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Alter M. [Hidradenitis suppurativa]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:497-506. [PMID: 38512397 DOI: 10.1007/s00105-024-05321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/23/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin and systemic disease that is associated with considerable discomfort and a significant reduction in the quality of life. Despite a significantly increased understanding of the disease, the diagnosis is still delayed for many years. Delayed patient access to suitable treatment often leads to disease progression with increased surgical interventions and the occurrence of possible comorbidities. In recent years, there has been an improved understanding of the pathophysiology and, as a result the authorization of modern therapeutic agents for HS. The treatment of HS is based on three treatment pillars: surgery, antibiotics and biologics. Additionally, risk factors, such as smoking and obesity should be positively influenced. Knowledge of comorbidities and their interdisciplinary treatment is important for the individualized care of patients.
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Affiliation(s)
- M Alter
- Klinik für Dermatologie, Johannes-Wesling-Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, 32429, Minden, Deutschland.
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2
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Zouboulis CC, Prens EP, Sayed CJ, Molina-Leyva A, Bettoli V, Romanelli M, Szepietowski JC, Martinez AL, Kasparek T, Lobach I, Wozniak MB, Ortmann CE, Thomas N, Bachhuber T, Ravichandran S, Tzellos T. International Hidradenitis Suppurativa Severity Scoring System (IHS4) as a holistic measure of hidradenitis suppurativa disease severity compared with Hurley staging: A post hoc analysis of the SUNRISE and SUNSHINE phase 3 trials of secukinumab. J Eur Acad Dermatol Venereol 2024; 38:e496-e499. [PMID: 38058224 DOI: 10.1111/jdv.19681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christopher J Sayed
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alejandro Molina-Leyva
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Hidradenitis Suppurativa Unit, Instituto de Investigación Biosanitaria ibs and Servicio de Dermatologia, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Vincenzo Bettoli
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Romanelli
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, University of Pisa, Pisa, Italy
| | - Jacek C Szepietowski
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wrocław, Poland
| | | | | | | | | | | | | | | | | | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
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3
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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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Krajewski PK, Sanz-Motilva V, Flores Martinez S, Solera M, Ochando G, Jfri A, Martorell A. Deroofing: A safe, effective and well-tolerated procedure in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:931-936. [PMID: 38279608 DOI: 10.1111/jdv.19810] [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: 09/13/2023] [Accepted: 11/24/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. OBJECTIVES A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. METHODS HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. RESULTS The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). CONCLUSION Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.
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Affiliation(s)
- P K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
| | - V Sanz-Motilva
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | | | - M Solera
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | - G Ochando
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | - A Jfri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - A Martorell
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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Tan IJ, Podwojniak A, Parikh A, Cohen BA. Precision Dermatology: A Review of Molecular Biomarkers and Personalized Therapies. Curr Issues Mol Biol 2024; 46:2975-2990. [PMID: 38666916 PMCID: PMC11049353 DOI: 10.3390/cimb46040186] [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: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024] Open
Abstract
The evolution of personalized medicine in dermatology signifies a transformative shift towards individualized treatments, driven by the integration of biomarkers. These molecular indicators serve beyond diagnostics, offering insights into disease staging, prognosis, and therapeutic monitoring. Specific criteria guide biomarker selection, ensuring attributes like specificity, sensitivity, cost feasibility, stability, rapid detection, and reproducibility. This literature review, based on data from PubMed, SCOPUS, and Web of Science, explores biomarkers in Hidradenitis Suppurativa (HS), Psoriasis, Atopic Dermatitis (AD), Alopecia Areata (AA), Vitiligo, and Chronic Spontaneous Urticaria (CSU). In HS, TNF-α, IL-1β, and MMPs serve as biomarkers, influencing targeted therapies like adalimumab and anakinra. Psoriasis involves biomarkers such as TNF-α, IL-23, and HLA genes, shaping treatments like IL23 and IL17 inhibitors. AD biomarkers include ECP, IL-4, IL-13, guiding therapies like dupilumab and tralokinumab. For AA, lipocalin-2, cytokines, and genetic polymorphisms inform JAK inhibitors' use. Vitiligo biomarkers range from cytokines to genetic markers like TYR, TYRP1, guiding treatments like JAK inhibitors. CSU biomarkers encompass IgE, cytokines, and autologous serum tests, influencing therapies like omalizumab and cyclosporine. Comparing conditions, common proinflammatory markers reveal limited specificity. While some biomarkers aid diagnosis and standard treatments, others hold more scientific than clinical value. Precision medicine, driven by biomarkers, has shown success in skin malignancies. Future directions involve AI-powered algorithms, nanotechnology, and multi-omics integration for personalized dermatological care.
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Affiliation(s)
- Isabella J. Tan
- Rutgers Robert Wood Johnson Medical School, 125 Paterson Steet, New Brunswick, NJ 08901, USA; (I.J.T.); (A.P.)
| | - Alicia Podwojniak
- Rowan-Virtua School of Osteopathic Medicine, 113 E Laurel Road, Stratford, NJ 08084, USA;
| | - Aarushi Parikh
- Rutgers Robert Wood Johnson Medical School, 125 Paterson Steet, New Brunswick, NJ 08901, USA; (I.J.T.); (A.P.)
| | - Bernard A. Cohen
- Department of Dermatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA
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González-López MA. [Hidradenitis suppurativa]. Med Clin (Barc) 2024; 162:182-189. [PMID: 37968174 DOI: 10.1016/j.medcli.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 11/17/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic and debilitating inflammatory disease derived from the pilosebaceous unit, that affects approximately 1% of the general population. Clinically, it is characterized by inflammatory nodules, abscesses, and tunnels in the intertriginous areas of the body, especially in the axillary, inguinal, and anogenital regions. The etiopathogenesis of HS is not completely understood, although it is considered to be multifactorial, and the result of a complex interaction between genetic, hormonal, environmental, and immunological factors. In this sense, several proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α), interleukin (IL)-L-1β, and IL-17, among others, appear to play a crucial role in the pathogenesis of the disease. Currently, HS is recognized as a systemic disease associated with numerous comorbidities, including cardiovascular, immune-mediated, and endocrine-metabolic diseases. The treatment of HS must be carried out with an individualized and patient-oriented approach, considering medical and surgical treatment modalities.
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Affiliation(s)
- Marcos A González-López
- Servicio de Dermatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España; Departamento de Medicina y Psiquiatría, Universidad de Cantabria, Santander, Cantabria, España; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Cantabria, España; Real Academia de Medicina de Cantabria, Santander, Cantabria, España.
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7
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Chu YL, Yu S. Hidradenitis Suppurativa: An Understanding of Genetic Factors and Treatment. Biomedicines 2024; 12:338. [PMID: 38397941 PMCID: PMC10886623 DOI: 10.3390/biomedicines12020338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024] Open
Abstract
Hidradenitis suppurativa (HS), recognized as a chronic and debilitating skin disease, presents significant challenges in both diagnosis and treatment. This review explores the clinical manifestations, genetic landscape, and molecular mechanisms underlying HS. The disease's association with a predisposing genetic background, obesity, smoking, and skin occlusion underscores the complexity of its etiology. Genetic heterogeneity manifests in sporadic, familial, and syndromic forms, with a focus on mutations in the γ-secretase complex genes, particularly NCSTN. The dysregulation of immune mediators, including TNF-α, IL-17, IL-1β, and IL-12/23, plays a crucial role in the chronic inflammatory nature of HS. Recent advancements in genetic research have identified potential therapeutic targets, leading to the development of anti-TNF-α, anti-IL-17, anti-IL-1α, and anti-IL-12/23 therapies and JAK inhibitors. These interventions offer promise in alleviating symptoms and improving the quality of life for HS patients.
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Affiliation(s)
- Yi-Lun Chu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan;
- School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
| | - Sebastian Yu
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807377, Taiwan;
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Neuroscience Research Center, Kaohsiung Medical University, Kaohsiung 807378, Taiwan
- Master of Public Health Degree Program, National Taiwan University, Taipei 100025, Taiwan
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Abu Rached N, Gambichler T, Ocker L, Skrygan M, Seifert C, Scheel CH, Stockfleth E, Bechara FG. Haptoglobin is an independent marker for disease severity and risk for metabolic complications in hidradenitis suppurativa: A prospective study. J Eur Acad Dermatol Venereol 2024; 38:205-213. [PMID: 37669834 DOI: 10.1111/jdv.19495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease that is highly correlated with obesity. Haptoglobin serum levels have recently been recognized as an important biomarker linking obesity with chronic inflammation. OBJECTIVE To compare haptoglobin with previously proposed serum biomarkers for the determination of disease severity in HS patients. For this purpose, disease severity of HS patients was determined by a panel of clinical scores as well as several risk factors, such as weight and smoking habits. METHODS A prospective, diagnostic accuracy study was performed at the International Centre for Hidradenitis suppurativa/Acne inversa Bochum (ICH). The study included a total of 263 patients, including 131 who had a confirmed diagnosis of HS in Hurley I (n = 16), II (n = 56) and III (n = 59) HS, and 132 healthy controls. The main outcome was to identify serological inflammatory markers for HS disease severity [severe (III) vs. moderate/mild (II/I)] as assessed by Hurley classification. RESULTS The serum levels of acute phase proteins haptoglobin and CRP, as well as the number of neutrophils in peripheral blood, number of monocytes, the systemic immune-inflammation index and the pan-immune-inflammatory value correlated with disease severity according to established clinical scores (mHSS, SAHS, Hurley, DLQI). HS patients had significantly higher haptologlobin levels compared to healthy controls. Logistic regression analysis revealed haptoglobin as the only independent marker predicting severe HS. CONCLUSION In this prospective study, we discovered that the serum levels of the acute phase protein haptoglobin levels serve as an independent marker of disease severity in HS. While this presents the first study in the context of HS. Thus, the present data not only yield a highly promising serum marker to be further validated.
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Affiliation(s)
- N Abu Rached
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology and Phlebology, Christian Hospital Unna, Unna, Germany
| | - L Ocker
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - M Skrygan
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C Seifert
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - C H Scheel
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Ruhr-University Bochum, Bochum, Germany
- Department of Dermatology, Venereology and Allergology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
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Liao YH, Chu CB, Hui CYR, Li CY, Lin SY, Tseng HC, Wang YJ, Wu J, Yu WW, Chao SC. Taiwanese Dermatological Association (TDA) consensus recommendations for the definition, classification, diagnosis, and management of hidradenitis suppurativa. J Formos Med Assoc 2023:S0929-6646(23)00492-8. [PMID: 38160191 DOI: 10.1016/j.jfma.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful, recurrent, inflamed lesions most commonly occurring in the axillary, inguinal, and anogenital regions. HS can inflict immense physical and psychological impact on patients who suffer from this distressing disease. Management of HS generally requires combining various medical and procedural treatment modalities; however, the disease is often recalcitrant to conventional treatments. In light of recent evidence supporting the effectiveness of biologic agents in the treatment of HS, the Taiwanese Dermatological Association established an expert panel of nine dermatologists to develop consensus statements aimed to provide up-to-date evidence-based guidance in optimizing HS patient management in Taiwan. The recommendations described in the statements were summarized in a management algorithm in terms of general care, topical treatment, systemic treatment, and procedural treatment.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Yao Lin
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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10
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Rymaszewska JE, Karczewski M, Krajewski PK, Matusiak Ł, Maj J, Szepietowski JC. Patients' Expectations and Satisfaction with the Patient-Doctor Relationship in Hidradenitis Suppurativa. Healthcare (Basel) 2023; 11:3139. [PMID: 38132029 PMCID: PMC10742400 DOI: 10.3390/healthcare11243139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with a vast psychosocial burden. We analyzed the actual and ideal patient-doctor relationship and patients' satisfaction with the patient-doctor relationship in relation to their satisfaction with life (SWL), HS-related quality of life, and psychopathological symptoms. METHODS 105 HS patients (53% females; mean age 37.64 ± 14.01 years) were enrolled. Severity of the disease was measured using Hurley staging and the International HS Score System (IHS4). Instruments utilized: Patient Expectation Test; Satisfaction with Life Scale; HS Quality of Life; Patient Health Questionnaire-9; Generalized Anxiety Disorder-7; General Health Questionnaire. RESULTS Patients with Hurley I and mild IHS4 had the lowest satisfaction with the patient-doctor relationship. There were significant correlations between the actual patient-doctor relationship and the patients' SWL (r = 0.30; p = 0.002), depressive (r = -0.36; p < 0.01), anxiety (r = 0.37; p < 0.01) and psychopathological symptoms (r = -0.47; p < 0.0001) and between the satisfaction with the patient-doctor relationship and their SWL (r = -0.32; p = 0.00098). Multiple regression analysis revealed a significant influence of the following factors: Hurley II + III, psychopathological symptoms, and severe anxiety about the actual patient-doctor relationship and the satisfaction with the patient-doctor relationship. CONCLUSIONS Assessment of relations between patients and doctors is related to the patients' mental health and SWL. The usage of the Patient Expectation Test in clinical practice can improve the patient-doctor relationship and the general quality of care for and compliance by HS patients.
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Affiliation(s)
- Julia Ewa Rymaszewska
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Maciej Karczewski
- Department of Applied Mathematics, Wrocław University of Environmental and Life Sciences, Grunwaldzka Str. 53, 50-357 Wrocław, Poland;
| | - Piotr K. Krajewski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Joanna Maj
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Allergology and Venereology, Wrocław Medical University, T. Chałubińskiego Str. 1, 50-368 Wrocław, Poland (P.K.K.); (Ł.M.); (J.M.)
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11
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Agnese ER, Tariche N, Sharma A, Gulati R. The Pathogenesis and Treatment of Hidradenitis Suppurativa. Cureus 2023; 15:e49390. [PMID: 38146560 PMCID: PMC10749691 DOI: 10.7759/cureus.49390] [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: 10/30/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a multifactorial disease involving the skin and subcutaneous tissues characterized by deep-seated, painful nodules and abscesses with draining sinus tracts. It affects mostly younger individuals between the ages of 18 and 34. The discomfort and embarrassment that patients affected by HS experience negatively impact their daily lives. It is associated with decreased quality of life and high rates of comorbid depression and anxiety. The rate of depression in HS was reported to be as high as 26%. Its pathogenesis is multifactorial and as such requires a multimodal approach to treatment, which subsequently is reviewed here. Moreover, the pathogenesis of HS is complex and only partially understood. Autoinflammation is the key driver of disease development and is linked with dysregulated inflammasome activation with the subsequent production of inflammatory cytokines. Genetics and cutaneous microbiome play a role in the development of chronic inflammation and lesion formation. Risk factors such as obesity, metabolic syndrome, diabetes, and smoking also add to the systemic inflammation. Targeting these risk factors is a key aspect of the treatment of HS. Lifestyle modifications are used in conjunction with pharmacotherapy and procedures to effectively manage the disease.
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Affiliation(s)
- Erica R Agnese
- Dermatology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Nicole Tariche
- Obstetrics and Gynecology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Amit Sharma
- Dermatology, Lake Erie College of Osteopathic Medicine, Elmira, USA
| | - Raj Gulati
- General Surgery, Lake Erie College of Osteopathic Medicine, Elmira, USA
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12
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Somani AK, Atkin L, Bechara FG, Davidson JM, Jeffery S, Mostow E, Simman R, Armstrong DG, Karatzias A, Martínez JLL, Milne J, de Ceniga MV. Practical applications of small intestine submucosa extracellular matrix (SIS-ECM) an expert panel consensus. J Wound Care 2023; 32:S1-S16. [PMID: 37703212 DOI: 10.12968/jowc.2023.32.sup9b.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Ally-Khan Somani
- Director of Dermatologic Surgery and Cutaneous Oncology Division; Assistant Professor, Department of Dermatology; and Adjunct Assistant Professor of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, US
| | - Leanne Atkin
- Vascular Nurse Consultant, Mid Yorkshire Hospitals NHS Trust, Yorkshire, UK
| | - Falk G Bechara
- Head of the Department of Dermatologic Surgery, Ruhr-University, Bochum, Germany
| | - Jeffrey M Davidson
- Emeritus Professor of Pathology, Microbiology and Immunology, Vanderbilt University, School of Medicine, Nashville, Tennessee, US
| | - Steve Jeffery
- Professor of Wound Study, Birmingham, City University; Medical Director, Pioneer Wound, Telehealth, Birmingham, UK
| | - Eliot Mostow
- Head of the Dermatology Section, Northeast Ohio Medical University; Clinical Faculty, Case Western University, Ohio, US
| | - Richard Simman
- Professor of Plastic Surgery, University of Toledo College of Medicine and Life, Sciences; Jobst Vascular Institute, ProMedica Health, System, Toledo, Ohio, US
| | - David G Armstrong
- Professor of Surgery and Director of the Limb Preservation Program, University of Southern California, US
| | | | - José Luis Lázaro Martínez
- Tenured Professor and Clinical Director of the Diabetic Foot Unit, Complutense University of Madrid, Spain
| | - Jeanette Milne
- Clinical Lead for Tissue Viability, Northumbria Healthcare NHS Foundation Trust, UK
| | - Melina Vega de Ceniga
- Consultant Angiologist and Vascular and Endovascular Surgeon, Galdakao‑Usansolo Hospital, Bizkaia, Spain
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13
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Witte K, Schneider-Burrus S, Salinas G, Mössner R, Ghoreschi K, Wolk K, Sabat R. Blood T Helper Memory Cells: A Tool for Studying Skin Inflammation in HS? Int J Mol Sci 2023; 24:ijms24108854. [PMID: 37240200 DOI: 10.3390/ijms24108854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory skin disease characterized by painful lesions on intertriginous body areas such as the axillary, inguinal, and perianal sites. Given the limited treatment options for HS, expanding our knowledge of its pathogenetic mechanisms is a prerequisite for novel therapeutic developments. T cells are assumed to play a crucial role in HS pathogenesis. However, it is currently unknown whether blood T cells show specific molecular alterations in HS. To address this, we studied the molecular profile of CD4+ memory T (Thmem) cells purified from the blood of patients with HS and matched healthy participants. About 2.0% and 1.9% of protein-coding transcripts were found to be up- and down-regulated in blood HS Thmem cells, respectively. These differentially expressed transcripts (DETs) are known to be involved in nucleoside triphosphate/nucleotide metabolic processes, mitochondrion organization, and oxidative phosphorylation. The detected down-regulation of transcripts involved in oxidative phosphorylation suggest a metabolic shift of HS Thmem cells towards glycolysis. The inclusion of transcriptome data from skin from HS patients and healthy participants in the analyses revealed that in HS skin lesions, the expression pattern of transcripts identified as DETs in blood HS Thmem cells was very similar to the expression pattern of the totality of protein-coding transcripts. Furthermore, there was no significant association between the extent of the expressional changes in the DETs of blood HS Thmem cells and the extent of the expressional changes in these transcripts in HS skin lesions compared to healthy donor skin. Additionally, a gene ontology enrichment analysis did not demonstrate any association of the DETs of blood HS Thmem cells with skin disorders. Instead, there were associations with different neurological diseases, non-alcoholic fatty liver disease, and thermogenesis. The levels of most DETs linked to neurological diseases showed a positive correlation to each other, suggesting common regulatory mechanisms. In summary, the transcriptomic changes in blood Thmem cells observed in patients with manifest cutaneous HS lesions do not appear to be characteristic of the molecular changes in the skin. Instead, they could be useful for studying comorbidities and identifying corresponding blood biomarkers in these patients.
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Affiliation(s)
- Katrin Witte
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Sylke Schneider-Burrus
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Center for Dermatosurgery, Havelklinik Berlin, 13595 Berlin, Germany
| | - Gabriela Salinas
- NGS-Integrative Genomics Core Unit, Institute of Human Genetics, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Rotraut Mössner
- Department of Dermatology, Georg-August-University Goettingen, 37073 Goettingen, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Kerstin Wolk
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Robert Sabat
- Psoriasis Research and Treatment Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
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14
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Abu Rached N, Gambichler T, Ocker L, Dietrich JW, Quast DR, Sieger C, Seifert C, Scheel C, Bechara FG. Screening for Diabetes Mellitus in Patients with Hidradenitis Suppurativa—A Monocentric Study in Germany. Int J Mol Sci 2023; 24:ijms24076596. [PMID: 37047569 PMCID: PMC10094965 DOI: 10.3390/ijms24076596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic skin disease that is often associated with metabolic disorders. Diabetes mellitus (DM) is a frequent comorbidity in HS. There is currently no established screening for DM in HS patients. The aim of our study was to identify high-risk groups of HS patients that develop DM and to assess the frequency of different types of DM present in HS patients. To do so, we conducted a monocentric study in 99 patients with HS. All patients underwent detailed clinical and laboratory assessments, including the determination of glycated hemoglobin. Among the 20.2% of patients that presented with DM, type 2 was by far the most prevalent (19 out of 20 patients). Moreover, male gender, age, BMI, Hurley stage, modified Hidradenitis Suppurativa Score (mHSS), DLQI and hypertension all correlated with the glycated hemoglobin levels in the HS patients. In the multivariable analysis, Hurley stage III, older age, and higher BMI were significantly associated with DM. Specifically, patients at Hurley stage III were at a 5.3-fold increased risk of having DM type II compared to patients at earlier Hurley stages. Since many of the HS patients had not been diagnosed, our study reveals shortcomings in the screening for DM and suggest that this should be routinely performed in HS patients at high risk to avoid secondary complications.
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Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Thilo Gambichler
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Daniel R. Quast
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Christina Sieger
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Caroline Seifert
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Christina Scheel
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa, Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
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