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Holgersen N, Nielsen VW, Rosenø NAL, Thyssen JP, Egeberg A, Nielsen SH, Ring HC, Thomsen SF. Biomarkers of systemic inflammation are associated with disease severity and metabolic syndrome in patients with hidradenitis suppurativa. JAAD Int 2024; 15:170-178. [PMID: 38638915 PMCID: PMC11025002 DOI: 10.1016/j.jdin.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/20/2024] Open
Abstract
Background Biomarkers associated with disease severity and comorbid metabolic syndrome (MetS) in patients with hidradenitis suppurativa (HS) are lacking. Objective To identify biomarkers associated with disease severity and comorbid MetS in patients with HS. Methods Data on hospital outpatients with HS were obtained through clinical examination and interviews. Indicators of systemic inflammation; C-reactive protein (CRP), erythrocyte sedimentation-rate (ESR), neutrophil/lymphocyte-ratio (NLR), platelet/lymphocyte-ratio (PLR), monocyte/lymphocyte-ratio (MLR), platelet/neutrophil-ratio (PNR), pan-immune-inflammation-value (PIV), and systemic-immune-inflammatory-index (SII), were calculated from blood samples. Results Seven hundred patients were included; of those 444 (63.4%) and 256 (36.6%) were female and male, respectively, with a median age of 38.3 years (IQR = 27.9-51.0). Increasing CRP, ESR, NLR, PIV, and SII (P < .001) were significantly associated with increasing Hurley-stage and international hidradenitis suppurativa severity score system 4 (IHS4)-score in adjusted analysis. A doubling in CRP (OR 1.59 (1.36-1.85), P < .001), ESR (OR 1.39 (1.17-1.66), P < .001) and PIV (OR 1.41 (1.12-1.77) P = .002) was associated with MetS in adjusted analysis. ESR was the best estimator for severe IHS4-score (AUC = 0.72 (0.66-0.77), P < .001) and Hurley III (AUC = 0.79 (0.73-0.85), P < .001) whereas CRP was best for MetS (AUC = 0.67 (0.62-0.72), P < .001). Limitations Patients in a hospital setting tend to have more severe disease. Conclusion Biomarkers like CRP, ESR, and PIV measuring systemic inflammation were associated with disease severity and comorbid MetS in patients with HS.
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Affiliation(s)
- Nikolaj Holgersen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | | | | | - Jacob P. Thyssen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alexander Egeberg
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Greenlund L, Herzog C, Wendland Z, Rypka K, Frew JW, Kirby JS, Alavi A, Khalid B, Lowes MA, Garg A, Marzano AV, Zouboulis CC, Tzellos T, Jaleel T, Goldfarb N. Discrepancies in hidradenitis suppurativa lesion characterization by providers and patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595320 DOI: 10.1111/jdv.19999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The hidradenitis suppurativa (HS) clinical response (HiSCR) has come under scrutiny as several HS clinical trials failed to meet primary endpoints with high placebo responses. This may be due to limitations of the tool and raters' ability to accurately characterize and count lesions, rather than lack of efficacy of the studied drug. Due to HS lesion complexity and potential differences in rater training, it was hypothesized that there would be discrepancies in how providers characterize and count lesions for HS clinical trials. OBJECTIVE To evaluate how HS providers and patients name and count HS lesions and to identify discrepancies among providers to initiate the development of consensus-driven guidance for HS rater training. METHODS An online survey was distributed to the members of HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). Respondents were asked to classify lesion images composed of multiple and different morphology types and answer questions regarding inclusion of associated dermatological conditions. RESULTS Forty-seven HISTORIC members responded (29 providers; 18 patients). There was variability in how respondents classified HS lesions. Of 12 questions containing images, four had ≥50% of respondents choosing the same answer. With an image of a lesion composed of different morphologies, 45% of providers counted it as a single lesion and 45% counted it as multiple distinct lesions. With an image of multiple interconnected draining tunnels, 7% of providers classified it as a single draining tunnel while 79% categorized it as multiple draining tunnels with the number estimated by visual inspection. There was also variability in deciding whether lesions occurring in associated conditions should be considered separately or included in HS lesion counts. Patient responses were also variable. CONCLUSIONS The result of the current study reaffirms the gap in how providers characterize and count HS lesions for clinical trials and the need to develop consensus-driven rater training related to HS outcome measures.
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Affiliation(s)
| | - Claire Herzog
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Zachary Wendland
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katelyn Rypka
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health, Hershey, Pennsylvania, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bisma Khalid
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle A Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Amit Garg
- Northwell Health, New York, New York, USA
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - 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
| | - Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, NLSH Bodø, Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, TRomsø, Norway
| | - Tarannum Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Noah Goldfarb
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Department of Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
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3
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Thorlacius L, Riis PT, Musaeus KD, Saunte DM, Esmann S, Jemec GBE, Hansen ST. Severity rating of specific skin lesions in hidradenitis suppurativa: the ptient perspective. Br J Dermatol 2024; 190:579-581. [PMID: 38060986 DOI: 10.1093/bjd/ljad491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/28/2023] [Accepted: 01/13/2024] [Indexed: 03/16/2024]
Abstract
The assessment of physical signs in HS is a very complex matter. This qualitative study investigates how patients with HS themselves would rate the severity of different types of HS lesions, and suggests that the lesion severity weighting in currently used Outcome Measurement Instruments, do not match the patient experience of severity.
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Affiliation(s)
- Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Peter Theut Riis
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Katrine D Musaeus
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Ditte M Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences Faculty, University of Copenhagen, Denmark
| | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Institute of Clinical Medicine, Faculty of Health and Medical Sciences Faculty, University of Copenhagen, Denmark
| | - Stine Thestrup Hansen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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4
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Wiala A, Ranjan R, Schnidar H, Rappersberger K, Posch C. Automated classification of hidradenitis suppurativa disease severity by convolutional neural network analyses using calibrated clinical images. J Eur Acad Dermatol Venereol 2024; 38:576-582. [PMID: 38013510 DOI: 10.1111/jdv.19639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The assessment of hidradenitis suppurativa (HS) severity requires detailed, and error-prone lesion counts. This proof-of-concept study aimed to automatically classify HS disease severity using machine learning of clinical smartphone images. METHODS 777 ambient-light and size-controlled images were used to build a class-balanced synthetic dataset (n = 7675). Convolutional neural networks (CNN) were used for automated severity classification (scale 0-3), and to assess disease-dynamics. International Hidradenitis Suppurativa Severity Score System (IHS4) served as reference. A U-NET algorithm was implemented for automated localization of diseased skin. RESULTS CNNs were able to distinguish no/mild from moderate/severe disease with an overall prediction accuracy of 78% [receiver operating curve (AUC) 0.85]. Correct IHS4 classification was achieved with an overall accuracy of 72% (AUC 0.84-0.89). In addition, disease dynamics using IHS4 numerical values aligned with CNN outputs (NRMSE 0.262). The UNET algorithm localized lesions with a pixel accuracy of 88.1% and test loss of 0.42. LIMITATIONS Limitations in assessing tattooed and hairy skin. Limited number of patients with dark skin colour and Hurley I. CONCLUSION CNNs were able to distinguish no/mild from moderate/severe disease, classify disease severity over time, and automatically identify diseased skin areas and the skin phototype. This study breaks new grounds for fast, reliable, reproducible and easy-to-use HS severity assessments using clinical images.
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Affiliation(s)
- A Wiala
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
| | - R Ranjan
- SCARLETRED Holding GmbH, Vienna, Austria
| | - H Schnidar
- SCARLETRED Holding GmbH, Vienna, Austria
| | - K Rappersberger
- Department of Dermatology, Clinic Landstrasse, Vienna, Austria
- School of Medicine, Sigmund Freud University, Vienna, Austria
| | - C Posch
- School of Medicine, Sigmund Freud University, Vienna, Austria
- Department of Dermatology, Clinic Hietzing, Vienna, Austria
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
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5
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Garg A, Mastacouris N, Ingram JR, Strunk A. Addressing high placebo response rates in randomized clinical trials for hidradenitis suppurativa. Br J Dermatol 2024; 190:427-429. [PMID: 37757841 DOI: 10.1093/bjd/ljad375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/31/2023] [Accepted: 10/21/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Nicole Mastacouris
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
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Kimball AB, Podda M, Alavi A, Miller M, Shen YK, Li S, Xu Y, Han C, Fakharzadeh S, Yang YW, DePrimo S, Munoz E, Chen Y, Passeron T, Papp K. Guselkumab for the treatment of patients with moderate-to-severe hidradenitis suppurativa: A phase 2 randomized study. J Eur Acad Dermatol Venereol 2023; 37:2098-2108. [PMID: 37317022 DOI: 10.1111/jdv.19252] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes substantial physical, emotional and psychological burdens. Guselkumab, a monoclonal antibody that binds to the p19 subunit of interleukin-23, has demonstrated high levels of efficacy in the treatment of inflammatory diseases, including psoriasis and psoriatic arthritis. OBJECTIVE To evaluate the effect of guselkumab on the treatment of HS, a phase 2, multicentre, randomized, placebo-controlled, double-blind, proof-of-concept study was conducted. METHODS Patients ≥18 years of age with moderate-to-severe HS for ≥1 year were randomized to (1) guselkumab 200 mg by subcutaneous (SC) injection every 4 weeks (q4w) through Week 36 (guselkumab SC); (2) guselkumab 1200 mg intravenously (IV) q4w for 12 weeks, then switched to guselkumab 200 mg SC q4w from Weeks 12 through 36 (guselkumab IV); or (3) placebo for 12 weeks, with re-randomization to guselkumab 200 mg SC q4w at Weeks 16 through 36 (placebo → guselkumab 200 mg) or guselkumab 100 mg SC at Weeks 16, 20, 28 and 36 and placebo at Weeks 24 and 32 (placebo → guselkumab 100 mg). End points included HS clinical response (HiSCR) and patient-reported outcomes. RESULTS Although guselkumab SC or guselkumab IV resulted in numerically higher HiSCR versus placebo at Week 16 (50.8%, 45.0%, 38.7%, respectively), statistical significance was not achieved. Numerically greater improvements in patient-reported outcomes were also observed for guselkumab SC and guselkumab IV versus placebo at Week 16. Through Week 40, no clear differences to suggest a dose response were observed for HiSCR and patient-reported outcomes. CONCLUSIONS Despite modest improvements, the primary end point was not met and the overall findings do not support the efficacy of guselkumab in the treatment of HS. CLINICALTRIALS gov: NCT03628924.
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Affiliation(s)
- Alexa B Kimball
- Department of Dermatology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Maurizio Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Teaching Hospital Goethe-University Frankfurt, Darmstadt, Germany
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan Miller
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Yaung-Kaung Shen
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Shu Li
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Yan Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Chenglong Han
- Patient-Reported Outcomes, Janssen Global Services, LLC, Malvern, Pennsylvania, USA
| | - Steven Fakharzadeh
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | - Ya-Wen Yang
- Immunology Global Medical Affairs, Janssen Pharmaceutical Companies of Johnson & Johnson, Horsham, Pennsylvania, USA
| | | | | | - Yanqing Chen
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Thierry Passeron
- Department of Dermatology, CHU Nice, Cote d'Azur University, Nice, France
- C3M, INSERM U1065, Cote d'Azur University, Nice, France
| | - Kim Papp
- Alliance Clinical Trials and Probity Medical Research, Inc, Waterloo, Ontario, Canada
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7
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Koerts NDK, Bouwman K, Prens LM, Horváth B. Assessment tools and phenotype classification for hidradenitis suppurativa. Clin Dermatol 2023; 41:601-610. [PMID: 37652190 DOI: 10.1016/j.clindermatol.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Hidradenitis suppurativa (HS) is a heterogeneous chronic relapsing skin disease. Several assessment tools are used to assess disease severity and to classify disease phenotype; however, no consensus exists. This review evaluates the various assessment tools and phenotypes, assessing their validity and reliability. Numerous assessment tools and phenotype classifications have been proposed for identifying various subtypes within the hidradenitis suppurativa disease spectrum. Each has a different purpose, such as use in daily practice or in clinical trial settings. Several assessment tools and phenotype classifications have been validated but not always with satisfactory results and often with studies showing divergent intra-rater reliability results. A consensus is needed for a validated, easy-to-use, and timesaving assessment tool for routine daily practice. For clinical trials, a validated and extensive assessment tool that also measures response to treatment is also needed.
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Affiliation(s)
- Nicole D K Koerts
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Klasiena Bouwman
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette M Prens
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Koumaki D, Rovithi E, Apokidou ES, Papadakis M, Katoulis A, Evangelou G. Cutaneous body image in patients with hidradenitis suppurativa: a hospital-based cross-sectional study. Sci Rep 2023; 13:7898. [PMID: 37193758 DOI: 10.1038/s41598-023-35120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 05/12/2023] [Indexed: 05/18/2023] Open
Abstract
Hidradenitis suppurativa (HS) has been linked with body image (BI) impairment and reduced quality of life (QoL). We sought to evaluate the associations between Cutaneous Body Image Scale (CBIS) and disease severity in HS patients.Between July 2020 and January 2022, a cross-sectional study was carried out including consecutive HS patients above the age of 16 who attended a Tertiary Referral Hospital in Greece. Disease Severity was graded with the Hurley stage, HS-Physician's Global Assessment (HS-PGA) scale, and the Modified Sartorius scale (MSS). Patients completed at their first visit ten survey instruments including Patients' Severity of disease, pain and pruritus scale, CBIS, Multidimensional Body-Self Relations Questionnaire (MBSRQ) including 5 subscales: Appearance Evaluation (AE), Appearance Orientation (AO), Body Areas Satisfaction Scale (BASS), Overweight Preoccupation (OWP), and Self Classified Weight (SCW) , Dermatology Quality of Life Index (DLQI), Skindex-16, EQ5D 5L, EQ- visual analogue scale (VAS), PHQ9, and GAD7. In total, 70 HS patients above 16 years old participated, mean [SD] age, 34.44 [11.64] years; 49/70 (70%) males and 21/70 (30%) females. Mean ± SD CBI, DLQI, Skindex-16 total, EQ-5D-5L, EQ VAS, PHQ9 and GAD7 were 5.59 ± 1.58, 11.70 ± 8.88, 52.90 ± 27.75, 0.75 ± 0.21, 62.48 ± 21.12, 7.64 ± 5.56, 7.87 ± 5.23 respectively. Moderate to severe CBI dissatisfaction was reported by 36/70 (51.42%) patients. CBI was correlated with appearance evaluation (AE) (p < 0.01, r = 0.544), body areas satisfaction (BASS) (p < 0.01, r = 0.481), and overweight preoccupation subscale (OWPS) (p < 0.01, r = - 0.267), and Skindex-16 (p < 0.01, r = - 0.288). HS patients with affected genital areas scored higher in disease patient's severity score (p = 0.015), and male patients scored higher in Skindex-16 than females(p < 0.01). Our study found that the mean of CBI in HS patients was 5.59 ± SD 1.58. Predictors for CBI dissatisfaction were low scores of MBSRQ Appearance Evaluation (AE) and Body Areas Satisfaction Subscale (BASS).
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Evangelia Rovithi
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Erato Solia Apokidou
- Department of Internal Medicine, Agios Nikolaos General Hospital, Knosou 4, Ag. Nikolaos, 72100, Crete, Greece
| | - Marios Papadakis
- Department of Surgery II, Witten/Herdecke University, Heusnerstrasse 40, 42283, Witten, Germany.
| | - Alexander Katoulis
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Chaidari, Athens, Greece
| | - George Evangelou
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
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9
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Bellefeuille G, Paiewonsky B, Khalid B, Freese RL, Lowes MA, Kirby JS, Alavi A, Goldfarb N. Inflammatory induration in hidradenitis suppurativa and application to severity assessment. Br J Dermatol 2023; 188:309-310. [PMID: 36634097 DOI: 10.1093/bjd/ljac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/06/2022] [Accepted: 10/24/2022] [Indexed: 01/13/2023]
Abstract
Skin thickness, as known as inflammatory induration, is a component in several HS grading instruments including the HASI and HASI-R. This study sought to evaluate how thickest lesion measurement (mm) corresponds to HS severity. This study demonstrates that inflammatory induration has moderate association with HS severity, thickest lesion measurement (mm) demonstrates known-validity across Hurley stages, and cut-offs for thickest lesion measurement (mm) were determined for inflammatory induration grading for the purpose of HASI-R training.
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Affiliation(s)
| | - Briana Paiewonsky
- Department of Dermatology.,Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, FL, USA
| | | | - Rebecca L Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | | | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Noah Goldfarb
- Department of Dermatology.,Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota Academic Health Center, Minneapolis, MN, USA
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10
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Daoud M, Suppa M, Benhadou F, Daxhelet M, Njimi H, White J, Jemec G, del Marmol V. Overview and comparison of the clinical scores in hidradenitis suppurativa: A real-life clinical data. Front Med (Lausanne) 2023; 10:1145152. [PMID: 37138732 PMCID: PMC10149852 DOI: 10.3389/fmed.2023.1145152] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Partly due to its clinical heterogeneity, hidradenitis suppurativa (HS) is difficult to score accurately; illustrated by the large number of disease scores. In 2016, a systematic review by Ingram et al. reported the use of about thirty scores, and since then, this number has increased further. Our aim is twofold: to provide a succinct but detailed narrative review of the scores used to date, and to compare these scores with each other for individual patients. Materials and methods The review of the literature was done among articles in English and French, on Google, Google scholar, Pubmed, ScienceDirect and Cochrane. To illustrate the differences between scores, data from some Belgian patients included in the European Registry for HS were selected. A first series of patients compares the severity of the following scores: Hurley, Hurley Staging refined, three versions of Sartorius score (2003, 2007, 2009), Hidradenitis Suppurativa Physician Global Assessment (HS-PGA), International Hidradenitis Suppurativa Severity Scoring System (IHS4), Severity Assessment of Hidradenitis Suppurativa (SAHS), Hidradenitis Suppurativa Severity Index (HSSI), Acne Inversa Severity Index (AISI), the Static Metascore, and one score that is not specific to HS: Dermatology Life Quality Index (DLQI). A second set of patients illustrates how some scores change over time and with treatment: Hurley, Hurley Staging refined, Sartorius 2003, Sartorius 2007, HS-PGA, IHS4, SAHS, AISI, Hidradenitis Suppurativa Clinical Response (HiSCR), the very new iHS4-55, the Dynamic Metascore, and DLQI. Results Nineteen scores are detailed in this overview. We illustrate that for some patients, the scores do not predictably and consistently correlate with each other, either in an evaluation of the severity at a time-point t, or in the evaluation of the response to a treatment. Some patients in this cohort may be considered responders according to some scores, but non-responders according to others. The clinical heterogeneity of the disease, represented by its many phenotypes, seems partly to explain this difference. Conclusion These examples illustrate how the choice of a score can lead to different interpretations of the response to a treatment, or even potentially change the results of a randomized clinical trial.
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Affiliation(s)
- Mathieu Daoud
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
- *Correspondence: Mathieu Daoud,
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Mathilde Daxhelet
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hassane Njimi
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jonathan White
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gregor Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
- Health Sciences Faculty, University of Copenhagen, København, Denmark
| | - Véronique del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles (ULB), Brussels, Belgium
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11
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Mintoff D, Borg I, Pace NP. Serum Immunoglobulin G Is a Marker of Hidradenitis Suppurativa Disease Severity. Int J Mol Sci 2022; 23. [PMID: 36430277 DOI: 10.3390/ijms232213800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory condition of the skin that is brought about by autoinflammation and hyperkeratosis at the pilosebaceous unit. The clinical severity of HS can be measured using static (Hurley Severity Scoring (HSS)) and/or dynamic (International HS Severity Scoring System (IHS4)) severity scoring instruments. However, few clinically available serological parameters have been found to correlate with disease severity. In this study, we sought to investigate the role of serum immunoglobulin (Ig) G, M and A levels as biomarkers of disease severity and to compare them with other, more conventional inflammatory indices, such as the erythrocyte sedimentation rate, C-reactive protein, the neutrophil-lymphocyte ratio, the platelet-lymphocyte ratio and the systemic immune-inflammation index. In this cross-sectional study, patients were recruited from the only dermatology referral centre in Malta, Europe, and subjected to clinical examination and the assessment of inflammatory and immunologic parameters. Serum IgG, M and A levels were assessed using the Atellica® NEPH 630 System (SIEMENS-Healthineers AF, Erlangen, Germany) nephelometric analyser. Serum IgG, M and A levels correlate with both dynamic and static HS severity scoring systems. Serum IgG behaves as a marker of severe HS disease as categorised by HSS and the IHS4. Our findings suggest that the serum IgG level can be used in the clinical setting as a biomarker of disease severity and, therefore, as an adjunct to clinical severity scoring.
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12
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LeWitt TM, Mammis-Gierbolini A, Parnell M, Sarfo A, Paek SY, Benhadou F, del Marmol V, Hsiao JL, Kirby J, Daveluy S. International consensus definition of disease flare in hidradenitis suppurativa. Br J Dermatol 2022; 187:785-787. [PMID: 35531746 PMCID: PMC9633352 DOI: 10.1111/bjd.21647] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/13/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Akua Sarfo
- Case Western Reserve University/University Hospitals Cleveland Medical Center
| | | | - Farida Benhadou
- Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jennifer L. Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Joslyn Kirby
- Department of Dermatology, Penn State Health, Hershey, PA, USA
| | - Steven Daveluy
- Wayne State University School of Medicine, Detroit, MI, USA
- Department of Dermatology, Wayne State University, Detroit, MI, USA
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13
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Burlando M, Fabbrocini G, Marasca C, Dapavo P, Chiricozzi A, Malvaso D, Dini V, Campanati A, Offidani A, Dattola A, Caro RDC, Bianchi L, Venturini M, Gisondi P, Guarneri C, Malara G, Trifirò C, Malagoli P, Fargnoli MC, Piaserico S, Carmisciano L, Castelli R, Parodi A. Adalimumab Originator vs. Biosimilar in Hidradenitis Suppurativa: A Multicentric Retrospective Study. Biomedicines 2022; 10:2522. [PMID: 36289787 DOI: 10.3390/biomedicines10102522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
This study aimed to compare adalimumab originator vs. biosimilar in HS patients, and to evaluate the effect of a switch to a biosimilar, or a switch back to the originator, in terms of treatment ineffectiveness. Patients with a diagnosis of HS were enrolled from 14 Italian sites. Treatment ineffectiveness was measured using Hurley score. The major analyses were 1) comparison between the two treatment groups (non-switcher analysis), and 2) the cross-over trend of Hurley score between treatment switchers (switcher analysis). Cox and Poisson regression models were used to compare the treatment ineffectiveness between groups. A total of 326 patients were divided into four groups: 171 (52.5%) taking originator; 61 (18.7%) patients taking biosimilar; 66 (20.2%) switchers; 28 (8.6%) switchers from originator to biosimilar and switched. A greater loss of efficacy was observed in the group allocated to the biosimilar than the originator group. The switcher analysis showed an effectiveness loss in the biosimilar compared to the originator. These results seem to indicate that a switch from one drug to the other may lead to a greater risk of inefficacy. A return to the previous treatment also does not ensure efficaciousness.
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14
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Garg A, Zema C, Kim K, Gao W, Chen N, Jemec GB, Kirby J, Thorlacius L, Villumsen B, Ingram JR. Development and initial validation of the HS-IGA: a novel hidradenitis suppurativa-specific investigator global assessment for use in interventional trials. Br J Dermatol 2022; 187:203-210. [PMID: 35599448 PMCID: PMC9542331 DOI: 10.1111/bjd.21236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/23/2021] [Accepted: 03/03/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Few validated instruments exist for use in hidradenitis suppurativa (HS) trials. OBJECTIVES To develop a novel HS Investigator Global Assessment (HS-IGA) and to validate its psychometric properties. METHODS Development of HS-IGA involved discussion among stakeholders, including patients, within HISTORIC. Data from replicate phase III randomized controlled trials evaluating HS treatment were utilized. Multivariate models identified lesion type and body region as variables of importance. Classification and regression trees for ordinal responses were built. Validation included assessment of test-retest reliability, predictive validity, responsiveness and clinical meaningfulness. RESULTS There were 3024 unique measurements available in PIONEER I. Mean and median lesion counts by region were largely <10 and were highest in axillary and inguinal regions. The mean and median number of regions involved were ≤ 3 for individual lesions and combinations. Regardless of lesion type, axillary and inguinal regions most influenced the HS-IGA score. Accordingly, regions were combined into a six-point IGA based on the maximum lesion number in either upper or lower body regions with a score of 0 (0-1 lesions), 1 (2-5), 2 (6-10), 3 (11-15), 4 (16-20) and 5 (≥ 20 lesions). The intraclass correlation coefficient for test-retest reliability was 0·91 (95% confidence interval 0·87-0·94). Spearman's rank order correlations (SROCs) with HS-PGA and Hidradenitis Suppurativa Clinical Response (HiSCR) were 0·73 and 0·51, respectively (P < 0·001 for both comparisons). SROCs with Dermatology Life Quality Index (DLQI), pain numerical rating scale and HS-QoL were 0·42, 0·34 and -0·25, respectively (P < 0·001 for all comparisons). HS-IGA was responsive at weeks 12 and 36. Predictive convergent validity was very good with HS-PGA (area under the curve = 0·89) and with HiSCR (area under the curve = 0·82). Predictive divergent validity was low with DLQI and HS-QoL. CONCLUSIONS HS-IGA has moderate-to-strong psychometric properties and is simple to calculate.
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Affiliation(s)
- Amit Garg
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell1991 Marcus Avenue, Suite 300New Hyde ParkNY11042USA
| | | | - Katherine Kim
- AbbVie, Inc.1 North Waukegan StNorth ChicagoIL60064USA
| | - Weihua Gao
- AbbVie, Inc.1 North Waukegan StNorth ChicagoIL60064USA
| | - Naijun Chen
- AbbVie, Inc.1 North Waukegan StNorth ChicagoIL60064USA
| | - Gregor B.E. Jemec
- Department of DermatologyZealand University HospitalSygehusvej 10RoskildeDK‐4000Denmark
| | - Joslyn Kirby
- Penn State Health500 University DriveHersheyPA17033USA
| | - Linnea Thorlacius
- Department of DermatologyZealand University HospitalSygehusvej 10RoskildeDK‐4000Denmark
| | | | - John R. Ingram
- Division of Infection and ImmunityCardiff UniversityCardiffUK
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15
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Guillem P, Mintoff D, Kabbani M, Cogan E, Vlaeminck-Guillem V, Duquesne A, Benhadou F. Case Report: Comorbid Hyper-IgD Syndrome and Hidradenitis Suppurativa - A New Syndromic Form of HS? A Report of Two Cases. Front Immunol 2022; 13:883811. [PMID: 35720358 PMCID: PMC9204359 DOI: 10.3389/fimmu.2022.883811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
Hidradenitis Suppurativa (HS) is a chronic suppurative disease of the pilosebaceous unit. The current model of HS pathophysiology describes the condition as the product of hyperkeratinisation and inflammation at the hair follicular unit. Environmental factors (such as smoking and obesity), gender, genetic predisposition, and skin dysbiosis are considered the main pathogenic drivers of the disease. Autoinflammatory syndromes associated with HS are rare but may help to highlight the potential roles of autoinflammation and dysregulated innate immune system in HS. Therefore, it is of major relevance to increase the awareness about these diseases in order to improve the understanding of the disease and to optimize the management of the patients. Herein, we report for the first time, to our knowledge, two clinical cases of Hyper-IgD syndrome-associated HS. Hyper-IgD is an autoinflammatory syndrome caused by a mevalonate kinase deficiency (MKD), a key kinase in the sterol and isoprenoid production pathway. We describe the potentially shared pathophysiological mechanisms underpinning comorbid MKD-HS and propose therapeutic options for the management of these patients.
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Affiliation(s)
- Philippe Guillem
- Department of Surgery, Clinique du Val d'Ouest, Lyon, France.,ResoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Dillon Mintoff
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Mater Dei Hospital, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mariam Kabbani
- Department of Dermatology, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Elie Cogan
- Department of Internal Medicine, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Departement of Internal Medecine, Hôpital Delta, CHIREC, Brussels, Belgium
| | - Virginie Vlaeminck-Guillem
- Université Claude Bernard Lyon 1, INSERM 1052, CNRS 5286, Centre Léon Bérard, Centre de 9 Recherche en Cancérologie de Lyon, Lyon, France.,Centre de Biologie Sud, Hôpital Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Agnes Duquesne
- Department of Paediatric Nephrology, Rheumatology and Dermatology, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Farida Benhadou
- ResoVerneuil, Paris, France.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Hôpital Universitaire Erasme, Université Libre de Bruxelles, Brussels, Belgium
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16
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van Straalen KR, Ingram JR, Augustin M, Zouboulis CC. New treatments and new assessment instruments for hidradenitis suppurativa. Exp Dermatol 2022; 31 Suppl 1:33-39. [PMID: 35582833 PMCID: PMC9542859 DOI: 10.1111/exd.14609] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/08/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
Research interest in Hidradenitis Suppurativa (HS) has grown exponentially over the past decades. Several groups have worked to develop novel scores that address the drawbacks of existing investigator assessed and patient reported outcome measures currently used in HS trials, clinical practice and research. In clinical trial settings, the drawbacks of the HiSCR have become apparent; mainly it's lack of a dynamic measurement of draining tunnels. The newly developed (dichotomous) IHS4 and HASI-R are backed up by adequate validation data and are good contenders to become the new primary outcome measure in HS clinical trials. Patient reported outcomes, as well as physician reported measures, are being developed by the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC). For example, the Hidradenitis Suppurativa Quality of Life (HiSQOL) score is a validated measure of HS-specific quality of life and is already being used in many HS trials. Magnitude of pain measurement via a 0-10 numerical rating scale is well-established, however consensus is still required to ensure consistent administration and interpretation of the instrument. A longitudinal measurement over multiple days rather than at one time point, such as for example the Pain Index could provide increased reliability and reduced recall bias. Ultimately, these newly developed scores and tools can be included in a standardized registry to be used in routine clinical practice.
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Affiliation(s)
- K R van Straalen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - J R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - M Augustin
- Institute for Health Care Services Research in Dermatology and Nursing, University Hospital Medical Center Hamburg-Eppendorf, Hamburg, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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17
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Shamsalinia A, Ghadimi R, Ebrahimi Rad R, Jahangasht Ghoozlu K, Mahmoudian A, Moradi M, Masoudi R, Ghaffari F. Psychometric Properties of the Persian Version of Adult Eating Behavior Questionnaire in Patients with Epilepsy. Iran J Med Sci 2022; 47:236-247. [PMID: 35634526 PMCID: PMC9126902 DOI: 10.30476/ijms.2021.89396.2011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/21/2021] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Abstract
Background Adult eating behavior questionnaire (AEBQ) is an age upward extension tool that measures appetite traits in individuals. This instrument was developed by Hunot in 2016. The present study aimed to determine the psychometric properties of the Persian version of AEBQ in adults with epilepsy. Methods The current research is a cross-sectional study conducted in 2019 in Iran. 700 adults with epilepsy completed the 35-item AEBQ. Qualitative face validity, qualitative content and structure validity (exploratory factor analysis [EFA], N=400, and confirmatory factor analysis [CFA], N=300) appetitive traits were evaluated. Reliability was also measured using Cronbach's alpha, Construct reliability (CR), and Intra-Class Correlation (ICC). The SPSS 26-AMOS24 software was employed to analyze the data with a significance level of 0.05. Results The EFA and CFA results comprised eight factors, namely enjoyment of food, emotional over-eating, food responsiveness, hunger, satiety responsiveness, emotional under-eating, food fussiness, and eating slowly. Indices of root mean square error of approximation=0.068, parsimonious normed fit index=0.644, parsimonious comparative fit index=0.671, adjusted goodness of fit index=0.618, goodness of fit index=0.911, and Chi square degree-of-freedom ratio (normalized Chi square CMIN/DF=2.842) confirmed the fitness of the final model. Convergent and divergent validity was acceptable for all the factors. The results revealed that the internal stability>0.8 and CR>0.7 of the eight extracted AEBQ structures are confirmed. The ICC was 0.899 (95% CI: 0.878-0.917; P<0.001). The results also showed that AEBQ has acceptable convergent and divergent validity. Conclusion The eight-factor structure of AEBQ can measure eating behavior traits and is of good validity and reliability for assessing the eating behavior of Iranian adults with epilepsy.
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Affiliation(s)
- Abbas Shamsalinia
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ghadimi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Reza Ebrahimi Rad
- Department of Medicine, Islamic Azad University, Tonekabon Branch, Tonekabon, Mazandaran, Iran
| | | | - Amaneh Mahmoudian
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mozhgan Moradi
- Department of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Masoudi
- Department of Nursing, School of Nursing and Midwifery, Shahr-e-Kord University of Medical Sciences Shahr-e-kord, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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18
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Fritsche M, Okun M, Kirby JS. Damage in Hidradenitis Suppurativa: A Narrative Review Emphasizing the Need for a Novel Outcome Measure. Br J Dermatol 2022; 187:288-294. [PMID: 35104363 DOI: 10.1111/bjd.21043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
Abstract
Cutaneous damage caused by hidradenitis suppurativa is an important contributor to disease burden, independent of active lesions. Outcome measures used to specifically assess damage are becoming commonplace in assessment of inflammatory diseases. However, no standardized method for assessing HS damage currently exists. The purpose of this study was to review outcome measures in HS that include constructs of both active disease and damage, review damage-specific instruments used in other inflammatory and destructive diseases, and review instruments used to assess scars of various etiologies. This ultimately provides insight into how attributes of different tools can be applied to develop an outcome measure specific to HS damage.
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Affiliation(s)
| | | | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, 17033, USA
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19
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Ramirez-GarciaLuna JL, Wang SC, Yangzom T, Piguet V, Kirby JS, Alavi A. Use of thermal imaging and a dedicated wound imaging smartphone app as an adjunct to staging hidradenitis suppurativa. Br J Dermatol 2021; 186:723-726. [PMID: 34748648 DOI: 10.1111/bjd.20884] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/28/2022]
Abstract
Hidradenitis suppurativa (HS) presents with painful nodules, draining tunnels, abscesses, ulcers, and fistula formation1 . Grading systems, (e.g. Hurley Staging System, International Hidradenitis Suppurativa Severity Score System (IHS4), Severity Assessment of Hidradenitis Suppurativa Score (HS-PGA score), and Hidradenitis Suppurativa Area and Severity Index (HASI)) assess disease severity in terms of lesion count, extension and morphology.
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Affiliation(s)
- J L Ramirez-GarciaLuna
- Division of Experimental Surgery, McGill, University Health Centre, Montreal, Quebec, Canada.,Swift Medical, Toronto, Ontario, Canada
| | - S C Wang
- Division of Dermatology, McGill, University Health Centre, Montreal, Quebec, Canada.,Swift Medical, Toronto, Ontario, Canada
| | - T Yangzom
- Swift Medical, Toronto, Ontario, Canada
| | - V Piguet
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - J S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A Alavi
- Division of Dermatology, Women's College Hospital, Toronto, Ontario, Canada.,Department of Dermatology, Mayo Clinic, Rochester, MN, USA
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20
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Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco
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21
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Frew JW, Jiang CS, Singh N, Navrazhina K, Vaughan R, Krueger JG. Quantifying the natural variation in lesion counts over time in untreated hidradenitis suppurativa: Implications for outcome measures and trial design. JAAD Int 2021; 1:208-221. [PMID: 34409342 PMCID: PMC8361889 DOI: 10.1016/j.jdin.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/05/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) demonstrates high placebo response rates in clinical trials, possibly due to the natural variability of the disease. No quantification of variability in lesion counts of untreated disease has been undertaken. Objective To quantify the variability of untreated HS. Methods Deidentified individual patient data from the placebo arms of PIONEER studies were analyzed, and measurements of within-subject coefficients of variation were examined. Variability was stratified by disease-associated variables (Hurley stage, BMI, sex, smoking, family history) and body site. Results Analysis of within-subject coefficients of variation demonstrated that half of the participants had a middle spread [difference between 75th and 25th percentiles of the subject's abscess and nodule counts] greater than 33% and 40% of their median abscess and nodule counts, and 25% of the subjects had a middle spread greater than 70% and 78% of their median abscess and nodule counts in PIONEER I and II, respectively. Hurley stage 2 participants had significantly greater within-subject variation than Hurley stage 3 patients. Variation was greater in the axillary and groin regions than in other anatomical locations. Limitations Limitations include the use of precollected clinical trial data. Conclusion The within-subject variability of the lesion counts in untreated HS was greater than previously appreciated. This has profound effects on outcome measures and the conduct of future clinical trials of HS.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
| | - Caroline S Jiang
- Department of Biostatistics, Rockefeller University, New York, New York
| | - Neha Singh
- Department of Biostatistics, Rockefeller University, New York, New York
| | - Kristina Navrazhina
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, Weill Cornell, New York, New York
| | - Roger Vaughan
- Department of Biostatistics, Rockefeller University, New York, New York
| | - James G Krueger
- Laboratory of Investigative Dermatology, Rockefeller University, New York, New York
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22
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Lyons AB, Narla S, Kohli I, Zubair R, Nahhas AF, Braunberger TL, Joseph MK, Nicholson CL, Jacobsen G, Hamzavi IH. Assessment of Inter-rater Reliability of Clinical Hidradenitis Suppurativa Outcome Measures Using Ultrasonography. Clin Exp Dermatol 2021; 47:319-324. [PMID: 34388853 DOI: 10.1111/ced.14889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) staging and severity is typically based upon physical examination findings which can result in misclassification of severity based on subclinical disease activity and significant variation between healthcare providers. Ultrasound (US) is an objective tool to help evaluate subclinical disease and more accurately classify severity of disease. The objective of this study was to evaluate inter-rater reliability in HS disease severity assessment using clinical and US techniques. METHODS Twenty subjects underwent clinical evaluation of HS using clinical outcome measures including Hurley, Sartorius, HS Physician Global Assessment (HS-PGA), and Hidradenitis Suppurativa Clinical Response (HiSCR) independently by two physicians. US was subsequently performed, and clinical assessments were repeated. Intra-class correlation coefficients (ICC) were obtained to evaluate inter-rater agreement of each outcome measure before and after US. RESULTS Pre- to post-US improvement in ICC was seen with the Sartorius, HiSCR nodule and abscess count, and HiSCR draining fistula count. The scores went from having "good" rater agreement for Sartorius and HiSCR nodule and abscess count and "poor" rater agreement for HiSCR draining fistula count to "excellent" rater agreement amongst these scores. CONCLUSIONS US improved inter-rater agreement and should be used in conjunction with physical examination findings to evaluate disease severity to ensure uniform staging.
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Affiliation(s)
- A B Lyons
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - S Narla
- Department of Dermatology, St. Lukes Hospital, Easton, PA, USA
| | - I Kohli
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics & Astronomy, Wayne State University, Detroit, MI, USA
| | - R Zubair
- Department of Dermatology, Broward Hospital, Ft. Lauderdale, FL, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Health-Farmington Hills, Farmington Hills, MI, USA
| | - T L Braunberger
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - M K Joseph
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - C L Nicholson
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - G Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - I H Hamzavi
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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23
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Kashetsky N, Mufti A, Alabdulrazzaq S, Lytvyn Y, Sachdeva M, Rahat A, Yeung J. Treatment Outcomes of IL-17 Inhibitors in Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg 2021; 26:79-86. [PMID: 34365863 DOI: 10.1177/12034754211035667] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The IL-17 pathway is a potential therapeutic target shown to be implicated in hidradenitis suppurativa (HS), however, it remains unclear whether evidence from mechanistic studies may translate into clinical practice. This systematic review summarizes available treatment outcomes of IL-17 inhibitors in patients with HS. Embase, MEDLINE, PubMed, and clinicaltrials.gov were comprehensively searched on February 26, 2021 to include 16 original studies representing 128 patients with HS (mean age: 36.5 years; age range: 21-47 years; male: 50.0%). Treatment outcomes were reported for the following biologics: secukinumab (n = 105), brodalumab (n = 22), and ixekizumab (n = 1). Patients were classified as responders or non-responders according to achievement of a positive response/improvement based on criteria established for each included study. For secukinumab 57.1% (n = 60/105) of patients were responders in a mean response period of 16.2 weeks and 42.9% (n = 45/105) were non-responders; for brodalumab, 100.0% (n = 22/22) of patients were responders within 4.4 weeks; and the one patient treated with ixekizumab was a responder within 10 weeks. In conclusion, IL-17 inhibitors may serve as an effective therapeutic target in approximately two-thirds of patients with HS and can be considered in those who are refractory to other treatment modalities. We also stress the importance of consistent outcome measures to enhance evidence synthesis, decrease reporting bias, provide potential for future meta-analysis, and ultimately improve clinical outcomes for patients with HS.
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Affiliation(s)
- Nadia Kashetsky
- 7512 Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Asfandyar Mufti
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Yuliya Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | | | - Jensen Yeung
- 7938 Division of Dermatology, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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24
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Weigelt MA, Hilerowicz Y, Leichter JA, Lev-Tov H. Sonographic Evaluation of Hidradenitis Suppurativa with Smartphone-Linked Portable Ultrasound. Dermatology 2021; 237:378-382. [PMID: 33684921 DOI: 10.1159/000513920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical staging systems for hidradenitis suppurativa (HS) have poor interrater reliability and may underestimate disease activity. Sonographic staging systems may overcome these challenges, but conventional ultrasound (US) machines are expensive and bulky. Portable (p)US may facilitate the integration of sonography into routine practice. OBJECTIVES To assess the ability of a novel smartphone-linked pUS device to identify key sonographic lesions of HS. METHODS The charts of 16 patients with HS who were assessed with pUS at the outpatient Dermatology and Wound Care Clinics of a university hospital center were retrospectively reviewed. Clinical and sonographic images of the affected areas were examined. The main outcome measures were the number of patients with identifiable sonographic lesions and the number of patients with subclinical lesions detected by pUS. RESULTS All 3 key sonographic lesions of HS were identifiable with pUS. Sonographic lesions were identified in 10 patients (62.5%). Subclinical lesions were identified in 2 patients (12.5%); in both cases, this affected management decisions. CONCLUSIONS We demonstrate the ability of pUS to identify the key sonographic lesions of HS. pUS is a simple and affordable way to integrate HSUS into clinical and research settings, with clear potential benefits to patients.
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Affiliation(s)
- Maximillian A Weigelt
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA,
| | - Yuval Hilerowicz
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Jeffrey A Leichter
- UHealth Interventional Radiology, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
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25
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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] [What about the content of this article? (0)] [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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26
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Emtestam L, Lapins J, Sartorius K. A growing family of outcome measurement proposals for hidradenitis suppurativa. Br J Dermatol 2021; 184:796-798. [PMID: 33398878 PMCID: PMC8247045 DOI: 10.1111/bjd.19712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
Linked Article: Goldfarb et al. Br J Dermatol 2021; 184:905–912.
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Affiliation(s)
- L Emtestam
- Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - J Lapins
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - K Sartorius
- Department of Dermatology, South General Hospital, Stockholm, Sweden
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27
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Kjærsgaard Andersen R, Saunte D, Jemec G. What counts? The relationship between patient estimated numbers of painful hidradenitis suppurativa lesions over 4 weeks compared with clinician's lesion count at the time of examination. J Eur Acad Dermatol Venereol 2020; 34:e827-e830. [DOI: 10.1111/jdv.16704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Kjærsgaard Andersen
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - D.M.L. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - G.B.E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
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28
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Shaver RL, Jemec GBE, Freese R, Alavi A, Lowes MA, Goldfarb N. A survey of clinicians regarding preferred severity assessment tools for hidradenitis suppurativa. Int J Dermatol 2020; 60:e248-e251. [PMID: 33179770 DOI: 10.1111/ijd.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Rob L Shaver
- School of Medicine, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Dermatology, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Noah Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
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29
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Goldfarb N, Lowes MA, Butt M, King T, Alavi A, Kirby JS. Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R): psychometric property assessment. Br J Dermatol 2020; 184:905-912. [PMID: 32969027 DOI: 10.1111/bjd.19565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/09/2020] [Accepted: 09/21/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Validated, reliable, globally accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts, which are time-consuming and unreliable. OBJECTIVES To assess the reliability and validity of the Hidradenitis suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation and body surface area involved. METHODS The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis instruments. Twenty raters evaluated 15 patients with HS in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter- and intra-rater reliability of the HASI-R and its components, as well as its construct and known-groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools. RESULTS The HASI-R had moderate inter-rater reliability [intra-class correlation coefficients (ICC) 0·60]. This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0·5). HASI-R had the highest intra-rater reliability (ICC 0·91). The HASI-R had good construct validity and demonstrated known-groups validity. The HASI-R was also the most preferred tool by all raters. CONCLUSIONS Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.
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Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.,Departments of Medicine and Dermatology, Minneapolis Veteran Affairs Health Care System, Minneapolis, MN, USA
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - T King
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, Canada
| | - J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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30
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Wortsman X. Strong validation of ultrasound as an imaging biomarker in hidradenitis suppurativa. Br J Dermatol 2020; 184:591-592. [PMID: 32869312 DOI: 10.1111/bjd.19433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 01/01/2023]
Affiliation(s)
- X Wortsman
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile.,Department of Dermatology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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31
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Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, and debilitating skin disease of the hair follicle unit that typically develops after puberty. HS has a significant negative impact on both the quality of life (QOL) of patients affected by this disease as well as family members and caregivers. However, the pathogenesis of HS is multifactorial and still remains to be fully elucidated, which makes the development of treatments difficult. The last 10 years have seen a surge in HS research, and many new findings have come to light, yet much more remains to be elucidated. Physicians must employ a multidisciplinary approach to maximally address all facets of HS. Clinical characteristics of the disease that differ between females and males as well as across different races and ethnic groups must be considered. Targeted topical, oral, and injectable therapies continue to be developed for HS as a greater understanding of the pathogenesis is reached. However, randomized controlled trials regarding dietary factors that may contribute to HS are needed to meet our patients’ growing concerns and questions about the role of diet in HS pathogenesis. Finally, improved outcome measures are needed to standardize HS severity and grading between physicians and clinical trials, and a more diverse representation of HS populations is needed in clinical trials.
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Affiliation(s)
- Shanthi Narla
- 1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Alexis B Lyons
- 1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Iltefat H Hamzavi
- 1. Multicultural Dermatology Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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32
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Zouboulis CC, Gulliver W, Ingram J, Kirby B, Giamarellos-Bourboulis EJ, Podda M, Tzellos T, Jemec GBE. Endpoints of clinical trials for Hidradenitis Suppurativa: Proceedings of a round-table session. Exp Dermatol 2020; 29 Suppl 1:67-72. [PMID: 32691939 DOI: 10.1111/exd.14123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - Wayne Gulliver
- Memorial University of Newfoundland, St. John's, NL, Canada.,NewLab Clinical Research Inc, St. John's, NL, Canada
| | - John Ingram
- Division of Infection and Immunity, Department of Dermatology and Academic Wound Healing, Cardiff University, Cardiff, UK
| | - Brian Kirby
- St Vincent's University Hospital and Charles Institute, University College Dublin, Dublin, Ireland
| | | | | | | | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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33
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Dubois A, Meggitt S, Hampton PJ. Description of a disease activity proforma for documentation of hidradenitis suppurativa severity and distribution, and suggestions for use as a patient‐reported outcome measure. Clin Exp Dermatol 2020; 45:598-599. [DOI: 10.1111/ced.14167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2019] [Indexed: 12/01/2022]
Affiliation(s)
- A. Dubois
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
| | - S. Meggitt
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
| | - P. J. Hampton
- Department of Dermatology Royal Victoria Infirmary Newcastle upon Tyne UK
- Institute of Cellular Medicine Newcastle University Newcastle upon Tyne UK
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34
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Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa. J Am Acad Dermatol 2020; 82:1045-58. [DOI: 10.1016/j.jaad.2019.08.090] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/14/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
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35
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Goldfarb N, Ingram JR, Jemec GBE, Naik HB, Piguet V, Hyde MJ, Freese R, Lowes MA, Alavi A. Hidradenitis Suppurativa Area and Severity Index (HASI): a pilot study to develop a novel instrument to measure the physical signs of hidradenitis suppurativa. Br J Dermatol 2019; 182:240-242. [PMID: 31286486 DOI: 10.1111/bjd.18335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, U.S.A.,Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, U.S.A
| | - J R Ingram
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Dermatology, University of Copenhagen, Copenhagen, Denmark
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - V Piguet
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M J Hyde
- The Rockefeller University, New York, NY, U.S.A
| | - R Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, U.S.A
| | - M A Lowes
- The Rockefeller University, New York, NY, U.S.A
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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36
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Włodarek K, Stefaniak A, Matusiak Ł, Szepietowski J. Could Residents Adequately Assess the Severity of Hidradenitis Suppurativa? Interrater and Intrarater Reliability Assessment of Major Scoring Systems. Dermatology 2019; 236:8-14. [DOI: 10.1159/000501771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022] Open
Abstract
A wide variety of assessment tools have been proposed for hidradenitis suppurativa (HS) until now, but none of them meets the criteria for an ideal score. Because there is no gold standard scoring system, the choice of the measure instrument depends on the purpose of use and even on the physician’s experience in the subject of HS. The aim of this study was to assess the intrarater and interrater reliability of 6 scoring systems commonly used for grading severity of HS: the Hurley Staging System, the Refined Hurley Staging, the Hidradenitis Suppurativa Severity Score System (IHS4), the Hidradenitis Suppurativa Severity Index (HSSI), the Sartorius Hidradenitis Suppurativa Score and the Hidradenitis Suppurativa Physician’s Global Assessment Scale (HS-PGA). On the scoring day, 9 HS patients underwent a physical examination and disease severity assessment by a group of 16 dermatology residents using all evaluated instruments. Then, intrarater reliability was calculated using intraclass correlation coefficient (ICC), and interrater variability was evaluated using the coefficient of variation (CV). In all 6 scorings the ICCs were >0.75, indicating high intrarater reliability of all presented scales. The study has also demonstrated moderate agreement between raters in most of the evaluated measure instruments. The most reproducible methods, according to CVs, seem to be the Hurley staging, IHS4, and HSSI. None of the 6 evaluated scoring systems showed a significant advantage over the other when comparing ICCs, and all the instruments seem to be very reliable methods. The interrater reliability was usually good, but the most repeatable results between researchers were obtained for the easiest scales, including Hurley scoring, IHS4 and HSSI.
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37
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Oosterhaven J. How reliable are scoring systems for hidradenitis suppurativa? Br J Dermatol 2019; 181:438-439. [DOI: 10.1111/bjd.18249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J.A.F Oosterhaven
- Department of Dermatology University Medical Center Groningen University of Groningen the Netherlands
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38
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Kirby JS, Butt M, King T. Severity and Area Score for Hidradenitis (SASH): a novel outcome measurement for hidradenitis suppurativa. Br J Dermatol 2019; 182:940-948. [PMID: 31233623 DOI: 10.1111/bjd.18244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease with a large impact on patients' health-related quality of life. However, reliable and consistent outcome measures to assess body surface area (BSA) of HS have not been established. OBJECTIVES To develop and assess the reliability and validity of a novel outcome instrument for assessment of HS BSA in a clinical trial setting. METHODS Qualitative interviews and focus groups were conducted from July to August 2015 and October 2017 to January 2018. Evaluation of the measurement was assessed during a single-day grading session with patients in April 2018. Participants, who included clinicians or patients, were recruited from academic medical centres in the U.S. mid-Atlantic region. RESULTS Concept elicitation included input from 10 providers, of which 60% (n = 6) were female, 80% (n = 8) dermatology specialists and 20% (n = 2) gynaecology specialists. Cognitive debriefing was conducted with 11 providers, of which 82% (n = 9) were dermatologists and 18% (n = 2) gynaecologists. The evaluation stage included 10 clinicians and 23 patients. The intraclass correlation coefficient (ICC) for inter-rater reliability was 0·60 [95% confidence interval (CI) 0·44-0·74]. The ICC for intrarater reliability was 0·98 (95% CI 0·94-1·00). Transformation of the BSA score resulted in an increase in inter-rater reliability to 0·75 (95% CI 0·62-0·85) or 0·76 (95% CI 0·62-0·85). Scores all demonstrated concurrent validity, with statistically significant correlations with extant scoring methods. CONCLUSIONS This novel scale is a reliable and valid HS outcome instrument and may capture a wide range of patients by assessing BSA. Future research is necessary to demonstrate its responsiveness. What's already known about this topic? The major HS disease activity scales rely on lesions counts and have moderate-to-good reliability. Body surface area (BSA) is one of the physical signs included in the Core Outcome Set for HS, but is not a part of existing HS disease activity scales. What does this study add? A novel disease severity scale, the Severity and Area Score for Hidradenitis (SASH), was developed and the psychometric properties assessed. There was high inter-rater reliability of 0·75 and 0·76 when BSA was scored on an ordinal scale, and an excellent intrarater reliability of 0·98. The SASH score also demonstrated convergent validity with extant instruments. What are the clinical implications of this work? The ability of clinicians to accurately assess disease status will be improved. Implementation of the SASH score will help guide and assess the effectiveness of appropriate treatment choice.
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Affiliation(s)
- J S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - M Butt
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, U.S.A
| | - T King
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, U.S.A
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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40
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Affiliation(s)
- L Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Health Sciences Faculty, University of Copenhagen, Sygehusvej 10, 4000, Roskilde, Denmark.,Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark
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41
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Zouboulis CC, Matusiak Ł, Jemec GBE, Szepietowski JC, Álvarez-Chinchilla PJ, Asoskova A, Bonnekoh H, Brattoli G, Cetinarslan TS, Dawicka J, Dente V, Gallyamova Y, Giovanardi G, Glasenhardt K, Ionescu AM, Janushaj E, Lakhssassi MK, Lőrincz KK, Ludew D, Makmatov-Rys M, Malickova M, Mengesha SW, Mintoff D, Otlewska A, Papakou M, Pirvan AM, Provvidenziale L, Quadrana F, Savickaja N, Tamulyté G, Trifu A, Vīgante A, Włodarek K, Zouboulis VA. Inter-rater and intrarater agreement and reliability in clinical staging of hidradenitis suppurativa/acne inversa. Br J Dermatol 2019; 181:852-854. [PMID: 30968946 DOI: 10.1111/bjd.17982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Ł Matusiak
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - G B E Jemec
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Zealand University Hospital, Roskilde; Health Sciences Faculty, University of Copenhagen, Denmark
| | - J C Szepietowski
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | | | | | | | | | | | | | - K Glasenhardt
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | | | | | | | | | | | | | | | - S W Mengesha
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - D Mintoff
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - A Otlewska
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | | | - N Savickaja
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | | | | | | | - K Włodarek
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.,Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
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43
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Senthilnathan A, Kolli SS, Cardwell LA, Richardson I, Feldman SR, Pichardo RO. Validation of a Hidradenitis Suppurativa Self-Assessment Tool. J Cutan Med Surg 2019; 23:388-390. [DOI: 10.1177/1203475419839965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background: Hidradenitis suppurativa (HS) is a debilitating dermatologic condition presenting with recurrent abscesses. While there are multiple scales to determine HS severity, none are designed for self-administration. A validated severity self-assessment tool may facilitate survey research and improve communication by allowing patients to objectively report their HS severity between clinic visits. Objectives: The purpose of this study was to assess a self-administered HS measure. Methods: An HS self-assessment tool (HSSA) with 10 photographs of different Hurley stages was developed. The tool was administered to patients diagnosed with HS who visited the Wake Forest Baptist Health dermatology clinic over a span of 2 months. Physician-administered Hurley stage was recorded to determine criterion validity. To assess test-retest reliability of the measure, patients completed the HSSA again at least 30 minutes after the first completion. Results: Twenty-four patients completed the measure, and 20 of these patients completed it twice. Agreement between physician-determined Hurley stage and self-determined Hurley stage was 66.7% with a weighted kappa of 0.57 (95% confidence interval [CI]: 0.30-0.84). The weighted kappa for agreement between patients’ initial and second completion of the HSSA was 0.81 (95% CI: 0.64-0.99). Conclusions: The self-administered measure provides moderate agreement with physician-determined Hurley stage and good test-retest reliability.
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Affiliation(s)
- Aditi Senthilnathan
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sree S. Kolli
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah A. Cardwell
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Irma Richardson
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Steven R. Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Rita O. Pichardo
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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