the NHIS database of Korea were obtained between January 2003 and December 2019. Odds ratios were estimated to determine the association between comorbidities and HS during the study period. Hazard ratios for the risk of incident comorbidities in patients with HS were obtained using the multivariable Cox proportional hazard analysis. This study included 45 511 patients with HS and 910 220 controls matched for age, sex, insurance type, and income level. The incidence rate of HS per 1 000 000 person-years in Korea increased from 11.69 in 2003 to 78.78 in 2019. The annual prevalence per 1 000 000 people also increased from 34.68 in 2003 to 140.10 in 2019, showing a similar trend. Many comorbidities, including atopic, metabolic and end-organ, autoimmune/inflammatory, and psychiatric diseases were associated with HS at baseline. In many diseases, the risk of incident comorbidities in patients with HS was higher than that in controls. The incidence and prevalence of HS in Korea have increased over the past 17 years. Various comorbidities, including allergic diseases, hypertension, diabetes mellitus, dyslipidemia, myocardial infarction, chronic hepatitis and cirrhosis, chronic kidney disease, inflammatory bowel diseases, rheumatoid arthritis, vitamin D deficiency, and psychiatric diseases, were associated with HS. Physicians need to keep in mind and closely monitor these comorbidities in patients with HS.
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Affiliation(s)
- Jong Won Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
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21
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Ju T, Hernandez L, Mohsin N, Labib A, Frech F, Nouri K. Evaluation of risk in chronic cutaneous inflammatory conditions for malignant transformation. J Eur Acad Dermatol Venereol 2023; 37:231-242. [PMID: 36251409 DOI: 10.1111/jdv.18663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/06/2022] [Indexed: 01/18/2023]
Abstract
Skin carcinomas are the most common form of cancer, and every year thousands of people die from skin cancer-related malignancies. Chronic inflammation is linked to the development and progression of cancer in multiple organ systems - about 20% of all human cancers are a result of chronic inflammation - skin included. While acute inflammation under normal circumstances is a mechanism for host defence and tissue regeneration following insult by trauma or infection by pathogens, over the long term it can drive oncogenic transformation of epithelial cells and promote cancer development, growth and metastasis. Therefore, inflammatory conditions may put individuals at a higher risk to developing skin malignancies. Many skin conditions are characterized by chronic inflammatory processes. These conditions may be particularly susceptible to malignant transformation and predispose patients to develop skin malignancies. As more pathophysiology of chronic inflammatory skin conditions is unveiled, we find that many of these conditions are characterized by immune dysregulation and signalling that result in chronic activation and upregulation of pro-inflammatory chemokines and cytokines, leading to downstream processes that further exacerbate inflammatory processes and cause abnormal cell growth and apoptosis. Here, we review the major chronic cutaneous inflammatory diseases that may have an increased risk of skin malignancies, including atopic dermatitis, psoriasis, discoid lupus erythematosus, lichen planus, hidradenitis suppurativa, prurigo nodularis, lichen sclerosus, systemic sclerosis and morphea, chronic leg ulcers, seborrheic keratoses and basal cell carcinoma. We evaluate the evidence for increased incidence and prevalence, the risk factors associated, the populations at heightened risk and the best management practices.
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Affiliation(s)
- Teresa Ju
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Loren Hernandez
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Noreen Mohsin
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Angelina Labib
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Fabio Frech
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
| | - Keyvan Nouri
- Dr Phillip Frost Department of Dermatology, University of Miami, Miami, Florida, USA
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22
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A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med 2023; 136:42-53. [PMID: 36252715 DOI: 10.1016/j.amjmed.2022.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
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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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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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25
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Abu Rached N, Gambichler T, Dietrich JW, Ocker L, Seifert C, Stockfleth E, Bechara FG. The Role of Hormones in Hidradenitis Suppurativa: A Systematic Review. Int J Mol Sci 2022; 23:ijms232315250. [PMID: 36499573 PMCID: PMC9736970 DOI: 10.3390/ijms232315250] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease manifesting in inverse body regions. In a systematic review, the role of hormones in HS will be presented to better understand the pathomechanisms of HS. The review is based on the PRISMA criteria. Systematic research was carried out using keywords. Subsequently, the data were analyzed based on the clinical response and other relevant information. The main focus of our systematic review was on HS manifestation, exacerbation, sex hormones, antiandrogen therapy, thyroid function, polycystic ovary syndrome, insulin resistance, and adipokines. In HS, there appears to be a dysregulated adipokine release that is shifted towards pro-inflammatory adipokines. Insulin resistance is significantly more common in HS than in healthy patients regardless of BMI, age, and gender. Insulin resistance in HS patients leads to further cardiovascular disease. The mechanism of insulin resistance and role of adipokines should be investigated in future studies to better provide the pathomechanisms of HS. The role of androgens seems to be important in a certain subgroup of female patients. Anti-androgenic therapy can be useful and helpful in some patients. However, further studies are needed to better understand the hormonal relationship in HS.
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Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
- Correspondence: (N.A.R.); (F.G.B.); Tel.: +49-234-509-3420 (N.A.R.)
| | - Thilo Gambichler
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Caroline Seifert
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Eggert Stockfleth
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
- Correspondence: (N.A.R.); (F.G.B.); Tel.: +49-234-509-3420 (N.A.R.)
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McKenzie S, Brown-Korsah JB, Syder NC, Omar D, Taylor SC, Elbuluk N. Variations in genetics, biology, and phenotype of cutaneous disorders in skin of color. Part II: Differences in clinical presentation and disparities in cutaneous disorders in skin of color. J Am Acad Dermatol 2022; 87:1261-1270. [PMID: 35817332 DOI: 10.1016/j.jaad.2022.03.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
Skin of color (SOC) patients are projected to comprise the majority of the population by 2044, yet knowledge gaps in the clinical presentation and treatment of both common and uncommon dermatologic conditions in skin of color persist. Improved awareness of disparities that disproportionately impact SOC patients is necessary to address health inequity in the field of dermatology. The first part of this CME discussed structural, genetic, and immunophenotypic differences in SOC in common inflammatory disorders as well as cutaneous malignancies. The second part of this CME highlights clinical differences in the phenotypic presentation of the inflammatory disorders of atopic dermatitis, psoriasis, and hidradenitis suppurativa as well as the cutaneous malignancies of melanoma, basal cell carcinoma, and cutaneous T-cell lymphoma. Health disparities associated with each of these conditions are also discussed.
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Affiliation(s)
- Shanice McKenzie
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jessica B Brown-Korsah
- Case Western Reserve University, School of Medicine, Cleveland, Ohio; Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicole C Syder
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Deega Omar
- George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia
| | - Susan C Taylor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nada Elbuluk
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California.
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27
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Wang CX, Buss JL, Keller M, Anadkat MJ. Factors Associated With Dermatologic Follow-up vs Emergency Department Return in Patients With Hidradenitis Suppurativa After an Initial Emergency Department Visit. JAMA Dermatol 2022; 158:1378-1386. [PMID: 36287553 PMCID: PMC9607935 DOI: 10.1001/jamadermatol.2022.4610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/31/2022] [Indexed: 01/13/2023]
Abstract
Importance Emergency department (ED) visitation is common for the treatment of hidradenitis suppurativa (HS), whereas dermatology outpatient care is low. The reasons underlying this differential follow-up have not been elucidated. Objective To assess the interventions and patient factors associated with ED return following an initial ED visit for HS. Design, Setting, and Participants This retrospective cohort study used data from the IBM® MarketScan® Commercial and Multi-State Medicaid databases (trademark symbols retained per database owner requirement). An HS cohort was formed from patients who had 2 or more claims for HS during the study period of 2010 to 2019 and with at least 1 ED visit for their HS or a defined proxy. Data were analyzed from November 2021 to May 2022. Exposures Factors analyzed included those associated with the ED visit and patient characteristics. Main Outcomes and Measures Primary outcomes were return to the ED or dermatology outpatient follow-up for HS or related proxy within 30 or 180 days of index ED visit. Results This retrospective cohort study included 20 269 patients with HS (median [IQR] age, 32 [25-41] years; 16 804 [82.9%] female patients), of which 7455 (36.8%) had commercial insurance and 12 814 (63.2%) had Medicaid. A total of 9737 (48.0%) patients had incision and drainage performed at the index ED visit, 14 725 (72.6%) received an oral antibiotic prescription, and 9913 (48.9%) received an opioid medication prescription. A total of 3484 (17.2%) patients had at least 1 return ED visit for HS or proxy within 30 days, in contrast with 483 (2.4%) who had a dermatology visit (P < .001). Likewise, 6893 (34.0%) patients had a return ED visit for HS or proxy within 180 days, as opposed to 1374 (6.8%) with a dermatology visit (P < .001). Patients with Medicaid and patients who had an opioid prescribed were more likely to return to the ED for treatment of their disease (odds ratio [OR], 1.48; 95% CI, 1.38-1.58; and OR, 1.48; 95% CI, 1.39-1.58, respectively, within 180 days) and, conversely, less likely to have dermatology follow-up (OR, 0.16; 95% CI, 0.14-0.18; and OR, 0.81; 95% CI, 0.71-0.91, respectively, within 180 days). Conclusions and Relevance This cohort study suggests that many patients with HS frequent the ED for their disease but are not subsequently seen in the dermatology clinic for ongoing care. The findings in this study raise the opportunity for cross-specialty interventions that could be implemented to better connect patients with HS to longitudinal care.
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Affiliation(s)
- Cynthia X. Wang
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Joanna L. Buss
- Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Matthew Keller
- Institute for Informatics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Milan J. Anadkat
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri
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Hardin J, Murray G, Swerdel J. Phenotype Algorithms to Identify Hidradenitis Suppurativa Using Real-World Data: Development and Validation Study. JMIR DERMATOLOGY 2022; 5:e38783. [PMID: 37632892 PMCID: PMC10334943 DOI: 10.2196/38783] [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: 04/15/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a potentially debilitating, chronic, recurring inflammatory disease. Observational databases provide opportunities to study the epidemiology of HS. OBJECTIVE This study's objective was to develop phenotype algorithms for HS suitable for epidemiological studies based on a network of observational databases. METHODS A data-driven approach was used to develop 4 HS algorithms. A literature search identified prior HS algorithms. Standardized databases from the Observational Medical Outcomes Partnership (n=9) were used to develop 2 incident and 2 prevalent HS phenotype algorithms. Two open-source diagnostic tools, CohortDiagnostics and PheValuator, were used to evaluate and generate phenotype performance metric estimates, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value. RESULTS We developed 2 prevalent and 2 incident HS algorithms. Validation showed that PPV estimates were highest (mean 86%) for the prevalent HS algorithm requiring at least two HS diagnosis codes. Sensitivity estimates were highest (mean 58%) for the prevalent HS algorithm requiring at least one HS code. CONCLUSIONS This study illustrates the evaluation process and provides performance metrics for 2 incident and 2 prevalent HS algorithms across 9 observational databases. The use of a rigorous data-driven approach applied to a large number of databases provides confidence that the HS algorithms can correctly identify HS subjects.
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Affiliation(s)
- Jill Hardin
- Janssen Research and Development, Titusville, NJ, United States
- Observational Health Data Sciences and Informatics, New York, NY, United States
| | - Gayle Murray
- Janssen Research and Development, Titusville, NJ, United States
| | - Joel Swerdel
- Janssen Research and Development, Titusville, NJ, United States
- Observational Health Data Sciences and Informatics, New York, NY, United States
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Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits. Biomedicines 2022; 10:biomedicines10112973. [PMID: 36428540 PMCID: PMC9687269 DOI: 10.3390/biomedicines10112973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.
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Faverio K, Peitsch WK, Görig T, Schneider‐Burrus S, Benzel F, Goebeler M, Schummer P, Badran A, Schaarschmidt M, Harth W, Mössner R, Kromer C. Patient Preferences in Hidradenitis Suppurativa (APProach‐HS): a discrete choice experiment. J Dtsch Dermatol Ges 2022; 20:1441-1452. [DOI: 10.1111/ddg.14886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin Faverio
- Department of Dermatology and Phlebology Vivantes Klinikum im Friedrichshain Berlin Germany
- Faculty of Medicine Charité – University Medicine Berlin Berlin Germany
| | - Wiebke K. Peitsch
- Department of Dermatology and Phlebology Vivantes Klinikum im Friedrichshain Berlin Germany
| | - Tatiana Görig
- Department of Medical Informatics Biometry and Epidemiology Friedrich‐Alexander‐University of Erlangen‐Nuremberg Erlangen Germany
| | | | - Friderike Benzel
- Department of Dermatology and Phlebology Vivantes Klinikum im Friedrichshain Berlin Germany
| | - Matthias Goebeler
- Department of Dermatology Venereology and Allergology University Hospital Würzburg Würzburg Germany
| | - Patrick Schummer
- Department of Dermatology Venereology and Allergology University Hospital Würzburg Würzburg Germany
| | - Alaa Badran
- Department of Dermatology Venereology and Allergology University Hospital Würzburg Würzburg Germany
| | - Marthe‐Lisa Schaarschmidt
- Department of Dermatology Venereology and Allergology University Medical Center Mannheim Heidelberg University Mannheim Germany
| | - Wolfgang Harth
- Department of Dermatology and Allergology Vivantes Klinikum Spandau Berlin Germany
| | - Rotraut Mössner
- Department of Dermatology Venereology and Allergology University Medical Center Göttingen Göttingen Germany
| | - Christian Kromer
- Department of Dermatology Venereology and Allergology University Medical Center Göttingen Göttingen Germany
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31
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Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan AM. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol 2022; 61:1372-1379. [PMID: 35485975 PMCID: PMC10835602 DOI: 10.1111/ijd.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders. OBJECTIVE Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions. METHODS From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups. RESULTS A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others. LIMITATIONS Our study was limited by its retrospective design. CONCLUSIONS Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.
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Affiliation(s)
- Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL
| | - David O. Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Sophia A. Ederaine
- Student, Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, AZ
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Ali M. Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, CA
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Bonds PD, Huang J, Ike J, Mukherjee E, Petukhova L, Wheless L. International Classification of Diseases codes do not capture all cases of hidradenitis suppurativa in the electronic health record: a retrospective cohort. Br J Dermatol 2022; 187:787-788. [PMID: 35656711 PMCID: PMC10266923 DOI: 10.1111/bjd.21695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/04/2022] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Joyce Huang
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Eric Mukherjee
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lynn Petukhova
- Departments of Dermatology and Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Lee Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
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Faverio K, Peitsch WK, Görig T, Schneider‐Burrus S, Benzel F, Goebeler M, Schummer P, Badran A, Schaarschmidt M, Harth W, Mössner R, Kromer C. Patientenpräferenzen bei Hidradenitis suppurativa (APProach‐HS): ein “Discrete‐Choice”‐Experiment. J Dtsch Dermatol Ges 2022; 20:1441-1454. [DOI: 10.1111/ddg.14886_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin Faverio
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin Deutschland
- Medizinische Fakultät Charité –Universitätsmedizin Berlin Deutschland
| | - Wiebke K. Peitsch
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin Deutschland
| | - Tatiana Görig
- Institut für Medizininformatik Biometrie und Epidemiologie (IMBE) Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Deutschland
| | | | - Friderike Benzel
- Klinik für Dermatologie und Phlebologie Vivantes Klinikum im Friedrichshain Berlin Deutschland
| | - Matthias Goebeler
- Klinik und Poliklinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Würzburg Würzburg Deutschland
| | - Patrick Schummer
- Klinik und Poliklinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Würzburg Würzburg Deutschland
| | - Alaa Badran
- Klinik und Poliklinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Würzburg Würzburg Deutschland
| | - Marthe‐Lisa Schaarschmidt
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Mannheim Universität Heidelberg Mannheim Deutschland
| | - Wolfgang Harth
- Klinik für Dermatologie und Allergologie Vivantes Klinikum Spandau Berlin Deutschland
| | - Rotraut Mössner
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen Göttingen Deutschland
| | - Christian Kromer
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen Göttingen Deutschland
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Díaz D, Rivera A, Otero V, Rueda L. Epidemiology of Hidradenitis Suppurativa: Current Status. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Purpose of Review
This review aimed to provide a comprehensive and current state of art about epidemiology and clinical aspects of the HS.
Recent Findings
Our search yielded 17 articles that included studies that showed a prevalence range from 0.00033 to 1.4%. Incidence data is limited. HS is more prevalent in women than in men. The highest prevalence is found in the third and fourth decade of life. The most frequent localizations are the inguinal, axillary, and perianal regions. There are associations between HS and obesity (OR 2.09), hypertension (OR 1.84), and dyslipidemia (OR 4.06), among others.
Summary
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by occlusion of hair follicles as a primary pathogenic factor. It affects areas of the body with apocrine glands, predominantly in the axillary, inguinal, intermammary, and anogenital regions. Clinically, its manifestations vary from inflammatory nodules and abscesses to the formation of sinus tracts and scarring. HS used to be considered a disorder of apocrine glands; today, it is considered a disease of the pilosebaceous unit associated with an immune imbalance in a genetically predisposed individual, thus linked to other autoimmune diseases.
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Ulschmid C, Serrano L, Wu R, Roth GM, Sokumbi O. African American race is a risk factor for severe hidradenitis suppurativa. Int J Dermatol 2022; 62:657-663. [PMID: 36183313 DOI: 10.1111/ijd.16428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/15/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND African Americans face a disproportionate incidence and prevalence of hidradenitis suppurativa (HS) in the United States, but HS severity and outcomes across racial and ethnic groups have not been well-established while controlling for potentially confounding factors. In this retrospective cohort study, we investigated the associations of race and ethnicity with HS severity, emergency department (ED) visits, hospitalizations, and surgeries for HS while controlling for age, sex, body mass index (BMI), tobacco use, and insurance type. METHODS We reviewed 1190 patients seen at the Medical College of Wisconsin with ≥3 encounters for HS between 1/1/2002 and 3/19/2019, excluding those without race data or an encounter in which HS was treated. RESULTS A total of 953 patients were included; 470 patients were Black or African American non-Hispanic (49%), 39 Hispanic (4%), 418 White non-Hispanic (44%), and 26 other race or ethnicity (3%). Controlling for age, sex, BMI, tobacco use, and insurance type, Black patients had 2.8 times the odds of having Hurley stage III disease (95% CI 1.76-4.45, P < 0.001), 2.86 times the risk for experiencing an ED visit for HS (95% CI 2.12-3.88, P < 0.001), 2.25 times the risk for experiencing a hospitalization for HS (95% CI 1.42-3.56, P < 0.001), and 1.61 times the risk for experiencing a surgical encounter for HS (95% CI 1.34-1.95, P < 0.001) when compared to White patients. CONCLUSIONS African Americans face significant disparities in HS severity, ED visits, hospitalizations, and surgeries. The causes of these disparities must be further investigated and addressed.
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Affiliation(s)
- Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Linda Serrano
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ruizhe Wu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gretchen M Roth
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, USA
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Aroonsakul N, Phinyo P, Lumkul L, Jarupanich N, Szepietowski J, Chuamanochan M, Nochaiwong S. Pharmacological interventions for hidradenitis suppurativa: a protocol for systematic review and network meta-analysis of randomised trials and non-randomised studies. BMJ Open 2022; 12:e062351. [PMID: 36691211 PMCID: PMC9462131 DOI: 10.1136/bmjopen-2022-062351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/14/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Therapeutic recommendations for hidradenitis suppurativa (HS) have recently shifted towards non-invasive pharmacological options. Recent evidence has shown promising efficacy for specific treatments. However, data regarding the comparative efficacy of these treatments in patients with HS are still limited. Therefore, we plan to conduct a systematic review and network meta-analysis (NMA) to summarise the benefits and harms of different pharmacological interventions for treating people living with HS. METHODS AND ANALYSIS We will search electronic databases, including Medline, Embase, PubMed, Web of Science, Scopus, CINAHL and Cochrane Library beginning from their inception dates with no language restrictions. A grey literature search will be performed to supplement the electronic databases. Both randomised trials and non-randomised studies using validated measurement tools that investigated the benefits and harms of pharmacological interventions among people living with HS will be included. The predefined primary outcomes will include treatment responses that reflect the patient's perspective and all-cause discontinuation. Screening, selection, extraction, assessment of the risk of bias and analysis of the strength of the evidence will be performed independently by a pair of reviewers. A two-step approach of traditional pairwise and NMA will be performed. Based on a random-effects model, standardised weighted mean differences and ORs with corresponding 95% CIs will be pooled as effect estimates for the continuous and categorical endpoints, respectively. Statistical and methodological heterogeneities will be assessed. Preplanned subgroup analyses and univariate meta-regression will be conducted to quantify the potential sources of heterogeneity. Evidence-based synthesis will be based on the magnitudes of effect size, evidence certainty and the surface under the cumulative ranking curve values. ETHICS AND DISSEMINATION Ethical approval is not required because this study is based on existing published data. These findings will be disseminated through scientific meetings and publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER CRD42022302795.
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Affiliation(s)
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Suthep, Thailand
| | - Lalita Lumkul
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Mati Chuamanochan
- Department of Internal Medicine, Chiang Mai University, Muang, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, Thailand
- Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Understanding the systemic burden of disease in hidradenitis suppurativa from plasma lipidomic analysis. J Dermatol Sci 2022; 107:133-141. [PMID: 36008225 DOI: 10.1016/j.jdermsci.2022.08.005] [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: 04/11/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory skin condition that is often considered a systemic disease due to its association with metabolic comorbidity. OBJECTIVE In this study, we aimed to identify differences in plasma lipidomic profiles between HS patients and control subjects. METHODS HS patients were recruited from a tertiary dermatological centre and demographic and comorbidity matched controls from the general population. A targeted lipidomic approach was performed to characterize over 700 lipid species representing 35 lipid classes/sub-classes. Linear regression models adjusted for confounding factors were used to compare the plasma lipidomic profiles of HS patients to controls. Ordinal regression models were used to study the association of lipids with disease activity and severity scores. RESULTS 60 HS patients and 73 control subjects were recruited. Differential levels (p < 0.05) of 32 lipid species in HS patients compared to controls were observed, including a decrease in the long chain base d19:1 containing ceramides, and elevation of hydroxyeicosatetraenoic acid (HETE) and dihydroxyeicosatrienoic acid (DHET) oxylipins. These lipids along with several other molecules showed associations with Hurley, HS-PGA and disease activity scores. CONCLUSION This study found mild changes in plasma lipidomic profiles, consistent with previous studies showing attenuated metabolomic changes in plasma as opposed to lesional skin. However, a number of lipid species were associated with increasing activity and severity of the disease. Further, the significant lipid species within the same class showed consistent trends of increase or decrease in HS as compared to controls.
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Contemporary Advice for Medical Providers Caring for Pilonidal Disease in Women. Dis Colon Rectum 2022; 65:1075-1076. [PMID: 35333795 DOI: 10.1097/dcr.0000000000002463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Interviewing Women with Hidradenitis Suppurativa-Thematic and Content Analysis. Adv Skin Wound Care 2022; 35:381-384. [PMID: 35723957 DOI: 10.1097/01.asw.0000831084.75243.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hidradenitis suppurativa (HS) is a chronic autoinflammatory skin disease with a higher prevalence in women. The disease results in a low quality of life as well as physical and psychological comorbidities. The authors sought to determine the effects of HS on women's self-perception and life experiences. METHODS Semistructured interviews were conducted with 22 women of varying age and family status. The content was transcribed and subjected to both thematic and content analyses. RESULTS Five themes and a number of subthemes were revealed, involving physical, emotional, coping, and functional aspects. Somatic features, especially pain, were the most troubling issues, along with the emotional burden of shame and loss of femininity and intimacy. However, women also revealed strength and expressed optimism. CONCLUSIONS These findings reveal the inner world of women coping with HS, addressing multiple dilemmas, problems, and concerns. Healthcare providers should pay special attention to the specific needs of these patients. Additional research is needed to further shed light on the impact of HS on women.
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van Straalen KR, Prens EP, Gudjonsson JE. Insights into hidradenitis suppurativa. J Allergy Clin Immunol 2022; 149:1150-1161. [PMID: 35189127 DOI: 10.1016/j.jaci.2022.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. A complex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate in vitro and animal models.
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Affiliation(s)
- Kelsey R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Mich; Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hwang J, Rick J, Hsiao J, Hamzavi IH, Shi VY. Microbiome in Hidradenitis Suppurativa: Current Evidence and Practice. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-021-00349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Alsadhan H, Alfawzan AI, Yaqoub A, Almoneef A, Almohideb M. Hidradenitis Suppurativa: Estimated Prevalence, Clinical Features, and Risk Factors in Riyadh, Saudi Arabia. Cureus 2022; 14:e23029. [PMID: 35419230 PMCID: PMC8994480 DOI: 10.7759/cureus.23029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/11/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory disease with a global prevalence of 1-4%, characterized by multiple painful nodules, abscesses, and fistulas that form scars in intertriginous regions (i.e., inguinal, axillary, mammary). HS is a complex and debilitating disease with a negative impact on quality of life. We aim to determine the prevalence, clinical features, risk factors, and comorbidities of HS. Methodology A retrospective, descriptive, cross-sectional study was conducted in King Abdulaziz Medical City from 2016 to 2020. Information of all confirmed cases of HS was extracted via computerized medical records. Data analysis was performed using SPSS version 24 (IBM Corp., Armonk, NY, USA). Categorical data were calculated based on frequency and percentage using the chi-square test to obtain p-values. Results Our initial search yielded 196 cases, of which 13 were excluded due to incomplete medical information. The prevalence of HS was 1.29%. The mean age was 27 years, with a male predominance. More than one-third of our patients were morbidly obese, and most of the patients were in Hurley stage 1 of both genders. The most commonly affected area was the axilla, followed by the inguinal area. The most common coexisting disease was diabetes mellitus type 2, followed by lipid disorders and acne. Conclusions This study documents the common demographic and clinical features of HS. It is a challenging disease in terms of detection and management, and it is critical to raise awareness among the public and physicians to minimize the devastating impact on HS patients.
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Prens LM, Bouwman K, Troelstra LD, Prens EP, Alizadeh BZ, Horváth B. New Insights in Hidradenitis Suppurativa from a Population-based Dutch Cohort: Prevalence, Smoking Behaviour, Socioeconomic Status and Comorbidities. Br J Dermatol 2021; 186:814-822. [PMID: 34921556 PMCID: PMC9321679 DOI: 10.1111/bjd.20954] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/26/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic autoinflammatory skin condition and is associated with several comorbidities. Previous studies report variable prevalence rates of HS, depending on the methodology. However, the exact prevalence remains unknown. Objectives To estimate the prevalence of HS in a large population‐based cohort in the Northern Netherlands, and to compare patients with HS to the general population, investigate characteristics and identify potential associated comorbidities. Methods Data were collected through a cross‐sectional survey‐based study within the Lifelines Cohort Study (n = 167 729), based on the general population located in the Northern Netherlands. A digital self‐reported questionnaire was developed consisting of validated questions for determining HS. Results Among 56 084 respondents, the overall prevalence of HS was 2.1% [95% confidence interval (CI) 2.0–2.2]. The respondents with HS had lower socioeconomic status than the controls (P < 0.001) and more frequently currently smoked (P < 0.001). Several new significant associations in patients with HS were revealed, such as fibromyalgia (OR 2.26, 95% CI 1.64–3.11), irritable bowel syndrome (OR 1.63, 95% CI 1.18–2.26), chronic fatigue syndrome (OR 1.72, 95% CI 1.06–2.78) and migraine (OR 1.48, 95% CI 1.11–1.96). Fibromyalgia and chronic fatigue syndrome remained significantly associated with HS in the multivariate analysis after adjusting for age, sex, body mass index, smoking status and socioeconomic status. Conclusions Our study showed a higher prevalence of HS in the Northern Netherlands compared with the overall estimated prevalence of 1% and identified several new associated comorbidities.
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Affiliation(s)
- Lisette M Prens
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klasiena Bouwman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisa D Troelstra
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Amat-Samaranch V, Agut-Busquet E, Vilarrasa E, Puig L. New perspectives on the treatment of hidradenitis suppurativa. Ther Adv Chronic Dis 2021; 12:20406223211055920. [PMID: 34840709 PMCID: PMC8613896 DOI: 10.1177/20406223211055920] [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] [Received: 05/12/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the presence of painful nodules, abscesses, chronically draining fistulas, and scarring in apocrine gland-bearing areas of the body. The exact pathogenesis of HS is not yet well understood, but there is a consensus in considering HS a multifactorial disease with a genetic predisposition, an inflammatory dysregulation, and an influence of environmental modifying factors. Therapeutic approach of HS is challenging due to the wide clinical manifestations of the disease and the complex pathogenesis. This review describes evidence for effectiveness of current and emerging HS therapies. Topical therapy, systemic treatments, biological agents, surgery, and light therapy have been used for HS with variable results. Adalimumab is the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS, but new therapeutic options are being studied, targeting different specific cytokines involved in HS pathogenesis. Comparing treatment outcomes between therapies is difficult due to the lack of randomized controlled trials. Treatment strategy should be selected in concordance to disease severity and requires combination of treatments in most cases.
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Affiliation(s)
- Victoria Amat-Samaranch
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Eugènia Agut-Busquet
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041 Barcelona, Spain
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Hua VJ, Kilgour JM, Cho HG, Li S, Sarin KY. Characterization of comorbidity heterogeneity among 13,667 patients with hidradenitis suppurativa. JCI Insight 2021; 6:151872. [PMID: 34546979 PMCID: PMC8663549 DOI: 10.1172/jci.insight.151872] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent abscesses in the groin and flexural areas. HS is associated with a wide range of comorbidities that complicate the disease course. Although these comorbidities have been well described, it remains unclear how these comorbidities coassociate and whether comorbidity profiles affect disease trajectory. In addition, it is unknown how comorbidity associations are modulated by race and sex. In this comprehensive analysis of 77 million patients in a large US population–based cohort, we examined coassociation patterns among HS comorbidities and identified clinically relevant phenotypic subtypes within HS. We demonstrated that these subtypes not only differed among races, but also influenced clinical outcomes as measured by HS-related emergency department visits and cellulitis. Taken together, our findings provide key insights that elucidate the unique disease trajectories experienced by patients with HS and equip clinicians with a framework for risk stratification and improved targeted care in HS.
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Vulvoperineal Hidradenitis Suppurativa: Diagnosis, Treatment, and Management of Deformities. Obstet Gynecol Surv 2021; 76:644-653. [PMID: 34724076 DOI: 10.1097/ogx.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists. Objective The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition. Evidence Acquisition Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including "hidradenitis suppurativa," "pathogenesis," "prevalence," "management," "surgery," "perineal," and "vulva." Results Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management. Conclusions Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease. Relevance Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.
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Li Pomi F, Macca L, Motolese A, Ingrasciotta Y, Berretta M, Guarneri C. Neoplastic Implications in Patients Suffering from Hidradenitis Suppurativa under Systemic Treatments. Biomedicines 2021; 9:biomedicines9111594. [PMID: 34829823 PMCID: PMC8615387 DOI: 10.3390/biomedicines9111594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease of the apocrine glands. It typically involves the axillary, submammary, genital, inguinal, perineal, and perianal regions. The development of abscesses, sinus tracts, and scars can lead to pain, scarring, disfigurement and decreased quality of life. HS is associated with a wide range of comorbidities. Several studies of co-occurrence of HS and nonmelanoma skin cancer suggest a causal relationship. In an attempt to assess the link between HS and cancer, we performed a systematic review of the current scientific knowledge through a PubMed-based literature search. Results show that HS could be associated with an overall risk of cancer and numerous specific cancers such as: nonmelanoma skin cancer (NMSC), hematologic malignancies, and metastatic cancer. Among NMSC, squamous cell carcinoma (SCC) is considered the most common complication arising in long-standing HS. Based on our review, we suggest that cautious surveillance and active intervention may be warranted in patients with HS. Moreover, an age-appropriate cancer screening should be offered to all patients, especially those who developed HS later in their life or in long-standing moderate to severe HS with multiple comorbidities.
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Affiliation(s)
- Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 1-98125 Messina, Italy; (F.L.P.); (L.M.); (A.M.)
| | - Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 1-98125 Messina, Italy; (F.L.P.); (L.M.); (A.M.)
| | - Alfonso Motolese
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, 1-98125 Messina, Italy; (F.L.P.); (L.M.); (A.M.)
| | - Ylenia Ingrasciotta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Pharmacology, University of Messina, 1-98125 Messina, Italy;
| | - Massimiliano Berretta
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Infectious Diseases, University of Messina, 1-98125 Messina, Italy;
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, 1-98125 Messina, Italy
- Correspondence: ; Tel.: +39-0902212894; Fax: +39-0902927691
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Savaş Erdoğan S, Falay Gür T, Özkur E, Doğan B. Insulin Resistance and Metabolic Syndrome in Patients with Seborrheic Dermatitis: A Case-Control Study. Metab Syndr Relat Disord 2021; 20:50-56. [PMID: 34698561 DOI: 10.1089/met.2021.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: Our knowledge of the systemic effects of seborrheic dermatitis (SD) as a chronic inflammatory skin disease remains limited. We aimed to evaluate metabolic syndrome (MS) and glucose metabolism disorders in patients with SD. Methods: The study includes 53 patients over the age of 18 diagnosed with SD and 50 age-, gender-, and body mass index-matched healthy controls. Demographic data, anthropometric measurements, blood pressure levels, family history of SD and metabolic disorder, smoking history, and severity of the disease in SD patients were obtained. Fasting plasma glucose, insulin, hemoglobin A1c, lipid profile levels, and two-hour plasma glucose in the oral glucose tolerance test (OGTT 2-h PG), homeostasis model assessment of insulin resistance (HOMA-IR), and presence of MS were determined. Results: Weight, waist circumference, family history of SD, family history of metabolic disorder, and smoking status were significantly higher in the SD group compared with the control group (P = 0.04, P = 0.007, P = 0.004, P = 0.004, and P = 0.048, respectively). The levels of fasting plasma insulin and triglyceride, HOMA-IR and OGTT 2-h PG were also significantly higher in the SD group than in the control group (P = 0.0001, P = 0.033, P = 0.0001, and P = 0.049, respectively). In addition, the number of those with insulin resistance was significantly higher in the group with SD (n = 31, 58.49%) than in the control group (n = 11, 22%) (P = 0.0001). Although the rate of MS was higher in patients with SD (n = 12, 22.64%) than the controls (n = 6, 12%), the difference was not significant (P = 0.155). Conclusion: Our findings suggest an association between SD and insulin resistance, which may be due to their common inflammatory pathogenesis. This may be an indicator of susceptibility to diabetes, and these patients can be followed up for conditions associated with insulin resistance and encouraged to adopt a healthy lifestyle.
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Affiliation(s)
- Sevil Savaş Erdoğan
- Department of Dermatology, Sultan 2.Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tuğba Falay Gür
- Department of Dermatology, Sultan 2.Abdulhamid Han Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ezgi Özkur
- Department of Dermatology, Şişli Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Bilal Doğan
- Department of Dermatology, Maltepe University, Istanbul, Turkey
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49
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Liy-Wong C, Kim M, Kirkorian AY, Eichenfield LF, Diaz LZ, Horev A, Tollefson M, Oranges T, Philips R, Chiu YE, Ghafari G, Arnold JD, Sprague J, Nguyen H, Wan S, Atenafu EG, Pope E, Hamilton J, Naik HB, Lara-Corrales I. Hidradenitis Suppurativa in the Pediatric Population: An International, Multicenter, Retrospective, Cross-sectional Study of 481 Pediatric Patients. JAMA Dermatol 2021; 157:385-391. [PMID: 33625473 DOI: 10.1001/jamadermatol.2020.5435] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Hidradenitis suppurativa (HS) in pediatric patients has been understudied. Increased awareness and recognition of HS prevalence in children demand efforts to better understand this condition. Objective To describe the demographics, clinical features, treatment, associated comorbidities, and outcomes in a large cohort of pediatric patients with HS. Design, Setting, and Participants International, multicenter, retrospective medical record review of pediatric patients (aged 1-18 years) with a clinical diagnosis of HS carried out in 10 dermatology clinics across the US, Canada, Israel, Australia, and Italy from January 1996 to January 2017. Main Outcomes and Measures Patient demographics, clinical features, severity, associated comorbidities, and treatments in pediatric patients with HS. Results This cross-sectional study included 481 patients diagnosed with HS. Overall, 386 (80%) were girls. The mean (SD) age of disease onset was 12.5 (2.9) years, and the mean (SD) age at diagnosis was 14.4 (3.5) years. Family history of HS was present in 111 of 271 (41%) patients. First signs/symptoms reported at disease onset were cyst/abscess in 229 of 481 (48%), pain/tenderness in 118 of 481 (25%), and papules/pustules in 117 of 481 (24%). At initial dermatologic assessment, 233 of 481 (48%) patients already had evidence of skin scarring. Disease severity (Hurley staging) was documented in 288 of 481 (60%) patients (47% stage 1, 45% stage 2 and 8% stage 3). Comorbid conditions were reported in 406 of 481 (85%) patients, the most common being obesity (263/406 [65%]) and acne vulgaris (118/406 [29%]). Complications occurred in 378 of 481 (79%) patients, the most common of which were scars or contractures (301/378 [80%]). Conclusions and Relevance The findings of this study indicate that there is a gap in recognizing and diagnosing pediatric HS. Pediatric patients with HS are likely to present with other comorbidities. Prospective observational and interventional studies are needed to better understand clinical course and optimal treatments for pediatric HS.
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Affiliation(s)
- Carmen Liy-Wong
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mary Kim
- Section of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego.,Rady Children's Hospital, San Diego, California
| | - Lucia Z Diaz
- Dell Children's Medical Center, Austin, Texas.,Dell Medical School at Austin, Austin, Texas
| | | | - Megha Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | | | - Roderic Philips
- Department of Pediatrics, Monash University, Melbourne, Australia.,Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Yvonne E Chiu
- Section of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Ghazal Ghafari
- Department of Dermatology, University of California, San Francisco
| | | | - Jessica Sprague
- Departments of Dermatology and Pediatrics, University of California, San Diego.,Rady Children's Hospital, San Diego, California
| | - Henry Nguyen
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Stephanie Wan
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Elena Pope
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jill Hamilton
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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50
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Seivright JR, Collier E, Grogan T, Hogeling M, Shi VY, Hsiao JL. Physical and psychosocial comorbidities of pediatric hidradenitis suppurativa: A retrospective analysis. Pediatr Dermatol 2021; 38:1132-1136. [PMID: 34463372 PMCID: PMC8578297 DOI: 10.1111/pde.14765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND/OBJECTIVES Hidradenitis suppurativa (HS) is understudied in the pediatric population. Adult HS patients are known to have a high comorbidity burden. We aimed to describe physical and psychosocial comorbidities in a cohort of pediatric HS patients. METHODS A retrospective chart review of pediatric HS patients at a single academic institution was conducted. Data on patient demographics, disease characteristics, and physical and psychosocial comorbidities in pediatric patients with HS were collected and analyzed. RESULTS Seventy-three pediatric patients were included in this study, 81% female. Mean (SD) age of HS disease onset was 12.6 (2.9) years. Comorbid conditions were reported in 68 of 73 (93%) patients. Significantly increased rates of several comorbidities were seen in our cohort as compared to the general US pediatric population. Metabolic and endocrine abnormalities were prevalent, with 52% (22/42) patients with obesity and 10% (6/59) with polycystic ovary syndrome. The most common cutaneous comorbidity was acne vulgaris, seen in 37% (27/73) of patients. Over one quarter (21/73, 29%) of patients had either an anxiety or depression disorder. Almost one-fifth (14/73, 19%) of our cohort had a diagnosis of asthma and other reactive airway diseases. Only one-third (24/73, 33%) of patients had documentation regarding impact of HS on their daily life. Overall, comorbidities largely did not significantly differ based on race, gender, or disease severity. CONCLUSIONS Pediatric patients with HS face a high-comorbidity burden, especially with psychiatric conditions. Early identification, including routine mental health screening, and management of comorbidities is warranted in the pediatric HS population.
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Affiliation(s)
- Justine R Seivright
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Erin Collier
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Marcia Hogeling
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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