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Macca L, Li Pomi F, Ingrasciotta Y, Morrone P, Trifirò G, Guarneri C. Hidradenitis suppurativa and psoriasis: the odd couple. Front Med (Lausanne) 2023; 10:1208817. [PMID: 37484864 PMCID: PMC10360127 DOI: 10.3389/fmed.2023.1208817] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Psoriasis and hidradenitis suppurativa are chronic inflammatory skin diseases that can develop together, negatively impacting on the patient's quality of life. We aimed to review the most up-to-date information regarding the epidemiology, pathogenesis, clinical presentation and possible therapeutical choices in patients with both psoriasis and hidradenitis suppurativa, thus linking these two autoimmune and autoinflammatory conditions. A narrative review of articles dating from 2017 to 2022 has been performed using the PubMed database. We analyzed the case reports and case series found in the literature regarding patients who suffered from both psoriasis and HS. Psoriasis arose before hidradenitis suppurativa in the majority of cases, while only a minority of them had hidradenitis suppurativa before psoriasis. Interestingly, some patients suffered from paradoxical hidradenitis suppurativa following biological therapy administered to treat the already present psoriasis. Lastly, new biological drugs have been marketed with great success for the outcome of psoriasis, but similar progress did not happen for hidradenitis. Novel therapeutic approaches and lines of research are needed for the treatment of these pathologies, even if concomitant, in order to improve patient's quality of life.
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Affiliation(s)
- Laura Macca
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Section of Dermatology, University of Messina, Messina, Italy
| | - Ylenia Ingrasciotta
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pietro Morrone
- Unit of Dermatology, Mariano Santo Hospital, Cosenza, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Dermatology, University of Messina, Messina, Italy
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Seigel K, Croitoru D, Nathanielsz N, Elsawi R, Silverberg MS, Sibbald C, Piguet V. Clinical Features and Treatment Outcomes in Hidradenitis Suppurativa With Fistulizing Crohn’s Disease: A Systematic Review. J Cutan Med Surg 2022; 26:426-427. [DOI: 10.1177/12034754221083980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kyle Seigel
- Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | | | - Rawaan Elsawi
- Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Mark S. Silverberg
- Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, ON, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Section of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
- Division of Dermatology, Department of Medicine, Women’s College Hospital, Toronto, ON, Canada
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Paradoxical Hidradenitis Suppurativa during Biologic Therapy, an Emerging Challenge: A Systematic Review. Biomedicines 2022; 10:biomedicines10020455. [PMID: 35203664 PMCID: PMC8962303 DOI: 10.3390/biomedicines10020455] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease usually occurring after puberty with painful, deep-seated, inflammatory lesions in the apocrine gland-bearing areas of the body. Although HS pathogenesis is still unproven, recent major research advantages have increased our knowledge of the mechanisms behind HS lesions. Particularly, follicular occlusion followed by follicular rupture has been shown to be crucial to HS development, leading to immune response activation, and resulting in typical clinical HS lesions. Moreover, an increased and imbalanced cytokine production, such as interleukin (IL) 17 and tumor necrosis factor (TNF) α, may play a role in HS. In recent years, paradoxical adverse events have been described during treatment. Since the recent increased use of biologic treatments in HS, an increased number of paradoxical HS occurrences have been reported. In this review, we analyzed all current data on paradoxical HS triggered by biological drugs.
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Paradoxical hidradenitis suppurativa in Crohn's disease patients receiving infliximab: a case report and review of literature. Eur J Gastroenterol Hepatol 2021; 33:e1046-e1050. [PMID: 33905217 DOI: 10.1097/meg.0000000000002170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The introduction of TNF blockers in the therapeutic armamentarium of inflammatory bowel diseases (IBD) has largely advanced the way by which clinicians manage these disorders. However, some patients develop de novo immune-mediated diseases during the treatment. We here present the case of paradoxical hidradenitis suppurativa, a chronic inflammatory skin disease characterized by the development of recurrent nodules and abscesses in intertriginous areas, in a 20-year-old, nonsmoker, normal-weight women, with no family history of hidradenitis suppurativa or IBD, diagnosed with nonstricturing nonpenetrating ileocolonic Crohn's disease in 2013, during treatment with infliximab. Infliximab discontinuation was followed by a significant improvement of skin lesions. We also discuss 22 additional cases of paradoxical hidradenitis suppurativa in IBD patients on TNF antagonists reported in the literature with the aim to identify potential risk factors for the development of such a complication. All the patients had Crohn's disease, and the majority of them were women (19/23; 82.6%). All cases occurred during therapy with anti-TNF agents [14/23 (61%) patients were treated with adalimumab and 9/23 (39%) patients were treated with infliximab]. The therapeutic approach directed at maintaining/holding the undergoing biologic therapy is still uncertain. Further studies are needed to determine the most appropriate treatment choice toward ongoing biologic therapy.
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Rawal S, Kianian S, Guo W, Marquez J, Ayasse M, Siamas KA, Lee Y, Salvemini J. Alternative uses of ustekinumab for non-indicated dermatological conditions: a systematic review. Arch Dermatol Res 2021; 314:503-514. [PMID: 34156549 DOI: 10.1007/s00403-021-02262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/31/2021] [Accepted: 06/11/2021] [Indexed: 12/23/2022]
Abstract
Ustekinumab is approved for the treatment of psoriasis and Crohn's disease. Because many dermatological conditions are due to immune-mediated development, ustekinumab may be effective in other conditions. A systematic review of the off-label uses of ustekinumab, as well as on-label adverse effect, was performed, reporting on clinical improvement. MEDLINE, Embase, Web of Science, and Cochrane databases were searched for studies regarding ustekinumab treatment of rativa (HS), lichen planus (LP), pyoderma gangrenosum (PG), pityriasis rubra pilaris (PRP), cutalopecia areata (AA), atopic dermatitis (AD), Bechet's disease, bullous pemphigoid (BP), hidradenitis suppuaneous sarcoidosis, cutaneous systemic lupus erythematosus (SLE), and vitiligo. Descriptive statistics were performed. 74 articles of 4596 screened were included, and reported on 212 patients receiving ustekinumab treatment. Across all studies, ustekinumab showed promise in treating patients: AA (10/12 patients; 83.3% improvement), AD (28/74 patients; 37.8% improvement), HS (42/52 patients; 80.8% improvement), and PRP (25/27 patients; 92.6% improvement), among others. Adverse events were noted with the use of ustekinumab, including development of AA (four patients), AD (three patients), and BP (four patients), among others. Ustekinumab can be a promising option for patients with dermatological conditions refractory to traditional therapies. Adverse events must be monitored in certain patients.
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Affiliation(s)
- Sahil Rawal
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
| | - Sara Kianian
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - William Guo
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Jocellie Marquez
- Division of Plastic and Reconstructive Surgery at Stony, Brook University Hospital, Stony Brook, NY, USA
| | - Marissa Ayasse
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA
| | - Katherine A Siamas
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Yoojin Lee
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Joann Salvemini
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, NY, USA
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Pinter A, Sarlak M, Zeiner KN, Malisiewicz B, Kaufmann R, Romanelli M, Koenig A, Chiricozzi A. Coprevalence of Hidradenitis Suppurativa and Psoriasis: Detailed Demographic, Disease Severity and Comorbidity Pattern. Dermatology 2020; 237:759-768. [PMID: 33326954 DOI: 10.1159/000511868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/30/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa (HS) and plaque psoriasis (Pso) are supposed to have a coprevalence. However, data showing a more detailed description of patients with both diseases are rare. In this study, we characterized patients with both skin diseases in terms of onset, disease course, severity, concomitant diseases and therapeutical management. PATIENTS AND METHODS Data from 28 patients with a confirmed codiagnosis of HS and Pso from 2 university hospitals presented between 2015 and 2019 were evaluated retrospectively. For further characterization, patients were divided into different cohorts depending on whether HS or Pso was diagnosed as the first disease. RESULTS The average age of patients with a coprevalence of both diseases was 44.4 years with a female/male ratio of 1:1.15. Fifteen patients were diagnosed first with HS at an average age of 22.8 years, 13 patients first showed symptoms of Pso at a mean age of 21.7 years. The average time to the onset of the corresponding second disease was 14.3 years. Patients with HS as first disease showed a significantly severer form of HS compared to patients with a first diagnosis of Pso (mean highest International Hidradenitis Suppurativa Severity Score System: 23.5 vs. 8.2; p = 0.02). Severity of psoriatic disease in patients with HS at first diagnosis was numerically lower but not significant compared to the cohort with Pso at first diagnosis (mean highest Psoriasis Area and Severity Index: 7.8 vs. 13.2; p = 0.299). The most frequent comorbidity in all patients was obesity (64.3%; mean body mass index: 32.2) followed by psychiatric complaints (25%) and psoriatic arthritis (21.4%). Adalimumab was the most commonly used drug that had a positive effect on both diseases, HS and Pso. CONCLUSIONS In patients with a coprevalence of HS and Pso, the disease which occurs first appears to take a severer course, with an increased risk of development of obesity and psychiatric comorbidity in both cohorts.
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Affiliation(s)
- Andreas Pinter
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany,
| | - Mana Sarlak
- Department of Dermatology, Hospital Darmstadt, Darmstadt, Germany
| | - Kim Nicola Zeiner
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Bartosz Malisiewicz
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marco Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Anke Koenig
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andrea Chiricozzi
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.,Institute of Dermatology, Catholic University, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Shaharir SS, Jamil A, Chua SH, Arumugam M, Rosli N. A case paradoxical hidradenitis suppurativa with janus kinase inhibitor, literature review and pooled analysis of biological agent-induced HS. Dermatol Ther 2020; 33:e14021. [PMID: 32677247 DOI: 10.1111/dth.14021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/06/2020] [Indexed: 12/28/2022]
Abstract
Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease. Biological therapy has revolutionized it's the treatment. Paradoxical HS occur with various biological and targeted agents. We report a patient with juvenile rheumatoid arthritis who developed HS after 6 months of tofacitinib therapy. A comprehensive literature review identified 43 cases of paradoxical HS among patients on biological and targeted agents. Pooled analysis of the cases showed Crohn's disease 18(41.8%) and RA 9(20.9%) as commonest indications for biological therapy. Adalimumab 20(46.5%) followed by infliximab 9(20.9%) were the commonest offending agents. Duration of biological treatment prior to HS manifestation was 12(1-120) months. Smoking 21(48.8%) and overweight or obese 20(46.5%) were most frequent HS risk factors. Fourteen (32.6%) patients had a second paradoxical event, 11(25.6%) developed psoriasis and 4(9.3%) Crohn's disease. Presence of ≥1 risk factor for HS, continuation of the implicated biological agent and occurrence of more than one paradoxical event were factors associated with poor paradoxical HS outcome.
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Affiliation(s)
| | - Adawiyah Jamil
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Siew Houy Chua
- Department of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Mohan Arumugam
- Department of Medicine, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Nurwahyuna Rosli
- Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Takeda K, Kikuchi K, Kanazawa Y, Yamasaki K, Aiba S. Ustekinumab treatment for hidradenitis suppurativa. J Dermatol 2019; 46:1215-1218. [DOI: 10.1111/1346-8138.15122] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kana Takeda
- Departments ofDepartment of DermatologyTohoku University Graduate School of MedicineSendai Japan
| | - Katsuko Kikuchi
- Departments ofDepartment of DermatologyTohoku University Graduate School of MedicineSendai Japan
| | - Yoshitake Kanazawa
- Department of Gastroenterology Tohoku University Graduate School of Medicine Sendai Japan
| | - Kenshi Yamasaki
- Departments ofDepartment of DermatologyTohoku University Graduate School of MedicineSendai Japan
| | - Setsuya Aiba
- Departments ofDepartment of DermatologyTohoku University Graduate School of MedicineSendai Japan
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Kjærsgaard Andersen R, Saunte SK, Jemec GBE, Saunte DM. Psoriasis as a comorbidity of hidradenitis suppurativa. Int J Dermatol 2019; 59:216-220. [DOI: 10.1111/ijd.14651] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Rune Kjærsgaard Andersen
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - Sara K. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Gregor B. E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - Ditte M. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Health Sciences Faculty University of Copenhagen Copenhagen Denmark
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Neves JM, Cunha N, Lencastre A, Cabete J. Paradoxical hidradenitis suppurativa to biologic agents: a case series and literature review. Int J Dermatol 2019; 58:e226-e228. [DOI: 10.1111/ijd.14585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/07/2019] [Accepted: 06/19/2019] [Indexed: 12/13/2022]
Affiliation(s)
- José M. Neves
- Department of Dermatology and Venereology Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central Lisboa Portugal
| | - Nélia Cunha
- Department of Dermatology and Venereology Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central Lisboa Portugal
| | - André Lencastre
- Department of Dermatology and Venereology Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central Lisboa Portugal
| | - Joana Cabete
- Department of Dermatology and Venereology Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central Lisboa Portugal
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Romaní J, Vilarrasa E, Martorell A, Fuertes I, Ciudad C, Molina-Leyva A. Ustekinumab with Intravenous Infusion: Results in Hidradenitis Suppurativa. Dermatology 2019; 236:21-24. [PMID: 31288233 DOI: 10.1159/000501075] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022] Open
Abstract
Adalimumab is the only approved biological therapy for hidradenitis suppurativa (HS). The last published recommendations support the use of other off-label biologic therapies. We report on a multicentric retrospective review of patients with HS treated with an ustekinumab dosing schedule of intravenous infusion adjusted by weight, followed by a subcutaneous maintenance dose of 90 mg every 8 weeks, as recently approved for Crohn's disease. The minimal follow-up period required for inclusion was 16 weeks. A total of 14 patients from six hospitals were included. In 50% of the treated patients, therapeutic outcomes, measured by means of the Hidradenitis Suppurativa Clinical Response (HiSCR) and decrease of Dermatology Life Quality Index (DLQI) and visual analog scale (VAS) of pain, were reached at week 16. In 71.42% of patients DLQI and VAS of pain improved, irrespective of achievement of HiSCR. Two patients abandoned treatment due to lack of efficacy or patient preferences. No ustekinumab-related adverse effects were reported. The results are limited by the retrospective nature of the study, the short follow-up period, and the small patient number. This therapeutic regime proved to be safe and showed moderate efficacy in treating HS with failure to previous biologic therapy. Ideally, the efficacy of ustekinumab in HS should be tested in randomized and controlled clinical trials.
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Affiliation(s)
| | - Eva Vilarrasa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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