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Elzawawi KE, Elmakaty I, Habibullah M, Ahmed MB, Al Lahham S, Al Harami S, Albasti H, Alsherawi A. Hidradenitis suppurativa and its association with obesity, smoking, and diabetes mellitus: A systematic review and meta-analysis. Int Wound J 2024; 21:e70035. [PMID: 39267324 PMCID: PMC11393007 DOI: 10.1111/iwj.70035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/09/2024] [Accepted: 08/11/2024] [Indexed: 09/17/2024] Open
Abstract
Our meta-analysis aimed to quantify the association between Hidradenitis suppurativa (HS) and several risk factors including obesity, smoking, and type 2 diabetes mellitus (T2DM). We searched PubMed, Scopus, Embase, Web of Science, and cumulative index to nursing and allied health literature for articles reporting either the odds ratio (OR) or the numbers of HS cases associated with obesity, smoking, or T2DM, and including HS negative controls. Risk of bias was assessed against the risk of bias in non-randomized studies of interventions tool. Data synthesis was done using the random effects model with heterogeneity being evaluated with I2 statistic. Twenty-three studies with a total of 29 562 087 patients (average age of 36.6 years) were included. Ten studies relied on country-level data, while six studies collected their data from HS clinics. The analysis showed a significant association between HS and female sex (OR 2.34, 95% CI 1.89-2.90, I2 = 98.6%), DM (OR 2.78, 95% CI 2.23-3.47, I2 = 98.9%), obesity (OR 2.48, 95% CI 1.64-3.74, I2 = 99.9%), and smoking (OR 3.10 95% CI 2.60-3.69, I2 = 97.1%). Our meta-analysis highlights HS links to sex, DM, obesity, and smoking, with emphasis on holistic management approach. Further research is needed on molecular mechanisms and additional risk factors for improved patient care.
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Affiliation(s)
- Khaled E Elzawawi
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ibrahim Elmakaty
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohammad Habibullah
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohamed Badie Ahmed
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Department of Medical Education, Hamad Medical Corporation (HMC), Doha, Qatar
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salim Al Lahham
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sara Al Harami
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Habib Albasti
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abeer Alsherawi
- Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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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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Verde L, Cacciapuoti S, Caiazzo G, Megna M, Martora F, Cavaliere A, Mattera M, Maisto M, Tenore GC, Colao A, Savastano S, Muscogiuri G, Barrea L. Very low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): an effective and safe tool for improvement of the clinical severity of disease. Results of a pilot study. J Transl Med 2024; 22:149. [PMID: 38350939 PMCID: PMC10863195 DOI: 10.1186/s12967-024-04853-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/02/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS), an inflammatory-based dermatological condition often associated with obesity, poses significant challenges in management. The very low-calorie ketogenic diet (VLCKD) has shown efficacy in addressing obesity, related metabolic disorders, and reducing chronic inflammation. However, its effects on HS remain underexplored. In this prospective pilot study, we aimed to investigate the impact of a 28-day active phase of VLCKD on HS in a sample of treatment-naive women with HS and excess weight. METHODS Twelve women with HS and overweight or obesity (BMI 27.03 to 50.14 kg/m2), aged 21 to 54 years, meeting inclusion/exclusion criteria and agreeing to adhere to VLCKD, were included. Baseline lifestyle habits were assessed. The Sartorius score was used to evaluate the clinical severity of HS. Anthropometric parameters (waist circumference, weight, height, and body mass index), body composition via bioelectrical impedance analysis, levels of trimethylamine N-oxide (TMAO), oxidized low-density lipoprotein (oxLDL), and derivatives of reactive oxygen metabolites (dROMs) were assessed at baseline and after 28 days of the active phase of VLCKD. RESULTS VLCKD led to general improvements in anthropometric parameters and body composition. Notably, a significant reduction in the Sartorius score was observed after the intervention (Δ%: - 24.37 ± 16.64, p < 0.001). This reduction coincided with significant decreases in TMAO (p < 0.001), dROMs (p = 0.001), and oxLDL (p < 0.001) levels. Changes in the Sartorius score exhibited positive correlations with changes in TMAO (p < 0.001), dROMs (p < 0.001), and oxLDL (p = 0.002). CONCLUSION The 28-day active phase of VLCKD demonstrated notable improvements in HS severity and associated metabolic markers, highlighting the potential utility of VLCKD in managing HS and its association with metabolic derangements in women with overweight or obesity.
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Affiliation(s)
- Ludovica Verde
- Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Giuseppina Caiazzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Fabrizio Martora
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Annarita Cavaliere
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Mattera
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maria Maisto
- ChimNutra labs, Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131, Naples, Italy
| | - Gian Carlo Tenore
- ChimNutra labs, Department of Pharmacy, University of Naples Federico II, via Domenico Montesano 49, 80131, Naples, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del Paziente con Obesità (C.I.B.O), Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione Alla Salute E Allo Sviluppo Sostenibile", University Federico II, Naples, Italy
| | - Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Centro Direzionale, Via Porzio, Isola F2, 80143, Naples, Italy.
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Ezanno AC, Guillem P, Gorin C, Gabison G, Malgras B, Fougerousse AC. What should a surgeon know about hidradenitis suppurativa? J Visc Surg 2023; 160:444-455. [PMID: 37722942 DOI: 10.1016/j.jviscsurg.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
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Affiliation(s)
- Anne Cecile Ezanno
- Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - Philippe Guillem
- Val d'Ouest Clinic, 39, chemin de la Vernique, 69130 Écully, France
| | - Cécile Gorin
- Psychiatry Department, HIA Sainte-Anne, 2, boulevard Sainte-Anne BP600, 83000 Toulon, France
| | - Germaine Gabison
- Dermatology, 32, avenue du Maréchal-de-Lattre-de-Tassigny, 94410 Saint-Maurice, France
| | - Brice Malgras
- Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Val de Grâce School, Army Health Service, 75005 Paris, France
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5
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Hrvatin Stancic B, Falabella P, Dolenc Voljč M. The influence of body mass index and smoking on the severity of hidradenitis suppurativa in the Slovenian population. J Eur Acad Dermatol Venereol 2023; 37:e1305-e1306. [PMID: 37415336 DOI: 10.1111/jdv.19301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Bor Hrvatin Stancic
- Dermatovenereology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Falabella
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mateja Dolenc Voljč
- Dermatovenereology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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6
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Mintoff D, Agius R, Benhadou F, Das A, Frew JW, Pace NP. Obesity and hidradenitis suppurativa: targeting meta-inflammation for therapeutic gain. Clin Exp Dermatol 2023; 48:984-990. [PMID: 37171791 DOI: 10.1093/ced/llad182] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the pilosebaceous unit. The typical patient with HS is characterized as someone with obesity, who smokes and who has nodules, abscesses and/or draining tunnels predominantly distributed in intertriginous skin. It has been established that lifestyle and genetic factors are the main pathophysiological drivers of HS. In this critical review, we explore the interrelatedness of meta-inflammation, obesity and HS and discuss if and how this relationship may be manipulated for a therapeutic end.
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Affiliation(s)
- Dillon Mintoff
- Department of Dermatology
- Department of Pathology, Faculty of Medicine and Surgery
| | - Rachel Agius
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Anupam Das
- Department of Dermatology, Venereology and Leprosy; KPC Medical College & Hospital, Kolkata, India
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Nikolai P Pace
- Faculty of Medicine and Surgery
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
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Mandour MO, Al-Musawi S, Idowu E, Long PF, Rashidghamat E, Oben JA. Metabolic endoscopy and a simplified low-carbohydrate-high-dietary fiber template as novel treatments for hidradenitis suppurativa - A case series. JAAD Case Rep 2023; 34:23-26. [PMID: 36941875 PMCID: PMC10023847 DOI: 10.1016/j.jdcr.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Affiliation(s)
- Mandour O. Mandour
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Safa Al-Musawi
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Esther Idowu
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Paul F. Long
- Institute of Cancer and Pharmaceutical Science, King’s College, London, United Kingdom
| | - Ellie Rashidghamat
- Department of Dermatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
| | - Jude A. Oben
- Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, London, United Kingdom
- Faculty of Life Sciences & Medicine, Guy’s and St Thomas’ Hospital, United Kingdom
- Correspondence: Jude A Oben, MD, Department of Gastroenterology & Hepatology, Guy’s and St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH.
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8
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Abu Rached N, Gambichler T, Ocker L, Dietrich JW, Quast DR, Sieger C, Seifert C, Scheel C, Bechara FG. Screening for Diabetes Mellitus in Patients with Hidradenitis Suppurativa—A Monocentric Study in Germany. Int J Mol Sci 2023; 24:ijms24076596. [PMID: 37047569 PMCID: PMC10094965 DOI: 10.3390/ijms24076596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic skin disease that is often associated with metabolic disorders. Diabetes mellitus (DM) is a frequent comorbidity in HS. There is currently no established screening for DM in HS patients. The aim of our study was to identify high-risk groups of HS patients that develop DM and to assess the frequency of different types of DM present in HS patients. To do so, we conducted a monocentric study in 99 patients with HS. All patients underwent detailed clinical and laboratory assessments, including the determination of glycated hemoglobin. Among the 20.2% of patients that presented with DM, type 2 was by far the most prevalent (19 out of 20 patients). Moreover, male gender, age, BMI, Hurley stage, modified Hidradenitis Suppurativa Score (mHSS), DLQI and hypertension all correlated with the glycated hemoglobin levels in the HS patients. In the multivariable analysis, Hurley stage III, older age, and higher BMI were significantly associated with DM. Specifically, patients at Hurley stage III were at a 5.3-fold increased risk of having DM type II compared to patients at earlier Hurley stages. Since many of the HS patients had not been diagnosed, our study reveals shortcomings in the screening for DM and suggest that this should be routinely performed in HS patients at high risk to avoid secondary complications.
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Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Thilo Gambichler
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Daniel R. Quast
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Christina Sieger
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Caroline Seifert
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Christina Scheel
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
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9
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Sampogna F, Fania L, Mastroeni S, Fusari R, Panebianco A, Abeni D. Quality of life in patients with early- and late-onset hidradenitis suppurativa. Arch Dermatol Res 2023; 315:473-479. [PMID: 35997825 DOI: 10.1007/s00403-022-02374-8] [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: 10/28/2021] [Revised: 06/14/2022] [Accepted: 08/01/2022] [Indexed: 11/02/2022]
Abstract
Hidradenitis suppurativa (HS) usually has an early onset, however, also onset in the mid-40 s may occur. Recently, the threshold of 28 years to distinguish patients with early and late onset has been proposed. The objective of our study was to compare the quality of life (QoL) and psychological distress in early- and late-onset HS patients. In this cross-sectional, observational study, consecutive patients diagnosed with HS aged ≥ 16 years were recruited. Dermatology-specific QoL was evaluated using the Skindex-17 questionnaire, and psychological distress using the 12-item General Health Questionnaire (GHQ-12). Patients were categorized into "early onset" (< 28 years) and "late onset" (≥ 28 years). Data were collected on 467 patients. Mean age at diagnosis was 21.6 years, with 22.0% of patients presenting with late disease onset. Patients with late onset reported worse psychosocial QoL and higher psychological distress compared to early onset. No differences between the two groups were observed for clinical severity. In the final multivariate model lower diagnostic delay, higher number of fistulae, higher BMI, ex-smoker, no localization on axillae, no localization on mammary region, presence of psoriasis, and higher scores on the psychosocial scale of Skindex-17 were statistically significantly associated with late onset. In conclusion, the psychosocial impact of HS is higher in patients with late onset compared to those with early onset. Differences between these two groups should be further investigated.
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Affiliation(s)
- F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy.
| | - L Fania
- Dermatology Unit, IDI-IRCCS, Rome, Italy
| | - S Mastroeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
| | - R Fusari
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
| | | | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
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Employing Adalimumab in Treatment of Moderate-to-Severe Hidradenitis Suppurativa: Real-Life Multicenter Data from the Czech Republic. Dermatol Ther 2023. [DOI: 10.1155/2023/3640285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Adalimumab is the only approved biologic treatment for moderate-to-severe hidradenitis suppurativa, nonetheless, long-term data from real-life setting are still limited. The objective of this observational multicenter study was to evaluate the effectiveness, safety, and drug survival of adalimumab in patients with hidradenitis suppurativa included in the BIOREP registry. A total of 299 patients who initiated adalimumab therapy for hidradenitis suppurativa from 2011 to November 2021 were included. The Dermatology-Life-Quality-Index (DLQI), pain scale, the number of abscesses, inflammatory nodules and draining tunnels, and International Hidradenitis Suppurativa Severity Score System (IHS4) were recorded in the 0th, 3rd, and 6th months; then every 6 months during the ongoing adalimumab treatment. Studied patients underwent treatment for up to 48 months, with the average duration of treatment lasting 2.3 years. The mean age of the patients was 44.9 years, 79% were smokers or ex-smokers, 54.8% were obese, and 26.4% were overweight, the mean BMI was 30.8. The mean time from diagnosis to initiation adalimumab therapy was 9.1 years. The number of patients with severe IHS4 dropped from the initial 249 (83.3%) to 65 (30.1%) after 12 months and this trend was maintained up to the 48th month. A decreasing number of inflammatory lesions were rapid and sustained and correlated to the improvement of patients’ quality of life, the mean DLQI score dropped from 17.6 to 8.5 after 3 months and to 5, 7 after 48 months. No unexpected risk signals were observed. Our long-term study demonstrates the effectiveness and safety of adalimumab in a real-life setting.
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Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits. Biomedicines 2022; 10:biomedicines10112973. [PMID: 36428540 PMCID: PMC9687269 DOI: 10.3390/biomedicines10112973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.
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12
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Coromilas A, Micheletti RG. Strategies for Effective Management of Hidradenitis Suppurativa in the Hospital Setting. CURRENT DERMATOLOGY REPORTS 2022. [DOI: 10.1007/s13671-022-00373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
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13
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Ulschmid C, Serrano L, Wu R, Roth GM, Sokumbi O. African American race is a risk factor for severe hidradenitis suppurativa. Int J Dermatol 2022; 62:657-663. [PMID: 36183313 DOI: 10.1111/ijd.16428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/15/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND African Americans face a disproportionate incidence and prevalence of hidradenitis suppurativa (HS) in the United States, but HS severity and outcomes across racial and ethnic groups have not been well-established while controlling for potentially confounding factors. In this retrospective cohort study, we investigated the associations of race and ethnicity with HS severity, emergency department (ED) visits, hospitalizations, and surgeries for HS while controlling for age, sex, body mass index (BMI), tobacco use, and insurance type. METHODS We reviewed 1190 patients seen at the Medical College of Wisconsin with ≥3 encounters for HS between 1/1/2002 and 3/19/2019, excluding those without race data or an encounter in which HS was treated. RESULTS A total of 953 patients were included; 470 patients were Black or African American non-Hispanic (49%), 39 Hispanic (4%), 418 White non-Hispanic (44%), and 26 other race or ethnicity (3%). Controlling for age, sex, BMI, tobacco use, and insurance type, Black patients had 2.8 times the odds of having Hurley stage III disease (95% CI 1.76-4.45, P < 0.001), 2.86 times the risk for experiencing an ED visit for HS (95% CI 2.12-3.88, P < 0.001), 2.25 times the risk for experiencing a hospitalization for HS (95% CI 1.42-3.56, P < 0.001), and 1.61 times the risk for experiencing a surgical encounter for HS (95% CI 1.34-1.95, P < 0.001) when compared to White patients. CONCLUSIONS African Americans face significant disparities in HS severity, ED visits, hospitalizations, and surgeries. The causes of these disparities must be further investigated and addressed.
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Affiliation(s)
- Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Linda Serrano
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ruizhe Wu
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gretchen M Roth
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL, USA
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14
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Jemec GBE, Del Marmol V, Bettoli V, Augustin M, Prens EP, Zouboulis CC. Register, multicenter and genome-wide association studies in hidradenitis suppurativa. Exp Dermatol 2022; 31 Suppl 1:22-28. [PMID: 35582836 DOI: 10.1111/exd.14610] [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: 03/17/2022] [Revised: 05/04/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
The European Hidradenitis Suppurativa Foundation (EHSF) e.V. has taken several initiatives to collaborative studies. They result from the data of the European Registry of Hidradenitis Suppurativa (ERHS) based on the knowledge obtained from the regional Northern countries (HISREG) and Italian (IRHIS) registries and the real-world data generated from claims data from insurance databases. Multicenter studies, such as the Hidradenitis Suppurativa collaborative study of subtypes (HORUS) and the Global Hidradenitis Suppurativa Atlas (GHISA) are planned to provide an ideal complement to the register studies. Most recently, the role of EHSF as a coordinator or key player is being explored in multiple genetic studies, such as a genome-wide association study (GWAS) and the exome sequencing and cellular/molecular profiling project, which will speed up gene and drug discovery in HS.
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Affiliation(s)
- G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - V Del Marmol
- Department of Dermatology, Hopital Erasme, Université Libre de Bruxelles, Belgium.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - V Bettoli
- Department of Dermatology, University of Ferrara, Ferrara, Italy.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - E P Prens
- Department of Dermatology, Erasmus Medical Center, University of Rotterdam, Rotterdam, Netherlands.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergollogy and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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15
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Barak-Levitt J, Held R, Synett Y, Kremer N, Hodak E, Sherman S. Hidradenitis Suppurativa International Online Community: Patient Characteristics and a Novel Model of Treatment Effectiveness. Acta Derm Venereol 2022; 102:adv00686. [PMID: 35312027 PMCID: PMC9558329 DOI: 10.2340/actadv.v102.1056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Treatment for hidradenitis suppurativa is diverse, yet frequently unsatisfactory. The aims of this study were to create a reproducible artificial intelligence-based patient-reported outcome platform for evaluation of the clinical characteristics and comorbidities of patients with hidradenitis suppurativa, and to use this to grade treatment effectiveness. A retrospective patient-reported outcome study was conducted, based on online questionnaires completed by English-speaking patients registered to the hidradenitis suppurativa Stuff-ThatWorks® online community. Data collected included patient characteristics, comorbidities and treatment satisfaction. These were recoded into scalable labels using a combination of machine learning algorithm, manual coding and validation. A model of treatment effectiveness was generated. The cohort included 1,050 patients of mean ± standard deviation age 34.3 ± 10.3 years. Greater severity of hidradenitis suppurativa was associated with younger age at onset (p < 0.001) and male sex (p < 0.001). The most frequent comorbidities were depression (30%), anxiety (26.4%), and polycystic ovary syndrome (16.6%). Hurley stage I patients rated topical agents, dietary changes, turmeric, and pain relief measures more effective than tetracyclines. For Hurley stage II, adalimumab was rated most effective. For Hurley stage III, adalimumab, other biologic agents, systemic steroids, and surgical treatment were rated more effective than tetracyclines. Patients with hidradenitis suppurativa often have comorbid psychiatric and endocrine diseases. This model of treatment effectiveness provides a direct comparison of standard and complementary options.
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Affiliation(s)
| | | | | | | | | | - Shany Sherman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
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16
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17
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Velluzzi F, Anedda J, Pisanu S, Dell'Antonia M, Deledda A, Boi A, Ferreli C, Atzori L. Mediterranean diet, lifestyle and quality of life in Sardinian patients affected with Hidradenitis suppurativa. J Public Health Res 2021; 11. [PMID: 34850622 PMCID: PMC8958440 DOI: 10.4081/jphr.2021.2706] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Hidradenitis Suppurativa is a chronic inflammatory skin disease with a strong negative impact on physical and psychological health. Obesity, especially visceral adiposity, but also smoking or unhealthy nutritional habits, have been reported to be significantly associated with hidradenitis suppurativa. Design and methods: Case-control study in 35 patients of both sexes affected with hidradenitis suppurativa, and 35 healthy subjects matched for sex, age, and geographic origin (Sardinia, Italy). Results: Several anthropometric measures (body mass index, waist circumference, body composition), lifestyle (Mediterranean diet adherence, and physical activity level), and the perceived physical and mental health status were evaluated in case and controls. Hidradenitis patients showed significantly higher values of body mass index, waist circumference, body composition, fat mass, and lower values of physical and mental health status compared to controls, while both groups showed a similar moderate physical activity level which can be assumed to counteract the negative effects of obesity or poor nutritional pattern in hidradenitis patients. However, none of the evaluated variables were correlated with the severity of the disease, assessed by means of the Hurley stage system or the Sartorius score. Instead, the Sartorius score showed a positive correlation with the duration of hidradenitis, mainly imputable to the diagnostic delay and the consequent long lasting inflammatory status. Conclusions: Although nutritional factors and lifestyle can be important and modifiable factors in the hidradenitis suppurativa course, the detrimental effect of chronic inflammation and delayed management are clearly prevalent and heavily influence the disease burden. Significance for public health The negative impact of Hidradenitis Suppurativa on physical and psychological health is incontrovertibly high, especially in young adults, in the midst of their social and working life. Modifiable negative attitude and lifestyles are an important field of study and intervention, which remain controversial. Although smoking and unhealthy nutritional habits, have been reported to be significantly associated with Hidradenitis Suppurativa, main studies were performed in geographical areas with a high prevalence of obesity. Present case-control study is conducted in a sample of Sardinian population, which confirm a lower obesity rate, a certain relevance of altered anthropometric measures (body mass index, waist circumference, body composition), lower Mediterranean diet adherence, and perceived physical and mental health status in hidradenitis cases. However, none of these factors resulted statistically associated with the severity of the disease, as opposed to the diagnostic and consequent management delay, which confirms is prominent role on the disease burden.
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Affiliation(s)
- Fernanda Velluzzi
- Department of Medical Sciences and Public Health, Obesity Unit, University of Cagliari.
| | - Jasmine Anedda
- Department of Medical Sciences and Public Health, Dermatology Unit, University of Cagliari.
| | - Silvia Pisanu
- Department of Medical Sciences and Public Health, Obesity Unit, University of Cagliari.
| | - Massimo Dell'Antonia
- Department of Medical Sciences and Public Health, Dermatology Unit, University of Cagliari.
| | - Andrea Deledda
- Department of Medical Sciences and Public Health, Obesity Unit, University of Cagliari.
| | - Alessandro Boi
- Department of Medical Sciences and Public Health, Obesity Unit, University of Cagliari.
| | - Caterina Ferreli
- Department of Medical Sciences and Public Health, Dermatology Unit, University of Cagliari.
| | - Laura Atzori
- Department of Medical Sciences and Public Health, Dermatology Unit, University of Cagliari.
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18
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Garcovich S, Fania L, Caposiena D, Giovanardi G, Chiricozzi A, De Simone C, Tartaglia C, Ciccone D, Bianchi L, Abeni D, Peris K. Pediatric Hidradenitis Suppurativa: A Cross-Sectional Study on Clinical Features and Treatment Approaches. J Cutan Med Surg 2021; 26:127-134. [PMID: 34615396 DOI: 10.1177/12034754211039993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hidradenitis suppurativa is uncommon in patients of pediatric age, and differentiation with adult-onset disease is controversial. Treatment of pediatric hidradenitis suppurativa is scarcely standardized, and specific guidelines are lacking. OBJECTIVE We report the clinical features, relevant risk-factors, comorbidity profile, and treatment patterns of a hospital-based cohort of pediatric hidradenitis suppurativa. METHODS In a cross-sectional study data on patients' demographics, disease-specific characteristics, early/pre-pubertal onset of disease, comorbidities, and treatment management were retrieved. Reference population data and clinical data from the national hidradenitis suppurativa disease registry were used for comparison. RESULTS From a database of 870 patients with hidradenitis, 71 (15 males and 56 females) patients aged <18 years (mean age: 15.3 years; range 8-17 years), with mild (Hurley I, 45.1%) and moderate-severe disease (Hurley II-III, 54.9%), were retrieved. Smoking (23.9%) and overweight/obese frequencies (59.2%) were higher than reference population standards. Patient's older age at baseline (OR 1.43, 95% CI: 1.01 to 2.02) and higher BMI (OR 1.26, 95% CI: 1.07-1.48) were the only factors associated with moderate-severe disease. Family history and early/pre-pubertal onset of disease were not associated with severity or extent of disease. Sebaceous-follicular comorbid conditions were associated with cigarette smoking (P = .002). Among 81 treatment courses, clindamycin-based and zinc-sulphate-based combination regimens were most frequently used (59.3%). Female preponderance, family history of disease and extensive involvement were significantly different from the general hidradenitis suppurativa population. CONCLUSIONS Pediatric hidradenitis suppurativa presents a clinical spectrum comparable to adult-onset disease. Increased preventive measures should target obesity and smoking in this population.
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Affiliation(s)
- Simone Garcovich
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Luca Fania
- 9363 Dermatology Department, IDI-IRCCS, Rome, Italy
| | - Dante Caposiena
- 9318 Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Giulia Giovanardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Andrea Chiricozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Clara De Simone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Chiara Tartaglia
- 9318 Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | | | - Luca Bianchi
- 9318 Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | | | - Ketty Peris
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
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19
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Rosi E, Fastame MT, Scandagli I, Di Cesare A, Ricceri F, Pimpinelli N, Prignano F. Insights into the Pathogenesis of HS and Therapeutical Approaches. Biomedicines 2021; 9:1168. [PMID: 34572354 PMCID: PMC8467309 DOI: 10.3390/biomedicines9091168] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, (auto)inflammatory disease primarily affecting apocrine gland-rich areas of the body. Although pathogenic mechanisms responsible for HS have not yet been fully elucidated, it is a multifactorial process whose main target is the terminal follicle. The role of the inflammatory process (and consequently of cytokine milieu) and of several other factors (genetics, lifestyle, hormonal status, microbiome, innate and adaptive immune systems) involved in HS pathogenesis has been investigated (and often defined) over the years with a view to transferring research results from bench to bedside and describing a unique and universally accepted pathogenetic model. This review will update readers on recent advances in our understanding of HS pathogenesis and novel (potential) medical therapies for patients with moderate-to-severe HS.
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Affiliation(s)
| | | | | | | | | | | | - Francesca Prignano
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy; (E.R.); (M.T.F.); (I.S.); (A.D.C.); (F.R.); (N.P.)
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20
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Fabbrocini G, Ruina G, Giovanardi G, Dini V, Raone B, Venturini M, Caposiena Caro RD, Veraldi S, Cannavò SP, Merlo G, Bertoldi AM, Fiorentini F, Molinelli E, Atzori L, Bongiorno MR, Lo Re M, Skroza N, Lasagni C, Franchi C, Ardigò M, Di Costanzo L, Stingeni L, Amerio P, Sanna F, Pescitelli L, Broganelli P, De Cupis C, Gualberti G, Saragaglia V, Argenziano G. Hidradenitis Suppurativa in a Large Cohort of Italian Patients: Evaluation of the Burden of Disease. Dermatology 2021; 238:487-497. [PMID: 34474409 DOI: 10.1159/000517412] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 05/25/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually occurs after puberty with painful, deep-seated, inflamed nodules and sinus tracts in the apocrine gland-bearing areas of the body, most commonly the axillae and inguinal and anogenital regions, with a relevant impact on patients' quality of life (QoL). OBJECTIVE To evaluate how the burden of HS disease impacts on patient well-being and working activities in a large Italian population over a period of 9 months. METHODS A multicenter, prospective, epidemiologic cohort study was conducted in adult Italian patients with HS. HS severity was assessed through Hurley stage and HS Physician's Global Assessment (HS-PGA), clinical improvement by HS Clinical Response (HiSCR) and partial response, and disease burden through QoL questionnaires (HIDRAdisk, Skindex-16, Dermatology Life Quality Index [DLQI]), and Work Productivity and Activity Impairment - General Health (WPAI:GH). RESULTS A total of 308 patients (56.2% women; mean age 35.2 ± 12.9 years) were enrolled in 27 dermatologic clinics. Men were older (37.4 years vs. 33.5), more smoking addicted (74.1% vs. 60.1%), and alcohol consumer (34.1% vs. 13.9%), while more women were obese (34.10% vs. 22.22%). At baseline, most patients had a Hurley severity stage of 2 (43.9%), a moderate HS-PGA score (57.1%), and poor QoL (HIDRAdisk: 65.7 ± 23.3, Skindex-16: 60.3 ± 26.9, and DLQI: 10.8 ± 8.1). Patients with more severe disease showed worse QoL. Mean values for the variables related to HS severity decreased during the study period. The achievement of HiSCR and partial response increased during the study. CONCLUSION This study offers insight into the disease burden of HS in an Italian population. Our results underline the impact of QoL evaluation, also with the use of the HIDRAdisk, in clinical routine as a support to validated severity clinical and instrumental indexes for a "360-degree" assessment of HS patient's burden of disease.
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Affiliation(s)
- Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico, Naples, Italy
| | - Giulia Ruina
- Royal London Hospital, Barts NHS Trust, London, United Kingdom
| | - Giulia Giovanardi
- Istituto di Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Beatrice Raone
- Department of Specialized, Diagnostic and Experimental Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Marina Venturini
- Department of Dermatology, University of Brescia and ASST-Spedali Civili Hospital, Brescia, Italy
| | | | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Giulia Merlo
- Dermatology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Laura Atzori
- Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Maria Rita Bongiorno
- U.O.C. Dermatologia e MTS, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Università di Palermo, Palermo, Italy
| | - Michele Lo Re
- U.O.C di Dermatologia Azienda Ospedaliera Papardo, Messina, Italy
| | - Nevena Skroza
- Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Polo Pontino, Italy
| | - Claudia Lasagni
- Clinica Dermatologica, A.O.U. Policlinico di Modena, Modena, Italy
| | | | | | - Luisa Di Costanzo
- UOC di Dermatologia Azienda Ospedaliera San Pio Presidio G. Rummo, Benevento, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Paolo Amerio
- Department of Dermatology, University of Chieti-Pescara, Chieti, Italy
| | | | - Leonardo Pescitelli
- Department Health Science Section of Dermatology, University of Florence, Florence, Italy
| | - Paolo Broganelli
- Dermatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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21
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Hidradenitis Suppurativa: Where We Are and Where We Are Going. Cells 2021; 10:cells10082094. [PMID: 34440863 PMCID: PMC8392140 DOI: 10.3390/cells10082094] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 12/19/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.
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22
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Macklis PC, Tyler K, Kaffenberger J, Kwatra S, Kaffenberger BH. Lifestyle modifications associated with symptom improvement in hidradenitis suppurativa patients. Arch Dermatol Res 2021; 314:293-300. [PMID: 33893517 DOI: 10.1007/s00403-021-02233-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/08/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that substantially reduces patient quality of life. Many HS patients ask their dermatologist about potential lifestyle modifications, such as following particular diets or avoiding specific products, in an attempt to alleviate their symptoms. However, insufficient research has been conducted to support well-informed lifestyle modification counseling, and patients frequently defer to anecdotal endorsements of various interventions found on social media support groups. Therefore, we sought to clarify what lifestyle modifications were capable of improving HS symptoms. METHODS We conducted a survey-based study to examine modifiable risk factors and their association with the severity of HS. Five hundred and ninety-one patients with HS participated in an online survey detailing the severity of their HS symptoms before and after various lifestyle interventions. Average improvements in both subjective and objective ratings of symptom severity were calculated and statistical differences between the levels of improvement seen among various categories of lifestyle interventions were determined. RESULTS Numerous lifestyle interventions including substantial weight loss, smoking cessation, use of gentle skin and depilatory products, and menstrual regulation were associated with both subjective and objective improvements in symptom severity. CONCLUSIONS Our results suggest that patients affected by HS may experience clinically significant improvement from a variety of lifestyle modifications.
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Affiliation(s)
- Paul C Macklis
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kelly Tyler
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA
| | - Jessica Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA
| | - Shawn Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Benjamin H Kaffenberger
- Division of Dermatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Rm 232, Columbus, OH, 43212, USA.
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23
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Dmitriev A, König A, Lang V, Diehl S, Kaufmann R, Pinter A, Buerger C. mTORC1 - a potential player in the pathogenesis of hidradenitis suppurativa? J Eur Acad Dermatol Venereol 2021; 35:e444-e447. [PMID: 33656206 DOI: 10.1111/jdv.17202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 02/06/2023]
Affiliation(s)
- A Dmitriev
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
| | - A König
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
| | - V Lang
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
| | - S Diehl
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
| | - R Kaufmann
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
| | - A Pinter
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
| | - C Buerger
- Department of Dermatology, Venerology and Allergology, Clinic of the Goethe University, Frankfurt, Germany
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Hsieh MS, Hung PS, Hsieh VCR, Liao SH, How CK. Association between thiazolidinedione use and rheumatoid arthritis risk in patients with type II diabetes, a population-based, case-control study. Int J Clin Pract 2021; 75:e13804. [PMID: 33124165 DOI: 10.1111/ijcp.13804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/21/2020] [Indexed: 11/27/2022] Open
Abstract
AIM A previous study revealed that PPARγ agonists have anti-inflammatory effects in rheumatoid arthritis (RA). Furthermore, some studies have shown that type 2 diabetes mellitus (T2DM) may elicit the development of RA. In this study, we aimed to investigate whether the use of thiazolidinediones (TZDs) is associated with a lower risk of developing RA in patients with T2DM. METHODS Based on the Taiwan National Health Insurance Research Database, we conducted a nationwide case-control study. The selected cases were patients with T2DM who were diagnosed with RA between 2000 and 2013. The controls were retrieved at a ratio of 1:4 by propensity score matching. Logistic regression was conducted to evaluate whether TZD use lowers the risk of RA in patients with T2DM. The dose-response effect was examined according to the total TZD dose, within 2 years before the index date (the first diagnosis date of RA), and TZD doses were divided into four groups by cumulative Defined Daily Dose (cDDD): <30, 31-90, 91-365, and >365 cDDDs. RESULTS A total of 3605 cases and 14 420 controls were included in this study. After adjusting for age, sex, baseline comorbidities, the results demonstrated that TZD use did not significantly reduce the risk of RA in patients with T2DM (adjusted OR = 0.91, 95% CI 0.81-1.02). In the subgroup analysis by total TZD exposure dose within 2 years, 91-365 cDDDs of TZD had a lower risk of RA development, aOR = 0.87 (95% CI 0.71-1.06) and >365 cDDDs of TZD, aOR = 0.85 (95% CI 0.73-1.01). In the trend test, P was <.05. CONCLUSIONS TZD use might reduce the risk of RA in patients with T2DM, but it was non-statistically significant. Further research is necessary to assess this association.
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Affiliation(s)
- Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pin-Shun Hung
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Shu-Hui Liao
- Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
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Sexuality in Patients with Hidradenitis Suppurativa: Beliefs, Behaviors and Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238808. [PMID: 33260862 PMCID: PMC7730576 DOI: 10.3390/ijerph17238808] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022]
Abstract
Little is known about the impact of hidradenitis suppurativa (HS) on patients’ sexuality. The aim of this research is to investigate the impact of HS on several previously unexplored aspects of sexuality. In March 2018, we conducted a crowd-sourced cross-sectional online survey hosted by the Spanish association of patients with HS (ASENDHI) and available in Spanish. A panel of experts and patients from ASENDHI designed various questions in order to explore the extent to which HS influenced participants’ sex lives. The final sample consisted of 386 participants, 79.27% (306/386) of which were women and 20.73% (80/306) of which were men. Seventy-seven point one percent (236/306) of women and 67.5% (54/80) of men were in stable relationships; the rest of the participants were single. Forty-seven point nine percent (185/386) admitted to feeling fear of rejection. Pain was the symptom that most interfered with sexual relations in women and suppuration in men. Forty-four point three percent (171/386) of the participants considered themselves to be less attractive than average. Considering the participants in a stable relationship, women described receiving more emotional support from their partners, while men received more help with lesion dressing in intimate areas. Seventy-one point four percent (207/290) of participants stated that HS negatively affected their relationship. Among single patients, women experienced greater fear of rejection and were less willing to meet new people because of HS. Ninety-four point three percent (66/70) of women and 80.8% (21/26) of men stated that HS had a negative influence on their chances of having a relationship or sexual relations. In conclusion, HS has a significant, unrecognized and misunderstood impact on sexuality which must be addressed.
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Colosimo C, Yon JR, Fredericks C, Kingsley S, Gupta S, Mentzer CJ, Bokhari F, Poulakidas S. Obesity is Not Associated With Need for Skin Grafting After Hidradenitis Excision. Am Surg 2020; 87:458-462. [PMID: 33047967 DOI: 10.1177/0003134820950686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating disease associated with inflammation, recurrent abscesses, and fistulae of skin containing apocrine sweat glands. We hypothesize that the need for skin grafting after vacuum-assisted closure was decreased with increasing body mass index (BMI). METHODS Seventy-one consecutive patients with excisions for HS were retrospectively evaluated for demographic data, number of excisions, the total area of excised skin, need for skin grafting, and BMI. Patients were stratified for BMI and underwent logistic regression to compare all other variables. RESULTS Average for BMI was 30.8 ± 7.72, age was 36.89 ±13.52, area excised was 743 cm2 ± 774 cm2, mean operating room trips were 2.62 ± 1.59, and skin grafting was 0.52 ± 0.55. Patients were 60% male. Forty out of 71 patients were obese. There was no correlation between age, BMI, sex, thenumber of excisions, amount of skin excised, or need for a skin graft. There was a statistically significant relationship between the amount of skin excised and the need for skin grafting (P = .006). CONCLUSIONS The amount of skin affected by HS appears to be independent of patient BMI. The need for skin grafting is solely dependent upon the amount of tissue excised. APPLICABILITY OF RESEARCH TO PRACTICE This knowledge will help preoperative planning for all patients with HS, regardless of BMI.
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Affiliation(s)
| | - James R Yon
- Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, CO, USA
| | - Charles Fredericks
- Division of Trauma, Acute Care, and General Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Samuel Kingsley
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Sameer Gupta
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Caleb J Mentzer
- Division of Trauma, Critical Care & Acute Care Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
| | - Faran Bokhari
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
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Marasca C, Ruggiero A, Napolitano M, Fabbrocini G, Megna M. May COVID-19 outbreaks lead to a worsening of skin chronic inflammatory conditions? Med Hypotheses 2020; 143:109853. [PMID: 32492559 PMCID: PMC7236705 DOI: 10.1016/j.mehy.2020.109853] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/17/2020] [Indexed: 01/07/2023]
Abstract
The emergence of the novel betaCoronavirus has raised serious concerns due to the virus rapid dissemination worldwide. Many areas throughout the world are now experiencing the COVID 19 outbreaks with government and policy authorities taking many aggressive isolation or restriction measures, drastically reducing also patient's visits and limiting only to the most urgent ones such as oncological visits or emergencies. Several studies have demonstrated a relationship between increased weight, obesity, diabetes, hypertension and inflammatory skin diseases. Furthermore, weight loss interventions have been shown to improve psoriasis, as well as hidradenitis suppurativa, and increase responsiveness to treatment of this conditions. We suppose that due to aggressive isolation or restriction measures, in the next future dermatologist will face with a common worsening of chronic skin inflammatory conditions due to reduced physical activities, increased intake of calories with the derived increase body weight and always more frequent treatment discontinuation. It is time to start potential preventive strategies which could limit the expected negative impact of COVID-19 related quarantine on skin diseases.
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Affiliation(s)
- Claudio Marasca
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy.
| | - Angelo Ruggiero
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
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Chiricozzi A, Giovanardi G, Caposiena Caro DR, Iannone M, De Simone C, Cannizzaro MV, Oranges T, Fossati B, Di Matteo E, Dini V, Bianchi L, Peris K. Characterization of comorbid conditions burdening hidradenitis suppurativa: a multicentric observational study. GIORN ITAL DERMAT V 2020; 155:335-340. [DOI: 10.23736/s0392-0488.18.06165-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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29
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Zagaria O, Ruggiero A, Fabbrocini G, Gallo L, Romanelli M, Marasca C. Wound care, adalimumab, and multidisciplinary approach in a patient affected by PASH syndrome. Int Wound J 2020; 17:1528-1531. [PMID: 32441488 DOI: 10.1111/iwj.13403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Orlando Zagaria
- Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II, Napoli, Italy
| | - Angelo Ruggiero
- Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II, Napoli, Italy
| | - Lucia Gallo
- Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II, Napoli, Italy
| | | | - Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery , University of Naples Federico II, Napoli, Italy
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Sampogna F, Fania L, Mastroeni S, Ciccone D, Panebianco A, Abeni D. Age-specific physical and mental health status in Italian patients with hidradenitis suppurativa: a comparison with the general population. Arch Dermatol Res 2020; 313:41-47. [PMID: 32270321 DOI: 10.1007/s00403-020-02063-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/04/2020] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
Hidradenitis suppurativa (HS) has a considerable impact on quality of life. Despite comparisons of health status between HS patients and the general population have been done, there is a need to make more meaningful comparisons, such as age-specific ones. The objective of the study was to compare age-specific physical and mental health status in Italian patients with HS to that of a representative sample of the Italian general population. We conducted a cross-sectional, observational study on consecutive HS patients. Patients' health status was measured using the 36-item Short Form Health Survey (SF-36) and in the general population using the 12-item version (SF-12). The mean scores of the physical component summary (PCS) and the mental component summary (MCS) from the two instruments were graphically compared in different age categories according to sex and clinical severity. Data were complete for 298 HS patients. Young patients with HS reported a physical and mental health status similar to that of elderly people from the general population. Even HS patients with mild-to-moderate clinical severity had a consistently worse health status than the reference population. In conclusion, HS deeply affects patients' physical and mental status, starting from a very young age. An early intervention is advisable, not only with pharmacological treatment, but also with an appropriate discussion and interaction with the patient to focus on the aspects that would reduce the psychosocial impact of their condition.
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Affiliation(s)
- Francesca Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy.
| | - Luca Fania
- 1st Dermatological Unit, IDI-IRCCS, Rome, Italy
| | - Simona Mastroeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
| | | | | | - Damiano Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Via dei Monti di Creta, 104, 00167, Rome, Italy
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31
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Bettoli V, Cazzaniga S, Scuderi V, Zedde P, Di Landro A, Naldi L. Hidradenitis suppurativa epidemiology: from the first Italian registry in 2009 to the most recent epidemiology updates - Italian Registry Hidradenitis Suppurativa project 2. J Eur Acad Dermatol Venereol 2020; 33 Suppl 6:4-6. [PMID: 31535758 DOI: 10.1111/jdv.15826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/03/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of hidradenitis suppurativa (HS) is still not fully established with only a few studies reporting its estimates. Prevalence estimates range from 5:10 000 to 4:100. These extremely large variations could be explained by a combination of factors, including different selection procedures, different diagnostic criteria, and variations in the sex and age distribution of the examined samples. OBJECTIVES To analyze variations between two consecutive Italian Registries on HS. METHODS Data obtained from the second Italian Registry on HS, named 'Italian Registry Hidradenitis Suppurativa (IRHIS) Project 2', are compared to the previous first Italian registry on HS. RESULTS Data on 944 patients are reported. The more relevant aspects that characterize IRHIS 2 project, in comparison with the previous first Italian Registry on HS, are as follows: (i) the total number of patients, about fourfold higher; (ii) a more uniform national geographic distribution of the patient population; (iii) a larger number of dermatology units involved; (iv) a larger number of items considered in the data collection; (v) 6 years of difference between the onset of the two registries (2009-2013 vs. 2015-2019). Comparing data of the two registries, there are no statistically significant differences in terms of age at the time of the visit, gender, BMI, smoking habits, age at onset and age at first diagnosis by physician. Interestingly, the mean Sartorius score in the IRHIS project 2 (58.8) was significantly lower compared to the first Italian Registry (78.4). CONCLUSIONS The importance of the registries, at both national and international levels, in collecting useful real-life data is confirmed by these two Italian projects.
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Affiliation(s)
- V Bettoli
- Dermatology Unit, Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Italy
| | - S Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - V Scuderi
- Dermatology Unit, Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Italy
| | - P Zedde
- Dermatology Unit, Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Italy
| | | | - L Naldi
- Centro Studi GISED, Bergamo, Italy
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Hirt PA, Castillo DE, Yosipovitch G, Keri JE. Skin changes in the obese patient. J Am Acad Dermatol 2019; 81:1037-1057. [DOI: 10.1016/j.jaad.2018.12.070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/31/2022]
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Campanati A, Orciani M, Sorgentoni G, Consales V, Offidani A, Di Primio R. Pathogenetic Characteristics of Mesenchymal Stem Cells in Hidradenitis Suppurativa. JAMA Dermatol 2019; 154:1184-1190. [PMID: 30140888 DOI: 10.1001/jamadermatol.2018.2516] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Hidradenitis suppurativa (HS) is a disease of the terminal hair follicle in apocrine gland-enriched skin areas, where immunobiology dysregulation of mesenchymal stem cells (MSCs) may have a key role. Objective To investigate the MSC profile in patients with HS and in healthy controls. Design, Setting, and Participants In this prospective case-control study, patients with HS were recruited from the Dermatological Clinic at the Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy. Biopsy specimens were analyzed at the Histology Section of the Department of Clinical and Molecular Sciences. Participants included 11 patients with HS and 9 healthy controls, who were recruited into the study between January 20, 2015, and September 20, 2016, and underwent punch biopsy from axillary skin. None of the participants had received any antibiotics (systemic or topical therapy) within almost 12 weeks before the study. Main Outcomes and Measures The immunophenotypic profile of MSCs was characterized following the minimal criteria established by the International Society for Cellular Therapy for the identification of MSCs. Levels of 12 cytokines belonging to helper T-cell subtypes 1, 2, and 17 pathways were examined on the secretome of isolated cells by enzyme-linked immunoabsorbent assay. Results Skin MSCs were characterized in 11 patients with HS (8 women and 3 men; mean [SD] age, 35.8 [7.9] years) and 9 healthy controls (7 women and 2 men; mean [SD] age, 36.7 [6.9] years). The healthy controls were matched with patients with HS for body mass index. Mesenchymal stem cells isolated from patients with HS (HS-MSCs) and from healthy controls (C-MSCs) met the International Society for Cellular Therapy minimal criteria. Compared with C-MSCs, cytokine analyses of HS-MSCs revealed statistically significant overexpression of interleukin (IL) 6 (median [interquartile range {IQR}], 8765.00 [7659.00-9123.00] vs 2849.00 [2609.00-3001.00] pg/mL; P = .008), IL-10 (median [IQR], 29.46 [26.35-35.79] vs 21.36 [19.89-23.33] pg/mL; P = .004), IL-12 (median [IQR], 15.25 [13.27-16.25] vs 11.89 [10.73-12.33] pg/mL; P = .03), IL-17A (median [IQR], 15.24 [13.23-17.24] vs 11.24 [10.28-11.95] pg/mL; P = .008), tumor necrosis factor (median [IQR], 42.54 [42.20-43.94] vs 32.55 [31.78-33.28] pg/mL; P = .004), transforming growth factor β1 (median [IQR], 1728.00 [1535.00-1979.00] vs 500.80 [465.00-634.50] pg/mL; P = .004), and interferon γ (median [IQR], 11.49 [10.71-12.35] vs 9.45 [9.29-10.01] pg/mL; P = .005). Conclusions and Relevance Mesenchymal stem cells isolated from the skin of patients with HS seem to be activated toward an inflammatory status. The imbalance between proinflammatory and anti-inflammatory activities of MSCs favors the hypothesis of their pathogenic involvement in HS.
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Affiliation(s)
- Anna Campanati
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Monia Orciani
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giulia Sorgentoni
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Veronica Consales
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto Di Primio
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
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Sivanand A, Gulliver WP, Josan CK, Alhusayen R, Fleming PJ. Weight Loss and Dietary Interventions for Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg 2019; 24:64-72. [PMID: 31502868 DOI: 10.1177/1203475419874412] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hidradenitis suppurativa (HS) is a common inflammatory disorder characterized by recurrent, painful, and malodorous abscesses and nodules predominantly in skin folds. HS is associated with substantial morbidity and poor quality of life. There are no curative therapies, and the only approved biologic drug has variable efficacy and requires high doses, making adjunct treatments crucial. An important risk factor for disease severity is obesity. Our primary objective was to conduct a systematic review examining weight loss and dietary interventions, in HS. Our secondary objective was to examine nutritional supplements in HS.A systematic literature search was conducted using Medline, EMBASE, and the Cochrane Database. We included all study types in adults (>18 years), with a minimum sample size of 5, examining the effects of any dietary or weight loss intervention on HS severity. Two authors screened n = 1279 articles of which 9 met inclusion criteria. All included studies were observational and all interventions were associated with various measures of decreased HS severity. Patient-controlled weight loss and bariatric surgery were associated with HS regression, though a subset of patients with significant increase in panniculi experienced exacerbations and required excision of excess skin. Diets demonstrating benefit eliminated dairy and brewer's yeast. Nutritional supplements including zinc gluconate, vitamin D, and riboflavin had a suppressive, rather than curative, effect on HS lesions in single studies. Overall, the reviewed interventions show promise as potential adjunct treatments in a HS management plan. Prospective randomized controlled trials should validate these findings.
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Affiliation(s)
| | - Wayne P Gulliver
- 7512 Department of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | | | - Raed Alhusayen
- 494622 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,210484 Division of Dermatology, University of Toronto, Canada
| | - Patrick J Fleming
- 210484 Division of Dermatology, University of Toronto, Canada.,Lynde Dermatology (Private Practice), Markham, ON, Canada
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Cuenca-Barrales C, Molina-Leyva A. Risk Factors of Sexual Dysfunction in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study. Dermatology 2019; 236:37-45. [PMID: 31434072 DOI: 10.1159/000501905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) has a high impact on quality of life. However, sexual health has scarcely been investigated. OBJECTIVE To describe the frequency of sexual dysfunction (SD) in women and erectile dysfunction (ED) in men with HS and to explore potential risk factors. PATIENTS AND METHODS We conducted a cross-sectional study using a crowd-sourced online questionnaire spread by the Spanish hidradenitis suppurativa patients' association (ASENDHI). RESULTS In total, 393 participants answered the questionnaire. SD was found in 51% (95% CI 45-57%) of women and ED in 60% (95% CI 49-70%) of men. Factors related to SD were education status, patient's global assessment for disease activity, numeric rating scale for pain and unpleasant odour and the absence of a stable relationship. Factors related to ED were increasing age, the presence of active lesions in the genital area and the number of areas affected by active lesions. CONCLUSIONS There is a high prevalence of SD and ED in HS patients. Being in a stable relationship has been a protective factor of SD in women. The results suggest that sexual impairment in HS patients is due, at least in part, to disease activity, symptoms and active lesions.
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Affiliation(s)
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain, .,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany, .,Instituto de Investigación Biosanitaria Granada, Granada, Spain,
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Hendricks AJ, Hirt PA, Sekhon S, Vaughn AR, Lev-Tov HA, Hsiao JL, Shi VY. Non-pharmacologic approaches for hidradenitis suppurativa – a systematic review. J DERMATOL TREAT 2019; 32:11-18. [DOI: 10.1080/09546634.2019.1621981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Penelope A. Hirt
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Sahil Sekhon
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Alexandra R. Vaughn
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Hadar A. Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Jennifer L. Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Vivian Y. Shi
- Division of Dermatology, University of Arizona Department of Medicine, Tucson, AZ, USA
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and metabolic syndrome - systematic review and adjusted meta-analysis. Int J Dermatol 2019; 58:1112-1117. [PMID: 31148159 DOI: 10.1111/ijd.14500] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 04/06/2019] [Accepted: 04/28/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating and distressing chronic systemic inflammatory skin disease. There have been several prior observational studies which reported a possibility link between HS and metabolic syndrome, however the current evidence is not definitive. It is unclear in HS whether this possible relationship is independent or driven by underlying risk factors and comorbidities. OBJECTIVE To determine whether HS is independently associated with metabolic syndrome via adjusted meta-analysis of case-control studies. METHODS A systematic review and meta-analysis was performed according to PRISMA guidelines. Electronic searches were performed using six electronic databases (Ovid Medline, PubMed, CCTR, CDSR, ACP Journal Club, and DARE) from their inception until September 2018. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS We identified six case-control studies included for meta-analysis. Based on unadjusted analysis, we found a significant association between adult cases of HS and metabolic syndrome (OR 1.95, 95% CI 1.31-2.89, P = 0.001). Adjusted meta-analysis, after adjustment for age, sex, other cardiovascular risk factors, and comorbidities, found a significant association (OR 2.19, 95% CI 1.70-2.81, I2 = 32%, P < 0.00001). LIMITATIONS Studies reviewed were observational by design which are susceptible to bias, and there was lack of randomization. The quality of the current systematic review is also limited by the quality of available evidence which was predominantly observational in nature. CONCLUSIONS This pooled analysis of existing case-control studies supports an association between HS and metabolic syndrome. Clinicians treating patients with HS should be aware of this potential association.
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Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Olivia Charlton
- Department of Dermatology, Royal North Shore Hospital, Saint Leonards, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Saxon D Smith
- Department of Dermatology, Royal North Shore Hospital, Saint Leonards, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Gosford, Australia
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Sampogna F, Fania L, Mazzanti C, Caggiati A, Pallotta S, Panebianco A, Mastroeni S, Didona B, Pintori G, Abeni D. The Broad-Spectrum Impact of Hidradenitis Suppurativa on Quality of Life: A Comparison with Psoriasis. Dermatology 2019; 235:308-314. [PMID: 31121589 DOI: 10.1159/000496604] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/03/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Hidradenitis suppurativa (HS) is a chronic skin disease with a heavy impact on patients' quality of life (QoL). The aim of this study was to evaluate in detail the QoL impact of HS comparing it with other skin conditions, and in particular with psoriasis. METHODS Patients with a diagnosis of HS were recruited. QoL was measured using the Skindex-17 questionnaire. RESULTS Data were available for 69 HS patients. HS had the worst QoL among several skin conditions. Compared to psoriasis the mean symptom score was 69.4 versus 53.7, and the mean psychosocial score was 56.1 versus 32.7. Overall, the scores of patients with HS were higher than those of psoriasis patients on 16 of the 17 items of the Skindex-17. CONCLUSIONS When compared to many different skin conditions, and in particular to psoriasis, HS was the most impairing condition, even at low levels of clinical severity.
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Affiliation(s)
| | - Luca Fania
- First Dermatology Clinic, IDI-IRCCS, Rome, Italy
| | | | | | | | | | | | | | - Giusi Pintori
- Inversa Onlus, the Italian Association of Patients with Hidradenitis Suppurativa, Rome, Italy
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Cuenca-Barrales C, Ruiz-Villaverde R, Molina-Leyva A. Sexual Distress in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study. J Clin Med 2019; 8:jcm8040532. [PMID: 31003427 PMCID: PMC6518250 DOI: 10.3390/jcm8040532] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress (SD) in patients with HS and to explore potentially associated epidemiological and clinical factors. We conducted a cross-sectional study by means of a crowd-sourced online questionnaire hosted by the Spanish hidradenitis suppurativa patients’ association (ASENDHI). Sexual distress (SD) was evaluated with a Numeric Rating Scale (NRS) for HS impact on sex life. A total of 393 participants answered the questionnaire. The mean NRS for HS impact on sex life was 7.24 (2.77) in women and 6.39 (3.44) in men (p < 0.05). Variables significantly associated (p < 0.05) with SD in the multiple linear regression model were sex, with a higher risk in females, the presence of active lesions in the groin and genitals and NRS for pain and unpleasant odor; being in a stable relationship was an important protector factor. Regarding these results, it seems that SD in HS patients is due, at least in part, to disease symptoms and active lesions in specific locations, emphasizing the importance of disease control with a proper treatment according to management guidelines. Women and single patients are more likely to suffer from sexual distress.
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Affiliation(s)
- Carlos Cuenca-Barrales
- Dermatology, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016 Granada, Spain.
| | - Ricardo Ruiz-Villaverde
- Dermatology, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016 Granada, Spain.
| | - Alejandro Molina-Leyva
- Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain.
- European Hidradenitis Suppurativa Foundation (EHSF), 06847 Dessau-Roßlau, Germany.
- Instituto de Investigación Biosanitaria Granada, 18016 Granada, Spain.
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40
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Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and diabetes mellitus: updated systematic review and adjusted meta-analysis. Clin Exp Dermatol 2019; 44:e126-e132. [PMID: 30730068 DOI: 10.1111/ced.13922] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating and distressing chronic inflammatory skin disease. There is also evolving evidence supporting the association between HS and cardiovascular risk factors, including smoking, obesity, hyperlipidaemia and metabolic syndrome. Notably, these are clinical features and risk factors that are closely associated with type 2 diabetes mellitus (DM). AIMS We performed a pooled adjusted meta-analysis of comparative studies to investigate the relationship between HS and DM. METHODS A systematic review and meta-analysis was performed according to recommended Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OR was used as the summary effect size. RESULTS From pooled analysis of unadjusted data from 12 studies, we found a significantly higher proportion of DM in HS cases compared with non-HS healthy controls (16.1% vs. 15.7%; OR = 2.17; 95% CI 1.85-2.55; P < 0.001). Adjusted effect sizes from five studies were also pooled. A significantly higher proportion of DM was found for HS compared with healthy controls, although the effect size was attenuated compared with unadjusted analyses (OR 1.69; 95% CI 1.50-1.91; P < 0.001). CONCLUSIONS To our knowledge, our systematic review and meta-analysis is the first to pool adjusted effect sizes. We found that HS was associated with a 1.69-fold increased odds of diabetes; however, the absolute risk difference was small (16.1% vs. 15.7%) and is probably not clinically relevant. Treating clinicians should be aware of this association, but there may not be an urgent need to perform screening for impaired glucose tolerance or diabetes.
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Affiliation(s)
- K Phan
- Department of Dermatology, Liverpool Hospital, Liverpool, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - O Charlton
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - S D Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia.,The Dermatology and Skin Cancer Centre, Gosford and St Leonards, Sydney, Australia
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41
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Bianchi L, Caposiena Caro RD, Ganzetti G, Molinelli E, Dini V, Oranges T, Romanelli M, Fabbrocini G, Monfrecola G, Napolitano M, Egan CG, Musumeci ML, Lacarrubba F, Micali G, Passoni E, Calzavara-Pinton PG, Venturini M, Zanca A, Offidani AM. Sex-related differences of clinical features in hidradenitis suppurativa: analysis of an Italian-based cohort. Clin Exp Dermatol 2018; 44:e177-e180. [PMID: 30593710 DOI: 10.1111/ced.13861] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2018] [Indexed: 01/08/2023]
Abstract
The clinical characteristics associated with hidradenitis suppurativa (HS) severity are poorly understood. In this study, 124 patients with HS from 6 Italian dermatology centres participated in this study. Disease severity was assessed using the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA) and Hurley score. The impact of clinical characteristics on disease severity was assessed by logistic regression. Clinical characteristics were similar between men (n = 53) and women (n = 71). Disease severity was also similar; 75% of the patients had Hurley stage II or III disease, and > 60% had moderate, severe or very severe HS as judged by HS-PGA. Lesions were more frequent in the gluteal region in men (32.3% in men vs. 8.7% in women, P < 0.001) and more frequent on the breast in women (16.3% in women vs. 4.6% in men, P = 0.02). Obesity was associated with increased disease severity as measured by HS-PGA (OR: 3.28, 95% CI 1.55-6.95, P < 0.01) and Hurley classification (OR: 3.22, 95% CI 1.34-7.31, P < 0.01). Although severity of HS is similar between the sexes, the localization of lesions is different.
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Affiliation(s)
- L Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Rome, Italy
| | | | - G Ganzetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - E Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - V Dini
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - T Oranges
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - M Romanelli
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - G Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - G Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - M Napolitano
- Department of Medicine and Health Sciences, Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | | | - M L Musumeci
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - E Passoni
- Department of Medical and Surgical Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.,Unit of Dermatology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - M Venturini
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - A Zanca
- Department of Dermatology, University of Brescia, Brescia, Italy
| | - A M Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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42
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Kimball AB, Sundaram M, Gauthier G, Guérin A, Pivneva I, Singh R, Ganguli A. The Comorbidity Burden of Hidradenitis Suppurativa in the United States: A Claims Data Analysis. Dermatol Ther (Heidelb) 2018; 8:557-569. [PMID: 30306395 PMCID: PMC6261111 DOI: 10.1007/s13555-018-0264-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Prior studies have reported that hidradenitis suppurativa (HS) is accompanied by a myriad of physical and mental conditions. However, given the small sample sizes and the limited number of pre-selected comorbidities, these studies do not provide a complete picture of the comorbidity burden of HS in the USA. Moreover, the relationship between HS severity and comorbidity burden has yet to be characterized. Using a large US claims database, we estimated the comorbidity burden associated with HS, stratified by disease severity. METHODS A retrospective matched cohort design was used. Patients with HS were classified into two severity cohorts (milder and more severe) using an empirical algorithm based on treatments received. The comorbidity burden was compared between each HS cohort and their matched HS-free cohort, and between patients with milder vs. those with more severe forms of HS. RESULTS Several physical and mental comorbidities were found to be more prevalent in both cohorts of patients with milder and more severe forms of HS than in their matched HS-free cohorts. The comorbidity burden also increased greatly as the disease progressed to more severe forms. CONCLUSIONS The results of this study highlight the complexity of the comorbidity burden of HS patients and the need for a multidisciplinary approach to optimize the management of HS and its numerous associated comorbidities. FUNDING AbbVie, Inc.
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Affiliation(s)
- Alexandra B Kimball
- Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Murali Sundaram
- AbbVie Inc, North Chicago, IL, USA
- Janssen Scientific Affairs, Horsham, PA, USA
| | | | | | | | - Rakesh Singh
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, IL, USA
| | - Arijit Ganguli
- Global Health Economics and Outcomes Research, AbbVie Inc, North Chicago, IL, USA
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43
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Molina-Leyva A, Cuenca-Barrales C. Adolescent-Onset Hidradenitis Suppurativa: Prevalence, Risk Factors and Disease Features. Dermatology 2018; 235:45-50. [DOI: 10.1159/000493465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
Background/Aims: Hidradenitis suppurativa (HS) is a chronic inflammatory and destructive skin disorder. Early diagnosis and treatment are critical to stop its progression. Data concerning adolescent-onset HS are scarce. The aims of this study are to describe the prevalence of adolescent-onset HS and to explore potential risk factors and the disease features of these patients. Patients and Methods: A cross-sectional study including 134 patients was performed. Results: Adolescent-onset HS occurred in 51.5% (69/134) of patients. Adolescent-onset HS was associated with female sex, positive family history, presence of pilonidal sinus, acne conglobata, longer disease duration and a worse perception of disease severity. Conclusion: Adolescent-onset HS might be more frequent than previously reported. Female sex, positive family history and the presence of elements of the follicular occlusion tetrad identify individuals with a higher risk of early onset. These patients experience a longer disease duration and perceive their disease as severer.
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44
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De Vita V, Melnik BC. mTORC1 at the crossroad of metabolism and immunity in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2018; 33:e107-e109. [PMID: 30288815 DOI: 10.1111/jdv.15270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- V De Vita
- Young Dermatologists Italian Network, Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), Via Clara Maffei 4, 24121, Bergamo, Italy
| | - B C Melnik
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, A m Finkenhügel 7a, D-49076, Osnabrück, Germany
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45
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Donnarumma M, Marasca C, Palma M, Vastarella M, Annunziata MC, Fabbrocini G. An oral supplementation based on myo-inositol, folic acid and liposomal magnesium may act synergistically with antibiotic therapy and can improve metabolic profile in patients affected by Hidradenitis suppurativa: our experience. GIORN ITAL DERMAT V 2018; 155:749-753. [PMID: 30249083 DOI: 10.23736/s0392-0488.18.06012-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over recent years, the link between obesity, metabolic syndrome and Hidradenitis suppurativa (HS) has been explored. It has been demonstrated that HS patients have a high prevalence of the metabolic syndrome and an increased frequency of insulin resistance. The objective of our study is to estimate the effectiveness of an oral supplementation based on myo-inositol (MI), folic acid and liposomal magnesium (Levigon®, Sanitpharma; Milan, Italy) on the clinical and metabolic profile of patients affected by HS. METHODS Twenty subjects with HS and an impaired glucose metabolism were enrolled. Group A: 10 subjects received for 6 months MI 2000 mg, liposomal magnesium and folic acid associated to topical antibiotic therapy (clindamycin gel 1%), systemic antibiotic therapy (clindamycin 300 mg b.i.d. and rifampicin 600 mg daily for 6 weeks) and a normocaloric diet group B: 10 subjects received topical and systemic antibiotic therapy associated to a normocaloric diet for 6 months. RESULTS After 6 months group A patients showed an average reduction of Sartorius Score from 38.3±7.75 to 27.3±13.53 (P value <0.04) while in the control group there was a reduction of the Sartorius from 38.4±7.88 to 31.1±8.02 (P value =0.55). Moreover in group A Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) was significantly reduced from 2.43±0.35 to 2.1±0.31 (P<0.01) whereas in group B HOMA-IR did not significantly decrease (2.51±0.65 at T0 at 2.40±0.67 at T1). CONCLUSIONS Our study underlines the importance of the evaluation of metabolic profile in patients with HS. Moreover, it suggests that the supplementation of MI, folic acid and liposomal magnesium in HS can improve the efficacy of concomitant therapies and the metabolic profile.
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Affiliation(s)
- Marianna Donnarumma
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy -
| | - Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Palma
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria Vastarella
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Maria C Annunziata
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
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46
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Chiricozzi A, Bettoli V, De Pità O, Dini V, Fabbrocini G, Monfrecola G, Musumeci ML, Parodi A, Sampogna F, Pennella A, Buzzulini F, Gualberti G, di Luzio Paparatti U, Atzori L. HIDRAdisk: an innovative visual tool to assess the burden of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2018; 33:e24-e26. [PMID: 29894009 PMCID: PMC7027443 DOI: 10.1111/jdv.15122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Chiricozzi
- Dipartimento di Dermatologia, Università di Pisa, Pisa, Italy
| | - V Bettoli
- Dipartimento di Medicina Clinica e Sperimentale, U.O. di Dermatologia, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - O De Pità
- Struttura Complessa di Patologia Clinica, Ospedale Cristo Re, Rome, Italy
| | - V Dini
- U.O. di Dermatologia Universitaria, Ospedale Santa Chiara, Pisa, Italy
| | - G Fabbrocini
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy
| | - G Monfrecola
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli "Federico II", Naples, Italy
| | - M L Musumeci
- Clinica Dermatologica, P.O. "G. Rodolico", A.O.U. Policlinico-Vittorio Emanuele, Università di Catania, Catania, Italy
| | - A Parodi
- DiSSal, Sezione Dermatologia, Ospedale-Policlinico San Martino, Università di Genova, Genoa, Italy
| | - F Sampogna
- Unità di Epidemiologia, IRCCS FLMM, Istituto Dermopatico dell'Immacolata (IDI), Rome, Italy
| | - A Pennella
- Scuola di Specializzazione in Psicologia della Salute, Università degli Studi di Roma"Sapienza", Rome, Italy
| | | | | | | | - L Atzori
- Clinica Dermatologica, Dipartmento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
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Cazzaniga S, Naldi L, Damiani G, Atzori L, Patta F, Guidarelli G, Bettoli V. Validation of a visual-aided questionnaire for the self-assessment of hidradenitits suppurativa. J Eur Acad Dermatol Venereol 2018; 32:1993-1998. [PMID: 29729101 DOI: 10.1111/jdv.15050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/09/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Hidradenitis Suppurativa (HS) is a chronic, highly debilitating disease. Few questionnaires have been developed to identify potential HS cases based on simple questions. A visual representation may help in characterising these lesions. OBJECTIVE To develop and validate a visually assisted questionnaire for HS detection. METHODS This was an observational diagnostic study on a series of patients with a first diagnosis of HS and a corresponding series of age and gender-matched controls consecutively observed in two Italian centres. The questionnaire was developed based on a critical appraisal of the relevant literature and on expert consensus. Measures of accuracy and reproducibility were assessed. RESULTS 57 patients with HS and 57 controls were included in the study (mean age 32.9 ± 12.3 years). Based on at least one affirmative answer to the proposed questionnaire items, the accuracy was 95.6%, with a sensitivity of 98.2% and a specificity of 93.0%. Reproducibility was almost perfect on all the tested items (Cohen's kappa ≥ 0.85). LIMITATIONS The questionnaire was tested only in experimental conditions. CONCLUSION The questionnaire could be a useful tool for HS screening in the general population. Further studies are needed to confirm its performance in a real-world setting.
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Affiliation(s)
- S Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital, Bern, Switzerland
| | - L Naldi
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - G Damiani
- Centro Studi GISED, Bergamo, Italy.,Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy.,Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | - L Atzori
- Department of Medical Science, Section of Dermatology, University of Cagliari, Cagliari, Italy
| | - F Patta
- Department of Medical Science, Section of Dermatology, University of Cagliari, Cagliari, Italy
| | - G Guidarelli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
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48
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Hidradenitis Suppurativa in Kuala Lumpur, Malaysia: A 7-Year Retrospective Review. Dermatol Res Pract 2018; 2018:2017959. [PMID: 29951091 PMCID: PMC5987333 DOI: 10.1155/2018/2017959] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/11/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition characterized by inflamed nodules, abscesses, sinus tracts, and scarring, which can occur in any skin containing folliculopilosebaceous units. We aim to identify the demographic and clinical characteristics and treatment modalities in patients with HS. Methods A retrospective analysis involving records of patients diagnosed with HS in Hospital Kuala Lumpur from July 2009 to June 2016. Results Sixty-two patients were identified, with equal cases involving males and females. Majority of patients were Malays (41.9%), followed by Indians (35.5%), Chinese (17.7%), and other ethnicities (4.8%). Median age at diagnosis was 25 (IQR: 14) years. There is a delay in diagnosis with a median of 24 (IQR: 52) months. Most of the patients had lesions on the axilla (85.5%), followed by groin (33.9%) and gluteal region (29%). Gluteal lesions were more common in males. Nodules (67.7%), sinuses (56.5%), and abscesses (33.9%) were the main clinical features, with 43.5% classified under Hurley stage 2. There was no difference in terms of symptoms and types of lesions among different ethnicities and genders. Majority received systemic antibiotics, more than half had retinoid, and third of the patients had surgical intervention. Conclusions A prompt recognition of HS is imperative, to screen for comorbidities and to initiate early treatment to reduce physical and psychological complications.
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49
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Dessinioti C, Tzanetakou V, Zisimou C, Kontochristopoulos G, Antoniou C. A retrospective study of the characteristics of patients with early-onset compared to adult-onset hidradenitis suppurativa. Int J Dermatol 2018; 57:687-691. [PMID: 29604044 DOI: 10.1111/ijd.13985] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 02/01/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The mean age of onset of hidradenitis suppurativa (HS) is between 20 and 24 years. Very few data about patients with early-onset HS exist. OBJECTIVE To investigate the association of early-onset HS with the clinical characteristics: age, gender, body mass index (BMI), smoking, family history of HS, Hurley stage, and number of areas affected. METHODS This was a retrospective study of the reported early age at HS onset (≤17 years old) with clinical characteristics and with the severity of HS at first consultation visit. RESULTS In 166 patients, 42 patients (25.3%) reported early-onset HS. Compared to adult-onset HS, patients with early-onset HS were younger (mean age: 37 years vs. 27 years, P < 0.0001), had a significantly younger mean age of onset (28.2 years old vs. 14.5 years old, respectively, P < 0.0001), longer mean disease duration (8.8 years vs. 12.6 years, respectively, P = 0.011) and were less frequently smokers (P < 0.001), whereas there was no association with gender (P = 0.177) or BMI (0.086). Patients with a family history had increased risk for early-onset HS (OR: 2.45, 95% CI: 1.08-5.56). Early-onset HS was not associated with Hurley stage (OR: 1.12, 95% CI: 0.33-3.74) or with the number of body areas affected (OR: 1.54, 95% CI: 0.49-4.83). CONCLUSION Early-onset HS was frequent and associated with a family history of HS. There was no difference in the severity of HS in adult life for patients with an onset of HS at ≤17 years, compared to patients with adult-onset, which may be reassuring information for these younger patients.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology, A.Syggros Hospital, University of Athens, Athens, Greece
| | - Vassiliki Tzanetakou
- 1st Department of Dermatology, A.Syggros Hospital, University of Athens, Athens, Greece
| | - Chrisa Zisimou
- 1st Department of Dermatology, A.Syggros Hospital, University of Athens, Athens, Greece
| | | | - Christina Antoniou
- 1st Department of Dermatology, A.Syggros Hospital, University of Athens, Athens, Greece
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Bui TL, Silva-Hirschberg C, Torres J, Armstrong AW. Hidradenitis suppurativa and diabetes mellitus: A systematic review and meta-analysis. J Am Acad Dermatol 2018; 78:395-402. [DOI: 10.1016/j.jaad.2017.08.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/16/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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