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Myers EM, Nassim JS. Beyond caregiving: Navigating life with a developmentally disabled daughter with a severe case of Hidradenitis Suppurativa. SKIN HEALTH AND DISEASE 2024; 4:e403. [PMID: 39104650 PMCID: PMC11297441 DOI: 10.1002/ski2.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Elisha M. Myers
- Trinity College DublinDublinIreland
- Charles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonFloridaUSA
| | - Janelle S. Nassim
- Department of DermatologyIndiana University School of MedicineIndianapolisIndianaUSA
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2
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Boucher A, Peters M, Jones GB. How Digital Solutions Might Provide a World of New Opportunities for Holistic and Empathic Support of Patients with Hidradenitis Suppurativa. Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01234-9. [PMID: 39042318 DOI: 10.1007/s13555-024-01234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a complex chronic relapsing inflammatory condition anchored in the hair follicle wherein painful abscesses, nodules, and tunnels form under the skin with the potential for intermittent pus drainage and tissue scarring. Current estimates of incidence are 1-4% globally with the disease three times more prevalent in women and higher rates among Black populations. Patients with HS are also more likely to suffer from depression, anxiety, and loneliness underscoring the need for carefully approached strategies on disease awareness and interventions. Delays in formal diagnosis, which have been estimated at 7-10 years on average, impede timely provision of optimal care. Despite best intent, when patients present at a physician's office, stigmas relating to physical appearance can be exacerbated by negative interactions experienced by patients. In addition to long wait times and the dearth of available HS expert dermatology professionals, patients perceive heightened physician focus on two of the HS flare risk factors (smoking and body mass index [BMI]) as negatively impacting their care. Given the need for continual, personal, and sensitive patient support, herein we advocate for re-examination of approach to care and the leveraging of highly personalized digital support solutions. New medications which can directly or indirectly control elements of the disease and its comorbidities are also entering the marketplace. Collectively, we posit that these new developments provide opportunity for a holistic approach for patients with HS, leading to long-term engagement and improved outcomes.
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Affiliation(s)
- Annie Boucher
- Novartis Pharma AG, Lichtstrasse 35, 4056, Basel, Switzerland
| | - Martin Peters
- Novartis Pharma AG, Lichtstrasse 35, 4056, Basel, Switzerland
| | - Graham B Jones
- Novartis Pharmaceuticals, 250 Massachusetts Avenue, Cambridge, MA, 02139, USA.
- Clinical and Translational Science Institute, Tufts University Medical Center, 800 Washington Street, Boston, MA, 02111, USA.
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Hjuler KF, Møller LF, Elgaard CDB, Gaïni L, Iversen L, Hjuler TF. On the Interdisciplinary Treatment and Management of Patients with Immune-Mediated Inflammatory Diseases. A Study on Patients' Personal Experiences and Perspectives. J Multidiscip Healthc 2024; 17:2635-2646. [PMID: 38828269 PMCID: PMC11141566 DOI: 10.2147/jmdh.s432820] [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] [Received: 08/22/2023] [Accepted: 04/12/2024] [Indexed: 06/05/2024] Open
Abstract
Purpose Immune-mediated inflammatory diseases (eg, axial spondylitis, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis, and hidradenitis suppurativa) are common diseases that exert an extensive effect on the health-related quality of life, particularly when multiple concomitant conditions are present. Previous reports indicate that the traditional siloed approach to care can lead to a lack of patient centricity and inefficient disease management. In this article, we aimed to evaluate an interdisciplinary program for the treatment of immune-mediated inflammatory diseases compared to routine clinical practice. Patients and Methods This was a mixed-method study, combining qualitative and quantitative data. Patients with co-occurrence of ≥2 immune-mediated inflammatory diseases treated in an interdisciplinary clinic (n = 48) or traditional usual care (n = 17) answered open-ended questions about their care experiences. Two independent coders blinded to patients' treatment group coded three aspects of the narratives provided by the patients' responses: Themes, Emotional valence, and Personal growth (ie, redemption). Themes were analyzed descriptively to explore possible differences between patients assigned to the interdisciplinary clinic and patients assigned to the usual care setting. Group differences in patients' emotional experiences were assessed, and we examined potential group differences in positive personal growth. Results Our findings indicate that an interdisciplinary combined clinic approach provides benefits for patients with multiple inflammatory diseases towards the usual setup. Patients experienced benefits on a number of specific quality-of-life themes including acceptance, optimism, disease understanding, personal growth, and better disease control. The narratives of the patients in the interdisciplinary group were significantly more emotionally positive and included more positive personal growth compared to the usual care group. Conclusion The findings indicate a patient-reported benefit, especially from the holistic approach and cross-specialty combined consultations in an interdisciplinary clinic compared to usual specialized healthcare, which was underscored by narratives highlighting an overall improved quality of life.
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Affiliation(s)
- Kasper Fjellhaugen Hjuler
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
- Danish National Centre for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Louise Faurskov Møller
- Danish National Centre for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Cathrine Dawn Büttner Elgaard
- Danish National Centre for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Laura Gaïni
- Institute of Psychology, Aarhus University, Aarhus, Denmark
| | - Lars Iversen
- Danish National Centre for Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
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Shan HD, Huffman SS, Bovill JD, Haffner ZK, Towfighi P, Benedict CD, Evans KK. Psychiatric Influences on Hidradenitis Suppurativa: A Call for Help. Arch Plast Surg 2024; 51:304-310. [PMID: 38737841 PMCID: PMC11081730 DOI: 10.1055/a-2258-2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/26/2023] [Indexed: 05/14/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is associated with a high prevalence of psychiatric disorders. However, no studies examine how psychiatric disorders influence surgical and financial outcomes. This study aimed to assess impact of a psychiatric diagnosis on patients treated for HS. Methods Patients with HS were retrospectively identified at a single institution from 2010 to 2021. Cohorts were stratified by the presence of a psychiatric disorder. Demographics, comorbidities, and disease characteristics were collected. Outcomes assessed included the procedural interventions and emergency department (ED) visits. Financial distress was assessed via the COST-FACIT Version 2 survey. Results Out of 138 patients, 40 (29.0%) completed the survey of which 19 (47.5%) had a preexisting psychiatric diagnosis. No demographic differences were found between cohorts. Mean follow-up was 16.1 ± 11.0 months. The psychiatric cohort had a higher median number of surgeries received (7.0 vs. 1.5, p < 0.001), a higher median number of ED visits (1.0 vs. 0, p = 0.006), and a similar hospital length of stay ( p = 0.456). The mean COST-FACIT score of the overall study population was 19.2 ± 10.7 (grade 1 financial toxicity). The psych cohort had a lower mean COST-FACIT score (16.8 vs. 21.3, p = 0.092) and reported greater financial hardship (3.3 vs. 1.7, p < 0.001). On multivariate analysis, a psychiatric diagnosis was predictive of lower credit scores, more ED visits, and a higher number of surgeries. Conclusion Preexisting psychiatric conditions in patients with HS are associated with increased health care utilization and surgical intervention with substantial financial distress. Plastic surgeons should be cognizant of such comorbid disorders to facilitate holistic care addressing all patient needs.
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Affiliation(s)
- Holly D. Shan
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Samuel S. Huffman
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - John D. Bovill
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Zoë K. Haffner
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Parhom Towfighi
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia
| | - Carol D. Benedict
- Department of Rheumatology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Karen K. Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
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Rinderknecht FAB, Naik HB. Access to dermatologic care and provider impact on hidradenitis suppurativa care: global survey insights. Int J Womens Dermatol 2024; 10:e130. [PMID: 38240011 PMCID: PMC10796138 DOI: 10.1097/jw9.0000000000000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is an understudied disease, and current HS studies have focused on participants already connected to dermatologic care. Objective We surveyed participants in online HS support communities to gain a comprehensive understanding of how provider type impacts HS disease management and the issues individuals with HS face when accessing care. Methods From June 13 to June 30, 2021, we administered an anonymous cross-sectional online survey to HS Facebook support group participants who had a self-confirmed diagnosis of HS. Survey items assessed respondent demographics, primary HS provider, and barriers to HS care and pain management. Descriptive analyses are presented. Results The survey was viewed 5,168 times and 1,040 surveys met eligibility criteria (20.1%). Survey participants were 97% female and 72% White. Seventy-two percentage resided in the United States and 22% in Europe. Forty-seven percentage reported having a dermatologist as their primary HS provider, 38% reported a nondermatologist, and 15% reported no HS provider. We found that Asian race, full-time employment, private health insurance, and urban setting were each associated with higher rates of having a dermatologist as a primary HS provider. However, 43.7% of those with a dermatologist reported biologic use, as compared with 14.5% with nondermatologist HS providers. Our cohort was notably more severely impacted by comorbid diseases; 55.9% of our cohort had anxiety, 53.6% had depression, and 50.7% had obesity. Overall, 74.2% of our cohort reported experiencing stigma while accessing care for their HS. Limitations Participant recruitment via social media platform facilitates recruitment of individuals across the spectrum of healthcare access, but may introduce selection bias and favor well-resourced areas. Self-reported data may be subject to recall bias. Conclusion Our study provides unique insights into the characteristics and experiences of individuals with HS across the spectrum of health care access.
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Affiliation(s)
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco, California
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6
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Krueger JG, Frew J, Jemec GBE, Kimball AB, Kirby B, Bechara FG, Navrazhina K, Prens E, Reich K, Cullen E, Wolk K. Hidradenitis suppurativa: new insights into disease mechanisms and an evolving treatment landscape. Br J Dermatol 2024; 190:149-162. [PMID: 37715694 DOI: 10.1093/bjd/ljad345] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need. The prevalence of HS reported in most studies is 1-2%, although it is likely to be under-reported and estimates vary globally owing to variance in data collection methods, ethnicity, geographical location and under-diagnosis. HS is characterized by persistent, painful cutaneous nodules, abscesses and draining tunnels commonly affecting the axillary, anogenital, inguinal and perianal/gluteal areas. Over time, chronic uncontrolled inflammation results in irreversible tissue destruction and scarring. Although the pathophysiology of HS has not been fully elucidated, the tumour necrosis factor (TNF)-α and interleukin (IL)-17 pathways have an important role, involving multiple cytokines. Currently, treatment options include topical medications; systemic therapies, including repeated and/or rotational courses of systemic antibiotics, retinoids and hormonal therapies; and various surgical procedures. The anti-TNF-α antibody adalimumab is currently the only biologic approved by both the US Food and Drug Administration and the European Medicines Agency for HS; however, its efficacy varies, with a clinical response reported in approximately 50% of patients in phase III trials. HS is a rapidly evolving field of discovery, with a diverse range of agents with distinct mechanisms of action currently being explored in clinical trials. Several other promising therapeutic targets have recently emerged, and agents targeting the IL-17 and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways are the most advanced in ongoing or completed phase III clinical trials. Alongside limited therapeutic options, significant challenges remain in terms of diagnosis and disease management, with a need for better treatment outcomes. Other unmet needs include significant diagnostic delays, thus missing the therapeutic 'window of opportunity'; the lack of standardized outcome measures in clinical trials; and the lack of established, well-defined disease phenotypes and biomarkers.
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Affiliation(s)
- James G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - John Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Brian Kirby
- Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Kristina Navrazhina
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, TheNetherlands
| | - Kristian Reich
- Translational Research in Inflammatory Skin Diseases, Institute for Health Care Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Germany
- MoonLake Immunotherapeutics AG, Zug, Switzerland
| | - Eva Cullen
- MoonLake Immunotherapeutics AG, Zug, Switzerland
| | - Kerstin Wolk
- Psoriasis Research and Treatment Centre, Department of Dermatology, Venereology and Allergology and Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Marquez DG, Sadeghi NB, Westerkam LL, Blum FR, Dresselhaus A, Sayed CJ. A survey-based study on experiences with and perspectives toward medical providers among patients with hidradenitis suppurativa. Br J Dermatol 2023; 190:127-129. [PMID: 37766476 DOI: 10.1093/bjd/ljad367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 09/29/2023]
Abstract
Patients with hidradenitis suppurativa frequently visit medical providers and are often misdiagnosed or inappropriately educated on their disease. This survey study investigated how often patients received misinformation about their disease. Many participants reported receiving incorrect information that caused shame and made them avoid seeing medical providers.
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Affiliation(s)
| | | | - Linnea L Westerkam
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Christopher J Sayed
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, USA
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Tsentemeidou A, Sotiriou E, Bakirtzi K, Papadimitriou I, Chatzi-Sotiriou T, Panagopoulou A, Kougkas N, Lallas A, Vakirlis E. Quality-of-Life Endpoints in Women of Childbearing Age with Hidradenitis Suppurativa: A Tertiary-Care-Centre-Based Study. Mediterr J Rheumatol 2023; 34:469-478. [PMID: 38282935 PMCID: PMC10815518 DOI: 10.31138/mjr.220823.qoe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/19/2023] [Accepted: 04/02/2023] [Indexed: 01/30/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) principally affects women of childbearing age, who face gender-specific challenges and have lower life-quality than men. HS also seems to impact desire for procreation. Objective To investigate various quality-of-life endpoints in women of childbearing age with HS. Study design A cross-sectional questionnaire-based study was performed at a university dermatology department. Eighteen yes/no and one open-ended questions explored impact of HS on social life, sexual life, family planning, working life and healthcare-backed support. A sensitivity analysis was performed for women under 25, who are significantly less likely to be married/in a permanent relationship in Greece, as this could act as a confounding factor regarding family planning. Results Ninety-six women were included. Most women (80.8%) carry a stigma because of HS, which also affects their choice of clothes and social relationships. Sexual impairment affects 73.1% of women. One third of women wants less or no children because of HS, 67.7% worry about its impact on pregnancy, birth, and the postpartum, and 84.6% worry about the impact of HS treatment on fertility and their babies' health. Almost 43% fear losing their job because of HS, 34.4% are discriminated against at work and 33.3% state HS has hindered their career. Most women are not adequately informed about their disease or available support groups/material and 41.7% have not received good enough care through pregnancy/postpartum. Conclusions Life-quality endpoints should be meticulously screened in women. Multidisciplinary-led treatment should be offered during pregnancy and the postpartum.
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Affiliation(s)
- Aikaterini Tsentemeidou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Elena Sotiriou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Katerina Bakirtzi
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Ilias Papadimitriou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Themis Chatzi-Sotiriou
- Department of International and European Studies, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
| | - Angeliki Panagopoulou
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Nikolaos Kougkas
- Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Department of Dermatology and Venereology, School of Medicine, Aristotle University, Thessaloniki, Greece
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Fisher J, Fones G. Reflecting on the intersectionality of lived experiences of dermatological diseases and the WHO Framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:51-53. [PMID: 37805999 DOI: 10.1111/jdv.19270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Jack Fisher
- Global Coordination Mechanism for the Prevention and Control of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Guy Fones
- Global Coordination Mechanism for the Prevention and Control of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Gisondi P, Puig L, Richard MA, Paul C, Nijsten T, Taieb C, Stratigos A, Trakatelli M, Salavastru C. Quality of life and stigmatization in people with skin diseases in Europe: A large survey from the 'burden of skin diseases' EADV project. J Eur Acad Dermatol Venereol 2023; 37 Suppl 7:6-14. [PMID: 37806002 DOI: 10.1111/jdv.18917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/09/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Several large studies on the burden of skin diseases have been performed in patients recruited in hospitals or clinical centres, thus missing people with skin diseases who do not undergo a clinical consultation. OBJECTIVES To evaluate the burden of the most common dermatological diseases in adult patients across Europe, in terms of quality of life, work life, and stigmatization. METHODS Population-based survey on a representative sample of the European general population aged 18 years or older. Participants who declared to have had one or more skin problem or disease during the previous 12 months completed the Dermatology Life Quality Index questionnaire, and answered questions regarding the impact of their skin disease on daily and work life, anxiety/depression, and stigmatization. RESULTS The study population included 19,915 individuals, 44.7% of whom were men. Quality of life was particularly impaired in people with hidradenitis suppurativa (HS), and sexually transmitted diseases. About a half of participants with acne, alopecia, or chronic urticaria, and about 40% of those with atopic dermatitis (AD), skin cancers, or psoriasis reported a modest to extremely large effect of the disease on their quality of life. Overall, 88.1% of participants considered their skin disease as embarrassing in personal life and 83% in work life. About half of the respondents reported sleeping difficulty, feeling tired, and impact of the disease on taking care of themselves. Concerning stigmatization, 14.5% felt to have been rejected by others because of the skin disease, and 19.2% to have been looked at with disgust. Anxiety and depression were frequently reported by patients with all the diseases. CONCLUSIONS Skin diseases may heavily affect patients' daily and work life, and cause feelings of stigmatization. An early intervention is needed to avoid consequences on the patients' life course.
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Affiliation(s)
- Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marie Aleth Richard
- CEReSS-EA 3279, Research Centre in Health Services and Quality of Life Aix Marseille University, Dermatology Department, University Hospital Timone, Assistance Publique Hôpitaux de Marseille, APHM, Marseille, France
| | - Carle Paul
- INSERM Infinity U1291, Université de Toulouse et CHU, Toulouse, France
| | - Tamar Nijsten
- Department of Dermatology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Alex Stratigos
- Department of Dermatology, Andreas Syggros Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Trakatelli
- Second Department of Dermatology and Venerology of Aristotle School of Medicine Papageorgiou Hospital, Thessaloniki, Greece
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
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Snyder CL, Chen SX, Porter ML. Obstacles to Early Diagnosis and Treatment of Hidradenitis Suppurativa: Current Perspectives on Improving Clinical Management. Clin Cosmet Investig Dermatol 2023; 16:1833-1841. [PMID: 37483473 PMCID: PMC10361090 DOI: 10.2147/ccid.s301794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can progress to significant tunnels and scars that affect quality of life, especially if diagnosis and treatment are delayed. Average delay after initial presentation of HS symptoms can range from 3 to 10 years in adults and 1 to 2 years in children. Factors associated with diagnostic delay include female gender, non-white race, and greater disease severity at diagnosis. Contributing factors include misdiagnoses, difficulty accessing a dermatologist, hesitation in seeking care due to the stigmatizing nature of the disease, and lack of awareness among providers and patients. While efforts to increase awareness include academic talks at conferences and by foundations geared toward HS, social media offers the opportunity to reach young audiences. Many patients report dissatisfaction with their HS treatments. Better understanding of HS pathophysiology and implementation of clinically focused phenotypes and endotypes can lead to development of more targeted and efficacious therapies. FDA approval of medications for HS beyond adalimumab will increase access to a wider selection of therapies, and implementation of therapeutic drug monitoring may maximize the use of biologics for HS.
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Affiliation(s)
- Corey L Snyder
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Stella X Chen
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, Massachusetts General Hospital, Harvard Combined Dermatology Residency Program, Boston, MA, USA
| | - Martina L Porter
- Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Koumaki D, Rovithi E, Apokidou ES, Papadakis M, Katoulis A, Evangelou G. Cutaneous body image in patients with hidradenitis suppurativa: a hospital-based cross-sectional study. Sci Rep 2023; 13:7898. [PMID: 37193758 DOI: 10.1038/s41598-023-35120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 05/12/2023] [Indexed: 05/18/2023] Open
Abstract
Hidradenitis suppurativa (HS) has been linked with body image (BI) impairment and reduced quality of life (QoL). We sought to evaluate the associations between Cutaneous Body Image Scale (CBIS) and disease severity in HS patients.Between July 2020 and January 2022, a cross-sectional study was carried out including consecutive HS patients above the age of 16 who attended a Tertiary Referral Hospital in Greece. Disease Severity was graded with the Hurley stage, HS-Physician's Global Assessment (HS-PGA) scale, and the Modified Sartorius scale (MSS). Patients completed at their first visit ten survey instruments including Patients' Severity of disease, pain and pruritus scale, CBIS, Multidimensional Body-Self Relations Questionnaire (MBSRQ) including 5 subscales: Appearance Evaluation (AE), Appearance Orientation (AO), Body Areas Satisfaction Scale (BASS), Overweight Preoccupation (OWP), and Self Classified Weight (SCW) , Dermatology Quality of Life Index (DLQI), Skindex-16, EQ5D 5L, EQ- visual analogue scale (VAS), PHQ9, and GAD7. In total, 70 HS patients above 16 years old participated, mean [SD] age, 34.44 [11.64] years; 49/70 (70%) males and 21/70 (30%) females. Mean ± SD CBI, DLQI, Skindex-16 total, EQ-5D-5L, EQ VAS, PHQ9 and GAD7 were 5.59 ± 1.58, 11.70 ± 8.88, 52.90 ± 27.75, 0.75 ± 0.21, 62.48 ± 21.12, 7.64 ± 5.56, 7.87 ± 5.23 respectively. Moderate to severe CBI dissatisfaction was reported by 36/70 (51.42%) patients. CBI was correlated with appearance evaluation (AE) (p < 0.01, r = 0.544), body areas satisfaction (BASS) (p < 0.01, r = 0.481), and overweight preoccupation subscale (OWPS) (p < 0.01, r = - 0.267), and Skindex-16 (p < 0.01, r = - 0.288). HS patients with affected genital areas scored higher in disease patient's severity score (p = 0.015), and male patients scored higher in Skindex-16 than females(p < 0.01). Our study found that the mean of CBI in HS patients was 5.59 ± SD 1.58. Predictors for CBI dissatisfaction were low scores of MBSRQ Appearance Evaluation (AE) and Body Areas Satisfaction Subscale (BASS).
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Evangelia Rovithi
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Erato Solia Apokidou
- Department of Internal Medicine, Agios Nikolaos General Hospital, Knosou 4, Ag. Nikolaos, 72100, Crete, Greece
| | - Marios Papadakis
- Department of Surgery II, Witten/Herdecke University, Heusnerstrasse 40, 42283, Witten, Germany.
| | - Alexander Katoulis
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Chaidari, Athens, Greece
| | - George Evangelou
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
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Singh R, Kelly KA, Senthilnathan A, Feldman SR, Pichardo RO. Stigmatization, a social perception which may have a debilitating impact on hidradenitis suppurativa patients: an observational study. Arch Dermatol Res 2023; 315:1049-1052. [PMID: 36315267 PMCID: PMC9628443 DOI: 10.1007/s00403-022-02412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/13/2022] [Indexed: 11/26/2022]
Abstract
Hidradenitis suppurativa (HS) is a debilitating disease and patients are prone to feelings of stigmatization. In our cohort, we assessed how feelings of stigmatization may relate to patient quality of life (QOL), depression, and social anxiety. Participants completed the Dermatology Life Quality Index (DLQI) to assess QOL, Patient Health Questionnaire 9 (PHQ-9) to assess depression, the Brief Fear of Negative Evaluation (BFNE) to assess social anxiety, and an adapted version of the Feelings of Stigmatization (FoS) to assess stigmatization. The FoS also correlated with DLQI (R = 0.68), PHQ-9 (R = 0.42), and BFNE (R = 0.52). Participants with greater FoS were also more likely to have worse QOL (18.1), higher levels of depression (11.1), and higher social anxiety (30.1), as compared to those with less FoS (6.7, P < 0.001; 4.9, P < 0.001; 23.2, P < 0.001, respectively). HS is a chronic disease with no definitive treatment. Effective screening protocols, coupled with pharmacological and nonpharmacological interventions, may help patients with HS's psychosocial burden.
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Affiliation(s)
- Rohan Singh
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA.
| | - Katherine A Kelly
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Aditi Senthilnathan
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rita O Pichardo
- Department of Dermatology, Center for Dermatology Research, Wake Forest School of Medicine, 1 Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA
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Ortiz-Álvarez J, Hernández-Rodríguez JC, Durán-Romero AJ, Conejo-Mir Sánchez J, Pereyra-Rodríguez JJ, Osorio-Gómez GF. Hidradenitis suppurativa and suicide risk: a multivariate analysis in a disease with a high psychological burden. Arch Dermatol Res 2023; 315:637-642. [PMID: 36107231 PMCID: PMC9477168 DOI: 10.1007/s00403-022-02391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/06/2022] [Accepted: 09/07/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a disorder that can lead to serious sequelae and important comorbidities. It has been associated with different mental health conditions, such as depression, anxiety or completed suicide. The objective is to analyze the suicide risk (SR) among patients in a monographic HS consultation, as well as to establish individual association factors. METHODS Patients older than 18 years seen in our specific HS unit were consecutively included and invited to respond to the self-administered Beck hopelessness scale. Those patients with significant intellectual disabilities or severe mental health conditions, including a history of psychosis, were excluded. In addition, data related to the skin process were collected. Subsequently, it was studied whether there were significant differences between patients with absent-mild SR and those with moderate-severe SR and a logistic regression analysis was performed to determine the relationship of these variables with SR. RESULTS A total of 136 patients were included in the study, 51.5% men. Of them, 21.3% presented a moderate or severe SR (score ≥ 9 in the Beck test). This risk was significantly related to having a previous or concomitant psychiatric disorder (OR = 2.586, 95% CI 1.044-6.409, p = 0.040) followed by the history of biological treatment (OR = 2.867, 95% CI 1.004-8.182, p = 0.049). The existence of other affected relatives was confirmed as a protective factor (OR = 0.377, 95% CI 0.150-0.951, p = 0.039). CONCLUSIONS The prevalence of SR in patients with HS is higher than that of the general Spanish population. The presence of a psychiatric disorder and the need for biological treatment are established as factors that increase SR, both of which can be interpreted as a more advanced disease. As a protective factor, the presence of other cases in the family is established, which suggests a greater normalization of the disease.
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Affiliation(s)
- Juan Ortiz-Álvarez
- Dermatology Unit, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot sn, 41013, Seville, Spain.
| | | | - Antonio José Durán-Romero
- Dermatology Unit, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot sn, 41013, Seville, Spain
| | - Julián Conejo-Mir Sánchez
- Dermatology Unit, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot sn, 41013, Seville, Spain
- Medicine Department, Universidad de Sevilla, Seville, Spain
| | - José Juan Pereyra-Rodríguez
- Dermatology Unit, Hospital Universitario Virgen del Rocío, Avda Manuel Siurot sn, 41013, Seville, Spain
- Medicine Department, Universidad de Sevilla, Seville, Spain
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A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med 2023; 136:42-53. [PMID: 36252715 DOI: 10.1016/j.amjmed.2022.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
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Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits. Biomedicines 2022; 10:biomedicines10112973. [PMID: 36428540 PMCID: PMC9687269 DOI: 10.3390/biomedicines10112973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/31/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.
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Perche PO, Singh R, Senthilnathan A, Feldman SR, Pichardo RO. Hidradenitis Suppurativa’s Impact on Social Activities: An Observational Study. Cureus 2022; 14:e25292. [PMID: 35637919 PMCID: PMC9128839 DOI: 10.7759/cureus.25292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
Abstract
Hidradenitis suppurativa (HS) can severely impact patients’ quality of life. However, its specific impact on participation in everyday social activities is not well characterized. We recruited a cohort of patients with HS to complete a survey assessing the degree of interference HS has on participation in social activities. Patients also completed the Brief Fear of Negative Evaluation (BFNE) to assess levels of social anxiety. The majority of patients in our cohort, regardless of Hurley Stage, reported interference with social activities, and patients with more painful nodules and greater body region involvement reported greater interference with social activities. BFNE scores were high in our cohort, and patients with higher BFNE scores reported greater interference in all social activities assessed. Both the physical and psychological effects of HS may interfere with patients’ participation in social activities, and efforts to treat both aspects may improve quality of life.
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Ingram JR, Bettoli V, Espy JI, Kokolakis G, Martorell A, Villani AP, Wallinger H, Coak E, Kasparek T, Muscianisi E, Richardson C, Kimball AB. Unmet clinical needs and burden of disease in hidradenitis suppurativa: Real-world experience from EU5 and US. J Eur Acad Dermatol Venereol 2022; 36:1597-1605. [PMID: 35445469 PMCID: PMC9545202 DOI: 10.1111/jdv.18163] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/17/2022] [Indexed: 12/04/2022]
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease characterized by painful deep lesions and associated with substantial disease burden. Objectives The objective of this study was to describe physician‐ and patient‐reported clinical unmet needs from a real‐world perspective. Methods This study used data from the Adelphi HS Disease Specific Programme, a point‐in‐time survey of dermatologists and their patients with HS in Europe and the United States. Dermatologists completed patient record forms (PRFs) for 5–7 consecutively consulting patients with HS; patients or carers of patients also optionally completed a patient/carer self‐completion questionnaire (PSC/CSC). Data collection included demographics, symptomatology and impact on quality of life (QoL). Results Dermatologists (N = 312) completed PRFs for 1787 patients with HS; patient‐ and carer‐reported questionnaires (PSC/CSC) were completed for 33.1% (591/1787) of patients. The mean age was 34.4 ± 12.2 years and 57.6% of patients were female (1029/1787). Physician‐judged disease severity at sampling was categorized as mild in 66.0% (1179/1787), moderate in 29.3% (523/1787) and severe in 4.7% (85/1787) of patients. Deterioration or unstable condition over the previous 12 months was described by 17.1% [235/1372] and 12.6% [41/325] of physician‐ and patient/carer‐reported cases, respectively. Despite receiving treatment, high proportions of patients still experienced symptoms at sampling (general pain/discomfort [49.5%, 885/1787]; inflammation/redness of lesions/abscesses [46.1%, 823/1787] and itching [29.9%, 535/1787]); these symptoms were more frequent in patients with moderate or severe disease. Patients reported a mean Dermatology Life Quality Index score of 5.9 ± 5.4 (555/591; mild, 4.1 ± 4.3; moderate, 9.4 ± 5.4; severe, 13.3 ± 5.5) and a mean Hidradenitis Suppurativa Quality of Life score of 11.0 ± 10.6 (518/591; mild, 7.6 ± 8.3; moderate, 17.7 ± 10.0; severe, 31.0 ± 15.4) indicating a substantial impact on QoL. Conclusions Patients with HS experienced a high disease burden despite being actively treated by a dermatologist. This study demonstrates that the burden of HS disease is generally poorly managed with a considerable impact observed on patients' QoL.
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Affiliation(s)
- J R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - V Bettoli
- Department of Oncology and Specialistic Medicine, O.U. of Dermatology, Azienda Ospedaliera - University of Ferrara, Italy
| | - J I Espy
- Hidradenitis Suppurativa Patient Advocate, Multimedia Journalist, and Filmmaker
| | - G Kokolakis
- Psoriasis Research and Treatment Center, Clinic of Dermatology, Venereology, and Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Martorell
- Department of Dermatology, Hospital de Manises, Valencia, Spain
| | - A P Villani
- Hospices Civils de Lyon, Claude Bernard Lyon I University, Department of Dermatology - Edouard Herriot Hospital, Lyon, France
| | | | - E Coak
- Adelphi Real World, Bollington, UK
| | | | - E Muscianisi
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | | | - A B Kimball
- Harvard Medical School and Clinical Laboratory for Epidemiology and Applied Research in Skin (CLEARS), Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, USA
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Association between Androgenetic Alopecia and Psychosocial Disease Burden: A Cross-Sectional Survey among Polish Men. Dermatol Res Pract 2022; 2022:1845044. [PMID: 35340914 PMCID: PMC8947924 DOI: 10.1155/2022/1845044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
A decline in quality of life in men with androgenetic alopecia (AGA) is frequently reported, so we aimed to evaluate the psychosocial burden related to AGA in Polish male patients with AGA. We enrolled 75 adult patients with AGA. The study was conducted in an outpatient dermatology clinic in Poland. Each participant answered 23 dedicated questions about demographic data, history of the disease, and a psychosocial condition. Overall, 38.7% of patients did not notice any impact of AGA on their contact with other people or activity in their free time; 50.7% of patients observed little or no effect on their relationship with their partner; 60% of patients often or sometimes felt embarrassed by their baldness (mainly those aged 18–25 years; p=0.002); 66.7% of patients reported a rather large negative impact on their self-esteem; and 81.3% of patients sometimes experienced stress in everyday life. We conclude that AGA impairs the emotional condition and social functioning of men of all ages, but particularly of younger men. Broader interventions should be planned to allow access to a psychological and psychosocial support, starting treatment at an early stage of the disease, and involving family physicians in the treatment of AGA.
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Schienle A, Wabnegger A. Self-disgust in Patients with Dermatological Diseases. Int J Behav Med 2022; 29:827-832. [PMID: 35113320 DOI: 10.1007/s12529-022-10058-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Dermatological diseases can be associated with symptoms such as oozing pus, weeping, and/or bleeding, which represent primary disgust elicitors. This study examined the role of self-disgust in people with different skin conditions (e.g., hidradenitis suppurativa, psoriasis, lichen sclerosus). METHODS A self-selected sample of 200 dermatology patients completed questionnaires for the assessment of self-disgust, experienced stigmatization, symptoms of depression, anxiety, and somatization. Multiple regression analysis and mediation analysis were computed to examine the relationship between self-disgust and the other selected variables. RESULTS Sixty-four percent of the patients reported elevated self-disgust. Sex, age, depression, and perceived stigmatization were predictors of self-disgust. Depression mediated the relationship between stigmatization (e.g., staring by others) and self-disgust. CONCLUSIONS This study points to the important role of self-disgust in dermatological conditions. Public health programs to counteract stigmatization of patients with skin diseases as well as therapy approaches that help decrease patients' self-disgust and increase self-acceptance are urgently needed.
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Affiliation(s)
- Anne Schienle
- Institute of Psychology, University of Graz, Universitätsplatz 2, 8010, Graz, Austria.
| | - Albert Wabnegger
- Institute of Psychology, University of Graz, Universitätsplatz 2, 8010, Graz, Austria
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Han HR, Choi CE, Nagad M, Patwardhan KR, Boer J, Jemec G, Chandran NS. Prevalence and Perceptions Towards Hidradenitis suppurativa; A Cross-Sectional Study in a Non-Dermatological Outpatient Population. J Eur Acad Dermatol Venereol 2022; 36:e392-e394. [PMID: 35034401 DOI: 10.1111/jdv.17933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/05/2021] [Accepted: 01/07/2022] [Indexed: 11/26/2022]
Affiliation(s)
- H R Han
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - C E Choi
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - M Nagad
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - K R Patwardhan
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - J Boer
- Department of Dermatology, Deventer Hospital, N. Bolkesteinlaan 75, 7416 SE, The Netherlands
| | - Gbe Jemec
- Department of Dermatology, Zealand University Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - N S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
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Alavi A, Hamzavi I, Brown K, Santos LL, Zhu Z, Liu H, Howell MD, Kirby J. Janus kinase 1 inhibitor INCB054707 for patients with moderate-to-severe hidradenitis suppurativa: results from two phase 2 studies. Br J Dermatol 2022; 186:803-813. [PMID: 34978076 PMCID: PMC9314604 DOI: 10.1111/bjd.20969] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
Abstract
Background Janus kinase (JAK)‐mediated cytokine signalling contributes to local and systemic inflammation in hidradenitis suppurativa (HS). Objectives To describe the safety and efficacy results from two multicentre phase II trials of the JAK1 inhibitor INCB054707 in patients with moderate‐to‐severe HS. Methods Patients received open‐label INCB054707 15 mg once daily (QD; Study 1) or were randomized to INCB054707 30, 60 or 90 mg QD or placebo (3 : 1 within each cohort; Study 2) for 8 weeks. Eligible patients were aged 18–75 years and had moderate‐to‐severe HS (Hurley stage II/III disease), lesions present in at least two anatomical locations, and a total abscess and inflammatory nodule count ≥ 3. The primary endpoint for both studies was safety and tolerability. Secondary endpoints included HS Clinical Response (HiSCR) and other efficacy measures. Results Ten patients were enrolled in Study 1 (15 mg INCB054707) and 35 in Study 2 (INCB054707: 30 mg, n = 9; 60 mg, n = 9; 90 mg, n = 8; placebo, n = 9). Overall, 70% of patients in Study 1 and 81% of patients receiving INCB054707 in Study 2 experienced at least one treatment‐emergent adverse event; 30% and 42% of patients, respectively, had at least one treatment‐related adverse event. Among the evaluable patients, three (43%) in Study 1 and 17 (65% overall: 30 mg, 56%; 60 mg, 56%; 90 mg, 88%) receiving INCB054707 vs. 4 patients (57%) receiving placebo in Study 2 achieved HiSCR at week 8. Conclusions INCB054707 was well tolerated, with responses observed in patients with moderate‐to‐severe HS. The safety and efficacy findings from these studies demonstrate proof of concept for JAK1 inhibition in HS. The studies are registered on ClinicalTrials.gov (NCT03569371 and NCT03607487).
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Affiliation(s)
- Afsaneh Alavi
- Mayo Clinic, Rochester, MN, USA.,York Dermatology Clinic and Research Centre, Richmond Hill, ON, Canada
| | | | | | | | | | | | | | - Joslyn Kirby
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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de Filippis R, Menculini G, D'Angelo M, Carbone EA, Tortorella A, De Fazio P, Steardo L. Internalized-stigma and dissociative experiences in bipolar disorder. Front Psychiatry 2022; 13:953621. [PMID: 35966460 PMCID: PMC9372275 DOI: 10.3389/fpsyt.2022.953621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Dissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD. MATERIALS AND METHODS In this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA). RESULTS Average age and age at BD (BD-I n = 66, 55%; BD-II n = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female (n = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) (p < 0.001) and Stereotype (13.8, SD±3.9) (p < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (p < 0.001), stereotype (p < 0.001) and MANSA total-score (p < 0.001). DISCUSSION For the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Martina D'Angelo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Psychiatry Unit, Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Luca Steardo
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Sommer R, Weinberger NA, Von Spreckelsen R, Mrowietz U, Schielein MC, Luck-Sikorski C, Augustin M. A Structured Intervention for Medical Students Significantly Improves Awareness for Stigmatisation in Visible Chronic Skin Diseases: A Randomised Controlled Trial. Acta Derm Venereol 2021; 102:adv00641. [PMID: 34904689 PMCID: PMC9631292 DOI: 10.2340/actadv.v101.894] [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] [Indexed: 11/26/2022] Open
Abstract
People with visible skin diseases often experience stigmatisation. The aim of this study was to develop and evaluate a new intervention for medical students to counter the stigmatisation of people with skin diseases. The intervention was evaluated using a randomised controlled design. Effectiveness was assessed at 3 time points. Data from 127 participants were analysed. Regarding the outcome “social distance”, a significant difference between the measurement points was observed for the intervention group (χ2(2) = 54.32, p < 0.001), which also showed a significant effect on agreement with negative stereotypes (F(1.67, 118.67) = 23.83, p < 0.001, partial η2 = 0.25). Regarding the outcome “agreement with disease-related misconceptions”, a significant difference between the measurement time points was observed for the intervention group (χ2(2) = 46.33, p < 0.001); similar results were found for the outcome “stigmatising behaviour” (F(1.86, 131.89) = 6.16, p = 0.003, partial η2 = 0.08). The results should encourage medical faculties to invest in such courses in order to prevent stigmatisation of people with skin diseases.
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Affiliation(s)
- Rachel Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, DE-20246 Hamburg, Germany.
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25
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Zhang H, Zhang D, Tang K, Sun Q. The Relationship Between Alzheimer's Disease and Skin Diseases: A Review. Clin Cosmet Investig Dermatol 2021; 14:1551-1560. [PMID: 34729018 PMCID: PMC8554316 DOI: 10.2147/ccid.s322530] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/15/2021] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease is the most common type of dementia placing a heavy burden on the healthcare system worldwide. Skin diseases are also one of the most common health problems. Several skin diseases are associated with Alzheimer's disease through different mechanisms. This review summarizes the relationship between Alzheimer's disease and several types of skin diseases, including bullous pemphigoid, hidradenitis suppurativa, psoriasis, skin cancer, and cutaneous amyloidosis, and provides suggestions based on these associations. Neurologists, dermatologists, and general practitioners should be aware of the relationship between Alzheimer's disease and skin diseases. Dermatology/neurology consultation or referral is necessary when needed.
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Affiliation(s)
- Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Dingyue Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Keyun Tang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
| | - Qiuning Sun
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Skin and Immune Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People's Republic of China
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26
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Akoglu G, Esme P, Yildiz I. Patients With Hidradenitis Suppurativa Negatively Perceive Both Medical and Euphemistic Appellations of Their Disease: A Study From Turkey. Dermatol Pract Concept 2021; 11:e2021092. [PMID: 34631262 DOI: 10.5826/dpc.1104a92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2021] [Indexed: 10/31/2022] Open
Abstract
Background The use of medical terms and folk names (euphemisms) affect a patient's understanding of diseases and perceptions of severity. Objectives We determine the psychological effects on patients with hidradenitis suppurativa of medical and folk names of their disease. Methods This was a cross-sectional and exploratory study conducted at a tertiary referral university hospital in Turkey. A questionnaire on the medical and folk names of hidradenitis suppurativa was administered to 31 males and 25 females. Results The patients expressed that they found the medical term hidradenitis suppurativa to be incomprehensible because it is a foreign term. When hearing it for the first time, it evoked negative responses such as confusion and worry about their health. Half of the patients preferred their doctors to use a more understandable and pronounceable name. More than 80% of patients expressed feeling depressed and stigmatized by the folk name of their disease. They preferred the terms boils, abscesses, or hidradenitis when referring to their disease. Conclusion Both medical and folk names for hidradenitis suppurativa have negative effects on patients, and most patients feel stigmatized by either term.
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Affiliation(s)
- Gulsen Akoglu
- University of Health Sciences, Gulhane Training and Research Hospital, Department of Dermatology and Venereology, Ankara, Turkey
| | - Pelin Esme
- University of Health Sciences, Gulhane Training and Research Hospital, Department of Dermatology and Venereology, Ankara, Turkey
| | - Irem Yildiz
- Hacettepe University Faculty of Medicine, Department of Psychiatry, Ankara, Turkey
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27
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Rick JW, Thompson AM, Fernandez JM, Maarouf M, Seivright JR, Hsiao JL, Shi VY. Misdiagnoses and barriers to care in hidradenitis suppurativa: A patient survey. Australas J Dermatol 2021; 62:e592-e594. [PMID: 34314017 DOI: 10.1111/ajd.13672] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Jonathan W Rick
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | | | - Melody Maarouf
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Justine R Seivright
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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28
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Weigelt MA, Milrad SF, Kirby JRS, Lev-Tov H. Psychosocial impact of hidradenitis suppurativa: a practical guide for clinicians. J DERMATOL TREAT 2021; 33:1861-1868. [PMID: 34060964 DOI: 10.1080/09546634.2021.1937483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a debilitating skin disease with significant and often underappreciated effects on quality of life; available treatments fail to achieve consistent rates of remission. Targeting the psychosocial impact of HS has great potential to improve care for these patients. Although the literature on this topic is broad, there is a lack of specific tools that guide clinicians in this domain. METHODS The authors surveyed the literature to find the aspects of psychosocial functioning that most significantly impact Health-Related Quality of Life (HRQOL) for HS patients, and which may be assessed in a simple and efficient manner. RESULTS AND DISCUSSION Depression and anxiety, sexuality and body image, and financial strain were identified as the most significant drivers of poor HRQOL with the greatest potential to be screened for and addressed succinctly and effectively. A practical psychosocial management guide for clinicians is presented. The guide includes a list of preexisting validated screening questions, clear guidelines for interpretation, and a suggested management algorithm all geared toward a 'real-life' medical practice. CONCLUSION Such an approach holds a great potential for improving the care of patients with HS. Validation of this approach via controlled trials is a logical next step.
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Affiliation(s)
- Maximillian A Weigelt
- Department of Internal Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Sara F Milrad
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Joslyn R S Kirby
- Penn State Health Dermatology - Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Hadar Lev-Tov
- Dr Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
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29
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von Stülpnagel CC, Augustin M, Düpmann L, da Silva N, Sommer R. Mapping risk factors for cumulative life course impairment in patients with chronic skin diseases - a systematic review. J Eur Acad Dermatol Venereol 2021; 35:2166-2184. [PMID: 33988873 DOI: 10.1111/jdv.17348] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/27/2021] [Indexed: 02/01/2023]
Abstract
Patients with chronic skin diseases suffer from physical and psychosocial impairments which can lead to a cumulative life-long burden. Therefore, the concept of cumulative life course impairment (CLCI) was introduced, referring to the non-reversible damage due to the persistent life-long burden. This systematic review (PROSPERO registry number: CRD42020179141) aimed at mapping the risk factors and the associated burden over time in patients with psoriasis, atopic dermatitis (AD) and hidradenitis suppurativa (HS). Three electronic databases were searched (date of the last search: December 2019). Studies with a longitudinal study design that assessed the association between a risk factor and the associated burden over time in patients with psoriasis, AD and HS were included. Quality assessment of the included studies was done using Critical Appraisal Skills Programme (CASP) checklists. In total, 40 publications reflecting 25 different studies were included: nine studies addressed patients with psoriasis, 13 patients with AD, two studies included patients with HS and one study enrolled patients with psoriasis and AD, respectively. Twenty-two potential risk factors with underlying evidence were found in this review. These risk factors include mainly sociodemographic (such as age or gender) and clinical (such as disease severity or comorbidities) variables. Disease severity and comorbidities were the most often studied risk factors, while only a few studies evaluated psychosocial risk factors over time. Patients with chronic skin diseases are at high risk to develop a life-long negative impact from the disease. However, there is a lack of data that evaluates the psychosocial burden and its influence on the patients' life course over time. The risk factors found in this review help to identify patients at risk, to treat them adequately and, ultimately, to prevent CLCI. These results can be the basis to develop a highly needed tool to assess the risk for CLCI in the future.
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Affiliation(s)
- C C von Stülpnagel
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Augustin
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Düpmann
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N da Silva
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Sommer
- German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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30
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Akoglu G, Yildiz I, Karaismailoğlu E, Esme P. Disease severity and poor mental health are the main predictors of stigmatization in patients with hidradenitis suppurativa. Dermatol Ther 2021; 34:e14910. [PMID: 33619860 DOI: 10.1111/dth.14910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/06/2021] [Accepted: 02/19/2021] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa (HS) causes significant psychological distress in patients. We aimed to investigate the stigmatization level of HS patients and to determine the related physical, social, and psychological factors. A questionnaire with 22 questions about the physical and psychosocial problems related to HS was administered to 29 male and 34 female patients between the ages of 18 and 66 to evaluate the thoughts, emotions, attitudes, and behaviors of patients. Each patient filled Dermatology Life Quality Index, Beck Depression Inventory, Liebowitz Social Anxiety Scale, Body Image Scale, and 6-item Stigmatization Scale. Hurley classification was used to assess severity of disease. Patients with HS feel stigmatized depending on physical and psychosocial problems caused by the disease. Higher stigmatization scores correlated with higher scores of depression (r: .437, P < .001), social anxiety (r: .263, P: .03), and worse life quality (r: .522, P < .001), and body image perception (r: .696, P < .001). The degree of stigmatization was closely associated with the presence of painful lesions and disruption of socializing (P: .021 and .033, respectively). Disease severity (β: 5.12, P: .003 for moderate disease) and reporting feeling psychologically negatively affected due to HS (β: 4.26 P: .007) were the two main predictors of stigmatization in patients with HS. Cross-sectional nature of the study is the limitation. In conclusion, the stigmatization level of patients with HS is strongly related to disease severity and poor mental health.
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Affiliation(s)
- Gulsen Akoglu
- Department of Dermatology and Venereology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Irem Yildiz
- Faculty of Medicine, Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - Eda Karaismailoğlu
- Department of Medical Informatics, University of Health Sciences, Gulhane School of Medicine, Ankara, Turkey
| | - Pelin Esme
- Department of Dermatology and Venereology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
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31
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Bouazzi D, McPhie ML, Kjaersgaard Andersen R, Alavi A, Jemec GBE. Hidradenitis suppurativa and perceived stigmatization in a diverse Canadian clinic population: a pilot study. Br J Dermatol 2020; 184:570-571. [PMID: 33095910 DOI: 10.1111/bjd.19626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Affiliation(s)
- D Bouazzi
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - M L McPhie
- School of Medicine, Queen's University, 15 Arch St, Kingston, ON, K7L 3N6, Canada
| | - R Kjaersgaard Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada.,Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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32
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Wollina U, Brzezinski P, Koch A, Philipp-Dormston WG. Immunomodulatory drugs alone and adjuvant to surgery for hidradenitis suppurativa/acne inversa-A narrative review. Dermatol Ther 2020; 33:e13877. [PMID: 32558202 DOI: 10.1111/dth.13877] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
Hidradenitis suppurativa/acne inversa (HS/AI) is one of the most debilitating dermatoses with a strong negative impact on every dimension of quality of life. Treatment is dependent on the severity of clinical manifestations and comorbidities. While anti-inflammatory and antimicrobial approaches are recommended for mild and moderate stages, immunomodulatory drugs have gained increasing interest in all stages of HS/AI. We reviewed the available data on this subject in a narrative review and included not only substances with published final outcome but those where either the ongoing trials or experience from case report. Furthermore, we investigated combined surgical therapy and immunomodulatory drugs and raised specific questions to be answered in controlled settings. This aspect seems to be underrepresented. The first approved medical treatment for HS/AI is adalimumab. Other cytokine, interleukin, Janus kinase and C5a inhibitors and antagonists are under investigation. IL-1 inhibitors and antagonists may become an option for mild to moderate HS/AI, while most of the other medical compounds target moderate to severe HS/AI. Despite medical efforts with immunomodulatory agents, surgery remains a cornerstone of efficient HS/AI therapy. Better outcome in advanced disease might be achieved by combining drug therapy and surgery, but more systematic clinical trials are necessary for the optimal combination.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Piotr Brzezinski
- Institute of Biology and Environmental Protection, Pomeranian Academy, Slupsk, Poland.,Department of Dermatology, 6th Military Support Unit, Ustka, Poland
| | - André Koch
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Wolfgang G Philipp-Dormston
- Faculty of Health, University Witten/Herdecke, Witten, Germany.,Hautzentrum Koeln, Klinik Links vom Rhein, Cologne, Germany
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33
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Impact of 970 nm photobiomodulation therapy on wound healing in cellular models of hidradenitis suppurativa. Lasers Med Sci 2020; 36:691-698. [PMID: 32647934 DOI: 10.1007/s10103-020-03097-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
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34
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Misitzis A, Goldust M, Jafferany M, Lotti T. Psychiatric comorbidities in patients with hidradenitis suppurativa. Dermatol Ther 2020; 33:e13541. [DOI: 10.1111/dth.13541] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Angelica Misitzis
- 1st Department of Dermatology and Venereology, School of Health Sciences National and Kapodistrian University of Athens Athens Greece
| | - Mohamad Goldust
- Department of Dermatology University Hospital Basel Basel Switzerland
| | - Mohammad Jafferany
- Division of Psychodermatology, Department of Psychiatry Central Michigan University College of Medicine Saginaw Michigan USA
| | - Torello Lotti
- Department of Dermatology and Venereology University of Studies Guglielmo Marconi Rome Italy
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