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Wainman HE, Chandran NS, Frew JW, Garg A, Gibbons A, Gierbolini A, Horvath B, Jemec GB, Kirby B, Kirby J, Lowes MA, Martorell A, McGrath BM, Naik HB, Oon HH, Prens E, Sayed CJ, Thorlacius L, Van der Zee HH, Villumsen B, Ingram JR. Global consensus process to establish a core dataset for hidradenitis suppurativa registries. Br J Dermatol 2024; 190:510-518. [PMID: 37976235 DOI: 10.1093/bjd/ljad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Several registries for hidradenitis suppurativa (HS) already exist in Europe and the USA. There is currently no global consensus on a core dataset (CDS) for these registries. Creating a global HS registry is challenging, owing to logistical and regulatory constraints, which could limit opportunities for global collaboration as a result of differences in the dataset collected. The solution is to encourage all HS registries to collect the same CDS of information, allowing registries to collaborate. OBJECTIVES To establish a core set of items to be collected by all HS registries globally. The core set will cover demographic details, comorbidities, clinical examination findings, patient-reported outcome measures and treatments. METHODS Beginning in September 2022, 20 participants - including both clinicians with expertise in HS and patient advocates - from eight countries across three continents participated in a Delphi process consisting of four rounds of voting, with all participants completing each round. A list of potential items for inclusion in the core set was generated from the relevant published literature, including systematic reviews of comorbidities in HS, clinical and examination findings, and epidemiology. For disease severity and progression items, the Hidradenitis SuppuraTiva Core outcome set International Collaboration (HiSTORIC) core set and other relevant instruments were considered for inclusion. This resulted in 47 initial items. Participants were invited to suggest additional items to include during the first round. Anonymous feedback was provided to inform each subsequent round of voting to encourage consensus. RESULTS The eDelphi process established a CDS of 48 items recommended for inclusion in all HS registries globally. CONCLUSIONS The routine adoption of this CDS in current and future HS registries should allow registries in different parts of the world to collaborate, enabling research requiring large numbers of participants.
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Affiliation(s)
- Hannah E Wainman
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nisha S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - Angela Gibbons
- Patient Representative, The HS Support Network UK and Ireland, UK
| | | | - Barbara Horvath
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Brian Kirby
- Charles Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Joselyn Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | | | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Hazel H Oon
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H Van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bente Villumsen
- Patient Representative, The Patients' Association HS Denmark, Denmark
| | - John R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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Vellaichamy G, Amin AT, Dimitrion P, Hamzavi Z, Zhou L, Adrianto I, Mi QS. Recent advances in hidradenitis suppurativa: Role of race, genetics, and immunology. Front Genet 2022; 13:918858. [PMID: 36092908 PMCID: PMC9458948 DOI: 10.3389/fgene.2022.918858] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/02/2022] [Indexed: 12/01/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a multifactorial chronic skin disease characterized by inflammation around the hair follicles commonly affecting intertriginous areas. The underlying pathogenesis of HS and its molecular mechanisms are largely understudied. Genetic studies in families have identified variants within the γ-secretase complex associated with HS; however, no definitive genotype-phenotype correlations have been made. The lack of knowledge regarding the intersection of genetics, immunology and environmental risk factors is a major obstacle to improving treatment for patients with HS. This article provides an overview of the role of race, genetics, and immunology in HS to provide insight into the multiple factors influencing the pathophysiology of HS.
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Affiliation(s)
- Gautham Vellaichamy
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
| | - Anya T. Amin
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, United States
| | - Peter Dimitrion
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Zaakir Hamzavi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
| | - Li Zhou
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Department of Internal Medicine, Henry Ford Health, Detroit, MI, United States
| | - Indra Adrianto
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Center for Bioinformatics, Department of Public Health Sciences, Henry Ford Health, Detroit, MI, United States
| | - Qing-Sheng Mi
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health, Detroit, MI, United States
- Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health, Detroit, MI, United States
- Cancer Biology Graduate Program, School of Medicine, Wayne State University, Detroit, MI, United States
- Department of Internal Medicine, Henry Ford Health, Detroit, MI, United States
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3
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Seivright JR, Villa NM, Grogan T, Parvataneni RK, Thompson AM, Shi VY, Hsiao JL. Impact of Pregnancy on Hidradenitis Suppurativa Disease Course: A Systematic Review and Meta-Analysis. Dermatology 2022; 238:260-266. [PMID: 34515085 PMCID: PMC8850527 DOI: 10.1159/000517283] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/18/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Hormones are thought to play a role in hidradenitis suppurativa (HS). However, data on the HS disease course during pregnancy and the postpartum period has not been well established. The objective of this study is to analyze the available literature to determine HS disease activity during pregnancy and the postpartum period. METHODS The PubMed and Embase databases were systematically searched for relevant articles from database inception until November 22, 2020. The inclusion criteria were a study population with the diagnosis of HS and discussion of pregnancy impact on the HS disease course or postpartum flare. Study characteristics, patient demographics, HS severity, and HS disease course during pregnancy and the postpartum period were extracted by 2 independent reviewers. The quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies. Heterogeneity was assessed using Cochran's Q statistic and I2 index. The random-effects meta-analytical model was used. The primary study outcome was the pooled odds ratio of improvement or of worsening of HS disease activity during pregnancy. RESULTS The systematic search identified 8 studies for analysis. There was a total of 672 cases for which data on the patient-reported HS disease course during pregnancy were available, and 164 cases for which data on patient-reported postpartum flare were available. In the meta-analyses, the rate of HS disease improvement was 24% (95% CI 0.13-0.40) and the rate of HS disease worsening was 20% (95% CI 0.11-0.34). Sixty percent (99/164) of patients experienced a postpartum flare. CONCLUSION While about a quarter of women will experience an improvement in HS during pregnancy, the majority will have a stable or worsened disease course, and over half of patients will experience a postpartum flare. Close monitoring of HS patients is needed during pregnancy and postpartum periods, as patients may need continued, or even escalated, disease management.
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Affiliation(s)
| | - Natalie M. Villa
- University of California Los Angeles, Department of Medicine, Division of Dermatology, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ram K. Parvataneni
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | | | - Vivian Y. Shi
- University of Arkansas for Medical Sciences, Department of Dermatology, Little Rock, AR, USA
| | - Jennifer L. Hsiao
- University of California Los Angeles, Department of Medicine, Division of Dermatology, Los Angeles, CA, USA
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4
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Kozera EK, Lowes MA, Hsiao JL, Frew JW. Clinical considerations in the management of hidradenitis suppurativa in women. Int J Womens Dermatol 2021; 7:664-671. [PMID: 35028361 PMCID: PMC8714605 DOI: 10.1016/j.ijwd.2021.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 12/20/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory disease of the skin with a predilection for women. The role of sex hormones, including estrogen and progesterone, is incompletely understood, but alterations in hormone levels may play a role in disease activity for many patients. Specific clinical considerations should be made for women with HS, particularly in the setting of pregnancy, childbirth, breastfeeding, and menopause. Current knowledge gaps regarding HS include the cumulative impact of disease across an individual's lifespan, as well as the mechanistic role of sex hormones in the disease. An improved understanding of the pathophysiologic role of hormones in HS would optimize our ability to use targeted therapies for hormonally driven disease. Psychological and psychosexual support for women with HS is an important facet of any holistic management strategy for the disease. This article integrates up-to-date pathogenic and mechanistic insights with evidence-based clinical management to optimize care for women with HS.
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Affiliation(s)
- Emily K. Kozera
- Liverpool Hospital Department of Dermatology, Sydney, Australia
| | | | - Jennifer L. Hsiao
- Division of Dermatology, University of California, Los Angeles, California
| | - John W. Frew
- Liverpool Hospital Department of Dermatology, Sydney, Australia
- University of New South Wales, Sydney, Australia
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5
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Adelekun AA, Villa NM, Hsiao JL, Micheletti RG. Pregnancy in Hidradenitis Suppurativa-Patient Perspectives and Practice Gaps. JAMA Dermatol 2021; 157:227-230. [PMID: 33439230 DOI: 10.1001/jamadermatol.2020.5162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Natalie M Villa
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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6
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Montero-Vilchez T, Salvador-Rodriguez L, Rodriguez-Tejero A, Sanchez-Diaz M, Arias-Santiago S, Molina-Leyva A. Reproductive Potential and Outcomes in Patients with Hidradenitis Suppurativa: Clinical Profile and Therapeutic Implications. Life (Basel) 2021; 11:life11040277. [PMID: 33810294 PMCID: PMC8066603 DOI: 10.3390/life11040277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
There are scarce data available regarding the impact of hidradenitis suppurativa (HS) on fertility, course and outcome of pregnancy and risk associated with treatments. The aims of this study are (1) to describe the clinical profile of HS women of childbearing age with and without accomplished reproductive desires and (2) to describe the prescribed treatments based on the fulfillment of reproductive intentions. We conducted a prospective observational study that included 104 HS women of childbearing age, 50.96% (53/104) with unfulfilled reproductive desires. These women were younger (29.08 vs. 42.06 years, p < 0.001), less frequently married and higher educated than women with fulfilled reproductive desires. Their age of disease onset was lower, but disease duration was shorter, in concordance with a lower International Hidradenitis Suppurativa Severity Score System (IHS4) and lower number of draining tunnels. Combined oral contraceptives were more frequently prescribed in women with unfulfilled reproductive desires (30.19% vs. 9.80%, p = 0.013) while biologics were less used in this group (3.77% vs. 13.73%, p = 0.08). In conclusion, a higher educational level and an earlier disease onset, with potential implications in finding a partner, may make the fulfillment of reproductive desires difficult for patients with HS. This study could help clinicians to achieve a better understanding of the specific characteristics of HS during childbearing age and consider reproductive desires when making treatment decisions.
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Affiliation(s)
- Trinidad Montero-Vilchez
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain; (T.M.-V.); (L.S.-R.); (A.R.-T.); (M.S.-D.); (A.M.-L.)
- Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain
| | - Luis Salvador-Rodriguez
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain; (T.M.-V.); (L.S.-R.); (A.R.-T.); (M.S.-D.); (A.M.-L.)
- Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain
| | - Andrea Rodriguez-Tejero
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain; (T.M.-V.); (L.S.-R.); (A.R.-T.); (M.S.-D.); (A.M.-L.)
- Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain
| | - Manuel Sanchez-Diaz
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain; (T.M.-V.); (L.S.-R.); (A.R.-T.); (M.S.-D.); (A.M.-L.)
- Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain
| | - Salvador Arias-Santiago
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain; (T.M.-V.); (L.S.-R.); (A.R.-T.); (M.S.-D.); (A.M.-L.)
- Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain
- Dermatology Department, Faculty of Medicine, University of Granada, 18001 Granada, Spain
- Correspondence: ; Tel.: +34-9580-23422
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, 18012 Granada, Spain; (T.M.-V.); (L.S.-R.); (A.R.-T.); (M.S.-D.); (A.M.-L.)
- Instituto de Investigación Biosanitaria GRANADA, 18012 Granada, Spain
- Dermatology Department, Faculty of Medicine, University of Granada, 18001 Granada, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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7
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Collier EK, Seivright JR, Shi VY, Hsiao JL. Pregnancy and breastfeeding in hidradenitis suppurativa: A review of medication safety. Dermatol Ther 2020; 34:e14674. [PMID: 33320387 DOI: 10.1111/dth.14674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2020] [Accepted: 12/11/2020] [Indexed: 12/22/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease that disproportionately affects women of childbearing age. Pregnancy influences HS severity for many women, thus diligent continued management throughout pregnancy and postpartum may be required. Herein, we provide an updated review of pregnancy and lactation safety data for HS medications, including topical antiseptic washes, topical and systemic antibiotics, biologic and nonbiologic immunomodulators, immunosuppressants, adjunct medical therapies, and pain medications, to help guide risk-benefit discussions between providers and HS patients.
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Affiliation(s)
- Erin K Collier
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Justine R Seivright
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Collier EK, Price KN, Grogan T, Fernandez JM, Seivright JR, Alhusayen R, Alavi A, Hamzavi IH, Lowes MA, Porter MJ, Shi VY, Hsiao JL. Provider perspectives on the management of hidradenitis suppurativa in pregnancy - A survey study. Int J Womens Dermatol 2020; 7:346-348. [PMID: 34222596 PMCID: PMC8243159 DOI: 10.1016/j.ijwd.2020.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 10/26/2022] Open
Affiliation(s)
- Erin K Collier
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Kyla N Price
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Tristan Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | | | - Justine R Seivright
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Raed Alhusayen
- Division of Dermatology and Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Women College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, United States
| | | | - Martina J Porter
- Department of Dermatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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9
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Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, and debilitating skin disease of the hair follicle unit that typically develops after puberty. HS has a significant negative impact on both the quality of life (QOL) of patients affected by this disease as well as family members and caregivers. However, the pathogenesis of HS is multifactorial and still remains to be fully elucidated, which makes the development of treatments difficult. The last 10 years have seen a surge in HS research, and many new findings have come to light, yet much more remains to be elucidated. Physicians must employ a multidisciplinary approach to maximally address all facets of HS. Clinical characteristics of the disease that differ between females and males as well as across different races and ethnic groups must be considered. Targeted topical, oral, and injectable therapies continue to be developed for HS as a greater understanding of the pathogenesis is reached. However, randomized controlled trials regarding dietary factors that may contribute to HS are needed to meet our patients’ growing concerns and questions about the role of diet in HS pathogenesis. Finally, improved outcome measures are needed to standardize HS severity and grading between physicians and clinical trials, and a more diverse representation of HS populations is needed in clinical trials.
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Affiliation(s)
- Shanthi Narla
- 1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Alexis B Lyons
- 1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat H Hamzavi
- 1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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10
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Fernandez JM, Hendricks AJ, Thompson AM, Mata EM, Collier EK, Grogan TR, Shi VY, Hsiao JL. Menses, pregnancy, delivery, and menopause in hidradenitis suppurativa: A patient survey. Int J Womens Dermatol 2020; 6:368-371. [PMID: 33898700 PMCID: PMC8060662 DOI: 10.1016/j.ijwd.2020.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/21/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic inflammatory disorder that primarily affects women of childbearing age. There is a paucity of data on HS disease activity during menstruation, pregnancy, and menopause and the potential impact of HS on the method of delivery. Objective We aimed to characterize the natural history of HS symptoms during menses, pregnancy, and menopause. We also sought to evaluate the potential impact of HS on delivery method and whether there were delivery-related healing complications unique to women with HS. Methods An anonymous survey was distributed via social media to international HS support groups and patients at three HS specialty clinics in North America. Responses were collected from March to July 2019. Results A total of 279 respondents answered questions on disease changes during pregnancy. Menstruation caused worsening of HS symptoms in 76.7%, no change in 22.2%, and improvement in 1.1%. During pregnancy, the distribution between symptoms worsening (34.8%), having no change (28.7%), and improving (36.6%) was relatively even. After menopause, participants typically reported either worsening (39.5%) or no change (44.2%) in HS symptoms. Among respondents with anogenital HS involvement who delivered vaginally, 3.1% believed that HS interfered with vaginal delivery (VD), and 23.5% believed that VD caused an HS flare. Cesarean section (C-section) delivery was reported by 44.2% of participants. Ten participants reported that they were advised by their doctor to have a C-section instead of a VD because of severe anogenital HS. Of those who underwent a C-section, 33.9% reported that HS interfered with incision healing, and 51.2% reported developing new HS lesions in their C-section scar. Conclusion To our knowledge, this is the first study describing the potential influence of HS on a patient’s method of delivery. Multidisciplinary collaboration plays a pivotal role in developing individualized treatment and birth plans for pregnant women with HS.
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Affiliation(s)
| | | | - Alyssa M Thompson
- University of Arizona, College of Medicine, Tucson, AZ, United States
| | - Elizabeth M Mata
- University of Arizona, College of Medicine, Tucson, AZ, United States
| | - Erin K Collier
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Tristan R Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Vivian Y Shi
- Department of Medicine, Division of Dermatology, University of Arizona, Tucson, AZ, United States
| | - Jennifer L Hsiao
- Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, CA, United States
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11
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Collier E, Shi VY, Parvataneni RK, Lowes MA, Hsiao JL. Special considerations for women with hidradenitis suppurativa. Int J Womens Dermatol 2020; 6:85-88. [PMID: 32258337 PMCID: PMC7105653 DOI: 10.1016/j.ijwd.2020.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/18/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating disease that manifests as painful nodules, abscesses, sinus tracts, and scars with a predilection for intertriginous sites. HS disproportionately affects women of childbearing age and often leads to impairments in patients' health-related quality of life. Women with HS face unique challenges related to menstruation, pregnancy, and lactation that require additional strategies for optimization of management. Practical interventions include lifestyle modifications, treatment of premenstrual HS flares, enhancing HS management during pregnancy, and creating optimal delivery plans in collaboration with obstetricians. This discussion is based on expert recommendations and aims to highlight the special challenges for women with HS, as well as provide a practical discourse on optimizing care of female patients with HS.
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Affiliation(s)
- Erin Collier
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Vivian Y. Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ram K. Parvataneni
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, United States
| | - Michelle A. Lowes
- The Rockefeller University Laboratory for Investigative Dermatology, New York, NY, United States
| | - Jennifer L. Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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