Hidradenitis Suppurativa in Down Syndrome: A Case Series

Hidradenitis Suppurativa: Estimated Prevalence, Clinical Features, and Risk Factors in Riyadh, Saudi Arabia

Background

Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory disease with a global prevalence of 1-4%, characterized by multiple painful nodules, abscesses, and fistulas that form scars in intertriginous regions (i.e., inguinal, axillary, mammary). HS is a complex and debilitating disease with a negative impact on quality of life. We aim to determine the prevalence, clinical features, risk factors, and comorbidities of HS.

Methodology

A retrospective, descriptive, cross-sectional study was conducted in King Abdulaziz Medical City from 2016 to 2020. Information of all confirmed cases of HS was extracted via computerized medical records. Data analysis was performed using SPSS version 24 (IBM Corp., Armonk, NY, USA). Categorical data were calculated based on frequency and percentage using the chi-square test to obtain p-values.

Results

Our initial search yielded 196 cases, of which 13 were excluded due to incomplete medical information. The prevalence of HS was 1.29%. The mean age was 27 years, with a male predominance. More than one-third of our patients were morbidly obese, and most of the patients were in Hurley stage 1 of both genders. The most commonly affected area was the axilla, followed by the inguinal area. The most common coexisting disease was diabetes mellitus type 2, followed by lipid disorders and acne.

Conclusions

This study documents the common demographic and clinical features of HS. It is a challenging disease in terms of detection and management, and it is critical to raise awareness among the public and physicians to minimize the devastating impact on HS patients.

Common Dermatologic Disorders in Down Syndrome: Systematic Review

BACKGROUND

Down syndrome (DS) has been associated with cardiovascular, gastrointestinal, and immune-related abnormalities. Several dermatologic conditions, including hidradenitis suppurativa, have also been found to be associated with DS.

OBJECTIVE

The objective of this study was to characterize the prevalence, presentation, and unique features of dermatologic disorders associated with DS.

METHODS

Electronic searches of EMBASE (via Ovid), MEDLINE (via Ovid), and Web of Science databases were conducted on December 14, 2020. Observational studies including case reports of patients with DS presenting with concomitant primary dermatologic disorder were included.

RESULTS

This systematic review captured 40 observational studies and 99 case reports, including 10 observational studies that examined the prevalence of common skin disorders in patients with DS. The most common dermatologic conditions reported includes atopic dermatitis (8 studies, n=180; 19.7% mean prevalence), hidradenitis suppurativa (15, n=478; 3.2%), ichthyosis (4, n=16; 4.7%), lichen nitidus (6, n=6; 1.1%), psoriasis (21, n=65; 4.8%), alopecia areata (27, n=253; 7.4%), vitiligo (8, n=40; 4.4%), onychomycosis (3, n=198; 24.7%), calcinosis cutis (14, n=15), connective tissue nevi (6, n=6), dermatofibroma (3, n=3), melanoma (3, n=3), syringomas (14, n=182; 21.2%), and elastosis perforans serpiginosa (19, n=24; 0.5%).

CONCLUSIONS

Our results indicate an increased prevalence of common cutaneous disorders in patients with DS, particularly infectious, inflammatory, autoimmune, and connective tissue conditions. Current guidelines for the screening, general management, and use of systemic immunomodulatory agents in this patient population are lacking. Patients with DS would benefit from screening for dermatologic disorders not otherwise regularly performed for earlier diagnosis and treatment.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021226295; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226295.

Dermatologic conditions in Down syndrome

Down syndrome (DS) is the most common chromosomal condition and affects many organs including the skin. Dermatologists are an integral part of the DS care team. This is a review of both common and rare dermatologic conditions in DS. We provide practical strategies for a successful dermatology interview and examination. We explore the downstream effects of trisomy of chromosome 21, in particular on the immune system, and how these insights may enhance our pathophysiologic understanding of their cutaneous conditions.

Prevalence and incidence of physical health conditions in people with intellectual disability - a systematic review

OBJECTIVE

To synthesize evidence on the prevalence and incidence of physical health conditions in people with intellectual disability (ID).

METHODS

We searched Medline, PsycInfo, and Embase for eligible studies and extracted the prevalence, incidence, and risk of physical health conditions in people with ID.

RESULTS

Of 131 eligible studies, we synthesized results from 77 moderate- to high-quality studies, which was mainly limited to high-income countries. The highest prevalence estimates were observed for epilepsy, ear and eye disorders, cerebral palsy, obesity, osteoporosis, congenital heart defects, and thyroid disorders. Some conditions were more common in people with a genetic syndrome. Compared with the general population, many health conditions occur more frequently among people with ID, including asthma and diabetes, while some conditions such as non-congenital circulatory diseases and solid cancers occur at the same or lower rate. The latter associations may reflect under-detection.

CONCLUSIONS

People with ID have a health profile more complex than previously known. There is a pressing need for targeted, evidence-informed population health initiatives including preventative programs for this population.

Hidradenitis suppurativa and chromosomal abnormalities: a case report and systematic review of the literature

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disorder that involves painful nodules, abscesses, and tunnels of intertriginous sites. Although the etiology has not been fully elucidated, recent studies have highlighted its association with chromosomal abnormalities.We present a rare case of HS in a patient with Trisomy 1q;13 and systematically summarize the association between HS and chromosomal abnormalities. A search was conducted using MEDLINE and EMBASE in OVID database. Original studies reporting HS among human subjects with chromosomal abnormalities were included. Patient demographics, disease symptomology, clinical features, and treatment histories were extracted and summarized.Thirteen studies describing 428 cases met the inclusion criteria. Of the 13 articles, nine studies reported patients with HS and Down syndrome (DS), one article investigated HS and Smith-Magenis syndrome (SMS), and three articles analyzed HS and Patau syndrome (PS). While increased prevalence of HS was found in populations with DS, with suggested mechanisms involving amyloid precursor protein cleavage product, keratinocyte proliferation, and follicular plugging, the associations between HS and both SMS and PS remain inconclusive because of limited studies with small sample size.Although evidence suggests that the genetic regulation of chromosome 21 may be implicated in the association between HS and DS, this association may be confounded by additional factors that increase the risk of HS. Further research with larger sample sizes must be conducted to strengthen our understanding of the association between HS and chromosomal abnormalities.

Hidradenitis suppurativa and Down syndrome: A systematic review and meta-analysis

BACKGROUND

Hidradenitis suppurativa (HS), characterized by inflammatory nodules, sinus tracts, and abscesses, has been linked to several factors, including immune dysfunction and obesity, which are thought to contribute to its development. Several follicular disorders have also been associated with Down syndrome (DS), a common chromosomal disorder, including HS, although studies on this topic are limited.

OBJECTIVES

To characterize HS in Down syndrome patients and to further examine the association between HS and DS compared to HS patients without DS.

METHODS

We systematically searched MEDLINE, Embase, Web of Science, and CENTRAL electronic databases from their dates of conception to February 2020. Random-effects meta-analyses were performed analyzing (a) HS characteristics between DS and non-DS participants, and (b) prevalence or association between HS and DS compared to non-DS individuals.

RESULTS

Twelve studies were included in this systematic review, with a total of 358 participants presenting with both HS and DS. Pooled analysis of mean differences between DS and non-DS participants presenting with HS found a significantly younger age of HS symptom onset for DS patients (-6.24; 95% CI, -10.01--2.24). A meta-analysis examining the association between HS and DS found a significantly increased likelihood of HS in DS patients (OR 9.61; 95% CI, 5.70-16.20).

CONCLUSIONS

Our findings suggest an association between HS and DS, with DS patients suffering from an earlier onset of HS symptoms compared to non-DS patients.

Clinical implications of immune-mediated diseases in children with Down syndrome

Children with Down syndrome have changes in their innate and adaptive immunity, which contribute to increased rates of infections, autoimmune diseases, and haematological malignancies. While improved care for congenital heart disease has decreased mortality and morbidity, complications related to immune-mediated diseases continue to limit the life expectancy in Down syndrome. Infectious diseases are common and have a significant effect on development, behaviour and quality of life. Infection frequency and severity are influenced by various anatomical and physiological alterations in addition to immunological changes in Down syndrome. Thus, prevention of respiratory tract infections requires a multifactorial approach. This could include additional active and/or passive immunizations, prophylactic antibiotics, immunoglobulin replacement and ear, nose and throat surgical interventions. Autoimmune conditions like coeliac disease, type I diabetes mellitus and thyroid disease are classically mentioned in the context of Down syndrome. However, autoinflammatory conditions are more prevalent as well. Screening for autoimmune diseases is required and immunosuppression has to be used with caution. Future studies should address optimal screening programmes for immune-mediated diseases in individuals with Down syndrome, as well as the effect of immune modulation, to further decrease morbidity and mortality, and improve the quality of life of individuals with Down syndrome.

Demographic and Clinical Features of Hidradenitis Suppurativa in Turkey

Background

The literature contains conflicting reports on the epidemiology and frequency of hidradenitis suppurativa (HS), a chronic, recurrent inflammatory disease of the apocrine glands.

Objective

To evaluate the clinical and demographic characteristics of HS cases in Turkey and investigate the similarities with world epidemiology.

Method

The records of 208 patients that presented to our polyclinics and were diagnosed with HS between June 2012 and July 2017 were retrospectively evaluated.

Results

Of the cases, 68.3% were male and 31.7% were female. Of the patients, 75.5% had no family history of HS, 60.6% were smokers, 39.4% were aged 20-29 years, and 36.1% were aged 30-39 years. The most commonly involved regions were the axilla (62%), groin (50.5%), and gluteus (15.9%). According to univariate analyses, male patients had higher disease stages than females (odds ratio=1.67). The patients with groin involvement, high body mass index (BMI), and low education level (0-8 years) had higher risk of severe disease stage (odds ratio=1.63, 8.91, and 1.51, respectively). The most commonly used treatment was oral antibiotics in Hurley stages I and II, and surgical intervention in Hurley III. In all 3 Hurley stages, clavulanic acid–amoxicillin combination was the mostly used systemic antibiotic (41.8%, 43.2%, and 47.8%, respectively).

Conclusions

This is the first epidemiological study on HS in the Turkish population, where HS shows male predominance. Male gender, low education level, absence of acne, high BMI, and groin involvement were associated with severe disease stages. Determining associated comorbidities and possible risk factors is important in progression and prevention of the disease.

Hidradenitis Suppurativa Associated with Down Syndrome Is Characterized by Early Age at Diagnosis

BACKGROUND/AIMS

The association between hidradenitis suppurativa (HS) and multiple comorbidities has been widely investigated but data about the coexistence of Down syndrome (DS) are scarce. We sought to evaluate the prevalence of DS among a population of HS patients and assess their clinical features.

METHODS

We collected demographic and clinical data of patients affected with HS referred to three Italian outpatient dermatology clinics.

RESULTS

A total of 257 HS patients were enrolled, 62% females and 38% males (mean age [±SD]: 23.3 ± 10.7 years); 9 of the 257 patients (3.5%), 7 females and 2 males, had concomitant HS and DS. The patients with DS and HS had a significantly earlier age of onset (mean age: 14.3 ± 3.6 vs. 23.4 ± 12.31 years; p = 0.029), a significantly younger age at diagnosis (mean age: 21.1 ± 11.1 vs. 31.8 ± 13.5 years; p = 0.015), and were significantly younger (mean age: 23.3 ± 10.7 vs. 34.6 ± 13.07 years; p = 0.005). No significant differences about other clinical data were found between the two groups.

CONCLUSION

The prevalence of DS in HS patients corresponds to a not negligible 3.5% of cases, who experienced an onset of HS at a younger age compared to patients with HS only.