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Haselgruber S, Fernández-Crehuet-Serrano P, Fernández-Ballesteros MD, Padial-Gómez A, Hernández-Rodríguez JC, Ortiz-Álvarez J, Navarro-Guillamón P, Membrive-Jiménez C, Cuenca-Barrales C, Molina-Leyva A. Insights into the Window of Opportunity and Outcome Measures in Patients with Moderate to Severe Hidradenitis Suppurativa Treated with Secukinumab: A Real-World Study. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01209-w. [PMID: 38896382 DOI: 10.1007/s13555-024-01209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCION The concept of a window of opportunity in hidradenitis suppurativa (HS) management suggests that early initiation of biological therapy leads to better outcomes, though its timing remains uncertain. METHODS We conducted a retrospective observational multicenter study, including consecutive patients with moderate to severe HS who initiated secukinumab treatment following prior failure with systemic antibiotics or adalimumab. Therapeutic burden was defined as the sum of previous systemic treatment cycles and previous major surgical interventions for HS. Patients were followed up for 24 weeks. Main outcomes were safety and effectiveness, assessed through the proportion of patients achieving HS Clinical Response (HiSCR) and a 55% reduction in International HS Severity Score System (IHS4-55). Additionally, potential predictors of response to secukinumab were studied. Analysis was performed on an intention-to-treat basis. RESULTS A total of 67 patients (33 men, 34 women) were included, with a mean age of 41.55 (11.94) years and a mean baseline IHS4 of 17.88 (11.13). The mean therapeutic burden was 6.06 (3.49). At week 24, 10.45% (7/67) of patients experienced adverse events, with three leading to treatment discontinuation. At week 24, 41.79% (28/67) of patients achieved HiSCR, and 44.78% (30/67) of patients achieved IHS4-55. HiSCR could not be calculated in 12 patients with a baseline AN count < 3. A lower therapeutic burden was significantly associated with a higher likelihood of achieving HiSCR and IHS4-55 at week 24. CONCLUSIONS Secukinumab showed safety and efficacy in real-world patients with HS, and the inverse correlation found between therapeutic burden and treatment response supports the concept of a window of opportunity, offering insights into its timing.
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Affiliation(s)
- Sofía Haselgruber
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | | | | | - Alicia Padial-Gómez
- Servicio de Dermatología, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
| | | | - Juan Ortiz-Álvarez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Cristina Membrive-Jiménez
- Departamento de Bioquímica y Biología Molecular II, Universidad de Granada, Granada, Spain
- Unidad de Farmacogenética, Servicio de Farmacia Hospitalaria, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carlos Cuenca-Barrales
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Alejandro Molina-Leyva
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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2
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Kimball AB, Jemec GBE, Sayed CJ, Kirby JS, Prens E, Ingram JR, Garg A, Gottlieb AB, Szepietowski JC, Bechara FG, Giamarellos-Bourboulis EJ, Fujita H, Rolleri R, Joshi P, Dokhe P, Muller E, Peterson L, Madden C, Bari M, Zouboulis CC. Efficacy and safety of bimekizumab in patients with moderate-to-severe hidradenitis suppurativa (BE HEARD I and BE HEARD II): two 48-week, randomised, double-blind, placebo-controlled, multicentre phase 3 trials. Lancet 2024; 403:2504-2519. [PMID: 38795716 DOI: 10.1016/s0140-6736(24)00101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Patients with hidradenitis suppurativa have substantial unmet clinical needs and scarce therapeutic options. We aimed to assess the efficacy and safety of bimekizumab, a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F and IL-17A, in patients with moderate-to-severe hidradenitis suppurativa. METHODS BE HEARD I and II were two identically designed, 48-week randomised, double-blind, placebo-controlled, multicentre phase 3 trials. Patients aged 18 years or older with moderate-to-severe hidradenitis suppurativa were randomly assigned 2:2:2:1 using interactive response technology (stratified by worst Hurley Stage at baseline and baseline systemic antibiotic use) to receive subcutaneous bimekizumab 320 mg every 2 weeks; bimekizumab 320 mg every 2 weeks to week 16, then every 4 weeks to week 48; bimekizumab 320 mg every 4 weeks to week 48; or placebo to week 16, then bimekizumab 320 mg every 2 weeks. The primary outcome was an hidradenitis suppurativa clinical response of at least 50%, defined as a reduction in total abscess and inflammatory nodule count of at least 50% from baseline with no increase from baseline in abscess or draining tunnel count (HiSCR50) at week 16. Efficacy analyses included all randomly assigned study patients (intention-to-treat population). Safety analyses included all patients who received at least one full or partial dose of study treatment in the safety set, and of bimekizumab in the active-medication set. These trials are registered at ClinicalTrials.gov, NCT04242446 and NCT04242498, and both are completed. FINDINGS Patients for BE HEARD I were recruited from Feb 19, 2020, to Oct 27, 2021, and 505 patients were enrolled and randomly assigned. Patients for BE HEARD II were recruited from March 2, 2020, to July 28, 2021, and 509 patients were enrolled and randomly assigned. The primary outcome at week 16 was met in the group who received bimekizumab every 2 weeks using modified non-responder imputation; higher responder rates were observed with bimekizumab versus placebo in both trials: 138 (48%) of 289 patients versus 21 (29%) of 72 patients in BE HEARD I (odds ratio [OR] 2·23 [97·5% CI 1·16-4·31]; p=0·0060) and 151 (52%) of 291 patients versus 24 (32%) of 74 patients in BE HEARD II (2·29 [1·22-4·29]; p=0·0032). In BE HEARD II, HiSCR50 was also met in the group who were administered bimekizumab every 4 weeks (77 [54%] of 144 vs 24 [32%] of 74 with placebo; 2·42 [1·22-4·80]; p=0·0038). Responses were maintained or increased to week 48. Serious treatment-emergent adverse events were reported in 40 (8%) patients in BE HEARD I and in 24 (5%) patients in BE HEARD II treated with bimekizumab over 48 weeks. The most frequently reported treatment-emergent adverse events to week 48 were hidradenitis in both trials, in addition to coronavirus infection and diarrhoea in BE HEARD I, and oral candidiasis and headache in BE HEARD II. One death was reported across the two trials, and was due to congestive heart failure in a patient with substantial cardiovascular history treated with bimekizumab every 2 weeks in BE HEARD I (considered unrelated to bimekizumab treatment by the investigator). No new safety signals were observed. INTERPRETATION Bimekizumab was well tolerated by patients with hidradenitis suppurativa and produced rapid and deep clinically meaningful responses that were maintained up to 48 weeks. Data from these two trials support the use of bimekizumab for the treatment of patients with moderate-to-severe hidradenitis suppurativa. FUNDING UCB Pharma.
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Affiliation(s)
- Alexa B Kimball
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark; European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State University, Hershey, PA, USA
| | - Errol Prens
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology, Erasmus University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - John R Ingram
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology and Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Amit Garg
- Northwell Health, New Hyde Park, NY, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacek C Szepietowski
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Falk G Bechara
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Department of Dermatology, Venereology, and Allergology, St Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Evangelos J Giamarellos-Bourboulis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Hideki Fujita
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | | | | | | | | | | | | | | | - Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany; Departments of Dermatology, Venereology, Allergology, and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Lelonek E, Szepietowski JC. Insights into Gut Microbiome Composition in Hidradenitis Suppurativa: A Comprehensive Examination of Dietary Habits and Environmental Influences. Nutrients 2024; 16:1776. [PMID: 38892709 PMCID: PMC11174550 DOI: 10.3390/nu16111776] [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: 05/16/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
This study explores the relationship between dietary habits, environmental influences, and gut microbiome composition in individuals with hidradenitis suppurativa (HS), a chronic inflammatory skin condition. A cohort of 80 participants, equally divided into HS patients and healthy controls, was assessed through comprehensive questionnaires capturing demographics, dietary habits, and other health-related information. Fecal samples were collected and analyzed using next-generation sequencing to examine microbiome composition. Despite previous studies suggesting gut dysbiosis in HS, this research found no significant differences in alpha-diversity and Shannon diversity index between the groups. However, significant disparities in dietary habits were observed, with HS patients showing higher sugar and milk consumption. The study also identified a significant correlation between coffee consumption and the presence of certain bacterial genera. While the study did not reveal major differences in microbiome diversity, the findings on dietary habits and specific microbiome components suggest potential targets for therapeutic intervention. These results underscore the importance of further research into the gut-skin axis and its role in HS, aiming to enhance management strategies through dietary modifications and lifestyle interventions.
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Affiliation(s)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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Thasneem A, Sif S, Rahman MM, Crovella S. Can telomeric changes orchestrate the development of autoinflammatory skin diseases? Ital J Dermatol Venerol 2024; 159:318-328. [PMID: 38502535 DOI: 10.23736/s2784-8671.23.07689-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Telomeres, the safeguarding caps at the tips of chromosomes, are pivotal in the aging process of cells and have been linked to skin ailments and inflammatory conditions. Telomeres undergo a gradual reduction in length and factors such as oxidative stress hasten this diminishing process. Skin diseases including inflammatory conditions can be correlated with the shortening of telomeres and the persistent activation of DNA damage response in skin tissues. Telomere dysfunction could disrupt the balance of the skin, impairs wound healing, and may contribute to abnormal cytokine production. Skin aging and processes related to telomeres may function as one of the triggers for skin diseases. The presence of proinflammatory cytokines and dysfunctional telomeres in conditions such as Dyskeratosis Congenita implies a possible connection between the shortening of telomeres and the onset of chronic inflammatory skin disorders. In autoinflammatory skin diseases, chronic inflammation hinders wound healing thus aggravating the progression of the disease. The NF-ĸB pathway might contribute to the initiation or progression of chronic disorders by influencing mechanisms associated with telomere biology. The intricate connections between telomeres, telomerase, telomere-associated proteins, and skin diseases are still a complex puzzle to be solved. Here, we provide an overview of the impact of telomeres on both health and disease with a specific emphasis on their role in skin, inflammation and autoinflammatory skin disorders.
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Affiliation(s)
- Ayshath Thasneem
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Said Sif
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Md Mizanur Rahman
- Biological Science Program, Department of Biological and Environmental Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Sergio Crovella
- Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar -
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5
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Alter M. [Hidradenitis suppurativa]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:497-506. [PMID: 38512397 DOI: 10.1007/s00105-024-05321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin and systemic disease that is associated with considerable discomfort and a significant reduction in the quality of life. Despite a significantly increased understanding of the disease, the diagnosis is still delayed for many years. Delayed patient access to suitable treatment often leads to disease progression with increased surgical interventions and the occurrence of possible comorbidities. In recent years, there has been an improved understanding of the pathophysiology and, as a result the authorization of modern therapeutic agents for HS. The treatment of HS is based on three treatment pillars: surgery, antibiotics and biologics. Additionally, risk factors, such as smoking and obesity should be positively influenced. Knowledge of comorbidities and their interdisciplinary treatment is important for the individualized care of patients.
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Affiliation(s)
- M Alter
- Klinik für Dermatologie, Johannes-Wesling-Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, 32429, Minden, Deutschland.
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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7
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Holgersen N, Nielsen VW, Rosenø NAL, Thyssen JP, Egeberg A, Nielsen SH, Ring HC, Thomsen SF. Biomarkers of systemic inflammation are associated with disease severity and metabolic syndrome in patients with hidradenitis suppurativa. JAAD Int 2024; 15:170-178. [PMID: 38638915 PMCID: PMC11025002 DOI: 10.1016/j.jdin.2024.03.002] [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] [Accepted: 03/03/2024] [Indexed: 04/20/2024] Open
Abstract
Background Biomarkers associated with disease severity and comorbid metabolic syndrome (MetS) in patients with hidradenitis suppurativa (HS) are lacking. Objective To identify biomarkers associated with disease severity and comorbid MetS in patients with HS. Methods Data on hospital outpatients with HS were obtained through clinical examination and interviews. Indicators of systemic inflammation; C-reactive protein (CRP), erythrocyte sedimentation-rate (ESR), neutrophil/lymphocyte-ratio (NLR), platelet/lymphocyte-ratio (PLR), monocyte/lymphocyte-ratio (MLR), platelet/neutrophil-ratio (PNR), pan-immune-inflammation-value (PIV), and systemic-immune-inflammatory-index (SII), were calculated from blood samples. Results Seven hundred patients were included; of those 444 (63.4%) and 256 (36.6%) were female and male, respectively, with a median age of 38.3 years (IQR = 27.9-51.0). Increasing CRP, ESR, NLR, PIV, and SII (P < .001) were significantly associated with increasing Hurley-stage and international hidradenitis suppurativa severity score system 4 (IHS4)-score in adjusted analysis. A doubling in CRP (OR 1.59 (1.36-1.85), P < .001), ESR (OR 1.39 (1.17-1.66), P < .001) and PIV (OR 1.41 (1.12-1.77) P = .002) was associated with MetS in adjusted analysis. ESR was the best estimator for severe IHS4-score (AUC = 0.72 (0.66-0.77), P < .001) and Hurley III (AUC = 0.79 (0.73-0.85), P < .001) whereas CRP was best for MetS (AUC = 0.67 (0.62-0.72), P < .001). Limitations Patients in a hospital setting tend to have more severe disease. Conclusion Biomarkers like CRP, ESR, and PIV measuring systemic inflammation were associated with disease severity and comorbid MetS in patients with HS.
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Affiliation(s)
- Nikolaj Holgersen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | - Jacob P. Thyssen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Kromer C, Stanisz-Bogeski H. Aktuelle Empfehlungen zur Therapie der Hidradenitis suppurativa. J Dtsch Dermatol Ges 2024; 22:757-758. [PMID: 38857096 DOI: 10.1111/ddg.15472_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
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9
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Zouboulis CC, Prens EP, Sayed CJ, Molina-Leyva A, Bettoli V, Romanelli M, Szepietowski JC, Martinez AL, Kasparek T, Lobach I, Wozniak MB, Ortmann CE, Thomas N, Bachhuber T, Ravichandran S, Tzellos T. International Hidradenitis Suppurativa Severity Scoring System (IHS4) as a holistic measure of hidradenitis suppurativa disease severity compared with Hurley staging: A post hoc analysis of the SUNRISE and SUNSHINE phase 3 trials of secukinumab. J Eur Acad Dermatol Venereol 2024; 38:e496-e499. [PMID: 38058224 DOI: 10.1111/jdv.19681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christopher J Sayed
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alejandro Molina-Leyva
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Hidradenitis Suppurativa Unit, Instituto de Investigación Biosanitaria ibs and Servicio de Dermatologia, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Vincenzo Bettoli
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Romanelli
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Jacek C Szepietowski
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | | | | | | | | | | | | | | | | | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
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10
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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11
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Strobel A, Schultheis M, Staubach P, Grabbe S, Mann C, Hennig K, Szepietowski JC, Matusiak L, Krajewski P, von Stebut E, Garcovich S, Bayer H, Heise M, Podda M, Kirschner U, Nikolakis G. Real-world effectiveness and safety of the LAight-therapy in patients with hidradenitis suppurativa. J Dtsch Dermatol Ges 2024. [PMID: 38807028 DOI: 10.1111/ddg.15403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/18/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa (HS)/Acne inversa (Ai) is a chronic debilitating disease with limited therapy options. The device-based LAight therapy was approved in Europe in 2017. The aim of this study was to evaluate the effect of real-world care with at least one treatment with LAight therapy on disease activity and burden in 3,437 patients. PATIENTS AND METHODS Patients were included in the analysis if they had a diagnosis of HS and received at least one treatment. The endpoints Hidradenitis Suppurativa Severity Score System (IHS4), pain on the numeric rating scale (pain-NRS) and Dermatology Life Quality Index (DLQI) were analyzed using a linear mixed model for repeated measures (MMRM) over 26 weeks of care with LAight therapy. Furthermore, responder rates were calculated for all endpoints, and the therapy's safety profile and patient satisfaction were thoroughly examined. RESULTS A significant decrease in IHS4, pain-NRS, and DLQI was achieved during 26 weeks of care with LAight. The BMI at baseline had a significant negative effect on therapy response for pain-NRS and DLQI. CONCLUSIONS This study confirms that LAight therapy leads to satisfactory disease control in all stages of severity and is a valuable addition to the therapeutic repertoire of HS.
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Affiliation(s)
- Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Schultheis
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Caroline Mann
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Dept. of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Piotr Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Hans Bayer
- Dermatology Outpatient Office Hautmedizin Bad Soden, Bad Soden, Germany
| | - Marcus Heise
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- Institute for Health- and Nursing Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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12
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Omari N, Simonsen S, Gluud LL, Martin HM, Trelle MB, Jemec GB, Skov L, Näslund-Koch C. Assessment of metabolic dysfunction-associated steatotic liver disease in patients with hidradenitis suppurativa: A cross-sectional study. J Eur Acad Dermatol Venereol 2024. [PMID: 38764439 DOI: 10.1111/jdv.20110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Affiliation(s)
- N Omari
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S Simonsen
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - L L Gluud
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Gastro Unit, Copenhagen University Hospital-Hvidovre, Copenhagen, Denmark
| | - H M Martin
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - M B Trelle
- Department of Clinical Biochemistry, Odense University Hospital, Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - G B Jemec
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - L Skov
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - C Näslund-Koch
- Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Maronese CA, Marzano AV. Identifying candidates for early intervention in hidradenitis suppurativa. Br J Dermatol 2024; 190:787-788. [PMID: 38282335 DOI: 10.1093/bjd/ljae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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14
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Kjærsgaard Andersen R, Pedersen O, Eidsmo L, Jemec G, Saunte D. Initial steps towards developing a predictive algorithm of disease progression for hidradenitis suppurativa (HS): results from a Cox proportional hazard regression analysis on disease progression among a cohort of 335 Danish patients with HS. Br J Dermatol 2024; 190:904-914. [PMID: 38169316 DOI: 10.1093/bjd/ljad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory and scarring disease with a wide spectrum of disease severity. The amount of scarring is proportional to the preceding tissue damage and poses a challenge to patients. Severe HS is most often treatment recalcitrant, but hypothetically avoidable through early biologic treatment. Early prediction of individual risk of disease progression is therefore essential for patient management. OBJECTIVES To investigate risk factors associated with disease progression and to design an algorithm capable of predicting disease -progression. METHODS A prospective cohort study of 335 Hurley III-naïve patients with HS, not treated with biologics, was followed for a median of 2 years. Potential risk factors covered basic demographics, HS anamnestic factors and clinical HS factors collected during physical examination. Two separate Cox proportional hazard regression (CPHR) analyses were conducted. A summated 'progression score' was calculated and used in the predictive algorithm of severe disease. Subsequent bootstrap sampling was used to validate the predictability of the predictive algorithm. RESULTS The CPHR analysis of Transition to severe disease found that active smoking [hazard ratio (HR) 4.01, 95% confidence interval (CI) 1.71-9.40, P = 0.001]; body mass index (BMI) points > 25 at baseline (each point: HR 1.06, 95% CI 1.02-1.09, P < 0.001); active disease in 2 (HR 4.26, 95% CI 1.23-14.84, P = 0.02) and ≥ 3 areas (HR 6.54, 95% CI 1.89-22.72, P = 0.003) all constituted substantial risk factors. Conversely, the CPHR analysis of Disease progression did not yield results of clinical relevance. A 'progression score' of 3.04 was used as a threshold in the predictive algorithm of Transition to severe disease and achieved the following test specifics: sensitivity = 0.51, specificity = 0.86, positive predictive value = 0.50, negative predictive value = 0.86. CONCLUSIONS We found a disparity between factors increasing the risk of simple Disease progression and those increasing the risk of Transition to severe disease. For the latter, active smoking, BMI points > 25, active disease in 2 or ≥ 3 areas were all shown to be the clinically relevant factors that could be used to construct an algorithm that correctly predicted progression to severe HS in more than half of all instances.
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Affiliation(s)
- Rune Kjærsgaard Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center
| | - Ole Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Liv Eidsmo
- Department of Immunology and Microbiology, Leo Foundation Skin Immunology Research Center
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Ditte Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
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15
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Calabrese L, Vitale A, Moltrasio C, Genovese G, Romagnuolo M, Marzano AV, Maglie R, Rubegni P, Cantarini L. Hyper-IgD syndrome and hidradenitis suppurativa: An intriguing link. J Eur Acad Dermatol Venereol 2024; 38:e444-e446. [PMID: 38069555 DOI: 10.1111/jdv.19706] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024]
Affiliation(s)
- Laura Calabrese
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
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16
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Aarts P, van Huijstee JC, van der Zee HH, van Straalen KR, Prens EP. Improved clinical effectiveness of adalimumab when initiated with clindamycin and rifampicin in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:904-909. [PMID: 38112226 DOI: 10.1111/jdv.19725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/09/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Adalimumab monotherapy for hidradenitis suppurativa (HS) is often insufficient with a maximum clinical efficacy of 60% in Hidradenitis Suppurativa Clinical Response (HiSCR) and limited effect on draining tunnels. Data suggest that adalimumab therapy could be improved by concomitant antibiotics. OBJECTIVE To compare the clinical effectiveness of adalimumab with clindamycin and rifampicin versus adalimumab monotherapy after 12 weeks. METHODS This retrospective study included patients who started adalimumab with additional clindamycin and rifampicin and patients treated with adalimumab monotherapy, matched on sex and refined Hurley score. The primary outcome measure was the difference in change in the International Hidradenitis Suppurativa Severity Score System (IHS4) at 12 weeks. RESULTS In total, 62 patients were included in the combination therapy group (n = 31) and adalimumab monotherapy group (n = 31), showing comparable IHS4 scores; 32.5 versus 29, p = 0.87 at baseline respectively. The combination therapy demonstrated greater clinical effectiveness expressed in median IHS4 improvement (-20 vs. -9, p < 0.001), IHS4-55 (74% vs. 36%, p = 0.002), median draining tunnel reduction (-4 vs. -2, p < 0.001) and pain response (47% vs. 27%, p = 0.02). CONCLUSION Adalimumab initiated with clindamycin and rifampicin shows greater clinical effectiveness than adalimumab monotherapy. An important difference in effect was observed in the decrease of draining tunnels, addressing a serious limitation of adalimumab monotherapy.
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Affiliation(s)
- P Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J C van Huijstee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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17
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Greenlund L, Herzog C, Wendland Z, Rypka K, Frew JW, Kirby JS, Alavi A, Khalid B, Lowes MA, Garg A, Marzano AV, Zouboulis CC, Tzellos T, Jaleel T, Goldfarb N. Discrepancies in hidradenitis suppurativa lesion characterization by providers and patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595320 DOI: 10.1111/jdv.19999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The hidradenitis suppurativa (HS) clinical response (HiSCR) has come under scrutiny as several HS clinical trials failed to meet primary endpoints with high placebo responses. This may be due to limitations of the tool and raters' ability to accurately characterize and count lesions, rather than lack of efficacy of the studied drug. Due to HS lesion complexity and potential differences in rater training, it was hypothesized that there would be discrepancies in how providers characterize and count lesions for HS clinical trials. OBJECTIVE To evaluate how HS providers and patients name and count HS lesions and to identify discrepancies among providers to initiate the development of consensus-driven guidance for HS rater training. METHODS An online survey was distributed to the members of HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Respondents were asked to classify lesion images composed of multiple and different morphology types and answer questions regarding inclusion of associated dermatological conditions. RESULTS Forty-seven HISTORIC members responded (29 providers; 18 patients). There was variability in how respondents classified HS lesions. Of 12 questions containing images, four had ≥50% of respondents choosing the same answer. With an image of a lesion composed of different morphologies, 45% of providers counted it as a single lesion and 45% counted it as multiple distinct lesions. With an image of multiple interconnected draining tunnels, 7% of providers classified it as a single draining tunnel while 79% categorized it as multiple draining tunnels with the number estimated by visual inspection. There was also variability in deciding whether lesions occurring in associated conditions should be considered separately or included in HS lesion counts. Patient responses were also variable. CONCLUSIONS The result of the current study reaffirms the gap in how providers characterize and count HS lesions for clinical trials and the need to develop consensus-driven rater training related to HS outcome measures.
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Affiliation(s)
| | - Claire Herzog
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Zachary Wendland
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katelyn Rypka
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health, Hershey, Pennsylvania, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bisma Khalid
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Amit Garg
- Northwell Health, New York, New York, USA
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, NLSH Bodø, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, TRomsø, Norway
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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18
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Navrazhina K, Renert-Yuval Y, Khattri S, Hamade H, Meariman M, Andrews E, Kim M, NandyMazumdar M, Gour DS, Bose S, Williams SC, Garcet S, Correa da Rosa J, Gottlieb AB, Krueger JG, Guttman-Yassky E. Tape strips detect molecular alterations and cutaneous biomarkers in skin of patients with hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:749-758. [PMID: 38049071 DOI: 10.1016/j.jaad.2023.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) has a high unmet need for better treatments. Biopsies are considered the gold standard for studying molecular alterations in skin. A reproducible, minimally invasive approach is needed for longitudinal monitoring in trials and in pediatric populations. OBJECTIVE To determine whether skin tape strips can detect molecular alterations in HS and identify biomarkers of disease activity. METHODS We performed RNA sequencing on tape strips collected from lesional and healthy-appearing (nonlesional) HS skin (n = 22) and healthy controls (n = 21). We correlated the expression of skin biomarkers between tape strips and a previously published gene-signature of HS biopsies. RESULTS Tape strips detected upregulation of known HS biomarkers (eg, Interleukin[IL]-17A) in nonlesional and/or lesional skin and also identified novel clinically actionable targets, including OX40 and JAK3. The expression of Th17 and tumor necrosis factor-α pathways were highly correlated between tape strips and biopsies. HS clinical severity was significantly associated with expression of biomarkers (eg tumor necrosis factor-α , IL-17 A/F, OX40, JAK1-3, IL-4R) in HS lesional and/or nonlesional skin. LIMITATIONS Sample size. Tape stripping is limited in depth. CONCLUSION This study validates tape strips as a minimally-invasive approach to identify cutaneous biomarkers in HS. This provides a novel avenue for monitoring treatment efficacy and a potential step toward individualized therapy in HS.
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Affiliation(s)
- Kristina Navrazhina
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York; Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - Yael Renert-Yuval
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York; Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Saakshi Khattri
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hassan Hamade
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marguerite Meariman
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth Andrews
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Madeline Kim
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Monali NandyMazumdar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Digpal S Gour
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Swaroop Bose
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samuel C Williams
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sandra Garcet
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joel Correa da Rosa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James G Krueger
- Laboratory for Investigative Dermatology, Rockefeller University, New York, New York
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York.
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Liakou AI, Tsantes AG, Kalamata M, Tsamtsouri L, Agiasofitou E, Vladeni S, Dragoutsou A, Bompou EK, Tsante KA, Chatzidimitriou E, Kotsafti O, Bonovas S, Stratigos AI. Flares and new related lesions of Hidradenitis Suppurativa following COVID-19 vaccination: A retrospective cohort study of 250 patients in Greece. J Eur Acad Dermatol Venereol 2024. [PMID: 38511998 DOI: 10.1111/jdv.19968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Aikaterini I Liakou
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Andreas G Tsantes
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, University of Athens Medical School, Athens, Greece
- Microbiology Department, "Saint Savvas" Oncology Hospital, Athens, Greece
| | - Magdalini Kalamata
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Lydia Tsamtsouri
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Efthymia Agiasofitou
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Soultana Vladeni
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Angeliki Dragoutsou
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Evangelia-Konstantina Bompou
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Konstantina A Tsante
- Laboratory of Haematology and Blood Bank Unit, "Attikon" Hospital, University of Athens Medical School, Athens, Greece
| | - Eleni Chatzidimitriou
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Ourania Kotsafti
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alexandros I Stratigos
- 1st Department of Dermatology-Venereology, "Andreas Sygros" Hospital, University of Athens Medical School, Athens, Greece
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20
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Krajewski PK, Szukała W, Szepietowski JC. The NLRP3 Inflammasome Gene Is Overexpressed in Hidradenitis Suppurativa Lesions: A Preliminary Study on the Role of Pyroptosis in Disease Pathogenesis. Curr Issues Mol Biol 2024; 46:2544-2552. [PMID: 38534777 DOI: 10.3390/cimb46030161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 03/28/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating inflammatory skin disorder, and its pathogenesis remains incompletely understood. This study aimed to investigate the role of the P2X7 receptor (P2X7R) and NLRP3 inflammasome in HS pathogenesis. RNA sequencing and real-time PCR were performed to assess the gene expression levels of P2X7R and NLRP3 in the skin biopsies of HS patients and healthy controls (HC). The results of our study revealed a significantly increased expression of the NLRP3 gene in both the lesional and perilesional skin of HS patients compared to healthy controls. Moreover, the mRNA levels of NLRP3 were significantly higher in lesional skin compared to non-lesional skin in HS patients, indicating the spread of inflammation to adjacent tissues. In contrast, no significant differences in P2X7R gene expression were observed between the three groups. These findings suggest the involvement of NLRP3 inflammasomes in HS pathogenesis, while P2X7R may not play a significant role in the disease. This research sheds light on the complex inflammatory pathways in HS, highlighting the potential of NLRP3 as a therapeutic target. Understanding the molecular mechanisms underlying HS is crucial for the development of targeted treatment modalities for this debilitating condition.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland
| | - Weronika Szukała
- Doctoral School of Exact and Natural Sciences, Jagiellonian University, Lojasiewicza 11, 30-348 Krakow, Poland
- Faculty of Biochemistry, Biophysics and Biotechnology, Department of General Biochemistry, Jagiellonian University, Gronostajowa 7, 30-387 Krakow, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chalubinskiego 1, 50-368 Wroclaw, Poland
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21
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Manfredini M, Ragusa E, Gibertini M, Bigi L, Ferrari B, Lasagni C, Magnoni C, Lazzerini A, Farnetani F, Verdina T. Retinal Microvascular Alterations in Hidradenitis Suppurativa Patients: A Pilot Study Using Optical Coherence Tomography Angiography. J Clin Med 2024; 13:1464. [PMID: 38592296 PMCID: PMC10932047 DOI: 10.3390/jcm13051464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a relapsing-remitting inflammatory disease characterized by the progression of asymptomatic nodules to deep-seated lesions and fistula formation that leads to suppuration and scarring. Optical coherence tomography angiography (OCTA) is a new non-invasive imaging technique that carefully analyzes retinal microvasculature networks with high-resolution imaging. Recent studies have demonstrated that retinal vessel density and retinal perfusion reflect systemic inflammatory responses. This study's aim was to analyze OCTA-derived retinal microvasculature parameters to understand if patients affected by HS and without any relevant ocular or systemic comorbidities showed impaired retinal vascular function and morphology. Method: We performed a case-control study of HS patients and age- and sex-matched control cohort. A total of 20 eyes from 10 HS patients and 30 eyes from 15 healthy controls were analyzed, and OCTA-derived microvasculature parameters were compared between groups. Results: OCTA images showed that HS patients, compared to healthy controls, were typically characterized by higher values of the foveal avascular zone (FAZ) both in the superficial capillary plexus (SCP) and in the deep capillary plexus (DCP), and by lower values of vessel density (VD)-SCP, VD-DCP, and vessel length density (VLD)-SCP in the foveal region. These findings partially reflect changes that have been demonstrated in diabetic patients that could be induced by a protracted metabolic or systemic inflammatory dysregulation. Conclusions: In conclusion, OCTA enables large-scale, non-invasive visual screening and follow-up of the retinal vasculature features, providing a new strategy for the prevention and monitoring of visual changes in HS patients.
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Affiliation(s)
- Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Emanuele Ragusa
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Matteo Gibertini
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Laura Bigi
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Barbara Ferrari
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Claudia Lasagni
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Cristina Magnoni
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Andrea Lazzerini
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy (C.L.)
| | - Tommaso Verdina
- Institute of Ophthalmology, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy
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22
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Tzellos T. First steps into AI-supported hidradenitis suppurativa severity assessment. J Eur Acad Dermatol Venereol 2024; 38:456-457. [PMID: 38391213 DOI: 10.1111/jdv.19785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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23
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Kirby JS, Okun MM, Alavi A, Bechara FG, Zouboulis CC, Brown K, Santos LL, Wang A, Bibeau KB, Kimball AB, Porter ML. Efficacy and safety of the oral Janus kinase 1 inhibitor povorcitinib (INCB054707) in patients with hidradenitis suppurativa in a phase 2, randomized, double-blind, dose-ranging, placebo-controlled study. J Am Acad Dermatol 2024; 90:521-529. [PMID: 37871805 DOI: 10.1016/j.jaad.2023.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Janus kinase 1 inhibition may alleviate hidradenitis suppurativa (HS)-associated inflammation and improve symptoms. OBJECTIVE To assess efficacy and safety of povorcitinib (selective oral Janus kinase 1 inhibitor) in HS. METHODS This placebo-controlled phase 2 study randomized patients with HS 1:1:1:1 to receive povorcitinib 15, 45, or 75 mg or placebo for 16 weeks. Primary and key secondary end points were mean change from baseline in abscess and inflammatory nodule count and percentage of patients achieving HS Clinical Response at week 16. RESULTS Of 209 patients randomized (15 mg, n = 52; 45 mg, n = 52; 75 mg, n = 53; placebo, n = 52), 83.3% completed the 16-week treatment. At week 16, povorcitinib significantly reduced abscess and inflammatory nodule count from baseline (least squares mean [SE] change: 15 mg, -5.2 [0.9], P = .0277; 45 mg, -6.9 [0.9], P = .0006; 75 mg, -6.3 [0.9], P = .0021) versus placebo (-2.5 [0.9]). More povorcitinib-treated patients achieved HS Clinical Response at week 16 (15 mg, 48.1%, P = .0445; 45 mg, 44.2%, P = .0998; 75 mg, 45.3%, P = .0829) versus placebo (28.8%). A total of 60.0% and 65.4% of povorcitinib- and placebo-treated patients had adverse events. LIMITATIONS Baseline lesion counts were mildly imbalanced between groups. CONCLUSION Povorcitinib demonstrated efficacy in HS, with no evidence of increased incidence of adverse events among doses.
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
| | - Martin M Okun
- Department of Dermatology, Fort Memorial Hospital, Fort Atkinson, Wisconsin
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Falk G Bechara
- Department of Dermatology, Allergology and Venereology, Ruhr University Bochum, Bochum, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Kurt Brown
- Incyte Corporation, Wilmington, Delaware
| | | | - Annie Wang
- Incyte Corporation, Wilmington, Delaware
| | | | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Martina L Porter
- Department of Dermatology, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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24
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Wiala A, Ranjan R, Schnidar H, Rappersberger K, Posch C. Automated classification of hidradenitis suppurativa disease severity by convolutional neural network analyses using calibrated clinical images. J Eur Acad Dermatol Venereol 2024; 38:576-582. [PMID: 38013510 DOI: 10.1111/jdv.19639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images. METHODS 777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin. RESULTS CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42. LIMITATIONS Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I. CONCLUSION CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.
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Affiliation(s)
- A Wiala
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
| | - R Ranjan
- SCARLETRED Holding GmbH, Vienna, Austria
| | - H Schnidar
- SCARLETRED Holding GmbH, Vienna, Austria
| | - K Rappersberger
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
- School of Medicine, Sigmund Freud University, Vienna, Austria
| | - C Posch
- School of Medicine, Sigmund Freud University, Vienna, Austria
- Department of Dermatology, Clinic Hietzing, Vienna, Austria
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
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25
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González-López MA. [Hidradenitis suppurativa]. Med Clin (Barc) 2024; 162:182-189. [PMID: 37968174 DOI: 10.1016/j.medcli.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.
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Affiliation(s)
- Marcos A González-López
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, España; Real Academia de Medicina de Cantabria, Santander, Cantabria, España.
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26
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Kimball AB, Ravichandran S. Secukinumab treatment of hidradenitis suppurativa: questions remain - Authors' reply. Lancet 2024; 403:617-618. [PMID: 38368012 DOI: 10.1016/s0140-6736(23)01615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Alexa B Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA.
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27
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Maul JT, Kolios AGA, Thomsen SF, Ring HC. Secukinumab treatment of hidradenitis suppurativa: questions remain. Lancet 2024; 403:616-617. [PMID: 38368009 DOI: 10.1016/s0140-6736(23)01616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/02/2023] [Indexed: 02/19/2024]
Affiliation(s)
- Julia-Tatjana Maul
- Department of Dermatology and Venereology, University Hospital of Zürich, 8091 Zürich, Switzerland; Faculty of Medicine, University of Zürich, Zürich, Switzerland.
| | - Antonios G A Kolios
- Department of Dermatology and Venereology, University Hospital of Zürich, 8091 Zürich, Switzerland
| | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Christian Ring
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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28
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Ingram JR, Bates J, Cannings-John R, Collier F, Evans J, Gibbons A, Harris C, Howells L, Hood K, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study (THESEUS): a prospective cohort study. Br J Dermatol 2024; 190:382-391. [PMID: 37823414 DOI: 10.1093/bjd/ljad388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, painful disease affecting flexures and other skin regions, producing nodules, abscesses and skin tunnels. Laser treatment targeting hair follicles and deroofing of skin tunnels are standard HS interventions in some countries but are rarely offered in the UK. OBJECTIVES To describe current UK HS management pathways and influencing factors to inform the design of future randomized controlled trials (RCTs). METHODS THESEUS was a nonrandomized 12-month prospective cohort study set in 10 UK hospitals offering five interventions: oral doxycycline 200 mg daily; oral clindamycin and rifampicin both 300 mg twice daily for 10 weeks, extended for longer in some cases; laser treatment targeting hair follicles; deroofing; and conventional surgery. The primary outcome was the combination of clinician-assessed eligibility and participant hypothetical willingness to receive each intervention. The secondary outcomes were the proportion of participants selecting each intervention as their final treatment option; the proportion who switch treatments; treatment fidelity; and attrition rates. THESEUS was prospectively registered on the ISRCTN registry: ISRCTN69985145. RESULTS The recruitment target of 150 participants was met after 18 months, in July 2021, with two pauses due to the COVID-19 pandemic. Baseline demographics reflected the HS secondary care population: average age 36 years, 81% female, 20% non-White, 64% current or ex-smokers, 86% body mass index ≥ 25, 68% with moderate disease, 19% with severe disease and 13% with mild disease. Laser was the intervention with the highest proportion (69%) of participants eligible and willing to receive treatment, then deroofing (58%), conventional surgery (54%), clindamycin and rifampicin (44%), and doxycycline (37%). Laser was ranked first choice by the greatest proportion of participants (41%). Attrition rates were 11% and 17% after 3 and 6 months, respectively. Concordance with doxycycline was 52% after 3 months due to lack of efficacy, participant choice and adverse effects. Delays with procedural interventions were common, with only 43% and 26% of participants starting laser and deroofing, respectively, after 3 months. Uptake of conventional surgery was too small to characterize the intervention. Switching treatment was uncommon and there were no serious adverse events. CONCLUSIONS THESEUS has established laser treatment and deroofing for HS in the UK and demonstrated their popularity with patients and clinicians for future RCTs.
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Affiliation(s)
| | - Janine Bates
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | - Judith Evans
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rachel Howes
- Department of Plastic Surgery, John Radcliffe Hospital, Oxford NHS Trust, Oxford, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
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Crovella S, Suleman M, Tricarico PM, Al-Khuzaei S, Moltrasio C, El Omri A, Marzano AV. Harnessing artificial intelligence for advancing early diagnosis in hidradenitis suppurativa. Ital J Dermatol Venerol 2024; 159:43-49. [PMID: 38345291 DOI: 10.23736/s2784-8671.23.07829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
This perspective delves into the integration of artificial intelligence (AI) to enhance early diagnosis in hidradenitis suppurativa (HS). Despite significantly impacting Quality of Life, HS presents diagnostic challenges leading to treatment delays. We present a viewpoint on AI-powered clinical decision support system designed for HS, emphasizing the transformative potential of AI in dermatology. HS diagnosis, primarily reliant on clinical evaluation and visual inspection, often results in late-stage identification with substantial tissue damage. The incorporation of AI, utilizing machine learning and deep learning algorithms, addresses this challenge by excelling in image analysis. AI adeptly recognizes subtle patterns in skin lesions, providing objective and standardized analyses to mitigate subjectivity in traditional diagnostic approaches. The AI integration encompasses diverse datasets, including clinical records, images, biochemical and immunological data and OMICs data. AI algorithms enable nuanced comprehension, allowing for precise and customized diagnoses. We underscore AI's potential for continuous learning and adaptation, refining recommendations based on evolving data. Challenges in AI integration, such as data privacy, algorithm bias, and interpretability, are addressed, emphasizing the ethical considerations of responsible AI deployment, including transparency, human oversight, and striking a balance between automation and human intervention. From the dermatologists' standpoint, we illustrate how AI enhances diagnostic accuracy, treatment planning, and long-term follow-up in HS management. Dermatologists leverage AI to analyze clinical records, dermatological images, and various data types, facilitating a proactive and personalized approach. AI's dynamic nature supports continuous learning, refining diagnostic and treatment strategies, ultimately reshaping standards of care in dermatology.
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Affiliation(s)
- Sergio Crovella
- Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar -
| | - Muhammad Suleman
- Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar
| | | | - Safaa Al-Khuzaei
- Department of Dermatology and Venereology, Hamad Medical Corporation, Rumailah Hospital, Doha, Qatar
| | - Chiara Moltrasio
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Angelo V Marzano
- Unit of Dermatology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Radhakrishna U, Ratnamala U, Jhala DD, Uppala LV, Vedangi A, Saiyed N, Patel M, Vadsaria N, Shah SR, Rawal RM, Mercuri SR, McGonagle D, Jemec GBE, Damiani G. Hidradenitis suppurativa associated telomere-methylome dysregulations in blood. J Eur Acad Dermatol Venereol 2024; 38:393-403. [PMID: 37872100 DOI: 10.1111/jdv.19586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/03/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic debilitating disease with a significant burden of both organic and psychological comorbidities. It has been shown that certain telomere-related genes (TRGs) affect a wide range of diseases, including HS and its associated comorbidities, but their exact role in HS pathogenesis is still unknown. OBJECTIVES To determine whether TRG methylomes can be used as biomarkers in HS. METHODS Using the Illumina HumanMethylation450 BeadChip array, we examined methylation variations associated with TRGs in HS cases and age-, sex- and ethnicity-matched healthy controls. The study utilized integrated bioinformatics statistical methods, such as a false discovery rate (FDR), the area under the receiver operating characteristic curve (AUC) and principal component analysis. RESULTS There were a total of 585 different differentially methylated CpG sites identified in 585 TRGs associated with HS (474 hypomethylated and 111 hypermethylated) (FDR p-value < 0.05). A number of these CpGs have been identified as being involved in increased pain sensitivity including EPAS1, AHR, CSNK1D, DNMT1, IKBKAP, NOS3, PLCB1 and PRDM16 genes; GABRB3 as a potential alcohol addiction marker; DDB1, NSMCE2 and HNRNPA2B1 associated with cancers. Pathway analysis identified 67 statistically significant pathways, including DNA repair, telomere maintenance, mismatch repair and cell cycle control (p < 0.001). CONCLUSION The disruption of TRGs leads to the shortening of telomeres, which is associated with HS progression, ageing, cellular senescence and an increased risk of various diseases, including cancer and associated comorbidities, such as metabolic syndrome, cardiovascular disease and inflammatory disorders. Further research is necessary to better understand the underlying mechanisms and establish causal links between TRGs and HS. The present study is the first effort to comprehend potential pathomechanisms of sporadic HS cases concentrating on PBMC methylome since ours.
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Affiliation(s)
- Uppala Radhakrishna
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Uppala Ratnamala
- Department of Life Sciences, School of Sciences, Gujarat University, Ahmedabad, India
| | | | - Lavanya V Uppala
- College of Information Science & Technology, Peter Kiewit Institute, the University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Aaren Vedangi
- Department of Clinical Research, KIMS ICON Hospital, A Unit of ICON Krishi Institute Medical Sciences, Visakhapatnam, India
| | - Nazia Saiyed
- Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | | | | | - Sushma R Shah
- Department of Obstetrics and Gynecology, BJ Medical College Institute of Medical Post-Graduate Studies and Research, Ahmedabad, India
| | - Rakesh M Rawal
- Department of Life Sciences, School of Sciences, Gujarat University, Ahmedabad, India
| | - Santo R Mercuri
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milano, Italy
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Giovanni Damiani
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milano, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Italian Center of Precision Medicine and Chronic Inflammation, University of Milan, Milan, Italy
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Schultheis M, Grabbe S, Staubach P, Hennig K, Mauch M, Burckhardt M, Langer G, Heise M, Zamsheva M, Schollenberger L, Strobel A. Drivers of disease severity and burden of hidradenitis suppurativa: a cross-sectional analysis on 553 German patients. Int J Dermatol 2024; 63:188-195. [PMID: 37919257 DOI: 10.1111/ijd.16889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions with an age peak at around 40 years and an estimated prevalence of 1%. Nodules and abscesses can develop into fistules and scarring, which cause severe pain. HS is a progressive, life-defining disease that leads to physical limitations, inability to work, and social isolation. There is still little data on the drivers of disease severity and burden. METHOD The cross-sectional study is based on the baseline data of 553 participants of the health care research project "EsmAiL," which was carried out as a multicenter randomized controlled trial. It included adult HS-patients presenting with at least three inflammatory lesions and at least a moderate impact on quality of life. RESULTS Disease activity increases with age. Men are more severely affected than women but feel less burdened. Obesity negatively influences disease activity and disease burden. Affected individuals have a higher level of education than the age adjusted population, but the unemployment rate is significantly higher. Disease activity significantly reduces quality of life and promotes depression and anxiety. CONCLUSIONS HS is a severe and debilitating dermatosis. As a result of the well-established factors involved, HS requires a multi-causal approach to management, in addition to medical and surgical treatment. This must take into account all available therapeutic options, as well as patient education to reduce risk factors and pain, and psychological support. HS requires interdisciplinary and multi-professional care. To prevent disease progression, a structured treatment plan is needed.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marcus Heise
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of General Practice and Family Medicine, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lukas Schollenberger
- Interdisciplinary Center for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Alexandra Strobel
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
- Profile Centre of Health Sciences Halle, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
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Kim Y, Lee J, Kim HS, Ko HC, Kim BS, Kim MB, Shin K. Review of Scoring Systems for Hidradenitis Suppurativa. Ann Dermatol 2024; 36:9-17. [PMID: 38325429 PMCID: PMC10861310 DOI: 10.5021/ad.23.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/05/2023] [Accepted: 11/06/2023] [Indexed: 02/09/2024] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disorder characterized by chronic deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in apocrine gland-bearing regions. Assessing its severity is challenging because of its clinical heterogeneity, lack of a standardized tool, and increasing severity scores. This article provides a chronological overview of HS grading scales to aid in the understanding and comparison of different scoring systems. A literature review of articles published in English on PubMed was conducted searched from 1989 to 2023. The review includes 15 scores that are the most relevant and widely used and acknowledges the existence of over 30 scoring systems for HS. The expanding landscape of HS scoring systems presents challenges when patients evaluated using different systems are compared. A universally accepted scoring system is required for consistent application across diverse populations. A comprehensive assessment should balance subjective and objective items, considering observer-reported signs and patient-reported symptoms to make meaningful treatment decisions.
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Affiliation(s)
- Youngbeom Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jungsoo Lee
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hoon-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyun-Chang Ko
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Byung-Soo Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Moon-Bum Kim
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kihyuk Shin
- Department of Dermatology, School of Medicine, Pusan National University, Busan, Korea
- Department of Dermatology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
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Zouboulis CC, Hrvatin Stancic B, Abaitancei A, Guimarães MJ, Lobo IL, Massa AF, Nikolakis G, Nogueira MO, Özdemir AO, Pirogova A, Prens EP, Szepietowski JC, Tusheva I, Tzellos T, Zouboulis VA. The inter-rater reliability of IHS4 corroborates its aptitude as primary outcome measurement instrument for large clinical studies in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:e185-e187. [PMID: 37728531 DOI: 10.1111/jdv.19525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Affiliation(s)
- C C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences, Dessau, Germany
| | - B Hrvatin Stancic
- Department of Dermatology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Abaitancei
- Department of Dermatology, Universitaet Transilvania, Brașov, Romania
| | - M J Guimarães
- Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal
| | - I L Lobo
- Serviço de Dermatovenereologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A F Massa
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - G Nikolakis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences, Dessau, Germany
| | - M O Nogueira
- Serviço de Dermatovenereologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A O Özdemir
- Sağlık Bakanlığı-Turkish Ministry of Health, Istanbul, Turkey
| | - A Pirogova
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E P Prens
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J C Szepietowski
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - I Tusheva
- Clinic of Dermatovenerology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - T Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
| | - V A Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Universitaetsklinikum Hamburg-Eppendorf (UKE), Faculty of Medicine, Hamburg, Germany
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Martora F, Marasca C, Cacciapuoti S, Fariello F, Potestio L, Battista T, Scalvenzi M, Megna M. Secukinumab in Hidradenitis Suppurativa Patients Who Failed Adalimumab: A 52-Week Real-Life Study. Clin Cosmet Investig Dermatol 2024; 17:159-166. [PMID: 38283798 PMCID: PMC10821645 DOI: 10.2147/ccid.s449367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
Background The treatment of hidradenitis suppurativa (HS) has always been a real challenge for dermatologists; to date, adalimumab the only biologic drug approved for HS is adalimumab, an anti-tumor necrosis factor (TNF)-α drug, the approval of this drug dates to 2015, data provided by real life show an effectiveness rate of about 60% percent. Recently (31 October 2023) FDA approves secukinumab for moderate-severe HS. The treatment and management of HS is very challenging as available treatments are very limited and show very variable outcomes. Methods We conducted a prospective monocentric study designed to evaluate the efficacy and safety of secukinumab treatment in HS patients in a real-life setting. Results The initial cohort of patients recruited included 21 HS patients including 12 females and 9 males. About 57.1% of patients achieved the primary endpoint and recorded significant decrease in all the severity assessment scales (IHS4, DLQI and VAS pain scale) at week 16 and 52, when HiSCR reached 71.4%. Conclusion The results of our study highlight that treatment with secukinumab in patients with severe HS who failed adalimumab may be a safe and effective therapeutic weapon.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio Marasca
- Dermatology Unit, Medical Department, “Antonio Cardarelli” National Hospital, Naples, Italy
| | - Sara Cacciapuoti
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Federica Fariello
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Massimiliano Scalvenzi
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Krueger JG, Frew J, Jemec GBE, Kimball AB, Kirby B, Bechara FG, Navrazhina K, Prens E, Reich K, Cullen E, Wolk K. Hidradenitis suppurativa: new insights into disease mechanisms and an evolving treatment landscape. Br J Dermatol 2024; 190:149-162. [PMID: 37715694 DOI: 10.1093/bjd/ljad345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need. The prevalence of HS reported in most studies is 1-2%, although it is likely to be under-reported and estimates vary globally owing to variance in data collection methods, ethnicity, geographical location and under-diagnosis. HS is characterized by persistent, painful cutaneous nodules, abscesses and draining tunnels commonly affecting the axillary, anogenital, inguinal and perianal/gluteal areas. Over time, chronic uncontrolled inflammation results in irreversible tissue destruction and scarring. Although the pathophysiology of HS has not been fully elucidated, the tumour necrosis factor (TNF)-α and interleukin (IL)-17 pathways have an important role, involving multiple cytokines. Currently, treatment options include topical medications; systemic therapies, including repeated and/or rotational courses of systemic antibiotics, retinoids and hormonal therapies; and various surgical procedures. The anti-TNF-α antibody adalimumab is currently the only biologic approved by both the US Food and Drug Administration and the European Medicines Agency for HS; however, its efficacy varies, with a clinical response reported in approximately 50% of patients in phase III trials. HS is a rapidly evolving field of discovery, with a diverse range of agents with distinct mechanisms of action currently being explored in clinical trials. Several other promising therapeutic targets have recently emerged, and agents targeting the IL-17 and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways are the most advanced in ongoing or completed phase III clinical trials. Alongside limited therapeutic options, significant challenges remain in terms of diagnosis and disease management, with a need for better treatment outcomes. Other unmet needs include significant diagnostic delays, thus missing the therapeutic 'window of opportunity'; the lack of standardized outcome measures in clinical trials; and the lack of established, well-defined disease phenotypes and biomarkers.
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Affiliation(s)
- James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - John Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian Kirby
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, TheNetherlands
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Germany
- MoonLake Immunotherapeutics AG, Zug, Switzerland
| | - Eva Cullen
- MoonLake Immunotherapeutics AG, Zug, Switzerland
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Department of Dermatology, Venereology and Allergology and Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Abu Rached N, Gambichler T, Ocker L, Skrygan M, Seifert C, Scheel CH, Stockfleth E, Bechara FG. Haptoglobin is an independent marker for disease severity and risk for metabolic complications in hidradenitis suppurativa: A prospective study. J Eur Acad Dermatol Venereol 2024; 38:205-213. [PMID: 37669834 DOI: 10.1111/jdv.19495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is highly correlated with obesity. Haptoglobin serum levels have recently been recognized as an important biomarker linking obesity with chronic inflammation. OBJECTIVE To compare haptoglobin with previously proposed serum biomarkers for the determination of disease severity in HS patients. For this purpose, disease severity of HS patients was determined by a panel of clinical scores as well as several risk factors, such as weight and smoking habits. METHODS A prospective, diagnostic accuracy study was performed at the International Centre for Hidradenitis suppurativa/Acne inversa Bochum (ICH). The study included a total of 263 patients, including 131 who had a confirmed diagnosis of HS in Hurley I (n = 16), II (n = 56) and III (n = 59) HS, and 132 healthy controls. The main outcome was to identify serological inflammatory markers for HS disease severity [severe (III) vs. moderate/mild (II/I)] as assessed by Hurley classification. RESULTS The serum levels of acute phase proteins haptoglobin and CRP, as well as the number of neutrophils in peripheral blood, number of monocytes, the systemic immune-inflammation index and the pan-immune-inflammatory value correlated with disease severity according to established clinical scores (mHSS, SAHS, Hurley, DLQI). HS patients had significantly higher haptologlobin levels compared to healthy controls. Logistic regression analysis revealed haptoglobin as the only independent marker predicting severe HS. CONCLUSION In this prospective study, we discovered that the serum levels of the acute phase protein haptoglobin levels serve as an independent marker of disease severity in HS. While this presents the first study in the context of HS. Thus, the present data not only yield a highly promising serum marker to be further validated.
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Affiliation(s)
- N Abu Rached
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - L Ocker
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C Seifert
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C H Scheel
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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Liao YH, Chu CB, Hui CYR, Li CY, Lin SY, Tseng HC, Wang YJ, Wu J, Yu WW, Chao SC. Taiwanese Dermatological Association (TDA) consensus recommendations for the definition, classification, diagnosis, and management of hidradenitis suppurativa. J Formos Med Assoc 2023:S0929-6646(23)00492-8. [PMID: 38160191 DOI: 10.1016/j.jfma.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful, recurrent, inflamed lesions most commonly occurring in the axillary, inguinal, and anogenital regions. HS can inflict immense physical and psychological impact on patients who suffer from this distressing disease. Management of HS generally requires combining various medical and procedural treatment modalities; however, the disease is often recalcitrant to conventional treatments. In light of recent evidence supporting the effectiveness of biologic agents in the treatment of HS, the Taiwanese Dermatological Association established an expert panel of nine dermatologists to develop consensus statements aimed to provide up-to-date evidence-based guidance in optimizing HS patient management in Taiwan. The recommendations described in the statements were summarized in a management algorithm in terms of general care, topical treatment, systemic treatment, and procedural treatment.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Yao Lin
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Antonelli F, Ippoliti E, Rosi E, Moltrasio C, Malvaso D, Botti E, Abeni D, Dini V, Cannizzaro MV, Bruni M, Di Nardo L, Fargnoli MC, Romanelli M, Fania L, Bianchi L, Marzano AV, Prignano F, Peris K, Chiricozzi A. Clinical Features and Response to Treatment in Elderly Subjects Affected by Hidradenitis Suppurativa: A Cohort Study. J Clin Med 2023; 12:7754. [PMID: 38137823 PMCID: PMC10744325 DOI: 10.3390/jcm12247754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic-relapsing inflammatory skin disease. It usually appears in the second and third decades, but a smaller proportion of patients develop late-onset HS. Geriatric HS, defined as the persistence or the development of HS after the age of 65 years, has been poorly explored. This study aimed to investigate the clinical features, treatment management and response to therapies of HS elderly subjects (≥65 years old). We designed a multicentric observational study, gathering data from seven Italian university hospitals. Demographic and clinical data of HS patients aged over 65 years were collected at baseline, week 12 and week 24. Overall, 57 elderly subjects suffering from HS were enrolled. At baseline, disease severity was predominantly moderate-to-severe, with 45.6% of patients classified as Hurley III. The gluteal phenotype was the most frequently observed; it also appeared to affect patients' quality of life more than other phenotypes. Gluteal involvement was detected in about half (49.1%) of cases and associated with severe stages of the disease. In terms of therapeutic response, Hurley III patients showed the persistency of higher values of mean IHS4, DLQI, itch- and pain-NRS scores compared to Hurley I/II. In conclusion, disease severity in this subpopulation appears high and treatment is often challenging.
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Affiliation(s)
- Flaminia Antonelli
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (E.I.); (L.D.N.); (K.P.)
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
| | - Elena Ippoliti
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (E.I.); (L.D.N.); (K.P.)
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
| | - Elia Rosi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Firenze, Italy; (E.R.); (F.P.)
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.M.); (A.V.M.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Dalma Malvaso
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
| | - Elisabetta Botti
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (E.B.); (L.B.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Damiano Abeni
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, 00167 Rome, Italy; (D.A.); (L.F.)
| | - Valentina Dini
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.R.)
| | - Maria Vittoria Cannizzaro
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
| | - Manfredo Bruni
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.B.); (M.C.F.)
- Dermatology Unit, Ospedale San Salvatore, 67100 L’Aquila, Italy
| | - Lucia Di Nardo
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (E.I.); (L.D.N.); (K.P.)
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
| | - Maria Concetta Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.B.); (M.C.F.)
- Dermatology Unit, Ospedale San Salvatore, 67100 L’Aquila, Italy
| | - Marco Romanelli
- Unit of Dermatology, University of Pisa, 56126 Pisa, Italy; (V.D.); (M.R.)
| | - Luca Fania
- Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Dermatological Research Hospital, 00167 Rome, Italy; (D.A.); (L.F.)
| | - Luca Bianchi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy; (E.B.); (L.B.)
- Dermatology Unit, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.M.); (A.V.M.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Firenze, Italy; (E.R.); (F.P.)
| | - Ketty Peris
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (E.I.); (L.D.N.); (K.P.)
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.A.); (E.I.); (L.D.N.); (K.P.)
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (D.M.); (M.V.C.)
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Rymaszewska JE, Karczewski M, Krajewski PK, Matusiak Ł, Maj J, Szepietowski JC. Patients' Expectations and Satisfaction with the Patient-Doctor Relationship in Hidradenitis Suppurativa. Healthcare (Basel) 2023; 11:3139. [PMID: 38132029 PMCID: PMC10742400 DOI: 10.3390/healthcare11243139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with a vast psychosocial burden. We analyzed the actual and ideal patient-doctor relationship and patients' satisfaction with the patient-doctor relationship in relation to their satisfaction with life (SWL), HS-related quality of life, and psychopathological symptoms. METHODS 105 HS patients (53% females; mean age 37.64 ± 14.01 years) were enrolled. Severity of the disease was measured using Hurley staging and the International HS Score System (IHS4). Instruments utilized: Patient Expectation Test; Satisfaction with Life Scale; HS Quality of Life; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; General Health Questionnaire. RESULTS Patients with Hurley I and mild IHS4 had the lowest satisfaction with the patient-doctor relationship. There were significant correlations between the actual patient-doctor relationship and the patients' SWL (r = 0.30; p = 0.002), depressive (r = -0.36; p < 0.01), anxiety (r = 0.37; p < 0.01) and psychopathological symptoms (r = -0.47; p < 0.0001) and between the satisfaction with the patient-doctor relationship and their SWL (r = -0.32; p = 0.00098). Multiple regression analysis revealed a significant influence of the following factors: Hurley II + III, psychopathological symptoms, and severe anxiety about the actual patient-doctor relationship and the satisfaction with the patient-doctor relationship. CONCLUSIONS Assessment of relations between patients and doctors is related to the patients' mental health and SWL. The usage of the Patient Expectation Test in clinical practice can improve the patient-doctor relationship and the general quality of care for and compliance by HS patients.
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Affiliation(s)
- Julia Ewa Rymaszewska
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Maciej Karczewski
- Department of Applied Mathematics, Wrocław University of Environmental and Life Sciences, Grunwaldzka Str. 53, 50-357 Wrocław, Poland;
| | - Piotr K. Krajewski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Joanna Maj
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
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Ingram JR, Bates J, Cannings-John R, Collier F, Gibbons A, Harris C, Hood K, Howells L, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study: the THESEUS prospective cohort study. Health Technol Assess 2023; 27:1-107. [PMID: 38149635 PMCID: PMC11017627 DOI: 10.3310/hwnm2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom. Objective To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials. Design Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop. Setting Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments. Participants Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment. Interventions Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery. Main outcome measures Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness. Results Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study's primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days. Limitations It was not possible to characterise conventional surgery due to a low number of participants. Conclusion The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials. Future work The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment. Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Janine Bates
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Angela Gibbons
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ceri Harris
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Howes
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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Mann C, Staubach P, Grabbe S, Wegner J, Hennig K, Nikolakis G, Szepietowski JC, Matusiak L, von Stebut E, Kirschner U, Podda M, Garcovich S, Schultheis M. Self-management-competency as a new target in Hidradenitis suppurativa care. J DERMATOL TREAT 2023; 34:2245082. [PMID: 37577779 DOI: 10.1080/09546634.2023.2245082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Background: Hidradenitis suppurativa affects approximately 1% of the population.Objective: Highlighting the relevance of self-management-competency as a new therapeutic target.Method: 258 patients from the 'Epidemiology and Care in Acne inversa (EpiCAi)' project were included in the study. Disease burden was measured by patient-rated questionnaires in terms of disease activity, pain, quality of life, depression and insomnia and correlated with the domains of the health education impact questionnaire (heiQ) measuring self-management-competency.Results: 66 male (25.6%) and 192 female (74.4%) patients, with a mean age of 40.3 ± 10.24 years were included. Mean scores of pain on the numeric rating scale (NRS), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) were 5.11 ± 2.68, 11.35 ± 7.79 and 13.71 ± 7.57, respectively. The Insomnia severity index (ISI) showed a mean of 9.58 ± 5.76. The HADS has the highest increased total risk across all heiQ domains. With respect to the heiQ domains, the highest exposure can be attributed to improving constructive attitudes and approaches as well as decreasing emotional distress.Conclusion: There is a clear association of self-management-competency with overall disease burden, which underlines the need for psychoeducational support. This study provides ideas to develop new possible strategies of care.
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Affiliation(s)
- C Mann
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - P Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - S Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - J Wegner
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - K Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - G Nikolakis
- Department of Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - L Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - E von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - U Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - M Podda
- Hautklinik, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - S Garcovich
- Dermatology Outpatient Office Dr, Simone Garcovich, Rome, Italy
| | - M Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Sabat R, Gudjonsson JE, Brembilla NC, van Straalen KR, Wolk K. Biology of Interleukin-17 and Novel Therapies for Hidradenitis Suppurativa. J Interferon Cytokine Res 2023; 43:544-556. [PMID: 37824200 DOI: 10.1089/jir.2023.0105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
Skin disorders affect ∼40% of the human population. One of the most debilitating cutaneous disorders is Hidradenitis suppurativa (HS), a noncommunicable chronic inflammatory disease with an estimated global prevalence of 0.4% to 2.5%. In January 2011, high levels of IL-17 were discovered in skin lesions of HS patients. In the following years, translational and clinical research led to a better understanding of the pathogenesis of HS. In June 2023, more than 12 years after the initial note, secukinumab, an anti-IL-17A monoclonal antibody, was approved for the treatment of moderate to severe HS. This is the next milestone in improving the treatment of these patients after the approval of the anti-TNF-α monoclonal antibody adalimumab in 2015. In this review article, we present the IL-17 pathway in HS and discuss the use of secukinumab as a therapeutic option for this disease. Our review starts with a description of the epidemiology, clinical features, etiology, and pathogenesis of HS. An overview of the IL-17/IL-17 receptor system in general and a detailed description of the known facts about the expression and action of IL-17 in HS follow. Afterward, we consider the results of clinical trials evaluating the safety and efficacy of IL-17 inhibitors in HS. Finally, a comparison is made between secukinumab and adalimumab and the characteristics of the patients that may be particularly suitable for each of these biologics are described.
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Affiliation(s)
- Robert Sabat
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johann Eli Gudjonsson
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
- Taubman Medical Research Institute, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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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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Heise M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Podda M, Grabbe S, Schultheis M. A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effectiveness. J DERMATOL TREAT 2023; 34:2284105. [PMID: 38010850 DOI: 10.1080/09546634.2023.2284105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. METHODS EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). RESULTS Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. CONCLUSION Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.
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Affiliation(s)
- Marcus Heise
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- School of Business and Health, Baden-Wuerttemberg Cooperative State University, Stuttgart, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
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Wang Y, Han C, Wang X. Advances in surgical treatment of hidradenitis suppurative. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:795-801. [PMID: 37986703 PMCID: PMC10764190 DOI: 10.3724/zdxbyxb-2023-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Hidradenitis suppurative is a chronic, refractory and recurrent dermatological disease. The disease should be managed by targeted surgical intervention on the basis of medical treatment. Currently, the surgical treatment methods include local treatments like incision and drainage, unroofing, laser therapy, intense pulsed light therapy, photodynamic therapy, as well as complete lesion resection such as skin-tissue saving excision with electrosurgical peeling and extended excision. The clearance range, therapeutic effect, postoperative complications, and recurrence risk vary among the different treatment methods. Local treatments cause less damage, but have high recurrence rates, and are mainly for mild to moderate hidradenitis suppurative patients. Complete lesion resections have relatively low recurrence rates, but may bring more surgical injuries, and postoperative reconstructions are needed, which are mainly for moderate to severe hidradenitis suppurative patients. In this article, the surgical treatment principles and various surgical treatment methods of hidradenitis suppurative are reviewed, to provide a reference for the diagnosis and treatment of this disease in clinical practice.
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Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Chunmao Han
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xingang Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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Raimondi G, Samela T, Fania L, Abeni D. Item-specific patterns of the Skindex-17 in individuals with different levels of Hidradenitis Suppurativa severity: a network analysis study. Front Public Health 2023; 11:1284365. [PMID: 38026379 PMCID: PMC10646184 DOI: 10.3389/fpubh.2023.1284365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Recent studies are stressing the idea that the level of Hidradenitis Suppurativa (HS) severity does not always correspond to the same illness load. In fact, it was found that there was no significant association between Skindex-17 and clinical severity of HS, and that some items of the Skindex-17 might be more related to HS severity than others. Objective The aim of the current study was to explore the associations between different levels of clinical severity of HS (mild, moderate, severe) and the Skindex-17 single-item responses in a large sample of adults patients. Methods A cross-sectional study with a sample include 547 consecutive HS patients, approaching for the first time the specific dermatologic evaluation. Eligible criteria included age ≥ 18 years, HS diagnosis formulated contextually by the same expert clinician, and providing informed consent. All participants completed the Skindex-17 and were evaluated for the disease clinical severity with the International Hidradenitis Suppurativa Severity Score System. A Network Analysis was conducted, which represents a powerful methodological approach in clinical research. It allows to study specific patterns and the structure of complex system in order to better understand how the elements of the system interact with each-other. Three different Network Analyses were conducted for each group of HS clinical severity by including the items of the Skindex-17 as the nodes of each network. Results Among 547 patients, 40% (219) were female and mean age was of 32.70 (±11.41). Different patterns among items of the Skindex-17 for the three clinical severity groups emerged, meaning that in each group different items are more crucial than others. The psychosocial subscale of the Skindex-17 is the most relevant when assessing the Quality of Life of individuals with different levels of HS severity, however, with the progression of the disease, individuals place attention also on two different aspects of the symptoms subscale of the Skindex-17, irritation and pain, which in turn perfectly reflect the severity of HS, from a clinical perspective. Conclusion These results provide new insights on the association between levels of HS severity and related Quality of Life, measured with the Skindex-17.
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Affiliation(s)
- Giulia Raimondi
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
- Department of Human Sciences, European University of Rome, Rome, Italy
| | - Tonia Samela
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
- Clinical Psychology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
| | - Luca Fania
- Dermatology Unit, IDI-IRCSS, Rome, Italy
| | - Damiano Abeni
- Clinical Epidemiology Unit, Istituto Dermopatico dell’Immacolata, IDI-IRCCS, Rome, Italy
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Malvaso D, Calabrese L, Chiricozzi A, Antonelli F, Coscarella G, Rubegni P, Peris K. IL-17 Inhibition: A Valid Therapeutic Strategy in the Management of Hidradenitis Suppurativa. Pharmaceutics 2023; 15:2450. [PMID: 37896210 PMCID: PMC10609891 DOI: 10.3390/pharmaceutics15102450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a significant negative impact on the quality of life of patients. To date, the therapeutic landscape for the management of the disease has been extremely limited, resulting in a profound unmet need. Indeed, adalimumab, an anti-tumor necrosis factor (TNF)-α monoclonal antibody, is the only approved biologic agent for HS, obtaining a therapeutic response in only 50% of HS patients. Numerous clinical trials are currently ongoing to test novel therapeutic targets in HS. The IL-17-mediated cascade is the target of several biologic agents that have shown efficacy and safety in treating moderate-to-severe HS. Both bimekizumab and secukinumab, targeting IL-17 in different manners, have successfully completed phase III trials with promising results; the latter has recently been approved by EMA for the treatment of HS. The aim of this review is to summarize the current state of knowledge concerning the relevant role of IL-17 in HS pathogenesis, highlighting the key clinical evidence of anti-IL-17 agents in the treatment of this disease.
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Affiliation(s)
- Dalma Malvaso
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.); (L.C.); (F.A.); (G.C.); (K.P.)
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Laura Calabrese
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.); (L.C.); (F.A.); (G.C.); (K.P.)
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Andrea Chiricozzi
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.); (L.C.); (F.A.); (G.C.); (K.P.)
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Flaminia Antonelli
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.); (L.C.); (F.A.); (G.C.); (K.P.)
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Giulia Coscarella
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.); (L.C.); (F.A.); (G.C.); (K.P.)
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy;
| | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.M.); (L.C.); (F.A.); (G.C.); (K.P.)
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli-IRCCS, 00168 Rome, Italy
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Damiani G, Poli P, Pacifico A, Rosi E, Allocca G, Berti E, Taschieri S, Tumedei M, Del Fabbro M, Mercuri SR, Bindi M, Francetti L, Buja A, Prignano F, Maiorana C. The Relevant Oral Burden of Patients with Hidradenitis Suppurativa. Dermatol Ther (Heidelb) 2023; 13:2319-2329. [PMID: 37653235 PMCID: PMC10539249 DOI: 10.1007/s13555-023-01006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Interleukin-17 plays a pivotal role in both hidradenitis suppurativa (HS) and in maintaining oral homeostasis, but their potential link remains unknown. Thus, we aimed to evaluate and quantify the oral burden of patients with HS. METHODS In this real-life, multicenter, cross-sectional study, patients with HS were clinically evaluated by two board-certified dermatologists and two board-certified dentists. Oral comorbidities were carefully collected with medical history and therapeutic information. RESULTS A total of 102 patients (44.0 ± 0.9 years, body mass index 27.0 ± 2.2 kg/m2) were enrolled. Remarkably, 48% and 43% did not undergo at least an oral hygiene or a dental visit each year, respectively. Oral disorders were found in 55.9% of patients with HS, in particular 39.2% had caries and 46.7% reported at least one missing tooth. The main oral manifestations in patients with HS were recurrent aphthous stomatitis (N = 19, 19.2%), amalgam tattoo (N = 14, 14.1%), leukoplakia (N = 11, 11.1%), nicotinic stomatitis (N = 9, 9.1%), papilloma (N = 8, 8.1%), and geographic tongue (N = 8, 8.1%). Whilst the main predictor of oral pathological conditions was Hurley staging (P = 0.0276), multivariate regression analysis indicated that gender and International Hidradenitis Suppurativa Severity Score System (IHS4) were the main predictors for the presence of caries and number of missing teeth. CONCLUSION As a result of the relevant oral burden in patients with HS, dentists should be part of the multidisciplinary team and oral education should be promoted among patients with HS.
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Affiliation(s)
- Giovanni Damiani
- Italian Center of Precisione Medicine and Chronic Inflammation Milan, Milan, Italy.
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy.
- Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital, Milan, Italy.
- Dermatology Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
| | - Pierpaolo Poli
- Maxillofacial Surgery and Odontostomatology Unit, Implant Center for Edentulism and Jawbone Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessia Pacifico
- Clinical Dermatology Department, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Elia Rosi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Allocca
- Maxillofacial Surgery and Odontostomatology Unit, Implant Center for Edentulism and Jawbone Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emilio Berti
- UOC Dermatologia, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvio Taschieri
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
- Dentistry Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Margherita Tumedei
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
- Maxillofacial Surgery and Odontostomatology Unit, Implant Center for Edentulism and Jawbone Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Santo R Mercuri
- Dermatology and Cosmetology Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marino Bindi
- Director of Dental Assistants Regional Course, CAN Formazione, Forlì, Italy
| | - Luca Francetti
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
- Dentistry Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
| | - Alessandra Buja
- Department of Cardiologic, Vascular and Thoracic Sciences, and Public Health, University of Padua, Padua, Italy
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Carlo Maiorana
- Maxillofacial Surgery and Odontostomatology Unit, Implant Center for Edentulism and Jawbone Atrophies, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Aarts P, van Huijstee JC, van der Zee HH, van Doorn MBA, van Straalen KR, Prens EP. Adalimumab in conjunction with surgery compared with adalimumab monotherapy for hidradenitis suppurativa: A Randomized Controlled Trial in a real-world setting. J Am Acad Dermatol 2023; 89:677-684. [PMID: 37116615 DOI: 10.1016/j.jaad.2023.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Adalimumab, the only biologic registered for hidradenitis suppurativa, shows clinical response in up to 60% of patients, leaving many patients in need for other treatment options such as surgery. OBJECTIVE To compare the clinical effectiveness of adalimumab combined with surgery vs adalimumab monotherapy in patients with moderate to severe hidradenitis suppurativa. METHODS A pragmatic Randomized Controlled Trial was performed from August 2018 to July 2022. Primary outcome was the difference in mean International Hidradenitis Suppurativa Severity Score System reduction after 12 months of treatment with the difference in mean Dermatology Life Quality Index reduction as a key secondary outcome. RESULTS Thirty-one patients were included per arm. The mean International Hidradenitis Suppurativa Severity Score System at baseline was 23.9 ± 10.7 in the surgery group and 20.9 ± 16.4, in the monotherapy group. After 12 months of treatment the surgery group had a significantly greater reduction in International Hidradenitis Suppurativa Severity Score System compared with the monotherapy group (-19.1 ± 11.3 vs -7.8 ± 11.8, P < .001). Moreover, the surgery group showed a greater reduction in Dermatology Life Quality Index after treatment compared with the monotherapy group (-8.2 ± 6.2 vs -4 ± 7.7, P = .02). LIMITATIONS The study follow-up was too short to assess surgical recurrence rates. DISCUSSION Combining adalimumab with surgery resulted in greater clinical effectiveness and improved quality of life after 12 months in patients with moderate to severe hidradenitis suppurativa.
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Affiliation(s)
- Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Johanna C van Huijstee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Towfighi P, Huffman SS, Bovill JD, Shan HD, Haffner ZK, Kim EY, Slamin R, Benedict CD, Evans KK. Financial toxicity of hidradenitis suppurativa: A single-center experience at an urban wound-care clinic. J Dermatol 2023; 50:1279-1286. [PMID: 37501527 DOI: 10.1111/1346-8138.16868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/12/2023] [Accepted: 06/08/2023] [Indexed: 07/29/2023]
Abstract
Hidradenitis suppurativa (HS), is a chronic inflammatory skin disorder that confers a substantial financial burden to patients. The aim of the current study was to assess the patient-reported financial impact of HS. Patients presenting to a wound center between 2010 and 2021 were retrospectively reviewed. Demographics, comorbidities, and disease characteristics were collected. The financial impact of HS was assessed via the Comprehensive Score for Financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST-FACIT) version 2 and investigator-generated surveys. Of 199 patients contacted, 27.1% (n = 54) completed the survey. The majority were women (77.8%, n = 42) and had private health insurance (n = 30; 55.6%). Most patients (66.7%, n = 36) had Hurley stage III disease. Mean follow-up was 2.3 + 2.8 years. The overall COST score was 19.7 + 12.4, indicating grade 1 financial toxicity (FT). Grade 0 FT was reported in 31.5% (n = 17) of patients, grade 1 in 37.0% (n = 20), grade 2 in 27.8% (n = 15), and grade 3 in 3.7% (n = 2). The mean self-reported 12-month out-of-pocket cost and credit scores were $2250 + 3269.24 and 674.6 + 95.3, respectively. Patients with private insurance had lower FT compared with Medicaid and Medicare (p = 0.003). Higher out-of-pocket costs were positively correlated with FT (p = 0.042), while higher credit scores were negatively correlated (p = 0.003). Patients with HS lesions in three or more anatomic regions reported the highest FT (p = 0.031). HS is a debilitating skin disorder that affects the livelihood of patients in a multifaceted manner. These patient-reported outcomes highlight the impact that HS has on an individual's financial security, calling for further attention to this vulnerable population.
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Affiliation(s)
- Parhom Towfighi
- Georgetown University School of Medicine, Washington, DC, USA
| | - Samuel S Huffman
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John D Bovill
- Georgetown University School of Medicine, Washington, DC, USA
| | - Holly D Shan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Zoë K Haffner
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Emily Y Kim
- Georgetown University School of Medicine, Washington, DC, USA
| | - Robert Slamin
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Carol D Benedict
- Department of Rheumatology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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