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Russell N, Kpughur-Tule N, Ravichandar E, Dorta Torres G, Tiesenga F. Challenges in the Management of Perianal Hidradenitis Suppurativa in an African American Male: A Case Report. Cureus 2023; 15:e45788. [PMID: 37872932 PMCID: PMC10590627 DOI: 10.7759/cureus.45788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Hidradenitis suppurativa (HS), more commonly known as acne inversa, occurs due to chronic inflammation of the body's apocrine glands, most commonly affecting areas of the body where there is prolonged skin-on-skin friction. HS affects approximately 4% of the United States population, most commonly women in their second or third decade of life, especially those of African American ethnicity. HS presents as tender subcutaneous nodules which often rupture, leading to the formation of painful dermal abscesses which undergo fibrosis and lead to the formation of extensive sinus tracts, a phenomenon known as "tunneling". HS is staged clinically using the Hurley staging system, where the stage determines what treatment modalities are used. These modalities can include medical management such as antibiotics, or biologics such as tumor necrosis factor (TNF)-alpha inhibitors like adalimumab, as well as surgical options including incision with or without drainage. Due to the similar presentation of HS with other conditions, this disease is commonly misdiagnosed, often leading to delayed treatment initiation and worse outcomes for patients. Presented is a case report of a 30-year-old African American male with perianal HS and the potential long-term complications and challenges of management of this disease.
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Affiliation(s)
- Natalie Russell
- Clinical Sciences, Saint James School of Medicine, Chicago, USA
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Steyn M, Ayis S, O'Connor J, Lakhan MK, Ferguson F, Shah A, Rashidghamat E. Dapsone therapy for hidradenitis suppurativa: a retrospective review of characteristics and treatment outcomes in a cohort of 122 patients in a tertiary dermatology setting. Br J Dermatol 2022; 188:573-574. [PMID: 36736348 DOI: 10.1093/bjd/ljac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Mia Steyn
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - Salma Ayis
- School of Population Health & Environmental Sciences, King's College London, London, UK
| | - Jane O'Connor
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | | | - Felicity Ferguson
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
| | - Aadarsh Shah
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK.,Bart's Hospital NHS Trust, London, UK
| | - Ellie Rashidghamat
- St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, UK
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Ghanian S, Yamanaka-Takaichi M, Naik HB, Alavi A. Medical Management of Hidradenitis Suppurativa with Non-Biologic Therapy: What's New? Am J Clin Dermatol 2022; 23:167-176. [PMID: 34990004 DOI: 10.1007/s40257-021-00667-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/25/2022]
Abstract
Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body. The disease can often result in disfigurement and adversely impact patient quality of life. The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities. Management can often be clinically challenging and may involve the combination of medical and surgical approaches for optimal results. The purpose of this review is to present an update on non-biologic and non-interventional modalities published in 2019-2021 in the clinical management of HS. With emerging therapies, ongoing clinical trials, and heightened awareness about HS, there is hope that new treatment options will revolutionize the management of patients suffering from HS.
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Affiliation(s)
- Soha Ghanian
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Rabindranathnambi A, Jeevankumar B. Dapsone in Hidradenitis Suppurativa: A Systematic Review. Dermatol Ther (Heidelb) 2022; 12:285-293. [PMID: 34997914 PMCID: PMC8850499 DOI: 10.1007/s13555-021-00674-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disease, usually presenting after puberty with inflammatory lesions that mainly affect the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal and anogenital regions. The treatment of HS is associated with certain challenges due to intrinsic resistance to various treatments and the presence of comorbidities and complications. The antibiotic dapsone is an established treatment for HS, but the current evidence base is limited. The aim of this review is to systematically review the literature on the efficacy of dapsone in the treatment of HS. METHODS The Cochrane, PubMed and CINAHL databases were searched for relevant articles to be included in the systematic review. RESULTS A total of seven studies, with a cumulative patient population of 135 patients, were included. Of these 135 patients, 62.2% demonstrated various degrees of improvement following treatment. However, as only three of the seven studies used dapsone monotherapy it is difficult to assess the effectiveness of dapsone because the benefits observed may be due to concurrently administered treatment. CONCLUSION Overall, the quality of evidence supporting the use of dapsone is weak. However, it is a well established treatment recommended in current, various national guidelines. There is a crucial need for well-designed randomized controlled trials to support its usage.
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López-Llunell C, Riera-Martí N, Gamissans M, Romaní J. Dapsone in hidradenitis suppurativa: A case series of 56 patients. Dermatol Ther 2021; 34:e15161. [PMID: 34665504 DOI: 10.1111/dth.15161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/06/2021] [Accepted: 10/17/2021] [Indexed: 01/25/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a challenging treatment. Current guidelines reserve dapsone as a third line agent for patients with mild to moderate HS. To our knowledge, only four small case series have been reported. The objective of this study was to assess the effectiveness and safety of dapsone in our clinical practice. A retrospective observational single-center study of 56 HS patients who underwent treatment with dapsone from May 1, 2015, to June 1, 2021, was performed. The Hidradenitis Suppurativa Clinical Response (HiSCR) scale was used to evaluate the response to treatment. Fifty-six patients were included, 66% of which were men, with a median age of 33 years. Most of them had mild or moderate disease and belonged to LC2 follicular phenotype. All patients had been refractory to first-line treatments. Dapsone was prescribed at doses of 50-150 mg/day. 62.5% of the patients achieved HiSCR after 12 weeks of treatment. No serious adverse reactions were detected. The median duration of treatment was 8 months. After multivariate analysis, an association was found between the presence of fistulous tracts and the risk of non-response to the drug. In four of the dapsone responders, oral retinoids were added to achieve a sustained response. Limitations include the retrospective and non-controlled nature of this study. In conclusion, dapsone is an effective and well-tolerated option for long-term HS treatment, and in this series, it was mainly chosen for patients with LC2 phenotype. It would be interesting to study combination with retinoids and other management options.
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Affiliation(s)
- Cristina López-Llunell
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Spain
| | - Núria Riera-Martí
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Spain
| | - Marta Gamissans
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Spain
| | - Jorge Romaní
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Spain
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Johnston DGW, Kirby B, Tobin DJ. Hidradenitis suppurativa: A folliculotropic disease of innate immune barrier dysfunction? Exp Dermatol 2021; 30:1554-1568. [PMID: 34418166 DOI: 10.1111/exd.14451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022]
Abstract
The innate immune system of human skin consists of a multi-layered barrier consisting of cells and soluble effector molecules charged with maintaining homeostasis and responding to insults and infections. It has become increasingly clear that these barrier layers become compromised in skin diseases, especially in disorders of an (auto)inflammatory nature. In the case of hidradenitis suppurativa, great strides have been made in recent years in characterizing the underlying breakdown in homeostatic innate immunity, including an increasing understanding of the central role of the hair follicle in this process. This breakdown appears to occur at multiple levels: the pilosebaceous unit, associated epithelium, the cutaneous microbiome, alteration of immune cell function and local molecular events such as complement activation. This review seeks to summarize, contextualize and analyse critically our current understanding of how these innate immune barriers become dysregulated in the early stage(s) of hidradenitis suppurativa, and to speculate on where potential hidradenitis suppurativa research could be most fruitful.
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Affiliation(s)
- Daniel G W Johnston
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Brian Kirby
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Dublin 4, Ireland.,The Conway Institute, University College Dublin, Dublin 4, Ireland
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Pinter A, Mrowietz U, Volz T. [Systemic treatment of moderate/severe hidradenitis suppurativa]. DER HAUTARZT 2021; 72:686-691. [PMID: 34189590 DOI: 10.1007/s00105-021-04844-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 11/24/2022]
Abstract
Systemic treatment together with radical surgical excision is the most important treatment option for all severity grades of hidradenitis suppurativa. Tetracycline in mild-to-moderate forms and clindamycin in combination with rifampicin in moderate-to-severe forms are guideline-compliant first-line therapy with a good clinical response. Other antibiotics such as ertepenem or multiple combinations are recommended as last-line therapy due to a lack of data. Success rate with dapsone and retinoids, on the other hand, are insufficient-only acitretin can be recommended on the basis of the available studies, but with limited success. With the TNF-alpha blocker adalimumab, an effective and safe long-term therapy is available-further biologics are in clinical trials and could significantly expand the treatment portfolio in the future.
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Affiliation(s)
- A Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - U Mrowietz
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - T Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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