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Zouboulis CC, Hrvatin Stancic B, Abaitancei A, Guimarães MJ, Lobo IL, Massa AF, Nikolakis G, Nogueira MO, Özdemir AO, Pirogova A, Prens EP, Szepietowski JC, Tusheva I, Tzellos T, Zouboulis VA. The inter-rater reliability of IHS4 corroborates its aptitude as primary outcome measurement instrument for large clinical studies in hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:e185-e187. [PMID: 37728531 DOI: 10.1111/jdv.19525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Affiliation(s)
- C C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences, Dessau, Germany
| | - B Hrvatin Stancic
- Department of Dermatology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Abaitancei
- Department of Dermatology, Universitaet Transilvania, Brașov, Romania
| | - M J Guimarães
- Department of Dermatology and Venereology, Hospital de Braga, Braga, Portugal
| | - I L Lobo
- Serviço de Dermatovenereologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A F Massa
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - G Nikolakis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences, Dessau, Germany
| | - M O Nogueira
- Serviço de Dermatovenereologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - A O Özdemir
- Sağlık Bakanlığı-Turkish Ministry of Health, Istanbul, Turkey
| | - A Pirogova
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - E P Prens
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J C Szepietowski
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - I Tusheva
- Clinic of Dermatovenerology, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | - T Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
| | - V A Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Universitaetsklinikum Hamburg-Eppendorf (UKE), Faculty of Medicine, Hamburg, Germany
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Nikolakis G, Vaiopoulos AG, Georgopoulos I, Papakonstantinou E, Gaitanis G, Zouboulis CC. Insights, Advantages, and Barriers of Teledermatology vs. Face-to-Face Dermatology for the Diagnosis and Follow-Up of Non-Melanoma Skin Cancer: A Systematic Review. Cancers (Basel) 2024; 16:578. [PMID: 38339329 PMCID: PMC10854718 DOI: 10.3390/cancers16030578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/21/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Teledermatology is employed in the diagnosis and follow-up of skin cancer and its use was intensified during and after the COVID-19 pandemic. At the same time, demographic changes result in an overall increase in non-melanoma skin cancer and skin precancerous lesions. The aim of this study was to elucidate the role of teledermatology in comparison to conventional face-to-face dermatology for such lesions and determine the advantages and limitations of this workflow for patients and physicians. METHODS Research was performed using relevant keywords in MEDLINE and CENTRAL. Relevant articles were chosen following a predetermined standardized extraction form. RESULTS Diagnostic accuracy and interrater/intrarater agreement can be considered comparable-although lower-than in-person consultation. Improvement of particular features such as image quality, medical history availability, and teledermoscopy can further increase accuracy. Further aspects of limitations and advantages (mean time-to-assessment, time-to-treatment, cost-effectiveness) are discussed. CONCLUSIONS Teledermatology has comparable diagnostic accuracy with face-to-face dermatology and can be utilized both for the effective triage of non-melanocytic epithelial tumors and precancerous lesions, as well as the follow-up. Easy access to dermatologic consultation with shorter mean times to diagnostic biopsy and/or treatment coupled with cost-effectiveness could compensate for the lower sensitivity of teledermatology and offer easier access to medical care to the affected populations.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany;
- Docandu Ltd., London Ν8 0ES, UK;
| | - Aristeidis G. Vaiopoulos
- Second Department of Dermatology and Venereology, “Attikon” University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Ioannis Georgopoulos
- Docandu Ltd., London Ν8 0ES, UK;
- Surgical Department, “Agia Sofia” Children’s Hospital, 11527 Athens, Greece
| | | | - George Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany;
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Krajewski PK, Strobel A, Schultheis M, Staubach P, Grabbe S, Hennig K, Matusiak L, von Stebut E, Garcovich S, Bayer H, Heise M, Kirschner U, Nikolakis G, Szepietowski JC. Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment. Dermatology 2024; 240:205-215. [PMID: 38190809 DOI: 10.1159/000536128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/25/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. METHODS We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project "Epidemiology and Care in Acne inversa (EpiCAi)." The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. RESULTS Regardless of gender, HS has an enormous impact on patients' sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (β = 0.25), the number of active lesions, the affected areas (β = 0.14), and psychosocial aspects, including low quality of life (β = 0.404), stigmatization (β = 0.411), depression (β = 0.413), and anxiety (β = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. CONCLUSION Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Alexandra Strobel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | | | - Hans Bayer
- Dermatology Outpatient Office Hautmedizin Bad Soden, Bad Soden, Germany
| | - Marcus Heise
- Profile Centre of Health Sciences Halle, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute for Health- and Nursing Science, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
- Institute of General Practice and Family Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle/, Saale, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Zouboulis VA, Massa AF, Nikolakis G, Prens EP, Szepietowski JC, Tzellos T, Zouboulis CC. Baseline knowledge of dermatology specialists/residents on hidradenitis suppurativa and immediate learning outcome after their participation at an EADV School. J Eur Acad Dermatol Venereol 2024; 38:e89-e90. [PMID: 37595961 DOI: 10.1111/jdv.19442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023]
Affiliation(s)
- V A Zouboulis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Faculty of Medicine, Universitaetsklinikum Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A F Massa
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Department of Dermatology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - G Nikolakis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - E P Prens
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J C Szepietowski
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - T Tzellos
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway
| | - C C Zouboulis
- European Hidradenitis Suppurativa Foundation, Dessau, Germany
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Mann C, Staubach P, Grabbe S, Wegner J, Hennig K, Nikolakis G, Szepietowski JC, Matusiak L, von Stebut E, Kirschner U, Podda M, Garcovich S, Schultheis M. Self-management-competency as a new target in Hidradenitis suppurativa care. J DERMATOL TREAT 2023; 34:2245082. [PMID: 37577779 DOI: 10.1080/09546634.2023.2245082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
Background: Hidradenitis suppurativa affects approximately 1% of the population.Objective: Highlighting the relevance of self-management-competency as a new therapeutic target.Method: 258 patients from the 'Epidemiology and Care in Acne inversa (EpiCAi)' project were included in the study. Disease burden was measured by patient-rated questionnaires in terms of disease activity, pain, quality of life, depression and insomnia and correlated with the domains of the health education impact questionnaire (heiQ) measuring self-management-competency.Results: 66 male (25.6%) and 192 female (74.4%) patients, with a mean age of 40.3 ± 10.24 years were included. Mean scores of pain on the numeric rating scale (NRS), Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale (HADS) were 5.11 ± 2.68, 11.35 ± 7.79 and 13.71 ± 7.57, respectively. The Insomnia severity index (ISI) showed a mean of 9.58 ± 5.76. The HADS has the highest increased total risk across all heiQ domains. With respect to the heiQ domains, the highest exposure can be attributed to improving constructive attitudes and approaches as well as decreasing emotional distress.Conclusion: There is a clear association of self-management-competency with overall disease burden, which underlines the need for psychoeducational support. This study provides ideas to develop new possible strategies of care.
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Affiliation(s)
- C Mann
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - P Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - S Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - J Wegner
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - K Hennig
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - G Nikolakis
- Department of Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - L Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - E von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - U Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - M Podda
- Hautklinik, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - S Garcovich
- Dermatology Outpatient Office Dr, Simone Garcovich, Rome, Italy
| | - M Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
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Heise M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Podda M, Grabbe S, Schultheis M. A center-based, ambulatory care concept for hidradenitis suppurativa improves patient outcomes and is also cost-effectiveness. J DERMATOL TREAT 2023; 34:2284105. [PMID: 38010850 DOI: 10.1080/09546634.2023.2284105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. METHODS EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). RESULTS Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. CONCLUSION Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run.
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Affiliation(s)
- Marcus Heise
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- School of Business and Health, Baden-Wuerttemberg Cooperative State University, Stuttgart, Germany
| | - Marina Zamsheva
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Profile Area Clinical Studies & Biostatistics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
- Profile Centre of Health Sciences Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Katharina Hennig
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
| | - Michael Schultheis
- Department of Dermatology, University Medical Centre, Johannes Gutenberg University, Mainz, Germany
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Schultheis M, Staubach P, Nikolakis G, Schollenberger L, Mauch M, Burckhardt M, Heise M, Zamsheva M, Strobel A, Langer G, Bechara F, Kirschner U, Hennig K, Kunte C, Goebeler M, Grabbe S. A centre-based ambulatory care concept for hidradenitis suppurativa improves disease activity, disease burden and patient satisfaction: results from the randomized controlled EsmAiL trial. Br J Dermatol 2023; 189:170-179. [PMID: 37132470 DOI: 10.1093/bjd/ljad135] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/20/2023] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory disease of the inverse skin regions that occurs in young women, in particular, and affects approximately 1% of the population. Outpatient care is often inadequate and usually cannot prevent progression. OBJECTIVES To evaluate in the EsmAiL ('Evaluation eines strukturierten und leitlinienbasierten multmodalen Versorgungskonzepts für Menschen mit Akne inversa') trial whether an innovative care concept can decrease disease activity and burden, and improve patient satisfaction. METHODS EsmAiL was conducted as a two-arm, multicentre, prospective, randomized controlled trial that included 553 adults with HS. Inclusion criteria were a minimum of three inflammatory lesions and at least a moderate impact of the disease on quality of life. The control group (CG) remained under standard care, while patients in the intervention group (IG) were treated according to a trial-specific, multimodal concept. The primary endpoint was the absolute change in International Hidradenitis Suppurativa Severity Score System (IHS4). RESULTS In total, 274 patients were randomized to the IG and 279 to the CG. Altogether, 377 attended the final assessment after 12 months of intervention. Participants in the IG (n = 203) achieved a mean improvement in IHS4 of 9.3 points, while the average decrease in IHS4 in patients in the CG (n = 174) was 5.7 points (P = 0.003). Patients treated under the new care concept also reported a statistically significantly higher decrease in pain, Dermatology Life Quality Index and Hospital Anxiety and Depression Scale scores compared with those in the CG (P < 0.001). Patient satisfaction was also statistically significantly higher in the IG compared with the CG (P < 0.001). CONCLUSIONS The establishment of standardized treatment algorithms in so-called 'acne inversa centres' in the ambulatory setting has a substantial, positive impact on the course of HS and significantly improves patient satisfaction.
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Affiliation(s)
| | | | - Georgios Nikolakis
- Department of Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Lukas Schollenberger
- Interdisciplinary Centre for Clinical Trials, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Melanie Mauch
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
| | - Marion Burckhardt
- German Society for Wound Healing and Wound Treatment (DGfW), Giessen, Germany
- Baden-Wuerttemberg Cooperative State University, School of Business and Health, Stuttgart, Germany
| | - Marcus Heise
- Institute for Health and Nursing Science
- Institute of General Practice and Family Medicine
- Profile Centre of Health Sciences Halle
| | - Marina Zamsheva
- Institute for Health and Nursing Science
- Profile Centre of Health Sciences Halle
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Alexandra Strobel
- Profile Centre of Health Sciences Halle
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Gero Langer
- Institute for Health and Nursing Science
- Profile Centre of Health Sciences Halle
| | - Falk Bechara
- Department of Dermatology, Venereology, and Allergology, St Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | | | - Christian Kunte
- Department of Dermatologic Surgery and Dermatology, Artemed Fachklinik München, Munich, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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Abdel-Naser MB, Nikolakis G, Zouboulis CC. Preservation of epidermal melanocyte integrity in an ex vivo co-culture skin model with sebocytes. Exp Dermatol 2023. [PMID: 37287089 DOI: 10.1111/exd.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/01/2023] [Accepted: 04/02/2023] [Indexed: 06/09/2023]
Abstract
A direct contact co-culture of skin explants to SZ95 sebocytes (3D-SeboSkin) has been shown to preserve the integrity of epidermal keratinocytes and dermis. In this study, the properties of epidermal melanocytes were evaluated in the same 3D SeboSkin ex vivo model. Skin explants (n = 6) were maintained in the 3D-SeboSkin model, in direct contact to fibroblasts and alone in serum-free medium (SFM). Histopathological, immunohistochemical, apoptosis and oil red staining evaluations were performed at Days 0 and 6 of incubation. Results revealed preservation and prominent proliferation of basal keratinocytes of the skin explants in addition to preservation of dermal collagen and vasculature at Day 6 in the 3D-SeboSkin culture model and to a lesser extent in co-culture with fibroblasts but not in SFM alone. Melan-A+/Ki67- epidermal melanocytes remained attached to the dermis even at sites of epidermal detachment in the three skin explant models tested. However, the number of epidermal melanocytes was significantly conserved in 3D-SeboSkin cultures in comparison with skin explants in SFM (p < 0.05), whereas no difference was found in comparison with the co-culture with fibroblasts. Few DAPI/TUNEL+ apoptotic melanocytes could mostly be observed in SFM-incubated skin explants. Furthermore, only SZ95 sebocytes in contact to skin explants in 3D-SeboSkin exhibited increased lipogenesis with accumulation of abundant lipid droplets. These results denote that the 3D-SeboSkin model yielded significant preservation of epidermal melanocytes and hence it is optimal for ex vivo studies of abnormalities of skin pigmentation, melanocyte neoplasms and effects of different hormones, cytokines, carcinogens and various therapeutics in a pattern that recapitulates the in vivo environment.
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Affiliation(s)
- Mohamed Badawy Abdel-Naser
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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9
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Zouboulis CC, Kaleta KP, Broniatowska E, Jarienė V, Nikolakis G. Atrophic papulosis (Köhlmeier-Degos disease) in children and adolescents-A cross-sectional study and literature review. J Eur Acad Dermatol Venereol 2023; 37:810-816. [PMID: 36606530 DOI: 10.1111/jdv.18844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Atrophic papulosis (Köhlmeier-Degos disease, Degos disease) is a rare thrombo-obliterative microangiopathy of unknown pathogenesis. It usually affects people between the ages of 20 and 50. However, it can occur at any age. The condition is considered uncommon in children. OBJECTIVE Clinical characterization of paediatric patients with atrophic papulosis. METHODS Single-centre prospective cohort study with data derived from the international Degos Disease Registry collected between 2000 and 2021. RESULTS Among 96 registered patients with atrophic papulosis fulfilling the criteria, 19 were aged 0 to completed 17 years at the time of onset. The median age at the time of onset was 5 years, ranging from 0 to 1 years for girls to 8 years for boys. In contrast to adult patients (male-to-female ratio 1:2.2), there was a male predominance in paediatric patients with a male-to-female ratio of 1.7:1. Systemic involvement, in particular gastrointestinal, central nervous system and cardiac, was more frequent in children than in adult patients. There were no statistically significant differences between family history, multisystem involvement, mortality and median survival time in the two groups. CONCLUSIONS Atrophic papulosis has some distinct features in the paediatric population. It presents an important and still under-recognized problem. Therefore, it is mandatory to pay attention to the typical skin lesions in combination with neurological or gastrointestinal symptoms in order to make a prompt and accurate diagnosis.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Katarzyna P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Broniatowska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Vaiva Jarienė
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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10
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Garg A, Rawal S, Akilov O, Alavi A, Ardon C, Bechara FG, Cohen AD, Cohen SR, Daveluy S, Del Marmol V, Delage M, Esmann S, Fisher S, Giamarellos-Bourboulis EJ, Glowaczewska A, Goldfarb N, Gonzalez Brant E, Grimstad Ø, Guilbault S, Hamzavi I, Hughes R, Ingram JR, Jemec GBE, Ju Q, Kappe N, Kirby B, Kirby JS, Lowes MA, Matusiak L, Micha S, Micheletti RG, Miller AP, Moseng D, Naik HB, Nassif A, Nikolakis G, Paek SY, Pascual JC, Prens E, Resnik B, Riad H, Sayed C, Smith SD, Soliman Y, Szepietowski JC, Tan J, Thorlacius L, Tzellos T, van der Zee HH, Villumsen B, Wang L, Zouboulis CC, Strunk A. Factors associated with disease-specific life impact in patients with hidradenitis suppurativa: results from the Global VOICE project. Br J Dermatol 2023; 188:808-810. [PMID: 36891871 DOI: 10.1093/bjd/ljad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/30/2023] [Accepted: 03/12/2023] [Indexed: 03/10/2023]
Abstract
Patients with hidradenitis suppurativa experience significant life impact related to their disease. Younger age, Black race, high BMI, active smoking, flares, depression, anxiety, high comorbidity burden, disability, and difficult access to a dermatologist adversely influence life impact related to having hidradenitis suppurativa. Attention to these factors, particularly modifiable ones, may reduce overall impact of disease.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Sahil Rawal
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Oleg Akilov
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Christine Ardon
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, International Center for Hidradenitis suppurativa/Acne inversa (ICH), St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Arnon D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University, Israel
| | - Steven R Cohen
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maïa Delage
- Centre Médical, Institut Pasteur, Paris, France
| | - Solveig Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Shani Fisher
- Dermatology Department, Emek Medical Center, Afula, Israel
| | | | - Amelia Glowaczewska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Noah Goldfarb
- Departments of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | | | - Øystein Grimstad
- Department of Dermatology, NLSH Bodø, Institute of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | | | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Rosalind Hughes
- Department of Dermatology, St Vincent's University Hospital, and Charles Institute, University College Dublin, Dublin, Ireland
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Qiang Ju
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, China
| | - Naomi Kappe
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Brian Kirby
- Department of Dermatology, St Vincent's University Hospital, and Charles Institute, University College Dublin, Dublin, Ireland
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, PA, USA
| | | | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Stella Micha
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela P Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Dagfinn Moseng
- Department of Dermatology, NLSH Bodø, Institute of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Paris, France
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - So Yeon Paek
- Department of Dermatology, Baylor University Medical Center, Texas A&M College of Medicine, Dallas, TX, USA
| | - Jose Carlos Pascual
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Barry Resnik
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hassan Riad
- Dermatology Department, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Yssra Soliman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Jerry Tan
- Department of Medicine, Western University, Windsor campus, Ontario, Canada
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Thrasyvoulos Tzellos
- Department of Dermatology, NLSH Bodø, Institute of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Lanqi Wang
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, China
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Andrew Strunk
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
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11
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Schultheis M, Staubach-Renz P, Grabbe S, Hennig K, Khoury F, Nikolakis G, Kirschner U. Can hidradenitis suppurativa patients classify their lesions by means of a digital lesion identification scheme? J Dtsch Dermatol Ges 2023; 21:27-32. [PMID: 36721936 DOI: 10.1111/ddg.14926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Hidradenitis suppurativa (HS) differs widely with respect to its clinical presentation. Literature imposes different phenotypes potentially implying different treatment modalities. The aim of this study is to develop a validated scheme that enables HS patients to identify their own lesion types. PATIENTS AND METHODS The developed schemes for physicians and patients were implemented in a specific software. Upon patient consent, the physician used the software to document the lesions identified. Patients subsequently logged into the patient-version of the software from the convenience of their home and selected the lesions they identified on themselves. Afterwards the correlation between professionals and patients was tested. RESULTS For seven lesion types, correlation coefficients were statistically significant. A large/strong correlation between patients and physicians was found for the draining fistulas (0.59) and double-ended comedones (0.50). For five other lesion types, correlation was medium/moderate, namely the inflammatory nodule (0.37), abscess (0.30), accordion like-/ bridged scar (0.45), epidermal cyst (0.33) and pilonidal sinus (0.39). CONCLUSIONS HS-patients demonstrate high willingness to share their experiences and data. Therefore, a self-assessment scheme, as the developed LISAI, can be a valuable tool to enrich patient surveys with the identification of lesion types, for instance as a basis for phenotyping.
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Affiliation(s)
- Michael Schultheis
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Petra Staubach-Renz
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Stephan Grabbe
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Katharina Hennig
- Departement of Dermatology, University Medical Center, Johannes Gutenberg, University, Mainz, Germany
| | - Fareed Khoury
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
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12
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Schultheis M, Staubach-Renz P, Grabbe S, Hennig K, Khoury F, Nikolakis G, Kirschner U. Können Acne-inversa-Patienten ihre Läsionen mit Hilfe eines digitalen Läsionsidentifikationsschemas klassifizieren? J Dtsch Dermatol Ges 2023; 21:27-34. [PMID: 36721938 DOI: 10.1111/ddg.14926_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Michael Schultheis
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Petra Staubach-Renz
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Stephan Grabbe
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | - Katharina Hennig
- Hautklinik und Poliklinik der Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
| | | | - Georgios Nikolakis
- Abteilungen für Dermatologie, Venerologie, Allergologie und Immunologie, Medizinisches Zentrum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
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13
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Midgette B, Strunk A, Akilov O, Alavi A, Ardon C, Bechara FG, Cohen AD, Cohen S, Daveluy S, Del Marmol V, Delage M, Esmann S, Fisher S, Giamarellos-Bourboulis EJ, Glowaczewska A, Goldfarb N, Brant EG, Grimstad Ø, Guilbault S, Hamzavi I, Hughes R, Ingram JR, Jemec GBE, Ju Q, Kappe N, Kirby B, Kirby JS, Lowes MA, Matusiak L, Micha S, Micheletti R, Miller AP, Moseng D, Naik H, Nassif A, Nikolakis G, Paek SY, Pascual JC, Prens E, Resnik B, Riad H, Sayed C, Smith SD, Soliman Y, Szepietowski JC, Tan J, Thorlacius L, Tzellos T, van der Zee HH, Villumsen B, Wang L, Zouboulis C, Garg A. Factors associated with treatment satisfaction in patients with hidradenitis suppurativa: results from the Global VOICE project. Br J Dermatol 2022; 187:927-935. [PMID: 36056741 DOI: 10.1111/bjd.21798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Nearly half of patients with hidradenitis suppurativa (HS) report dissatisfaction with their treatment. However, factors related to treatment satisfaction have not been explored. OBJECTIVES To measure associations between treatment satisfaction and clinical and treatment-related characteristics among patients with HS. METHODS Treatment satisfaction was evaluated utilizing data from a cross-sectional global survey of patients with HS recruited from 27 institutions, mainly HS referral centres, in 14 different countries from October 2017 to July 2018. The primary outcome was patients' self-reported overall satisfaction with their current treatments for HS, rated on a five-point scale from 'very dissatisfied' to 'very satisfied'. RESULTS The final analysis cohort comprised 1418 patients with HS, most of whom were European (55%, 780 of 1418) or North American (38%, 542 of 1418), and female (85%, 1210 of 1418). Overall, 45% (640 of 1418) of participants were either dissatisfied or very dissatisfied with their current medical treatment. In adjusted analysis, patients primarily treated by a dermatologist for HS had 1·99 [95% confidence interval (CI) 1·62-2·44, P < 0·001] times the odds of being satisfied with current treatment than participants not primarily treated by a dermatologist. Treatment with biologics was associated with higher satisfaction [odds ratio (OR) 2·36, 95% CI 1·74-3·19, P < 0·001] relative to treatment with nonbiologic systemic medications. Factors associated with lower treatment satisfaction included smoking (OR 0·78, 95% CI 0·62-0·99; active vs. never), depression (OR 0·69, 95% CI 0·54-0·87), increasing number of comorbidities (OR 0·88 per comorbidity, 95% CI 0·81-0·96) and increasing flare frequency. CONCLUSIONS There are several factors that appear to positively influence satisfaction with treatment among patients with HS, including treatment by a dermatologist and treatment with a biologic medication. Factors that appear to lower treatment satisfaction include active smoking, depression, accumulation of comorbid conditions and increasing flare frequency. Awareness of these factors may support partnered decision making with the goal of improving treatment outcomes. What is already known about this topic? Nearly half of patients with hidradenitis suppurativa report dissatisfaction with their treatments. What does this study add? Satisfaction with treatment is increased by receiving care from a dermatologist and treatment with biologics. Satisfaction with treatment is decreased by tobacco smoking, accumulation of comorbid conditions including depression, and higher flare frequency. What are the clinical implications of this work? Awareness of the identified factors associated with poor treatment satisfaction may support partnered decision making and improve treatment outcomes.
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Affiliation(s)
- Bria Midgette
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Andrew Strunk
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Oleg Akilov
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Christine Ardon
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, St Josef Hospital, Ruhr-University, Bochum, Germany
| | - Arnon D Cohen
- Department of Quality Measures and Research, Clalit Health Services, Tel Aviv, Israel
| | - Steven Cohen
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maïa Delage
- Centre Médical, Institut Pasteur, Université de Paris, Paris, France
| | - Solveig Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Shani Fisher
- Dermatology Department, Emek Medical Center, Afula, Israel
| | | | - Amelia Glowaczewska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Noah Goldfarb
- Departments of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | | | - Øystein Grimstad
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | | | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Rosalind Hughes
- Department of Dermatology, St Vincent's University Hospital, and Charles Institute, University College Dublin, Dublin, Ireland
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Qiang Ju
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Naomi Kappe
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Brian Kirby
- Department of Dermatology, St Vincent's University Hospital, and Charles Institute, University College Dublin, Dublin, Ireland
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, PA, USA
| | | | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Stella Micha
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela P Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Dagfinn Moseng
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Haley Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Université de Paris, Paris, France
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - So Yeon Paek
- Department of Dermatology, Baylor University Medical Center, Texas A&M College of Medicine, Dallas, TX, USA
| | - Jose Carlos Pascual
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Barry Resnik
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, Miami, FL, USA
| | - Hassan Riad
- Dermatology Department, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Saxon D Smith
- Department of Dermatology, Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Yssra Soliman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jerry Tan
- Department of Medicine, Western University, Windsor campus, Windsor, ON, Canada
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Institute of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Lanqi Wang
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Christos Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Amit Garg
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
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14
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Schultheis M, Staubach P, Grabbe S, Ruckes C, von Stebut E, Kirschner U, Matusiak Ł, Szepietowski JC, Nikolakis G. LAight® Therapy Is an Effective Treatment Option to Maintain Long-Term Remission of Hurley I and II Hidradenitis Suppurativa: Results from Period B of RELIEVE, a Multicenter Randomized, Controlled Trial. Dermatology 2022; 238:1092-1103. [PMID: 35679831 PMCID: PMC9808664 DOI: 10.1159/000524739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa is a chronic, inflammatory, burdensome skin disease where current first-line treatments are limited to topical and/or systemic antibiotics which cannot be applied for long-term disease management. Period B of the RELIEVE study analyzes whether LAight® therapy can sustain or even increase remission after a first topical antibiotic treatment cycle. METHODS The RELIEVE study was performed as a two-period multicenter randomized controlled trial with blinded assessment. For period A from week 0 to week 16, the 88 participating Hurley I and II patients were randomized to either a group receiving topical clindamycin 1% solution combined with 8 additional bi-weekly treatments with LAight® therapy (group TC + L) or a group which was treated with topical clindamycin 1% solution only (group TC). After 16 weeks, patients entered open-label period B and both groups were treated exclusively with LAight® therapy for an additional 16 weeks (8 sessions, group TC + L/L and group TC/L). RESULTS In total, 88 patients were enrolled in RELIEVE. Seventy-eight patients entered period B; 39 belonged to group TC + L/L and 39 to group TC/L. The IHS4-response at the start of period B was 62% (group TC + L/L) and 33% (group TC + L). During the 16 weeks of additional monotherapy with LAight, in both groups >90% of patients who responded to therapy in period A maintained their IHS4-response at week 32. IHS4 response rates continued to rise up to 79% of the TC + L/L group and up to 71% of the TC/L group during period B at week 32. Achievement of HiSCR and certain patient reported outcomes confirmed primary endpoint results. CONCLUSION LAight® therapy is an effective approved therapy option for Hurley I and II HS that can be used continuously to maintain treatment success. During 16 weeks of follow-up in period B, over 90% of patients with response after period A maintained their treatment outcome, while more than 60% of prior nonresponders gained response. The fact that LAight® therapy can be applied continuously, is very effective and is well tolerated makes it a valuable treatment tool in the design of HS long-term treatment modalities.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Studies, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Kaleta KP, Jarienė V, Theodoridis A, Nikolakis G, Zouboulis CC. Atrophic papulosis (Köhlmeier-Degos disease) revisited. A cross-sectional study on 105 patients. J Eur Acad Dermatol Venereol 2022; 36:2190-2194. [PMID: 35610757 DOI: 10.1111/jdv.18260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrophic papulosis is a very rare vascular disease of unknown pathogenesis, mostly described by case reports. OBJECTIVE To assess demographic data and prognosis in patients with atrophic papulosis. METHODS Single-centre study on a series of 105 patients with atrophic papulosis, diagnosed 2000-2021. Patients referred and diagnosed at the evaluation centre and patients' clinical data provided by the Degos Support Network and evaluated by the authors for confirming diagnosis for skin lesions and fulfilling the diagnostic criteria for a malignant subset. A unique set of variables was collected from all patients. RESULTS The mean age of disease onset was 33.3±18.3 years and the male-to-female ratio 1:1.6. The family history rate was 8.1%. The classification into a benign, merely cutaneous one (benign atrophic papulosis), and malignant atrophic papulosis, associating cutaneous and visceral lesions was confirmed due to their striking prognostic difference. Benign atrophic papulosis was detected in 41% of the patients with no deaths occurring throughout the follow-up period (median 3.00 years; range 0.13-23). Malignant atrophic papulosis was reported in 59% of patients with 47.5% multisystemic involvement and a median skin lesion onset to systemic symptoms duration of 0.54 years (-6 to 20). Gastrointestinal tract and central nervous system were equally involved; however, the neurological sign-caused death rate was slightly higher. The disease-specific mortality rate of malignant atrophic papulosis was 22.6%. CONCLUSIONS Atrophic papulosis presents with striking prognostic difference of benign - merely cutaneous - involvement or quickly developing - into less than one year - malignant subset, associating cutaneous and visceral lesions and multiorgan involvement in 1/2 of the patients, which leads to premature, disease-specific mortality in 1/4 of the cases. Central nervous system and gastrointestinal tract involvement complications are the major reasons for disease-specific death. Over the years the diagnosis of severe nervous system involvement has become more common.
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Affiliation(s)
- K P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - V Jarienė
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - A Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
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Di Cesare A, Nikolakis G, Kanni T, Giammarellos-Bourboulis EJ, Matusiak Ł, Szepietowski JC, Zouboulis CC, Prignano F. Identification of clinical features affecting diagnostic delay in pediatric hidradenitis suppurativa: results from a multicenter observational study. Br J Dermatol 2022; 187:428-430. [PMID: 35292964 DOI: 10.1111/bjd.21247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Antonella Di Cesare
- Dermatology Section, Department of Health Sciences, University of Florence, Florence, Italy.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venerology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Theodora Kanni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Evangelos J Giammarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venerology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Francesca Prignano
- Dermatology Section, Department of Health Sciences, University of Florence, Florence, Italy.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
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Nikolakis G, Baroud S, Georgopoulos I, Appel L, Zouboulis CC. Teledermatologie: Fluch oder Segen? Aktuelle Dermatologie 2022. [DOI: 10.1055/a-1645-9932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungTeledermatologische Dienste haben sich insbesondere während der COVID-19-Pandemie als Alternative zu „Echt“visiten verbreitet. Der Mangel an Dermatologen und die Möglichkeit einer präzisen Diagnose auch bei unterversorgten Regionen macht diese Alternative für alle Beteiligten besonders attraktiv. Trotzdem ist der Bedarf an Schulungen des Personals und der Anwender hoch. Ebenfalls können Implementierungs-, Instandhaltungs- und Wartungskosten der notwendigen Ausrüstung und die Heterogenität der unterschiedlichen Anbieter nachteilig für Patient und Arzt sein. In diesem Artikel werden wesentliche Vorteile und Nachteile der Teledermatologie zusammengefasst.
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Affiliation(s)
- Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
| | - Sumer Baroud
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
- Sharjah Universität, Sharjah, Vereinigte Arabische Emirate
| | - Ioannis Georgopoulos
- Klinik für Chirurgie, Allgemeines Pädiatrisches Krankenhaus Agia Sofia, Athen, Griechenland
- DOCANDU LTD, London, Vereinigtes Königreich
| | - Lena Appel
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
- Medizinisches Versorgungszentrum des Städtischen Klinikums Dessau, Dessau, Deutschland
| | - Christos C. Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau
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18
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Kristandt A, Nikolakis G, Hauptmann M, Becker M, Zouboulis C. 064 Short-term intravenous clindamycin accelerates the benefit of oral clindamycin-rifampicin treatment in hidradenitis suppurativa (HS). J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Nikolakis G, Kreibich K, Vaiopoulos A, Kaleta K, Talas J, Becker M, Zouboulis CC. Case Report: PsAPSASH syndrome: an alternative phenotype of syndromic hidradenitis suppurativa treated with the IL-17A inhibitor secukinumab. F1000Res 2021; 10:381. [PMID: 34540202 PMCID: PMC8424462 DOI: 10.12688/f1000research.52100.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
Syndromic hidradenitis suppurativa (HS) is a form of symptom constellations, which differs from the familial and genetic form and comprises predominantly osteoarticular manifestations. Many forms include pyoderma gangrenosum and acne (PASH), pyogenic arthritis (PAPASH), spondyloarthritis (PASS) and psoriatic arthritis (PsAPASH) and are categorized in the autoinflammatory syndromes. Anti-TNF-α and anti-IL-1a blockade are between the therapeutic approaches that improve skin symptoms and prevent permanent osteoarticular damage. This case report refers to the successful treatment of a mixed phenotype of the aforementioned symptoms using the IL-17A inhibitor secukinumab after initial treatment with adalimumab. The therapy improved both cutaneous and reported osteoarticular symptoms. Different approaches for these recalcitrant HS syndromes are essential in order to achieve long-term remission for those patients.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, 06847, Germany
| | - Katja Kreibich
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany
| | - Aristeidis Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, 06847, Germany
| | - Katarzyna Kaleta
- Department of Dermatology, Jagiellonian University Medical College, Krakow, 31-008, Poland
| | - Joud Talas
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany
| | - Markus Becker
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, 06847, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, 06847, Germany
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20
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Schultheis M, Staubach P, Nikolakis G, Grabbe S, Ruckes C, von Stebut E, Kirschner U, Matusiak Ł, Szepietowski JC. LAight® Therapy Significantly Enhances Treatment Efficacy of 16 Weeks of Topical Clindamycin Solution in Hurley I and II Hidradenitis Suppurativa: Results from Period A of RELIEVE, a Multicenter Randomized, Controlled Trial. Dermatology 2021; 238:476-486. [PMID: 34535610 DOI: 10.1159/000518540] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, burdensome skin disease where medical first-line treatment is still limited to long-term, topical and/or systemic antibiotics. The RELIEVE study aimed at evaluating the efficacy of LAight® therapy - a combination of intense pulsed light and radiofrequency - as an adjunct treatment to first-line therapies in Hurley stage I and II HS. METHODS The RELIEVE study was performed as a two-period multicenter randomized controlled trial with blinded assessment. For period A from week 0 to week 16, the 88 participating subjects were randomized into either an intervention group (IG) or a control group (CG). The IG received topical clindamycin 1% solution combined with 8 additional bi-weekly treatments with LAight® therapy. The CG was treated with topical clindamycin 1% solution only. After 16 weeks, patients entered open-label period B and both groups were treated exclusively with LAight® therapy for an additional 16 weeks (8 sessions). The primary efficacy endpoint was the change in International Hidradenitis Suppurativa Score System (∆IHS4) at week 16 to baseline. Secondary endpoints were DLQI, HiSCR, Pain-NRS, and HADS. RESULTS In total, from the 88 patients enrolled in RELIEVE, 81 patients were included in the endpoint analysis after period A. After 16 weeks of treatment, the ∆IHS4 of the group treated with the combination of LAight® therapy and topical clindamycin 1% solution was -7.2 ± 6.7 (-60.0%), which was significantly higher in magnitude than the ∆IHS4 in the group treated with clindamycin 1% solution alone (-1.8 ± 5.6, -17.8%, p < 0.001). Secondary endpoints, including other clinical scores as well as patient-reported outcomes, confirmed that the efficacy of the combined treatment was superior to monotherapy. CONCLUSION The results of the primary endpoint analysis of period A of the RELIEVE study show that the combined therapy with LAight® and topical clindamycin 1% solution, resulted in a significantly higher decrease in disease severity and an improvement of quality of life in comparison to topical clindamycin 1% solution monotherapy. Treatment was well tolerated, and side effects were all mild and transitory. These data speak for the implementation of the combined treatment as a first-line therapy in Hurley stage I and II HS. LAight® therapy as long-term monotherapy (results from period B), will be analyzed in a consecutive paper.
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Affiliation(s)
- Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Studies, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, Mainz, Germany
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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21
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Jfri A, Nassim D, O'Brien E, Gulliver W, Nikolakis G, Zouboulis CC. Prevalence of Hidradenitis Suppurativa: A Systematic Review and Meta-regression Analysis. JAMA Dermatol 2021; 157:924-931. [PMID: 34037678 DOI: 10.1001/jamadermatol.2021.1677] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by occlusion of hair follicles as a primary pathogenic factor. There are scarce data regarding the prevalence of HS. Objective To estimate overall HS prevalence. Data Sources This review and meta-regression analysis was conducted using the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline. The academic search included PubMed, Cochrane registry, ClinicalTrials.gov, and evidence by NHS UK and Trip databases from inception through May 2020. To analyze HS prevalence, only cross-sectional studies or baseline assessments of longitudinal cohorts using census-based surveys or probabilistic and nonprobabilistic epidemiologic methods were considered. The search terms were (prevalence OR incidence OR epidemiology) AND (hidradenitis suppurativa OR acne inversa OR Verneuil's disease). No language restriction was applied. Study Selection Original investigations that reported HS prevalence were included. After exclusion criteria were applied, 17 studies qualified for qualitative analysis, but only 16 studies were quantitatively assessed. Data Extraction and Measures Two reviewers extracted data by age, diagnostic criteria, presence of any comorbidity, sample sizes, continent/location, sex, and other characteristics. Assessment of bias risk used the Joanna Briggs Institute Critical Appraisal Instrument for Studies Reporting Prevalence Data using random-effects models to synthesize available evidence. Main Outcomes and Measures Hidradenitis suppurativa prevalence (with 95% CI) among the overall population and among subgroups. Between-study heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). Results In 16 quantitatively assessed studies included, prevalence estimates were reported only from Western European and Scandinavian countries, the US, and Australia. Meta-analysis with random effects, after adjusting for publication bias in the prevalence estimates, revealed a 0.40% prevalence (95% CI, 0.26%-0.63%) for HS. Studies based on clinical samples revealed a higher pooled prevalence of HS (1.7%) than population-based studies (0.3%). Conclusions and Relevance The findings of this systematic review and meta-regression analysis may help facilitate policy formulation, channeling funding and guiding principles for better disease diagnosis using universal valid tools and management.
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Affiliation(s)
- Abdulhadi Jfri
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - David Nassim
- Faculty of Medicine, McGill University, Quebec, Quebec, Canada
| | - Elizabeth O'Brien
- Division of Dermatology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada
| | - Wayne Gulliver
- Division of Dermatology, Memorial University of Newfoundland, St John's, Newfoundland, Canada
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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22
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Kaleta KP, Nikolakis G, Hossini AM, Balthasar O, Almansouri D, Vaiopoulos A, Knolle J, Boguslawska A, Wojas-Pelc A, Zouboulis CC. Metabolic Disorders/Obesity Is a Primary Risk Factor in Hidradenitis Suppurativa: An Immunohistochemical Real-World Approach. Dermatology 2021; 238:251-259. [PMID: 34293747 DOI: 10.1159/000517017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory, potentially scarring disease of the hair follicle, affecting the apocrine gland-bearing skin areas. The major comorbid disorders associated with the occurrence or the aggravation of the disease are obesity and smoking. Numerous efforts to dissociate these factors led to controversial results. OBJECTIVES To assess the importance of metabolic disorders/obesity, smoking/environmental toxins, and inflammation in HS by utilizing the differential expression of major relevant protein markers in lesional skin of obese/smoking versus non-obese/non-smoking HS patients. METHODS Lesional skin specimens deriving from two groups of HS patients (BMI >30 and smokers, n = 12 vs. BMI <30 and non-smokers, n = 10) were stained with antibodies raised against irisin, PPARγ, and IGF-1R, which correlate with metabolic disorders/obesity, EGFR and AhR, associated with smoking, and IL-17, IL-17R, and S100A8, as markers of inflammation. RESULTS Metabolic disorders/obesity-related markers exhibited marked differential expression between the two groups, while smoking-associated markers a limited one. IL-17R expression was stronger in obese/smokers, and S100A8 staining exhibited intense strong immunoreactivity in both groups without significant difference. CONCLUSIONS The notion that obesity plays a role in HS development appears to be supported by the prominent regulation of the associated lesional biomarkers. Tobacco smoking might contribute less to HS than previously suspected.
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Affiliation(s)
- Katarzyna P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Amir M Hossini
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Ottfried Balthasar
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Daifallah Almansouri
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Aristeidis Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Jürgen Knolle
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Anna Boguslawska
- Department of Paediatric and Adolescence Endocrinology, Paediatric Institute, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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Nikolakis G, Kristandt A, Hauptmann M, Becker M, Zouboulis CC. Efficacy of short-term intravenous clindamycin prior to oral clindamycin-rifampicin treatment in hidradenitis suppurativa: A retrospective case-series. Br J Dermatol 2021; 185:1270-1272. [PMID: 34270785 DOI: 10.1111/bjd.20645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022]
Abstract
antibiotics represent the first-line hidradenitis suppurativa (HS) treatment, although HS is not an infectious disease1 . Prolonged antibiotic courses exhibit an anti-inflammatory effect, utilized for treating follicular/inflammatory skin diseases, e.g. acne and rosacea. Clindamycin/rifampicin or tetracyclines are usually administered for 10 to 12 weeks in moderate-to-severe HS treatment1 , mostly based on retrospective studies using non-validated severity scoring systems.
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Affiliation(s)
- G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor-Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V, Dessau, Germany
| | - A Kristandt
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor-Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - M Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - M Becker
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor-Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor-Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V, Dessau, Germany
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24
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Nikolakis G, Kokolakis G, Kaleta K, Wolk K, Hunger R, Sabat R, Zouboulis CC. [Pathogenesis of hidradenitis suppurativa/acne inversa]. Hautarzt 2021; 72:658-665. [PMID: 34228138 DOI: 10.1007/s00105-021-04853-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa/acne inversa (HS) has a multifactorial pathogenesis. In addition to a sporadic form, a familial form is reported in around 40% of patients, for whom an autosomal dominant (AD) inheritance with reduced gene penetrance is assumed. The phenotype of the disease with inflammatory nodules, abscesses and secreting sinus tracts suggests an infectious origin, but the exact role of the bacteria detected in HS pathogenesis remains unclear. Smoking and metabolic syndrome are regarded as important trigger factors in HS, with obesity and hormonal changes playing a pathogenic role in the latter. Ultimately, Toll-like receptors, antimicrobial peptides, immune cells and key cytokines are involved in the excessive inflammatory reaction of HS and are also the targets of future therapies.
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Affiliation(s)
- G Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland. .,European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.
| | - G Kokolakis
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - K Kaleta
- Klinik für Dermatologie und Venerologie, Jagiellonen-Universität, Krakow, Polen
| | - K Wolk
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - R Hunger
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Klinik für Dermatologie, Inselspital, Bern Universitätsklinikum, Bern Universität, Bern, Schweiz
| | - R Sabat
- European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - C C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Auenweg 38, 06847, Dessau, Deutschland.,European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland
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25
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Nikolakis G, von Stebut E. [Topical and novel device-based therapies for mild hidradenitis suppurativa]. Hautarzt 2021; 72:676-685. [PMID: 34223936 DOI: 10.1007/s00105-021-04849-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin folds, which requires more outpatient treatment alternatives. Although the disease was previously treated using surgery, new treatment modalities now allow the effective treatment of mild and moderate cases in an ambulatory care setting. AIM OF STUDY Local and instrument-based therapies are presented and their efficacy and safety profiles are highlighted. MATERIALS AND METHODS Clinical evidence for each therapeutic modality are presented and current treatment developments are analyzed based on the future treatment of HS patients in Germany. RESULTS Effective treatments for outpatient care of HS patients include topical clindamycin, resorcinol, and intralesional corticosteroids. New devices such as LAight therapy (combining intense pulsed light [IPL] with radiofrequency) are available, which can be used as monotherapy or adjunct therapy in combination with systemic treatment and/or surgery for the management of HS. CONCLUSION Evidence-based use of local treatments can provide more efficient outpatient and self-administered strategies, which improves the quality of life of HS patients, especially for patients with recurrent mild and moderate disease.
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Affiliation(s)
- G Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland.,European Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland
| | - E von Stebut
- Klinik für Dermatologie und Venerologie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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26
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Zouboulis CC, Frew JW, Giamarellos-Bourboulis EJ, Jemec GBE, Del Marmol V, Marzano AV, Nikolakis G, Sayed CJ, Tzellos T, Wolk K, Prens EP. Target molecules for future hidradenitis suppurativa treatment. Exp Dermatol 2021; 30 Suppl 1:8-17. [PMID: 34085329 DOI: 10.1111/exd.14338] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022]
Abstract
The registration of the tumour necrosis factor-α inhibitor adalimumab in 2015 was a major step forward in the treatment of hidradenitis suppurativa/acne inversa (HS). However, it soon became evident that the effectiveness of adalimumab in daily practice was highly variable. A significant unmet medical need of HS patients remained, and the search for novel therapeutic targets was intensified. During the 10th European Hidradenitis Suppurativa Foundation (EHSF) e.V. Conference, reknown international HS investigators virtually presented and discussed the published data on these potential target molecules for future HS treatment. This article addresses the most promising molecules currently under investigation from a pathophysiological and clinical point of view. With phase III trials ongoing, the anti- interleukin (IL)-17 biologics bimekizumab and secukinumab are in the most advanced stage of clinical development showing promising results. In addition, targeting IL-1α with bermekimab has shown encouraging results in two clinical trials. Directing treatment at neutrophil recruitment and activation by targeting IL-36 with spesolimab fits well in the pathogenic concept of HS and clinical phase II trial results are pending. In contrast to in situ evidence, Complement 5a (C5a) and C5a receptor blockade have only shown greater clinical benefit in patients with severe HS. Inhibition of Janus kinase (JAK) 1 signalling in HS showed clinical efficacy only in the highest dosage, highlighting that careful surveillance of the balance between safety and efficacy of JAK inhibition is warranted. Overall, clinical efficacies of all novel treatments reported so far are modest. To guide drug development, more and better-defined translational data on the pathogenesis of this severe and enigmatic inflammatory skin disease are required.
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Affiliation(s)
- Christos C Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Evangelos J Giamarellos-Bourboulis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregor B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veronique Del Marmol
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Hôpital Erasme, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Angelo V Marzano
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Georgios Nikolakis
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, NLSH University Hospital, Bodø, Norway
| | - Kerstin Wolk
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology and Institute of Medical Immunology/Psoriasis Research and Treatment Center, Charité-University Medicine, Berlin, Germany
| | - Errol P Prens
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Laboratory for Experimental Immunodermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Dermatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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27
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Hou X, Hossini AM, Nikolakis G, Balthasar O, Kurtz A, Zouboulis CC. 3D-SeboSkin Model for Human ex vivo Studies of Hidradenitis Suppurativa/Acne Inversa. Dermatology 2021; 238:236-243. [PMID: 34077928 DOI: 10.1159/000515955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa/acne inversa (HS) is a chronic, recurrent inflammatory skin disease. Its pivotal pathogenetic event is believed to be the occlusion of the hair follicle generating a perifollicular lympho-histiocytic inflammation. However, knowledge of the exact HS pathogenesis requires further research. OBJECTIVE To develop a human HS model applicable in preclinical research which could help to understand the pathophysiology of HS and to determine the action of therapeutic candidates. METHODS The 3D-SeboSkin technology was applied to maintain explants of involved and uninvolved skin of HS patients ex vivo for 3 days. Detection of differential expression of previously detected HS biomarkers was performed by immunohistochemistry in a group of female patients (n = 9, mean age 37.2 ± 8.4 years). RESULTS The application of the 3D-SeboSkin model preserved the structural integrity of lesional and perilesional HS skin ex vivo, as previously described for healthy skin. Moreover, the HS 3D-SeboSkin setting maintained the differential expression and pattern of several HS biomarkers (S100A9, KRT16, SERPINB3) in epidermal and dermal tissue and the appendages. CONCLUSION We have validated HS 3D-SeboSkin as a reproducible, human model, which is appropriate for preclinical lesional and perilesional HS skin studies ex vivo.
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Affiliation(s)
- Xiaoxiao Hou
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Berlin Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Amir M Hossini
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Ottfried Balthasar
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Andreas Kurtz
- Berlin Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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28
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Krajewski PK, Matusiak Ł, von Stebut E, Schultheis M, Kirschner U, Nikolakis G, Szepietowski JC. Quality-of-Life Impairment among Patients with Hidradenitis Suppurativa: A Cross-Sectional Study of 1795 Patients. Life (Basel) 2021; 11:34. [PMID: 33429896 PMCID: PMC7828046 DOI: 10.3390/life11010034] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
The chronic, inflammatory skin disorder hidradenitis suppurativa (HS) is associated well documented negative influences on patients' quality of life (QoL). The aim of this study was to present more robust data on patients' QoL impairment by demographic data and its correlation with well-known HS risk factors on a cohort of 1795 German patients. The instrument used for measuring QoL in this study was the Dermatology Life Quality Index (DLQI). Overall, patients reported a very large effect of HS on their QoL (mean DLQI: 13.2 ± 8.1 points), and 22% of the analyzed population even reported to consider the effect as extremely large. Women tended to experience significantly higher impairment than men (p < 0.001). QoL impairment correlated positively with pain (r = 0.581, p < 0.001), HS severity (measured by the International Hidradenitis Suppurativa Severity Score System (IHS4)) as well as Hurley. Neck involvement tended to decrease QoL significantly more than any other location (14.7 ± 8.3 points). This study confirms the enormous influence of HS on patients' QoL in a large cohort. Knowledge of QoL impairment in such patients is crucial for proper understanding and holistic management of this disease.
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Affiliation(s)
- Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
| | - Esther von Stebut
- Department of Dermatology, Faculty of Medicine, University of Cologne, 50923 Cologne, Germany;
| | - Michael Schultheis
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, 55122 Mainz, Germany;
| | - Uwe Kirschner
- Dermatology Outpatient Office Dr. Uwe Kirschner, 55116 Mainz, Germany;
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, 06847 Dessau, Germany;
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (Ł.M.)
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29
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Krajewski PK, Matusiak Ł, von Stebut E, Schultheis M, Kirschner U, Nikolakis G, Szepietowski JC. Pain in Hidradenitis Suppurativa: A Cross-sectional Study of 1,795 Patients. Acta Derm Venereol 2021; 101:adv00364. [PMID: 33320274 PMCID: PMC9309859 DOI: 10.2340/00015555-3724] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 11/16/2022] Open
Abstract
Hidradenitis suppurativa is a chronic, inflammatory skin disorder that affects the pilosebaceous unit of the intertriginous body areas. Pain is one of the most important problems in patients with hidradenitis suppurativa. The aim of this study, which included 1,795 patients, was to evaluate the prevalence and characteristics of pain. The intensity of pain was assessed with a numerical rating scale. In addition, pain intensity was correlated with various clinical features. Pain was reported by 83.6% of subjects. The majority of patients (77.6%) experienced mild pain; women and smokers tended to experience more intense pain. Pain intensity was greater in patients with multiple affected skin areas and correlated positively with the number of those affected areas (r = 0.151, p < 0.001). There was no difference in pain intensity between affected locations. The worst pain was observed in the patients with the most severe disease and it would weaken significantly along with the severity of hidradenitis suppurativa (assessed using the Hurley staging system and the International Hidradenitis Suppurativa Severity Score System).
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Affiliation(s)
- Piotr K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, PL-51-165 Wrocław, Poland
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30
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Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos‐Bourboulis EJ, Fabbrocini G, Frew JW, Fujita H, González‐López MA, Guillem P, Gulliver WPF, Hamzavi I, Hayran Y, Hórvath B, Hüe S, Hunger RE, Ingram JR, Jemec GB, Ju Q, Kimball AB, Kirby JS, Konstantinou MP, Lowes MA, MacLeod AS, Martorell A, Marzano AV, Matusiak Ł, Nassif A, Nikiphorou E, Nikolakis G, Nogueira da Costa A, Okun MM, Orenstein LA, Pascual JC, Paus R, Perin B, Prens EP, Röhn TA, Szegedi A, Szepietowski JC, Tzellos T, Wang B, van der Zee HH. What causes hidradenitis suppurativa ?—15 years after. Exp Dermatol 2020; 29:1154-1170. [DOI: 10.1111/exd.14214] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
| | - Farida Benhadou
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hôpital Erasme Universite Libre de Bruxelles Bruxelles Belgium
| | - Angel S. Byrd
- Department of Dermatology Howard University College of Medicine Washington DC USA
| | - Nisha S. Chandran
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Department of Medicine National University Hospital Singapore
| | - Evangelos J. Giamarellos‐Bourboulis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- 4th Department of Internal Medicine National and Kapodistrian University of Athens Medical School Athens Greece
| | - Gabriella Fabbrocini
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | | | - Hideki Fujita
- Division of Cutaneous Science Department of Dermatology Nihon University School of Medicine Tokyo Japan
| | - Marcos A. González‐López
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Division of Dermatology Hospital Universitario Marqués de Valdecilla University of Cantabria IDIVAL Santander Spain
| | - Philippe Guillem
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Surgery Clinique du Val d’Ouest (Lyon), ResoVerneuil (Paris) and Groupe de Recherche en Proctologie de la Société Nationale Française de ColoProctologie Paris France
| | - Wayne P. F. Gulliver
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Faculty of Medicine Memorial University of Newfoundland, and NewLab Clinical Research Inc St. John's Canada
| | - Iltefat Hamzavi
- Department of Dermatology Henry Ford Hospital Wayne State University Detroit MI USA
| | - Yildiz Hayran
- Department of Dermatology Ankara Numune Training and Research Hospital Ankara Turkey
| | - Barbara Hórvath
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology University Medical Centre Groningen University of Groningen Groningen The Netherlands
| | | | - Robert E. Hunger
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Inselspital Bern University Hospital Bern Switzerland
| | - John R. Ingram
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology & Academic Wound Healing Division of Infection and Immunity Cardiff University Cardiff UK
| | - Gregor B.E. Jemec
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - Qiang Ju
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology RenJi Hospital School of Medicine Shanghai Jiaotong University Shanghai China
| | - Alexa B. Kimball
- Department of Dermatology Beth Israel Deaconess Medical Center and Harvard Medical School Boston MA USA
| | - Joslyn S. Kirby
- Department of Dermatology Penn State Milton S. Hershey Medical Center Hershey PA USA
| | - Maria P. Konstantinou
- Dermatology Department Paul Sabatier University University Hospital of Toulouse Toulouse France
| | | | - Amanda S. MacLeod
- Department of Dermatology Department of Immunology Department of Molecular Genetics and Microbiology Duke University Durham NC USA
| | - Antonio Martorell
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Hospital of Manises Valencia Spain
| | - Angelo V. Marzano
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dermatology Unit Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Łukasz Matusiak
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Aude Nassif
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Institut Pasteur Paris France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases King’s College London, and Department of Rheumatology King’s College Hospital London UK
| | - Georgios Nikolakis
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg Dessau Germany
| | - André Nogueira da Costa
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Translational Science and Experimental Medicine Early Respiratory and Immunology Biopharmaceuticals R&D AstraZeneca Gothenburg Sweden
| | | | | | - José Carlos Pascual
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Alicante University General Hospital Alicante Institute for Health and Biomedical Research (ISABIAL‐FISABIO Foundation) Alicante Spain
| | - Ralf Paus
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery University of Miami Miller School of Medicine Miami FL USA
| | - Benjamin Perin
- Division of Dermatology University of Washington Seattle WA USA
| | - Errol P. Prens
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
| | - Till A. Röhn
- Autoimmunity, Transplantation and Inflammation Novartis Institutes for BioMedical Research Novartis Pharma AG Basel Switzerland
| | - Andrea Szegedi
- Division of Dermatological Allergology Department of Dermatology Faculty of Medicine University of Debrecen Debrecen Hungary
| | - Jacek C. Szepietowski
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology, Venereology and Allergology Wrocław Medical University Wrocław Poland
| | - Thrasyvoulos Tzellos
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Nordland Hospital Trust Bodø Norway
| | - Baoxi Wang
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Plastic Surgery Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hessel H. van der Zee
- European Hidradenitis Suppurativa Foundation e.V. Dessau Germany
- Department of Dermatology Erasmus University Medical Center Rotterdam The Netherlands
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Nikolakis G, Kaleta K, Vaiopoulos A, Wolter K, Baroud S, Wojas-Pelc A, Zouboulis C. Phenotypes and Pathophysiology of Syndromic Hidradenitis Suppurativa: Different Faces of the Same Disease? A Systematic Review. Dermatology 2020; 237:673-697. [DOI: 10.1159/000509873] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/27/2020] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> There is growing evidence that (certain) hidradenitis suppurativa (HS) comorbidities comprise syndromes including HS as a key cutaneous manifestation. These apparently autoinflammatory syndromes and their diagnostic delay might have detrimental effects on affected patients. <b><i>Methods:</i></b> A systematic review was performed on the databases MEDLINE, EMBASE, and CENTRAL utilizing a standardized extraction form according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. <b><i>Results:</i></b> Sixty-four eligible articles on syndromic HS were retrieved. The identified syndromes included already described ones (pyoderma gangrenosum-acne-suppurative hidradenitis, pyogenic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, psoriatic arthritis-pyoderma gangrenosum-acne-suppurative hidradenitis, pyoderma gangrenosum-acne vulgaris-hidradenitis suppurativa-ankylosing spondylitis, synovitis-acne-pustulosis-hyperostosis-osteitis) and further novel symptom constellations. Cutaneous signs, including HS lesions, usually precede signs from other organs. The cutaneous signs of a considerable proportion of patients appear refractory to conventional treatment, and monotherapy with biologics does not suffice to sustain remission. <b><i>Conclusion:</i></b> The results are subsequently discussed with focus on the pathophysiology and treatment of the detected syndromes. The dermatologist’s role in the precise diagnosis and early treatment administration of HS is pivotal. The purpose of the treatment should be the effective prevention or delay of the autoinflammatory march and its irreversible consequences.
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Vaiopoulos AG, Nikolakis G, Zouboulis CC. Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature. J Eur Acad Dermatol Venereol 2020; 34:2140-2146. [PMID: 32324936 DOI: 10.1111/jdv.16520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle affecting apocrine glands-rich areas of the body. The disease usually occurs after puberty leading to painful nodules, abscesses, tunnels and scarring. Although uncommonly, HS can also occur in children and adolescents. OBJECTIVE Our objective was to describe the epidemiology, characteristics, predisposing factors and clinical course of HS in paediatric patients. METHODS The retrospective cohort study included patients with HS, who have been diagnosed in Dessau Medical Center and reported development of HS during childhood or adolescence, fulfilled the diagnostic criteria for HS and had a follow-up period of at least one year. A systematic review was conducted on MEDLINE, EMBASE and CENTRAL on 19 March 2020 using the terms 'hidradenitis' or 'acne inversa' together with the terms 'children', 'paediatric' and 'adolescence'. RESULTS Twenty paediatric patients [1 child (0.22%), 19 adolescents (4.25%)] were detected out of 447 patients evaluated (4.5%) with a male to female ratio of 1.86 : 1. The median age at diagnosis was 17 years [interquartile range (IQR) 16-18] and the median age at onset 15 years (IQR: 14-16.5). The majority of the patients suffered from moderate disease were overweight or obese and non-smokers. The most common comorbid disorder was acne vulgaris. The systematic review revealed reports with data heterogeneity and lack of systematic documentation of specific demographic characteristics. Most paediatric patients were female, obese and non-smokers, with considerable comorbid disorders. CONCLUSIONS Hidradenitis suppurativa in Germany may affect children and adolescents exhibiting a particular phenotype of mainly male non-smokers.
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Affiliation(s)
- A G Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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Zouboulis CC, Nogueira da Costa A, Makrantonaki E, Hou XX, Almansouri D, Dudley JT, Edwards H, Readhead B, Balthasar O, Jemec GBE, Bonitsis NG, Nikolakis G, Trebing D, Zouboulis KC, Hossini AM. Alterations in innate immunity and epithelial cell differentiation are the molecular pillars of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2020; 34:846-861. [PMID: 31838778 DOI: 10.1111/jdv.16147] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The large unmet need of hidradenitis suppurativa/acne inversa (HS) therapy requires the elucidation of disease-driving mechanisms and tissue targeting. OBJECTIVE Robust characterization of the underlying HS mechanisms and detection of the involved skin compartments. METHODS Hidradenitis suppurativa/acne inversa molecular taxonomy and key signalling pathways were studied by whole transcriptome profiling. Dysregulated genes were detected by comparing lesional and non-lesional skin obtained from female HS patients and matched healthy controls using the Agilent array platform. The differential gene expression was confirmed by quantitative real-time PCR and targeted protein characterization via immunohistochemistry in another set of female patients. HS-involved skin compartments were also recognized by immunohistochemistry. RESULTS Alterations to key regulatory pathways involving glucocorticoid receptor, atherosclerosis, HIF1α and IL17A signalling as well as inhibition of matrix metalloproteases were detected. From a functional standpoint, cellular assembly, maintenance and movement, haematological system development and function, immune cell trafficking and antimicrobial response were key processes probably being affected in HS. Sixteen genes were found to characterize HS from a molecular standpoint (DEFB4, MMP1, GJB2, PI3, KRT16, MMP9, SERPINB4, SERPINB3, SPRR3, S100A8, S100A9, S100A12, S100A7A (15), KRT6A, TCN1, TMPRSS11D). Among the proteins strongly expressed in HS, calgranulin-A, calgranulin-B and serpin-B4 were detected in the hair root sheath, koebnerisin and connexin-32 in stratum granulosum, transcobalamin-1 in stratum spinosum/hair root sheath, small prolin-rich protein-3 in apocrine sweat gland ducts/sebaceous glands-ducts and matrix metallopeptidase-9 in resident monocytes. CONCLUSION Our findings highlight a panel of immune-related drivers in HS, which influence innate immunity and cell differentiation in follicular and epidermal keratinocytes as well as skin glands.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | | | - E Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - X X Hou
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - D Almansouri
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - J T Dudley
- Department of Genetics and Genomic Sciences, Institute of Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - H Edwards
- Translational Medicine, UCB SA, Slough, UK
| | - B Readhead
- Department of Genetics and Genomic Sciences, Institute of Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - O Balthasar
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - G B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - N G Bonitsis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - D Trebing
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - K C Zouboulis
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - A M Hossini
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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Hou X, Hossini A, Nikolakis G, Zouboulis C. 605 3D-SeboSkin model application in Hidradenitis suppurativa/acne inversa. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Nikolakis G, Kyrgidis A, Zouboulis CC. Is There a Role for Antiandrogen Therapy for Hidradenitis Suppurativa? A Systematic Review of Published Data. Am J Clin Dermatol 2019; 20:503-513. [PMID: 31073704 DOI: 10.1007/s40257-019-00442-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hidradenitis suppurativa/acne inversa is a disease with deep-seated chronic painful nodules, abscesses, and draining sinus tracts, which manifests on the apocrine gland-rich skin areas of the body. Observational findings demonstrate that the disease usually appears after puberty, exhibits pre-menstrual flares in women, improves in pregnancy, and worsens post-partum, which indicates a role of hormones and particularly of androgens in its pathophysiology. Because increased androgen levels in serum have not been widely reported, an end-organ androgen hypersensitivity has been postulated. OBJECTIVE The aim of this systematic review was to identify and present evidence for antiandrogen therapeutic options for the treatment of hidradenitis suppurativa/acne inversa. METHODS A literature search was conducted in different medical electronic databases using the keywords "hidradenitis", "suppurativa", "acne inversa", and "antiandrogen" on 1 December, 2018. The main therapeutic options were subsequently used as separate keywords with the disease terms in a separate search. RESULTS The main therapeutic options yielded were cyproterone acetate, spironolactone, finasteride, and metformin. One randomized controlled crossover trial and seven case series were identified following use of a standard extraction form for eligibility. CONCLUSION The existing studies do not allow a robust evidence-based recommendation for the use of antiandrogens in the treatment of hidradenitis suppurativa/acne inversa. Further randomized controlled trials are needed to define the role of hormonal treatment as an alternative or concomitant therapy together with antibiotics or biologics.
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Garg A, Neuren E, Cha D, Kirby JS, Ingram JR, Jemec GBE, Esmann S, Thorlacius L, Villumsen B, Marmol VD, Nassif A, Delage M, Tzellos T, Moseng D, Grimstad Ø, Naik H, Micheletti R, Guilbault S, Miller AP, Hamzavi I, van der Zee H, Prens E, Kappe N, Ardon C, Kirby B, Hughes R, Zouboulis CC, Nikolakis G, Bechara FG, Matusiak L, Szepietowski J, Glowaczewska A, Smith SD, Goldfarb N, Daveluy S, Avgoustou C, Giamarellos-Bourboulis E, Cohen S, Soliman Y, Brant EG, Akilov O, Sayed C, Tan J, Alavi A, Lowes MA, Pascual JC, Riad H, Fisher S, Cohen A, Paek SY, Resnik B, Ju Q, Wang L, Strunk A. Evaluating patients' unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project. J Am Acad Dermatol 2019; 82:366-376. [PMID: 31279015 DOI: 10.1016/j.jaad.2019.06.1301] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND A needs assessment for patients with hidradenitis suppurativa (HS) will support advancements in multidisciplinary care, treatment, research, advocacy, and philanthropy. OBJECTIVE To evaluate unmet needs from the perspective of HS patients. METHODS Prospective multinational survey of patients between October 2017 and July 2018. RESULTS Before receiving a formal HS diagnosis, 63.7% (n = 827) of patients visited a physician ≥5 times. Mean delay in diagnosis was 10.2 ± 8.9 years. Patients experienced flare daily, weekly, or monthly in 23.0%, 29.8%, and 31.1%, respectively. Most (61.4% [n = 798]) rated recent HS-related pain as moderate or higher, and 4.5% described recent pain to be the worst possible. Access to dermatology was rated as difficult by 37.0% (n = 481). Patients reported visiting the emergency department and hospital ≥5 times for symptoms in 18.3% and 12.5%, respectively. An extreme impact on life was reported by 43.3% (n = 563), and 14.5% were disabled due to disease. Patients reported a high frequency of comorbidities, most commonly mood disorders. Patients were dissatisfied with medical or procedural treatments in 45.9% and 34.6%, respectively. LIMITATIONS Data were self-reported. Patients with more severe disease may have been selected. CONCLUSION HS patients have identified several critical unmet needs that will require stakeholder collaboration to meaningfully address.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
| | - Erica Neuren
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Denny Cha
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - John R Ingram
- Institute of Infection and Immunity, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Solveig Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | | | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Aude Nassif
- Department of Dermatology, Institut Pasteur, Centre Medical, Paris, France
| | - Maia Delage
- Department of Dermatology, Institut Pasteur, Centre Medical, Paris, France
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Institute of Clinical Medicine, Arctic University, Tromsø, Norway
| | - Dagfinn Moseng
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Institute of Clinical Medicine, Arctic University, Tromsø, Norway
| | - Øystein Grimstad
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Institute of Clinical Medicine, Arctic University, Tromsø, Norway
| | - Haley Naik
- Department of Dermatology, University of California, San Francisco, California
| | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Angie Parks Miller
- Hope For HS, Detroit, Michigan; Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Hessel van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Naomi Kappe
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christine Ardon
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Rosalind Hughes
- Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Centre, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Amelia Glowaczewska
- Department of Dermatology, Venereology and Allergology, Wrocław Medical University, Wrocław, Poland
| | - Saxon D Smith
- Department of Dermatology, Northern Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, Michigan
| | - Christina Avgoustou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | - Steven Cohen
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Yssra Soliman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Oleg Akilov
- Department of Dermatology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jerry Tan
- Department of Medicine, Western University, Windsor Campus, Windsor, Ontario, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York
| | - José Carlos Pascual
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Hassan Riad
- Dermatology Department, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shani Fisher
- Dermatology Department, Emek Medical Center, Afula, Israel
| | - Arnon Cohen
- Department of Quality Measures and Research Chief Physician Office, General Management Clalit Health Services, Tel Aviv, Israel
| | - So Yeon Paek
- Department of Dermatology, Baylor Scott & White Health, Dallas, Texas
| | - Barry Resnik
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, Miami, Florida
| | - Qiang Ju
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lanqi Wang
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
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Benhadou F, Van der Zee H, Pascual J, Rigopoulos D, Katoulis A, Liakou A, Daxhelet M, Romanelli M, Iannone M, Kinyó Á, Nikolakis G, Zouboulis C, Dessinioti C, Zisimou C, Antoniou C, Alavi A, Mintoff D, Aquilina S, Matusiak L, Szepietowski J, Sinclair R, Husein‐ElAhmed H, von Laffert M, Revuz J, Danby B, Puig L, Theut Riis P, Jemec G, Straalen K, Wigny K, Marmol V, Guillem P. Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross‐sectional study among 2465 patients. Br J Dermatol 2019; 181:1198-1206. [DOI: 10.1111/bjd.17927] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 12/14/2022]
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Abstract
The skin represents the first bearer of marks of time as well as an easily accessible model for the assessment and determination of the involved molecular mechanisms. The deterioration of important skin functions due to intrinsic and extrinsic aging leads to clinical manifestations, which mirror several internal age-associated diseases, such as neurodegenerative, cardiovascular, skeletal, and endocrine/metabolic skin diseases. Current molecular data indicate that skin aging, especially intrinsic aging, mirrors age-related deficiencies in the entire human body. These data and the development of new biologic technologies highlight the importance of the skin in aging research and should enable future interdisciplinary projects on internal diseases, which could barely have been performed until recently due mainly to the lack of respective tissue.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.
| | - Eugenia Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
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Nikolakis G, Liakou AI, Bonovas S, Seltmann H, Bonitsis N, Join-Lambert O, Wild T, Karagiannidis I, Zolke-Fischer S, Langner K, Zouboulis CC. Bacterial Colonization in Hidradenitis Suppurativa/Acne Inversa: A Cross-sectional Study of 50 Patients and Review of the Literature. Acta Derm Venereol 2017; 97:493-498. [PMID: 27882387 DOI: 10.2340/00015555-2591] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is unclear whether bacterial colonization in hidradenitis suppurativa/acne inversa (HS) comprises a primary cause, triggering factor or secondary phenomenon of the disease pathogenesis. Furthermore, the connection between certain bacterial species, the disease severity and its localization is unknown. Bacterial species were isolated from HS lesions to reveal a potential correlation with localization and disease severity. Ninety swab tests were prospectively obtained from 90 HS lesions of 50 consecutive patients. The material was cultured under aerobic and anaerobic conditions. The identified species were statistically correlated with Hurley stage and localization of the lesions. The most prevalent isolates were reported. Hurley stage significantly correlated with disease localization. Particular bacterial species were associated with "extended" disease and Hurley III stage with the detection of both aerobic and anaerobic bacteria and with a higher number of species. The presence of bacterial species is dependent on the local milieu, which correlates with the localization of the disease, its clinical manifestations and its extension.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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Abstract
A 35-year-old man presented with two annular, reddish-brown, atrophic skin lesions in the navel and on the right lower abdomen. The lesions had persisted for more than 4 years and had remained unchanged and asymptomatic. Histology revealed annular atrophic lichen planus with a lichenoid lymphocytic infiltration and cystoid bodies. The patient was treated with local corticosteroids without improvement.
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Affiliation(s)
- I Karagiannidis
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland.
| | - M Brunner
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
| | - G Nikolakis
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
| | - C C Zouboulis
- Klinik für Dermatologie, Venerologie und Allergologie, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau-Roßlau, Deutschland
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41
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Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of unknown etiology. The role of hormones in HS remains unclear, but the observation of premenstrual flares, female predominance, and improvement during pregnancy suggest a hormonal/metabolic background. The reported positive effects of antiandrogen therapy supports a possible role of androgens. The predominant onset of the disease years after puberty may indicate a metabolic disorder. Obesity contributes significantly to HS pathogenesis; diabetes, dyslipidemia, the metabolic syndrome, and polycystic ovarian syndrome are among the commonest comorbidities. More studies are required to clarify a potential hormonal dysregulation in HS.
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Affiliation(s)
- Ioannis Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847 Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847 Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847 Dessau, Germany.
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Abstract
Diabetes is a debilitating, life-threatening disease accounting in 2015 for the death of 5 million people worldwide. According to new estimations, 415 million adults currently suffer from the disease, and this number is expected to rise to 642 million by 2040. High glucose blood levels also affect the skin among systemic organs, and skin disorders can often predict the onset of this metabolic disorder. In this review, we address the pathomechanistic effects of diabetes on the skin and give an overview on the most common skin diseases associated with diabetes.
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Affiliation(s)
- E Makrantonaki
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany.
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany.
| | - D Jiang
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - A M Hossini
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - G Nikolakis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
| | - M Wlaschek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - K Scharffetter-Kochanek
- Department of Dermatology and Allergic Diseases, Universitätsklinikum Ulm, Life Science Building N27, James-Franck Ring/Meyerhofstrasse 11c, 89081, Ulm, Germany
| | - C C Zouboulis
- Department of Dermatology, Venereology, Allergology and Immunology, Städtisches Klinikum Dessau, Dessau, Germany
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Abstract
The skin is an important extra-gonadal steroidogenic organ, capable of metabolizing various hormones from their precursors, as well as of synthesizing de novo a broad palette of sex steroids and glucocorticoids from cholesterol. In this manuscript, we review the major steroidogenic properties of human skin and we suggest steroidogenesis' impairment as a cardinal factor for various pathological conditions such as acne, rosacea, atopic dermatitis, and androgenic alopecia.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany.
| | | | - Theodora Kanaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany
| | - Andrej Slominski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany
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Abstract
Hidradenitis suppurativa / acne inversa (HS) is a chronic inflammatory, debilitating skin disorder with a largely unknown etiology. However, many observations such as the typical onset of the disease after puberty, the female predominance, the pre-menstrual flare ups and the improvement during pregnancy suggest a contribution of endocrinological factors to the emergence of the disease. In addition, the reported efficacy of anti-androgen treatment on HS indicates a possible involvement of androgens in the pathogenesis. Furthermore, the common comorbidity with metabolic syndrome points to possible interactions between endocrinological and metabolic alterations in the development of HS. Taking into account the endocrine functions of the human skin, several studies investigated the effects of hormones and the behavior of the pilosebaceous unit in the skin of patients with HS. In this review we describe the current view on the hormonal dysregulation and metabolic syndrome and their role in HS.
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Affiliation(s)
- Ioannis Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany
| | - Robert Sabat
- Interdisciplinary Group of Molecular Immunopathology, Dermatology/Medical Immunology, University Hospital Charité, Berlin, Germany
- Psoriasis Research and Treatment Center, University Hospital Charité, Berlin, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Auenweg 38, 06847, Dessau, Germany.
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Giamarellos-Bourboulis EJ, Platzer M, Karagiannidis I, Kanni T, Nikolakis G, Ulrich J, Bellutti M, Gollnick H, Bauer M, Zouboulis CC, Huse K. High Copy Numbers of β-Defensin Cluster on 8p23.1, Confer Genetic Susceptibility, and Modulate the Physical Course of Hidradenitis Suppurativa/Acne Inversa. J Invest Dermatol 2016; 136:1592-1598. [PMID: 27164300 DOI: 10.1016/j.jid.2016.04.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 03/29/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
Hidradenitis suppurativa/acne inversa (HS) has a multifactorial pathogenesis, with many patients reporting positive family history. Nine β-defensin genes (among them DEFB4 and DEFB103, encoding for proinflammatory mediators human β-defensin-2 and human β-defensin-3, respectively) exist as a cluster (DEFB) affected by copy number (CN). We hypothesized that CNs are greater in patients with HS and that they are linked to genetic susceptibility. CNs of DEFB were studied in two independent patient cohorts: 163 patients from Greece and 98 from Germany. CNs were greater in patients than control subjects in both studied cohorts. Carriage of more than six CNs was associated with a 7.53 odds ratio for HS in the Greek cohort and a 5.76 odds ratio for HS in the German cohort. The common odds ratio after meta-analysis was 6.72 (P < 0.0001). However, presence of fewer than six copies was linked with disease onset at an earlier age (P = 0.048), less frequent presentation of permanent purulence of the affected skin lesions (P = 0.036), and fewer skin localizations (P = 0.042). A robust genetic trait for susceptibility to HS is provided, and this is confirmed in two independent cohorts. Susceptibility arises from carriage of more than six DEFB copies, which interferes directly with the HS phenotype.
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Affiliation(s)
- Evangelos J Giamarellos-Bourboulis
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece; Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - Matthias Platzer
- Genome Analysis, Leibniz Institute on Aging-Fritz Lipmann Institute, Jena, Germany
| | - Ioannis Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Theodora Kanni
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Jens Ulrich
- Department of Dermatology and Allergology, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg, Germany
| | - Michael Bellutti
- Department of Dermatology and Venereology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Harald Gollnick
- Department of Dermatology and Venereology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Michael Bauer
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Klaus Huse
- Genome Analysis, Leibniz Institute on Aging-Fritz Lipmann Institute, Jena, Germany
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Altenburg A, Abdel-Naser MB, Nikolakis G, Wild T, Wojtalewicz N. CD40/CD40 ligand interactions and TNFα treatment reduce activity of P105 promoter of the human papilloma virus-18 in vitro. Exp Oncol 2016; 38:22-25. [PMID: 27031714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cervical carcinoma cells including those infected with the oncogenic human papilloma virus (HPV) and several cervical carcinoma cell lines show a strong expression of the CD40 receptor, unlike benign cervical epithelial cells infected with HPV. The functional relevance of this up-regulated expression in the tumor is not fully understood. Nevertheless, it might offer a unique possibility to target those malignant cells due to the antiviral and antitumoral effects of the CD40/CD40 ligand (CD40L) interactions. AIM In vitro assessment of the effect of CD40L on HPV 18-P105 promoter activity and the subsequent release of IL-6 by the promoter transfected HeLa(CD40) cells, which express CD40 constitutively. MATERIAL AND METHODS Transfection of HeLa(CD40) cells was achieved by electroporation after optimizing the parameters by the pCMV-β-Gal vector and β-Gal stain. Transfected HeLa(CD40) cells were challenged with BHK(CD40L) and TNFα, in addition to BHK(wt) and medium alone as controls. HPV18-P105 promoter activity was demonstrated by luciferase reporter gene assay while IL-6 was assessed by ELISA. RESULTS CD40/CD40L interactions and TNFα treatment significantly reduced HPV18-P105 promoter activity (56.0 ± 10.2% and 64.1 ± 9.1% vs. control, respectively; p < 0.001). Likewise, IL-6, which is a sensitive cytokine of CD40 activation, was significantly increased in HeLa(CD40) cells in the same experiments (2.7 fold after stimulation with BHK(CD40L) and 5.2 fold after stimulation with TNFα vs. control; p < 0.01 and p < 0.001, respectively). CONCLUSION It is likely that the CD40/CD40L interactions and TNFα are effective against cervical carcinomas by repressing transcriptional activity of HPV promoter. This can result in new adjuvant treatments.
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Affiliation(s)
- A Altenburg
- Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau D-06847, Germany
| | | | - G Nikolakis
- Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau D-06847, Germany
| | - T Wild
- Department of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau D-06847, Germany
| | - N Wojtalewicz
- Center of Life Sciences Institute of Bioanalytical Sciences (IBAS), Anhalt University of Applied Sciences, Bernburg D-06406, Germany
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47
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Nikolakis G, Join-Lambert O, Karagiannidis I, Guet-Revillet H, Zouboulis CC, Nassif A. Bacteriology of hidradenitis suppurativa/acne inversa: A review. J Am Acad Dermatol 2016; 73:S12-8. [PMID: 26470608 DOI: 10.1016/j.jaad.2015.07.041] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/16/2015] [Indexed: 01/30/2023]
Abstract
Given that follicular papules and pustules, as well as nodules and abscesses, are the clinical hallmarks of hidradenitis suppurativa (HS), an infectious, bacterial pathway has been suspected in the pathogenesis of this chronic, inflammatory condition. Elucidating the behavior and role of bacterial species in HS and their interaction with cutaneous innate immunity will provide more insight into the pathophysiology of this condition. This review of prospective investigations suggests a synergistic relationship between impaired innate immunity and microbial factors in the etiology of HS.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Olivier Join-Lambert
- Laboratory of Clinical Microbiology, Necker-Enfants Malades Hospital, Assistance publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm U1151, équipe 11 "Physiopathologie des infections systémiques", Paris, France; Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Ioannis Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Hélène Guet-Revillet
- Laboratory of Clinical Microbiology, Necker-Enfants Malades Hospital, Assistance publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Inserm U1151, équipe 11 "Physiopathologie des infections systémiques", Paris, France; Centre d'Infectiologie Necker-Pasteur, Paris, France
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.
| | - Aude Nassif
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany; Institut Pasteur, Centre Médical, Service de Pathologie Infectieuse et Tropicale, Paris, France; Centre d'Infectiologie Necker-Pasteur, Paris, France
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48
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Nikolakis G, Karagiannidis I, Zampeli VA, Altenburg A, Brunner M, Zouboulis CC. Multiple HPV-Induced Squamous Cell Carcinomas on the Fingers of a Patient with Systemic Lupus Erythematosus: A Case and Review. Case Rep Dermatol 2015; 7:329-34. [PMID: 26674851 PMCID: PMC4677700 DOI: 10.1159/000442017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human papilloma virus (HPV) infection is documented to be involved in the development of epithelial malignancies, mostly in cervical cancer. Systemic lupus erythematosus (SLE) patients have an increased prevalence of such an infection. We report the case of a 55-year-old female SLE patient who developed multiple in situ squamous cell carcinomas on her fingers, after chronic HPV infection. HPV-33 DNA was isolated from the lesions. The purpose of this case presentation is to raise awareness about HPV-induced malignancies for this high-risk group and propose an early HPV vaccination to efficiently prevent such comorbidities.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Ioannis Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Vasiliki A Zampeli
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Martina Brunner
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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49
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Zampeli VA, Lippert U, Nikolakis G, Makrantonaki E, Tzellos TG, Krause U, Zouboulis CC. Disseminated refractory pyoderma gangraenosum during an ulcerative colitis flare. Treatment with infliximab. J Dermatol Case Rep 2015; 9:62-6. [PMID: 26512301 DOI: 10.3315/jdcr.2015.1206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 07/13/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pyoderma gangraenosum is an immune-mediated, inflammatory, neutrophilic dermatosis of unknown etiology, which represents one of the extraintestinal manifestations of inflammatory bowel disease. It is a rare disease that occurs in less than 1% of patients with inflammatory bowel disease and with the same ratio in patients with Crohn's disease and ulcerative colitis. MAIN OBSERVATIONS A 36-year-old woman was diagnosed with ulcerative colitis 6 years before admission to our dermatology department with an acute disseminated pyoderma gangraenosum with mucosal involvement, during a flare of ulcerative colitis. Disease progression was interrupted by intravenous administration of the tumor necrosis factor-α inhibitor infliximab at 5 mg/kg at weeks 0, 2, and 6 (1st cycle) and every 8 weeks thereafter. Improvement of intestinal, skin and oral manifestations was evident already after the 1st cycle of treatment and has been maintained since (at least 16 months). CONCLUSIONS This case report is one of very few on disseminated pyoderma gangraenosum with oral involvement complicating ulcerative colitis, where infliximab was shown to have a rapid efficacy on skin, mucosal and bowel symptoms.
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Affiliation(s)
- Vasiliki A Zampeli
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Undine Lippert
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Evgenia Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Thrasivoulos G Tzellos
- Division of Evidenced Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
| | - Ulf Krause
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany; ; Division of Evidenced Based Dermatology, Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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50
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Nikolakis G, Zouboulis CC. Skin and glucocorticoids: effects of local skin glucocorticoid impairment on skin homeostasis. Exp Dermatol 2015; 23:807-8. [PMID: 25056134 DOI: 10.1111/exd.12519] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 12/11/2022]
Abstract
The role of skin as a de novo source of glucocorticoids and the importance of cutaneous glucocorticoidogenesis as a homeostatic mechanism in human skin is highlighted by Slominski et al. in a recently published issue. Impairment of glucocorticoidogenesis through noxious stimuli, such as UVB, can explain pathophysiology of skin diseases (e.g. rosacea). In addition to keratinocytes, melanocytes and fibroblasts, cutaneous adnexes also play a significant role as targets and sources of glucocorticoids, because they express most of the enzymes required for steroidogenesis. Glucocorticoids are also involved in the pathogenesis of acne lesions, affecting sebum production in vivo and in vitro. Certain steroidogenic enzymes, such as 11β-hydroxysteroid dehydrogenase, are upregulated in acne lesions. On this background, the paper by Slominski et al. provides further insights into dermatoendocrinology, with emphasis on the importance of an impairment of the skin's own hypothalamic-pituitary-adrenal-like axis in the pathophysiology of several skin diseases.
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Affiliation(s)
- Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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