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Eshmawi MT, Yousef Al-Mudaiheem H, Fatani M, Binamer Y, Alajlan M, Alharithy R, Alotaibi H, Almohanna HM, Alsantali A, Madani A, Al-Faraidy N, Bechara FG, Hamden Al-Jedaie A. Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia. J DERMATOL TREAT 2024; 35:2353693. [PMID: 38862417 DOI: 10.1080/09546634.2024.2353693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024]
Abstract
Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.
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Affiliation(s)
- Maysa T Eshmawi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- King Abdullah Medical Complex Jeddah, MOH, Saudi Arabia
| | | | - Mohammed Fatani
- Department of Dermatology, Hera General Hospital, Makkah, Saudi Arabia
| | - Yousef Binamer
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Alajlan
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ru'aa Alharithy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Hend Alotaibi
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Almohanna
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Adel Alsantali
- Department of Dermatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulaziz Madani
- Department of Dermatology, College of medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nadya Al-Faraidy
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
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Barzilai A, Toubiana S, Dalal A, Baum S. The role of piperacillin/tazobactam in the treatment of Hidradenitis suppurativa. J DERMATOL TREAT 2024; 35:2363318. [PMID: 39103159 DOI: 10.1080/09546634.2024.2363318] [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: 04/09/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024]
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Most patients with moderate-to-severe disease require long-term antibiotic treatment, or biologic treatments to control their disease. Despite these interventions, relapses are common. This study evaluated the effectiveness of piperacillin/tazobactam treatment in patients with Hurley stage II and III HS who experienced disease flares and did not respond to conventional antibiotic and biologic treatment. Methods: Patients with HS hospitalized at the Department of Dermatology, Sheba Medical Center between August 2021 and January 2023 were retrospectively analyzed. Results: A cohort of ten such patients were treated with piperacillin/tazobactam for 6-21 days. Eight (80%) and two (20%) patients respectively demonstrated 2- and 1-grade improvements, from their baseline HS-Physician Global Assessment score. During the follow-up period, nine patients were monitored. HS Clinical Response (HiSCR) was achieved in six (66.7%) and five (55.6%) patients at the 3- and 6-month follow-up visits, respectively. Conclusions: In conclusion, Piperacillin/tazobactam emerges as a promising therapeutic option for disease flare-up in patients with Hurley stage II and III HS who do not respond to conventional treatment. Thus, piperacillin/tazobactam should be considered as crisis therapy for this patient subset.
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Affiliation(s)
- Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
- Institute of Pathology, Sheba Medical Center, Ramat-Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Toubiana
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
| | - Adam Dalal
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Baum
- Department of Dermatology, Sheba Medical Center, Tel-HaShomer, Ramat-Gan, Tel Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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3
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Sidhom S, Petry SU, Ward R, Daveluy S. Treatment of hidradenitis suppurativa with 755-nm alexandrite laser hair removal: A randomized controlled trial. JAAD Int 2024; 16:239-243. [PMID: 39072264 PMCID: PMC11277998 DOI: 10.1016/j.jdin.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 07/30/2024] Open
Abstract
Background Hidradenitis supprativa is a chronic inflammatory skin disease that can respond to treatment with laser hair removal. Objective To assess alexandrite laser hair removal laser as a treatment for hidradenitis suppurativa as measured by the Hidradenitis Supprativa Clinical Response. Materials and methods We conducted a prospective, randomized, controlled study in adult patients with hidradenitis supprativa. Participants underwent a series of 4 monthly laser treatments to 1 side of the body, with the contralateral side serving as a control. The primary outcome was Hidradenitis Supprativa Clinical Response at week 24, 8 weeks after the final laser treatment. Results The percent improvement across treated sites after 4 treatments was 72.73% axillary, 70% inguinal, and 100% inframammary. Across all body regions, Hidradenitis Supprativa Clinical Response was significantly higher for the sites treated with the alexandrite laser compared to the contralateral controls: 75% vs 33.33% (P = .0046, 95% CI: [0.16, 1]). Limitations The limitations of this study include a small sample size from which the data was collected. Conclusions The 775-nm alexandrite laser is a safe and effective treatment for hidradenitis supprativa at various anatomic sites in both resolving preexisting lesions and preventing new eruptions.
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Affiliation(s)
- Seraphima Sidhom
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Sarah Utz Petry
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Rachel Ward
- Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Dearborn, Michigan
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Marzano AV, Magnoni C, Micali G, De Magnis A, Pintori G, Fiorini S, Simonella V, Bastioli L, Nappi F, Pappagallo G, Prignano F. Improving hidradenitis suppurativa management: consensus statements from physicians and patients' perspectives. Arch Dermatol Res 2024; 316:577. [PMID: 39180694 PMCID: PMC11344722 DOI: 10.1007/s00403-024-03316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/05/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024]
Abstract
Hidradenitis suppurativa (HS) is a frequent chronic inflammatory skin condition primarily affecting areas rich in apocrine sweat glands, presenting with comedones, papules, nodules, and abscesses, as well as tunnels and hypertrophic scarring. Despite its prevalence and impact on quality of life, the pathogenesis of HS remains incompletely understood. Notably, its diagnosis often suffers from delays and misidentification, therefore an improved education for healthcare providers is mandatory. Moreover, HS is frequently associated with systemic comorbidities and a multidisciplinary approach is suggested for its management. Recognizing these challenges, a group of Italian HS experts and patients convened to develop consensus guidelines via the Nominal Group Technique. Through iterative meetings and remote collaboration, they identified key areas for improvement and formulated consensus statements to guide healthcare providers in delivering optimal care. This collaborative effort highlights the importance of standardized approaches and interdisciplinary collaboration in managing HS effectively.
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Affiliation(s)
- Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy.
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Via Pace, 9, 20122, Milan, Italy.
| | - Cristina Magnoni
- Università Degli Studi Di Modena E Reggio Emilia, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Giuseppe Micali
- Università Di Catania, AOU Policlinico Vittorio Emanuele, Catania, Italy
| | | | | | | | | | - Linda Bastioli
- AISI-Associazione Italiana Sostegno Idrosadenite, Viterbo, Italy
| | - Francesca Nappi
- AISI-Associazione Italiana Sostegno Idrosadenite, Viterbo, Italy
| | - Giovanni Pappagallo
- Scuola Di Metodologia Clinica, IRCCS Ospedale Sacro Cuore Don Calabria, Negrar Di Valpolicella, Verona, Italy
| | - Francesca Prignano
- Dipartimento Di Scienze Della Salute, Sezione Di Dermatologia, Università Di Firenze, Florence, Italy
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Lai PT, Tseng HC. Adopting adalimumab combined surgery in the management of moderate to severe hidradenitis suppurativa: Experience from a single medical center in southern Taiwan. J Dermatol 2024. [PMID: 39032108 DOI: 10.1111/1346-8138.17375] [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: 04/13/2024] [Revised: 06/05/2024] [Accepted: 06/21/2024] [Indexed: 07/22/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder primarily affecting the intertriginous and anogenital regions. Guidelines recommend various treatments for HS, including biologic agents like adalimumab for moderate to severe cases. Adalimumab is a type of human monoclonal IgG1 antibody designed to target tumor necrosis factor α. Recent studies have shown the effectiveness of adalimumab, either alone or combined with surgery, in managing HS. We retrospectively analyzed the medical chart of HS patients in a southern Taiwan medical center from 2019 to 2022 and investigated clinical features and treatment response. The institutional review board at Chang Gung Medical Foundation granted approval for the study. We primarily focused on moderate to severely affected patients. One hundred and two clinically diagnosed HS patients participated, with a male-to-female ratio of 2:1 and an average age of 31.8 at diagnosis. Among them, 41.2% were in Hurley stage III and 32.4% in stage II. Nineteen patients received excision with pre-surgical adalimumab; their average age at diagnosis was 31.1, with a gender ratio of 5.3:1. Surgery was most common on the buttocks (68%), axillae (21%), and groin (10%). Excision patients were primarily in advanced stages (Hurley III 94.7%, II 5.3%) with high body mass index. Adalimumab and surgery combined yielded a 68.4% improvement rate, while 15.8% remained stable and 15.8% did not respond as expected. In addition, smoking and obesity were prevalent among patients. Adalimumab showed promising results in moderate to severe HS, with significant improvement observed in our cases. The combination of adalimumab and surgery appeared effective in advanced HS patients with larger involved areas and more tunnels. No severe adverse events were reported. However, our study was limited by its retrospective nature and the lack of a control group. Despite these limitations, our study revealed the benefits of integrating adalimumab with suitable surgical procedures in managing patients experiencing moderate to severe HS in real-world scenarios.
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Affiliation(s)
- Po-Ta Lai
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, ROC
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
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Chen ML, Kim J, Naik HB, Aleshin MA, Sarin KY, Barnes LA, Linos E. Analysing common topics of secure patient messages in hidradenitis suppurativa: a text-embedding and natural language-processing approach. Br J Dermatol 2024:ljae222. [PMID: 38975641 DOI: 10.1093/bjd/ljae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/14/2024] [Indexed: 07/09/2024]
Abstract
Our study of 410 patients with hidradenitis suppurativa (HS) and 12 805 direct patient messages identified common message topics, including scheduling; medication refills; itch, bleeding and burning symptoms; insurance and cost; pain; and wound care. Compared with the overall cohort of patients with HS, a lower proportion of Black and Hispanic patients utilized patient portal messaging. Our study provides insights into message topics among patients with HS and identifies opportunities for optimizing care via secure messaging.
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Affiliation(s)
- Michael L Chen
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
- Center for Digital Health, Stanford University, Stanford, CA, USA
| | - Jiyeong Kim
- Center for Digital Health, Stanford University, Stanford, CA, USA
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kavita Y Sarin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Leandra A Barnes
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
- Center for Digital Health, Stanford University, Stanford, CA, USA
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7
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Mendes-Bastos P, Benhadou F, Venturini M, Molina-Levya A, Thomas N, Alarcon I, Bechara FG. Biologic drugs in hidradenitis suppurativa: what does the GP have to know? A narrative review. Front Med (Lausanne) 2024; 11:1403455. [PMID: 39040895 PMCID: PMC11261743 DOI: 10.3389/fmed.2024.1403455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with a profound disease burden. In recent years, the advent of biologic therapies has improved the treatment landscape for patients with moderate to severe HS. In this new therapeutic era, the role of the general practitioner (GP) in HS treatment is becoming more important than ever. This review discusses how to recognize and diagnose HS by detailing common symptoms. HS can also present with multiple comorbidities. The GP's role in screening for and treating these important comorbidities is pivotal. This review highlights the HS treatment landscape, with a specific focus on what the GP can recommend. The three approved biologics for treating HS include adalimumab, secukinumab and bimekizumab; the benefits and concerns of biologics in everyday clinical practice are detailed. In summary, this review serves as a HS management guide for GPs, with a particular focus on the biologic treatment landscape.
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Affiliation(s)
| | - Farida Benhadou
- Department of Dermatology, Hôpitaux Universitaires de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marina Venturini
- Dermatology Department, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | | | | | | | - Falk G. Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
- ICH—International Center for Hidradenitis Suppurativa/Acne Inversa, Ruhr-University, Bochum, Germany
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8
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Shipman WD, Williams MN, Suozzi KC, Eisenstein AS, Dover JS. Efficacy of laser hair removal in hidradenitis suppurativa: A systematic review and meta-analysis. Lasers Surg Med 2024; 56:425-436. [PMID: 38769894 DOI: 10.1002/lsm.23796] [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: 02/13/2024] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVES Hidradenitis suppurativa (HS) is a chronic inflammatory condition characterized by painful nodules, draining tunnels, and fibrotic scarring in intertriginous, hair-bearing areas. The pathogenesis involves follicular occlusion and subsequent rupture, leading to uncontrolled inflammation. Treatment options for HS are limited and lack universal effectiveness. Laser hair removal (LHR) has been explored as a potential treatment; however, the efficacy and appropriate laser modalities remain unclear. This systematic review examined the efficacy and adverse effects of LHR in HS. METHODS A comprehensive literature search was conducted from inception to September 2023 in Ovid MEDLINE, Ovid Embase, and The Cochrane Library (Wiley) with predefined inclusion and exclusion criteria, and a meta-analysis was conducted. RESULTS Ten studies were selected (n = 227 total patients) and included six randomized controlled trials, two nonrandomized experimental studies, and two case series. Various laser modalities, including long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) (n = 115), intense pulsed light (n = 18), Alexandrite (n = 54), intralesional 1064 nm diode (n = 20), and combined fractional CO2 and long-pulsed Nd:YAG laser (n = 20), consistently demonstrated significant improvement in HS disease severity, irrespective of the disease scoring method used. Minimal adverse effects (primarily mild pain and erythema) were reported. A meta-analysis of three studies utilizing long-pulsed Nd:YAG laser demonstrated a standardized mean difference in disease severity of -1.68 (95% confidence interval: -2.99; -0.37), favoring treatment with LHR for HS. CONCLUSIONS Hair follicles are key in HS pathogenesis and all included studies showed a significant improvement in HS disease severity after LHR regardless of the laser device used, likely related to hair follicle unit destruction. HS is a complex and heterogenous condition, and multiple disease scoring methods complicate outcome comparisons across studies. However, LHR, utilizing various techniques, is an effective treatment option for HS with minimal adverse effects.
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Affiliation(s)
- William D Shipman
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Monica N Williams
- Department of Dermatology, Medstar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Kathleen C Suozzi
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Anna S Eisenstein
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
| | - Jeffrey S Dover
- Department of Dermatology, Yale University, New Haven, Connecticut, USA
- SkinCare Physicians, Chestnut Hill, Massachusetts, USA
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9
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Li CP, Lo SW, Tsai RY, Chang HC, Gau SY. New-Onset Hidradenitis Suppurativa in Psoriasis Patients: A Multi-Center, Retrospective Cohort Study. Life (Basel) 2024; 14:730. [PMID: 38929713 PMCID: PMC11205059 DOI: 10.3390/life14060730] [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: 05/06/2024] [Revised: 05/25/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Previous research has indicated a potential correlation between hidradenitis suppurativa (HS) and psoriasis (PSO), two chronic inflammatory dermatological diseases. However, there is a lack of comprehensive evaluations that consider a variety of clinical and demographic factors, and the risk of developing HS in PSO patients remains unclear. Our study aims to examine HS risk over time among PSO patients versus matched controls while considering the influence of confounders to provide insights into the potential link between these two diseases. METHOD In this multi-institutional cohort study using the TriNetX database, we matched 202,318 patients with PSO with an equivalent number of individuals without PSO, using propensity score matching. The study period extended from 1 January 2005 to 31 December 2018. We computed hazard ratios and their respective 95% confidence intervals (CIs) to evaluate the probability of HS manifestation over a period of 5 years in patients with PSO in comparison to those without PSO. RESULTS PSO patients demonstrated a consistently higher risk of developing HS than matched controls across all analytic models with the hazard ratios (HR) ranging from 1.43 (95% CI 1.30-1.56) to 5.91 (95% CI 2.49-14.04). Stratified analyses showed the increased HS risk was observed in both genders but only significant in those aged 18-64 years. Kaplan-Meier analysis indicated PSO patients had a higher cumulative probability of developing HS over time (HR 1.77, 95% CI 1.49-1.89). CONCLUSIONS PSO was associated with increased HS risk, highlighting the importance of considering HS as a potential comorbidity in PSO patients and may have implications for early detection, prevention, and management strategies for both conditions. Shared inflammatory pathways, genetic components, and skin dysbiosis may contribute. Further research should elucidate underlying mechanisms.
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Affiliation(s)
- Chen-Pi Li
- Department of Nursing, Tungs’ Taichung MetroHarbor Hospital, Taichung 435403, Taiwan;
| | - Shao-Wei Lo
- Education Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan;
| | - Ru-Yin Tsai
- Department of Anatomy, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Hui-Chin Chang
- Evidence-Based Medicine Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Library, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Orthopedics Department, Chi-Mei Medical Center, Tainan 71004, Taiwan
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10
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Krajewski A, Alsayed A, Capek A, Casey K, Chandawarkar R. Surgical Management of Hidradenitis Suppurativa. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5860. [PMID: 38872991 PMCID: PMC11175856 DOI: 10.1097/gox.0000000000005860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/18/2024] [Indexed: 06/15/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of the skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. Treatment for this debilitating disease has been medical management with antibiotics and immune modulators. With the advent of better reconstructive surgical techniques, the role of surgery in the treatment of HS has expanded, from being a last resort to a modality that is deployed earlier. Larger defects can be more easily reconstructed, allowing for a more radical excision of diseased areas. Locoregional flaps, perforator flaps, and propeller flaps that use the fasciocutaneous tissue allow reconstruction of defects with similar tissue, and provide better cosmetic and functional outcomes. They are easy to execute and can be performed even in resource-poor settings with concurrent use of immune modulators and postoperative antibiotics. Hidradenitis can be successfully treated with surgery in early stages as well as severe disease, due to the advances in understanding disease behavior, multidisciplinary care, and advanced reconstructive techniques. Coupled with a multidisciplinary care team, surgery offers a durable, lasting cure for HS, significantly reducing disease morbidity.
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Affiliation(s)
| | - Ahmed Alsayed
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Allison Capek
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kathleen Casey
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rajiv Chandawarkar
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Heidari A, Ghane Y, Heidari N, Hosseini S, Goodarzi A. Golimumab and certolizumab pegol for the treatment of hidradenitis suppurativa: a literature review and future perspective. Ther Adv Chronic Dis 2024; 15:20406223241257342. [PMID: 38827348 PMCID: PMC11143857 DOI: 10.1177/20406223241257342] [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: 09/18/2023] [Accepted: 05/03/2024] [Indexed: 06/04/2024] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory skin condition with an underlying inflammatory process. Due to the limited efficacy of available treatments, HS remains a therapeutic challenge. The safety and efficacy of tumor necrosis factor-α (TNF-α) inhibitors, adalimumab, infliximab, and etanercept, are well studied in this patient population, and in some cases, HS was unresponsive to them. In recent years, evidence has been growing regarding the application of other anti-TNFs, including certolizumab pegol (CPZ) and golimumab. We sought to evaluate the overall safety and efficacy of golimumab and CPZ in the management of HS. A comprehensive search was performed on the PubMed, Scopus, Web of Science, and Ovid Embase databases, as well as the Google Scholar search engine from initiation to 31 August 2023. A total of nine and four studies used CPZ and golimumab to treat HS, respectively. Individuals with concomitant inflammatory immune-mediated diseases, pregnant females, and patients who were refractory to previous treatments achieved a Hidradenitis Suppurativa Clinical Response following CPZ administration. Also, golimumab showed promise in treating recalcitrant HS after the failure of other treatments, such as adalimumab and anti-interleukin-1. CPZ and golimumab can be efficacious treatment options for moderate-to-severe HS, especially in patients who are unresponsive to other TNF inhibitors, such as adalimumab.
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Affiliation(s)
- Amirhossein Heidari
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Yekta Ghane
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Heidari
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedayin Hosseini
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center, School of Medicine, Iran University of Medical Sciences, Rasool Akram Medical Complex, Sattarkhan Avenue, Niayesh Street, Tehran 1449614535, Iran
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12
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Wong HS, Jiang JY, Huang SD, Zhu P, Ji X, Wang DG. A review of surgical and reconstructive techniques for hidradenitis suppurativa. Arch Dermatol Res 2024; 316:270. [PMID: 38796609 DOI: 10.1007/s00403-024-03000-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
Hidradenitis suppurativa (HS) is an inflammatory follicular dermatological condition that typically affects the intertriginous and anogenital regions of the apocrine gland-bearing skin. The management of this chronic and recurring disease necessitates a combination of lifestyle changes, medication, and surgical approaches to achieve the best possible outcomes. While medical treatments are recommended for this multimodal disease, surgical therapy, which is the gold standard of treatment for HS, has proven to be the most effective treatment because it provides long-lasting local disease control, reduces the recurrence of lesions, and ensures complete healing of lesions. In the last decade, there has been exponential growth in research into various surgical techniques and reconstructive care, enabling patients to have more surgical options. There is a wide range of surgical management procedures available, such as incision and drainage, deroofing, excisional surgery, carbon dioxide laser therapy, and skin tissue-sparing excision with electrosurgical peeling. Among these surgical procedures, wide surgical excision is the best option since it can eradicate all the affected lesions. Meanwhile, the preferred approach to reconstruction at various anatomical locations remains debatable. Here, we review a variety of surgical treatments and reconstructive techniques for HS, particularly various flap techniques for the axillary, gluteal, and inframammary regions.
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Affiliation(s)
- Hoi-Shiwn Wong
- Department of Dermatology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Jia-Yi Jiang
- Department of Dermatology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Shu-Dai Huang
- Department of Dermatology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Ping Zhu
- Department of Dermatology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Xiang Ji
- Department of Dermatology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China
| | - Da-Guang Wang
- Department of Dermatology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, China.
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Yin CS, Minh Nguyen TT, Yi EJ, Zheng S, Bellere AD, Zheng Q, Jin X, Kim M, Park S, Oh S, Yi TH. Efficacy of probiotics in hair growth and dandruff control: A systematic review and meta-analysis. Heliyon 2024; 10:e29539. [PMID: 38698995 PMCID: PMC11064082 DOI: 10.1016/j.heliyon.2024.e29539] [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: 09/24/2023] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
Background Probiotics are intellectually rewarding for the discovery of their potential as a source of functional food. Investigating the economic and beauty sector dynamics, this study conducted a comprehensive review of scholarly articles to evaluate the capacity of probiotics to promote hair growth and manage dandruff. Methods We used the PRISMA 2020 with Embase, Pubmed, ClinicalTrials.gov, Scopus, and ICTRP databases to investigate studies till May 2023. Meta-analyses utilizing the random effects model were used with odds ratios (OR) and standardized mean differences (SMD). Result Meta-analysis comprised eight randomized clinical trials and preclinical studies. Hair growth analysis found a non-significant improvement in hair count (SMD = 0.32, 95 % CI -0.10 to 0.75) and a significant effect on thickness (SMD = 0.92, 95 % CI 0.47 to 1.36). In preclinical studies, probiotics significantly induced hair follicle count (SMD = 3.24, 95 % CI 0.65 to 5.82) and skin thickness (SMD = 2.32, 95 % CI 0.47 to 4.17). VEGF levels increased significantly (SMD = 2.97, 95 % CI 0.80 to 5.13), while IGF-1 showed a non-significant inducement (SMD = 0.53, 95 % CI -4.40 to 5.45). For dandruff control, two studies demonstrated non-significant improvement in adherent dandruff (OR = 1.31, 95 % CI 0.13-13.65) and a significant increase in free dandruff (OR = 5.39, 95 % CI 1.50-19.43). Hair follicle count, VEGF, IGF-1, and adherent dandruff parameters were recorded with high heterogeneity. For the systematic review, probiotics have shown potential in improving hair growth and controlling dandruff through modulation of the immune pathway and gut-hair axis. The Wnt/β-catenin pathway, IGF-1 pathway, and VEGF are key molecular pathways in regulating hair follicle growth and maintenance. Conclusions This review found significant aspects exemplified by the properties of probiotics related to promoting hair growth and anti-dandruff effect, which serve as a roadmap for further in-depth studies to make it into pilot scales.
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Affiliation(s)
- Chang-Shik Yin
- Acupuncture and Meridian Science Research Center, College of Oriental Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Trang Thi Minh Nguyen
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
| | - Eun-Ji Yi
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
- Snowwhitefactory Co, Ltd., 807 Nonhyeon-ro, Gangnam-gu, Seoul, 06032, Republic of Korea
| | - Shengdao Zheng
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
- Snowwhitefactory Co, Ltd., 807 Nonhyeon-ro, Gangnam-gu, Seoul, 06032, Republic of Korea
| | - Arce Defeo Bellere
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
| | - Qiwen Zheng
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
| | - Xiangji Jin
- Department of Pharmacology, School of Medicine, Kyung Hee University, 23 Kyungheedae-ro, Dong-daemun, Seoul, Republic of Korea
| | - Myeongju Kim
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
| | - Sejic Park
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
| | - Sarang Oh
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
- Snowwhitefactory Co, Ltd., 807 Nonhyeon-ro, Gangnam-gu, Seoul, 06032, Republic of Korea
| | - Tae-Hoo Yi
- Graduate School of Biotechnology, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, Republic of Korea
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14
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Krajewski PK, Sanz-Motilva V, Flores Martinez S, Solera M, Ochando G, Jfri A, Martorell A. Deroofing: A safe, effective and well-tolerated procedure in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:931-936. [PMID: 38279608 DOI: 10.1111/jdv.19810] [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: 09/13/2023] [Accepted: 11/24/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. OBJECTIVES A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. METHODS HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. RESULTS The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). CONCLUSION Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.
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Affiliation(s)
- P K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
| | - V Sanz-Motilva
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | | | - M Solera
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | - G Ochando
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | - A Jfri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - A Martorell
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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15
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Reddy S, Schwartzman G, Luu LA, Im G, Flowers RH, Guffey DJ. Differentiating hidradenitis suppurativa flare from infection in the emergency department and recommendations for transitioning care to the outpatient setting. Am J Emerg Med 2024; 79:58-62. [PMID: 38367431 DOI: 10.1016/j.ajem.2024.01.048] [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: 11/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/19/2024] Open
Abstract
Hidradenitis suppurativa is a painful and often progressive inflammatory skin condition that presents with papules, nodules, abscesses, and tunnels in the axillary, inframammary and anogenital regions. HS can be difficult to differentiate from a skin infection, such as a bacterial abscess. However, differentiation between the two is important as management of hidradenitis suppurativa often requires long-term follow-up and specialist care. Emergency physicians should be aware of how to differentiate acute hidradenitis suppurativa flares from similarly presenting conditions, particularly skin and soft tissue infection, when encountered in the emergency department and what steps should be taken to adequately bridge care to the outpatient setting.
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Affiliation(s)
- Soumya Reddy
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA.
| | | | - Lydia A Luu
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
| | - Grace Im
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
| | - R Hal Flowers
- Department of Dermatology, University of Virginia, Charlottesville, VA, USA
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16
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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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17
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Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Stein Gold LF, Tan JKL, Tollefson MM, Weiss JS, Wu PA, Zaenglein AL, Han JM, Barbieri JS. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024; 90:1006.e1-1006.e30. [PMID: 38300170 DOI: 10.1016/j.jaad.2023.12.017] [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: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS These guidelines provide evidence-based recommendations for the management of acne vulgaris.
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Affiliation(s)
- Rachel V Reynolds
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fran Cook-Bolden
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Seemal R Desai
- Innovative Dermatology, Plano, Texas; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kelly M Druby
- Penn State Health Hampden Medical Center, Enola, Pennsylvania
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonette E Keri
- University of Miami, Miller School of Medicine, Miami, Florida; Miami VA Medical Center, Miami, Florida
| | | | - Jerry K L Tan
- Western University, London, Ontario, Canada; Windsor Clinical Research Inc., Windsor, Ontario, Canada
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Jonathan S Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Georgia Dermatology Partners, Snellville, Georgia
| | - Peggy A Wu
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State/Hershey Medical Center, Hershey, Pennsylvania
| | - Jung Min Han
- American Academy of Dermatology, Rosemont, Illinois.
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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18
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Suleman S, Riddle AO, Pena-Robichaux V. Staged Regional Deroofing for the Treatment of Extensive Hidradenitis Suppurativa. Dermatol Surg 2024:00042728-990000000-00767. [PMID: 38651730 DOI: 10.1097/dss.0000000000004188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Saba Suleman
- Baylor Scott and White All Saints, Fort Worth, Texas
| | - Ashley O Riddle
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Venessa Pena-Robichaux
- Division of Dermatology, Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, Texas
- Central Texas Veterans Healthcare System, Medical Service, Dermatology Section, Austin, Texas
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19
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Malvaso D, Chiricozzi A, Fossati B, Antonelli F, Peris K. Efficacy and safety of a combined pharmacological and surgical approach in patients affected by hidradenitis suppurativa: data from a retrospective real-world clinical study. Ital J Dermatol Venerol 2024; 159:190-195. [PMID: 38650499 DOI: 10.23736/s2784-8671.24.07620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating chronic skin disease; its therapeutic approach often requires combined medical and surgical treatment. METHODS The aim of this study was to assess the efficacy and safety of the surgical approach combined with different pharmacological treatments, evaluating the proportion of patients achieving the hidradenitis suppurativa clinical response (HiSCR), along with the incidence of postoperative complications, and local recurrence. A retrospective study of HS patients (Hurley I-III) presenting at least one skin lesion requiring surgery was performed. Demographic and clinical data were collected (kind and anatomical location of lesion excised, type of surgical procedure). Further data included: Hurley stage and IHS4 at baseline and week 16, HiSCR at week 16 after surgery, ongoing therapy at the time of surgery (topical, systemic antibiotic, biologics), postoperative complications and local recurrence at week 16. RESULTS Forty-two patients with female predominance (66.7%, 28/42), with a mean age of 30.3 (SD±10.5) years, were enrolled. At week 16, 53% of patients achieved HiSCR, with baseline Hurley III inversely related to HiSCR achievement (P<0.05). No increased incidence of postoperative complications was detected. Three cases of local recurrence were reported at week 16. CONCLUSIONS The results support the efficacy and safety of the combined therapy in the management of HS; no increased risk of complications emerged among patients concomitantly treated with biologics, compared to those on conventional systemic therapy or exclusively treated with surgery.
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Affiliation(s)
- Dalma Malvaso
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Andrea Chiricozzi
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy -
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Barbara Fossati
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Flaminia Antonelli
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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20
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Bouadi N, Rijal H, Jeremian R, Li K, Abduelmula A, Maliyar K, Georgakopoulos JR, Yeung J. Comorbidities and Risk Factors Associated With Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis. J Cutan Med Surg 2024:12034754241239252. [PMID: 38554064 DOI: 10.1177/12034754241239252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2024]
Affiliation(s)
- Naila Bouadi
- Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Hibo Rijal
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Richie Jeremian
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Kaiyang Li
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Abrahim Abduelmula
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Khalad Maliyar
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Jensen Yeung
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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21
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Nosrati A, Ch’en PY, Torpey ME, Shokrian N, Ball G, Benesh G, Andriano TM, Zhu TR, Heibel HD, Hosgood HD, Campton KL, Cohen SR. Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa. JAMA Dermatol 2024; 160:312-318. [PMID: 38353987 PMCID: PMC10867774 DOI: 10.1001/jamadermatol.2023.6201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/11/2023] [Indexed: 02/17/2024]
Abstract
Importance Hidradenitis suppurativa (HS) is a debilitating follicular skin disorder in which bacterial colonization is typical. Oral antibiotic efficacy can be unreliable; however, selective intravenous antibiotics, specifically ertapenem, may provide favorable clinical outcomes. Objective To explore optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem for HS. Design, Setting, and Participants This retrospective review of the medical records of 98 patients with HS between 2018 and 2022 measured and evaluated patient outcomes before and after treatment with intravenous ertapenem. Participants were followed up in a telephone survey assessing patient perspectives and satisfaction. All of those included in this study received medical care from the Albert Einstein College of Medicine's Montefiore HS Center. Exposures Patients were treated with 1 g of ertapenem that was self-administered at home through a peripheral intravenous central catheter using an elastomeric pump for 12 to 16 weeks. Antiandrogens and immunomodulatory biologic therapies initiated prior to ertapenem were maintained throughout the treatment course. Main Outcomes and Measures The primary outcomes, encompassing clinical severity (evaluated through the HS Physician Global Assessment score [a 6-point scale ranging from clear to very severe] and a numerical rating scale for pain [an 11-point scale in which a score of 0 indicates no pain and a score of 10 indicates the worst possible pain]) and markers of inflammation (such as leukocytes, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6), were measured at baseline, the midcourse of intravenous ertapenem treatment, at the end of the course, and posttherapy. Bacterial abundance was also examined at these 4 points, and patient satisfaction was assessed during follow-up. Results A total of 98 patients (mean [SD] age, 35.8 [13.0] years; 61 [62.2%] female) with HS were treated with intravenous ertapenem. The self-reported racial distribution included 3 individuals identifying as Asian (3.1%), 59 as Black/African American (60.2%), 13 as White (13.3%), and 23 as either other or unknown (23.5%). Additionally, 24 participants (24.5%) reported Spanish/Hispanic/Latino ethnicity. The mean (SD) treatment duration spanned 13.1 (4.0) weeks, with posttherapy follow-up occurring after 7.8 (3.6) weeks. From baseline to posttherapy follow-up, significant reductions were found in the mean (SD) HS Physician Global Assessment scores (3.9 [1.0] vs 2.7 [1.2]; P < .001) and the numerical rating scale for pain (4.2 [3.3] vs 1.8 [2.7]; P < .001), C-reactive protein (5.4 [11.4] vs 2.4 [2.0] mg/dL; P < .001), interleukin-6 (25.2 [21.1] vs 13.7 [13.9]; P < .001), and leukocytes (11.34 [3.9] vs 10.0 [3.4]; P < .001). At follow-up, 76 patients (78.0%) participated in the telephone survey, where 63 (80.3%) reported medium to high satisfaction; further, 69 (90.8%) would recommend ertapenem to other patients. Conclusions and Relevance In this retrospective review of medical records and telephone survey, treating HS with intravenous ertapenem, administered for a mean of 13 weeks, was associated with improvement in clinical and inflammatory markers, as well as heightened patient satisfaction. Nonetheless, this approach should be monitored for the emergence of antimicrobial resistance given a longer than standard treatment course.
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Affiliation(s)
- Avigdor Nosrati
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Peter Y. Ch’en
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - McCall E. Torpey
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Neda Shokrian
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Gretchen Ball
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Gabrielle Benesh
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Tyler M. Andriano
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Tian Ran Zhu
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Haley D. Heibel
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - H. Dean Hosgood
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Kristina L. Campton
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
| | - Steven R. Cohen
- Division of Dermatology, Department of Medicine, Albert Einstein College of Medicine, New York, New York
- Department of Dermatology, Weill Cornell Medicine, Cornell University, New York, New York
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22
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Ituarte BE, Sharma D, Fernandez JM, Wysong A, Wei EX. A cross-sectional analysis of social media searches for popular hidradenitis suppurativa treatments using Facebook, Reddit, and Google Trends. Int Wound J 2024; 21:e14725. [PMID: 38468420 PMCID: PMC10928241 DOI: 10.1111/iwj.14725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Bianca E. Ituarte
- School of MedicineUniversity of Missouri‐Kansas CityKansas CityMissouriUSA
- Department of DermatologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Divya Sharma
- Department of DermatologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | | | - Ashley Wysong
- Department of DermatologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Erin X. Wei
- Department of DermatologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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23
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Verde L, Cacciapuoti S, Caiazzo G, Megna M, Martora F, Cavaliere A, Mattera M, Maisto M, Tenore GC, Colao A, Savastano S, Muscogiuri G, Barrea L. Very low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): an effective and safe tool for improvement of the clinical severity of disease. Results of a pilot study. J Transl Med 2024; 22:149. [PMID: 38350939 PMCID: PMC10863195 DOI: 10.1186/s12967-024-04853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS), an inflammatory-based dermatological condition often associated with obesity, poses significant challenges in management. The very low-calorie ketogenic diet (VLCKD) has shown efficacy in addressing obesity, related metabolic disorders, and reducing chronic inflammation. However, its effects on HS remain underexplored. In this prospective pilot study, we aimed to investigate the impact of a 28-day active phase of VLCKD on HS in a sample of treatment-naive women with HS and excess weight. METHODS Twelve women with HS and overweight or obesity (BMI 27.03 to 50.14 kg/m2), aged 21 to 54 years, meeting inclusion/exclusion criteria and agreeing to adhere to VLCKD, were included. Baseline lifestyle habits were assessed. The Sartorius score was used to evaluate the clinical severity of HS. Anthropometric parameters (waist circumference, weight, height, and body mass index), body composition via bioelectrical impedance analysis, levels of trimethylamine N-oxide (TMAO), oxidized low-density lipoprotein (oxLDL), and derivatives of reactive oxygen metabolites (dROMs) were assessed at baseline and after 28 days of the active phase of VLCKD. RESULTS VLCKD led to general improvements in anthropometric parameters and body composition. Notably, a significant reduction in the Sartorius score was observed after the intervention (Δ%: - 24.37 ± 16.64, p < 0.001). This reduction coincided with significant decreases in TMAO (p < 0.001), dROMs (p = 0.001), and oxLDL (p < 0.001) levels. Changes in the Sartorius score exhibited positive correlations with changes in TMAO (p < 0.001), dROMs (p < 0.001), and oxLDL (p = 0.002). CONCLUSION The 28-day active phase of VLCKD demonstrated notable improvements in HS severity and associated metabolic markers, highlighting the potential utility of VLCKD in managing HS and its association with metabolic derangements in women with overweight or obesity.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Giuseppina Caiazzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Annarita Cavaliere
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Mattera
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Maisto
- ChimNutra labs, Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131, Naples, Italy
| | - Gian Carlo Tenore
- ChimNutra labs, Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131, Naples, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143, Naples, Italy.
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24
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Satapathy T, Kishore Y, Pandey RK, Shukla SS, Bhardwaj SK, Gidwani B. Recent Advancement in Novel Wound Healing Therapies by Using Antimicrobial Peptides Derived from Humans and Amphibians. Curr Protein Pept Sci 2024; 25:587-603. [PMID: 39188211 DOI: 10.2174/0113892037288051240319052435] [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: 11/18/2023] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 08/28/2024]
Abstract
The skin is the biggest organ in the human body. It is the first line of protection against invading pathogens and the starting point for the immune system. The focus of this review is on the use of amphibian-derived peptides and antimicrobial peptides (AMPs) in the treatment of wound healing. When skin is injured, a chain reaction begins that includes inflammation, the formation of new tissue, and remodelling of existing tissue to aid in the healing process. Collaborating with non-immune cells, resident and recruited immune cells in the skin remove foreign invaders and debris, then direct the repair and regeneration of injured host tissues. Restoration of normal structure and function requires the healing of damaged tissues. However, a major issue that slows wound healing is infection. AMPs are just one type of host-defense chemicals that have developed in multicellular animals to regulate the immune response and limit microbial proliferation in response to various types of biological or physical stress. Therefore, peptides isolated from amphibians represent novel therapeutic tools and approaches for regenerating damaged skin. Peptides that speed up the healing process could be used as therapeutic lead molecules in future research into novel drugs. AMPs and amphibian-derived peptides may be endogenous mediators of wound healing and treat non-life-threatening skin and epithelial lesions. Thus, the present article was drafted with to incorporate different peptides used in wound healing, their method of preparation and routes of administration.
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Affiliation(s)
- Trilochan Satapathy
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh, 493111, India
| | - Yugal Kishore
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh, 493111, India
| | - Ravindra Kumar Pandey
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh, 493111, India
| | - Shiv Shankar Shukla
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh, 493111, India
| | - Shiv Kumar Bhardwaj
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh, 493111, India
| | - Beena Gidwani
- Department of Pharmacology, Columbia Institute of Pharmacy, Raipur, Chhattisgarh, 493111, India
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25
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Liao YH, Chu CB, Hui CYR, Li CY, Lin SY, Tseng HC, Wang YJ, Wu J, Yu WW, Chao SC. Taiwanese Dermatological Association (TDA) consensus recommendations for the definition, classification, diagnosis, and management of hidradenitis suppurativa. J Formos Med Assoc 2023:S0929-6646(23)00492-8. [PMID: 38160191 DOI: 10.1016/j.jfma.2023.12.012] [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: 08/08/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful, recurrent, inflamed lesions most commonly occurring in the axillary, inguinal, and anogenital regions. HS can inflict immense physical and psychological impact on patients who suffer from this distressing disease. Management of HS generally requires combining various medical and procedural treatment modalities; however, the disease is often recalcitrant to conventional treatments. In light of recent evidence supporting the effectiveness of biologic agents in the treatment of HS, the Taiwanese Dermatological Association established an expert panel of nine dermatologists to develop consensus statements aimed to provide up-to-date evidence-based guidance in optimizing HS patient management in Taiwan. The recommendations described in the statements were summarized in a management algorithm in terms of general care, topical treatment, systemic treatment, and procedural treatment.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Yao Lin
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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26
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Ingram JR, Bates J, Cannings-John R, Collier F, Gibbons A, Harris C, Hood K, Howells L, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study: the THESEUS prospective cohort study. Health Technol Assess 2023; 27:1-107. [PMID: 38149635 PMCID: PMC11017627 DOI: 10.3310/hwnm2189] [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: 12/28/2023] Open
Abstract
Background Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom. Objective To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials. Design Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop. Setting Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments. Participants Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment. Interventions Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery. Main outcome measures Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness. Results Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study's primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days. Limitations It was not possible to characterise conventional surgery due to a low number of participants. Conclusion The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials. Future work The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment. Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Janine Bates
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Angela Gibbons
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ceri Harris
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Howes
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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27
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Du HX, Hong CX, Yu T. Ertapenem combined with metronidazole for treatment of complex abdominal infections: Efficacy and impact on serum inflammatory indicators and T lymphocyte subsets. Shijie Huaren Xiaohua Zazhi 2023; 31:940-948. [DOI: 10.11569/wcjd.v31.i22.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/27/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Complex intra-abdominal infections (cIAIs), often associated with abdominal trauma, have a complex etiology, are acute and severe, and have a high risk. They are an important cause of death in patients with abdominal trauma. Safe and effective treatment strategies are the factors affecting the prognosis of such patients.
AIM To investigate the efficacy and safey of ertapenem combined with metronidazole in the treatment of cIAIs as well as the impact on serum inflammatory markers and T lymphocyte subsets, recovery status, and treatment costs.
METHODS A total of 92 patients with cIAIs treated at our hospital from June 2021 to January 2023 were randomly divided into a control group and a study group, with 46 cases in each group. After admission, both groups received puncture drainage, continuous double-cannula irrigation, anti-infection therapy, organ function support, nutritional support, and other treatments. On this basis, the control group was treated with piperacillin/tazobactam combined with metronidazole, while the study group was treated with ertapenem combined with metronidazole. The therapeutic effects, recovery conditions, treatment costs, serum inflammatory indicators [procalcitonin (PCT), Toll-like receptor 4 (TLR-4), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP)], T lymphocyte subsets (CD3+, CD4+, and CD4+/CD8+ ratio), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, adverse reactions, and bacterial culture results were compared between the two groups.
RESULTS The total effective rate of the study group was 93.48%, significantly higher than that of the control group (78.26%; P < 0.05). After 3 d and 7 d of treatment, the levels of serum PCT, TLR-4, TNF-α, and CRP in the study group were significantly lower and the levels of serum CD3+ and CD4+ T lymphocytes and CD4+/CD8+ ratio were significantly higher than those of the control group (P < 0.05). The APACHEⅡ score and SOFA score of the study group were significantly lower than those of the control group after 3 d and 7 d of treatment (P < 0.05). The time to fever resolution, ICU stay duration, and hospital stay in the study group were significantly shorter than those of the control group, and the costs of drugs and other resources were less than those of the control group (P < 0.05). The incidence of adverse reactions in the study group was 4.35%, significantly lower than that of the control group (17.39%; P < 0.05). There was no significant difference in the distribution of pathogenic bacteria between the two groups before and after treatment (P > 0.05).
CONCLUSION Ertapenem combined with metronidazole is effective in the treatment of cIAIs, which can reduce inflammation, improve immune function, control disease progression, reduce the risk of organ failure, reduce the economic burden of patients, and improve treatment safety.
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Affiliation(s)
- Hai-Xu Du
- Department of Pharmacy, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Chun-Xia Hong
- Department of Pharmacy, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
| | - Tong Yu
- Department of Pharmacy, Jinhua Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang Province, China
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28
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Wang Y, Han C, Wang X. Advances in surgical treatment of hidradenitis suppurative. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:795-801. [PMID: 37986703 PMCID: PMC10764190 DOI: 10.3724/zdxbyxb-2023-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Hidradenitis suppurative is a chronic, refractory and recurrent dermatological disease. The disease should be managed by targeted surgical intervention on the basis of medical treatment. Currently, the surgical treatment methods include local treatments like incision and drainage, unroofing, laser therapy, intense pulsed light therapy, photodynamic therapy, as well as complete lesion resection such as skin-tissue saving excision with electrosurgical peeling and extended excision. The clearance range, therapeutic effect, postoperative complications, and recurrence risk vary among the different treatment methods. Local treatments cause less damage, but have high recurrence rates, and are mainly for mild to moderate hidradenitis suppurative patients. Complete lesion resections have relatively low recurrence rates, but may bring more surgical injuries, and postoperative reconstructions are needed, which are mainly for moderate to severe hidradenitis suppurative patients. In this article, the surgical treatment principles and various surgical treatment methods of hidradenitis suppurative are reviewed, to provide a reference for the diagnosis and treatment of this disease in clinical practice.
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Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Chunmao Han
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xingang Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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29
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Kashyap MP, Mishra B, Sinha R, Jin L, Kumar N, Goliwas KF, Deshane J, Elewski BE, Elmets CA, Athar M, Shahid Mukhtar M, Raman C. NK and NKT cells in the pathogenesis of Hidradenitis suppurativa: Novel therapeutic strategy through targeting of CD2. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.31.565057. [PMID: 37961206 PMCID: PMC10634971 DOI: 10.1101/2023.10.31.565057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic debilitating inflammatory skin disease with poorly understood pathogenesis. Single-cell RNAseq analysis of HS lesional and healthy individual skins revealed that NKT and NK cell populations were greatly expanded in HS, and they expressed elevated CD2, an activation receptor. Immunohistochemistry analyses confirmed significantly expanded numbers of CD2+ cells distributed throughout HS lesional tissue, and many co-expressed the NK marker, CD56. While CD4+ T cells were expanded in HS, CD8 T cells were rare. CD20+ B cells in HS were localized within tertiary follicle like structures. Immunofluorescence microscopy showed that NK cells (CD2 + CD56 dim ) expressing perforin, granzymes A and B were enriched within the hyperplastic follicular epidermis and tunnels of HS and juxtaposed with apoptotic cells. In contrast, NKT cells (CD2 + CD3 + CD56 bright ) primarily expressed granzyme A and were associated with α-SMA expressing fibroblasts within the fibrotic regions of the hypodermis. Keratinocytes and fibroblasts expressed high levels of CD58 (CD2 ligand) and they interacted with CD2 expressing NKT and NK cells. The NKT/NK maturation and activating cytokines, IL-12, IL-15 and IL-18, were significantly elevated in HS. Inhibition of cognate CD2-CD58 interaction with blocking anti-CD2 mAb in HS skin organotypic cultures resulted in a profound reduction of the inflammatory gene signature and secretion of inflammatory cytokines and chemokines in the culture supernate. In summary, we show that a cellular network of heterogenous NKT and NK cell populations drives inflammation, tunnel formation and fibrosis in the pathogenesis of HS. Furthermore, CD2 blockade is a viable immunotherapeutic approach for the management of HS.
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30
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Martora F, Ruggiero A, Potestio L, Battista T, Megna M. Reply to "Dalbavancin for the treatment of severe hidradenitis suppurativa". J Eur Acad Dermatol Venereol 2023; 37:e1328-e1329. [PMID: 37417387 DOI: 10.1111/jdv.19313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Fabrizio Martora
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luca Potestio
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Teresa Battista
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Matteo Megna
- Section of Dermatology-Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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31
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Chadha SA, Stout MA, Goyal PK, Nguyen CV, Lu KQ. Assessing unmet needs in patients with hidradenitis suppurativa. Arch Dermatol Res 2023; 315:2555-2560. [PMID: 37264285 PMCID: PMC10234229 DOI: 10.1007/s00403-023-02645-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/02/2023] [Accepted: 05/17/2023] [Indexed: 06/03/2023]
Abstract
The diagnosis and management of hidradenitis suppurativa (HS) varies greatly between providers, often resulting in gaps in care including diagnostic delays and poor outcomes. As dermatologists strive to improve HS management, understanding patient perspectives is key. This study aims to characterize existing gaps in HS care as understood through patients' experiences. This study recruited adult patients with a diagnosis of HS seen at dermatology practices affiliated with Northwestern University. Data were collected through participant surveys and three semi-structured focus groups. Focus group meetings were transcribed verbatim and data were abstracted into themes using conventional content analysis. Six final themes were abstracted after review of 20 pages of transcribed conversation. Four themes centered on improved medical management of HS (access to care, disease-modifying therapies, symptom treatment, prevention of treatment-related adverse events). Two themes centered on supportive care (mental health support, specialized daily wear products). Limitations of this study include single-center recruitment and recall bias introduced by the focus group format. This study identifies six unmet needs for patients with HS and highlights the efficacy of a virtual format for research, conversation, and possibly clinical engagement. Moreover, multiple themes underscore the need for further collaboration across specialties in managing HS.
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Affiliation(s)
- Simran A Chadha
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60607, USA.
| | - Molly A Stout
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60607, USA
| | - Parul Kathuria Goyal
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60607, USA
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60607, USA
| | - Kurt Q Lu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60607, USA
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Bellei EA, de Carvalho AVE, Eng BM, Tozato C, de Barros DH, Tamashiro EY, Duarte GV, de Fátima RTR, Magalhães RF, da Silva RS, Cesar WGG, Thies FG. Navigating the Multidimensional Impact of Living with Hidradenitis Suppurativa: An In-Depth Netnographic Study on Social Media Platforms. Dermatol Ther (Heidelb) 2023; 13:2797-2815. [PMID: 37794274 PMCID: PMC10613171 DOI: 10.1007/s13555-023-01032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic skin condition causing considerable distress. It impacts mobility, social interaction, and quality of life. In Brazil, there is a notable gap in epidemiological data and patient experiences regarding HS. METHODS This study, spanning 2019 to 2022, employed netnography to probe the experiences of Brazilian patients with HS. This approach gleans insights from online interactions, offering a direct view into patients' lives. RESULTS Notably, the data illuminated the challenges patients face, such as difficulties in obtaining a diagnosis and the complexities involved in managing a chronic, and often debilitating, condition. Furthermore, patients' experiences with various treatments, encompassing antibiotics, biologic agents, lifestyle alterations, surgical procedures, and alternative remedies, were also examined. CONCLUSION By undertaking a longitudinal analysis of patient interactions, the study aimed to offer a richer understanding of HS, from its diagnosis to its treatment. It underscores the necessity for a more patient-centered approach when managing this condition. We hope that this enhanced understanding can facilitate better care for those affected by HS.
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Affiliation(s)
| | | | | | - Carla Tozato
- Value and Access Division, Novartis, São Paulo, Brazil
| | | | | | | | | | | | - Roberto Souto da Silva
- Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
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Towfighi P, Huffman SS, Bovill JD, Shan HD, Haffner ZK, Kim EY, Slamin R, Benedict CD, Evans KK. Financial toxicity of hidradenitis suppurativa: A single-center experience at an urban wound-care clinic. J Dermatol 2023; 50:1279-1286. [PMID: 37501527 DOI: 10.1111/1346-8138.16868] [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: 03/23/2023] [Revised: 05/12/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023]
Abstract
Hidradenitis suppurativa (HS), is a chronic inflammatory skin disorder that confers a substantial financial burden to patients. The aim of the current study was to assess the patient-reported financial impact of HS. Patients presenting to a wound center between 2010 and 2021 were retrospectively reviewed. Demographics, comorbidities, and disease characteristics were collected. The financial impact of HS was assessed via the Comprehensive Score for Financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST-FACIT) version 2 and investigator-generated surveys. Of 199 patients contacted, 27.1% (n = 54) completed the survey. The majority were women (77.8%, n = 42) and had private health insurance (n = 30; 55.6%). Most patients (66.7%, n = 36) had Hurley stage III disease. Mean follow-up was 2.3 + 2.8 years. The overall COST score was 19.7 + 12.4, indicating grade 1 financial toxicity (FT). Grade 0 FT was reported in 31.5% (n = 17) of patients, grade 1 in 37.0% (n = 20), grade 2 in 27.8% (n = 15), and grade 3 in 3.7% (n = 2). The mean self-reported 12-month out-of-pocket cost and credit scores were $2250 + 3269.24 and 674.6 + 95.3, respectively. Patients with private insurance had lower FT compared with Medicaid and Medicare (p = 0.003). Higher out-of-pocket costs were positively correlated with FT (p = 0.042), while higher credit scores were negatively correlated (p = 0.003). Patients with HS lesions in three or more anatomic regions reported the highest FT (p = 0.031). HS is a debilitating skin disorder that affects the livelihood of patients in a multifaceted manner. These patient-reported outcomes highlight the impact that HS has on an individual's financial security, calling for further attention to this vulnerable population.
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Affiliation(s)
- Parhom Towfighi
- Georgetown University School of Medicine, Washington, DC, USA
| | - Samuel S Huffman
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John D Bovill
- Georgetown University School of Medicine, Washington, DC, USA
| | - Holly D Shan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Zoë K Haffner
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Emily Y Kim
- Georgetown University School of Medicine, Washington, DC, USA
| | - Robert Slamin
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Carol D Benedict
- Department of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Poondru S, Scott K, Riley JM. Electronic Nicotine Dispensing Systems Compared to Traditional Cigarettes in Hidradenitis Suppurativa: A Cross-Sectional Survey of Patient and Dermatologist Perceptions. Skin Appendage Disord 2023; 9:355-360. [PMID: 37900770 PMCID: PMC10601959 DOI: 10.1159/000531079] [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: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 10/31/2023] Open
Abstract
Background Smoking cigarettes can have deleterious effects on hidradenitis suppurativa (HS) disease severity, but little is known about the relationship between vaping electronic nicotine delivery systems (ENDS) and HS severity. Objectives The aim of this study was to determine the rate of ENDS use in those with HS and the perceptions of HS participants and dermatologists on the relationship between vaping and HS. Methods Two separate cross-sectional, anonymous, multiple-choice questionnaires were administered. One questionnaire was distributed to those with HS recruited via online HS-related forums. Inclusion criteria were diagnosis of HS, age 18 and over, and residence in USA. The other questionnaire was distributed to currently practicing, board-certified dermatologists recruited via an email listserv. Results Overall, 302 participants with HS completed the questionnaire. Fifty-six participants (18.5%) smoke cigarettes and 41 participants (13.6%) vape ENDS. One-third of ENDS users (14/41) switched from cigarettes to ENDS after learning of their HS diagnosis, of which 78.6% (11/14) believed that the switch decreased the severity and/or frequency of their HS flares. Fifty dermatologists completed the questionnaire, of whom over half (54%, 27/50) were unsure about the relationship between vaping and HS severity. Conclusions As cigarette smoking and HS are closely linked, the use of ENDS in HS warrants further study.
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Affiliation(s)
- Sneha Poondru
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kourtney Scott
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Julia M Riley
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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López Riquelme I, Fernández Ballesteros MD, Perea Polak A, Serrano Ordoñez A, Martínez Pilar L. Azathioprine in hidradenitis suppurativa with inflammatory phenotype: a case series of 11 patients. Int J Dermatol 2023; 62:1300-1303. [PMID: 37548251 DOI: 10.1111/ijd.16804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 05/30/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that negatively impacts the quality of life of patients. It presents as deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in the axilla, inguinal area, submammary folds, and perianal area. Recently, two phenotypes have been described: a follicular phenotype and an inflammatory phenotype. Numerous medical treatments are available for hidradenitis suppurativa, with particular importance of antitumor necrosis factor antibodies. Due to the association of HS with other conditions with a pro-inflammatory state, particularly Crohn's disease, it has been suggested that azathioprine may have a role in the treatment of HS. OBJECTIVE To assess the effectiveness of azathioprine monotherapy in patients with moderate-severe HS. METHODS We retrospectively studied patients with HS treated with azathioprine in monotherapy. We performed both clinical and ultrasound evaluation at baseline as well as in the follow-up visits. Their baseline score on the iHS4 and DLQI scales and 12-16 weeks after starting the treatment were compared. We also registered the number of patients who achieved HiSCR. RESULTS Six patients presented significant improvement, reducing their score in iHS4 and DLQI scales and achieving HiSCR. Another patient had clinical improvement, meaning reduction in iHS4 and DLQI, but without achieving HiSCR. Two patients stopped the treatment before week 12 because of adverse events. The remaining two patients presented no improvement. The median (Q3-Q1) baseline iHS4 score was 6 (12-6), and follow-up iHS4 score, 4 (6-2), being these differences statistically significant (P = 0.006). Median (Q3-Q1) baseline DLQI scores and 12-16 weeks after treatment were 17 (23-11) and 14 (18-9) although statistically nonsignificant (P = 0.099). CONCLUSION We present a case series of 11 patients treated with azathioprine with good clinical and ultrasonographic response. We suggest that azathioprine may benefit a certain patient profile with the inflammatory phenotype.
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Affiliation(s)
- Irene López Riquelme
- Dermatology Department, Hospital Regional Universitario de Málaga, Malaga, Spain
| | | | | | - Ana Serrano Ordoñez
- Dermatology Department, Hospital Regional Universitario de Málaga, Malaga, Spain
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Martora F, Scalvenzi M, Battista T, Fornaro L, Potestio L, Ruggiero A, Megna M. Guselkumab, Risankizumab, and Tildrakizumab in the Management of Hidradenitis Suppurativa: A Review of Existing Trials and Real-Life Data. Clin Cosmet Investig Dermatol 2023; 16:2525-2536. [PMID: 37745273 PMCID: PMC10516125 DOI: 10.2147/ccid.s418748] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023]
Abstract
The treatment of hidradenitis suppurativa (HS) has always been a real challenge for dermatologists; to date, the only biologic drugs approved for HS are adalimumab, an anti-tumor necrosis factor (TNF)-α drug, authorized in 2015, and secukinumab, recently licensed. The management of this condition is challenging as the available treatments show variable results, and the course of the condition is often chronic-recurrent; therefore, it will be necessary for the future to identify new therapeutic targets for HS. In recent years, studies have focused on the development towards new therapeutic targets. The purpose of our review was to perform a comprehensive literature review of real-life data on anti-IL23 (guselkumab, tildrakizumab, and risankizumab) in HS to summarize the existing evidence on the efficacy and safety of these drugs. We selected 64 articles, among which 32 had the characteristics that we were looking for in our review. To date, the positive data expressed in real-life experiences contrast with the three existing Phase 2 studies conducted so far, where it seems that these drugs may be useful only for a subgroup of patients with HS whose features need to be elucidated. Data from Phase 3 studies and other real-life experiences, perhaps more detailed and with higher numbers, will certainly be needed to fully understand the efficacy and safety of this class of drugs.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Battista
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Fornaro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Nowak-Liduk A, Kitala D, Ochała-Gierek G, Łabuś W, Bergler-Czop B, Pietrauszka K, Niemiec P, Szyluk K, Gierek M. Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery-Pathogenesis, Comorbidities, and Current Treatments. Life (Basel) 2023; 13:1895. [PMID: 37763299 PMCID: PMC10532726 DOI: 10.3390/life13091895] [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: 07/19/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory disease that manifests as painful nodules, abscesses, draining dermal tunnels, and scarring in intertriginous areas such as the axillae, groin, and breasts. The nature of the disease and its chronicity have a destructive impact on mental health and quality of life. HS has an estimated global prevalence of 0.00033-4.1% and it disproportionately affects females compared to males. HS involving the female anogenital regions is reported rarely in the gynecological literature, and it can often be mistaken for other vulvar diseases. The distinct phenotypes and HS rarity cause delayed diagnosis and the implementation of effective treatment. Acne inversa is associated with several comorbidities, including metabolic disease, diabetes mellitus, inflammatory bowel diseases, and spondyloarthropathies. Although HS etiology and pathogenesis remain unclear, studies have shown that lifestyle, immunological processes, genetics, and hormonal predispositions may promote follicular hyperkeratosis, dilatation, and rupture, leading to the development of chronic tissue inflammation. This article provides updated information on HS pathogenesis, comorbidities, and treatment methods. Furthermore, we share our experience in the surgical treatment of the disease, which often proves most effective, and highlight that an interdisciplinary management approach ensures optimal outcomes.
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Affiliation(s)
- Agnieszka Nowak-Liduk
- Department of Perinatology, Gynaecology and Obstetrics, General Hospital in Ruda Śląska, Wincentego Lipa Street 2, 41-703 Ruda Śląska, Poland;
| | - Diana Kitala
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| | - Gabriela Ochała-Gierek
- Department of Dermatology and Venerology, City Hospital in Sosnowiec, Zegadlowicza Street 3, 41-200 Sosnowiec, Poland;
| | - Wojciech Łabuś
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| | - Beata Bergler-Czop
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street 20-24, 40-027 Katowice, Poland; (B.B.-C.); (K.P.)
| | - Kornelia Pietrauszka
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street 20-24, 40-027 Katowice, Poland; (B.B.-C.); (K.P.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Street 18, 40-752 Katowice, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Street, 41-940 Piekary Slaskie, Poland
| | - Marcin Gierek
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
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Yamanaka-Takaichi M, Revankar R, Shih T, Gall M, Hsiao JL, Shi VY, Alavi A. Expert consensus on priority research gaps in dietary and lifestyle factors in hidradenitis suppurativa: a Delphi consensus study. Arch Dermatol Res 2023; 315:2129-2136. [PMID: 36951970 DOI: 10.1007/s00403-023-02610-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Hidradenitis suppurativa (HS) is a debilitating systemic inflammatory disease with limited treatment options. Although management through dietary and lifestyle changes is a primary interest of the HS patient community, there is lack of consensus regarding recommendations due to the paucity of evidence. To establish the priority research gaps on this topic, we performed and moderated a Delphi consensus study by integrating expert opinions and the relevant literature. Based on a literature review, research questions on dietary and lifestyle interventions in HS were constructed. HS dietary and lifestyle research questions were sent to an expert panel, consisting of 22 international members, including dermatologists, dietitians, pharmacists, and endocrinologists. Voting on the research questions was conducted using a modified Delphi technique. The primary outcome measure was whether participants could reach consensus on the priority of each research question in the HS dietary and lifestyle factors. After three rounds of surveys investigating the relationships between HS and various diet and lifestyle factors, "BMI", "Obesity", and "Smoking", reached consensus as high priority research questions. Low research priorities per consensus included "effects of iron supplements", "effects of magnesium supplements", "alcohol consumption" and "limiting Brewer's yeast intake. Smoking and obesity were identified as important research questions, concurrent to the literature indicating their association with more significant impact on disease activity. By shedding light on high priority research questions, our study provides a roadmap for further research on dietary and lifestyle modifications in HS and will help determine evidence-based lifestyle and dietary recommendations for patients with HS.
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Affiliation(s)
| | - Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Schukow C, Townsend C, Jess N, Daveluy S. Identifying Barriers to Developing Expertise in Hidradenitis Suppurativa. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:38-40. [PMID: 37720198 PMCID: PMC10503938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of hair-bearing intertriginous areas with a profound impact on quality of life. Objective We sought to determine what barriers to treatment exist among both HS experts and non-experts. Methods An IRB-approved, anonymous, voluntary survey was distributed to dermatologists through the HS Foundation listserv from June to September 2021. Results Eighty-eight total responses were collected from 49 (55.7%) experts and 39 (44.3%) non-experts. Statistically significant differences were found in the comfort level of treating moderate (p=0.0001) to severe (p<0.0001) disease between experts and non-experts, as well as interest in treating moderate (p=0.0001) and severe (p<0.0001) disease. Multiple barriers to developing expertise were identified (e.g., access to necessary equipment). HS experts also indicated higher levels of knowledge and experience than non-experts with several medical treatments (e.g., IV Ertapenem, p<0.0001). Limitations We were unable to calculate response rate since listserv survey recipients were encouraged to share the survey through their personal networks. Conclusion This data demonstrates statistically significant differences in levels of comfort and interest between experts and non-experts in treating moderate to severe disease, as well as differences in medical therapies utilized. Furthermore, multiple barriers to expertise were identified by both experts and non-experts.
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Affiliation(s)
- Casey Schukow
- Dr. Schukow is with the Department of Pathology at Corewell Health in Royal Oak, Michigan
| | - Clare Townsend
- Dr. Townsend is with the Boston Medical Center in Boston, Massachusetts
| | - Nicole Jess
- Ms. Jess is with Michigan State University in East Lansing, Michigan
| | - Steven Daveluy
- Dr. Daveluy is with the Department of Dermatology at Wayne State University in Detroit, Michigan
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Saunte DML, Jemec GBE. Laser and intense pulsed light in the treatment of hidradenitis suppurativa. Clin Dermatol 2023; 41:628-638. [PMID: 37659574 DOI: 10.1016/j.clindermatol.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
Treatment of hidradenitis suppurativa (HS) requires a combination of medical, surgical, and lifestyle interventions. Intense pulsed light (IPL) and lasers have been reported to be useful. The aim of this review is to find the evidence supporting IPL and laser treatment of HS and to provide guidance for the management of specific HS lesions. We searched PubMed and Web of Science for "laser" and "hidradenitis suppurativa" on April 6, 2022. Inclusion criteria were >10 patients, reported follow-up, English language, and human subjects with a diagnosis of HS. A total of 724 articles were screened, but only 17 studies qualified for inclusion (IPL (n = 4), Nd:YAG (n = 6), CO2 laser (n = 6), and intralesional treatment (n = 2). The majority of the studies had a low (n = 10) or moderate (n = 7) evidence level. Treatment effect was noticed in studies using IPL and Nd:YAG (hair reduction). CO2 laser was used for surgery with a success rate ranging from 70.7% to 96.7%. CO2 laser is useful for surgery of stationary HS lesions, but it is difficult to draw a conclusion on the use of IPL and Nd:YAG (hair reduction) as the studies were too heterogeneous to perform a meta-analysis.
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Affiliation(s)
- Ditte Marie L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark
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Sun Q, Broadaway KA, Edmiston SN, Fajgenbaum K, Miller-Fleming T, Westerkam LL, Melendez-Gonzalez M, Bui H, Blum FR, Levitt B, Lin L, Hao H, Harris KM, Liu Z, Thomas NE, Cox NJ, Li Y, Mohlke KL, Sayed CJ. Genetic Variants Associated With Hidradenitis Suppurativa. JAMA Dermatol 2023; 159:930-938. [PMID: 37494057 PMCID: PMC10372759 DOI: 10.1001/jamadermatol.2023.2217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
Importance Hidradenitis suppurativa (HS) is a common and severely morbid chronic inflammatory skin disease that is reported to be highly heritable. However, the genetic understanding of HS is insufficient, and limited genome-wide association studies (GWASs) have been performed for HS, which have not identified significant risk loci. Objective To identify genetic variants associated with HS and to shed light on the underlying genes and genetic mechanisms. Design, Setting, and Participants This genetic association study recruited 753 patients with HS in the HS Program for Research and Care Excellence (HS ProCARE) at the University of North Carolina Department of Dermatology from August 2018 to July 2021. A GWAS was performed for 720 patients (after quality control) with controls from the Add Health study and then meta-analyzed with 2 large biobanks, UK Biobank (247 cases) and FinnGen (673 cases). Variants at 3 loci were tested for replication in the BioVU biobank (290 cases). Data analysis was performed from September 2021 to December 2022. Main Outcomes and Measures Main outcome measures are loci identified, with association of P < 1 × 10-8 considered significant. Results A total of 753 patients were recruited, with 720 included in the analysis. Mean (SD) age at symptom onset was 20.3 (10.57) years and at enrollment was 35.3 (13.52) years; 360 (50.0%) patients were Black, and 575 (79.7%) were female. In a meta-analysis of the 4 studies, 2 HS-associated loci were identified and replicated, with lead variants rs10512572 (P = 2.3 × 10-11) and rs17090189 (P = 2.1 × 10-8) near the SOX9 and KLF5 genes, respectively. Variants at these loci are located in enhancer regulatory elements detected in skin tissue. Conclusions and Relevance In this genetic association study, common variants associated with HS located near the SOX9 and KLF5 genes were associated with risk of HS. These or other nearby genes may be associated with genetic risk of disease and the development of clinical features, such as cysts, comedones, and inflammatory tunnels, that are unique to HS. New insights into disease pathogenesis related to these genes may help predict disease progression and novel treatment approaches in the future.
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Affiliation(s)
- Quan Sun
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | | | - Sharon N. Edmiston
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Kristen Fajgenbaum
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Tyne Miller-Fleming
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linnea Lackstrom Westerkam
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- University of North Carolina at Chapel Hill School of Medicine
| | | | - Helen Bui
- Department of Internal Medicine, University of North Carolina at Chapel Hill School of Medicine
| | | | - Brandt Levitt
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Lan Lin
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Honglin Hao
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill
- Sociology Department, University of North Carolina at Chapel Hill
| | - Zhi Liu
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Nancy E. Thomas
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
- Carolina Population Center, University of North Carolina at Chapel Hill
| | - Nancy J. Cox
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yun Li
- Department of Biostatistics, University of North Carolina at Chapel Hill
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Karen L. Mohlke
- Department of Genetics, University of North Carolina at Chapel Hill
| | - Christopher J. Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine
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Poondru S, Scott K, Riley JM. Patient perspectives of wound care management in hidradenitis suppurativa. Arch Dermatol Res 2023; 315:1847-1850. [PMID: 36811730 DOI: 10.1007/s00403-023-02576-8] [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: 01/09/2023] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
Wound care management and costs in hidradenitis suppurativa (HS) are unmet needs. This study explored patient perspectives of at-home management of acute flares of HS and chronic daily wounds, their satisfaction with current wound care methods, and the financial burden of wound care supplies. An anonymous, multiple choice, cross-sectional questionnaire was distributed among online HS-related forums between August and October 2022. Participants 18 years or older with a diagnosis of HS who live in the United States were included. In total, 302 participants completed the questionnaire: 168 White (55.6%), 76 Black (25.2%), 33 Hispanic (10.9%), 7 Asian (2.3%), 12 multiracial (4.0%), and 6 other (2.0%). Dressings commonly reported included gauze, panty liners or menstrual pads, tissues or toilet paper, antiseptic dressing, abdominal pads, and adhesive bandages. Commonly reported topical remedies for acute flares of HS included warm compresses, Epsom salt baths, Vicks VapoRub, tea tree oil, witch hazel, and bleach baths. One-third of participants (n = 102) reported dissatisfaction with current wound care methods, and 48.8% (n = 103) believed that their dermatologist does not meet their wound care needs. Nearly half (n = 135) reported being unable to afford the type and quantity of dressings and wound care supplies they would ideally want. Black participants were more likely than White participants to report being unable to afford their dressings and find the cost as very burdensome. Overall, dermatologists must improve patient education of wound care methods in HS and address the financial burden of wound care supplies by exploring insurance-funded options.
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Affiliation(s)
- Sneha Poondru
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA
| | - Kourtney Scott
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA
| | - Julia M Riley
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St Ste 1600, Chicago, IL, 60611, USA.
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Lipa K, Zając N, Witkowski² G, Ciechanowicz P, Wiszniewski K, Szymańska E, Walecka I. Hidradenitis suppurativa - biologic therapy and other available treatment options. Postepy Dermatol Alergol 2023; 40:518-528. [PMID: 37692279 PMCID: PMC10485753 DOI: 10.5114/ada.2021.112075] [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: 07/19/2021] [Accepted: 10/13/2021] [Indexed: 09/12/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease which is characterized by painful, recurrent nodules and abscesses. The overall prevalence of HS is estimated to be 11 per 100 000 individuals in the United States and 4% of the world's population. Women are three times more affected than men, especially patients between 18 and 29 years. Similarly to acne vulgaris, HS is primarily associated with follicular occlusion, which results from a number of biological processes, including follicular epithelial hyperplasia and hyperkeratinization. There are numerous available treatment options for cutaneous lesions in the course of HS. A combination of conservative therapy and appropriate surgical treatment conducted by an experienced surgeon ensures the best possible clinical outcomes. Presently, biologic therapy is the most effective pharmacological treatment in patients with a moderate-to-severe course of the disease. Numerous ongoing clinical trials provide hope for greater availability of new biologic therapy methods.
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Affiliation(s)
- Katarzyna Lipa
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Natalia Zając
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Grzegorz Witkowski²
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
- Department of Gastroenterological Surgery and Transplantation Medicine, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Piotr Ciechanowicz
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Kacper Wiszniewski
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Elżbieta Szymańska
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Irena Walecka
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
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Revankar R, Rojas M, Walsh S, Patel H, Revankar N, Han J, Parameswaran A. Anemia in patients with hidradenitis suppurativa : A systematic review with meta-analysis. Arch Dermatol Res 2023; 315:1639-1648. [PMID: 36781458 DOI: 10.1007/s00403-023-02559-9] [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: 11/02/2022] [Revised: 11/02/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
IMPORTANCE Hidradenitis suppurativa (HS) is associated with a number of physical and psychological comorbidities. Studies have suggested an association between HS and anemia; however, this association is not widely understood and may result in delayed diagnosis and treatment and possible increase in morbidity and mortality. OBJECTIVE To systematically review and perform a meta-analysis regarding the association between HS and anemia, and to characterize the subtypes of anemia associated with HS. DATA SOURCES A search of the EMBASE, Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from the time of database inception to September 25, 2022, yielded 313 unique articles. STUDY SELECTION All observational studies and randomized controlled trials published in English that examined the odds ratio (OR) of anemia in patients with HS were screened by 2 independent reviewers. Case reports were excluded. Among 313 unique articles, 7 were deemed eligible. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines facilitated data extraction. The Newcastle-Ottawa Scale (NOS) was used to analyze risk of bias of included studies. In addition to OR and 95% confidence intervals, relevant data on patient demographics and anemia subtypes were also extracted. MAIN OUTCOMES AND MEASURES The primary outcome was the OR of anemia in HS patients. This study also attempted to characterize anemia subtypes associated with HS. RESULTS In total, 2 case-control and 5 cross-sectional studies featured a total of 11,693 patients. Among the studies, 4 of 7 demonstrated a statistically significant positive association between anemia and HS (ORs, 2.20 [1.42-3.41], 2.33 [1.99-2.73], 1.87 [1.02-3.44], and 1.50 [1.43-1.57]), with macrocytic and microcytic subtypes being most common. After adjusting for publication bias, meta-analysis with random effects revealed HS to be associated with increased odds of anemia compared to non-HS groups (OR 1.59 [1.19, 2.11]). CONCLUSIONS AND RELEVANCE There is a statistically significant positive association between HS and anemia, particularly for the aforementioned subtypes. Patients with HS should be screened for anemia. In case of lower hemoglobin concentration, the anemia of HS patients should be subdivided according to mean corpuscular volume of the red blood cells and further investigated depending on subtype.
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Affiliation(s)
- Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA.
| | - Mary Rojas
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA
| | - Heli Patel
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nikita Revankar
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Joseph Han
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA
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Rathod U, Prasad PN, Patel BM, Patel B, Patel C, Gandhi SK, Patel P. Hidradenitis Suppurativa: A Literature Review Comparing Current Therapeutic Modalities. Cureus 2023; 15:e43695. [PMID: 37724217 PMCID: PMC10505353 DOI: 10.7759/cureus.43695] [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] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a disease with a poor prognosis, often misinterpreted as an infection, with the highest impact on the patient's quality of life among all the assessed dermatological diseases. The main aim of this study was to compare various therapeutic interventions that are currently available for the treatment of HS. The pathogenesis of HS is not well understood, but it is mostly multifactorial involving a number of factors like genetic factors, androgens, local immunity, microflora, smoking, and obesity. Despite limited evidence on their effectiveness, topical antibiotics and antiseptics are commonly employed. Due to the colonization of bacteria and the presence of biofilms in the sinus tracts formed by HS lesions, systemic antibiotics are commonly employed as the primary form of therapy. In females with HS who experience menstrual flares or display symptoms of polycystic ovary syndrome, hormonal agents are often considered to be a viable and effective therapeutic option. At present, the sole treatment approved by both the Food and Drug Administration and the European Medicines Agency for addressing moderate to severe HS is adalimumab, an antibody that targets tumor necrosis factor alpha. Many surgical procedures in the management of HS aim to address inflammation by eliminating the affected folliculo-pilosebaceous unit, sinus tracts, and associated debris to impede further progression and scarring. HS continues to pose a considerable treatment challenge, necessitating a comprehensive approach for patients. However, the available evidence for most of these treatments is limited, indicating the need for more extensive research to identify the most effective interventions for managing HS.
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Affiliation(s)
- Urvashi Rathod
- Department of Internal Medicine, Narendra Modi Medical College, Ahmedabad, IND
| | - Pooja N Prasad
- Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | | | - Brinda Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Sola, Ahmedabad, IND
| | - Chintankumar Patel
- Department of Internal Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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Almuhanna N, Tobe SW, Alhusayen R. Risk of Chronic Kidney Disease in Hospitalized Patients with Hidradenitis Suppurativa. Dermatology 2023; 239:912-918. [PMID: 37487485 DOI: 10.1159/000531960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is associated with several comorbidities such as diabetes mellitus and cardiovascular diseases. These comorbidities are also risk factors for chronic kidney disease (CKD), yet little is known about the risk of CKD in HS patients. OBJECTIVES The objective was to study the prevalence of CKD in HS patients. METHODS Cross-sectional population-based study using the United States National Inpatient Sample database between January 1, 2002 and December 31, 2012 was performed. RESULTS We identified 23,767 hospital admissions for HS patients and 95,068 admissions for age- and gender-matched controls. The prevalence of CKD in HS patients was 6.3% (1,497/23,767) compared to non-HS controls which was 4.3% (4,052/95,068). The association of CKD was strongest in HS patients, who were ≥60 years old, 16.9% (475/2,811), male 7.3% (695/9,556), obese 7.8% (407/5,209), diabetic 12.5% (890/7,105), hyperlipidemic 13.3% (416/3,126), and had cardiovascular diseases 12.5% (631/5,045). The crude odds ratio of CKD in HS patients was 1.5 (95% CI: 1.420-1.605) compared to non-HS patients. The association remained significant after adjusting for important covariates with adjusted odds ratio of CKD in HS patients of 1.1 (95% CI: 1.014-1.176) compared to non-HS patients. CONCLUSIONS Our findings show that there is a possible association of HS with CKD. Any signs of CKD should be assessed by a nephrologist as early diagnosis can hopefully prevent further progression.
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Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Snyder CL, Chen SX, Porter ML. Obstacles to Early Diagnosis and Treatment of Hidradenitis Suppurativa: Current Perspectives on Improving Clinical Management. Clin Cosmet Investig Dermatol 2023; 16:1833-1841. [PMID: 37483473 PMCID: PMC10361090 DOI: 10.2147/ccid.s301794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can progress to significant tunnels and scars that affect quality of life, especially if diagnosis and treatment are delayed. Average delay after initial presentation of HS symptoms can range from 3 to 10 years in adults and 1 to 2 years in children. Factors associated with diagnostic delay include female gender, non-white race, and greater disease severity at diagnosis. Contributing factors include misdiagnoses, difficulty accessing a dermatologist, hesitation in seeking care due to the stigmatizing nature of the disease, and lack of awareness among providers and patients. While efforts to increase awareness include academic talks at conferences and by foundations geared toward HS, social media offers the opportunity to reach young audiences. Many patients report dissatisfaction with their HS treatments. Better understanding of HS pathophysiology and implementation of clinically focused phenotypes and endotypes can lead to development of more targeted and efficacious therapies. FDA approval of medications for HS beyond adalimumab will increase access to a wider selection of therapies, and implementation of therapeutic drug monitoring may maximize the use of biologics for HS.
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Affiliation(s)
- Corey L Snyder
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Stella X Chen
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Harvard Combined Dermatology Residency Program, Boston, MA, USA
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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48
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Abstract
Hidradenitis suppurativa (HS) is a chronic disease characterized by recurrent painful abscesses and chronic sinus tracts in intertriginous areas. In the United States, HS disproportionally affects adults of African-American heritage. Depending on the severity of disease, the consequences of HS can be far-reaching, significantly affecting mental health and quality of life. In recent years, concerted research efforts have been made to better understand the pathophysiology of the disease as well as identify emerging new treatment targets. Herein, we discuss the clinical presentation, diagnostic criteria, and treatment approach of HS with a focus on skin of color.
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Affiliation(s)
- Toni Jenkins
- Howard University College of Medicine, 520 West Street NW, Washington, DC 20059, USA
| | - Jahdonna Isaac
- Department of Dermatology, Howard University, 2041 Georgia Avenue NW, Towers Suite 4300, Washington, DC 20060, USA
| | - Alicia Edwards
- Howard University College of Medicine, 520 West Street NW, Washington, DC 20059, USA
| | - Ginette A Okoye
- Department of Dermatology, Howard University, 2041 Georgia Avenue NW, Towers Suite 4300, Washington, DC 20060, USA.
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49
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Raileanu M, Borlan R, Campu A, Janosi L, Turcu I, Focsan M, Bacalum M. No country for old antibiotics! Antimicrobial peptides (AMPs) as next-generation treatment for skin and soft tissue infection. Int J Pharm 2023:123169. [PMID: 37356506 DOI: 10.1016/j.ijpharm.2023.123169] [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: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Abstract
In recent years, the unprecedented rise of bacterial antibiotic resistance together with the lack of adequate therapies have made the treatment of skin infections and chronic wounds challenging, urging the scientific community to focus on the development of new and more efficient treatment strategies. In this context, there is a growing interest in the use of natural molecules with antimicrobial features, capable of supporting wound healing i.e., antimicrobial peptides (AMPs), for the treatment of skin and soft tissue infections. In this review, we give a short overview of the bacterial skin infections as well as some of the classic treatments used for topical application. We then summarize the AMPs classes, stressing the importance of the appropriate selection of the peptides based on their characteristics and physicochemical properties in order to maximize the antibacterial efficacy of the therapeutic systems against multi-drug resistant pathogens. Additionally, the present paper provides a comprehensive and rigorous assessment of the latest clinical trials investigating the efficacy of AMPs in the treatment of skin and soft tissue infections, highlighting the relevant outcomes. Seeking to obtain novel and improved compounds with synergistic activity, while also decreasing some of the known side effects of AMPs, we present two employed strategies using AMPs: (i) AMPs-conjugated nanosystems for systemic and topical drug delivery systems and (ii) antibiotics-peptide conjugates as a strategy to overcome antibiotics resistance. Finally, an important property of some of the AMPs used in wound treatment is highlighted: their ability to help in wound healing by generally promoting cell proliferation and migration, and in some cases re-epithelialization and angiogenesis among others. Thus, as the pursuit of improvement is an ongoing effort, this work presents the advances made in the treatment of skin and soft tissue infections along with their advantages and limitations, while the still remaining challenges are addressed by providing future prospects and strategies to overcome them.
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Affiliation(s)
- Mina Raileanu
- Department of Life and Environmental Physics, Horia Hulubei National Institute for Physics and Nuclear Engineering, Reactorului 30, Măgurele 077125, Romania
| | - Raluca Borlan
- Nanobiophotonics and Laser Microspectroscopy Center, Interdisciplinary Research Institute in Bio-Nano-Sciences, Babes-Bolyai University, Treboniu Laurian No. 42, 400271 Cluj-Napoca, Romania
| | - Andreea Campu
- Nanobiophotonics and Laser Microspectroscopy Center, Interdisciplinary Research Institute in Bio-Nano-Sciences, Babes-Bolyai University, Treboniu Laurian No. 42, 400271 Cluj-Napoca, Romania
| | - Lorant Janosi
- Molecular and Biomolecular Physics Department, National Institute for Research and Development of Isotopic and Molecular Technologies, 65-103 Donath Street, 400293 Cluj-Napoca, Romania
| | - Ioan Turcu
- Molecular and Biomolecular Physics Department, National Institute for Research and Development of Isotopic and Molecular Technologies, 65-103 Donath Street, 400293 Cluj-Napoca, Romania
| | - Monica Focsan
- Nanobiophotonics and Laser Microspectroscopy Center, Interdisciplinary Research Institute in Bio-Nano-Sciences, Babes-Bolyai University, Treboniu Laurian No. 42, 400271 Cluj-Napoca, Romania.
| | - Mihaela Bacalum
- Department of Life and Environmental Physics, Horia Hulubei National Institute for Physics and Nuclear Engineering, Reactorului 30, Măgurele 077125, Romania.
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50
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Roy T, Boateng ST, Uddin MB, Banang-Mbeumi S, Yadav RK, Bock CR, Folahan JT, Siwe-Noundou X, Walker AL, King JA, Buerger C, Huang S, Chamcheu JC. The PI3K-Akt-mTOR and Associated Signaling Pathways as Molecular Drivers of Immune-Mediated Inflammatory Skin Diseases: Update on Therapeutic Strategy Using Natural and Synthetic Compounds. Cells 2023; 12:1671. [PMID: 37371141 PMCID: PMC10297376 DOI: 10.3390/cells12121671] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
The dysregulated phosphatidylinositol-3-kinase (PI3K)-Akt-mammalian target of rapamycin (mTOR) signaling pathway has been implicated in various immune-mediated inflammatory and hyperproliferative dermatoses such as acne, atopic dermatitis, alopecia, psoriasis, wounds, and vitiligo, and is associated with poor treatment outcomes. Improved comprehension of the consequences of the dysregulated PI3K/Akt/mTOR pathway in patients with inflammatory dermatoses has resulted in the development of novel therapeutic approaches. Nonetheless, more studies are necessary to validate the regulatory role of this pathway and to create more effective preventive and treatment methods for a wide range of inflammatory skin diseases. Several studies have revealed that certain natural products and synthetic compounds can obstruct the expression/activity of PI3K/Akt/mTOR, underscoring their potential in managing common and persistent skin inflammatory disorders. This review summarizes recent advances in understanding the role of the activated PI3K/Akt/mTOR pathway and associated components in immune-mediated inflammatory dermatoses and discusses the potential of bioactive natural products, synthetic scaffolds, and biologic agents in their prevention and treatment. However, further research is necessary to validate the regulatory role of this pathway and develop more effective therapies for inflammatory skin disorders.
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Affiliation(s)
- Tithi Roy
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
| | - Samuel T. Boateng
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
| | - Mohammad B. Uddin
- Department of Toxicology and Cancer Biology, Center for Research on Environmental Diseases, College of Medicine, University of Kentucky, Lexington, KY 40536, USA;
| | - Sergette Banang-Mbeumi
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
- Division for Research and Innovation, POHOFI Inc., Madison, WI 53744, USA
- School of Nursing and Allied Health Sciences, Louisiana Delta Community College, Monroe, LA 71203, USA
| | - Rajesh K. Yadav
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
| | - Chelsea R. Bock
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
| | - Joy T. Folahan
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
| | - Xavier Siwe-Noundou
- Department of Pharmaceutical Sciences, School of Pharmacy, Sefako Makgatho Health Sciences University, P.O. Box 218, Pretoria 0208, South Africa;
| | - Anthony L. Walker
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
| | - Judy A. King
- Department of Pathology and Translational Pathobiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA;
- College of Medicine, Belmont University, 900 Belmont Boulevard, Nashville, TN 37212, USA
| | - Claudia Buerger
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, 60590 Frankfurt am Main, Germany;
| | - Shile Huang
- Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA;
- Department of Hematology and Oncology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA 71130, USA
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA
| | - Jean Christopher Chamcheu
- School of Basic Pharmaceutical and Toxicological Sciences, College of Pharmacy, University of Louisiana at Monroe, Monroe, LA 71209, USA; (T.R.); (S.T.B.); (S.B.-M.); (R.K.Y.); (C.R.B.); (J.T.F.); (A.L.W.)
- Department of Pathology and Translational Pathobiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, USA;
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