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Vural S, Baskurt D, Yıldırıcı Ş, Rasulova G, Danacı S, Botsalı A. Evaluating dietary considerations in hidradenitis suppurativa: a critical examination of existing knowledge. Int J Dermatol 2024. [PMID: 38406977 DOI: 10.1111/ijd.17101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/15/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
Hidradenitis suppurativa (HS) is a chronic condition that can overwhelm patients, and the effectiveness of supplementary dietary treatments remains uncertain. The primary aim of this review is to explore the connection between diet and HS progression. However, it is imperative to note that the evidence supporting a substantial role of the diet in HS remains weak. Dietary alterations alone should not be considered independent solutions for managing HS. Medical therapy continues to be indispensable for adequate treatment. Research indicates that the Mediterranean lifestyle and diet may provide cost-effective and beneficial adjustments when combined with traditional therapies. Conversely, foods with a high glycemic index and dairy could worsen HS symptoms, conceivably through mechanisms linked to insulin resistance and inflammation. Zinc, known for its antioxidant properties, shows promise as an adjunct therapy. Moreover, evidence suggests a connection between vitamin D deficiency and HS severity, although the findings are inconclusive. Brewer's yeast-free diet, B12 supplementation, intermittent fasting, and reducing the intake of refined sugar and dairy merit further investigation. In conclusion, this review highlights the need for additional research because of the lack of standardized reporting of clinical effects in the studies under scrutiny. A deeper exploration of the pathophysiology focusing on dietary modifications and their potential associations with HS severity is essential. Furthermore, it is crucial to recognize that patients' willingness to experiment with new diets makes them vulnerable to fraudulent interventions, highlighting the importance of evidence-based dietary guidance.
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Affiliation(s)
- Seçil Vural
- Department of Dermatology and Venereology, Koç University School of Medicine, Istanbul, Turkey
| | - Defne Baskurt
- School of Medicine, Koç University, Istanbul, Turkey
| | | | - Gunel Rasulova
- Department of Dermatology and Venereology, Koç University School of Medicine, Istanbul, Turkey
| | - Senem Danacı
- Department of Medical Pharmacology, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Aysenur Botsalı
- Department of Dermatology and Venereology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
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Yamanaka-Takaichi M, Revankar R, Shih T, Gall M, Hsiao JL, Shi VY, Alavi A. Expert consensus on priority research gaps in dietary and lifestyle factors in hidradenitis suppurativa: a Delphi consensus study. Arch Dermatol Res 2023; 315:2129-2136. [PMID: 36951970 DOI: 10.1007/s00403-023-02610-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/27/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023]
Abstract
Hidradenitis suppurativa (HS) is a debilitating systemic inflammatory disease with limited treatment options. Although management through dietary and lifestyle changes is a primary interest of the HS patient community, there is lack of consensus regarding recommendations due to the paucity of evidence. To establish the priority research gaps on this topic, we performed and moderated a Delphi consensus study by integrating expert opinions and the relevant literature. Based on a literature review, research questions on dietary and lifestyle interventions in HS were constructed. HS dietary and lifestyle research questions were sent to an expert panel, consisting of 22 international members, including dermatologists, dietitians, pharmacists, and endocrinologists. Voting on the research questions was conducted using a modified Delphi technique. The primary outcome measure was whether participants could reach consensus on the priority of each research question in the HS dietary and lifestyle factors. After three rounds of surveys investigating the relationships between HS and various diet and lifestyle factors, "BMI", "Obesity", and "Smoking", reached consensus as high priority research questions. Low research priorities per consensus included "effects of iron supplements", "effects of magnesium supplements", "alcohol consumption" and "limiting Brewer's yeast intake. Smoking and obesity were identified as important research questions, concurrent to the literature indicating their association with more significant impact on disease activity. By shedding light on high priority research questions, our study provides a roadmap for further research on dietary and lifestyle modifications in HS and will help determine evidence-based lifestyle and dietary recommendations for patients with HS.
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Affiliation(s)
| | - Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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Mintoff D, Agius R, Benhadou F, Das A, Frew JW, Pace NP. Obesity and hidradenitis suppurativa: targeting meta-inflammation for therapeutic gain. Clin Exp Dermatol 2023; 48:984-990. [PMID: 37171791 DOI: 10.1093/ced/llad182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the pilosebaceous unit. The typical patient with HS is characterized as someone with obesity, who smokes and who has nodules, abscesses and/or draining tunnels predominantly distributed in intertriginous skin. It has been established that lifestyle and genetic factors are the main pathophysiological drivers of HS. In this critical review, we explore the interrelatedness of meta-inflammation, obesity and HS and discuss if and how this relationship may be manipulated for a therapeutic end.
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Affiliation(s)
- Dillon Mintoff
- Department of Dermatology
- Department of Pathology, Faculty of Medicine and Surgery
| | - Rachel Agius
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Anupam Das
- Department of Dermatology, Venereology and Leprosy; KPC Medical College & Hospital, Kolkata, India
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Nikolai P Pace
- Faculty of Medicine and Surgery
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
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Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan AM. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol 2022; 61:1372-1379. [PMID: 35485975 PMCID: PMC10835602 DOI: 10.1111/ijd.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders. OBJECTIVE Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions. METHODS From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups. RESULTS A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others. LIMITATIONS Our study was limited by its retrospective design. CONCLUSIONS Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.
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Affiliation(s)
- Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL
| | - David O. Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Sophia A. Ederaine
- Student, Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, AZ
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Ali M. Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, CA
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Rout AN, Das A. Does weight loss lead to improvement of dermatological conditions: What is the evidence? Clin Exp Dermatol 2022; 47:1446-1453. [PMID: 35384013 DOI: 10.1111/ced.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
Obese and overweight individuals may have a wide gamut of cutaneous features and can have more severe manifestations of multiple dermatological conditions. There have been multiple expert opinions on the favorable effects of weight reduction in improving skin conditions. Over the past decade, there have been few studies evaluating the response of exercise and other modes of weight loss on various dermatoses such as psoriasis, acne, hidradenitis suppurativa, acanthosis nigricans. In this review, we have attempted to provide a summary of the benefits of reduction of body weight on various skin aliments.
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Affiliation(s)
- Arpita Nibedita Rout
- Department of Dermatology, Venereology, and Leprosy; All India Institute of Medical Sciences, Bhopal, India
| | - Anupam Das
- Department of Dermatology, Venereology, and Leprosy; KPC Medical College & Hospital, Kolkata, India
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the pathogenesis of hidradenitis suppurativa. 2. Discuss perioperative multimodal therapy of hidradenitis suppurativa, including medical optimization. 3. Determine an appropriate surgical plan with excision and reconstruction based on hidradenitis suppurativa severity, size, and anatomical location. SUMMARY Successful treatment of hidradenitis suppurativa requires a multidisciplinary team approach and multimodal therapy.
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Clinical Epidemiology and Management of Hidradenitis Suppurativa. Obstet Gynecol 2021; 137:731-746. [PMID: 33706337 PMCID: PMC7984767 DOI: 10.1097/aog.0000000000004321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/03/2020] [Indexed: 12/19/2022]
Abstract
Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1-1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18-40 years, obstetrician-gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.
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Kaleta KP, Nikolakis G, Hossini AM, Balthasar O, Almansouri D, Vaiopoulos A, Knolle J, Boguslawska A, Wojas-Pelc A, Zouboulis CC. Metabolic Disorders/Obesity Is a Primary Risk Factor in Hidradenitis Suppurativa: An Immunohistochemical Real-World Approach. Dermatology 2021; 238:251-259. [PMID: 34293747 DOI: 10.1159/000517017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is an inflammatory, potentially scarring disease of the hair follicle, affecting the apocrine gland-bearing skin areas. The major comorbid disorders associated with the occurrence or the aggravation of the disease are obesity and smoking. Numerous efforts to dissociate these factors led to controversial results. OBJECTIVES To assess the importance of metabolic disorders/obesity, smoking/environmental toxins, and inflammation in HS by utilizing the differential expression of major relevant protein markers in lesional skin of obese/smoking versus non-obese/non-smoking HS patients. METHODS Lesional skin specimens deriving from two groups of HS patients (BMI >30 and smokers, n = 12 vs. BMI <30 and non-smokers, n = 10) were stained with antibodies raised against irisin, PPARγ, and IGF-1R, which correlate with metabolic disorders/obesity, EGFR and AhR, associated with smoking, and IL-17, IL-17R, and S100A8, as markers of inflammation. RESULTS Metabolic disorders/obesity-related markers exhibited marked differential expression between the two groups, while smoking-associated markers a limited one. IL-17R expression was stronger in obese/smokers, and S100A8 staining exhibited intense strong immunoreactivity in both groups without significant difference. CONCLUSIONS The notion that obesity plays a role in HS development appears to be supported by the prominent regulation of the associated lesional biomarkers. Tobacco smoking might contribute less to HS than previously suspected.
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Affiliation(s)
- Katarzyna P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Amir M Hossini
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Ottfried Balthasar
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Daifallah Almansouri
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Aristeidis Vaiopoulos
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
| | - Jürgen Knolle
- Institute of Pathology, Dessau Medical Center, Dessau, Germany
| | - Anna Boguslawska
- Department of Paediatric and Adolescence Endocrinology, Paediatric Institute, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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10
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Frew JW, Singh N, Jiang CS, Vaughan R, Krueger JG. The Impact of Body Mass Index Upon the Efficacy of Adalimumab in Hidradenitis Suppurativa. Front Med (Lausanne) 2021; 8:603281. [PMID: 34239882 PMCID: PMC8257943 DOI: 10.3389/fmed.2021.603281] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 05/13/2021] [Indexed: 11/16/2022] Open
Abstract
Elevated BMI in Hidradenitis Suppurativa is associated with decreased response to Adalimumab therapy. BMI is proposed to segregate distinct disease subtypes. It remains unresolved whether a threshold BMI exists above which increased dosages may provide clinical benefit. Individual patient data from 578 PIONEER Phase 3 participants were analyzed. Descriptive, multivariable regression analysis and receiver operating characteristic (ROC) curves were calculated to assess the relationship between BMI and clinical outcome measures using R v3.5.3. Participants in the overweight and obese BMI category had reduced odds (58 and 67%, respectively) of achieving HiSCR [OR = 0.42 (95%CI −0.19, 0.91) p = 0.03], [OR = 0.33 (95%CI 0.16, 0.67) p = 0.002] compared to participants with BMI < 25. Reduction in AN count and IHS4 score was not significantly associated. ROC analysis did not reveal any cut off value predictive of treatment outcome. No correlation between BMI and baseline disease activity or covariate interactions were identified. These findings suggest BMI is a significant covariate in the setting of lower baseline disease activity, supporting the concept of disease heterogeneity and differential therapeutic response to Adalimumab.
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Affiliation(s)
- John W Frew
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States
| | - N Singh
- Department of Biostatistics, The Rockefeller University, New York, NY, United States
| | - C S Jiang
- Department of Biostatistics, The Rockefeller University, New York, NY, United States
| | - R Vaughan
- Department of Biostatistics, The Rockefeller University, New York, NY, United States
| | - J G Krueger
- Laboratory of Investigative Dermatology, The Rockefeller University, New York, NY, United States
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11
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Wright S, Strunk A, Garg A. Trends in body mass index before and after diagnosis of hidradenitis suppurativa. Br J Dermatol 2021; 185:74-79. [DOI: 10.1111/bjd.19713] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- S. Wright
- Department of DermatologyDonald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY USA
| | - A. Strunk
- Department of DermatologyDonald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY USA
| | - A. Garg
- Department of DermatologyDonald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park NY USA
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12
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Colosimo C, Yon JR, Fredericks C, Kingsley S, Gupta S, Mentzer CJ, Bokhari F, Poulakidas S. Obesity is Not Associated With Need for Skin Grafting After Hidradenitis Excision. Am Surg 2020; 87:458-462. [PMID: 33047967 DOI: 10.1177/0003134820950686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating disease associated with inflammation, recurrent abscesses, and fistulae of skin containing apocrine sweat glands. We hypothesize that the need for skin grafting after vacuum-assisted closure was decreased with increasing body mass index (BMI). METHODS Seventy-one consecutive patients with excisions for HS were retrospectively evaluated for demographic data, number of excisions, the total area of excised skin, need for skin grafting, and BMI. Patients were stratified for BMI and underwent logistic regression to compare all other variables. RESULTS Average for BMI was 30.8 ± 7.72, age was 36.89 ±13.52, area excised was 743 cm2 ± 774 cm2, mean operating room trips were 2.62 ± 1.59, and skin grafting was 0.52 ± 0.55. Patients were 60% male. Forty out of 71 patients were obese. There was no correlation between age, BMI, sex, thenumber of excisions, amount of skin excised, or need for a skin graft. There was a statistically significant relationship between the amount of skin excised and the need for skin grafting (P = .006). CONCLUSIONS The amount of skin affected by HS appears to be independent of patient BMI. The need for skin grafting is solely dependent upon the amount of tissue excised. APPLICABILITY OF RESEARCH TO PRACTICE This knowledge will help preoperative planning for all patients with HS, regardless of BMI.
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Affiliation(s)
| | - James R Yon
- Department of Trauma and Acute Care Surgery, Swedish Medical Center, Englewood, CO, USA
| | - Charles Fredericks
- Division of Trauma, Acute Care, and General Surgery, UC Davis Medical Center, Sacramento, CA, USA
| | - Samuel Kingsley
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Sameer Gupta
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Caleb J Mentzer
- Division of Trauma, Critical Care & Acute Care Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
| | - Faran Bokhari
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
| | - Stathis Poulakidas
- Department of Trauma and Burn, John H. Stroger, Jr, Hospital of Cook County, Chicago, IL, USA
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Tzellos T, Zouboulis CC. Review of Comorbidities of Hidradenitis Suppurativa: Implications for Daily Clinical Practice. Dermatol Ther (Heidelb) 2020; 10:63-71. [PMID: 31955366 PMCID: PMC6994573 DOI: 10.1007/s13555-020-00354-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Indexed: 02/07/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent skin inflammatory disease associated with a variety of comorbidities, like reduced quality of life, metabolic syndrome, sexual dysfunction, working disability, axial spondyloarthritis, inflammatory bowel disease, depression, and anxiety. Like psoriasis, HS patients have been found to have higher risk of cardiovascular death and suicide risk. Clinicians should be informed about these comorbidities so that appropriate screening is implemented. All this evidence suggests that for such a chronic, multi-comorbid disease, the use of validated outcomes to assess severity and effect of treatment, along with the use of clinically important patient reported outcomes, is essential. The potential of available treatments to negatively and positively affect these comorbidities should also be taken into account when designing treatment strategies. This review provides an outline of important HS comorbidities with emphasis on possible implications for daily clinical practice.
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Affiliation(s)
- Thrasyvoulos Tzellos
- Department of Dermatology, Nordland Hospital Trust, Bodø, Norway.
- Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway.
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School, Theodor Fontane, Dessau, Germany
- European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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14
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Rosen J, Darwin E, Tuchayi SM, Garibyan L, Yosipovitch G. Skin changes and manifestations associated with the treatment of obesity. J Am Acad Dermatol 2019; 81:1059-1069. [DOI: 10.1016/j.jaad.2018.10.081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
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15
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Choi F, Lehmer L, Ekelem C, Mesinkovska NA. Dietary and metabolic factors in the pathogenesis of hidradenitis suppurativa: a systematic review. Int J Dermatol 2019; 59:143-153. [PMID: 31651051 DOI: 10.1111/ijd.14691] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/10/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa (HS) is a systemic recalcitrant inflammatory condition characterized by debilitating lesions with high morbidity. Its known association with obesity and smoking indicate correlation with other environmental factors, such as diet, suggesting a larger role for lifestyle modifications in disease treatment. This study seeks to assess the contribution of weight loss and dietary intake in HS management. A primary literature search was conducted using PubMed, Web of Science, and CINAHL in November 2018 to include association and intervention studies on the influence of diet and weight on HS. Twenty-five articles were included. Meta-analysis of nine case-control studies across Asia, Europe, and the United States showed that HS patients are four times more likely to be obese compared to the general population; random effects pooled odds ratio 4.022 (2.667-6.065), P < 0.001. Five articles assessed weight-loss interventions and revealed mixed findings. The remaining articles included three association studies on micronutrient levels, eight dietary intervention studies, and one article analyzing both micronutrient association and dietary intervention. Included articles in this systematic review reveal that low serum zinc and vitamin D levels are associated with increased lesion count in HS. Supplementation of zinc, vitamin D, vitamin B12, or exclusion of dairy or brewer's yeast can be effective in partial or complete lesion resolution. Reviewed data show that weight loss from bariatric surgery may lead to HS improvement but often results in more severe malnutrition that worsens or even leads to new onset HS post bariatric surgery. Future reporting is needed to conclusively determine the role of diet in HS.
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Affiliation(s)
- Franchesca Choi
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA.,Kaohsiung Medical University, School of Medicine, Kaohsiung, Taiwan
| | - Larisa Lehmer
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Chloe Ekelem
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
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16
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Kurzen H, Kurzen M. Secondary prevention of hidradenitis suppurativa. Dermatol Reports 2019; 11:8243. [PMID: 31728176 PMCID: PMC6826242 DOI: 10.4081/dr.2019.8243] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a multifactorial disease with many facets of uncertain importance for optimal treatment and prevention. In order to explore options for secondary prevention in HS, we randomly and retrospectively selected 40 patients with HS that were analyzed on the basis of supposed trigger factors and proposed prevention measures. 67% of our HS patients were current smokers. They had started smoking on average 8 years prior to abscess formation. 35% complained of digestive problems and had tried different sorts of diet. We identified 2 cases of gluten-sensitive enteropathy, in which HS improved after introduction of gluten-free diet. In 7 further patients, introduction of low dairy/low carbohydrate diet considerably improved HS. 77.5% had never used any skin care in the intertriginous areas. Implementing secondary prevention by reducing irritation, avoiding shaving, improving skin care, performing laser epilation or applying fusidic acid/betamethasone cream led to an improvement in 62.5% of patients. We suggest a structured approach in daily practice in order to identify individual trigger factors. The crucial point for secondary prevention is the improvement of patient education.
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Affiliation(s)
- Hjalmar Kurzen
- Freising Skin and Laser Center, Freising.,Department of Dermatology, Venereology and Allergy, University Medical Center Mannheim, Ruprecht- Karls University of Heidelberg, Mannheim, Germany
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17
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Sivanand A, Gulliver WP, Josan CK, Alhusayen R, Fleming PJ. Weight Loss and Dietary Interventions for Hidradenitis Suppurativa: A Systematic Review. J Cutan Med Surg 2019; 24:64-72. [PMID: 31502868 DOI: 10.1177/1203475419874412] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hidradenitis suppurativa (HS) is a common inflammatory disorder characterized by recurrent, painful, and malodorous abscesses and nodules predominantly in skin folds. HS is associated with substantial morbidity and poor quality of life. There are no curative therapies, and the only approved biologic drug has variable efficacy and requires high doses, making adjunct treatments crucial. An important risk factor for disease severity is obesity. Our primary objective was to conduct a systematic review examining weight loss and dietary interventions, in HS. Our secondary objective was to examine nutritional supplements in HS.A systematic literature search was conducted using Medline, EMBASE, and the Cochrane Database. We included all study types in adults (>18 years), with a minimum sample size of 5, examining the effects of any dietary or weight loss intervention on HS severity. Two authors screened n = 1279 articles of which 9 met inclusion criteria. All included studies were observational and all interventions were associated with various measures of decreased HS severity. Patient-controlled weight loss and bariatric surgery were associated with HS regression, though a subset of patients with significant increase in panniculi experienced exacerbations and required excision of excess skin. Diets demonstrating benefit eliminated dairy and brewer's yeast. Nutritional supplements including zinc gluconate, vitamin D, and riboflavin had a suppressive, rather than curative, effect on HS lesions in single studies. Overall, the reviewed interventions show promise as potential adjunct treatments in a HS management plan. Prospective randomized controlled trials should validate these findings.
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Affiliation(s)
| | - Wayne P Gulliver
- 7512 Department of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | | | - Raed Alhusayen
- 494622 Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,210484 Division of Dermatology, University of Toronto, Canada
| | - Patrick J Fleming
- 210484 Division of Dermatology, University of Toronto, Canada.,Lynde Dermatology (Private Practice), Markham, ON, Canada
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18
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol 2019; 81:76-90. [PMID: 30872156 PMCID: PMC9131894 DOI: 10.1016/j.jaad.2019.02.067] [Citation(s) in RCA: 170] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 01/28/2023]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill
| | - Daniel B. Eisen
- Department of Dermatology, University of California at Davis, Sacramento
| | - Alice B. Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York
| | | | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham
| | | | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit
| | - Haley B. Naik
- Department of Dermatology, University of California San Francisco
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain
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19
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Hendricks AJ, Hirt PA, Sekhon S, Vaughn AR, Lev-Tov HA, Hsiao JL, Shi VY. Non-pharmacologic approaches for hidradenitis suppurativa – a systematic review. J DERMATOL TREAT 2019; 32:11-18. [DOI: 10.1080/09546634.2019.1621981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | - Penelope A. Hirt
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Sahil Sekhon
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Alexandra R. Vaughn
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
| | - Hadar A. Lev-Tov
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Jennifer L. Hsiao
- Division of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - Vivian Y. Shi
- Division of Dermatology, University of Arizona Department of Medicine, Tucson, AZ, USA
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20
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Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, Hirata SH, Ramos AMC. Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. An Bras Dermatol 2019; 94:7-19. [PMID: 31166401 PMCID: PMC6544037 DOI: 10.1590/abd1806-4841.20198607] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/13/2018] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa is a chronic immune mediated disease of universal
distribution that causes great damage to the quality of life of the affected
individual, whose prevalence is estimated at 0.41% in the Brazilian population.
The objective of this work was update on physiopathogenesis, diagnosis and
classification of hidradenitis suppurativa and to establish therapeutic
recommendations in the Brazilian reality. It was organized as a work group
composed of eight dermatologists from several institutions of the country with
experience in the treatment of hidradenitis suppurativa and carried out review
on the topic. Recommendations were elaborated and voted by modified Delphi
system and statistical analysis of the results was performed. The Brazilian
consensus on the clinical approach of hidradenitis suppurativa had the support
of the Brazilian Society of Dermatology.
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Affiliation(s)
| | | | | | - Roberto Souto
- Dermatology Service, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Daniel Holthausen Nunes
- Dermatology Service, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - Mario Chaves
- Dermatology Service, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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21
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Silfvast-Kaiser A, Youssef R, Paek SY. Diet in hidradenitis suppurativa: a review of published and lay literature. Int J Dermatol 2019; 58:1225-1230. [PMID: 31006861 DOI: 10.1111/ijd.14465] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/30/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurring, inflammatory skin disorder resulting in skin abscesses and sinus tracts of the skin folds. Hidradenitis suppurativa remains a disease with limited treatment options. Management of disease activity with dietary modification has been of considerable interest to the HS patient community. Limited evidence exists to support dietary changes for treatment of HS. Strategies such as eliminating dairy products, limiting simple carbohydrate and sugar intake, and avoiding nightshades (Solanaceae) and foods containing brewer's yeast have been reported to be helpful in some patients. Several supplements have also been touted as beneficial. Herein, we review the existing dietary recommendations in both peer-reviewed and lay literature in an attempt to consolidate and evaluate existing information, while stimulating further inquiry into the role of diet in HS. Although dietary modifications are often of considerable interest to HS patients, there is a paucity of data regarding diet as it relates to HS. It is unclear whether diet may prove to be of value in limiting the severity of HS. Further research is needed to determine the potential benefits of these dietary changes.
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Affiliation(s)
| | | | - So Yeon Paek
- Division of Dermatology, Baylor University Medical Center, Dallas, TX, USA.,Texas A&M College of Medicine, Dallas, TX, USA
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22
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Zouboulis CC, Bechara FG, Dickinson-Blok JL, Gulliver W, Horváth B, Hughes R, Kimball AB, Kirby B, Martorell A, Podda M, Prens EP, Ring HC, Tzellos T, van der Zee HH, van Straalen KR, Vossen ARJV, Jemec GBE. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization - systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol 2018; 33:19-31. [PMID: 30176066 PMCID: PMC6587546 DOI: 10.1111/jdv.15233] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Abstract
Hidradenitis suppurativa (HS)/acne inversa is a debilitating chronic disease that remains poorly understood and difficult to manage. Clinical practice is variable, and there is a need for international, evidence‐based and easily applicable consensus on HS management. We report here the findings of a systematic literature review, which were subsequently used as a basis for the development of international consensus recommendations for the management of patients with HS. A systematic literature review was performed for each of nine clinical questions in HS (defined by an expert steering committee), covering comorbidity assessment, therapy (medical, surgical and combinations) and response to treatment. Included articles underwent data extraction and were graded according to the Oxford Centre for Evidence‐based Medicine criteria. Evidence‐based recommendations were then drafted, refined and voted upon, using a modified Delphi process. Overall, 5310 articles were screened, 171 articles were analysed, and 65 were used to derive recommendations. These articles included six randomized controlled trials plus cohort studies and case series. The highest level of evidence concerned dosing recommendations for topical clindamycin in mild disease (with systemic tetracyclines for more frequent/widespread lesions) and biologic therapy (especially adalimumab) as second‐line agents (following conventional therapy failure). Good‐quality evidence was available for the hidradenitis suppurativa clinical response (HiSCR) as a dichotomous outcome measure in inflammatory areas under treatment. Lower‐level evidence supported recommendations for topical triclosan and oral zinc in mild‐to‐moderate HS, systemic clindamycin and rifampicin in moderate HS and intravenous ertapenem in selected patients with more severe disease. Intralesional or systemic steroids may also be considered. Local surgical excision is suggested for mild‐to‐moderate HS, with wide excision for more extensive disease. Despite a paucity of good‐quality data on management decisions in HS, this systematic review has enabled the development of robust and easily applicable clinical recommendations for international physicians based on graded evidence.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany
| | - F G Bechara
- Dermatologic Surgery Unit, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - J L Dickinson-Blok
- Department of Dermatology, Hospital Nij Smellinghe, Drachten, The Netherlands
| | - W Gulliver
- Division of Dermatology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - B Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R Hughes
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - A B Kimball
- Department of Dermatology, Harvard Medical School, Boston, MA, USA
| | - B Kirby
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland
| | - A Martorell
- Department of Dermatology, Hospital de Manises, Valencia, Spain
| | - M Podda
- Department of Dermatology, Medical Center Klinikum Darmstadt, Darmstadt, Germany
| | - E P Prens
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - H C Ring
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
| | - T Tzellos
- Department of Dermatology, Faculty of Health Sciences, University Hospital of North Norway, Harstad and Institute of Clinical Medicine, Arctic University, Tromsø, Norway
| | - H H van der Zee
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands.,DermaHaven, Rotterdam, The Netherlands
| | - K R van Straalen
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - A R J V Vossen
- Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
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23
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Garcovich S, De Simone C, Giovanardi G, Robustelli E, Marzano AV, Peris K. Post-bariatric surgery hidradenitis suppurativa: a new patient subset associated with malabsorption and micronutritional deficiencies. Clin Exp Dermatol 2018; 44:283-289. [PMID: 30144136 DOI: 10.1111/ced.13732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bariatric surgery (BS) represents the most effective treatment for morbid obesity and its related complications, potentially ameliorating chronic comorbid inflammatory skin conditions, such as psoriasis and hidradenitis suppurativa (HS). Weight-loss interventions are strongly encouraged in patients with HS, but the resulting effect on the course of the disease has been poorly reported. AIM To describe the effect of BS-associated weight-loss on the course of HS. METHODS This was a retrospective, descriptive study of a hospital-based patient cohort with HS in order to investigate the relationship between exposure to a BS procedure and the HS disease course. Clinical characteristics and BS-related outcomes were retrospectively analysed by chart review for identified cases. Laboratory parameters for selected micronutrients (levels of vitamin A, D and B12, plus zinc and iron) were re-evaluated at a follow-up visit in each post-BS case. Typical patients with HS from the general cohort served as controls for the comparison of vitamin D and zinc serum levels. RESULTS Of 178 patients with HS, 12 patients with incident HS who had undergone a BS procedure were identified. A subset of patients (n = 10) developed initial signs and symptoms of cutaneous suppuration after experiencing weight loss related to malabsorptive bariatric procedures. Post-BS patients with HS presented multiple micronutritional deficiencies and insufficient responses to standard, first-line antibiotic treatments. Of the micronutrients we selected for analysis, zinc was found to be at significantly lower serum levels in post-BS patients with HS compared with typical patients with HS. CONCLUSIONS Post-BS HS may represent a new patient subset, requiring customized clinical management.
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Affiliation(s)
- S Garcovich
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C De Simone
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Giovanardi
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Robustelli
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - A V Marzano
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - K Peris
- Institute of Dermatology, F. Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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24
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Micieli R, Alavi A. Lymphedema in patients with hidradenitis suppurativa: a systematic review of published literature. Int J Dermatol 2018; 57:1471-1480. [PMID: 30105858 DOI: 10.1111/ijd.14173] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/21/2018] [Accepted: 07/16/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lymphedema is a debilitating complication of hidradenitis suppurativa (HS) that can be therapeutically challenging. Systematic evaluation of the clinical presentation and management of this condition has yet to be performed. METHODS OVID MEDLINE and EMBASE databases were searched along with a review of the references of searched articles for all English reports discussing lymphedema secondary to HS. RESULTS Two case series and 15 case reports met inclusion criteria, representing 27 patients. On average, these patients had a history of HS for 18 years (range 4-30 years). Lymphedema was found in the following areas in order of frequency: scrotum (16 patients, 59%), penis (12 patients, 44%), labia majora (4 patients, 15%), perineum (3 patients, 11%), groin (3 patients, 11%), buttocks (2 patients, 7%), and abdomen (1 patient, 4%). In six patients (22%), lymphedema occurred in two or more of the aforementioned locations. Lymphedema most commonly presented not only as swelling with induration but also as verrucous papules or nodules. The majority of cases (14 patients, 52%) were treated with radical surgical excision combined with medical therapy and obtained favorable outcomes. Surgical defect was most frequently covered with split thickness skin grafts 7 patients, 54%) followed by skin flaps (3 patients, 11%) and healing by secondary intention (3 patients, 11%). CONCLUSIONS Lymphedema appears to be a relatively rare complication of chronic HS that most commonly affects the anogenital region. Based on the evidence available, dermatologists should pursue a collaborative approach with surgery in the management of this condition at early stages.
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Affiliation(s)
- Robert Micieli
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Afsaneh Alavi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
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25
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Vekic DA, Frew JW. Pharmaceutical Benefits Scheme listing of adalimumab for hidradenitis suppurativa: Is hidradenitis suppurativa a life-changing drug or does lifestyle change the drug? Australas J Dermatol 2017; 59:e243-e244. [PMID: 29285755 DOI: 10.1111/ajd.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dunja A Vekic
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
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26
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Theut Riis P, Saunte D, Benhadou F, del Marmol V, Guillem P, El-Domyati M, Abdel-Wahab H, Antoniou C, Dessinioti C, Gürer M, Beksaç B, Szepietowski J, Matusiak L, Emtestam L, Lapins J, Riad H, Doss N, Massa A, Hamzavi I, Nicholson C, Dolenc-Voljc M, Kim K, Ohn J, Zouboulis C, Karagiannidis I, Mokos Z, Durinec P, Jemec G. Low and high body mass index in hidradenitis suppurativa patients-different subtypes? J Eur Acad Dermatol Venereol 2017; 32:307-312. [DOI: 10.1111/jdv.14599] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/07/2017] [Indexed: 01/03/2023]
Affiliation(s)
- P. Theut Riis
- Department of Dermatology; University Hospital Zealand; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - D.M. Saunte
- Department of Dermatology; University Hospital Zealand; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | - F. Benhadou
- Department of Dermatology; Hopital Erasme; Université Libre de Bruxelles; Bruxelles Belgium
| | - V. del Marmol
- Department of Dermatology; Hopital Erasme; Université Libre de Bruxelles; Bruxelles Belgium
| | | | - M. El-Domyati
- Department of Dermatology; Minia University; Al-Minya Egypt
| | - H. Abdel-Wahab
- Department of Dermatology; Minia University; Al-Minya Egypt
| | - C. Antoniou
- Department of Dermatology; Andreas Sygros Hospital; University of Athens; Athens Greece
| | - C. Dessinioti
- Department of Dermatology; Andreas Sygros Hospital; University of Athens; Athens Greece
| | - M.A. Gürer
- Department of Dermatology; Faculty of Medicine; Gazi University; Ankara Turkey
| | - B. Beksaç
- Department of Dermatology; Faculty of Medicine; Gazi University; Ankara Turkey
| | - J.C. Szepietowski
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - L. Matusiak
- Department of Dermatology, Venereology and Allergology; Wroclaw Medical University; Wroclaw Poland
| | - L. Emtestam
- Unit of Infection and Dermatology; Department of Medicine; Huddinge at Karolinska Institutet; Stockholm Sweden
| | - J. Lapins
- Unit of Infection and Dermatology; Department of Medicine; Huddinge at Karolinska Institutet; Stockholm Sweden
| | - H. Riad
- Hamad medical corporation; Doha Quatar
| | - N. Doss
- Department of Dermatology; Military Hospital of Tunis; University Tunis El Manar; Tunis Tunisia
| | | | - I. Hamzavi
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
| | - C. Nicholson
- Department of Dermatology; Henry Ford Hospital; Detroit MI USA
| | - M. Dolenc-Voljc
- Department of Dermatovenereology; University Medical Centre Ljubljana; Ljubljana Slovenia
- Faculty of Medicine; University of Ljubljana; Ljubljana Slovenia
| | - K.H. Kim
- Laboratory of Cutaneous Aging and Hair Research; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- Institute of Human-Environment Interface Biology; Seoul National University College of Medicine; Seoul Korea
| | - J. Ohn
- Laboratory of Cutaneous Aging and Hair Research; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- Institute of Human-Environment Interface Biology; Seoul National University College of Medicine; Seoul Korea
| | - C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Brandenburg Medical School Theodore Fontane; Dessau Germany
| | - I. Karagiannidis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Brandenburg Medical School Theodore Fontane; Dessau Germany
| | - Z.B. Mokos
- Department of Dermatology and Venereology; University Hospital Center Zagreb and School of Medicine University of Zagreb; Zagreb Croatia
| | - P. Durinec
- Department of Dermatology and Venereology; University Hospital Center Zagreb and School of Medicine University of Zagreb; Zagreb Croatia
| | - G.B.E. Jemec
- Department of Dermatology; University Hospital Zealand; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
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27
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Abstract
The association of the metabolic syndrome (MetS) and its components with immune-mediated chronic inflammatory disorders has attracted much interest within the last two decades. In addition to the well-established association of psoriasis with MetS, recent data point to an association between MetS and hidradenitis suppurativa, as well. The association of hidradenitis suppurativa with MetS and its components, such as diabetes, obesity, and dyslipidemia, has been consistently identified in controlled studies. This relationship is not only limited to older individuals but also applicable to younger patients and those with mild disease. This review documents the link between these disorders and discusses its practical implications, mainly highlighting the importance of prevention and routine screening for early diagnosis to prevent cardiovascular-related morbidity.
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Affiliation(s)
- Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
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28
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Gallagher C, Kirthi S, Burke T, O'Shea D, Tobin AM. Remission of hidradenitis suppurativa after bariatric surgery. JAAD Case Rep 2017; 3:436-437. [PMID: 28932789 PMCID: PMC5594229 DOI: 10.1016/j.jdcr.2017.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | - Thomas Burke
- Department of Endocrinology and Diabetes Mellitus, St. Vincent's University Hospital, Dublin, Ireland
| | - Donal O'Shea
- Department of Endocrinology and Diabetes Mellitus, St. Vincent's University Hospital, Dublin, Ireland
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29
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Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: an update on connecting the tracts. F1000Res 2017; 6:1272. [PMID: 28794864 PMCID: PMC5538037 DOI: 10.12688/f1000research.11337.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 12/18/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a devastating disease involving abscesses, sinus tracts, and inflammation classically affecting the axilla, groin, and/or anogenital region. Although the disease pathogenesis is not fully understood, recent advances suggest that HS pathology runs much deeper than the cutaneous manifestations. It is now believed that HS is a systemic inflammatory disease that gives rise to the characteristic cutaneous manifestations. This disease is problematic for both patients and physicians to manage because of a variety of diagnostic and management difficulties. This article seeks to provide updates on the current understanding of HS to increase awareness and improve management.
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30
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Shah A, Alhusayen R, Amini-Nik S. The critical role of macrophages in the pathogenesis of hidradenitis suppurativa. Inflamm Res 2017; 66:931-945. [PMID: 28656364 DOI: 10.1007/s00011-017-1074-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/21/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a painful chronic inflammatory disease with a prevalence between 1 and 4% of general population. The pathogenesis of HS long eluded scientists, but growing evidence suggests that it is a consequence of inflammatory dysregulation. FINDINGS Recent studies suggest that dysregulated immune response to skin flora and overexpression of inflammatory cytokines leads to chronic skin inflammation seen in HS. Macrophages are the most numerous inflammatory cells found in HS infiltrates and release numerous pro-inflammatory cytokines such as IL-23, and IL-1β and TNF-α, exacerbating the inflammation and contributing to the pathogenesis of HS. Furthermore, in HS, there is dysregulated function of other immune players closely associated with macrophage function including: matrix metalloproteases (MMP) 2 and 9 overexpression, toll-like receptor upregulation, impaired Notch signalling, NLRP3 inflammasome upregulation, and dysregulated keratinocyte function. Lifestyle factors including obesity and smoking also contribute to macrophage dysfunction and correlate with HS incidence. CONCLUSIONS The overexpression of pro-inflammatory cytokines and subsequent efficacy of anti-cytokine biologic therapies highlights the importance of managing macrophage dysfunction. Future therapies should target key molecular drivers of macrophage dysfunction such as TLR2 and NLRP3 overexpression.
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Affiliation(s)
- Ahmed Shah
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Raed Alhusayen
- Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Dermatology, University of Toronto, Toronto, Canada.,Sunnybrook Health Science Center, Sunnybrook Research Institute, Toronto, Canada
| | - Saeid Amini-Nik
- Faculty of Medicine, University of Toronto, Toronto, Canada. .,Department of Surgery, University of Toronto, Toronto, Canada. .,Department of Laboratory Medicine and Pathobiology (LMP), University of Toronto, Toronto, Canada. .,Sunnybrook Health Science Center, Sunnybrook Research Institute, Toronto, Canada.
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Scuderi N, Monfrecola A, Dessy LA, Fabbrocini G, Megna M, Monfrecola G. Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review. Skin Appendage Disord 2017; 3:95-110. [PMID: 28560220 DOI: 10.1159/000462979] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 02/10/2017] [Indexed: 12/27/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease presenting with painful nodules, abscesses, sinus tracts, and scarring primarily affecting apocrine gland-rich intertriginous areas. HS prevalence ranges from 0.05 to 1%. The central pathogenic event in HS is believed to be the occlusion of the upper part of the folliculopilosebaceous unit, leading to the rupture of the sebofollicular canal with the consequent development of perifollicular lymphohistiocytic inflammation. The HS treatment choices are influenced by disease severity and its individual subjective impact, involving both medical and surgical interventions. However, given the chronic nature of HS, its destructive impact on social, working, and daily life of patients, its management is often frustrating for both the patient and physician. Hence, prompt and effective management strategies are urgently needed and a multidisciplinary approach is advocated. Therefore, in this article, we highlighted the main features of HS (clinical aspects, epidemiology, pathogenesis, diagnostic criteria, classifications, comorbidities, and treatments), so that awareness of this disease might be heightened in primary care physicians and surgeons, who may be the first health care providers to see patients with this disease owing to its characteristic clinical presentation (inflammatory nodules, abscesses, sinus tract, etc.).
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Affiliation(s)
- Nicolò Scuderi
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza," Rome, Naples, Italy
| | - Ambra Monfrecola
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza," Rome, Naples, Italy
| | - Luca Andrea Dessy
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome "Sapienza," Rome, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission.
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Affiliation(s)
- I E Deckers
- Department of Dermatology, Erasmus University Medical Center, Burg. s' Jacobplein 51, 3015 CA, Rotterdam, The Netherlands.
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Burg. s' Jacobplein 51, 3015 CA, Rotterdam, The Netherlands.
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Fabbrocini G, De Vita V, Donnarumma M, Russo G, Monfrecola G. South Italy: A Privileged Perspective to Understand the Relationship between Hidradenitis Suppurativa and Overweight/Obesity. Skin Appendage Disord 2016; 2:52-56. [PMID: 27843924 DOI: 10.1159/000447716] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that involves the terminal hair follicles of apocrine gland-bearing skin areas. OBJECTIVE To evaluate the relationship between HS and systemic medical conditions, such as overweight/obesity during adolescence. METHODS Epidemiologic data was collected from January 2014 up to December 2015 from 27 patients affected by HS, outpatients of the Dermatology Department of University of Naples Federico II, to examine the correlation between HS and overweight/obesity. RESULTS 70.4% of the patients were female and 29.6% were male. The mean age at onset of the disease was 18.1 ± 5.99 years, while the mean age at first diagnosis by the physician was 21.77 ± 6.61 years. A mean Sartorius score of 50.26 ± 21.75 was registered. Body mass index of HS patients was positively correlated with Sartorius score. CONCLUSION Our study underlines the fact that particular attention to metabolic alteration in adolescence can lead to a correct diagnosis with less delay in HS.
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Affiliation(s)
- Gabriella Fabbrocini
- Division of Clinical Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Valerio De Vita
- Division of Clinical Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Marianna Donnarumma
- Division of Clinical Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Russo
- Division of Clinical Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Monfrecola
- Division of Clinical Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Fleischer AB. Characterization of obesity rates for dermatologic ambulatory office visits to United States physicians. J DERMATOL TREAT 2016; 28:181-185. [PMID: 27241466 DOI: 10.1080/09546634.2016.1187707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obesity continues to increase in the United States (US) and elsewhere, with a number of published dermatologic associations. The purpose of this study was to characterize obesity among US office visits for dermatologic diseases. METHODS Data from the 2005 to 2011 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) were searched for the most common dermatologic diagnoses for which body mass index (BMI) could be classified. RESULTS For all dermatologic patient visits, 10% were underweight, 36.5% were normal weight, 23.8% were overweight and 29.7% were obese. Increasing age predicted the yearly increased likelihood of obesity (OR 1.02; 95% CI 1.01, 1.02; p < 0.0001). Logistic regression controlling for age, sex, race and dataset found that in addition to age, NHAMCS dermatologic diagnosis patients were more likely to be obese than NAMCS patients (OR 1.22; 95% CI 1.03, 1.45; p = 0.02). Specific diseases were found to have the highest obesity rates, including psoriasis, hidradenitis suppurativa and acanthosis nigricans. CONCLUSION A large proportion of dermatologic diagnosis patients are obese, and awareness could lead to interventions that may improve their disease and decrease risks of comorbidities.
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Affiliation(s)
- Alan B Fleischer
- a Department of Surgery , University of Kentucky College of Medicine , Lexington , KY , USA
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Lim ZV, Oon HH. Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities. Ann Dermatol 2016; 28:147-51. [PMID: 27081259 PMCID: PMC4828375 DOI: 10.5021/ad.2016.28.2.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/06/2015] [Accepted: 07/13/2015] [Indexed: 12/21/2022] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory skin condition associated with an increased prevalence of individual metabolic conditions such as insulin resistance, obesity, hyperlipidemia, hypertension, and with the metabolic syndrome, as a constellation of these risk factors. This places affected patients at an increased risk of early cardiovascular morbidity and mortality. Moreover, many of the therapeutic options, including the newer biologics, used in the treatment of hidradenitis suppurativa have both beneficial and adverse metabolic effects. Therefore, it is critical for physicians to consider the complex interactions between the disease process and the treatment options in the holistic management of these patients with an intrinsically higher risk of metabolic consequences. Other chronic systemic inflammatory diseases such as psoriasis and rheumatoid arthritis have been studied more extensively with regard to their associations and share an underlying link with the metabolic syndrome; we can draw upon the existing knowledge in our understanding and management of hidradenitis suppurativa.
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36
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Boer J, Nazary M, Riis PT. The Role of Mechanical Stress in Hidradenitis Suppurativa. Dermatol Clin 2016; 34:37-43. [DOI: 10.1016/j.det.2015.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Woodruff CM, Charlie AM, Leslie KS. Hidradenitis Suppurativa: A Guide for the Practicing Physician. Mayo Clin Proc 2015; 90:1679-93. [PMID: 26653298 DOI: 10.1016/j.mayocp.2015.08.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 11/17/2022]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease of apocrine gland-bearing skin. Although immunologic derangements, genetic predisposition, obesity, and smoking are likely important factors, the pathogenesis of the disease and the effect of available treatments on disease course have not been fully elucidated. In the absence of proper treatment, chronic inflammation results in diffuse scarring and a wide array of complications, including the development of cutaneous squamous cell carcinoma. This severe and chronic disease can have detrimental effects on self-esteem and quality of life. No ideal treatment regimen has been defined, but several therapies have been found to reduce lesion severity and improve symptoms. We reviewed the literature through July 2014 for existing treatments. Published articles were obtained via systematic review of medical databases (PubMed, Embase, Google Scholar) and scrutiny of citation lists using the search terms "hidradenitis suppurativa" and "acne inversa". Given the scarce literature on treatment strategies, we also reviewed data from any case reports or prospective and retrospective studies that were located. On the basis of the existing literature, we provide an evidence-based algorithm for the management of this disease in the primary care setting. More research is needed to evaluate the comparative effectiveness of topical and systemic treatments and to better understand the pathogenesis, natural history, and subtypes of hidradenitis suppurativa.
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Affiliation(s)
- Carina M Woodruff
- Department of Dermatology, University of California, San Francisco, San Francisco
| | - Abbas M Charlie
- Department of Dermatology, University of California, San Francisco, San Francisco
| | - Kieron S Leslie
- Department of Dermatology, University of California, San Francisco, San Francisco.
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39
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Boer J. Resolution of hidradenitis suppurativa after weight loss by dietary measures, especially on frictional locations. J Eur Acad Dermatol Venereol 2015; 30:895-6. [PMID: 25731202 DOI: 10.1111/jdv.13059] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J Boer
- Department of Dermatology, Deventer Hospital, Deventer, The Netherlands
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40
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Abstract
Hidradenitis suppurativa (HS) is a burdensome disease and has the potential to affect the life course of patients. It is a rare disease in children, and the recorded literature is correspondingly scarce. This article reviews the therapeutic options for HS in children and adolescents, and highlights particular differences or challenges with treating patients in this age group compared with adults. The work-up of paediatric patients with HS should include considerations of possible endocrine co-morbidities and obesity. Medical therapy of lesions may include topical clindamycin. Systemic therapy may include analgesics, clindamycin and rifampicin, finasteride, corticosteroids or tumour necrosis factor alpha (TNFα) blockers. Superinfections should be appropriately treated. Scarring lesions generally require surgery.
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Affiliation(s)
- Peter Riis Mikkelsen
- Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark,
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Kromann C, Deckers I, Esmann S, Boer J, Prens E, Jemec G. Risk factors, clinical course and long‐term prognosis in hidradenitis suppurativa: a cross‐sectional study. Br J Dermatol 2014; 171:819-24. [DOI: 10.1111/bjd.13090] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2014] [Indexed: 12/31/2022]
Affiliation(s)
- C.B. Kromann
- Department of Dermatology Health Sciences Faculty Roskilde Hospital University of Copenhagen Copenhagen Denmark
| | - I.E. Deckers
- Department of Dermatology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - S. Esmann
- Department of Dermatology Health Sciences Faculty Roskilde Hospital University of Copenhagen Copenhagen Denmark
| | - J. Boer
- Department of Dermatology Deventer Hospital Deventer The Netherlands
| | - E.P. Prens
- Department of Dermatology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - G.B.E. Jemec
- Department of Dermatology Health Sciences Faculty Roskilde Hospital University of Copenhagen Copenhagen Denmark
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Abstract
Hidradenitis suppurativa is a chronic relapsing disorder of the folliculopilosebaceous units (FPSUs). Its negative impact on quality of life is extreme, mainly due to the lack of early recognition, accurate diagnosis, and appropriate management. The support structure of the FPSUs is defective. Under the influence of endogenous reproductive hormones, exogenous hormones, androgens and their precursors in dairy products, and other dietary factors, the follicular unit is plugged and distended by retained keratin. Friction, shearing forces, and pressure lead to rupture and leakage of the ductal contents from the weakened FPSU, causing an inflammatory reaction mediated mainly by the innate immune system. Therapy requires patient comprehension and cooperation, counseling, aggressive hormonal and dietary modification, avoidance of the trauma that leads to rupture, active multimodal anti-inflammatory therapy, and early unroofing and debridement. The full therapeutic program is needed to avoid the aggressive surgery required if the condition is not diagnosed early and managed appropriately.
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