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Eshmawi MT, Yousef Al-Mudaiheem H, Fatani M, Binamer Y, Alajlan M, Alharithy R, Alotaibi H, Almohanna HM, Alsantali A, Madani A, Al-Faraidy N, Bechara FG, Hamden Al-Jedaie A. Expert consensus on unmet needs, referral criteria and treatment goals for hidradenitis suppurativa in Saudi Arabia. J DERMATOL TREAT 2024; 35:2353693. [PMID: 38862417 DOI: 10.1080/09546634.2024.2353693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/01/2024] [Indexed: 06/13/2024]
Abstract
Purpose: There is limited information about the diagnosis and treatment of hidradenitis suppurativa (HS) in the Kingdom of Saudi Arabia (KSA). This Delphi consensus study was conducted to develop recommendations for the management of HS in the KSA.Methods: The expert panel including 12 dermatologists with extensive experience treating HS patients provided nine consensus statements and recommendations on diagnosis and assessment, management, comorbidities and multidisciplinary approach, and education. The experts also developed clinical questions pertaining to the management of HS and rolled out as a survey to 119 dermatologists practising in the KSA.Results: The topics covered included: referring physicians' awareness of HS; referral criteria for HS; definition of moderate-to-severe HS; treatment goals; definition of treatment success; treatment and biologic initiation; comorbidities and multidisciplinary approach; patient education and awareness of HS. Full consensus (100%) from the expert dermatologists was received on all the topics except referring physicians' awareness of HS, definition of treatment success, and treatment and biologic initiation. The survey results resonated with the expert opinion.Conclusion: As HS is a chronic disease with negative impact on quality-of-life, timely diagnosis and treatment, early identification of comorbid conditions and a multidisciplinary care approach are crucial for effective management of HS.
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Affiliation(s)
- Maysa T Eshmawi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
- King Abdullah Medical Complex Jeddah, MOH, Saudi Arabia
| | | | - Mohammed Fatani
- Department of Dermatology, Hera General Hospital, Makkah, Saudi Arabia
| | - Yousef Binamer
- Department of Dermatology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammed Alajlan
- Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ru'aa Alharithy
- Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Hend Alotaibi
- Department of Dermatology, King Saud University, Riyadh, Saudi Arabia
| | - Hind M Almohanna
- Department of Dermatology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Adel Alsantali
- Department of Dermatology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulaziz Madani
- Department of Dermatology, College of medicine, King Saud University, Riyadh, Saudi Arabia
| | - Nadya Al-Faraidy
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
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Gibson RS, Snyder CL, Porter ML, Kimball AB. Prednisone and amoxicillin/clavulanic acid for the treatment of hidradenitis suppurativa flares: a prospective observational study. Int J Womens Dermatol 2024; 10:e162. [PMID: 38983584 PMCID: PMC11230732 DOI: 10.1097/jw9.0000000000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/28/2024] [Indexed: 07/11/2024] Open
Affiliation(s)
- Ruby S Gibson
- Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Corey L Snyder
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Martina L Porter
- Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Alexa B Kimball
- Harvard Medical School, Clinical Laboratory for Epidemiology and Applied Research in Skin Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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3
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López E, Cabrera R, Lecaros C. Targeted therapy for immune mediated skin diseases. What should a dermatologist know? An Bras Dermatol 2024; 99:546-567. [PMID: 38521706 PMCID: PMC11221168 DOI: 10.1016/j.abd.2023.10.002] [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: 08/25/2023] [Revised: 09/25/2023] [Accepted: 10/14/2023] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Molecularly targeted therapies, such as monoclonal antibodies (mAbs) and Janus Kinase inhibitors (JAKis), have emerged as essential tools in the treatment of dermatological diseases. These therapies modulate the immune system through specific signaling pathways, providing effective alternatives to traditional systemic immunosuppressive agents. This review aims to provide an updated summary of targeted immune therapies for inflammatory skin diseases, considering their pathophysiology, efficacy, dosage, and safety profiles. METHODS The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search was conducted on PubMed over the past 10 years, focusing on randomized clinical trials, case reports, and case series related to targeted immune therapies in dermatology. Eligibility criteria were applied, and data were extracted from each study, including citation data, study design, and results. RESULTS We identified 1360 non-duplicate articles with the initial search strategy. Title and abstract review excluded 1150, while a full-text review excluded an additional 50 articles. The review included 143 studies published between 2012 and 2022, highlighting 39 drugs currently under investigation or in use for managing inflammatory skin diseases. STUDY LIMITATIONS The heterogeneity of summarized information limits this review. Some recommendations originated from data from clinical trials, while others relied on retrospective analyses and small case series. Recommendations will likely be updated as new results emerge. CONCLUSION Targeted therapies have revolutionized the treatment of chronic skin diseases, offering new options for patients unresponsive to standard treatments. Paradoxical reactions are rarely observed. Further studies are needed to fully understand the mechanisms and nature of these therapies. Overall, targeted immune therapies in dermatology represent a promising development, significantly improving the quality of life for patients with chronic inflammatory skin diseases.
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Affiliation(s)
- Edinson López
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
| | - Raúl Cabrera
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile.
| | - Cristóbal Lecaros
- Department of Dermatology, Facultad de Medicina Universidad del Desarrollo-Clínica Alemana de Santiago, Santiago, Chile
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Krajewski A, Alsayed A, Capek A, Casey K, Chandawarkar R. Surgical Management of Hidradenitis Suppurativa. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5860. [PMID: 38872991 PMCID: PMC11175856 DOI: 10.1097/gox.0000000000005860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/18/2024] [Indexed: 06/15/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory disease of the skin, characterized by recurrent draining sinuses and abscesses, predominantly in skin folds carrying terminal hairs and apocrine glands. Treatment for this debilitating disease has been medical management with antibiotics and immune modulators. With the advent of better reconstructive surgical techniques, the role of surgery in the treatment of HS has expanded, from being a last resort to a modality that is deployed earlier. Larger defects can be more easily reconstructed, allowing for a more radical excision of diseased areas. Locoregional flaps, perforator flaps, and propeller flaps that use the fasciocutaneous tissue allow reconstruction of defects with similar tissue, and provide better cosmetic and functional outcomes. They are easy to execute and can be performed even in resource-poor settings with concurrent use of immune modulators and postoperative antibiotics. Hidradenitis can be successfully treated with surgery in early stages as well as severe disease, due to the advances in understanding disease behavior, multidisciplinary care, and advanced reconstructive techniques. Coupled with a multidisciplinary care team, surgery offers a durable, lasting cure for HS, significantly reducing disease morbidity.
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Affiliation(s)
| | - Ahmed Alsayed
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Allison Capek
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kathleen Casey
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rajiv Chandawarkar
- Department of Plastic Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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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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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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Nilforoushzadeh MA, Heidari N, Heidari A, Ghane Y, Hosseini S, Lotfi Z, Jaffary F, Nobari MN, Aghamiri ZS, Nobari NN. Efficacy and safety of radiofrequency in the treatment of hidradenitis suppurativa; a systematic review. Lasers Med Sci 2024; 39:139. [PMID: 38795173 DOI: 10.1007/s10103-024-04077-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/06/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND AIMS Hidradenitis suppurativa (HS) is an inflammatory skin disease affecting apocrine gland-bearing sites of the body. Radiofrequency (RF) is a minimally invasive method that acts by minimizing thermal damage to the dermis, resulting in collagen synthesis and scar improvement. We systematically reviewed the efficacy and safety of RF in treating HS. METHODS A systematic search was performed up to November 18th, 2023, in PubMed/Medline, Ovid Embase, and Web of Science. Clinical studies with English full texts were included. The National Institute of Health (NIH) Quality Assessment Tool for clinical trials and Methodological quality and synthesis of case series and case reports by Murad et al. were utilized for critical appraisal. RESULTS Out of 55 identified studies, 11 met our inclusion criteria with 167 subjects who underwent RF therapy alone or combined with an intense pulsed laser (IPL), known as LAight®. LAight® significantly improved clinical outcomes in mild-to-moderate HS patients based on the Dermatology Life Quality Index (DLQI), International Hidradenitis Suppurativa Score System (IHS4), Pain-Numerical Rating Scale (NRS), and Hidradenitis Suppurativa Clinical Response (HiSCR). Moreover, RF therapy alone significantly alleviated the clinical manifestations in patients with mild-to-moderate HS. Additionally, fractional microneedling RF significantly decreased HS-associated inflammatory markers. RF was found to be safe with limited adverse events. However, in moderate-to-severe HS, RF has failed to yield satisfactory results. CONCLUSION RF is a safe energy-based method with promising outcomes, especially for long-term application in mild-to-moderate HS. In moderate-to-severe cases, RF should be combined with a systemic medication for further beneficial impacts.
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Affiliation(s)
- Mohammad Ali Nilforoushzadeh
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Yekta Ghane
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedayin Hosseini
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Lotfi
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
| | - Fariba Jaffary
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Minou Najar Nobari
- Department of Orofacial Pain and Dysfunction, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Zahra Sadat Aghamiri
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Niloufar Najar Nobari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Nelson Mandela St. 1518963113, MirdamadTehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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8
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Zouboulis CC, Passeron T, Pariser D, Wozniak MB, Li X, Uhlmann L, Lobach I, Martinez AL, Ravichandran S, Alarcon I, Offidani A, Alam MS, Mendes-Bastos P. Secukinumab in patients with moderate-to-severe hidradenitis suppurativa based on prior biologic exposure: an efficacy and safety analysis from the SUNSHINE and SUNRISE phase III trials. Br J Dermatol 2024; 190:836-845. [PMID: 38470171 DOI: 10.1093/bjd/ljae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with a substantial disease burden. Secukinumab has previously been reported to have sustained efficacy with a favourable safety profile in patients with moderate-to-severe HS. It is unknown whether prior biologic exposure affects the efficacy and safety of secukinumab. OBJECTIVES To investigate the efficacy and safety of secukinumab in patients with moderate-to-severe HS based on prior exposure to -biologics. METHODS This was an analysis of the SUNSHINE and SUNRISE phase III trials of secukinumab in patients with moderate-to-severe HS. Patients were randomized at baseline to receive secukinumab every 2 (SECQ2W) or 4 weeks (SECQ4W), or placebo for 16 weeks. After week 16, patients on the SECQ2W and SECQ4W schedules remained on the same treatment regimen, while patients randomized to placebo were switched to either SECQ2W or SECQ4W up to week 52. Assessments based on prior exposure to biologics included Hidradenitis Suppurativa Clinical Response (HiSCR), abscess and inflammatory nodule (AN) count, flare rates, HS-related pain [numerical rating scale 30 (NRS30)], 55% reduction in the International Hidradenitis Suppurativa Severity Score System (IHS4-55), Dermatology Life Quality Index, EuroQol-5D and safety. RESULTS Overall, 1084 patients were randomized in the SUNSHINE and SUNRISE trials and included in this analysis; 255 (23.5%) were biologic-experienced [SECQ2W (n = 80); SECQ4W (n = 81); placebo (n = 94)] and 829 (76.5%) were biologic-naïve [SECQ2W (n = 281); SECQ4W (n = 279); placebo (n = 269)]. At week 16, responses were more efficacious for secukinumab than for placebo with regard to HiSCR in patients who were biologic-experienced {SECQ2W 37.0% [odds ratio (OR) 1.60, 95% confidence interval (CI) 0.83-3.08]; SECQ4W 38.8% [OR 1.67, 95% CI 0.86-3.22]; placebo 27.3%} and biologic-naïve [SECQ2W 45.6% (OR 1.64, 95% CI 1.15-2.33); SECQ4W 45.4% (OR 1.61, 95% CI 1.13-2.29); placebo 34.2%]. Similar results were observed for AN count, NRS30 and IHS4-55. The higher response seen at week 16 with secukinumab was sustained, with a trend toward improvement over time, through to week 52 in both subgroups. Additional efficacy was observed for quality-of-life assessments, and no differences in safety between subgroups were observed. CONCLUSIONS Regardless of prior biologic exposure, secukinumab was efficacious in improving the signs and symptoms of HS. This finding positions secukinumab as the first option in patients who are biologic-naïve, as well as in patients who have previously been treated with other biologic therapy, based on individual patient needs.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Thierry Passeron
- Department of Dermatology, CHU Nice
- INSERM U1065, C3M, Côte d'Azur University, Nice, France
| | - David Pariser
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Xianjun Li
- Novartis Pharma Co., Ltd, Shanghai, China
| | | | | | | | | | | | - Annamaria Offidani
- Unit of Dermatology, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Maryam S Alam
- Simcoderm Medical and Surgical Dermatology Centre, Barrie, ON, Canada
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9
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Pascual JC, Hernández-Quiles R, Sánchez-García V, Viudez-Martínez A, Belinchón Romero I, Sivera Mascaró F. Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T433-T448. [PMID: 38423507 DOI: 10.1016/j.ad.2024.02.024] [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: 09/12/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Affiliation(s)
- J C Pascual
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España.
| | - R Hernández-Quiles
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - V Sánchez-García
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - A Viudez-Martínez
- Servicio de Farmacia. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - I Belinchón Romero
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España; Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España
| | - F Sivera Mascaró
- Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España; Servicio de Reumatología. Hospital General Universitario de Elda, Alicante, España
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10
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Reynolds RV, Yeung H, Cheng CE, Cook-Bolden F, Desai SR, Druby KM, Freeman EE, Keri JE, Stein Gold LF, Tan JKL, Tollefson MM, Weiss JS, Wu PA, Zaenglein AL, Han JM, Barbieri JS. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol 2024; 90:1006.e1-1006.e30. [PMID: 38300170 DOI: 10.1016/j.jaad.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/05/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. OBJECTIVE The objective of this study was to provide evidence-based recommendations for the management of acne. METHODS A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. RESULTS This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. LIMITATIONS Analysis is based on the best available evidence at the time of the systematic review. CONCLUSIONS These guidelines provide evidence-based recommendations for the management of acne vulgaris.
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Affiliation(s)
- Rachel V Reynolds
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Carol E Cheng
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Fran Cook-Bolden
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Seemal R Desai
- Innovative Dermatology, Plano, Texas; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kelly M Druby
- Penn State Health Hampden Medical Center, Enola, Pennsylvania
| | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonette E Keri
- University of Miami, Miller School of Medicine, Miami, Florida; Miami VA Medical Center, Miami, Florida
| | | | - Jerry K L Tan
- Western University, London, Ontario, Canada; Windsor Clinical Research Inc., Windsor, Ontario, Canada
| | - Megha M Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Jonathan S Weiss
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Georgia Dermatology Partners, Snellville, Georgia
| | - Peggy A Wu
- Department of Dermatology, University of California Davis, Sacramento, California
| | - Andrea L Zaenglein
- Departments of Dermatology and Pediatrics, Penn State/Hershey Medical Center, Hershey, Pennsylvania
| | - Jung Min Han
- American Academy of Dermatology, Rosemont, Illinois.
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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11
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Pascual JC, Hernández-Quiles R, Sánchez-García V, Viudez-Martínez A, Belinchón I, Sivera F. Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:433-448. [PMID: 38159839 DOI: 10.1016/j.ad.2023.12.001] [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: 09/12/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and EMBASE databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Affiliation(s)
- J C Pascual
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - R Hernández-Quiles
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - V Sánchez-García
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - A Viudez-Martínez
- Department of Pharmacy, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - I Belinchón
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - F Sivera
- Department of Rheumatology, General University Hospital of Elda, Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
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12
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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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13
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Husein-ElAhmed H, Husein-ElAhmed S. Comparative efficacy and therapeutic positioning of biologics in hidradenitis suppurativa: A systematic review with network meta-analysis of randomised trials. Indian J Dermatol Venereol Leprol 2024; 0:1-9. [PMID: 38595016 DOI: 10.25259/ijdvl_665_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/03/2023] [Indexed: 04/11/2024]
Abstract
Background Hidradenitis suppurativa (HS) is a challenging inflammatory skin condition. Recently, many different biologics have been tested for HS, but the paucity of head-to-head comparative trials makes it difficult to determine the real value of each biological intervention. We aimed to determine the relative efficacy among biologics in treating moderate-to-severe HS throughout a network meta-analysis (NMA) and, to identify which pathogenetic pathways may be the most appropriate to target. Methods We comprehensively identified studies in 3 databases and clinicaltrials.gov. The eligibility criteria included randomised controlled trials (RCTs) reporting data on the efficacy of moderate-to-severe HS. Results The NMA comprised 13 studies comprising 14 interventions on 2,748 participants in the network. The NMA showed the odds of achieving the clinical response were significantly superior with adalimumab (RR: 0.37, 95% CI = 0.06-0.63), adalimumab QW (RR: 0.63, 95% CI = 0.43-0.87), MAB1p (RR: 1.33, 95% CI = 0.03-3.12), secukinumab (RR: 0.25, 95% CI = 0.11-0.47) and secukinumabQ2W (RR: 0.24, 95% CI = 0.1-0.46) compared to placebo. Conclusion Based on the NMA, inhibiting tumour necrosis factor (TNF)-a with adalimumab appears to be the best strategy, followed by the blockade of IL--17 with secukinumab. Data for bimekizumab and CJM112 are promising. Infliximab has inconsistent clinical response, and more data are necessary to confirm this molecule as a potential third-line therapy in HS. The blockade of IL-23 and CD5a pathways is not relevant, or at least the current evidence is insufficient to recommend further investigation of guselkumab, risankizumab, and vilobelimab in phase III trials.
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Affiliation(s)
| | - Sara Husein-ElAhmed
- Department of Dermatology, Montefrío Health Center, Andalusian Health Service, C. Mariana Pineda, Granada, Spain
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14
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Heidari A, Ghane Y, Heidari N, Sadeghi S, Goodarzi A. A systematic review of Janus kinase inhibitors and spleen tyrosine kinase inhibitors for Hidradenitis suppurativa treatment. Int Immunopharmacol 2024; 127:111435. [PMID: 38150881 DOI: 10.1016/j.intimp.2023.111435] [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: 10/03/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUNDS AND AIMS Hidradenitis suppurativa (HS) is a challenging skin disease with an underlying inflammatory process. Substantial progress has been made in our understanding of HS over the last few years, with the advancement of novel treatment approaches. The current systematic review aims to evaluate the safety and efficacy of Janus kinase (JAK) inhibitors and spleen tyrosine kinase (Syk) inhibitors in treating HS. METHOD A thorough systematic search was performed on PubMed/Medline, Web of Science, and Ovid Embase databases up to September 23th, 2023. Clinical studies published in English were included. RESULTS Our search yielded ten articles with a total of 165 patients treated with four types of JAK inhibitors (upadacitinib, povorcitinib, tofacitinib, and baricitinib) and one Syk inhibitor (fostamatinib). Upadacitinib, povorcitinib, and tofacitinib improved clinical outcomes, with a significant reduction in hidradenitis suppurativa clinical response (HiSCR) and abscess and inflammatory nodule count (AN count) during the treatment period. Also, these drugs are well tolerated in most HS patients with minimal adverse events (AEs). Moreover, baricitinib depicted an amelioration in signs and symptoms of HS in one case report. Also, fostamatinib exhibited favorable tolerability throughout a 12-week in moderate-to-severe HS patients. The remarkable clinical improvement, as assessed through HiSCR and hidradenitis suppurativa severity (IHS4), corresponded closely with serological indicators of inflammation following fostamatinib administration was achieved. CONCLUSION JAK and Syk inhibitors are potentially efficacious in managing moderate-to-severe HS since the proinflammatory cytokines are mediated by JAK and Syk signaling pathways. However, further research with a more rigorous examination is mandatory to evaluate such medication's long-term safety and efficacy.
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Affiliation(s)
- Amirhossein Heidari
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Yekta Ghane
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nazila Heidari
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Sara Sadeghi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Department of Medicine, New York Health System, South Brooklyn Hospital, Brooklyn, NY, USA.
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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15
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Dessinioti C, Dréno B, Bettoli V, Vural S, Brzezinski P, Nassif A, Svensson Å, Zouboulis CC. Isotretinoin-associated acne fulminans: A multicentre, retrospective study of the European Academy of Dermatology and Venereology Task Force on Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2024; 38:197-204. [PMID: 37643921 DOI: 10.1111/jdv.19477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Acne fulminans (AF) is a rare severe acne entity. Although occasionally reported, it is unclear whether AF development is associated with oral isotretinoin treatment. OBJECTIVES To investigate the occurrence of isotretinoin-associated AF, clinical characteristics and prognosis at follow-up. METHODS An international, multicentre, retrospective study was performed in eight hospitals following the call of the EADV Task Force on Acne, Rosacea and Hidradenitis Suppurativa (ARHS). Characteristics of patients treated with isotretinoin before the development of AF (isotretinoin-associated acne fulminans, IAF) were compared with non-IAF (NAF). RESULTS Forty-nine patients diagnosed with AF from 2008 to 2022 were included (mean age 16.4 years, SD 2.9, 77.6% male). Αrthralgias/arthritis occurred in 11 patients (22.9%). AF occurred without any previous acne treatment in 26.5% of the patients. Overall, 28 patients (57.1%) developed AF after oral isotretinoin intake (IAF group), while the remaining 21 patients (42.9%) developed AF without previous oral isotretinoin administration (NAF group). IAF occurred after a median duration of isotretinoin treatment of 45 days (IQR: 30, 90). Patients with IAF were more frequently male compared to patients with NAF (89.3% vs. 61.9%, respectively, p = 0.023). There were no differences in patients with IAF versus NAF in patient age, the duration of pre-existing acne, a family history of AF, the distribution of AF lesions or the presence of systemic symptoms or arthralgias. Regarding the management of AF, patients with IAF were treated more frequently with prednisolone (96.2%) compared to those with NAF (70%; p = 0.033) and less frequently with isotretinoin (32.1%) compared to NAF (85.7%; p < 0.001). At a median follow-up of 2.2 years, 76.4% of patients were free of AF and scarring was present in all patients. CONCLUSIONS No specific clinical or demographic characteristics of IAF compared with NAF could be detected, a fact that does not support IAF as a district clinical entity.
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Affiliation(s)
- Clio Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Brigitte Dréno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, Nantes, France
| | - Vincenzo Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - Secil Vural
- Department of Dermatology and Venereology, Koç University School of Medicine, İstanbul, Turkey
| | - Piotr Brzezinski
- Department of Physiotherapy and Medical Emergency, Faculty of Health Sciences, Pomeranian University, Slupsk, Poland
- Department of Dermatology, Provincial Specialist Hospital, Slupsk, Poland
| | | | - Åke Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - 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
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16
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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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17
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Segura Palacios JM, Soto Moreno A, Valladares Millán I, Rivas Ruiz F, Cuenca Barrales C, Molina Leyva A. Intramuscular ertapenem for the treatment of severe cases hidradenitis suppurativa. J DERMATOL TREAT 2023; 34:2179368. [PMID: 36779676 DOI: 10.1080/09546634.2023.2179368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
| | - Alberto Soto Moreno
- Department of Dermatology, Hospital Universitario Virgen de Las Nieves, Granada, Spain
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18
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Fortoul MC, Macias Martinez B, Ventura Rodriguez D, Dallara M, Stelnicki EJ, Kamel G. A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa. Ann Plast Surg 2023; 91:758-762. [PMID: 37856194 DOI: 10.1097/sap.0000000000003690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful and foul-smelling cystic nodules and sinus tracts in the apocrine gland-bearing regions. The treatment options include topical, intralesional, systemic, and surgical modalities. Currently, the most novel therapy is laser therapy to provide localized treatment without systemic adverse effects. However, data regarding patient outcomes after laser treatment are limited because of the low prevalence of this disease. This study aimed to evaluate the efficacy of laser therapy as a treatment modality for patients with HS. METHODS A retrospective review cohort analysis of patients with HS undergoing laser treatment between 2016 and 2021 was conducted. Patient demographics, lesion location(s), Hurley stage, age of onset and diagnosis, treatment length, type, outcomes, and complications were analyzed. RESULTS Ninety-four patients met the inclusion criteria; on average, patients were treated with 5.8 laser sessions for 14.8 months with no complications and minor blood loss. Hidradenitis suppurativa progression commonly starts during puberty, with a median onset of 13.8 years and diagnosis of HS at 16.2 years. All patients (n = 94) showed an improvement in HS disease severity: 59.6% completed treatment, 12.0% are currently undergoing treatment, and 26.0% were lost to follow-up. CONCLUSIONS Laser therapy is an effective and safe therapy for HS leading to improved quality of life and should be considered in the treatment and management of HS.
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Affiliation(s)
- Marla C Fortoul
- From the Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
| | - Brian Macias Martinez
- From the Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
| | | | - Marissa Dallara
- From the Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
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Garg A, Geissbühler Y, Houchen E, Choudhary N, Arora D, Vellanki V, Srivastava A, Priyanka, Darcy J, Richardson C, Kimball AB. Disease Burden and Treatment Patterns Among US Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study. Am J Clin Dermatol 2023; 24:977-990. [PMID: 37378875 PMCID: PMC10570206 DOI: 10.1007/s40257-023-00796-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval. METHODS This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12-17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018. RESULTS Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively). CONCLUSION In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 11042, USA.
| | | | | | | | - Disha Arora
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | | | | | - Priyanka
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | - John Darcy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Alexa B Kimball
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Starita-Fajardo G, Lucena-López D, Ballester-Martínez MA, Fernández-Guarino M, González-García A. Treatment Strategies in Neutrophilic Dermatoses: A Comprehensive Review. Int J Mol Sci 2023; 24:15622. [PMID: 37958609 PMCID: PMC10649056 DOI: 10.3390/ijms242115622] [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: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Neutrophilic dermatoses (NDs) are a group of noninfectious disorders characterized by the presence of a sterile neutrophilic infiltrate without vasculitis histopathology. Their physiopathology is not fully understood. The association between neutrophilic dermatoses and autoinflammatory diseases has led some authors to propose that both are part of the same spectrum of diseases. The classification of NDs depends on clinical and histopathological features. This review focuses on the recent developments of treatments in these pathologies.
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Affiliation(s)
- Grisell Starita-Fajardo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
| | - David Lucena-López
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
| | | | | | - Andrés González-García
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), 28801 Alcalá de Henares, Spain
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21
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Ureña-Paniego C, Gamissans-Cañada M, Molina-Leyva A, Romaní J. Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort. Acta Derm Venereol 2023; 103:adv6569. [PMID: 37766657 PMCID: PMC10549763 DOI: 10.2340/actadv.v103.6569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
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Affiliation(s)
- Clara Ureña-Paniego
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Gamissans-Cañada
- Hidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain; European Hidradenitis Suppurativa Foundation (EHSF). Dessau-Roßlau, Germany.
| | - Jorge Romaní
- HHidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
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Nowak-Liduk A, Kitala D, Ochała-Gierek G, Łabuś W, Bergler-Czop B, Pietrauszka K, Niemiec P, Szyluk K, Gierek M. Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery-Pathogenesis, Comorbidities, and Current Treatments. Life (Basel) 2023; 13:1895. [PMID: 37763299 PMCID: PMC10532726 DOI: 10.3390/life13091895] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory disease that manifests as painful nodules, abscesses, draining dermal tunnels, and scarring in intertriginous areas such as the axillae, groin, and breasts. The nature of the disease and its chronicity have a destructive impact on mental health and quality of life. HS has an estimated global prevalence of 0.00033-4.1% and it disproportionately affects females compared to males. HS involving the female anogenital regions is reported rarely in the gynecological literature, and it can often be mistaken for other vulvar diseases. The distinct phenotypes and HS rarity cause delayed diagnosis and the implementation of effective treatment. Acne inversa is associated with several comorbidities, including metabolic disease, diabetes mellitus, inflammatory bowel diseases, and spondyloarthropathies. Although HS etiology and pathogenesis remain unclear, studies have shown that lifestyle, immunological processes, genetics, and hormonal predispositions may promote follicular hyperkeratosis, dilatation, and rupture, leading to the development of chronic tissue inflammation. This article provides updated information on HS pathogenesis, comorbidities, and treatment methods. Furthermore, we share our experience in the surgical treatment of the disease, which often proves most effective, and highlight that an interdisciplinary management approach ensures optimal outcomes.
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Affiliation(s)
- Agnieszka Nowak-Liduk
- Department of Perinatology, Gynaecology and Obstetrics, General Hospital in Ruda Śląska, Wincentego Lipa Street 2, 41-703 Ruda Śląska, Poland;
| | - Diana Kitala
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| | - Gabriela Ochała-Gierek
- Department of Dermatology and Venerology, City Hospital in Sosnowiec, Zegadlowicza Street 3, 41-200 Sosnowiec, Poland;
| | - Wojciech Łabuś
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
| | - Beata Bergler-Czop
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street 20-24, 40-027 Katowice, Poland; (B.B.-C.); (K.P.)
| | - Kornelia Pietrauszka
- Department of Dermatology, Medical University of Silesia in Katowice, Francuska Street 20-24, 40-027 Katowice, Poland; (B.B.-C.); (K.P.)
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Street 18, 40-752 Katowice, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Street, 41-940 Piekary Slaskie, Poland
| | - Marcin Gierek
- Dr. Stanislaw Sakiel Centre for Burns Treatment, Siemianowice Ślaskie, Jana Pawła II Street 2, 43-100 Siemianowice Śląskie, Poland; (D.K.); (W.Ł.)
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Saunte DML, Jemec GBE. Laser and intense pulsed light in the treatment of hidradenitis suppurativa. Clin Dermatol 2023; 41:628-638. [PMID: 37659574 DOI: 10.1016/j.clindermatol.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
Treatment of hidradenitis suppurativa (HS) requires a combination of medical, surgical, and lifestyle interventions. Intense pulsed light (IPL) and lasers have been reported to be useful. The aim of this review is to find the evidence supporting IPL and laser treatment of HS and to provide guidance for the management of specific HS lesions. We searched PubMed and Web of Science for "laser" and "hidradenitis suppurativa" on April 6, 2022. Inclusion criteria were >10 patients, reported follow-up, English language, and human subjects with a diagnosis of HS. A total of 724 articles were screened, but only 17 studies qualified for inclusion (IPL (n = 4), Nd:YAG (n = 6), CO2 laser (n = 6), and intralesional treatment (n = 2). The majority of the studies had a low (n = 10) or moderate (n = 7) evidence level. Treatment effect was noticed in studies using IPL and Nd:YAG (hair reduction). CO2 laser was used for surgery with a success rate ranging from 70.7% to 96.7%. CO2 laser is useful for surgery of stationary HS lesions, but it is difficult to draw a conclusion on the use of IPL and Nd:YAG (hair reduction) as the studies were too heterogeneous to perform a meta-analysis.
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Affiliation(s)
- Ditte Marie L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark
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Hardin J, Makadia R, Black S, Lara-Corrales I, Diaz LZ, Kirby JS, DeKlotz CM. Characteristics and treatment pathways in pediatric and adult hidradenitis suppurativa: An examination using real world data. JAAD Int 2023; 12:124-132. [PMID: 37409312 PMCID: PMC10319301 DOI: 10.1016/j.jdin.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2023] [Indexed: 07/07/2023] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory disease. Contemporaneous real-world data can be used to elucidate the clinical treatment of pediatric patients and how treatment strategies compare with adult hidradenitis suppurativa patients. Objective The objective of this study is to evaluate clinical and treatment characteristics of pediatric and adult HS patients. Methods HS adult and pediatric patients were identified in 3 the United States administrative claims databases during the study period between 2016 to 2021. Patients were required to have 2 diagnostic codes for HS and have at least 365 days of prior observation time to the first HS diagnosis. Results Pediatric and adult HS treatments were similar. The proportions of subjects treated with topical and oral antibiotic or oral antibiotic alone or topical medication alone or surgery alone covered 90% of the treated pediatric subjects and 91% of treated adult subjects. The remaining proportion of subjects received other treatment combinations. Limitations The databases represent subjects with commercial or government insurance coverage and thus do not necessarily represent the broader US population. The databases do not capture information about medications obtained without insurance. Conclusions Although subtle differences exist, this study confirms that topical and systemic therapeutic treatment of HS in adults and adolescents is very similar.
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Affiliation(s)
- Jill Hardin
- Janssen Research and Development, Raritan, New Jersey
- Observational Health Data Sciences and Informatics (OHDSI), New York, New York
| | - Rupa Makadia
- Janssen Research and Development, Raritan, New Jersey
- Observational Health Data Sciences and Informatics (OHDSI), New York, New York
| | - Shawn Black
- Janssen Research and Development, Spring House, Pennsylvania
| | | | - Lucia Z. Diaz
- Department of Pediatrics, The University of Texas at Austin, Austin, Texas
| | - Joslyn S. Kirby
- Department of Dermatology, Pennsylvania State University, Hershey, Pennsylvania
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25
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Höper R, Rosen M, Kofler K, Häfner HM, Kofler L. Influence of perioperative antiplatelet and anticoagulant medication management on bleeding events in dermatosurgery-A prospective observational study. J Eur Acad Dermatol Venereol 2023; 37:1906-1913. [PMID: 37246474 DOI: 10.1111/jdv.19228] [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: 02/05/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Perioperative management of antiplatelet and anticoagulant (AP/AC) therapy is a matter of balancing the risks of bleeding and thromboembolic events. Reliable data for dermatosurgery are still lacking, especially for direct oral anticoagulants (DOAC). OBJECTIVES The aim was to prospectively evaluate the influence of AP/AC-medication on bleeding risk in dermatosurgery with focus on exact intervals between DOAC intake and procedure performed on post-operative bleeding. METHODS Patients with or without AP/AC-therapy were included in the study without randomization. Exact times of DOAC-intake, procedure performed and post-operative bleeding were documented. Data collection was prospectively and standardized done by one person. RESULTS We evaluated 1852 procedures in 675 patients. Post-operative bleeding occurred after 15.93% (n = 295) of all procedures, but only a few of them were severe (1.57%, n = 29). Compared to patients without AP/AC-medication, severe post-operative bleeding occurred significantly more often under dual antiplatelet therapy (11.76%, n = 2; p = 0.0166) and bridging of either vitamin K antagonist (9.09%, n = 2; p = 0.0270) or DOAC (15.38%, n = 2; p = 0.0099). There was no significant difference in the frequency of severe bleeding regarding to the preoperative DOAC-free period. CONCLUSIONS Although AP/AC-therapy is associated with a significant higher rate of post-operative bleeding, no life-threatening bleeding was recorded. Long preoperative pausing or bridging of DOAC does not lead to significantly less severe bleeding events.
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Affiliation(s)
- Rabea Höper
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Michael Rosen
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
| | - Katrin Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Scientific Working Group for Anticoagulation in Dermatosurgery of the German Working Group of Dermatological Angiology (ACoDermS of the ADA)
- skin+more MVZ GmbH, Biberach, Germany
| | - Hans-Martin Häfner
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Scientific Working Group for Anticoagulation in Dermatosurgery of the German Working Group of Dermatological Angiology (ACoDermS of the ADA)
| | - Lukas Kofler
- Department of Dermatology, University Medical Center, Eberhard Karls University, Tuebingen, Germany
- Scientific Working Group for Anticoagulation in Dermatosurgery of the German Working Group of Dermatological Angiology (ACoDermS of the ADA)
- skin+more MVZ GmbH, Biberach, Germany
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Lipa K, Zając N, Witkowski² G, Ciechanowicz P, Wiszniewski K, Szymańska E, Walecka I. Hidradenitis suppurativa - biologic therapy and other available treatment options. Postepy Dermatol Alergol 2023; 40:518-528. [PMID: 37692279 PMCID: PMC10485753 DOI: 10.5114/ada.2021.112075] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/13/2021] [Indexed: 09/12/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease which is characterized by painful, recurrent nodules and abscesses. The overall prevalence of HS is estimated to be 11 per 100 000 individuals in the United States and 4% of the world's population. Women are three times more affected than men, especially patients between 18 and 29 years. Similarly to acne vulgaris, HS is primarily associated with follicular occlusion, which results from a number of biological processes, including follicular epithelial hyperplasia and hyperkeratinization. There are numerous available treatment options for cutaneous lesions in the course of HS. A combination of conservative therapy and appropriate surgical treatment conducted by an experienced surgeon ensures the best possible clinical outcomes. Presently, biologic therapy is the most effective pharmacological treatment in patients with a moderate-to-severe course of the disease. Numerous ongoing clinical trials provide hope for greater availability of new biologic therapy methods.
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Affiliation(s)
- Katarzyna Lipa
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Natalia Zając
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Grzegorz Witkowski²
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
- Department of Gastroenterological Surgery and Transplantation Medicine, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Piotr Ciechanowicz
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Kacper Wiszniewski
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Elżbieta Szymańska
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
| | - Irena Walecka
- Dermatology Department, Centre of Postgraduate Medical Education/Central Clinical Hospital MSWiA, Warsaw, Poland
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Rathod U, Prasad PN, Patel BM, Patel B, Patel C, Gandhi SK, Patel P. Hidradenitis Suppurativa: A Literature Review Comparing Current Therapeutic Modalities. Cureus 2023; 15:e43695. [PMID: 37724217 PMCID: PMC10505353 DOI: 10.7759/cureus.43695] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a disease with a poor prognosis, often misinterpreted as an infection, with the highest impact on the patient's quality of life among all the assessed dermatological diseases. The main aim of this study was to compare various therapeutic interventions that are currently available for the treatment of HS. The pathogenesis of HS is not well understood, but it is mostly multifactorial involving a number of factors like genetic factors, androgens, local immunity, microflora, smoking, and obesity. Despite limited evidence on their effectiveness, topical antibiotics and antiseptics are commonly employed. Due to the colonization of bacteria and the presence of biofilms in the sinus tracts formed by HS lesions, systemic antibiotics are commonly employed as the primary form of therapy. In females with HS who experience menstrual flares or display symptoms of polycystic ovary syndrome, hormonal agents are often considered to be a viable and effective therapeutic option. At present, the sole treatment approved by both the Food and Drug Administration and the European Medicines Agency for addressing moderate to severe HS is adalimumab, an antibody that targets tumor necrosis factor alpha. Many surgical procedures in the management of HS aim to address inflammation by eliminating the affected folliculo-pilosebaceous unit, sinus tracts, and associated debris to impede further progression and scarring. HS continues to pose a considerable treatment challenge, necessitating a comprehensive approach for patients. However, the available evidence for most of these treatments is limited, indicating the need for more extensive research to identify the most effective interventions for managing HS.
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Affiliation(s)
- Urvashi Rathod
- Department of Internal Medicine, Narendra Modi Medical College, Ahmedabad, IND
| | - Pooja N Prasad
- Department of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, IND
| | | | - Brinda Patel
- Department of Internal Medicine, Gujarat Medical Education and Research Society, Sola, Ahmedabad, IND
| | - Chintankumar Patel
- Department of Internal Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Siddharth Kamal Gandhi
- Department of Internal Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Priyansh Patel
- Department of Internal Medicine, Medical College Baroda, Vadodara, IND
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Oliveira M, Rahawi K, Duan Y, Lane M, Amin AZ, Sayed CJ. Effect of Biologics on the Need for Procedural Interventions, Systemic Medications, and Healthcare Utilization in Patients with Hidradenitis Suppurativa: Real-World Data from the UNITE Registry. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00954-8. [PMID: 37314696 DOI: 10.1007/s13555-023-00954-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Management of hidradenitis suppurativa (HS) often requires a combined medical/procedural approach. Biologics are frequently reserved for severe cases after irreversible tissue damage has occurred. We evaluated the association between consistent biologic use and the need for procedural interventions, systemic medications, and healthcare utilization. METHODS UNITE, a 4-year, global, prospective, observational, HS disease registry, documented the natural history, diagnostic/treatment patterns, and clinical outcomes of HS. Patients aged 12 years or more, with active HS were enrolled between October 2013 and December 2015 and evaluated every 6 months for 48 months at 73 sites across 12 countries (data cutoff December 2019). Proportions of patients requiring different HS procedures, systemic medications, and healthcare utilization were assessed during the 6-month periods before, during, and after biologic initiation for 12 weeks or more (i.e., consistent use). RESULTS There were 63 instances of initiation of consistent biologic use (adalimumab [81%], infliximab [16%], and ustekinumab [3%]) in 57 patients. Patients' mean age was 40 years, 58% were female, and 53%/47% had Hurley stage II/III disease, respectively. Fewer patients required surgical/procedural interventions and systemic medications for the 6-month period during/6-month period after biologic initiation versus the 6-month period before biologic initiation, including intralesional corticosteroid injections (22%/14% vs 24%), incision and drainage (I&D) by physician (10%/10% vs 17%), I&D by patient (10%/10% vs 14%), surgical excision (8%/10% vs 11%), deroofing (5%/2% vs 5%), systemic antibiotics (43%/41% vs 54%), and systemic immunosuppressants (10%/6% vs 13%). Fewer patients required hospital admission for HS (17%/13% vs 21%) or emergency department visits for HS (8%/8% vs 16%) during the 6-month periods in which consistent biologics use started and continued versus the 6-month period before consistent biologic use. CONCLUSION Following initiation of consistent biologic use (12 weeks or more), fewer patients required acute procedural interventions, systemic medications, and healthcare utilization, supporting the importance of early biologic initiation.
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Affiliation(s)
- Marília Oliveira
- US Medical Affairs Dermatology, AbbVie Inc., North Chicago, IL, USA
| | - Kassim Rahawi
- US Medical Affairs Dermatology, AbbVie Inc., North Chicago, IL, USA
| | - Yinghui Duan
- US Medical Affairs Oncology, AbbVie Inc., North Chicago, IL, USA
| | - Michael Lane
- Medical Affairs Statistics, AbbVie Inc., North Chicago, IL, USA
| | - Ahmad Z Amin
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street #400, CB# 7715, Chapel Hill, NC, 27516, USA.
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Alhusain AM, Almosa AS, Alqirnas MQ, Alissa SI. Submental liposuction with VASER complicated with hidradenitis suppurativa in neck area: a case report. J Surg Case Rep 2023; 2023:rjad318. [PMID: 37397067 PMCID: PMC10308003 DOI: 10.1093/jscr/rjad318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/01/2023] [Indexed: 07/04/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder that is characterized by deep-seated painful nodules, classically in the intertriginous skin and apocrine gland-rich areas of the body such as the anogenital, axillary, inframammary and inguinal regions. This is a case of a 35-year-old female, who is known to have gluteal HS, she underwent neck liposuction procedure that was then complicated by anterior neck HS, which is considered as an atypical location. The patient received medical treatment with antibiotics and showed huge improvement. In addition, in patients who do not show response to medical therapy, surgical treatment is usually carried out by incising the area affected and leaving the wound open to be healed by secondary intention or covering it with a skin graft if the area is extensive.
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Affiliation(s)
- Abdullah M Alhusain
- Correspondence address. Plastic and Reconstructive Surgery Division, Surgery Department, Ministry of National Guards Health Affairs, King Abdullah Children's Specialist Hospital, P.O. Box 22490 Riyadh 14611, Saudi Arabia. Tel: +966-11-8011111; Fax: +966-11-8011000; E-mail:
| | - Abdulaziz S Almosa
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Muhannad Q Alqirnas
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sami I Alissa
- Plastic and Reconstructive Surgery Division, Surgery Department, Security Forces hospital, Riyadh, Saudi Arabia
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30
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Park HH, Vuong CL, Phan K, Nyun K, Kleinman E, Ignacio RC, Hightower GK. Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study. Int J Womens Dermatol 2023; 9:e086. [PMID: 37152610 PMCID: PMC10155899 DOI: 10.1097/jw9.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/08/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Helen H. Park
- Department of Dermatology, University of California San Diego, San Diego, California
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
| | - Carrie L. Vuong
- Department of Dermatology, University of California San Diego, San Diego, California
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
| | - Katy Phan
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
| | - Kumudra Nyun
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
| | - Elana Kleinman
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
| | - Romeo C. Ignacio
- Division of Pediatric Surgery, Rady Children’s Hospital, San Diego, California
- Department of Surgery, University of California San Diego School of Medicine, La Jolla, California
| | - George K. Hightower
- Department of Dermatology, University of California San Diego, San Diego, California
- Division of Pediatric and Adolescent Dermatology, Rady Children’s Hospital, San Diego, California
- * Corresponding author. E-mail address: (G.K. Hightower)
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31
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Molinelli E, De Simoni E, Candelora M, Sapigni C, Brisigotti V, Rizzetto G, Offidani A, Simonetti O. Systemic Antibiotic Therapy in Hidradenitis Suppurativa: A Review on Treatment Landscape and Current Issues. Antibiotics (Basel) 2023; 12:978. [PMID: 37370297 DOI: 10.3390/antibiotics12060978] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, and inflammatory skin disease characterized by painful, deep-seated, nodules, abscesses, and sinus tracts in sensitive areas of the body, including axillary, inguinal, and anogenital regions. Antibiotics represent the first-line pharmacological treatment of HS because of their anti-inflammatory properties and antimicrobial effects. This narrative review summarizes the most significant current issues on the role of systemic antibiotics in the management of HS, critically analyzing the main limits of their use (antibiotic resistance and toxicity). Although, in the last decades, several cytokines have been implicated in the pathomechanism of HS and the research on the use of novel biologic agents in HS has been intensified, antibiotics remain a valid therapeutic approach. Future challenges regarding antibiotic therapy in HS comprise their use in association with biologics in the management of acute flare or as a bridge therapy to surgery.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Edoardo De Simoni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Matteo Candelora
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60126 Ancona, Italy
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32
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Tsai YC, Hung CY, Tsai TF. Efficacy and Safety of Biologics and Small Molecules for Moderate-to-Severe Hidradenitis Suppurativa: A Systematic Review and Network Meta-Analysis. Pharmaceutics 2023; 15:pharmaceutics15051351. [PMID: 37242593 DOI: 10.3390/pharmaceutics15051351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Treatment of hidradenitis suppurativa (HS) is difficult and current guidelines are based mainly on expert opinion and non-randomized controlled trials. Recently, there have been some targeted therapies using uniform primary endpoints for outcome assessment. Objective: Recommendations can be provided on selecting biologics and targeted synthetic small molecules for refractory HS by comparing the efficacy and safety of these medications. Methods: Databases including ClinicalTrial.gov, Cochrane Library, and PubMed were searched. Randomized controlled trials (RCTs) for moderate-to-severe HS were eligible. We performed random-effect network meta-analysis and ranking probability. The primary outcome was Hidradenitis Suppurativa Clinical Response (HiSCR) at 12-16 weeks. Secondary outcome included Dermatology Life Quality Index (DLQI) 0/1, mean change of DLQI from baseline, and adverse effects. Results: A total of 12 RCTs involving 2915 patients were identified. Adalimumab, bimekizumab, secukinumab 300 mg q4w and secukinumab 300 mg q2w showed superiority to placebo in HiSCR at weeks 12 to 16. In addition, there was no significant difference between bimekizumab and adalimumab as measured by HiSCR (RR = 1.00; 95% CI: 0.66-1.52) and DLQI 0/1 (RR = 2.40, 95% CI: 0.88-6.50). In terms of ranking probability for achieving HiSCR at 12-16 weeks, adalimumab ranked first, followed by bimekizumab, secukinumab 300 mg q4w, and secukinumab 300 mg q2w. All biologics and small molecules did not differ in the development of adverse effects compared to placebo. Conclusions: Adalimumab, bimekizumab, secukinumab 300 mg q4w and secukinumab 300 mg q2w represent four regimens that produce better outcomes than placebo without increased risk of adverse events. Adalimumab and bimekizumab exhibited best HiSCR and DLQI 0/1 between weeks 12-16.
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Affiliation(s)
- Ya-Chu Tsai
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
- Department of Fashion Styling and Design, Minghsin University of Science and Technology, Hsinchu 30401, Taiwan
| | - Chen-Yiu Hung
- Department of Thoracic Medicine, Chang Gung University College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan
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33
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Scholl L, Schneider-Burrus S, Fritz B, Sabat R, Bechara FG. The impact of surgical interventions on the psychosocial well-being of patients with hidradenitis suppurativa. J Dtsch Dermatol Ges 2023; 21:131-139. [PMID: 36748846 DOI: 10.1111/ddg.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/15/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa is a chronic inflammatory skin disease. Depending on disease severity, a combination of conservative and surgical treatments is necessary. This analysis aimed to determine the impact of surgical interventions on patient psychosocial well-being. PATIENTS AND METHODS This is a prospective, noninterventional, multicenter study. The medical history, medical examination, and patient-reported outcomes, including the Hospital Anxiety and Depression Scale, Dermatology Life Quality Index, and the Short Form-12 Health Survey, were collected from 481 patients with hidradenitis suppurativa. RESULTS Among all patients with hidradenitis suppurativa included in this study, 74.2% reported surgery before study inclusion, of whom 92.4% could identify surgery type and location. Although adjusted for confounding factors, such as disease severity and activity, the aforementioned patient reported outcomes, did not vary significantly between groups of patients with different techniques and number of prior surgical intervention. However, patients without any prior surgical intervention yielded significantly better scores. CONCLUSIONS In patients with hidradenitis suppurativa, previous surgery was associated with worse outcomes in anxiety, depression, and quality of life, showing the apparent need of psychological support. It remains unclear whether the morbidity of surgical procedures or a possible higher severity score in patients undergoing surgery is responsible.
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Affiliation(s)
- Lisa Scholl
- Department of Dermatology, Venerology, and Allergology - St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sylke Schneider-Burrus
- Centre for Dermatosurgery, Havelklinik, Berlin, Germany.,Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Björn Fritz
- AbbVie Deutschland GmbH & Co. KG, Wiesbaden, Germany
| | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Psoriasis Research and Treatment Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Inflammation and Regeneration of Skin, BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology - St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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34
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Scholl L, Schneider-Burrus S, Fritz B, Sabat R, Bechara FG. Auswirkungen chirurgischer Eingriffe auf das psychosoziale Wohlbefinden von Patienten mit Hidradenitis suppurativa. J Dtsch Dermatol Ges 2023; 21:131-140. [PMID: 36808435 DOI: 10.1111/ddg.14934_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/15/2022] [Indexed: 02/22/2023]
Affiliation(s)
- Lisa Scholl
- Klinik für Dermatologie, Venerologie und Allergologie - St. Josef-Hospital, Ruhr-Universität Bochum
| | - Sylke Schneider-Burrus
- Zentrum für Dermatochirurgie, Havelklinik, Berlin.,Interdisziplinäre Gruppe für Molekulare Immunpathologie, Dermatologie/Medizinische Immunologie, Charité - Universitätsmedizin Berlin
| | | | - Robert Sabat
- Interdisziplinäre Gruppe für Molekulare Immunpathologie, Dermatologie/Medizinische Immunologie, Charité - Universitätsmedizin Berlin.,Psoriasis Forschungs- und BehandlungsCentrum, Charité - Universitätsmedizin Berlin.,Entzündung und Hautregeneration, BIH Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie - St. Josef-Hospital, Ruhr-Universität Bochum
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35
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Cabete J, Aparício Martins I. [Guidelines for the Management of Patients with Hidradenitis Suppurativa]. ACTA MEDICA PORT 2023; 36:133-139. [PMID: 36738185 DOI: 10.20344/amp.18916] [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: 08/02/2022] [Accepted: 10/14/2022] [Indexed: 02/04/2023]
Abstract
Hidradenitis suppurativa is a chronic and recurrent inflammatory dermatosis characterized by the presence of inflammatory nodules and abscesses in the apocrine gland-rich areas that may progress to suppurative fistulas and scars. Despite being considered one of the dermatological conditions with the greatest impact on patient quality of life, it is often underdiagnosed. Hidradenitis suppurativa, especially in its severe forms, is associated with numerous comorbidities, so a holistic and multidisciplinary perspective is crucial for the management of these patients. The therapeutic approach is complex and challenging. The medical treatment options are diverse and must be adapted to clinical presentation and disease severity. Surgical therapy should be considered as an adjuvant to medical treatment, particularly in refractory cases and in the presence of scars or anatomical and/or functional mutilation. These recommendations reflect the main aspects of the management of the patient with hidradenitis suppurativa and are addressed to all healthcare professionals who take part in their follow-up.
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Affiliation(s)
- Joana Cabete
- Serviço de Dermatovenereologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Inês Aparício Martins
- Serviço de Dermatovenereologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
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36
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Reshetylo S, Narla S, Bakker C, Freeman T, Farah RS, Hamzavi IH, Goldfarb N. Systematic review of photodynamic therapy for the treatment of hidradenitis suppurativa. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2023; 39:39-50. [PMID: 35713108 PMCID: PMC10087637 DOI: 10.1111/phpp.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of available literature regarding the use of 5-aminolevulinic acid (ALA) and ALA derivative photodynamic therapy (PDT) in the treatment of hidradenitis suppurativa (HS) and provide recommendations on its use. METHODS A systematic review was performed of all published studies up to September 1, 2019 from nine databases, including PubMed, that evaluated PDT in the treatment of HS. For each study, quality of evidence and risk of bias was evaluated. Recommendations from the body of evidence were created based on Strength of Recommendation and Taxonomy (SORT) criteria. RESULTS Eighteen studies met inclusion criteria. The majority of studies had a high risk of bias. Blue light PDT with 20% ALA and red light PDT with 16% methyl aminolevulinate (MAL) demonstrated some benefit based on a small number of poor-quality studies with a high risk of bias (Grade C, level III evidence). The most promising results were for 1%-5% ALA with intralesional diode, with good to complete response in 78%-94% of anatomic sites treated (Grade B, level II evidence). LIMITATIONS The majority of studies contained high levels of bias, with significant heterogeneity between studies. Conclusions are limited by small samples sizes, lack of randomized controlled trials, and differing protocols. CONCLUSION Further studies are needed to determine the clinical efficacy of 20% ALA with blue light and MAL with red light. Intralesional diode PDT shows the most promise and warrants further investigation in larger, randomized controlled trials.
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Affiliation(s)
- Sofiya Reshetylo
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Shanthi Narla
- Department of Dermatology, St. Luke's University Health Network, Easton, PA, USA
| | - Caitlin Bakker
- University of Minnesota Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Thomas Freeman
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.,Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ronda S Farah
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Iltefat H Hamzavi
- Department of Dermatology, Multicultural Center, Henry Ford Health System, Detroit, MI, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA.,Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.,Departments of Internal Medicine and Dermatology, Minneapolis VA Health Care System, Minneapolis, MN, USA
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37
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A Case Study of Hidradenitis Suppurativa. Adv Emerg Nurs J 2023; 45:29-34. [PMID: 36757744 DOI: 10.1097/tme.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Hidradenitis suppurativa (HS) is a complex, chronic, inflammatory skin disease that is often unrecognized or misdiagnosed. Patients frequently present to with painful nodules, inflammatory papules, sinus tracts, and scarring to intertriginous areas seeking care to alleviate symptoms. There is a paucity of information available specifically aimed to educate emergency nurse practitioners on how to recognize, diagnose, and treat this population. The article highlights the main diagnostic criteria and treatment options available for HS patients to help expand disease awareness.
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38
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Kontochristopoulos G, Tsiogka A, Agiasofitou E, Kapsiocha A, Soulaidopoulos S, Liakou AI, Gregoriou S, Rigopoulos D. Efficacy of Subantimicrobial, Modified-Release Doxycycline Compared to Regular-Release Doxycycline for the Treatment of Hidradenitis Suppurativa. Skin Appendage Disord 2022; 8:476-481. [PMID: 36407641 PMCID: PMC9672876 DOI: 10.1159/000524762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/13/2022] [Indexed: 07/30/2023] Open
Abstract
Introduction Antibiotics are frequently used to treat hidradenitis suppurativa (HS), but the evidence-based literature available on their use is limited. Considering that HS is not primarily an infectious disease, we sought to evaluate the efficacy of subantimicrobial, modified-release doxycycline (MR-DC) compared to regular-release doxycycline (RR-DC) for the treatment of HS. Materials and Methods Patients were randomly assigned to receive treatment with either MR-DC 40 mg once daily or RR-DC 100 mg twice daily for a period of 12 weeks. The treatment efficacy was assessed after 12 weeks of treatment using the International Hidradenitis Suppurativa Severity Score System (IHS4), the Dermatology Life Quality Index (DLQI), and the Hidradenitis Suppurativa Clinical Response (HiSCR). Results A total of 49 patients (25 in the MR-DC group and 24 in the RR-DC group) were included in the study. A statistically significant (p < 0.05) reduction of IHS4 and DLQI was observed in both groups at week 12. HiSCR was achieved by 64% of patients receiving MR-DC and 60% of those receiving RR-DC. Conclusion MR-DC demonstrated comparable efficacy to RR-DC in the treatment of HS. MR-DC may serve as a valuable alternative to other antibiotic regimes, considering its anti-inflammatory properties and its lower potential to induce antibiotic resistance.
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Affiliation(s)
- Georgios Kontochristopoulos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
| | - Aikaterini Tsiogka
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
| | - Efthymia Agiasofitou
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
| | - Anastasia Kapsiocha
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini I. Liakou
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
| | - Stamatios Gregoriou
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
| | - Dimitrios Rigopoulos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Faculty of Medicine, Andreas Syggros Hospital, Athens, Greece
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Ring HC, Yao Y, Maul J, Ingram JR, Frew JW, Thorsen J, Nielsen M, Wu JJ, Thyssen JP, Thomsen SF, Egeberg A. The road to biologics in patients with hidradenitis suppurativa: a nationwide drug utilization study. Br J Dermatol 2022; 187:523-530. [PMID: 35603888 PMCID: PMC9796665 DOI: 10.1111/bjd.21673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/15/2022] [Accepted: 05/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Prolonged systemic antibiotic treatment is often a part of management of hidradenitis suppurativa (HS). Although biologic therapies are now available, the patient's treatment journey leading to biologic therapy is unclear. OBJECTIVES To examine treatment patterns and duration of systemic treatment use in patients with HS preceding biologic therapy. METHODS We identified all patients with HS receiving treatment with biologics in the Danish National Patient Registry from 2010 to 2018 and extracted their entire prescription history of specific systemic treatments from the Danish National Prescription Registry since its inception in 1995. The patients' treatment journeys are graphically displayed through Sankey diagrams and box plots generated to show temporal distributions. Descriptive patient characteristics were presented as frequencies with percentages for categorical variables and as means with SDs or medians with interquartile ranges (IQRs) for continuous variables. RESULTS A total of 225 patients with HS were included. Patients had most frequently been treated with penicillin (n = 214; 95·1%), dicloxacillin (n = 194; 86·2%), tetracycline (n = 145; 64·4%) and rifampicin/clindamycin (n = 111; 49·3%), as well as the retinoids isotretinoin and acitretin, and dapsone. Prior to biologic therapy, patients received a mean of 4·0 (SD 1·3) different systemic therapies, across a mean of 16·9 (SD 11·3) different treatment series. The mean time from first systemic therapy until biologic therapy was initiated was 15·3 (SD 5·1) years [8·2 (SD 5·9) years when excluding penicillin and dicloxacillin]. CONCLUSIONS Patients with HS who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS. Delay in the initiation of biologic therapy may represent a missed opportunity to prevent disease progression. What is already known about this topic? The treatment journey leading to biologic therapy in patients with HS has not previously been investigated. What does this study add? Our data from 225 patients with HS illustrate that patients who receive biologic therapy have long preceding treatment histories with multiple drug classes and treatment series, many of which are supported by relatively weak evidence in HS.
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Affiliation(s)
- Hans Christian Ring
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Yiqiu Yao
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | | | - John R. Ingram
- Department of Dermatology & Academic Wound HealingInstitute of Infection & Immunity, Cardiff UniversityCardiffUK
| | - John W. Frew
- Department of DermatologyLiverpool HospitalSydneyAustralia
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte HospitalUniversity of CopenhagenDenmark
| | - Mia‐Louise Nielsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Jashin J. Wu
- Dermatology Research and Education FoundationIrvineCAUSA
| | - Jacob P. Thyssen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Simon F. Thomsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark,Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Alexander Egeberg
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
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40
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Vaillant C, Berkane Y, Lupon E, Atlan M, Rousseau P, Lellouch AG, Duisit J, Bertheuil N. Outcomes and Reliability of Perforator Flaps in the Reconstruction of Hidradenitis Suppurativa Defects: A Systemic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195813. [PMID: 36233681 PMCID: PMC9572569 DOI: 10.3390/jcm11195813] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a common and debilitating disease, in which the only effective treatment involves a wide excision of the affected skin. Secondary wound healing and skin grafting are two well-known options for managing these defects, but perforator flaps provide a new therapeutic alternative by ensuring reconstructions of large defects, reducing donor site morbidity, and enhancing functional recovery. The aim of this study was to achieve a systematic review of perforator flaps use in HS. PATIENTS AND METHODS PubMed and Cochrane databases were searched from 1989 to 2021. The PRISMA statement was used in the study selection process and the review was registered on PROSPERO. Furthermore, patient characteristics, operative technique, complications, and recurrences were searched. RESULTS Thirty-six articles were selected including 286 patients and 387 flaps. Axillary localization was mostly represented (83.2%). Direct donor site closure was achieved in 99.1% of cases. In total, 15.1% of the flaps presented at least one of the following complications: wound dehiscence (5.5%), partial necrosis (2.9%), hematoma or seroma (2.1%), infection (2.1%), venous congestion (1.8%), and nerve injury (0.3%). Two cases of total necrosis were recorded. Recurrence of the disease was observed in 2.7% of the defects. CONCLUSIONS Pedicled perforator flaps are a reliable and reproducible technique in the reconstruction of HS defects. They are associated with a low recurrence rate while ensuring an effective reconstruction with reduced morbidity and faster recovery compared to the techniques classically used in this indication.
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Affiliation(s)
- Camille Vaillant
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes 1, 35000 Rennes, France
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Angers, 49933 Angers, France
| | - Yanis Berkane
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes 1, 35000 Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital and Shriners Children’s Boston, Harvard Medical School, Boston, MA 02115, USA
| | - Elise Lupon
- Department of Plastic, Reconstructive and Aesthetic Surgery, Rangueil Hospital, CHU Toulouse, 31013 Toulouse, France
| | - Michael Atlan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Tenon Hospital, AP-HP, 75020 Paris, France
| | - Pascal Rousseau
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Angers, 49933 Angers, France
| | - Alexandre G. Lellouch
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital and Shriners Children’s Boston, Harvard Medical School, Boston, MA 02115, USA
| | - Jérôme Duisit
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes 1, 35000 Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, CHU Rennes, University of Rennes 1, 35000 Rennes, France
- INSERM U1236, University of Rennes 1, 35000 Rennes, France
- SITI Laboratory, Rennes University Hospital, 35203 Rennes, France
- Correspondence: ; Tel.: +33-2-99-26-71-68
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Switching from Adalimumab Originator to Biosimilar in Patients with Hidradenitis Suppurativa Results in Losses of Response—Data from the German HS Registry HSBest. Life (Basel) 2022; 12:life12101518. [PMID: 36294953 PMCID: PMC9605653 DOI: 10.3390/life12101518] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Since 2021, adalimumab biosimilar ABP 501 can be used alternatively to adalimumab originator (ADAO) in the treatment of hidradenitis suppurativa (HS). Effectiveness and safety data remain scarce. We investigated the impact of switching from ADAO to ABP 501 on disease severity and the occurrence of adverse events (AEs) in patients with HS. We analyzed clinical data on patients enrolled in the German HSBest registry. Evaluation outcomes were assessed at three time points (baseline of originator (t0), prior to switching to biosimilar (t1) and 12 to 14 weeks after switching (t2)) and included patient-reported AEs and disease severity using the International Hidradenitis Suppurativa Severity Score System (IHS4) score. In total, 94 patients were switched from ADAO to ABP 501. Overall, 33.3% (n = 31/94) of the patients developed AEs and/or loss of response (LoR) within 12 to 14 weeks after switching. Of these, 61.3% (n = 19/31) experienced LoR but no AEs, 22.6% (n = 7/31) LoR combined with AEs and 16.1% (n = 5/31) AEs only. Our study showed that switching HS patients from ADAO to ABP 501 does significantly affect treatment effectiveness. Switching patients who are on remission maintenance therapy should be viewed critically.
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Neves JM, Cunha N, Lencastre A, Cabete J. Treating hidradenitis suppurativa patients with adalimumab: a real-life experience of a tertiary care center in Lisboa, Portugal. An Bras Dermatol 2022; 97:816-819. [PMID: 36100476 PMCID: PMC9582881 DOI: 10.1016/j.abd.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- José Miguel Neves
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
| | - Nélia Cunha
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - André Lencastre
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Cabete
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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43
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Johnston LA, Alhusayen R, Bourcier M, Delorme I, George R, O'Brien E, Wong SM, Poelman SM. Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update. J Cutan Med Surg 2022; 26:2S-24S. [PMID: 36000460 DOI: 10.1177/12034754221116115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.
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Affiliation(s)
- Leah A Johnston
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Raed Alhusayen
- 282299 Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Isabelle Delorme
- Dr Isabelle Delorme Inc, Dermatologue, Drummondville, QC, Canada
| | - Ralph George
- 7938 Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth O'Brien
- 12367 Faculty of Medicine, Dermatology, McGill University, Montreal, QC, Canada
| | - Se Mang Wong
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Susan M Poelman
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada.,Beacon Dermatology, Calgary, AB, Canada
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Tzellos T. Implementing evidence-based strategies to optimize the journey of patients with hidradenitis suppurativa. Br J Dermatol 2022; 187:462-463. [PMID: 35972067 DOI: 10.1111/bjd.21809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
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Impact of Hidradenitis Suppurativa Surgical Treatment on Health-Related Life Quality. J Clin Med 2022; 11:jcm11154327. [PMID: 35893421 PMCID: PMC9330903 DOI: 10.3390/jcm11154327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 02/08/2023] Open
Abstract
(1) Background: Hidradenitis suppurativa is a disease that affects the intimacy of patients. This disease reduces the quality of life and functioning of patients in everyday life. The surgical treatment of HS is one of the treatments for HS that can improve the quality of life. (2) Methods: The main goal of this study was to assess quality of life before the surgical treatment and after the surgical treatment of HS at Center for Burn Treatment in Siemianowice Śląskie, Poland, using the EQ-5D-5L survey before the operation and at follow-up (6 months after). (3) Results: The average quality of life measured with the EQ-5D-5L survey before therapy was 39.3 ± 20.1 (min., 0; max., 60; most frequent value, 50), whereas after surgical treatment, the mean quality of life was 89.5 ± 12.5 (min., 50; max., 100; most frequent value, 100). The average increase in the quality of life was 50.2 ± 19.5 (min., 30; max., 100; most frequent value, 30), and it was statistically significant (p < 0.001).
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46
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Surgical Advances. Adv Skin Wound Care 2022; 35:359. [PMID: 35723952 DOI: 10.1097/01.asw.0000832804.54227.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Huang CH, Huang IH, Tai CC, Chi CC. Biologics and Small Molecule Inhibitors for Treating Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis. Biomedicines 2022; 10:1303. [PMID: 35740325 PMCID: PMC9220298 DOI: 10.3390/biomedicines10061303] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The treatment guidelines for hidradenitis suppurativa (HS) vary among different countries, and several biologics and small molecule inhibitors have been tested for treating moderate-to-severe HS over the past few years. However, treatment guidelines for HS vary among different countries. METHODS A systematic review and meta-analysis was performed to exam the efficacy and serious adverse events (SAEs) of biologics and small-molecule inhibitors in treating moderate-to-severe HS. Binary outcomes were presented as risk ratio (RR) with 95% confidence interval (CI). RESULTS We included 16 RCTs with a total of 2076 participants on nine biologics and three small-molecule inhibitors for treating moderate-to-severe HS, including adalimumab, anakinra, apremilast, avacopan, bimekizumab, CJM112, etanercept, guselkumab, IFX-1, INCB054707, infliximab, and MABp1. The meta-analysis revealed only adalimumab (RR 1.77, 95% CI, 1.44-2.17) and bimekizumab (RR 2.25, 95% CI, 1.03-4.92) achieved significant improvement on hidradenitis suppurativa clinical response (HiSCR), and adalimumab was superior to placebo in achieving dermatology life quality index (DLQI) 0/1 (RR 3.97; 95% CI, 1.70-9.28). No increase in SAEs was found for all included active treatments when compared with placebo. CONCLUSIONS Adalimumab and bimekizumab are the only two biologics effective in achieving HiSCR with acceptable safety profile, whereas adalimumab is the only biologic effective in achieving DLQI 0/1.
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Affiliation(s)
- Chun-Hsien Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, No. 5, Fuxing Street Guishan District, Taoyuan City 333423, Taiwan; (C.-H.H.); (I.-H.H.)
| | - I-Hsin Huang
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, No. 5, Fuxing Street Guishan District, Taoyuan City 333423, Taiwan; (C.-H.H.); (I.-H.H.)
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Chang Gung Memorial Hospital, Linkou Main Branch, No. 5, Fuxing Street Guishan District, Taoyuan City 333423, Taiwan;
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Main Branch, No. 5, Fuxing Street Guishan District, Taoyuan City 333423, Taiwan; (C.-H.H.); (I.-H.H.)
- College of Medicine, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City 333323, Taiwan
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48
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van Straalen KR, Ingram JR, Augustin M, Zouboulis CC. New treatments and new assessment instruments for hidradenitis suppurativa. Exp Dermatol 2022; 31 Suppl 1:33-39. [PMID: 35582833 PMCID: PMC9542859 DOI: 10.1111/exd.14609] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
Research interest in Hidradenitis Suppurativa (HS) has grown exponentially over the past decades. Several groups have worked to develop novel scores that address the drawbacks of existing investigator assessed and patient reported outcome measures currently used in HS trials, clinical practice and research. In clinical trial settings, the drawbacks of the HiSCR have become apparent; mainly it's lack of a dynamic measurement of draining tunnels. The newly developed (dichotomous) IHS4 and HASI-R are backed up by adequate validation data and are good contenders to become the new primary outcome measure in HS clinical trials. Patient reported outcomes, as well as physician reported measures, are being developed by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). For example, the Hidradenitis Suppurativa Quality of Life (HiSQOL) score is a validated measure of HS-specific quality of life and is already being used in many HS trials. Magnitude of pain measurement via a 0-10 numerical rating scale is well-established, however consensus is still required to ensure consistent administration and interpretation of the instrument. A longitudinal measurement over multiple days rather than at one time point, such as for example the Pain Index could provide increased reliability and reduced recall bias. Ultimately, these newly developed scores and tools can be included in a standardized registry to be used in routine clinical practice.
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Affiliation(s)
- K R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - J R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - M Augustin
- Institute for Health Care Services Research in Dermatology and Nursing, University Hospital Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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Surgical Treatment in Hidradenitis Suppurativa. J Clin Med 2022; 11:jcm11092311. [PMID: 35566438 PMCID: PMC9101712 DOI: 10.3390/jcm11092311] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/09/2022] [Accepted: 04/12/2022] [Indexed: 02/06/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, progressive inflammatory disorder of follicular occlusion with pubertal onset that presents as painful inflammatory nodules, sinus tracts, and tunnelling in apocrine-gland-rich areas, such as the axilla, groin, lower back, and buttocks. The disease course is complicated by contractures, keloids, and immobility and is often associated with a low quality of life. It is considered a disorder of follicular occlusion with secondary inflammation, though the exact cause is not known. Management can often be unsatisfactory and challenging due to the chronic nature of the disease and its adverse impact on the quality of life. A multidisciplinary approach is key to prompt optimal disease control. The early stages can be managed with medical treatment, but the advanced stages most likely require surgical intervention. Various surgical options are available, depending upon disease severity and patient preference. In this review an evidence-based outline of surgical options for the treatment of HS are discussed. Case reports, case series, cohort studies, case-control studies, and Randomized Clinical Trials (RCT)s available in medical databases regarding surgical options used in the treatment of HS were considered for the review presented in a narrative manner in this article.
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50
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Barak-Levitt J, Held R, Synett Y, Kremer N, Hodak E, Sherman S. Hidradenitis Suppurativa International Online Community: Patient Characteristics and a Novel Model of Treatment Effectiveness. Acta Derm Venereol 2022; 102:adv00686. [PMID: 35312027 PMCID: PMC9558329 DOI: 10.2340/actadv.v102.1056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Treatment for hidradenitis suppurativa is diverse, yet frequently unsatisfactory. The aims of this study were to create a reproducible artificial intelligence-based patient-reported outcome platform for evaluation of the clinical characteristics and comorbidities of patients with hidradenitis suppurativa, and to use this to grade treatment effectiveness. A retrospective patient-reported outcome study was conducted, based on online questionnaires completed by English-speaking patients registered to the hidradenitis suppurativa Stuff-ThatWorks® online community. Data collected included patient characteristics, comorbidities and treatment satisfaction. These were recoded into scalable labels using a combination of machine learning algorithm, manual coding and validation. A model of treatment effectiveness was generated. The cohort included 1,050 patients of mean ± standard deviation age 34.3 ± 10.3 years. Greater severity of hidradenitis suppurativa was associated with younger age at onset (p < 0.001) and male sex (p < 0.001). The most frequent comorbidities were depression (30%), anxiety (26.4%), and polycystic ovary syndrome (16.6%). Hurley stage I patients rated topical agents, dietary changes, turmeric, and pain relief measures more effective than tetracyclines. For Hurley stage II, adalimumab was rated most effective. For Hurley stage III, adalimumab, other biologic agents, systemic steroids, and surgical treatment were rated more effective than tetracyclines. Patients with hidradenitis suppurativa often have comorbid psychiatric and endocrine diseases. This model of treatment effectiveness provides a direct comparison of standard and complementary options.
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Affiliation(s)
| | | | | | | | | | - Shany Sherman
- Division of Dermatology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 4941492, Israel.
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