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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k‐Leitlinie zur Therapie der Hidradenitis suppurativa/Acne inversa – Kurzfassung. J Dtsch Dermatol Ges 2024; 22:868-892. [PMID: 38857106 DOI: 10.1111/ddg.15412_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 06/11/2024]
Abstract
ZusammenfassungDie S2k‐Leitlinie der Hidradenitis suppurativa/Acne inversa (HS/AI) soll eine akzeptierte Entscheidungshilfe für die Auswahl/Durchführung einer geeigneten/suffizienten Therapie liefern. Hidradenitis suppurativa/Acne inversa ist eine chronisch‐rezidivierende, entzündliche, potenziell mutilierende Hauterkrankung des terminalen Haartalgdrüsenapparats, mit schmerzhaften, entzündlichen Läsionen in den apokrinen drüsenreichen Körperregionen. Ihre Punktprävalenz in Deutschland ist 0,3%, sie wird mit einer Verspätung von 10,0 ± 9,6 Jahren diagnostiziert. Abnormale Differenzierung der Keratinozyten des Haartalgdrüsenapparats und eine begleitende Entzündung bilden die zentrale pathogenetische Grundlage. Primäre HS/AI‐Läsionen sind entzündliche Knoten, Abszesse und drainierende Tunnel. Rezidive in den letzten 6 Monaten mit mindestens zwei Läsionen an den Prädilektionsstellen verweisen auf eine HS/AI mit einer 97‐prozentigen Genauigkeit. HS/AI‐Patienten leiden an einer deutlichen Einschränkung der Lebensqualität. Zur korrekten Therapieentscheidung sollen Klassifikation und Aktivitätsbewertung mit einem validierten Instrument erfolgen, wie dem International Hidradenitis Suppurativa Severity Scoring System (IHS4). Hidradenitis suppurativa/Acne inversa wird nach der Ausprägung der nachweisbaren Entzündung in zwei Formen eingeteilt: aktive, entzündliche (milde, mittelschwere und schwere nach IHS4) und vorwiegend inaktive, nicht entzündliche (Hurley‐Grad‐I, ‐II und ‐III) HS/AI. Orale Tetrazykline oder eine 5‐tägige intravenöse Therapie mit Clindamycin sind mit der Effektivität von Clindamycin/Rifampicin vergleichbar. Subkutan applizierbares Adalimumab, Secukinumab und Bimekizumab sind für die Therapie der HS/AI zugelassen. Für die vorwiegend nicht entzündliche Erkrankungsform stehen verschiedene operative Verfahren zur Verfügung. Medikamentöse/chirurgische Kombinationen gelten als ganzheitliches Therapieverfahren.
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Affiliation(s)
- Christos C Zouboulis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau, Deutschland
- Dermatologie II, Colentina Klinik, Carol-Davila-Universität für Medizin und Pharmazie, Bukarest, Rumänien
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | | | - Elke Just
- Deutsche Akne Inversa Patientenvereinigung in Gründung, Kreis Coesfeld, Deutschland
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Institut für Versorgungsforschung (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Haut- und Laserzentrum, Freising, Deutschland
| | - Georgios Nikolakis
- Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Deutschland
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Hautklinik, Klinikum Darmstadt, Deutschland
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Zentrum für Dermatochirurgie, Havelklinik Berlin, Berlin, Deutschland
| | - Klaus-M Taube
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Thomas Volz
- Klinik für Dermatologie und Allergologie, Technische Universität München, München, Deutschland
| | | | - Anna Kristandt
- Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Deutschland
- Medizinische Fakultät, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
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2
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Zouboulis CC, Bechara FG, Fritz K, Goebeler M, Hetzer FH, Just E, Kirsten N, Kokolakis G, Kurzen H, Nikolakis G, Pinter A, Podda M, Rosinski K, Schneider-Burrus S, Taube KM, Volz T, Winkler T, Kristandt A, Presser D, Zouboulis VA. S2k guideline for the treatment of hidradenitis suppurativa / acne inversa - Short version. J Dtsch Dermatol Ges 2024; 22:868-889. [PMID: 38770982 DOI: 10.1111/ddg.15412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Falk G Bechara
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
- Dermatology II, Colentina Clinical Hospital, Carol-Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Matthias Goebeler
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | | | - Elke Just
- German Acne Inversa Patient Association in Formation, Kreis Coesfeld, Germany
| | - Natalia Kirsten
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Georgios Kokolakis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hjalmar Kurzen
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Freising Skin and Laser Center, Freising, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Andreas Pinter
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maurizio Podda
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Medical Center Darmstadt, Darmstadt, Germany
| | | | - Sylke Schneider-Burrus
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Center for Dermatosurgery, Havelklinik Berlin, Berlin, Germany
| | - Klaus-M Taube
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Volz
- Department of Dermatology and Allergology, Technical University of Munich, Munich, Germany
| | | | - Anna Kristandt
- Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Dagmar Presser
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Department of Dermatology, Venereology and Allergology, Würzburg University Hospital, Würzburg, Germany
| | - Viktor A Zouboulis
- Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Molinelli E, Gioacchini H, Marani A, Rizzetto G, Gambini D, De Simoni E, Offidani A, Simonetti O. Topical and Systemic Retinoids in the Management of Hidradenitis Suppurativa: A Comprehensive Literature Review. Dermatol Ther (Heidelb) 2024; 14:1079-1091. [PMID: 38700645 PMCID: PMC11116334 DOI: 10.1007/s13555-024-01169-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/15/2024] [Indexed: 05/24/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a debilitating chronic skin disorder characterized by painful inflammatory nodules, abscesses and sinus tracts involving intertriginous areas and has an adverse impact on patient quality of life. Over the past decade, the therapeutic options of HS have increased significantly to comprise multiple modalities, including topical medication, systemic therapies (mainly antibiotics, retinoids, and biologics), surgical approaches, and lifestyle modifications. Biologics alone or in combination with surgery remain the treatment of choice for moderate to severe disease. However, non-biologic therapies (including retinoids) may be used as monotherapy for mild disease and in combination with biologics and surgical treatment in moderate to severe disease. Retinoids, specifically isotretinoin, acitretin, and alitretinoin, are historically used in the management of HS, supported by anecdotal evidence and with variable treatment response. Although the current American and European guidelines offer different recommendations on the use of retinoids in HS, retinoids remain a valuable ally in HS management. This review provides a comprehensive analysis of the current scientific literature on retinoid therapy (topical and systemic) in HS, highlighting disparities in mechanisms of action, efficacy, and safety to clarify their role in HS treatment.
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Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Helena Gioacchini
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Andrea Marani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Daisy Gambini
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Edoardo De Simoni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy.
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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Liao YH, Chu CB, Hui CYR, Li CY, Lin SY, Tseng HC, Wang YJ, Wu J, Yu WW, Chao SC. Taiwanese Dermatological Association (TDA) consensus recommendations for the definition, classification, diagnosis, and management of hidradenitis suppurativa. J Formos Med Assoc 2023:S0929-6646(23)00492-8. [PMID: 38160191 DOI: 10.1016/j.jfma.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/12/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful, recurrent, inflamed lesions most commonly occurring in the axillary, inguinal, and anogenital regions. HS can inflict immense physical and psychological impact on patients who suffer from this distressing disease. Management of HS generally requires combining various medical and procedural treatment modalities; however, the disease is often recalcitrant to conventional treatments. In light of recent evidence supporting the effectiveness of biologic agents in the treatment of HS, the Taiwanese Dermatological Association established an expert panel of nine dermatologists to develop consensus statements aimed to provide up-to-date evidence-based guidance in optimizing HS patient management in Taiwan. The recommendations described in the statements were summarized in a management algorithm in terms of general care, topical treatment, systemic treatment, and procedural treatment.
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Affiliation(s)
- Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Bao Chu
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Dermatology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sheng-Yao Lin
- Department of Dermatology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Jen Wang
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Cosmetic Applications and Management, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jennifer Wu
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Wen Yu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sheau-Chiou Chao
- Department of Dermatology, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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5
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Chiang N, Sibbald C, Levy R, Lara-Corrales I. Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options. Paediatr Drugs 2023; 25:659-676. [PMID: 37782437 DOI: 10.1007/s40272-023-00595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin condition that manifests as painful, deep-seated, inflamed nodules and abscesses in the axillary, groin, perianal, perineal, and inframammary regions. The associated pain, malodour, and disfigurement contribute to its profound negative impact on psychosocial spheres and overall quality of life in affected individuals. Although the symptoms of HS classically begin in the second or third decade of life, HS affects children and adolescents as well. Despite this, there are limited pediatric data on treatment, which are largely based on expert opinion, extrapolation of efficacy data in adults with HS, and safety information from medication use in other pediatric diseases. On this basis, there exist several pharmacological modalities in the treatment of children and adolescents with HS including topical therapies, systemic therapies, and biologics. The goals of this review article are to: (1) review the efficacy of different pharmacological treatment modalities in children and adolescents with HS, and (2) review the safety and monitoring considerations of the different treatment options in children and adolescents with HS.
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Affiliation(s)
- Nicholas Chiang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Rebecca Levy
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Jastrząb B, Szepietowski JC, Matusiak Ł. Hidradenitis suppurativa and follicular occlusion syndrome: Where is the pathogenetic link? Clin Dermatol 2023; 41:576-583. [PMID: 37690621 DOI: 10.1016/j.clindermatol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The follicular occlusion tetrad complex encompasses several entities (hidradenitis suppurativa, acne conglobata, dissecting cellulitis of the scalp, and pilonidal cyst) that share common clinical features, risk factors, and pathophysiology. Follicular occlusion is a crucial triggering mechanism in the etiology in each of these disorders, leading to development of distinctive skin lesions such as deep-seated nodules, abscesses, comedones, and draining sinuses, often with accompanying scarring. Despite the fact that the follicular occlusion tetrad components manifest multiple similarities, they also exhibit many differences among themselves and require individual approaches and treatment.
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Affiliation(s)
- Beata Jastrząb
- 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.
| | - Łukasz Matusiak
- Department of Dermatology, Venereology, and Allergology, Wroclaw Medical University, Wroclaw, Poland
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Molinelli E, Sapigni C, Simonetti O, D'Agostino GM, Brisigotti V, Rizzetto G, Offidani A. Acitretin plus macrolides and acitretin monotherapy in the management of hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2023; 37:e392-e394. [PMID: 36306173 DOI: 10.1111/jdv.18706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giovanni Marco D'Agostino
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Giulio Rizzetto
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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8
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Current Medical and Surgical Treatment of Hidradenitis Suppurativa-A Comprehensive Review. J Clin Med 2022; 11:jcm11237240. [PMID: 36498816 PMCID: PMC9737445 DOI: 10.3390/jcm11237240] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with recurrent inflammatory lesions in intertriginous body regions. HS has a pronounced impact on patients' quality of life and is associated with a variety of comorbidities. Treatment of HS is often complex, requiring an individual approach with medical and surgical treatments available. However, especially in moderate-to-severe HS, there is an urgent need for new treatment approaches. In recent years, increased research has led to the identification of new potential therapeutic targets. This review aims to give a comprehensive and practical overview of current treatment options for HS. Furthermore, the clinically most advanced novel treatment approaches will be discussed.
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Bouwman K, Aarts P, Dudink K, Hao J, Alizadeh BZ, Prens LM, Vossen ARJV, van Straalen KR, van der Zee HH, Horváth B. Drug Survival of Oral Retinoids in Hidradenitis Suppurativa: A Real-Life Cohort Study. Am J Clin Dermatol 2022; 23:905-914. [PMID: 36070059 PMCID: PMC9449939 DOI: 10.1007/s40257-022-00725-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Cohort studies on the use of retinoids for hidradenitis suppurativa (HS) have yielded contradicting results. As the clinical presentation of HS is heterogeneous, with different predilection sites and hallmark features, it can be hypothesized that HS phenotypes are associated with the effectiveness of specific retinoid treatments. OBJECTIVES The aim of this study was to evaluate the drug survival of oral retinoids in the treatment of HS and to establish predictors for longer treatment duration. METHODS A retrospective, dual-center study was conducted in the Netherlands in adult HS patients treated with oral retinoids between 2011 and 2021. Drug survival analyses were performed through Kaplan-Meier survival curves. Additionally, Cox regression models were used to determine predictors for a longer drug survival. RESULTS In total, 102 patients were included. Overall drug survival of (low-dose) isotretinoin (n = 66) at 12 and 24 months was 44.2% and 15.5%, respectively. Termination of treatment was mostly due to ineffectiveness (26%). Presence of widespread comedones (p = 0.03) and the use of concomitant systemic medication (p = 0.04) were associated with a prolonged treatment duration. For acitretin (n = 36), the overall drug survival was 42.0% at 12 months and 37.4% at 24 months, and was also predominantly determined by ineffectiveness (28%). Interestingly, the scarring folliculitis phenotype (p < 0.05) was associated with prolonged drug survival time for acitretin treatment relative to the regular phenotype. CONCLUSION Comparable drug survival rates at 12 months for isotretinoin and acitretin were found. HS patients with widespread comedones and the scarring folliculitis phenotype could benefit from treatment with isotretinoin or acitretin, respectively.
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Affiliation(s)
- Klasiena Bouwman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Koen Dudink
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jiasi Hao
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lisette M Prens
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Allard R J V Vossen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Johnston LA, Alhusayen R, Bourcier M, Delorme I, George R, O'Brien E, Wong SM, Poelman SM. Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update. J Cutan Med Surg 2022; 26:2S-24S. [PMID: 36000460 DOI: 10.1177/12034754221116115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.
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Affiliation(s)
- Leah A Johnston
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Raed Alhusayen
- 282299 Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Isabelle Delorme
- Dr Isabelle Delorme Inc, Dermatologue, Drummondville, QC, Canada
| | - Ralph George
- 7938 Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth O'Brien
- 12367 Faculty of Medicine, Dermatology, McGill University, Montreal, QC, Canada
| | - Se Mang Wong
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Susan M Poelman
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada.,Beacon Dermatology, Calgary, AB, Canada
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11
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Das K, Daveluy S, Kroumpouzos G, Agarwal K, Podder I, Farnbach K, Ortega-Loayza AG, Szepietowski JC, Grabbe S, Goldust M. Efficacy and Toxicity of Classical Immunosuppressants, Retinoids and Biologics in Hidradenitis Suppurativa. J Clin Med 2022; 11:jcm11030670. [PMID: 35160122 PMCID: PMC8836901 DOI: 10.3390/jcm11030670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/09/2022] [Accepted: 01/18/2022] [Indexed: 12/05/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the apocrine glands characterized by recurrent episodes. Although several therapies exist, none is completely curative. Several immunosuppressives have been studied with encouraging results and targeted approaches. In this review, we highlight the various immunosuppressives used in this condition along with their salient features to enable physicians to choose the correct therapy for their patients. The search of the peer-reviewed literature included clinical trials, scientific reviews, case series, case reports, and guidelines. The literature was identified from electronic databases (MEDLINE and PubMed) through November 2021; additional articles were included from the references of the identified articles.
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Affiliation(s)
- Kinnor Das
- Department of Dermatology Venereology and Leprosy, Silchar Medical College, Silchar 788014, India;
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, MI 48202, USA;
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI 02903, USA;
- Department of Dermatology, Medical School of Jundiaí, São Paulo 13202-550, Brazil
- GK Dermatology, P.C, Weymouth, MA 02190, USA
| | - Komal Agarwal
- Department of Dermatology, CNMC, Kolkata 700014, India;
| | - Indrashis Podder
- Department of Dermatology, Venereology and Leprosy, College of Medicine and Sagore Dutta Hospital, Kolkata 700058, India;
| | - Katherine Farnbach
- Department of Dermatology, Oregon Health and Science University, Portland, OR 97239, USA; (K.F.); (A.G.O.-L.)
| | - Alex G. Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, OR 97239, USA; (K.F.); (A.G.O.-L.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence: (J.C.S.); (M.G.)
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany;
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany;
- Correspondence: (J.C.S.); (M.G.)
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12
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Zouboulis VA, Zouboulis KC, Zouboulis CC. Hidradenitis Suppurativa and Comorbid Disorder Biomarkers, Druggable Genes, New Drugs and Drug Repurposing-A Molecular Meta-Analysis. Pharmaceutics 2021; 14:pharmaceutics14010044. [PMID: 35056940 PMCID: PMC8779519 DOI: 10.3390/pharmaceutics14010044] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/23/2021] [Indexed: 12/28/2022] Open
Abstract
Chronic inflammation and dysregulated epithelial differentiation, especially of hair follicle keratinocytes, have been suggested as the major pathogenetic pathways of hidradenitis suppurativa/acne inversa (HS). On the other hand, obesity and metabolic syndrome have additionally been considered as an important risk factor. With adalimumab, a drug has already been approved and numerous other compounds are in advanced-stage clinical studies. A systematic review was conducted to detect and corroborate HS pathogenetic mechanisms at the molecular level and identify HS molecular markers. The obtained data were used to confirm studied and off-label administered drugs and to identify additional compounds for drug repurposing. A robust, strongly associated group of HS biomarkers was detected. The triad of HS pathogenesis, namely upregulated inflammation, altered epithelial differentiation and dysregulated metabolism/hormone signaling was confirmed, the molecular association of HS with certain comorbid disorders, such as inflammatory bowel disease, arthritis, type I diabetes mellitus and lipids/atherosclerosis/adipogenesis was verified and common biomarkers were identified. The molecular suitability of compounds in clinical studies was confirmed and 31 potential HS repurposing drugs, among them 10 drugs already launched for other disorders, were detected. This systematic review provides evidence for the importance of molecular studies to advance the knowledge regarding pathogenesis, future treatment and biomarker-supported clinical course follow-up in HS.
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Affiliation(s)
- Viktor A. Zouboulis
- Faculty of Medicine, Universitaetsklinikum Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany;
| | - Konstantin C. Zouboulis
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology (ETH) Zurich, 8092 Zurich, Switzerland;
| | - Christos C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
- Correspondence: ; Tel.: +49-340-5014000
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13
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Hidradenitis Suppurativa: Host-Microbe and Immune Pathogenesis Underlie Important Future Directions. JID INNOVATIONS 2021; 1:100001. [PMID: 34909706 PMCID: PMC8659377 DOI: 10.1016/j.xjidi.2021.100001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/24/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022] Open
Abstract
Hidradenitis suppurativa (HS) is an inflammatory disease of the skin with a chronic, relapsing-remitting course. The pathogenesis of the disease is poorly understood and involves multiple factors, including genetics, environment, host-microbe interactions, and immune dysregulation. In particular, the composition of the cutaneous microbiome shifts as the disease progresses, although it is unclear whether this is a primary or secondary process. Trials with immunomodulatory therapy elucidate the role of specific immune pathways and cytokine signaling in disease mechanism, such as TNF-α, IL-1β, IL-12, IL-17, IL-23, and complement. Future studies should continue examining the causes of and contributing factors to microbial changes and immune dysregulation in HS pathogenesis.
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Key Words
- AMP, antimicrobial peptide
- BD, β-defensin
- BMI, body mass index
- DC, dendritic cell
- DCD, dermcidin
- GSC, γ-secretase complex
- HS, hidradenitis suppurativa
- HiSCR, hidradenitis suppurativa clinical response
- IBD, inflammatory bowel disease
- IHS4, International Hidradenitis Suppurativa Severity Score System
- KC, keratinocyte
- MMP, matrix metalloproteinase
- NET, neutrophil extracellular traps
- NMSC, nonmelanoma skin cancer
- PG, pyoderma gangrenosum
- RCT, randomized controlled trial
- SAPHO, synovitis, acne, pustulosis, hyperostosis, and osteitis
- TLR, toll-like receptor
- Th, T helper type
- iNOS, inducible nitric oxide synthase
- pDC, plasmacytoid dendritic cell
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14
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Amat-Samaranch V, Agut-Busquet E, Vilarrasa E, Puig L. New perspectives on the treatment of hidradenitis suppurativa. Ther Adv Chronic Dis 2021; 12:20406223211055920. [PMID: 34840709 PMCID: PMC8613896 DOI: 10.1177/20406223211055920] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by the presence of painful nodules, abscesses, chronically draining fistulas, and scarring in apocrine gland-bearing areas of the body. The exact pathogenesis of HS is not yet well understood, but there is a consensus in considering HS a multifactorial disease with a genetic predisposition, an inflammatory dysregulation, and an influence of environmental modifying factors. Therapeutic approach of HS is challenging due to the wide clinical manifestations of the disease and the complex pathogenesis. This review describes evidence for effectiveness of current and emerging HS therapies. Topical therapy, systemic treatments, biological agents, surgery, and light therapy have been used for HS with variable results. Adalimumab is the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS, but new therapeutic options are being studied, targeting different specific cytokines involved in HS pathogenesis. Comparing treatment outcomes between therapies is difficult due to the lack of randomized controlled trials. Treatment strategy should be selected in concordance to disease severity and requires combination of treatments in most cases.
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Affiliation(s)
- Victoria Amat-Samaranch
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Eugènia Agut-Busquet
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041, Barcelona, Spain
| | - Lluís Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Mas Casanovas 90, 08041 Barcelona, Spain
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15
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Pinter A, Mrowietz U, Volz T. [Systemic treatment of moderate/severe hidradenitis suppurativa]. DER HAUTARZT 2021; 72:686-691. [PMID: 34189590 DOI: 10.1007/s00105-021-04844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/24/2022]
Abstract
Systemic treatment together with radical surgical excision is the most important treatment option for all severity grades of hidradenitis suppurativa. Tetracycline in mild-to-moderate forms and clindamycin in combination with rifampicin in moderate-to-severe forms are guideline-compliant first-line therapy with a good clinical response. Other antibiotics such as ertepenem or multiple combinations are recommended as last-line therapy due to a lack of data. Success rate with dapsone and retinoids, on the other hand, are insufficient-only acitretin can be recommended on the basis of the available studies, but with limited success. With the TNF-alpha blocker adalimumab, an effective and safe long-term therapy is available-further biologics are in clinical trials and could significantly expand the treatment portfolio in the future.
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Affiliation(s)
- A Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - U Mrowietz
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - T Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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16
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Frew JW, Marzano AV, Wolk K, Join-Lambert O, Alavi A, Lowes MA, Piguet V. A Systematic Review of Promising Therapeutic Targets in Hidradenitis Suppurativa: A Critical Evaluation of Mechanistic and Clinical Relevance. J Invest Dermatol 2021; 141:316-324.e2. [DOI: 10.1016/j.jid.2020.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
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17
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Rafiei-Sefiddashti R, Hejrati A, Mohammadi S, Gholami A, Hejrati L, Rohani M. Hidradenitis suppurativa; classification, remedies, etiology, and comorbidities; a narrative review. J Family Med Prim Care 2021; 10:4009-4016. [PMID: 35136760 PMCID: PMC8797099 DOI: 10.4103/jfmpc.jfmpc_795_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/30/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is more common in females, especially during puberty and menopause. These inflammatory lesions include painful deep-seated nodules and abscesses, draining sinus tracts, and fibrotic scars. This article is a narrative review to explain whole disease aspects, including complication, causes, epidemiology, history, classification, prognosis, comorbidities, the effect of sex hormone, and potent treatments. Most patients with HS, who are not aware of their primary disease, visit primary care physicians to superinfection lesions instead of specialists. If these physicians suspect HS, their illness will not get misdiagnosed. This brief and comprehensive information in this article may help doctors to decide better about the same situation.
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18
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Garcovich S, Genovese G, Moltrasio C, Malvaso D, Marzano AV. PASH, PAPASH, PsAPASH, and PASS: The autoinflammatory syndromes of hidradenitis suppurativa. Clin Dermatol 2020; 39:240-247. [PMID: 34272017 DOI: 10.1016/j.clindermatol.2020.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease usually involving the major skin folds characterized by a multifactorial pathogenesis and a wide spectrum of clinical manifestations. It can also rarely present in association with other diseases as complex clinical syndromes, causing additional diagnostic and therapeutic challenges. Different etiopathologic factors contribute to follicular inflammation and suppurative lesions of syndromic HS, including follicular hyperkeratinization and plugging, as well as activation of autoinflammatory pathways. Patients with syndromic HS frequently have a severe disease course, presenting with atypical skin involvement, signs of systemic inflammation, and resistance to conventional treatments. Systematic classification of syndromic HS is based on clinical, pathogenetic, and genetic factors, but it is constantly evolving due to increased disease awareness. Treatment of syndromic HS is difficult and should be personalized on a case-by-case basis. Investigating syndromic HS can lead to useful insights on genetics and pathogenesis, translating into new clinical approaches for sporadic hidradenitis. We review the classification, clinical presentation, disease associations, and therapeutic management of syndromic HS, focusing mainly on its autoinflammatory syndromes PASH, PAPASH, PsAPASH, and PASS.
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Affiliation(s)
- Simone Garcovich
- Institute of Dermatology, F. Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Advanced Diagnostics, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste, Italy
| | - Dalma Malvaso
- Institute of Dermatology, F. Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
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19
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20
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Orenstein LAV, Nguyen TV, Damiani G, Sayed C, Jemec GBE, Hamzavi I. Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice. Dermatology 2020; 236:393-412. [PMID: 32408306 PMCID: PMC8177083 DOI: 10.1159/000507323] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS. SUMMARY This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia, USA,
| | - Tien V Nguyen
- Bellevue Dermatology Clinic and Research Center, Bellevue, Washington, USA
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
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21
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Nesbitt E, Clements S, Driscoll M. A concise clinician's guide to therapy for hidradenitis suppurativa. Int J Womens Dermatol 2020; 6:80-84. [PMID: 32258336 PMCID: PMC7105662 DOI: 10.1016/j.ijwd.2019.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2019] [Accepted: 11/14/2019] [Indexed: 12/26/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, often debilitating, skin condition that historically does not respond well to treatment. Although there is no cure for HS, symptoms can be managed if the appropriate diagnosis is made. HS most commonly develops in postpubertal women and manifests as painful, deep-seated, inflamed lesions, including nodules, sinus tracts, and abscesses. HS flares are marked by increased pain and suppuration at varying intervals and can occur in women before menstruation. HS is commonly misdiagnosed; physicians might mistake a lesion for an infection, abscess, or sexually transmitted infection. Incision and drainage of these lesions often leads to recurrence. Given that management of this chronic disease is often difficult, we sought to outline current diagnosis and management strategies for HS.
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Affiliation(s)
- Emily Nesbitt
- University of Maryland School of Medicine, United States
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22
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Abstract
Hidradenitis suppurativa is a chronic skin condition characterized by recurrent painful abscesses usually limited to the intertriginous areas. Global prevalence has been estimated at up to 4% of the population. The exact pathogenesis of hidradenitis suppurativa is yet to be elucidated; however, recent research has shown that the disease occurs under the influence of multiple genetic, environmental, and lifestyle factors. Repeated insults result in sinus tract formation and disfigurement, which can have a significant psychosocial effect on patients. A wide range of treatments are available but none are curative. A combination antibiotic regimen is considered first line, and research into the use of biologics has been promising. Early recognition and treatment is paramount to achieving a better prognosis and improving patient quality of life.
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23
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Gurnani P, Williams NM, Long J, Zade J, Rajabi-Estarabadi A, Nouri K. Cells to Surgery Quiz: April 2020. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Vural S, Gündoğdu M, Akay BN, Boyvat A, Erdem C, Koçyiğit P, Bostancı S, Sanli H, Kundakci N. Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatol Ther 2019; 32:e13003. [DOI: 10.1111/dth.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/08/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Secil Vural
- Koç University School of Medicine, Dermatology Department İstanbul Turkey
| | | | - Bengu N. Akay
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Ayşe Boyvat
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Cengizhan Erdem
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Pelin Koçyiğit
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Seher Bostancı
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Hatice Sanli
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
| | - Nihal Kundakci
- Ankara UniversityFaculty of Medicine, Dermatology and Venereology Department Ankara Turkey
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25
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol 2019; 81:91-101. [PMID: 30872149 PMCID: PMC9131892 DOI: 10.1016/j.jaad.2019.02.068] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniel B Eisen
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada
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Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, Hirata SH, Ramos AMC. Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:7-19. [PMID: 31166401 PMCID: PMC6544037 DOI: 10.1590/abd1806-4841.20198607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa is a chronic immune mediated disease of universal
distribution that causes great damage to the quality of life of the affected
individual, whose prevalence is estimated at 0.41% in the Brazilian population.
The objective of this work was update on physiopathogenesis, diagnosis and
classification of hidradenitis suppurativa and to establish therapeutic
recommendations in the Brazilian reality. It was organized as a work group
composed of eight dermatologists from several institutions of the country with
experience in the treatment of hidradenitis suppurativa and carried out review
on the topic. Recommendations were elaborated and voted by modified Delphi
system and statistical analysis of the results was performed. The Brazilian
consensus on the clinical approach of hidradenitis suppurativa had the support
of the Brazilian Society of Dermatology.
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Affiliation(s)
| | | | | | - Roberto Souto
- Dermatology Service, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Holthausen Nunes
- Dermatology Service, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Mario Chaves
- Dermatology Service, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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27
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Pharmacological development in hidradenitis suppurativa. Curr Opin Pharmacol 2019; 46:65-72. [DOI: 10.1016/j.coph.2019.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
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Chernyshov PV, Zouboulis CC, Tomas-Aragones L, Jemec GB, Svensson A, Manolache L, Tzellos T, Sampogna F, Pustisek N, van der Zee HH, Marron SE, Spillekom-van Koulil S, Bewley A, Linder D, Abeni D, Szepietowski JC, Augustin M, Finlay AY. Quality of life measurement in hidradenitis suppurativa: position statement of the European Academy of Dermatology and Venereology task forces on Quality of Life and Patient-Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa. J Eur Acad Dermatol Venereol 2019; 33:1633-1643. [PMID: 31037773 DOI: 10.1111/jdv.15519] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
This paper is organized jointly by the European Academy of Dermatology and Venereology (EADV) Task Force (TF) on Quality of Life (QoL) and Patient-Oriented Outcomes and the EADV TF on acne, rosacea and hidradenitis suppurativa (ARHS). The purpose of this paper was to present current knowledge about QoL assessment in HS, including data on HS-specific health-related (HR) QoL instruments and HRQoL changes in clinical trials, and to make practical recommendations concerning the assessment of QoL in people with HS. HS results in significant quimp that is higher than in most other chronic skin diseases. HS impact in published studies was assessed predominantly (84% of studies) by the Dermatology Life Quality Index (DLQI). There is a lack of high-quality clinical trials in HS patients where HRQoL instruments have been used as outcome measures. One double-blind randomized placebo-controlled trial on infliximab with low number of participants reported significantly better HRQoL improvement in the treatment group than in the placebo group. Well-designed clinical studies in HS patients to compare different treatment methods, including surgical methods and assessing long-term effects, are needed. Because of lack of sufficient validation, the Task Forces are not at present able to recommend existing HS-specific HRQoL instruments for use in clinical studies. The EADV TFs recommend the dermatology-specific DLQI questionnaire for use in HS patients. The EADV TFs encourage the further development, validation and use of other HS-specific, dermatology-specific and generic instruments but such use should be based on the principles presented in the previous publications of the EADV TF on QoL and Patient-Oriented Outcomes.
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Affiliation(s)
- P V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - L Tomas-Aragones
- Department of Psychology, University of Zaragoza, Zaragoza, Spain
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - A Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - L Manolache
- Dermatology, Dali Medical, Bucharest, Romania
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Troms, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - N Pustisek
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - S Spillekom-van Koulil
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Bewley
- Whipps Cross University Hospital, London, UK.,The Royal London Hospital, London, UK
| | - D Linder
- Unit of Dermatology, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - D Abeni
- Clinical Epidemiology Unit, IDI-IRCCS, Rome, Italy
| | - J C Szepietowski
- Department of Dermatology, Wroclaw Medical University, Wroclaw, Poland
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Y Finlay
- Department of Dermatology and Wound Healing, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Kirby JS, Moore B, Leiphart P, Shumaker K, Mammis-Gierbolini A, Benhadou F, Del Marmol V. A narrative review of the definition of 'flare' in hidradenitis suppurativa. Br J Dermatol 2019; 182:24-28. [PMID: 31025310 DOI: 10.1111/bjd.18035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory condition that can have periodic worsening or flares. Measurement of flare is important because it can inform treatment efficacy; however, it is unclear how HS flare should be defined. OBJECTIVES This study reviewed the literature for definitions of HS flare. METHODS The PubMed MEDLINE online database was searched on 10 January 2018 and the search was repeated on 8 December 2018 for new publications. Titles and abstracts were screened for inclusion. Subsequently, full articles were screened for inclusion. Papers were included if the publication was a systematic review, clinical trial, cohort study, case report or series, or cross-sectional study. Studies were excluded if they were journalistic reviews, did not discuss clinical findings of HS or did not use the words 'flare', 'exacerbation', 'relapse' or 'recurrence'. RESULTS Two hundred and seventy-four papers were identified and 154 fulfilled the study criteria. Of these, 27 (17.5%) included the term 'flare' and 16 (10.4%) included the term 'exacerbation'. Two of the 27 papers (7%) defined the term flare and both included patient report of changes in symptoms or signs. One of 16 papers (6%) defined exacerbation, which was taken as one new HS lesion. The terms 'recurrence' and 'relapse' were more apt to be defined: 13% (13 of 100) and 14% (six of 44), respectively. CONCLUSIONS The lack of a specific and measurable definition of HS flare is a barrier to assessment of this important outcome. Once a specific and measurable definition is established, validated and reliable measures of HS flare can be incorporated into future studies. What's already known about this topic? Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin condition. The ability to assess flares is important to people who have HS; however, it is unclear how this is defined. HS flare is one of the core outcomes in the core outcome set for HS clinical trials; however, it is unclear how this should be assessed. What does this study add? This literature review reveals the paucity of measurable definitions associated with the use of the term 'flare' in the HS literature. It also highlights the variation and lack of a validated and reliable measure of HS flare.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, U.S.A
| | - B Moore
- Penn State College of Medicine, Hershey, PA, U.S.A
| | - P Leiphart
- Penn State College of Medicine, Hershey, PA, U.S.A
| | - K Shumaker
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, U.S.A
| | | | - F Benhadou
- Department of Dermatology, Hôpital Erasme - Universite Libre de Bruxelles, Bruxelles, Belgium
| | - V Del Marmol
- Department of Dermatology, Hôpital Erasme - Universite Libre de Bruxelles, Bruxelles, Belgium
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Schneider-Burrus S, Arpa E, Kors C, Stavermann T, Sabat R, Kokolakis G. [Drug therapy of acne inversa]. Hautarzt 2019; 69:58-63. [PMID: 29234829 DOI: 10.1007/s00105-017-4094-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Acne inversa is a chronic inflammatory destructive skin disease that affects about 1% of the population. The therapy should be personalized and consists of surgical and conservative procedures. Antibiotics are administered either topically or systemically. Combination therapy with clindamycin and rifampicin for 10-12 weeks can be very effective. Furthermore, TNF-α inhibitors show adequate efficacy and can be recommended. Adalimumab is the only approved drug product for systemic treatment of acne inversa. The efficacy of retinoids is controversial. Isotretinoin cannot be recommended for the treatment of acne inversa; however, acitretin has been proven to be more effective. Immune-modulating substances, like dapsone, cyclosporine A, methotrexate, colchicine, or corticosteroids, can be considered; however, the study data are insufficient for recommendation. Hormonal therapies can influence the course of the disease. Antiseptics are applied independent of the stage of disease. Patients should be informed about triggering factors.
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Affiliation(s)
- S Schneider-Burrus
- Zentrum für Dermatochirurgie, Havelklinik, Gatower Str. 191, 13595, Berlin, Deutschland. .,Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - E Arpa
- Zentrum für Dermatochirurgie, Havelklinik, Gatower Str. 191, 13595, Berlin, Deutschland
| | - C Kors
- Hautzentrum Weißensee, Berlin, Deutschland
| | - T Stavermann
- Hautzentrum Gropiuspassagen, Berlin, Deutschland
| | - R Sabat
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - G Kokolakis
- Interdisziplinäre Gruppe Molekulare Immunpathologie, Dermatologie/Med. Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Psoriasis Forschungs- und BehandlungsCentrum, Klinik für Dermatologie, Venerologie und Allergologie und Institut für Medizinische Immunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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31
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Frew JW, Hawkes JE, Krueger JG. Topical, systemic and biologic therapies in hidradenitis suppurativa: pathogenic insights by examining therapeutic mechanisms. Ther Adv Chronic Dis 2019; 10:2040622319830646. [PMID: 30854183 PMCID: PMC6399757 DOI: 10.1177/2040622319830646] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/16/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin, manifesting in chronic, recurrent painful pustules, nodules, boils and purulent draining abscesses. Our current understanding of the pathogenesis of the disease is incomplete. This review aims to identify available treatment options in HS and discuss the pharmacological mechanisms through which such agents function. Identifying common pathways may inform our understanding of the pathogenesis of HS as well as identify future therapeutic targets. The pharmacological mechanisms implicated in topical therapies, antibiotic, hormonal, systemic immunomodulatory and biologic therapies for HS are discussed. Significant differences exist between agents and implicated pathways in therapy for mild and severe disease. This is an expression of the possible dichotomy in inflammatory pathways (and treatment responses) in HS. Studies involving monoclonal antibodies provide the greatest insight into what these specific mechanisms may be. Their variable levels of clinical efficacy compared with placebo bolsters the suggestion that differential inflammatory pathways may be involved in different presentations and severity of disease. Nuclear factor kappa B (NF-κB), tumor necrosis factor (TNF)-α and other innate immune mechanisms are strongly represented in treatments which are effective in mild to moderate disease in the absence of scarring or draining fistulae, however complex feed-forward mechanisms in severe disease respond to interleukin (IL)-1 inhibition but are less likely to respond to innate immune inhibition (through NF-κB or TNF-α) alone. It is unclear whether IL-17 inhibition will parallel TNF-α or IL-1 inhibition in effect, however it is plausible that small molecule targets (Janus kinase1 and phosphodiesterase 4) may provide effective new strategies for treatment of HS.
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Affiliation(s)
- John W. Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, 1230 York Avenue, New York, NY 10065, USA
| | - Jason E. Hawkes
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - James G. Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Zouboulis CC, Bechara FG, Dickinson-Blok JL, Gulliver W, Horváth B, Hughes R, Kimball AB, Kirby B, Martorell A, Podda M, Prens EP, Ring HC, Tzellos T, van der Zee HH, van Straalen KR, Vossen ARJV, Jemec GBE. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol 2018; 33:19-31. [PMID: 30176066 PMCID: PMC6587546 DOI: 10.1111/jdv.15233] [Citation(s) in RCA: 136] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Abstract
Hidradenitis suppurativa (HS)/acne inversa is a debilitating chronic disease that remains poorly understood and difficult to manage. Clinical practice is variable, and there is a need for international, evidence‐based and easily applicable consensus on HS management. We report here the findings of a systematic literature review, which were subsequently used as a basis for the development of international consensus recommendations for the management of patients with HS. A systematic literature review was performed for each of nine clinical questions in HS (defined by an expert steering committee), covering comorbidity assessment, therapy (medical, surgical and combinations) and response to treatment. Included articles underwent data extraction and were graded according to the Oxford Centre for Evidence‐based Medicine criteria. Evidence‐based recommendations were then drafted, refined and voted upon, using a modified Delphi process. Overall, 5310 articles were screened, 171 articles were analysed, and 65 were used to derive recommendations. These articles included six randomized controlled trials plus cohort studies and case series. The highest level of evidence concerned dosing recommendations for topical clindamycin in mild disease (with systemic tetracyclines for more frequent/widespread lesions) and biologic therapy (especially adalimumab) as second‐line agents (following conventional therapy failure). Good‐quality evidence was available for the hidradenitis suppurativa clinical response (HiSCR) as a dichotomous outcome measure in inflammatory areas under treatment. Lower‐level evidence supported recommendations for topical triclosan and oral zinc in mild‐to‐moderate HS, systemic clindamycin and rifampicin in moderate HS and intravenous ertapenem in selected patients with more severe disease. Intralesional or systemic steroids may also be considered. Local surgical excision is suggested for mild‐to‐moderate HS, with wide excision for more extensive disease. Despite a paucity of good‐quality data on management decisions in HS, this systematic review has enabled the development of robust and easily applicable clinical recommendations for international physicians based on graded evidence.
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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
| | - F G Bechara
- Dermatologic Surgery Unit, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J L Dickinson-Blok
- Department of Dermatology, Hospital Nij Smellinghe, Drachten, The Netherlands
| | - W Gulliver
- Division of Dermatology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - B Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R Hughes
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - A B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - B Kirby
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - A Martorell
- Department of Dermatology, Hospital de Manises, Valencia, Spain
| | - M Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Darmstadt, Germany
| | - E P Prens
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H C Ring
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad and Institute of Clinical Medicine, Arctic University, Tromsø, Norway
| | - H H van der Zee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands.,DermaHaven, Rotterdam, The Netherlands
| | - K R van Straalen
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A R J V Vossen
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
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33
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van Straalen KR, Schneider-Burrus S, Prens EP. Current and future treatment of hidradenitis suppurativa. Br J Dermatol 2018; 183:e178-e187. [PMID: 29981245 DOI: 10.1111/bjd.16768] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 12/13/2022]
Abstract
This scholarly review on the current and future treatment of hidradenitis suppurativa (HS) focuses on medical and surgical treatment options, while novel pipeline drugs are also discussed. Treatment goals are to limit the incidence and duration of flares, reducing inflammation and suppuration, achieving local cure after surgery and, most importantly, to improve the quality of life of patients with HS. The type of medication and/or surgery should be chosen based on the stage of the disease and the degree of inflammation. However, the lack of a simple scoring system and the lack of clear surgical outcome definitions hamper the interpretation of treatment efficacy and the comparison between different treatment strategies. The therapeutic pipeline for HS is gradually expanding, and will probably lead to a broader panel of more effective therapeutic options.
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Affiliation(s)
- K R van Straalen
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - S Schneider-Burrus
- Department of Dermatology, University Hospital Charité, Berlin, Germany.,Centre for Dermatosurgery, Havelklinik, Berlin, Germany
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Negus D, Ahn C, Huang W. An update on the pathogenesis of hidradenitis suppurativa: implications for therapy. Expert Rev Clin Immunol 2018; 14:275-283. [PMID: 29509041 DOI: 10.1080/1744666x.2018.1449647] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa is a chronic, inflammatory disease characterized by painful nodules, abscesses, and sinuses in the intertriginous areas, with significant associated comorbidities. The pathogenesis remains unclear, although advances have been made in understanding the disease process. Management of the disease is challenging, with a wide range of treatment options available with variable clinical response. Areas covered: This review discusses the most updated studies on the complex pathogenic mechanisms of hidradenitis suppurativa and the relevant literature on the current treatment options for this condition. Expert commentary: There is increasing evidence supporting the role of Th17 cells and enhanced expression of IL-17 and IL-1β, which represent potential targets for therapy. Bacteria and biofilms are likely contributory but secondary drivers of inflammation. There is also evolving evidence to suggest the presence of systemic comorbidities associated with HS, which underlie the importance of better understanding the pathogenesis and treatment of this disease.
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Affiliation(s)
- Deborah Negus
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , NC , USA
| | - Christine Ahn
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , NC , USA
| | - William Huang
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , NC , USA
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Guenther LC, Kunynetz R, Lynde CW, Sibbald RG, Toole J, Vender R, Zip C. Acitretin Use in Dermatology. J Cutan Med Surg 2017; 21:2S-12S. [PMID: 28952335 DOI: 10.1177/1203475417733414] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acitretin has been used for the treatment of severe psoriasis for over 20 years. OBJECTIVE The current project was conceived to optimise patient care by recognising the role acitretin can play in the treatment of patients with psoriasis and those with other disorders of keratinisation. METHODS A literature review was conducted to explore the role of acitretin and to assess its value for dermatologic disorders other than severe psoriasis. A panel of Canadian dermatologists developed a clinical pathway using a case-based approach, focusing on specific patient features. RESULTS The clinical pathway covers plaque psoriasis with hyperkeratotic plantar disease, palmoplantar pustulosis, hyperkeratotic hand dermatitis, lichen planus, lamellar ichthyosis, and hidradenitis suppurativa. CONCLUSION The recommendations in our clinical pathway reflect the current use of acitretin in Canada for severe psoriasis and other disorders of keratinisation.
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Affiliation(s)
- Lyn C Guenther
- 1 Guenther Research Inc., London, ON, Canada.,2 Western University, London, ON, Canada
| | - Rod Kunynetz
- 3 Ultranova Clinical Trials and Probity Medical Research, Barrie, ON, Canada
| | - Charles W Lynde
- 4 Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Gary Sibbald
- 5 Della Lana Faculty of Public health and Faculty of Medicine, University of Toronto, Mississauga, ON, Canada.,6 University of Manitoba, Winnipeg, MB, Canada
| | - John Toole
- 6 University of Manitoba, Winnipeg, MB, Canada
| | - Ronald Vender
- 7 Division of Dermatology, Department of Medicine, McMaster University, Hamilton, ON, Canada.,8 Dermatrials Research & Venderm Innovations in Psoriasis. Hamilton, ON, Canada
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Robert E, Bodin F, Paul C, Konstantinou MP, Gall Y, Grolleau JL, Laloze J, Chaput B. Non-surgical treatments for hidradenitis suppurativa: A systematic review. ANN CHIR PLAST ESTH 2017; 62:274-294. [PMID: 28457725 DOI: 10.1016/j.anplas.2017.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/28/2017] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The management of hidradenitis suppurativa is multidisciplinary, involving general measures, medical treatment and surgery. Non-surgical treatments, often first-line procedures, mainly concern forms of low-to-moderate severity or, conversely, very severe forms in non-operable patients or those refusing surgery. While many treatments have been attempted, few randomized controlled trials have been conducted, so the choice of treatments is most often based on the personal experience of the clinicians. The objective of this systematic review is to propose a synthetic analysis of the currently available non-surgical procedures. METHODS This systematic review of the literature was conducted in accordance with the PRISMA criteria. We searched for articles in the Medline®, PubMed Central, Embase and Cochrane databases published between January 2005 and September 2015. RESULTS Sixty-four articles were included. They generally had a low level of evidence; indeed, the majority of them were retrospective observational studies. They involved biotherapy (44%), dynamic phototherapy (16%), antibiotics (11%), Laser (8%), retinoids (6%) and immunosuppressive therapies, anti-inflammatory drugs, zinc, metformin, gammaglobulins and fumarates. CONCLUSIONS None of the non-surgical treatments can treat all stages of the disease and offer long-term remission. Antibiotics and biotherapy seem to have real effectiveness but their effect remains suspensive and the disease is almost certain to reappear once they are stopped. As regards antibiotics, no association has shown their superiority in a study with a high level of evidence. And while some biotherapies seem quite effective, due to their side effects they should be reserved for moderate-to-severe, resistant or inoperable forms of the disease. Randomized controlled studies are needed before valid conclusions can be drawn. In the resistant or disabling forms, it is consequently advisable to orientate to the greatest possible extent towards radical surgery, which is the only treatment allowing hope for cure.
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Affiliation(s)
- E Robert
- Department of plastic surgery, Strasbourg university hospitals, university of Strasbourg, 67091 Strasbourg, France
| | - F Bodin
- Department of plastic surgery, Strasbourg university hospitals, university of Strasbourg, 67091 Strasbourg, France
| | - C Paul
- Department of dermatology, Rangueil-Larrey hospital, Paul-Sabatier university, 31059 Toulouse, France
| | - M-P Konstantinou
- Department of dermatology, Rangueil-Larrey hospital, Paul-Sabatier university, 31059 Toulouse, France
| | - Y Gall
- Department of dermatology, Rangueil-Larrey hospital, Paul-Sabatier university, 31059 Toulouse, France
| | - J-L Grolleau
- Department of plastic, reconstructive and aesthetic surgery, Rangueil hospital, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - J Laloze
- Department of plastic, reconstructive and aesthetic surgery, Rangueil hospital, 1, avenue Jean-Poulhès, 31059 Toulouse, France
| | - B Chaput
- Department of plastic, reconstructive and aesthetic surgery, Rangueil hospital, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
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Suárez Valladares MJ, Eiris Salvado N, Rodríguez Prieto MA. Treatment of hidradenitis suppurativa with intralesional photodynamic therapy with 5-aminolevulinic acid and 630nm laser beam. J Dermatol Sci 2017; 85:241-246. [DOI: 10.1016/j.jdermsci.2016.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/11/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Ponikowska M, Matusiak L, Szepietowski JC. Current systemic treatment strategies for hidradenitis suppurativa. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1281735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission.
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Affiliation(s)
- I E Deckers
- Department of Dermatology, Erasmus University Medical Center, Burg. s' Jacobplein 51, 3015 CA, Rotterdam, The Netherlands.
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Burg. s' Jacobplein 51, 3015 CA, Rotterdam, The Netherlands.
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Karagiannidis I, Nikolakis G, Sabat R, Zouboulis CC. Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder? Rev Endocr Metab Disord 2016; 17:335-341. [PMID: 27294593 DOI: 10.1007/s11154-016-9366-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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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Abstract
Background: Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease of the pilosebaceous follicle that severely affects patients’ quality of life and can be challenging for clinicians to manage. A few case series have reported on the efficacy of acitretin monotherapy in the treatment of intractable HS. Objective: To assess the efficacy of acitretin for the treatment of intractable HS. Methods: A retrospective review was conducted involving all patients with HS who received acitretin between January 2011 and January 2015 in a tertiary academic medical center. All patients with HS who received acitretin, either as a monotherapy or as an adjuvant to other systemic medications, were included, and clinical response was assessed using the physician global scale. Results: Fourteen patients with HS (mean age 48 years [range 32-64 years]; 9 [64%] were men) received acitretin. Most patients (86%) had Hurley stage II or III disease. All patients had failed other standard systemic medications prior to initiating acitretin. Six patients (43%) received acitretin monotherapy, and 8 patients (57%) received acitretin as an adjuvant to other standard systemic medications. None of the patients who received acitretin monotherapy exhibited clinical improvements. Clinical improvements were observed in 7 of the 8 (87.5%) patients who received acitretin as an adjuvant to other systemic medications, with 3 patients (37.5%) exhibiting partial response and 4 patients (50%) exhibiting good response. Conclusions and Relevance: Acitretin monotherapy was ineffective for the treatment of intractable HS. Acitretin may be effective when used as an adjuvant to other systemic medications.
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Scientific evidence for the use of current traditional systemic therapies in patients with hidradenitis suppurativa. J Am Acad Dermatol 2015; 73:S42-6. [DOI: 10.1016/j.jaad.2015.07.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/16/2015] [Indexed: 01/12/2023]
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Martorell A, García F, Jiménez-Gallo D, Pascual J, Pereyra-Rodríguez J, Salgado L, Villarrasa E. Actualización en hidradenitis supurativa (ii): aspectos terapéuticos. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:716-24. [DOI: 10.1016/j.ad.2015.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 06/30/2015] [Indexed: 01/10/2023] Open
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Update on Hidradenitis Suppurative (Part II): Treatment. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Dini V, Oranges T, Rotella L, Romanelli M. Hidradenitis Suppurativa and Wound Management. INT J LOW EXTR WOUND 2015; 14:236-44. [DOI: 10.1177/1534734615598890] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, burdensome, debilitating disease of the hair follicle. It presents with recurrent painful inflamed and noninflamed lesions usually in specific body areas such as axillary, inguinal, perineal, and genital areas. It is associated with a large range of other diseases and conditions, such as obesity, arthropathy, inflammatory bowel diseases, and sqaumous cell carcinoma. Medical therapy may be systemic or topical, mainly based on antibiotics, retinoids, hormones and immunosuppressive drugs, including biological therapies. Surgical and laser therapies may be a valid therapeutic approach in order to treat locally recurring lesions. The aim of this article is to review the wound healing options after skin excision and laser treatments, with a focus on lesions left to heal by secondary intention, analyzing the efficacy of moist wound dressings, negative pressure wound therapy, bioactive dressings, such as platelet-rich plasma gel and hylarunoic acid scaffold, or autologous keratinocyte suspension in platelet concentrate and skin-grafting tecniques.
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Hughes R, Kelly G, Sweeny C, Lally A, Kirby B. The medical and laser management of hidradenitis suppurativa. Am J Clin Dermatol 2015; 16:111-23. [PMID: 25708371 DOI: 10.1007/s40257-015-0118-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease characterized by painful recurrent nodules and abscesses. In advanced stages, sinus tracts form, with resulting fibrotic and cribriform scar formation, leading to dermal contractures and induration of the affected skin. The epidemiology of HS is poorly described, and few population-based studies exist. The reported incidence varies from 0.0003 to 4%. Effective treatment options for HS are limited, and randomized controlled trials addressing the safety and/or efficacy of available treatments are scarce. No medical treatment to date has been approved by the US FDA specifically for the treatment of HS. While some evidence of disease improvement exists with agents including clindamycin and rifampicin, metformin, fumarates, infliximab, and adalimumab, no single treatment has shown overwhelmingly positive outcomes. The lack of randomized controlled trials for most treatments and often disappointing treatment outcomes is disheartening. This study reviews the published evidence for treatment options for HS.
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Affiliation(s)
- Rosalind Hughes
- Department of Dermatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland,
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Blok JL, Boersma M, Terra JB, Spoo JR, Leeman FWJ, van den Heuvel ER, Huizinga J, Jonkman MF, Horváth B. Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients. J Eur Acad Dermatol Venereol 2015; 29:1590-7. [PMID: 25589154 DOI: 10.1111/jdv.12952] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 12/04/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. OBJECTIVES To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. METHODS A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. RESULTS A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). CONCLUSION The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery.
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Affiliation(s)
- J L Blok
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Boersma
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J B Terra
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J R Spoo
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F W J Leeman
- Department of Dermatology, Antonius Hospital, Sneek, The Netherlands
| | - E R van den Heuvel
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Huizinga
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M F Jonkman
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Horváth
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Abstract
Hidradenitis suppurativa (HS) is a burdensome disease and has the potential to affect the life course of patients. It is a rare disease in children, and the recorded literature is correspondingly scarce. This article reviews the therapeutic options for HS in children and adolescents, and highlights particular differences or challenges with treating patients in this age group compared with adults. The work-up of paediatric patients with HS should include considerations of possible endocrine co-morbidities and obesity. Medical therapy of lesions may include topical clindamycin. Systemic therapy may include analgesics, clindamycin and rifampicin, finasteride, corticosteroids or tumour necrosis factor alpha (TNFα) blockers. Superinfections should be appropriately treated. Scarring lesions generally require surgery.
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Affiliation(s)
- Peter Riis Mikkelsen
- Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark,
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