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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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Ingram JR, Geissbühler Y, Darcy J, Foley S, Gaffney A, McConnon A, Richardson C, Garg A. Comprehensive Codified Algorithms to Identify the Underestimated Burden of Hidradenitis Suppurativa in the United States. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01259-0. [PMID: 39316357 DOI: 10.1007/s13555-024-01259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a painful, inflammatory skin disease associated with a high disease burden and long diagnostic delay. Prevalence estimates of HS vary widely in the literature owing to differing estimation methodologies. This study aimed to apply stepwise algorithms to estimate the prevalence of possible/diagnosed cases of HS in the US. METHODS This was a retrospective cohort study in adult and pediatric patients with HS which utilized data from four US databases (MarketScan [Medicare and Medicaid] and Optum [electronic health record (EHR) and Clinformatics Data Mart (CDM)]). Patients with possible/diagnosed HS were identified using two algorithms (termed Algorithm 1 and Algorithm 2), which assessed symptoms such as multiple skin boils in site-specific areas based on international classification of disease (ICD) codes. Patients with diagnosed HS were defined as having ≥ 2 outpatient or ≥ 1 inpatient diagnosis codes of HS. In each database, patients with continuous medical and pharmacy benefits in the 365 days pre-index and 0-365 days post-index periods were eligible for inclusion. RESULTS Across all databases, Algorithm 2 (MarketScan Medicare [N = 309,916]; MarketScan Medicaid [N = 188,783]; Optum EHR [N = 366,158]; Optum CDM [N = 173,812]) identified more patients with possible/diagnosed HS than Algorithm 1 (MarketScan Medicare [N = 194,353]; MarketScan Medicaid [N = 99,276]; Optum EHR [N = 177,957]; Optum CDM [N = 112,244]). Based on ICD-9/10 codes, the 5-year period prevalence of HS ranged from 0.06% to 0.12% across all databases, while for Algorithm 1 and Algorithm 2, this ranged from 0.27% to 0.41% and 0.49% to 0.78%, respectively. Adults and females generally had a higher 5-year period prevalence versus pediatric patients and males, respectively. CONCLUSION This real-world study highlights that HS diagnosis codes alone may be insufficient to estimate the prevalence of HS, demonstrating the value of employing algorithms in practice which assess for parameters such as multiple skin boils in site-specific areas. Integrating robust methods to identify the prevalence of HS may improve the diagnostic delay observed in HS and improve treatment outcomes.
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Affiliation(s)
- John R Ingram
- Department of Dermatology and Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK.
| | | | - John Darcy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, US
| | | | | | | | | | - Amit Garg
- Northwell Health, New Hyde Park, NY, US
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3
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Raudonis T, Šakaitytė A, Vileikis TP, Černel V, Gancevičiene R, Zouboulis CC. Demographic Data, Risk Factors, and Disease Burden of HS Patients in Lithuania at a Reference Center. Healthcare (Basel) 2024; 12:1849. [PMID: 39337190 PMCID: PMC11431364 DOI: 10.3390/healthcare12181849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 09/08/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) diagnosis often faces a global delay of 7.2 years due to factors like lack of recognition, stigma, and socioeconomic barriers. Limited effective therapies and frequent exacerbations impact patients' quality of life, posing a significant burden on healthcare systems. METHODS HS patients were assessed according to European Hidradenitis Suppurativa Foundation (EHSF) Registry questionnaire guidelines at various stages of the disease and treatment. RESULTS The study included 49 patients; 57.14% (n = 28) of them were male. The average age of the subjects was 39.91 ± 13.665 years; the average BMI was 27.84 ± 7.362. A total of 59.18% (n = 29) were active or previous smokers. There were statistically more male smokers than female (p < 0.01). Average disease onset was 25.71 ± 13.743 years; the mean time to diagnosis was 5.2 ± 7.607 years. A total of 70.2% (n = 33) were previously misdiagnosed. Subjects had 6.17 ± 6.98 painful days over the preceding 4 weeks. The average intensity of pain according to the visual analogue scale (VAS) was 5.60 ± 3.36 points. The mean dermatology life quality index (DLQI) at baseline was 8.9 ± 7.436. CONCLUSIONS The research revealed delayed diagnoses, especially for females. Smoking was linked to higher Hurley stages, with a prevalence among male smokers, and HS had a substantial impact on patients' quality of life.
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Affiliation(s)
- Tadas Raudonis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Austėja Šakaitytė
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
| | - Tomas Petras Vileikis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
| | - Vitalij Černel
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania;
| | - Rūta Gancevičiene
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
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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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5
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Hayama K, Okazaki M, Akiyama T, Morita K, Nomura T. The Disease Burdens of Self-diagnosed Hidradenitis Suppurativa Patients in Japan: A Cross-sectional Web-based Survey. Acta Derm Venereol 2024; 104:adv32746. [PMID: 39175454 PMCID: PMC11358847 DOI: 10.2340/actadv.v104.32746] [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: 12/01/2023] [Accepted: 07/01/2024] [Indexed: 08/24/2024] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Koremasa Hayama
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan.
| | | | | | | | - Toshifumi Nomura
- Department of Dermatology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
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6
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Cohn E, Palma G, Mastacouris N, Strunk A, Garg A. Incidence of anxiety disorder in adults with hidradenitis suppurativa. Br J Dermatol 2024; 191:351-356. [PMID: 38564268 DOI: 10.1093/bjd/ljae139] [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: 08/11/2023] [Revised: 01/30/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND There are limited data on the risk of new-onset anxiety disorders in patients with hidradenitis suppurativa (HS). OBJECTIVES To compare the risk of new-onset anxiety disorder in patients with HS and controls, and to describe risk factors for the development of anxiety in patients with HS. METHODS We carried out a retrospective cohort analysis of a US electronic health records database between 2011 and 2020. Adults newly diagnosed with HS at a dermatology or primary care visit and control participants were included. The primary outcome was a new diagnosis of generalized anxiety disorder, phobic disorders, panic disorder or unspecified anxiety. Cox proportional hazards regression was used to compare the crude risk of any anxiety disorder between groups and to assess the independent association with HS while controlling for potential demographic, clinical and healthcare-related confounders. RESULTS Among 9597 patients with HS and 959 493 controls, the incidence rate (IR) of anxiety was 5.74 and 3.86 per 100 person-years (PY), respectively. The crude risk among all patients was 48% higher for those with HS vs. controls [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.40-1.55]. When stratified by index encounter type, patients with HS had 2.43 (95% CI 2.13-2.77) times the risk of anxiety disorder than dermatology controls and 1.46 (95%CI 1.38-1.55) times the risk than primary care controls. The adjusted HR for patients with HS vs. controls was 1.11 (95% CI 1.05-1.17) overall, 1.26 (95% CI 1.07-1.48) in the dermatology subgroup and 1.07 (95% CI 1.01-1.13) in the primary care subgroup. Risk factors for an incident anxiety diagnosis among patients with HS included depression (HR 1.69, 95% CI 1.48-1.93), female sex (HR 1.41, 95% CI 1.23-1.60), younger age (HR 0.87 per 10-year increase, 95% CI 0.84-0.90), White race, in the Medicaid insurance programme (HR 1.22, 95% CI 1.07-1.40), tobacco smoking (HR 1.16, 95% CI 1.03-1.31) and having one or more emergency department visits in the year before a HS diagnosis. Absolute IRs of anxiety disorders were highest among patients with HS who were aged 18-29 years (7.10 per 100 PY), female (6.34 per 100 PY) and White (6.79 per 100 PY). CONCLUSIONS HS is independently associated with an increased risk of anxiety disorders. An increased risk remains but is attenuated when confounders are controlled for. The relative risk may be particularly high in patients managed by dermatologists.
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Affiliation(s)
- Erica Cohn
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Gabriela Palma
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Nicole Mastacouris
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Andrew Strunk
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Amit Garg
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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7
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Offidani A, Marzano AV, Peris K, Molinelli E, Bettoli V, Magnoni C, Vaienti L, Pappagallo G, Amerio P, Atzori L, Balato A, Bianchi L, Bongiorno MR, Contedini F, Dapavo P, Di Benedetto G, Dini V, Donini M, Fabbrocini G, Fania L, Foti C, Gatti A, Guarneri C, Malara G, Manfredini M, Morrone P, Naldi L, Parodi A, Potenza C, Schianchi S, Stingeni L, Trovato E, Vaira F, Valenti M, Venturini M, Chiricozzi A, Prignano F. Guidelines How to Integrate Surgery and Targeted Therapy with Biologics for the Treatment of Hidradenitis Suppurativa: Delphi Consensus Statements from an Italian Expert Panel. Dermatology 2024:1-12. [PMID: 39004081 DOI: 10.1159/000539264] [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: 05/17/2023] [Accepted: 04/14/2024] [Indexed: 07/16/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent and painful nodules and abscesses in intertriginous skin areas, which can progress to sinus tract formation, tissue destruction, and scarring. HS is highly debilitating and severely impairs the psychological well-being and quality of life of patients. The therapeutic approach to HS is based on medical therapy and surgery. First-line medical therapy includes topical antibiotics, systemic antibiotics, and biologics. Main surgical procedures include deroofing, local excision, and wide local excision. Despite the availability of multiple therapeutic options, the rates of disease recurrence and progression continue to be high. In recent years, the possibility of combining biologic therapy and surgery has raised considerable interest. In a clinical trial, the perioperative use of adalimumab has been associated with greater response rates and improved inflammatory load and pain, with no increased risk of postoperative infectious complications. However, several practical aspects of combined biologic therapy and surgery are poorly defined. In June 2022, nine Italian HS experts convened to address issues related to the integration of biologic therapy and surgery in clinical practice. To this purpose, the experts identified 10 areas of interest based on published evidence and personal experience: (1) patient profiling (diagnostic criteria, disease severity classification, assessment of response to treatment, patient-reported outcomes, comorbidities); (2) tailoring surgery to HS characteristics; (3) wide local excision; (4) presurgery biologic treatment; (5) concomitant biologic and surgical treatments; (6) pre- and postsurgery management; (7) antibiotic systemic therapy; (8) biologic therapy after radical surgery; (9) management of adverse events to biologics; and (10) management of postoperative infectious complications. Consensus between experts was reached using the Estimate-Talk-Estimate method (Delphi Method). The statements were subsequently presented to a panel of 27 HS experts from across Italy, and their agreement was assessed using the UCLA Appropriateness Method. This article presents and discusses the consensus statements.
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Affiliation(s)
- Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi di Milano, Milan, Italy
| | - Ketty Peris
- UOC of Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Vincenzo Bettoli
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Cristina Magnoni
- Department of Dermatology, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Vaienti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giovanni Pappagallo
- School of Clinical Research Methodology, IRCCS "Sacro Cuore - Don Calabria Hospital", Negrar di Valpolicella, Italy
| | - Paolo Amerio
- Dermatologic Clinic, G. D'Annunzio University, Chieti, Italy
| | - Laura Atzori
- Unit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Anna Balato
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Bianchi
- UOSD of Dermatology, Policlinico Tor Vergata, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Maria Rita Bongiorno
- Department of Health Promotion Sciences, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Federico Contedini
- Department of Plastic Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Paolo Dapavo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Di Benedetto
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Valentina Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Massimo Donini
- Department of Dermatology, SS Giovanni e Paolo Civil Hospital, Venice, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Fania
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - Caterina Foti
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Dermatology, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Gatti
- Department of Dermatology, AULSS2 Marca Trevigiana, Hospital Ca' Foncello, Treviso, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giovanna Malara
- Dermatology Unit, Hospital "Bianchi Melacrino Morelli", Reggio Calabria, Italy
- Department of Dermatology, Papardo Hospital, Messina, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Pietro Morrone
- Unit of Dermatology, Mariano Santo Hospital, Cosenza, Italy
| | - Luigi Naldi
- Division of Dermatology, San Bortolo Hospital, Vicenza, Italy
| | - Aurora Parodi
- Unit of Dermatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | | | | | - Luca Stingeni
- Dermatology Section, Medical and Surgical Department, University of Perugia, Perugia, Italy
| | - Emanuele Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Fabrizio Vaira
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario Valenti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Marina Venturini
- Section of Dermatology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Chiricozzi
- UOC of Dermatology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatology, Department of Translational Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Prignano
- Department of Health Science, Section of Dermatology, University of Firenze, Firenze, Italy
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Strobel A, Schultheis M, Staubach P, Grabbe S, Mann C, Hennig K, Szepietowski JC, Matusiak L, Krajewski P, von Stebut E, Garcovich S, Bayer H, Heise M, Podda M, Kirschner U, Nikolakis G. Real-world effectiveness and safety of the LAight-therapy in patients with hidradenitis suppurativa. J Dtsch Dermatol Ges 2024; 22:936-945. [PMID: 38807028 DOI: 10.1111/ddg.15403] [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: 08/04/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa (HS)/Acne inversa (Ai) is a chronic debilitating disease with limited therapy options. The device-based LAight therapy was approved in Europe in 2017. The aim of this study was to evaluate the effect of real-world care with at least one treatment with LAight therapy on disease activity and burden in 3,437 patients. PATIENTS AND METHODS Patients were included in the analysis if they had a diagnosis of HS and received at least one treatment. The endpoints Hidradenitis Suppurativa Severity Score System (IHS4), pain on the numeric rating scale (pain-NRS) and Dermatology Life Quality Index (DLQI) were analyzed using a linear mixed model for repeated measures (MMRM) over 26 weeks of care with LAight therapy. Furthermore, responder rates were calculated for all endpoints, and the therapy's safety profile and patient satisfaction were thoroughly examined. RESULTS A significant decrease in IHS4, pain-NRS, and DLQI was achieved during 26 weeks of care with LAight. The BMI at baseline had a significant negative effect on therapy response for pain-NRS and DLQI. CONCLUSIONS This study confirms that LAight therapy leads to satisfactory disease control in all stages of severity and is a valuable addition to the therapeutic repertoire of HS.
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Affiliation(s)
- Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Schultheis
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Caroline Mann
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Hans Bayer
- Dermatology Outpatient Office Hautmedizin Bad Soden, Bad Soden, Germany
| | - Marcus Heise
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- Institute for Health- and Nursing Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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9
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Dagenet CB, Atluri S, Ma E, Tong L, Tran KA, Hekmatajah J, Masson R, Hsiao JL, Shi VY. Adherence to Hidradenitis Suppurativa Treatment. Am J Clin Dermatol 2024; 25:585-594. [PMID: 38861156 DOI: 10.1007/s40257-024-00871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/12/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that requires multimodal treatment. Adherence remains a significant challenge for many patients due to complex nature of treatment, thus presenting a barrier to management success. This review summarizes the current literature on the factors associated with adherence to medications, and lifestyle behaviors in patients with HS and proposes strategies to improve adherence. In February 2023, a systematic literature search was conducted by two independent authors on PubMed and EMBASE for articles from 2000 to 2023 on hidradenitis suppurativa adherence. A total of 21 articles met inclusion/exclusion criteria for this review. Of the studies, 11 addressed systemic medication adherence, 3 addressed topical medication adherence, 2 addressed both systemic and topical medication adherence, and 5 addressed lifestyle/behavioral modification adherence. The generalizability of results was limited by differences in study design, outcome measures, and sample size. English-only articles with full texts were used. The most reported reasons for non-adherence included presence of side effects, cost of medications, low efficacy, and unclear instructions. Proposed strategies to improve adherence in HS patients include management of side effects, use of reminder systems, improved patient education, patient support groups, aid of family and caregivers, personalization of the medication regimen, and regular follow-ups with patients. PROSPERO Registration Number: CRD42023488549.
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Affiliation(s)
| | - Swetha Atluri
- University of Arizona College of Medicine, Tucson, AZ, USA
| | - Elaine Ma
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lauren Tong
- University of Arkansas for Medical Sciences, Library, Little Rock, AR, USA
| | - Khiem A Tran
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Joshua Hekmatajah
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rahul Masson
- Keck School of Medicine, University of Southern 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.
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10
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Kimball AB, Jemec GBE, Sayed CJ, Kirby JS, Prens E, Ingram JR, Garg A, Gottlieb AB, Szepietowski JC, Bechara FG, Giamarellos-Bourboulis EJ, Fujita H, Rolleri R, Joshi P, Dokhe P, Muller E, Peterson L, Madden C, Bari M, Zouboulis CC. Efficacy and safety of bimekizumab in patients with moderate-to-severe hidradenitis suppurativa (BE HEARD I and BE HEARD II): two 48-week, randomised, double-blind, placebo-controlled, multicentre phase 3 trials. Lancet 2024; 403:2504-2519. [PMID: 38795716 DOI: 10.1016/s0140-6736(24)00101-6] [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: 10/28/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Patients with hidradenitis suppurativa have substantial unmet clinical needs and scarce therapeutic options. We aimed to assess the efficacy and safety of bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A, in patients with moderate-to-severe hidradenitis suppurativa. METHODS BE HEARD I and II were two identically designed, 48-week randomised, double-blind, placebo-controlled, multicentre phase 3 trials. Patients aged 18 years or older with moderate-to-severe hidradenitis suppurativa were randomly assigned 2:2:2:1 using interactive response technology (stratified by worst Hurley Stage at baseline and baseline systemic antibiotic use) to receive subcutaneous bimekizumab 320 mg every 2 weeks; bimekizumab 320 mg every 2 weeks to week 16, then every 4 weeks to week 48; bimekizumab 320 mg every 4 weeks to week 48; or placebo to week 16, then bimekizumab 320 mg every 2 weeks. The primary outcome was an hidradenitis suppurativa clinical response of at least 50%, defined as a reduction in total abscess and inflammatory nodule count of at least 50% from baseline with no increase from baseline in abscess or draining tunnel count (HiSCR50) at week 16. Efficacy analyses included all randomly assigned study patients (intention-to-treat population). Safety analyses included all patients who received at least one full or partial dose of study treatment in the safety set, and of bimekizumab in the active-medication set. These trials are registered at ClinicalTrials.gov, NCT04242446 and NCT04242498, and both are completed. FINDINGS Patients for BE HEARD I were recruited from Feb 19, 2020, to Oct 27, 2021, and 505 patients were enrolled and randomly assigned. Patients for BE HEARD II were recruited from March 2, 2020, to July 28, 2021, and 509 patients were enrolled and randomly assigned. The primary outcome at week 16 was met in the group who received bimekizumab every 2 weeks using modified non-responder imputation; higher responder rates were observed with bimekizumab versus placebo in both trials: 138 (48%) of 289 patients versus 21 (29%) of 72 patients in BE HEARD I (odds ratio [OR] 2·23 [97·5% CI 1·16-4·31]; p=0·0060) and 151 (52%) of 291 patients versus 24 (32%) of 74 patients in BE HEARD II (2·29 [1·22-4·29]; p=0·0032). In BE HEARD II, HiSCR50 was also met in the group who were administered bimekizumab every 4 weeks (77 [54%] of 144 vs 24 [32%] of 74 with placebo; 2·42 [1·22-4·80]; p=0·0038). Responses were maintained or increased to week 48. Serious treatment-emergent adverse events were reported in 40 (8%) patients in BE HEARD I and in 24 (5%) patients in BE HEARD II treated with bimekizumab over 48 weeks. The most frequently reported treatment-emergent adverse events to week 48 were hidradenitis in both trials, in addition to coronavirus infection and diarrhoea in BE HEARD I, and oral candidiasis and headache in BE HEARD II. One death was reported across the two trials, and was due to congestive heart failure in a patient with substantial cardiovascular history treated with bimekizumab every 2 weeks in BE HEARD I (considered unrelated to bimekizumab treatment by the investigator). No new safety signals were observed. INTERPRETATION Bimekizumab was well tolerated by patients with hidradenitis suppurativa and produced rapid and deep clinically meaningful responses that were maintained up to 48 weeks. Data from these two trials support the use of bimekizumab for the treatment of patients with moderate-to-severe hidradenitis suppurativa. FUNDING UCB Pharma.
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Affiliation(s)
- Alexa B Kimball
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State University, Hershey, PA, USA
| | - Errol Prens
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - John R Ingram
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology and Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Amit Garg
- Northwell Health, New Hyde Park, NY, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacek C Szepietowski
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Falk G Bechara
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology, Venereology, and Allergology, St Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Evangelos J Giamarellos-Bourboulis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Hideki Fujita
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | - Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Departments of Dermatology, Venereology, Allergology, and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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11
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Zouboulis CC, Passeron T, Pariser D, Wozniak MB, Li X, Uhlmann L, Lobach I, Martinez AL, Ravichandran S, Alarcon I, Offidani A, Alam MS, Mendes-Bastos P. Secukinumab in patients with moderate-to-severe hidradenitis suppurativa based on prior biologic exposure: an efficacy and safety analysis from the SUNSHINE and SUNRISE phase III trials. Br J Dermatol 2024; 190:836-845. [PMID: 38470171 DOI: 10.1093/bjd/ljae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with a substantial disease burden. Secukinumab has previously been reported to have sustained efficacy with a favourable safety profile in patients with moderate-to-severe HS. It is unknown whether prior biologic exposure affects the efficacy and safety of secukinumab. OBJECTIVES To investigate the efficacy and safety of secukinumab in patients with moderate-to-severe HS based on prior exposure to -biologics. METHODS This was an analysis of the SUNSHINE and SUNRISE phase III trials of secukinumab in patients with moderate-to-severe HS. Patients were randomized at baseline to receive secukinumab every 2 (SECQ2W) or 4 weeks (SECQ4W), or placebo for 16 weeks. After week 16, patients on the SECQ2W and SECQ4W schedules remained on the same treatment regimen, while patients randomized to placebo were switched to either SECQ2W or SECQ4W up to week 52. Assessments based on prior exposure to biologics included Hidradenitis Suppurativa Clinical Response (HiSCR), abscess and inflammatory nodule (AN) count, flare rates, HS-related pain [numerical rating scale 30 (NRS30)], 55% reduction in the International Hidradenitis Suppurativa Severity Score System (IHS4-55), Dermatology Life Quality Index, EuroQol-5D and safety. RESULTS Overall, 1084 patients were randomized in the SUNSHINE and SUNRISE trials and included in this analysis; 255 (23.5%) were biologic-experienced [SECQ2W (n = 80); SECQ4W (n = 81); placebo (n = 94)] and 829 (76.5%) were biologic-naïve [SECQ2W (n = 281); SECQ4W (n = 279); placebo (n = 269)]. At week 16, responses were more efficacious for secukinumab than for placebo with regard to HiSCR in patients who were biologic-experienced {SECQ2W 37.0% [odds ratio (OR) 1.60, 95% confidence interval (CI) 0.83-3.08]; SECQ4W 38.8% [OR 1.67, 95% CI 0.86-3.22]; placebo 27.3%} and biologic-naïve [SECQ2W 45.6% (OR 1.64, 95% CI 1.15-2.33); SECQ4W 45.4% (OR 1.61, 95% CI 1.13-2.29); placebo 34.2%]. Similar results were observed for AN count, NRS30 and IHS4-55. The higher response seen at week 16 with secukinumab was sustained, with a trend toward improvement over time, through to week 52 in both subgroups. Additional efficacy was observed for quality-of-life assessments, and no differences in safety between subgroups were observed. CONCLUSIONS Regardless of prior biologic exposure, secukinumab was efficacious in improving the signs and symptoms of HS. This finding positions secukinumab as the first option in patients who are biologic-naïve, as well as in patients who have previously been treated with other biologic therapy, based on individual patient needs.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thierry Passeron
- Department of Dermatology, CHU Nice
- INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Xianjun Li
- Novartis Pharma Co., Ltd, Shanghai, China
| | | | | | | | | | | | - Annamaria Offidani
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Maryam S Alam
- Simcoderm Medical and Surgical Dermatology Centre, Barrie, ON, Canada
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12
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Kjærsgaard Andersen R, Pedersen O, Eidsmo L, Jemec G, Saunte D. Initial steps towards developing a predictive algorithm of disease progression for hidradenitis suppurativa (HS): results from a Cox proportional hazard regression analysis on disease progression among a cohort of 335 Danish patients with HS. Br J Dermatol 2024; 190:904-914. [PMID: 38169316 DOI: 10.1093/bjd/ljad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory and scarring disease with a wide spectrum of disease severity. The amount of scarring is proportional to the preceding tissue damage and poses a challenge to patients. Severe HS is most often treatment recalcitrant, but hypothetically avoidable through early biologic treatment. Early prediction of individual risk of disease progression is therefore essential for patient management. OBJECTIVES To investigate risk factors associated with disease progression and to design an algorithm capable of predicting disease -progression. METHODS A prospective cohort study of 335 Hurley III-naïve patients with HS, not treated with biologics, was followed for a median of 2 years. Potential risk factors covered basic demographics, HS anamnestic factors and clinical HS factors collected during physical examination. Two separate Cox proportional hazard regression (CPHR) analyses were conducted. A summated 'progression score' was calculated and used in the predictive algorithm of severe disease. Subsequent bootstrap sampling was used to validate the predictability of the predictive algorithm. RESULTS The CPHR analysis of Transition to severe disease found that active smoking [hazard ratio (HR) 4.01, 95% confidence interval (CI) 1.71-9.40, P = 0.001]; body mass index (BMI) points > 25 at baseline (each point: HR 1.06, 95% CI 1.02-1.09, P < 0.001); active disease in 2 (HR 4.26, 95% CI 1.23-14.84, P = 0.02) and ≥ 3 areas (HR 6.54, 95% CI 1.89-22.72, P = 0.003) all constituted substantial risk factors. Conversely, the CPHR analysis of Disease progression did not yield results of clinical relevance. A 'progression score' of 3.04 was used as a threshold in the predictive algorithm of Transition to severe disease and achieved the following test specifics: sensitivity = 0.51, specificity = 0.86, positive predictive value = 0.50, negative predictive value = 0.86. CONCLUSIONS We found a disparity between factors increasing the risk of simple Disease progression and those increasing the risk of Transition to severe disease. For the latter, active smoking, BMI points > 25, active disease in 2 or ≥ 3 areas were all shown to be the clinically relevant factors that could be used to construct an algorithm that correctly predicted progression to severe HS in more than half of all instances.
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Affiliation(s)
- Rune Kjærsgaard Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center
| | - Ole Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Liv Eidsmo
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Ditte Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
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13
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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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14
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Maronese CA, Moltrasio C, Genovese G, Marzano AV. Biologics for Hidradenitis suppurativa: evolution of the treatment paradigm. Expert Rev Clin Immunol 2024; 20:525-545. [PMID: 38130204 DOI: 10.1080/1744666x.2023.2298356] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is an autoinflammatory skin disease with a high unmet need for effective medical management. Clinically, it is characterized by inflammatory nodules that may progress into abscesses, draining tunnels and extensive scarring, mainly affecting apocrine gland-bearing areas. AREAS COVERED Treatment options include topical and systemic medications and a variety of surgical procedures. The anti-TNF-α antibody adalimumab and the anti-IL-17 secukinumab are the only two approved biologics for HS, showing moderate efficacy. HS research is a rapidly growing field, with a wide range of agents leveraging distinct mechanisms of action currently under development. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathways are the most advanced in both ongoing and completed Phase 3 studies, promising deeper levels of response. Use of other, off-label biologics is also discussed. EXPERT OPINION A therapeutic algorithm is proposed based on comorbidities and existing evidence. Patient-tailored combinations between biologics and other biologics or small molecules will hopefully allow clinicians to target most events in HS pathophysiology in a complementary way while obtaining a meaningful effect on their devastating manifestations.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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15
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Holgersen N, Nielsen VW, Ali Z, Brøgger-Mikkelsen M, Flege MM, Thyssen JP, Egeberg A, Thomsen SF. Attitudes towards clinical research in adult patients with hidradenitis suppurativa during the COVID-19 pandemic: Insights from a survey. J Eur Acad Dermatol Venereol 2024; 38:e371-e373. [PMID: 38108515 DOI: 10.1111/jdv.19758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Nikolaj Holgersen
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Valdemar W Nielsen
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Zarqa Ali
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Marius M Flege
- Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Bispebjerg Hospital, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Simon F Thomsen
- Department of Dermato-Venereology, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Andersen R, Rostgaard K, Pedersen O, Jemec GBE, Hjalgrim H. Increased cancer incidence among patients with hidradenitis suppurativa - a Danish nationwide register study 1977-2017. Acta Oncol 2024; 63:220-228. [PMID: 38647025 PMCID: PMC11332540 DOI: 10.2340/1651-226x.2024.26182] [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: 11/15/2023] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The chronic, inflammatory skin disease hidradenitis suppurativa (HS) (prevalence: 0.5%-1%, diagnostic delay: 7-10 years) primarily arises in younger adults and frequently coincides with autoimmune comorbidities and unhealthy life-styles (smoking and obesity). These factors are known to increase cancer risk, but despite this, information on cancer occurrence among HS patients is scarce. MATERIALS AND METHODS A nationwide retrospective register-based study assessing relative risk of cancer - overall and by anatomical site - following HS diagnosis expressed as standardized incidence ratios (SIRs), which is ratios between observed cases among all Danes diagnosed with HS since 1977 and expected cases based on cancer incidence rates of the entire Danish population during the same period. RESULTS Participants consisted of a cohort of 13,919 Danes with HS, who during an average of 14.2 years of follow-up developed a total of 1,193 incident cancers, corresponding to a 40% increased risk (SIR = 1.4, 95% CI: 1.3 to 1.4, p < 0.001). Increased risks were observed for cancers of the respiratory system, oral cavity and pharynx, digestive organs and peritoneum, urinary tract, and the lymphatic tissues. INTERPRETATION These findings underline an unmet need for health monitoring, lifestyle interventions and cancer screening if and when relevant.
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Affiliation(s)
- Rune Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Immunology and Microbiology, Skin Immunology Research Center, University of Copenhagen, Denmark.
| | - Klaus Rostgaard
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Ole Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Henrik Hjalgrim
- Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark; Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark; Department of Haematology, Rigshospitalet, Copenhagen, Denmark
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17
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Moltrasio C, Silva CA, Tricarico PM, Marzano AV, Sueleman M, Crovella S. Biosensing circulating MicroRNAs in autoinflammatory skin diseases: Focus on Hidradenitis suppurativa. Front Genet 2024; 15:1383452. [PMID: 38655054 PMCID: PMC11035790 DOI: 10.3389/fgene.2024.1383452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
MicroRNAs (miRNAs) play a crucial role in the early diagnosis of autoinflammatory diseases, with Hidradenitis Suppurativa (HS) being a notable example. HS, an autoinflammatory skin disease affecting the pilosebaceous unit, profoundly impacts patients' quality of life. Its hidden nature, with insidious initial symptoms and patient reluctance to seek medical consultation, often leads to a diagnostic delay of up to 7 years. Recognizing the urgency for early diagnostic tools, recent research identified significant differences in circulating miRNA expression, including miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p, between HS patients and healthy controls. These miRNAs serve as potential biomarkers for earlier disease detection. Traditional molecular biology techniques, like reverse transcription quantitative-polymerase chain reaction (RT-qPCR), are employed for their detection using specific primers and probes. Alternatively, short peptides offer a versatile and effective means for capturing miRNAs, providing specificity, ease of synthesis, stability, and multiplexing potential. In this context, we present a computational simulation pipeline designed for crafting peptide sequences that can capture circulating miRNAs in the blood of patients with autoinflammatory skin diseases, including HS. This innovative approach aims to expedite early diagnosis and enhance therapeutic follow-up, addressing the critical need for timely intervention in HS and similar conditions.
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Affiliation(s)
- Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, Trieste, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | | | - Sergio Crovella
- Laboratory of Animal Research (LARC), Qatar University, Doha, Qatar
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18
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Maronese CA, Moltrasio C, Marzano AV. Hidradenitis Suppurativa-Related Autoinflammatory Syndromes: An Updated Review on the Clinics, Genetics, and Treatment of Pyoderma gangrenosum, Acne and Suppurative Hidradenitis (PASH), Pyogenic Arthritis, Pyoderma gangrenosum, Acne and Suppurative Hidradenitis (PAPASH), Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO), and Rarer Forms. Dermatol Clin 2024; 42:247-265. [PMID: 38423685 DOI: 10.1016/j.det.2023.12.004] [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: 03/02/2024]
Abstract
Hidradenitis suppurativa (HS) is an autoinflammatory skin disorder of the terminal hair follicle, which can present in sporadic, familial, or syndromic form. A classification has been proposed for the latter, distinguishing cases associated with a known genetic condition, with follicular keratinization disorders or with autoinflammatory diseases. This review focuses on the clinical and genetic features of those entities (ie, pyoderma gangrenosum [PG], acne and HS; PG, acne, pyogenic arthritis and HS; psoriatic arthritis, PG, acne and HS; synovitis, acne, pustulosis, hyperostosis, osteitis; and so forth) for which the collective term HS-related autoinflammatory syndromes is proposed.
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Affiliation(s)
- Carlo Alberto Maronese
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace, 9, Milan 20122, Italy; Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy
| | - Angelo Valerio Marzano
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Via Pace, 9, Milan 20122, Italy; Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, Milan 20122, Italy.
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19
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Kirby J, Kim K, Zivkovic M, Wang S, Garg V, Danavar A, Li C, Chen N, Garg A. Uncovering the burden of hidradenitis suppurativa misdiagnosis and underdiagnosis: a machine learning approach. FRONTIERS IN MEDICAL TECHNOLOGY 2024; 6:1200400. [PMID: 38591045 PMCID: PMC10999681 DOI: 10.3389/fmedt.2024.1200400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular skin condition that is associated with significant psychosocial and economic burden and a diminished quality of life and work productivity. Accurate diagnosis of HS is challenging due to its unknown etiology, which can lead to underdiagnosis or misdiagnosis that results in increased patient and healthcare system burden. We applied machine learning (ML) to a medical and pharmacy claims database using data from 2000 through 2018 to develop a novel model to better understand HS underdiagnosis on a healthcare system level. The primary results demonstrated that high-performing models for predicting HS diagnosis can be constructed using claims data, with an area under the curve (AUC) of 81%-82% observed among the top-performing models. The results of the models developed in this study could be input into the development of an impact of inaction model that determines the cost implications of HS diagnosis and treatment delay to the healthcare system.
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Affiliation(s)
- Joslyn Kirby
- Department of Dermatology, Penn State Health, Hershey, PA, United States
| | - Katherine Kim
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Marko Zivkovic
- Technology and Innovation, Genesis Research, Hoboken, NJ, United States
| | - Siwei Wang
- Technology and Innovation, Genesis Research, Hoboken, NJ, United States
| | - Vishvas Garg
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Akash Danavar
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Chao Li
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Naijun Chen
- Value and Evidence, AbbVie, Inc., North Chicago, IL, United States
| | - Amit Garg
- Department of Dermatology, Northwell Health, New Hyde Park, NY, United States
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20
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Krajewski PK, Szukała W, Szepietowski JC. The NLRP3 Inflammasome Gene Is Overexpressed in Hidradenitis Suppurativa Lesions: A Preliminary Study on the Role of Pyroptosis in Disease Pathogenesis. Curr Issues Mol Biol 2024; 46:2544-2552. [PMID: 38534777 DOI: 10.3390/cimb46030161] [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: 01/27/2024] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating inflammatory skin disorder, and its pathogenesis remains incompletely understood. This study aimed to investigate the role of the P2X7 receptor (P2X7R) and NLRP3 inflammasome in HS pathogenesis. RNA sequencing and real-time PCR were performed to assess the gene expression levels of P2X7R and NLRP3 in the skin biopsies of HS patients and healthy controls (HC). The results of our study revealed a significantly increased expression of the NLRP3 gene in both the lesional and perilesional skin of HS patients compared to healthy controls. Moreover, the mRNA levels of NLRP3 were significantly higher in lesional skin compared to non-lesional skin in HS patients, indicating the spread of inflammation to adjacent tissues. In contrast, no significant differences in P2X7R gene expression were observed between the three groups. These findings suggest the involvement of NLRP3 inflammasomes in HS pathogenesis, while P2X7R may not play a significant role in the disease. This research sheds light on the complex inflammatory pathways in HS, highlighting the potential of NLRP3 as a therapeutic target. Understanding the molecular mechanisms underlying HS is crucial for the development of targeted treatment modalities for this debilitating condition.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland
| | - Weronika Szukała
- Doctoral School of Exact and Natural Sciences, Jagiellonian University, Lojasiewicza 11, 30-348 Krakow, Poland
- Faculty of Biochemistry, Biophysics and Biotechnology, Department of General Biochemistry, Jagiellonian University, Gronostajowa 7, 30-387 Krakow, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland
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21
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Rinderknecht FAB, Naik HB. Access to dermatologic care and provider impact on hidradenitis suppurativa care: global survey insights. Int J Womens Dermatol 2024; 10:e130. [PMID: 38240011 PMCID: PMC10796138 DOI: 10.1097/jw9.0000000000000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is an understudied disease, and current HS studies have focused on participants already connected to dermatologic care. Objective We surveyed participants in online HS support communities to gain a comprehensive understanding of how provider type impacts HS disease management and the issues individuals with HS face when accessing care. Methods From June 13 to June 30, 2021, we administered an anonymous cross-sectional online survey to HS Facebook support group participants who had a self-confirmed diagnosis of HS. Survey items assessed respondent demographics, primary HS provider, and barriers to HS care and pain management. Descriptive analyses are presented. Results The survey was viewed 5,168 times and 1,040 surveys met eligibility criteria (20.1%). Survey participants were 97% female and 72% White. Seventy-two percentage resided in the United States and 22% in Europe. Forty-seven percentage reported having a dermatologist as their primary HS provider, 38% reported a nondermatologist, and 15% reported no HS provider. We found that Asian race, full-time employment, private health insurance, and urban setting were each associated with higher rates of having a dermatologist as a primary HS provider. However, 43.7% of those with a dermatologist reported biologic use, as compared with 14.5% with nondermatologist HS providers. Our cohort was notably more severely impacted by comorbid diseases; 55.9% of our cohort had anxiety, 53.6% had depression, and 50.7% had obesity. Overall, 74.2% of our cohort reported experiencing stigma while accessing care for their HS. Limitations Participant recruitment via social media platform facilitates recruitment of individuals across the spectrum of healthcare access, but may introduce selection bias and favor well-resourced areas. Self-reported data may be subject to recall bias. Conclusion Our study provides unique insights into the characteristics and experiences of individuals with HS across the spectrum of health care access.
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Affiliation(s)
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco, California
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22
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Haselgruber S, Muñoz Barba D, Ureña Paniego C, Lobo Benito S, Arias Santiago S, Molina-Leyva A. What concerns people with hidradenitis suppurativa? Towards a humanized health care in dermatology. J Eur Acad Dermatol Venereol 2024; 38:e227-e228. [PMID: 37803522 DOI: 10.1111/jdv.19546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Sofía Haselgruber
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Daniel Muñoz Barba
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Clara Ureña Paniego
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Silvia Lobo Benito
- Asociación Española de Enfermos de Hidradenitis Supurativa, ASHENDI, Madrid, Spain
| | - Salvador Arias Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
| | - Alejandro Molina-Leyva
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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23
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Xiong B, Zou J, Ali W, Daneshjou R, Williams J. Diagnosis and management of hidradenitis suppurativa: Analysis of US insurance claims data. JAAD Int 2024; 14:29-30. [PMID: 38058457 PMCID: PMC10696258 DOI: 10.1016/j.jdin.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Affiliation(s)
- Betty Xiong
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | - James Zou
- Department of Biomedical Data Science, Stanford University, Stanford, California
| | | | - Roxana Daneshjou
- Department of Biomedical Data Science and Dermatology, Stanford University, Stanford, California
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24
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Riva H, Hendricks A, Yoon T, Del Coro Amengual C, Maddox C. Decades Delayed in Diagnosis: Hidradenitis Suppurativa and a Review of Barriers to Care. Cureus 2024; 16:e56231. [PMID: 38618324 PMCID: PMC11016318 DOI: 10.7759/cureus.56231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
We present a case of a 40-year-old female seen on the inpatient general surgery service in consultation for a suspected abdominal wall abscess or seroma. The history and examination were consistent with a diagnosis of hidradenitis suppurativa. The patient had a 25-year history of similar lesions present since her teenage years, not properly investigated and diagnosed, despite presenting with symptoms in multiple clinic and hospital settings since disease onset. As an accurate diagnosis of HS is often missed or delayed for years, it is important to increase awareness and clinical recognition of this condition among providers to improve outcomes for patients with the potentially debilitating disease of HS.
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Affiliation(s)
- Hannah Riva
- Medical Education, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, USA
| | | | - Teresa Yoon
- Medical Education, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso, USA
| | | | - Craig Maddox
- Dermatology, Mountain View Dermatology, El Paso, USA
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25
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Ingram JR, Bates J, Cannings-John R, Collier F, Evans J, Gibbons A, Harris C, Howells L, Hood K, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study (THESEUS): a prospective cohort study. Br J Dermatol 2024; 190:382-391. [PMID: 37823414 DOI: 10.1093/bjd/ljad388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, painful disease affecting flexures and other skin regions, producing nodules, abscesses and skin tunnels. Laser treatment targeting hair follicles and deroofing of skin tunnels are standard HS interventions in some countries but are rarely offered in the UK. OBJECTIVES To describe current UK HS management pathways and influencing factors to inform the design of future randomized controlled trials (RCTs). METHODS THESEUS was a nonrandomized 12-month prospective cohort study set in 10 UK hospitals offering five interventions: oral doxycycline 200 mg daily; oral clindamycin and rifampicin both 300 mg twice daily for 10 weeks, extended for longer in some cases; laser treatment targeting hair follicles; deroofing; and conventional surgery. The primary outcome was the combination of clinician-assessed eligibility and participant hypothetical willingness to receive each intervention. The secondary outcomes were the proportion of participants selecting each intervention as their final treatment option; the proportion who switch treatments; treatment fidelity; and attrition rates. THESEUS was prospectively registered on the ISRCTN registry: ISRCTN69985145. RESULTS The recruitment target of 150 participants was met after 18 months, in July 2021, with two pauses due to the COVID-19 pandemic. Baseline demographics reflected the HS secondary care population: average age 36 years, 81% female, 20% non-White, 64% current or ex-smokers, 86% body mass index ≥ 25, 68% with moderate disease, 19% with severe disease and 13% with mild disease. Laser was the intervention with the highest proportion (69%) of participants eligible and willing to receive treatment, then deroofing (58%), conventional surgery (54%), clindamycin and rifampicin (44%), and doxycycline (37%). Laser was ranked first choice by the greatest proportion of participants (41%). Attrition rates were 11% and 17% after 3 and 6 months, respectively. Concordance with doxycycline was 52% after 3 months due to lack of efficacy, participant choice and adverse effects. Delays with procedural interventions were common, with only 43% and 26% of participants starting laser and deroofing, respectively, after 3 months. Uptake of conventional surgery was too small to characterize the intervention. Switching treatment was uncommon and there were no serious adverse events. CONCLUSIONS THESEUS has established laser treatment and deroofing for HS in the UK and demonstrated their popularity with patients and clinicians for future RCTs.
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Affiliation(s)
| | - Janine Bates
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | - Judith Evans
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rachel Howes
- Department of Plastic Surgery, John Radcliffe Hospital, Oxford NHS Trust, Oxford, 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 & Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
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Bouazzi D, Andersen RK, Vinding GR, Medianfar CE, Nielsen SM, Saunte DML, Chandran NS, van der Zee HH, Zouboulis CC, Benhadou F, Villumsen B, Alavi A, Ibekwe PU, Hamzavi IH, Ingram JR, Naik HB, Garg A, Boer J, Christensen R, Jemec GBE. The Global Hidradenitis Suppurativa Atlas Methodology: Combining Global Proportions in a Pooled Analysis. Dermatology 2024; 240:369-375. [PMID: 38354718 DOI: 10.1159/000536389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Data concerning the global burden of hidradenitis suppurativa (HS) are limited. Reported prevalence estimates vary between 0.0003% and 4.1%, and data from various geographical regions are still to be collected. Previously reported prevalences have been limited by the methodological approach and source of data. This has resulted in great heterogeneity as prevalence data from physician-diagnosed cases poorly match those of self-reported apparent HS disease. METHODS The Global Hidradenitis Suppurativa Atlas (GHiSA) introduces an innovative approach to determine the global prevalence of HS. This approach involves using a previously validated questionnaire to screen apparently healthy adults accompanying a patient to a non-dermatological outpatient clinic visit in a hospital or a private/family medicine clinic. The screening questionnaire (i.e., the index test) is combined with a subsequent physician-based in-person validation (i.e., the reference standard) of the participants who screen positive. Approximately ten percent of the screen-negative participants are also clinically assessed to verify the diagnostic precision of the test. The local prevalence (pi) will be estimated from each country that submits the number of patients who are HS positive according to the index test and clinical examination (n), and the corresponding total number of observations (N). CONCLUSION The GHiSA Global Prevalence studies are currently running simultaneously in 58 countries across six continents (Africa, Europe, Australia, North America, South America, and Asia). The goal of the combined global proportion is the generation of a single summary (i.e., proportional meta-analysis), which will be done after a logit transformation and synthesized using a random-effects model. The novel standardization of the Global Prevalence Studies conducted through GHiSA enables direct international comparisons, which were previously not possible due to substantial heterogeneity in past HS prevalence studies.
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Affiliation(s)
- Dorra Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Rune K Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Immunology and Microbiology, Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark
| | | | - Cecilia E Medianfar
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sabrina M Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Ditte M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Nisha S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Hessel H van der Zee
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B.), CUB Hôpital Erasme, Brussels, Belgium
| | - Bente Villumsen
- Danish Hidradenitis Suppurativa Patients' Association, Copenhagen, Denmark
| | - Afsaneh Alavi
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Perpetua U Ibekwe
- Dermatology Unit, Department of Medicine, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Iltefat H Hamzavi
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Director of Hidradenitis suppurativa clinic, Henry Ford Hospital, Detroit, Michigan, USA
| | - John R Ingram
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Haley B Naik
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, University of California, San Francisco, California, USA
| | - Amit Garg
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Northwell Health, New Hyde Park, New York, USA
| | - Jurr Boer
- Department of Dermatology, Deventer Hospital, Deventer, The Netherlands
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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Schultheis M, Grabbe S, Staubach P, Hennig K, Mauch M, Burckhardt M, Langer G, Heise M, Zamsheva M, Schollenberger L, Strobel A. Drivers of disease severity and burden of hidradenitis suppurativa: a cross-sectional analysis on 553 German patients. Int J Dermatol 2024; 63:188-195. [PMID: 37919257 DOI: 10.1111/ijd.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life-defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. METHOD The cross-sectional study is based on the baseline data of 553 participants of the health care research project "EsmAiL," which was carried out as a multicenter randomized controlled trial. It included adult HS-patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. RESULTS Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. CONCLUSIONS HS is a severe and debilitating dermatosis. As a result of the well-established factors involved, HS requires a multi-causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi-professional care. To prevent disease progression, a structured treatment plan is needed.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marcus Heise
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lukas Schollenberger
- Interdisciplinary Center for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexandra Strobel
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Salame N, Sow YN, Siira MR, Garg A, Chen SC, Patzer RE, Kavalieratos D, Orenstein LAV. Factors Affecting Treatment Selection Among Patients With Hidradenitis Suppurativa. JAMA Dermatol 2024; 160:179-186. [PMID: 38198173 PMCID: PMC10782374 DOI: 10.1001/jamadermatol.2023.5425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 11/03/2023] [Indexed: 01/11/2024]
Abstract
Importance Despite the US Food and Drug Administration's approval of adalimumab for the treatment of hidradenitis suppurativa (HS), prescription rates remain low, indicating a critical gap between evidence-based guidelines and clinical practice. Understanding the medical decision-making process that these patients use when considering biologic agents and other HS therapies may uncover opportunities for improved patient-physician communication and HS disease control. Objective To elucidate factors that affect the medical decision-making process for patients with HS, with an emphasis on biologic therapies. Design, Setting, and Participants Open-ended semistructured interviews were conducted with English-speaking adults with HS (aged ≥18 years) recruited from 2 dermatology clinics that are part of Emory University School of Medicine in Atlanta, Georgia. All participants had an average 7-day pain score of 1 or higher on a 0- to 10-point numeric rating scale. Surveys were conducted between November 2019 and March 2020, and data were analyzed from December 2021 to August 2022. Data collection continued until thematic saturation was reached at 21 interviews. Results A total of 21 participants (median [IQR] age, 38.5 [27.9-43.4] years; 16 females [76%]) were included in the analysis. Almost all participants (96%) had Hurley stage II or III disease, and 15 (71%) had a history of adalimumab use. Suffering threshold, perceptions of treatment risk, treatment fatigue, disease understanding, and sources of information (included dermatologists, the internet, advertisements, and friends and loved ones) were identified as factors affecting participants' decisions to initiate new treatments for HS. Conclusions and Relevance Results of this qualitative study suggest that mitigating misconceptions about treatment risk, identifying gaps in disease knowledge, and emphasizing early treatment to prevent scarring and disease progression may empower patients with HS to engage in treatment planning and to try new therapies.
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Affiliation(s)
- Nicole Salame
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Meron R. Siira
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Suephy C. Chen
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Rachel E. Patzer
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
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Krueger JG, Frew J, Jemec GBE, Kimball AB, Kirby B, Bechara FG, Navrazhina K, Prens E, Reich K, Cullen E, Wolk K. Hidradenitis suppurativa: new insights into disease mechanisms and an evolving treatment landscape. Br J Dermatol 2024; 190:149-162. [PMID: 37715694 DOI: 10.1093/bjd/ljad345] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need. The prevalence of HS reported in most studies is 1-2%, although it is likely to be under-reported and estimates vary globally owing to variance in data collection methods, ethnicity, geographical location and under-diagnosis. HS is characterized by persistent, painful cutaneous nodules, abscesses and draining tunnels commonly affecting the axillary, anogenital, inguinal and perianal/gluteal areas. Over time, chronic uncontrolled inflammation results in irreversible tissue destruction and scarring. Although the pathophysiology of HS has not been fully elucidated, the tumour necrosis factor (TNF)-α and interleukin (IL)-17 pathways have an important role, involving multiple cytokines. Currently, treatment options include topical medications; systemic therapies, including repeated and/or rotational courses of systemic antibiotics, retinoids and hormonal therapies; and various surgical procedures. The anti-TNF-α antibody adalimumab is currently the only biologic approved by both the US Food and Drug Administration and the European Medicines Agency for HS; however, its efficacy varies, with a clinical response reported in approximately 50% of patients in phase III trials. HS is a rapidly evolving field of discovery, with a diverse range of agents with distinct mechanisms of action currently being explored in clinical trials. Several other promising therapeutic targets have recently emerged, and agents targeting the IL-17 and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways are the most advanced in ongoing or completed phase III clinical trials. Alongside limited therapeutic options, significant challenges remain in terms of diagnosis and disease management, with a need for better treatment outcomes. Other unmet needs include significant diagnostic delays, thus missing the therapeutic 'window of opportunity'; the lack of standardized outcome measures in clinical trials; and the lack of established, well-defined disease phenotypes and biomarkers.
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Affiliation(s)
- James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - John Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian Kirby
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, TheNetherlands
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Germany
- MoonLake Immunotherapeutics AG, Zug, Switzerland
| | - Eva Cullen
- MoonLake Immunotherapeutics AG, Zug, Switzerland
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Department of Dermatology, Venereology and Allergology and Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Sinikumpu SP, Jokelainen J, Huilaja L. Prevalence and Characteristics of Hidradenitis Suppurativa in the Northern Finland Birth Cohort 1986 Study: A Cross-sectional Study of 2,775 Subjects. Acta Derm Venereol 2024; 104:adv14732. [PMID: 38197699 PMCID: PMC10795692 DOI: 10.2340/actadv.v104.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/17/2023] [Indexed: 01/11/2024] Open
Abstract
A negative stigmatization related to hidradenitis suppurativa may prevent patients from seeking care. Thus, a large proportion of patients with hidradenitis suppurativa may be missing from studies based on hospital data. The aim of this study was to examine the prevalence and characteristics of hidradenitis suppurativa among 2,775 subjects in the Northern Finland Birth Cohort 1986 Study (NFBC1986), who were in their mid-thirties. The prevalence of hidradenitis suppurativa was 4.0% (n = 110/2,775), being higher in females (4.8%) than in males (2.5%) (p < 0.01). Of those defined as having hidradenitis suppurativa in this study, only 4 cases (n = 4/110, 3.6%) were found to have a hidradenitis suppurativa diagnosis either in the hospital (Care Register for Health Care) or in the primary healthcare data. In an adjusted model in logistic regression analyses, hidradenitis suppurativa was significantly associated with obesity (body mass index 30-55 kg/m2) (odds ratio 3.81, 95% confidence interval 2.80-5.22), female sex (1.99, 1.53-2.61) and smoking (1.56, 1.21-2.00). In addition, there was an association between hidradenitis suppurativa and self-reported poor overall health status. Hidradenitis suppurativa seems to be common at the population level and only a minority of these patients seek care for the condition.
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Affiliation(s)
- Suvi-Päivikki Sinikumpu
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland; Medical Research Center, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
| | - Jari Jokelainen
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Laura Huilaja
- Department of Dermatology, University Hospital of Oulu, Oulu, Finland; Medical Research Center, Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
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Krajewski PK, Strobel A, Schultheis M, Staubach P, Grabbe S, Hennig K, Matusiak L, von Stebut E, Garcovich S, Bayer H, Heise M, Kirschner U, Nikolakis G, Szepietowski JC. Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment. Dermatology 2024; 240:205-215. [PMID: 38190809 DOI: 10.1159/000536128] [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: 10/16/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. METHODS We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project "Epidemiology and Care in Acne inversa (EpiCAi)." The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. RESULTS Regardless of gender, HS has an enormous impact on patients' sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (β = 0.25), the number of active lesions, the affected areas (β = 0.14), and psychosocial aspects, including low quality of life (β = 0.404), stigmatization (β = 0.411), depression (β = 0.413), and anxiety (β = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. CONCLUSION Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Hans Bayer
- Dermatology Outpatient Office Hautmedizin Bad Soden, Bad Soden, Germany
| | - Marcus Heise
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute for Health- and Nursing Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Schofield A. Reducing the pain of hidradenitis suppurativa wounds. J Wound Care 2024; 33:39-42. [PMID: 38197276 DOI: 10.12968/jowc.2024.33.1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Alison Schofield
- Independent Tissue Viability Clinical Nurse Specialist, UK
- Independent Tissue Viability Clinical Nurse Consultant, Pioneer Sussex Wound Healing and Lymphoedema Centres, UK
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33
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Kimball AB, Kirby J, Ingram JR, Tran T, Pansar I, Ciaravino V, Willems D, Lewis-Mikhael AM, Tongbram V, Garg A. Burden of Hidradenitis Suppurativa: A Systematic Literature Review of Patient Reported Outcomes. Dermatol Ther (Heidelb) 2024; 14:83-98. [PMID: 38183616 PMCID: PMC10828455 DOI: 10.1007/s13555-023-01085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/08/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) has a profound negative impact on patients' health-related quality of life (HRQoL). Here we summarize the evidence on HRQoL and Patient Reported Outcomes (PROs) in patients with HS in real-world settings by conducting a systematic literature review (SLR) of observational studies. METHODS Data sources included MEDLINE, Embase & PsycINFO between January 1, 2010 and August 29, 2021, and conference proceedings between 2019 and 2021. Identified abstracts were reviewed and screened independently by two reviewers. Eligibility criteria included patients with HS of any severity, sample size ≥ 100, reporting PROs including HRQoL measures. Included studies were critically appraised. RESULTS Fifty-eight observational studies matched inclusion criteria. Dermatology Life Quality Index (DLQI) was the most commonly utilized instrument: 57% of included studies reported mean baseline DLQI scores, ranging between 8.4 and 16.9, indicating a very large impact on the patients' HRQoL. Higher scores were reported with increasing disease severity and among female patients. Pain was assessed mostly by an 11-point (0-10) numeric rating scale (NRS) with a mean baseline score ranging from 3.6 to 7.7 indicating moderate to high pain levels. There was a negative impact of HS on patients' psychological well-being, based on PRO scores related to depression and anxiety. A high proportion of sexual dysfunction was reported, with a larger impact on women than men. Work productivity and leisure activity were consistently found to be impaired in patients with HS. CONCLUSIONS All included studies reported a negative impact of HS on patients' lives. A diverse set of disease- and non-disease-specific PRO instruments were utilized highlighting the need for more consistent use of HS-specific validated PRO instruments to assess the impact of HS on the different aspects of patients' HRQoL to allow for data to be more meaningfully interpreted and compared in real-world settings. Patients with HS need better disease management approaches that address the observed low quality of life.
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Affiliation(s)
- Alexa B Kimball
- Harvard Medical School and Beth Israel Deaconess Medical Center Boston, Boston, MA, USA.
| | | | | | | | | | | | | | | | | | - Amit Garg
- Northwell Health, New Hyde Park, New York, NY, USA
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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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Nardacchione EM, Tricarico PM, Moura R, d’Adamo AP, Thasneem A, Suleman M, Marzano AV, Crovella S, Moltrasio C. Unraveling the Epigenetic Tapestry: Decoding the Impact of Epigenetic Modifications in Hidradenitis Suppurativa Pathogenesis. Genes (Basel) 2023; 15:38. [PMID: 38254928 PMCID: PMC10815754 DOI: 10.3390/genes15010038] [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: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic autoinflammatory skin disorder, which typically occurs during puberty or early adulthood. The pathogenesis of HS is complex and multifactorial; a close interaction between hormonal, genetic, epigenetics factors, host-specific aspects, and environmental influences contributes to the susceptibility, onset, severity, and clinical course of this disease, although the exact molecular mechanisms are still being explored. Epigenetics is currently emerging as an interesting field of investigation that could potentially shed light on the molecular intricacies underlying HS, but there is much still to uncover on the subject. The aim of this work is to provide an overview of the epigenetic landscape involved in HS. Specifically, in this in-depth review we provide a comprehensive overview of DNA methylation/hydroxymethylation, histone modifications, and non-coding RNAs (such as microRNA-miRNA-132, miRNA-200c, miRNA-30a-3p, miRNA-100-5b, miRNA-155-5p, miRNA-338-5p) dysregulation in HS patients. An interesting element of epigenetic regulation in HS is that the persistent inflammatory milieu observed in HS lesional skin could be exacerbated by an altered methylation profile and histone acetylation pattern associated with key inflammatory genes. Deepening our knowledge on the subject could enable the development of targeted epigenetic therapies to potentially restore normal gene expression patterns, and subsequentially ameliorate, or even reverse, the progression of the disease. By deciphering the epigenetic code governing HS, we strive to usher in a new era of personalized and effective interventions for this enigmatic dermatological condition.
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Affiliation(s)
- Elena Maria Nardacchione
- Department of Advanced Diagnostics, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (E.M.N.); (P.M.T.); (R.M.); (A.P.d.)
| | - Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (E.M.N.); (P.M.T.); (R.M.); (A.P.d.)
| | - Ronald Moura
- Department of Advanced Diagnostics, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (E.M.N.); (P.M.T.); (R.M.); (A.P.d.)
| | - Adamo Pio d’Adamo
- Department of Advanced Diagnostics, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy; (E.M.N.); (P.M.T.); (R.M.); (A.P.d.)
- Department of Medical Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Ayshath Thasneem
- Laboratory of Animal Research Center (LARC), Qatar University, Doha 2713, Qatar; (A.T.); (M.S.); (S.C.)
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha 2713, Qatar
| | - Muhammad Suleman
- Laboratory of Animal Research Center (LARC), Qatar University, Doha 2713, Qatar; (A.T.); (M.S.); (S.C.)
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sergio Crovella
- Laboratory of Animal Research Center (LARC), Qatar University, Doha 2713, Qatar; (A.T.); (M.S.); (S.C.)
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
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36
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Marquez DG, Sadeghi NB, Westerkam LL, Blum FR, Dresselhaus A, Sayed CJ. A survey-based study on experiences with and perspectives toward medical providers among patients with hidradenitis suppurativa. Br J Dermatol 2023; 190:127-129. [PMID: 37766476 DOI: 10.1093/bjd/ljad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 09/29/2023]
Abstract
Patients with hidradenitis suppurativa frequently visit medical providers and are often misdiagnosed or inappropriately educated on their disease. This survey study investigated how often patients received misinformation about their disease. Many participants reported receiving incorrect information that caused shame and made them avoid seeing medical providers.
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Affiliation(s)
| | | | - Linnea L Westerkam
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Christopher J Sayed
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
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Rymaszewska JE, Karczewski M, Krajewski PK, Matusiak Ł, Maj J, Szepietowski JC. Patients' Expectations and Satisfaction with the Patient-Doctor Relationship in Hidradenitis Suppurativa. Healthcare (Basel) 2023; 11:3139. [PMID: 38132029 PMCID: PMC10742400 DOI: 10.3390/healthcare11243139] [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: 11/11/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with a vast psychosocial burden. We analyzed the actual and ideal patient-doctor relationship and patients' satisfaction with the patient-doctor relationship in relation to their satisfaction with life (SWL), HS-related quality of life, and psychopathological symptoms. METHODS 105 HS patients (53% females; mean age 37.64 ± 14.01 years) were enrolled. Severity of the disease was measured using Hurley staging and the International HS Score System (IHS4). Instruments utilized: Patient Expectation Test; Satisfaction with Life Scale; HS Quality of Life; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; General Health Questionnaire. RESULTS Patients with Hurley I and mild IHS4 had the lowest satisfaction with the patient-doctor relationship. There were significant correlations between the actual patient-doctor relationship and the patients' SWL (r = 0.30; p = 0.002), depressive (r = -0.36; p < 0.01), anxiety (r = 0.37; p < 0.01) and psychopathological symptoms (r = -0.47; p < 0.0001) and between the satisfaction with the patient-doctor relationship and their SWL (r = -0.32; p = 0.00098). Multiple regression analysis revealed a significant influence of the following factors: Hurley II + III, psychopathological symptoms, and severe anxiety about the actual patient-doctor relationship and the satisfaction with the patient-doctor relationship. CONCLUSIONS Assessment of relations between patients and doctors is related to the patients' mental health and SWL. The usage of the Patient Expectation Test in clinical practice can improve the patient-doctor relationship and the general quality of care for and compliance by HS patients.
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Affiliation(s)
- Julia Ewa Rymaszewska
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Maciej Karczewski
- Department of Applied Mathematics, Wrocław University of Environmental and Life Sciences, Grunwaldzka Str. 53, 50-357 Wrocław, Poland;
| | - Piotr K. Krajewski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Joanna Maj
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
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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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Durgu N, Ozan E, Gencoglan G. In Their Own Voices; Living with Hidradenitis Suppurativa: A Qualitative Study. Adv Skin Wound Care 2023; 36:1-6. [PMID: 37983582 DOI: 10.1097/asw.0000000000000067] [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: 11/22/2023]
Abstract
OBJECTIVE To provide a deeper assessment of the lived experience of patients with hidradenitis suppurativa, a chronic inflammatory disorder characterized by recurrent abscess, sinuses, and scars. METHODS This study used a phenomenologic approach. Researchers recruited 10 participants via purposive sampling. Data were collected via semistructured, in-depth, face-to-face interviews, and interpretative phenomenologic analysis was performed. RESULTS Data analysis uncovered two primary themes among participants' interview responses: "unending symptoms" and "life becoming hard." CONCLUSIONS The symptoms of hidradenitis suppurativa negatively affect individuals' family, professional, and daily lives, and patients may benefit from psychiatric intervention.
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Affiliation(s)
- Nihan Durgu
- At Manisa Celal Bayar University, Manisa, Turkey, Nihan Durgu, PhD, is Assistant Professor, Department of Mental Health Nursing, Faculty of Health Sciences; Erol Ozan, MD, is Associate Professor, Department of Psychiatry, School of Medicine; and Gulsum Gencoglan, MD, is Professor, Department of Dermatology, School of Medicine. Acknowledgment: The authors thank the patients who took the time to talk about their experiences. The authors have disclosed no financial relationships related to this article. Submitted November 7, 2022; accepted in revised form January 20, 2023
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Heise M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Podda M, Grabbe S, Schultheis M. A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effectiveness. J DERMATOL TREAT 2023; 34:2284105. [PMID: 38010850 DOI: 10.1080/09546634.2023.2284105] [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: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. METHODS EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). RESULTS Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. CONCLUSION Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.
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Affiliation(s)
- Marcus Heise
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- School of Business and Health, Baden-Wuerttemberg Cooperative State University, Stuttgart, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
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Chu CB, Yang CC, Hsueh YY, Chen PC, Hong YK, Kuo YY, Tsai SJ. Aberrant expression of interleukin-17A in mast cells contributes to the pathogenesis of hidradenitis suppurativa. Br J Dermatol 2023; 189:719-729. [PMID: 37540988 DOI: 10.1093/bjd/ljad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) significantly diminishes the quality of life for patients. Delayed diagnosis represents a significant challenge in effectively managing HS. OBJECTIVES To identify and characterize the key mediator in HS. METHODS Bioinformatic transcriptomic analysis was applied to identify potential candidates contributing to the disease process of HS. Skin samples from 40 patients with HS, four with psoriasis and 29 with normal skin were included. The expression of interleukin (IL)-17A was evaluated and compared among samples of normal skin, psoriatic skin and skin from different stages of HS by immunohistochemistry or dual-colour immunofluorescence. In vitro experiments and RNA sequencing analysis were also conducted to validate the expression of IL-17A and its pathogenic effect in HS. RESULTS Transcriptomic database analyses identified IL-17 signalling as a potential contributor to HS. In HS, the predominant IL-17A+ cell population was identified as mast cells. IL-17A+ mast-cell density was significantly elevated in HS, especially in samples with advanced Hurley stages, compared with normal skin and psoriasis samples. The close contact between IL-17A+ mast cells and IL-17 receptor A (IL-17RA)-expressing keratinocytes was demonstrated, along with the significant effects of IL-17A on keratinocyte cell proliferation and HS pathogenic gene expression. Treatment with biologics (brodalumab or adalimumab) reduced the severity of the disease and the number of IL-17A+ mast cells in affected tissues. CONCLUSIONS The presence of high-density IL-17A+ mast cells may serve as a valuable pathological marker for diagnosing HS. Moreover, developing therapeutic drugs targeting IL-17A+ mast cells may provide a new approach to treating HS.
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Affiliation(s)
- Chia-Bao Chu
- Department of Dermatology
- Institute of Basic Medical Sciences
| | - Chao-Chun Yang
- Department of Dermatology
- International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Yu Hsueh
- International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
- Department of Surgery
- Center of Cell Therapy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Yi-Kai Hong
- Department of Dermatology
- International Center for Wound Repair and Regeneration, National Cheng Kung University, Tainan, Taiwan
| | | | - Shaw-Jenq Tsai
- Institute of Basic Medical Sciences
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Mastacouris N, Tannenbaum R, Strunk A, Koptyev J, Aarts P, Alhusayen R, Bechara FG, Benhadou F, Bettoli V, Brassard A, Brown D, Choon SE, Coutts P, da Silva DLF, Daveluy S, Dellavalle RP, Del Marmol V, Emtestam L, Gebauer K, George R, Giamarellos-Bourboulis EJ, Goldfarb N, Hamzavi I, Hazen PG, Horváth B, Hsiao J, Ingram JR, Jemec GBE, Kirby JS, Lowes MA, Marzano AV, Matusiak L, Naik HB, Okun MM, Oon HH, Orenstein LAV, Paek SY, Pascual JC, Fernandez-Peñas P, Resnik BI, Sayed CJ, Thorlacius L, van der Zee HH, van Straalen KR, Garg A. Outcome Measures for the Evaluation of Treatment Response in Hidradenitis Suppurativa for Clinical Practice: A HiSTORIC Consensus Statement. JAMA Dermatol 2023; 159:1258-1266. [PMID: 37755725 DOI: 10.1001/jamadermatol.2023.3282] [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: 09/28/2023]
Abstract
Importance Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines. Objective To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied. Evidence Review Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice. Findings Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]). Conclusions and Relevance An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting.
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Affiliation(s)
| | | | | | | | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
| | - Farida Benhadou
- Department of Dermatology, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Vincenzo Bettoli
- Department of Medical Sciences, O.U. of Dermatology, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | | | - Debra Brown
- Medical Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Siew Eng Choon
- Hospital Sultanah Aminah and Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia
| | | | | | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz School of Medicine, Aurora, Colorado
- Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Aurora, Colorado
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Lennart Emtestam
- Section of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Noah Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Paul G Hazen
- Case-Western Reserve University School of Medicine, Cleveland, Ohio
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Joslyn S Kirby
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | | | - Hazel H Oon
- National Skin Centre, Singapore, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Singapore City, Singapore
| | - Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - So Yeon Paek
- Baylor University Medical Center, Dallas, Texas A&M University School of Medicine, Dallas
| | - José C Pascual
- Dermatology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Pablo Fernandez-Peñas
- Department of Dermatology, Westmead Hospital, The University of Sydney, Westmead, New South Wales, Australia
| | - Barry I Resnik
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amit Garg
- Northwell Health, New Hyde Park, New York
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Garg A, Geissbühler Y, Houchen E, Choudhary N, Arora D, Vellanki V, Srivastava A, Priyanka, Darcy J, Richardson C, Kimball AB. Disease Burden and Treatment Patterns Among US Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study. Am J Clin Dermatol 2023; 24:977-990. [PMID: 37378875 PMCID: PMC10570206 DOI: 10.1007/s40257-023-00796-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval. METHODS This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12-17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018. RESULTS Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively). CONCLUSION In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 11042, USA.
| | | | | | | | - Disha Arora
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | | | | | - Priyanka
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | - John Darcy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Alexa B Kimball
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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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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Sow Y, Salame N, Siira MR, Flowers N, Garg A, Patzer RE, Kavalieratos D, Curseen KA, Chen S, Orenstein LAV. Healthcare experiences among patients with hidradenitis suppurativa: a qualitative study. Br J Dermatol 2023; 189:624-626. [PMID: 37399246 PMCID: PMC10599793 DOI: 10.1093/bjd/ljad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/20/2023] [Accepted: 08/05/2023] [Indexed: 07/05/2023]
Abstract
In this qualitative study, 21 adults living with hidradenitis suppurativa (HS) were interviewed about their healthcare experiences. Participants detailed how delay in diagnosis, lack of provider knowledge, inadequate pain management, poor access to care and stigmatization negatively affected their interactions with the healthcare system. Improving disease knowledge among providers, proactively addressing HS-related pain and coordinating access to multidisciplinary care may improve healthcare experiences among individuals living with HS.
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Affiliation(s)
- Yacine Sow
- Morehouse School of Medicine, Atlanta, GA
| | | | | | | | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | | | | | - Kimberly A Curseen
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Suephy C Chen
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
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McGrath BM, Hughes O. The dermatology patient journey from initial consultation to diagnosis. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:25-26. [PMID: 37805996 DOI: 10.1111/jdv.18987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/25/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Barry M McGrath
- HS Ireland, Hidradenitis Suppurativa Association, County Clare, Ireland
| | - Olivia Hughes
- School of Psychology, Cardiff University, Tower Building, Cardiff, Wales, UK
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Li Y, Speck P, Viera E, Siira M, Orenstein LAV. The Influence of Pain on Reduced Quality of Life in Patients with Hidradenitis Suppurativa: A Single-Center Retrospective Study. Dermatology 2023; 239:1007-1012. [PMID: 37717562 DOI: 10.1159/000533740] [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: 04/25/2023] [Accepted: 08/20/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Pain and itch are impactful and burdensome symptoms of hidradenitis suppurativa (HS). Elucidating factors associated with pain and itch severity may identify groups disproportionally affected by HS-related pain and itch and further our understanding of how pain and itch impact quality of life (QoL) in patients with HS. OBJECTIVE The objective of the study was to determine factors associated with pain severity, itch severity, and reduced QoL in patients with HS. METHODS This is a retrospective cross-sectional study of 257 adults with HS who received care in an HS Specialty Clinic from January 2019 to August 2021. Multivariable mixed-effects linear regression was used to determine the relationships between clinical and demographic patient factors and the outcomes of pain severity, itch severity, and skin-specific QoL. RESULTS Factors associated with reduced QoL were Hurley stage II (β = 19.66, 95% CI: 1.40-37.93) and III (β = 21.98, 95% CI: 1.57-42.39) disease as well as severity of pain (β = 13.74, 95% CI: 11.93-15.55), itch (β = 4.57, 95% CI: 2.59-6.55), anxiety (β = 2.55 95% CI: 1.29-3.81), and depression (β = 1.43, 95% CI: 0.30-2.56). Increasing HS pain severity was associated with Hurley stage III disease (β = 2.04, 95% Cl: 0.99-3.09), black race (β = 1.23, 95% Cl: 0.40, 2.06), depression severity (β = 0.08, 95% Cl: 0.02, 0.14), and anxiety severity (β = 0.10 95% Cl: 0.04, 0.17). Factors associated with HS itch severity were Hurley stage III disease (β = 2.23, 95% Cl: 1.19, 3.27), black race (β = 0.92, 95% Cl: 0.07, 1.78), depression severity (β = 0.09, 95% Cl: 0.04, 0.14), and anxiety severity (β = 0.07, 95% Cl: 0.01, 0.13). CONCLUSION Pain is one of the largest contributors to QoL in patients with HS; on a 0-10 numeric rating scale, a 2-point increase in HS pain had a similar independent effect on QoL as having Hurley stage III disease compared to Hurley stage I.
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Affiliation(s)
- Yiwen Li
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA,
| | - Patrick Speck
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Eric Viera
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
| | - Meron Siira
- Department of Dermatology, Emory University School of Medicine, Atlanta, USA
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Johnston L, Dupuis E, Lam L, Poelman S. Understanding Hurley Stage III Hidradenitis Suppurativa Patients' Experiences With Pain: A Cross-Sectional Analysis. J Cutan Med Surg 2023; 27:487-492. [PMID: 37489915 PMCID: PMC10616983 DOI: 10.1177/12034754231188452] [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: 04/08/2023] [Revised: 05/20/2023] [Accepted: 07/01/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND More than 90% of patients with hidradenitis suppurativa (HS) report that pain interferes with their quality of life (QoL) and pain may have a larger impact on QoL than disease severity alone. OBJECTIVES The purpose of this study was to understand the impact of pain on the daily lives of patients with Hurley stage III HS. METHODS This was a single-center, prospective cross-sectional study that was conducted at Beacon Dermatology in Calgary, AB. Patients ≥ 18 years old with Hurley stage III HS in at least one area of the body were prospectively invited to participate in this study. The study consisted of survey questions on patients' demographic information, past medical histories, HS-related pain histories, and previous therapies for pain management. Additionally, patients completed a series of standardized rating scales on their pain and overall QoL. RESULTS Of the 10 patients that participated in the study, 90% (9/10) expressed a desire for more counselling on pain management options. Many patients (8/10, 80%) reported routine use of over-the-counter pain medications and 70% (7/10) used complementary and alternative medicines (CAMs) to manage their pain. Patients' efficacy ratings of HS treatments in controlling their pain revealed that topical treatments provided minimal or no relief, while surgical interventions had the highest efficacy for reducing pain. Patients' average worst pain over the preceding 24 hrs was 6.3 +/- 2.5 (2-9) on the Numerical Rating Scale for pain and the mean Dermatology Life Quality Index score was 19.5 +/- 8.2 (5-29). CONCLUSIONS Patients with Hurley stage III HS report high levels of daily pain and QoL impairment and many individuals use over-the-counter treatments and CAMs to manage their pain. Physicians involved in the care of HS patients should consider implementing routine counselling on pain management into their clinical practices, especially for patients with severe HS.
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Affiliation(s)
- Leah Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Elaine Dupuis
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Beacon Dermatology, Calgary, Canada
| | - Lauren Lam
- Beacon Dermatology, Calgary, Canada
- Department of Dermatology, University of Alberta, Edmonton, Canada
| | - Susan Poelman
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Beacon Dermatology, Calgary, Canada
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Williams JC, Alhusayen R, Guilbault S, Ingram JR, Lowes MA, Yannuzzi CA, Naik HB. Patient-reported influences on COVID-19 vaccine acceptance and hesitancy in people with hidradenitis suppurativa. Br J Dermatol 2023; 189:351-353. [PMID: 37210215 PMCID: PMC10449532 DOI: 10.1093/bjd/ljad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 05/20/2023] [Indexed: 05/22/2023]
Abstract
COVID-19 continues to pose a risk to patients with hidradenitis suppurativa (HS) due to the high prevalence of comorbidities associated with severe COVID-19 disease. We aimed to characterize perspectives on COVID-19 vaccination among patients with HS. International respondents from 20 online HS support groups were recruited to complete a voluntary, anonymous, online cross-sectional survey from 25 October to 21 November 2021 to obtain perspectives from people with HS who may and may not access healthcare. We report higher rates of COVID-19 vaccine hesitancy among patients with HS who expressed dissatisfaction with their dermatological care.
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Affiliation(s)
| | - Raed Alhusayen
- Dermatology Division, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology and Academic Wound Healing, Cardiff University, Cardiff, UK
| | | | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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Colvin A, Petukhova L. Inborn Errors of Immunity in Hidradenitis Suppurativa Pathogenesis and Disease Burden. J Clin Immunol 2023; 43:1040-1051. [PMID: 37204644 DOI: 10.1007/s10875-023-01518-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Hidradenitis suppurativa (HS), also known as Verneuil's disease and acne inversa, is a prevalent, debilitating, and understudied inflammatory skin disease. It is marked by repeated bouts of pathological inflammation causing pain, hyperplasia, aberrant healing, and fibrosis. HS is difficult to manage and has many unmet medical needs. There is clinical and pharmacological evidence for extensive etiological heterogeneity with HS, suggesting that this clinical diagnosis is capturing a spectrum of disease entities. Human genetic studies provide robust insight into disease pathogenesis. They also can be used to resolve etiological heterogeneity and to identify drug targets. However, HS has not been extensively investigated with well-powered genetic studies. Here, we review what is known about its genetic architecture. We identify overlap in molecular, cellular, and clinical features between HS and inborn errors of immunity (IEI). This evidence indicates that HS may be an underrecognized component of IEI and suggests that undiagnosed IEI are present in HS cohorts. Inborn errors of immunity represent a salient opportunity for rapidly resolving the immunological landscape of HS pathogenesis, for prioritizing drug repurposing studies, and for improving the clinical management of HS.
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Affiliation(s)
- Annelise Colvin
- Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY, USA
| | - Lynn Petukhova
- Department of Dermatology, Vagelos College of Physicians & Surgeons, Columbia University, New York City, NY, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, #527, York City, NY, USA.
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