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McGrath C, Steyn M, Rashidghamat E. Hidradenitis suppurativa in children and young adults: a retrospective cross-sectional observational study in the United Kingdom. Int J Dermatol 2024. [PMID: 38273707 DOI: 10.1111/ijd.17049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) in children and young adults (CYA) (<18 years) is uncommon. No previous observational studies have been carried out in a UK CYA HS population. METHODS This study was based on retrospective case note reviews of CYA HS patients attending tertiary-level care in the CYA HS service in a UK hospital. Patients <18 years old with a known diagnosis of HS were screened for inclusion. Exclusion criteria were those with less than one follow-up appointment. RESULTS Twenty-eight CYA HS patients were identified, with an M:F ratio of 1:8.3. Mean BMI was 25.2 (SD: 7.6). 17 (61%) of cases had a relevant family history. Long-term antibiotic monotherapy was the most common treatment initiated. Lymecycline was the most commonly prescribed antibiotic, accounting for 23 (56%) of the 41 courses prescribed. Additional treatments initiated included dual therapy with rifampicin and clindamycin, isotretinoin, and adalimumab, which were more commonly prescribed in patients with Hurley Stage II or III. CONCLUSIONS This group had a female predominance with an apparent strong genetic predisposition which is seen in other HS CYA cross-sectional research. Treatment was varied in this cohort, however long courses of antibiotics, including combined therapy with rifampicin and clindamycin, were the mainstay of treatment, similar to management in the adult population. This study therefore adds to the limited information on the demographics and management of the HS CYA population.
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Affiliation(s)
- Conn McGrath
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mia Steyn
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ellie Rashidghamat
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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2
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van der Weijden DAY, Koerts NDK, van Munster BC, van der Zee HH, Horváth B. Hidradenitis suppurativa tarda: defining an understudied elderly population. Br J Dermatol 2023; 190:105-113. [PMID: 37665963 DOI: 10.1093/bjd/ljad317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, devastating, multifactorial skin disease. Patients generally develop HS after puberty and the prevalence of the disease is assumed to decrease with higher age. Data outside the usual age range are limited, especially for elderly patients. OBJECTIVES To investigate the prevalence, clinical characteristics and associated comorbidities among the elderly HS population. METHODS Data were collected through a population-wide survey-based study within the Lifelines Cohort Study in the Netherlands. The clinical characteristics of elderly patients with HS (≥ 60 years) were compared with an adult population (< 60 years) with HS. The comorbidities in elderly patients with HS were compared with those of a non-HS sex- and age-matched elderly population in a 1 : 4 ratio. HS in the elderly was defined as active HS in patients aged 60 years and older. Within the HS elderly group, two subgroups were defined, late-onset HS (HS developed after 60 years of age) and persistent HS (HS developed from a younger age but continuing after 60 years of age). RESULTS Within the Lifelines cohort 209 elderly patients with HS were identified as well as an adult (< 60 years) group with HS (n = 793) and a non-HS sex- and age-matched control elderly group (n = 810). The prevalence of HS among the elderly bootstrap analysis population was 0.8% [95% confidence interval (CI) 0.4-1.2]. A significantly higher age of HS symptom onset was found compared with the adult HS group: respectively, 40 vs. 23 years (odds ratio 1.056, 95% CI 1.05-1.07). Among the elderly HS cohort (in the Discussion, the HS tarda cohort) a female : male ratio of 1.7 : 1.0 and a higher family history for HS were found. Moreover, elderly patients with HS had a significantly higher risk of having HS-associated comorbidities compared with the sex- and age-matched controls. CONCLUSIONS The prevalence of HS in the elderly is not rare. Among the elderly a shift from female predominance towards a lower female : male ratio in HS is observed. In addition, HS in the elderly showed significant variation in age of onset and involved body areas. Moreover, elderly patients with HS were more susceptible to multimorbidity. Finally, we propose defining HS in the elderly as 'HS tarda' and subdividing it as late-onset and persistent HS tarda.
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Affiliation(s)
| | | | - Barbara C van Munster
- Internal Medicine and Geriatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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3
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Chiang N, Sibbald C, Levy R, Lara-Corrales I. Hidradenitis Suppurativa in Children and Adolescents: An Update on Pharmacologic Treatment Options. Paediatr Drugs 2023; 25:659-676. [PMID: 37782437 DOI: 10.1007/s40272-023-00595-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin condition that manifests as painful, deep-seated, inflamed nodules and abscesses in the axillary, groin, perianal, perineal, and inframammary regions. The associated pain, malodour, and disfigurement contribute to its profound negative impact on psychosocial spheres and overall quality of life in affected individuals. Although the symptoms of HS classically begin in the second or third decade of life, HS affects children and adolescents as well. Despite this, there are limited pediatric data on treatment, which are largely based on expert opinion, extrapolation of efficacy data in adults with HS, and safety information from medication use in other pediatric diseases. On this basis, there exist several pharmacological modalities in the treatment of children and adolescents with HS including topical therapies, systemic therapies, and biologics. The goals of this review article are to: (1) review the efficacy of different pharmacological treatment modalities in children and adolescents with HS, and (2) review the safety and monitoring considerations of the different treatment options in children and adolescents with HS.
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Affiliation(s)
- Nicholas Chiang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cathryn Sibbald
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Rebecca Levy
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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4
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Alabdulkareem M, Berkane Y, Le Bras E, Rousson E, Chrelias T, Beaufils T, Leclere FM, Watier E, Bertheuil N. Axillary Hidradenitis Suppurativa: A Comparison between Two Perforator Flap Reconstructive Approaches after Radical Surgical Management. Plast Reconstr Surg Glob Open 2023; 11:e5301. [PMID: 37811354 PMCID: PMC10558224 DOI: 10.1097/gox.0000000000005301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023]
Abstract
Background Axillary hidradenitis suppurativa (HS) can result in significant functional impairment in both personal and professional lives. Stage 3 HS requires radical surgical treatment. Flap reconstruction allows for faster healing and better functional and aesthetic outcomes. We compared the results of thoracodorsal artery perforator (TDAP) and propeller inner arm artery perforator (IAAP) flap reconstructions after radical surgical treatment of axillary HS. Methods We conducted a retrospective study that included 13 consecutive patients who underwent stage 3 axillary HS treatment between August 2015 and January 2023. Seven patients underwent reconstruction by islanded TDAP flaps, whereas six patients underwent reconstruction by propeller IAAP flaps, with one patient undergoing bilateral reconstruction. The data collected from the patient records included age, gender, smoking status, body mass index, comorbidities, operative time, defect size, flap size, hospital stay, and complications. Results Although not statistically significant (P = 0.1923), a higher rate of flap complications is reported here with propeller IAAP flaps (42.86 %), whereas islanded TDAP flaps had no flap complications (0%). We found a statistically significant difference in operative time (P = 0.0006), defect size (P = 0.0064), and flap size (P = 0.0012) between the two groups. All patients exhibited satisfactory functional and aesthetic outcomes. Fourteen flaps were performed in total; only one case exhibited recurrence (7.14%). Conclusion After radical surgical management, both islanded TDAP and propeller IAAP flap reconstructions offer excellent outcomes for stage 3 axillary HS. We strongly encourage our peers to consider performing perforator flaps over secondary healing for these patients with a major functional impairment.
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Affiliation(s)
- Mohammad Alabdulkareem
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- Department of Surgery, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Yanis Berkane
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
- Vascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
- Shriners Children’s Boston, Harvard Medical School, Boston, Mass
| | - Enna Le Bras
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Etienne Rousson
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Theodoros Chrelias
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Tristan Beaufils
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Franck-Marie Leclere
- Department of Plastic, Reconstructive and Hand Surgery, Poitiers University Hospital, CHU de la Miletrie de Poitiers, Poitiers, France
- Laboratoire d’anatomie et de Simulation, Université de Poitiers, Poitiers, France
| | - Eric Watier
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
| | - Nicolas Bertheuil
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, CHU de Rennes, Rennes University, Rennes, France
- UMR U1236-MICMAC, Immunology and Therapy Lab, Rennes University Hospital, Rennes, France
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5
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Balić A, Marinović B, Bukvić Mokos Z. The genetic aspects of hidradenitis suppurativa. Clin Dermatol 2023; 41:551-563. [PMID: 37652193 DOI: 10.1016/j.clindermatol.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Genetic aspects have a substantial role in hidradenitis suppurativa (HS) pathogenesis. A positive family history of HS occurs in about one-third of HS cases and is significantly higher in patients with early onset of the disease. Recent twin studies have shown a high heritability in HS, fortifying the importance of genetic factors in disease pathogenesis. Based on existing knowledge on the genomics of HS, the disease can be categorized as familial HS, sporadic, syndromic HS, and "HS plus" associated with other syndromes. In familial HS, autosomal dominant transmission is proposed, and monogenic inheritance is rare. This monogenic trait is related to mutations of γ-secretase component genes and Notch signaling or defects in inflammasome function. With newly discovered gene mutations, such as those related to innate and adaptive immunity, skin microbiome, inflammasome, epidermal homeostasis, and keratinization pathway, we can define HS as a polygenic, multifactorial, autoinflammatory disease. To fully elucidate the genetic aspects of HS, we need extensive, long-term global collaborations.
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Affiliation(s)
- Anamaria Balić
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, European Reference Network (ERN) - Skin Reference Centre, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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6
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Di Cesare A, Rosi E, Amerio P, Prignano F. Clinical and Ultrasonographic Characterization of Hidradenitis Suppurativa in Female Patients: Impact of Early Recognition of the Disease. Life (Basel) 2023; 13:1630. [PMID: 37629487 PMCID: PMC10455481 DOI: 10.3390/life13081630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
Hidradenitis suppurativa (HS) is considered a post-pubertal disease; however, earlier onset is not infrequent. The burden of HS on the female population is very relevant, and early identification might reduce the quality of life impairment and improve the therapeutic approach. In this study, we investigated clinical biomarkers of HS that could impact the management of patients affected by HS. Female patients affected by stable HS were prospectively included in this study. Anamnestic data, clinical and ultrasonographic features were collected and analyzed. Overall, 53 patients were included in this study. The median age of onset was 19 (IQR: 14-25). Early onset was reported by 22/53 patients (median age of onset: 14; IQR: 11-16). Four patients had pre-menstruation occurrence. Early-onset patients had an earlier first-menstrual-cycle age and more frequent genital localization of HS, and were more often treated with biologics. Patients with early-onset-HS and genital localization had more severe disease with a higher number of areas affected, Hurley, and IHS4 scores. Genital involvement might be prevalent in patients with early-onset HS, leading to a worse impact on the global severity of the disease and tailored treatment protocols, including multidisciplinary approaches, in order to improve the early recognition of hidden lesions.
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Affiliation(s)
- Antonella Di Cesare
- Section of Dermatology, Department of Health Sciences, University of Florence, 50122 Florence, Italy; (A.D.C.); (E.R.)
| | - Elia Rosi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50122 Florence, Italy; (A.D.C.); (E.R.)
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Ageing Science, “G. D’Annunzio” University, 66100 Chieti, Italy;
| | - Francesca Prignano
- Section of Dermatology, Department of Health Sciences, University of Florence, 50122 Florence, Italy; (A.D.C.); (E.R.)
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7
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George EA, Nwankwo C, Castelo-Soccio L, Oboite M. Disorders in Children. Dermatol Clin 2023; 41:491-507. [PMID: 37236717 DOI: 10.1016/j.det.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance with therapeutic administration. The following section provides a subset of pediatric dermatoses and notable points for presentation in skin of color patients. Providers need to be able to recognize dermatology conditions in patients of varying skin tones and provide therapies that address the condition and any associated pigmentary alterations.
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Affiliation(s)
| | - Christy Nwankwo
- University of Missouri, Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Michelle Oboite
- University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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8
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Tricarico PM, Gratton R, dos Santos-Silva CA, de Moura RR, Ura B, Sommella E, Campiglia P, Del Vecchio C, Moltrasio C, Berti I, D’Adamo AP, Elsherbini AMA, Staudenmaier L, Chersi K, Boniotto M, Krismer B, Schittek B, Crovella S. A rare loss-of-function genetic mutation suggest a role of dermcidin deficiency in hidradenitis suppurativa pathogenesis. Front Immunol 2022; 13:1060547. [PMID: 36544771 PMCID: PMC9760663 DOI: 10.3389/fimmu.2022.1060547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/16/2022] [Indexed: 12/11/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a multifactorial aetiology that involves a strict interplay between genetic factors, immune dysregulation and lifestyle. Familial forms represent around 40% of total HS cases and show an autosomal dominant mode of inheritance of the disease. In this study, we conducted a whole-exome sequence analysis on an Italian family of 4 members encompassing a vertical transmission of HS. Focusing on rare damaging variants, we identified a rare insertion of one nucleotide (c.225dupA:p.A76Sfs*21) in the DCD gene encoding for the antimicrobial peptide dermcidin (DCD) that was shared by the proband, his affected father and his 11-years old daughter. Since several transcriptome studies have shown a significantly decreased expression of DCD in HS skin, we hypothesised that the identified frameshift insertion was a loss-of-function mutation that might be associated with HS susceptibility in this family. We thus confirmed by mass spectrometry that DCD levels were diminished in the affected members and showed that the antimicrobial activity of a synthetic DCD peptide resulting from the frameshift mutation was impaired. In order to define the consequences related to a decrease in DCD activity, skin microbiome analyses of different body sites were performed by comparing DCD mutant and wild type samples, and results highlighted significant differences between the groins of mutated and wild type groups. Starting from genetic analysis conducted on an HS family, our findings showed, confirming previous transcriptome results, the potential role of the antimicrobial DCD peptide as an actor playing a crucial part in the etio-pathogenesis of HS and in the maintenance of the skin's physiological microbiome composition; so, we can hypothesise that DCD could be used as a novel target for personalised therapeutic approach.
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Affiliation(s)
- Paola Maura Tricarico
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Rossella Gratton
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Ronald Rodrigues de Moura
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Blendi Ura
- Maternal-Neonatal Department, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | | | - Cecilia Del Vecchio
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Irene Berti
- Pediatric Department, Institute of Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Adamo Pio D’Adamo
- Department of Advanced Diagnostics, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Ahmed M. A. Elsherbini
- Department of Infection Biology, Interfaculty Institute of Microbiology and Infection Medicine, University of Tübingen, Tübingen, Germany
| | - Lena Staudenmaier
- Department of Dermatology, Division of Dermato-oncology, University of Tübingen, Tübingen, Germany
| | - Karin Chersi
- Dermatological Clinic, ASUGI - Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Michele Boniotto
- INSERM, IMRB, Translational Neuropsychiatry, University Paris Est Créteil, Créteil, France
| | - Bernhard Krismer
- Department of Infection Biology, Interfaculty Institute of Microbiology and Infection Medicine, University of Tübingen, Tübingen, Germany
| | - Birgit Schittek
- Department of Dermatology, Division of Dermato-oncology, University of Tübingen, Tübingen, Germany
| | - Sergio Crovella
- Department of Biological and Environmental Sciences, Biological Sciences Program, College of Arts and Sciences, University of Qatar, Doha, Qatar
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Bui H, Sayed C. A cross-sectional study of pediatric hidradenitis suppurativa and the value of the International Hidradenitis Suppurativa Severity Score System (IHS4) as a pediatric clinical trial inclusion criteria. Pediatr Dermatol 2022; 39:689-694. [PMID: 35766518 DOI: 10.1111/pde.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) often develops in pediatrics, but few interventional studies include pediatric patients. OBJECTIVES This dual analysis of a pediatric HS cohort and typical eligibility criteria in adult trials aims to identify potential patient characteristics and inclusion criteria for future pediatric HS studies. METHODS This cross-sectional and descriptive study is based on a prospectively collected data registry from an HS clinic. We also queried 125 HS studies from the Clinicaltrials.gov database and information from 61 interventional systemic HS drug trials was analyzed. RESULTS The mean abscess and inflammatory nodule (AN) count in 81 pediatric subjects was 2.3 compared to 5.0 in adults with majority being Hurley stage I (39.5%, 32/81) or II (55.6%, 45/81). Most clinical trials required patients to be Hurley stage II/III with AN count of ≥3. CONCLUSION When developing clinical trials for pediatric HS, it is imperative to consider how baseline characteristics impact recruitment and disease assessment. Frequently used eligibility criteria in adult trials may severely limit pediatric recruitment. Although our registry had a large adult sample size, the main limitation of this study was the relatively smaller pediatric sample size.
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Affiliation(s)
- Helen Bui
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher Sayed
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Dermatology, University of North Carolina, Chapel Hill, North Carolina, USA
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10
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Di Cesare A, Nikolakis G, Kanni T, Giammarellos-Bourboulis EJ, Matusiak Ł, Szepietowski JC, Zouboulis CC, Prignano F. Identification of clinical features affecting diagnostic delay in pediatric hidradenitis suppurativa: results from a multicenter observational study. Br J Dermatol 2022; 187:428-430. [PMID: 35292964 DOI: 10.1111/bjd.21247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Antonella Di Cesare
- Dermatology Section, Department of Health Sciences, University of Florence, Florence, Italy.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Georgios Nikolakis
- Departments of Dermatology, Venerology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Theodora Kanni
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Evangelos J Giammarellos-Bourboulis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Greece.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venerology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
| | - Francesca Prignano
- Dermatology Section, Department of Health Sciences, University of Florence, Florence, Italy.,European Hidradenitis Suppurativa Foundation, Dessau, Germany
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Gajanin V, Baroš N, Marošević G, Ninković-Baroš Đ, Balaban J. New approaches in management and treatment of 'Hidradenitis suppurativa'. Scripta Medica 2022. [DOI: 10.5937/scriptamed53-36048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background / Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that most often affects apocrine gland-bearing areas of the skin. The treatment depends on the severity of the clinical presentation. The paper objective was to present new modalities in management and treatment of HS. Methods: The subjects in this research included the patients suffering from the severe form of HS, who were treated in the University Clinical Centre of the Republic of Srpska for the past three years. The effect of treatment of HS were monitored. In four patients, biologic therapy with adalimumab or adalimumab biosimilars was administered, while four patients received radiotherapy and 17 of them, were treated surgically. Depending on the type of treatment, the effects of therapy were monitored after 6-12 weeks by using clinical examination and by assessing the disease stage according to the Hurley staging. Due to a small number of subjects, especially in patients treated with biologic and radiotherapy, it was not possible to perform any statistical analysis and the results were presented by description, in tables and photographs. Results: Biologic therapy: Adalimumab was administered subcutaneously 80 mg, twice a month. After 12 weeks, in 4 patients was observed a regression of changes by 60-70 % when compared to previous skin changes. Radiotherapy: the total radiation dose was 5 Gy, distributed in 5 or 10 fractions. After 12 weeks an improvement by 60-70 % was observed. Surgical treatment: after 6-8 weeks, the patients were fully recovered. Conclusions: Application of biologic and radiotherapy after 12 weeks had similar results, ie it brought to regression of changes by 60-70 %. The best results were achieved after surgical treatment of HS.
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Garcovich S, Fania L, Caposiena D, Giovanardi G, Chiricozzi A, De Simone C, Tartaglia C, Ciccone D, Bianchi L, Abeni D, Peris K. Pediatric Hidradenitis Suppurativa: A Cross-Sectional Study on Clinical Features and Treatment Approaches. J Cutan Med Surg 2021; 26:127-134. [PMID: 34615396 DOI: 10.1177/12034754211039993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Hidradenitis suppurativa is uncommon in patients of pediatric age, and differentiation with adult-onset disease is controversial. Treatment of pediatric hidradenitis suppurativa is scarcely standardized, and specific guidelines are lacking. OBJECTIVE We report the clinical features, relevant risk-factors, comorbidity profile, and treatment patterns of a hospital-based cohort of pediatric hidradenitis suppurativa. METHODS In a cross-sectional study data on patients' demographics, disease-specific characteristics, early/pre-pubertal onset of disease, comorbidities, and treatment management were retrieved. Reference population data and clinical data from the national hidradenitis suppurativa disease registry were used for comparison. RESULTS From a database of 870 patients with hidradenitis, 71 (15 males and 56 females) patients aged <18 years (mean age: 15.3 years; range 8-17 years), with mild (Hurley I, 45.1%) and moderate-severe disease (Hurley II-III, 54.9%), were retrieved. Smoking (23.9%) and overweight/obese frequencies (59.2%) were higher than reference population standards. Patient's older age at baseline (OR 1.43, 95% CI: 1.01 to 2.02) and higher BMI (OR 1.26, 95% CI: 1.07-1.48) were the only factors associated with moderate-severe disease. Family history and early/pre-pubertal onset of disease were not associated with severity or extent of disease. Sebaceous-follicular comorbid conditions were associated with cigarette smoking (P = .002). Among 81 treatment courses, clindamycin-based and zinc-sulphate-based combination regimens were most frequently used (59.3%). Female preponderance, family history of disease and extensive involvement were significantly different from the general hidradenitis suppurativa population. CONCLUSIONS Pediatric hidradenitis suppurativa presents a clinical spectrum comparable to adult-onset disease. Increased preventive measures should target obesity and smoking in this population.
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Affiliation(s)
- Simone Garcovich
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Luca Fania
- 9363 Dermatology Department, IDI-IRCCS, Rome, Italy
| | - Dante Caposiena
- 9318 Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Giulia Giovanardi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Andrea Chiricozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Clara De Simone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Chiara Tartaglia
- 9318 Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | | | - Luca Bianchi
- 9318 Dermatology Department, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | | | - Ketty Peris
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,602349371 Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
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Liy-Wong C, Kim M, Kirkorian AY, Eichenfield LF, Diaz LZ, Horev A, Tollefson M, Oranges T, Philips R, Chiu YE, Ghafari G, Arnold JD, Sprague J, Nguyen H, Wan S, Atenafu EG, Pope E, Hamilton J, Naik HB, Lara-Corrales I. Hidradenitis Suppurativa in the Pediatric Population: An International, Multicenter, Retrospective, Cross-sectional Study of 481 Pediatric Patients. JAMA Dermatol 2021; 157:385-391. [PMID: 33625473 DOI: 10.1001/jamadermatol.2020.5435] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Hidradenitis suppurativa (HS) in pediatric patients has been understudied. Increased awareness and recognition of HS prevalence in children demand efforts to better understand this condition. Objective To describe the demographics, clinical features, treatment, associated comorbidities, and outcomes in a large cohort of pediatric patients with HS. Design, Setting, and Participants International, multicenter, retrospective medical record review of pediatric patients (aged 1-18 years) with a clinical diagnosis of HS carried out in 10 dermatology clinics across the US, Canada, Israel, Australia, and Italy from January 1996 to January 2017. Main Outcomes and Measures Patient demographics, clinical features, severity, associated comorbidities, and treatments in pediatric patients with HS. Results This cross-sectional study included 481 patients diagnosed with HS. Overall, 386 (80%) were girls. The mean (SD) age of disease onset was 12.5 (2.9) years, and the mean (SD) age at diagnosis was 14.4 (3.5) years. Family history of HS was present in 111 of 271 (41%) patients. First signs/symptoms reported at disease onset were cyst/abscess in 229 of 481 (48%), pain/tenderness in 118 of 481 (25%), and papules/pustules in 117 of 481 (24%). At initial dermatologic assessment, 233 of 481 (48%) patients already had evidence of skin scarring. Disease severity (Hurley staging) was documented in 288 of 481 (60%) patients (47% stage 1, 45% stage 2 and 8% stage 3). Comorbid conditions were reported in 406 of 481 (85%) patients, the most common being obesity (263/406 [65%]) and acne vulgaris (118/406 [29%]). Complications occurred in 378 of 481 (79%) patients, the most common of which were scars or contractures (301/378 [80%]). Conclusions and Relevance The findings of this study indicate that there is a gap in recognizing and diagnosing pediatric HS. Pediatric patients with HS are likely to present with other comorbidities. Prospective observational and interventional studies are needed to better understand clinical course and optimal treatments for pediatric HS.
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Affiliation(s)
- Carmen Liy-Wong
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mary Kim
- Section of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | | | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California, San Diego.,Rady Children's Hospital, San Diego, California
| | - Lucia Z Diaz
- Dell Children's Medical Center, Austin, Texas.,Dell Medical School at Austin, Austin, Texas
| | | | - Megha Tollefson
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | | | - Roderic Philips
- Department of Pediatrics, Monash University, Melbourne, Australia.,Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Yvonne E Chiu
- Section of Pediatric Dermatology, Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Ghazal Ghafari
- Department of Dermatology, University of California, San Francisco
| | | | - Jessica Sprague
- Departments of Dermatology and Pediatrics, University of California, San Diego.,Rady Children's Hospital, San Diego, California
| | - Henry Nguyen
- Departments of Dermatology and Pediatrics, Mayo Clinic, Rochester, Minnesota
| | - Stephanie Wan
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Elena Pope
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jill Hamilton
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Canada
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14
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Anduquia-Garay F, Rodríguez-Gutiérrez MM, Poveda-Castillo IT, Valdes-Moreno PL, Agudelo-Rios DA, Benavides-Moreno JS, Lozada-Martínez ID, Bolaño-Romero MP, Borraez-Segura B, Rahman S. Hidradenitis suppurativa: Basic considerations for its approach: A narrative review. Ann Med Surg (Lond) 2021; 68:102679. [PMID: 34401142 PMCID: PMC8353381 DOI: 10.1016/j.amsu.2021.102679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/18/2023] Open
Abstract
Hidradenitis suppurativa is a chronic and debilitating skin disease, whose lesions can range from inflammatory nodules to abscesses and fistulas in the armpits, groin, perineum, inframammary region. Diagnosis can be confused with a large number of clinical pictures, and although studies on hidradenitis suppurativa are not so scarce in the literature, doctors are often unaware of this disease and therefore its diagnosis is often late. Pharmacological treatment ranges from retinoids to immunosuppression and radiation therapy, and surgical treatment ranges from incision and drainage to more complete excisions and laser therapies. Hidradenitis suppurativa is a disease seen and treated mainly by dermatologists and general surgeons, however, it is necessary for general practitioners to have basic knowledge about this entity, as they are the first line of care in the health system. Hidradenitis suppurativa is an entity of necessary recognition by the surgeon. It is a preventable and treatable condition with a good prognosis. This condition should be managed by a multidisciplinary team.
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Affiliation(s)
- Felipe Anduquia-Garay
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- School of Medicine, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - María Manuela Rodríguez-Gutiérrez
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Medical and Surgical Research Center, School of Medicine, Fundación Universitaria Autónoma de las Americas, Pereira, Colombia
| | | | | | | | | | - Ivan David Lozada-Martínez
- Future Surgeons Chapter, Colombian Surgery Association, Bogotá, Colombia
- Medical and Surgical Research Center, University of Cartagena, Cartagena, Colombia
| | | | | | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
- Corresponding author.
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15
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Abstract
ABSTRACT Hidradenitis suppurativa (HS) is a chronic and recurrent inflammatory skin condition resulting in the formation of nodules, sinus tracts, and abscesses in intertriginous areas. We provide recommendations for the management of children presenting to the emergency department with acute HS flares, based on a review of literature and insights from our own clinical experience. The purpose of the recommendations is to educate clinicians on specific considerations that should be made when caring for children with HS.
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Affiliation(s)
- Kavina Patel
- From the Medical Student, Department of Medical Education, Long School of Medicine, University of Texas Health San Antonio, San Antonio
| | - Maria Leszczynska
- Dermatology Research Fellow, Dermatologist and Assistant Professor, Department of Internal Medicine, Division of Dermatology
| | - Venessa Peña-Robichaux
- Dermatology Research Fellow, Dermatologist and Assistant Professor, Department of Internal Medicine, Division of Dermatology
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16
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Adenote A, Dumic I, Madrid C, Barusya C, Nordstrom CW, Rueda Prada L. NAFLD and Infection, a Nuanced Relationship. Can J Gastroenterol Hepatol 2021; 2021:5556354. [PMID: 33977096 DOI: 10.1155/2021/5556354] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of nonalcoholic fatty liver disease (NAFLD) has increased significantly over the last few decades mirroring the increase in obesity and type II diabetes mellitus. NAFLD has become one of the most common indications for liver transplantation. The deleterious effects of NAFLD are not isolated to the liver only, for it has been recognized as a systemic disease affecting multiple organs through protracted low-grade inflammation mediated by the metabolic activity of excessive fat tissue. Extrahepatic manifestations of NAFLD such as cardiovascular disease, polycystic ovarian syndrome, chronic kidney disease, and hypothyroidism have been well described in the literature. In recent years, it has become evident that patients suffering from NAFLD might be at higher risk of developing various infections. The proposed mechanism for this association includes links through hyperglycemia, insulin resistance, alterations in innate immunity, obesity, and vitamin D deficiency. Additionally, a risk independent of these factors mediated by alterations in gut microbiota might contribute to a higher burden of infections in these individuals. In this narrative review, we synthetize current knowledge on several infections including urinary tract infection, pneumonia, Helicobacter pylori, coronavirus disease 2019, and Clostridioides difficile as they relate to NAFLD. Additionally, we explore NAFLD's association with hidradenitis suppurativa.
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17
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Cazzaniga S, Pezzolo E, Garcovich S, Naldi L. Late-onset hidradenitis suppurativa: A cluster analysis of the National Italian Registry IRHIS. J Am Acad Dermatol 2021; 85:e29-e32. [PMID: 33677001 DOI: 10.1016/j.jaad.2021.02.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/28/2021] [Accepted: 02/19/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Simone Cazzaniga
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy; Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Pezzolo
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy; Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Dermatology, San Bortolo Hospital, Vicenza, Italy.
| | - Simone Garcovich
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy; Università Cattolica del Sacro Cuore, Dermatologia, Rome, Italy
| | - Luigi Naldi
- Study Center of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy; Department of Dermatology, San Bortolo Hospital, Vicenza, Italy
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18
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Theut Riis P, Loft I, Yazdanyar S, Kjærsgaard Andersen R, Pedersen O, Ring H, Huber R, Sultan M, Loesche C, Saunte D, Jemec G. Full exome sequencing of 11 families with Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2021; 35:1203-1211. [DOI: 10.1111/jdv.17095] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022]
Affiliation(s)
- P. Theut Riis
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - I.C. Loft
- Department of Clinical Immunology Naestved Hospital Naestved Denmark
| | - S. Yazdanyar
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | | | - O.B. Pedersen
- Department of Clinical Immunology Naestved Hospital Naestved Denmark
| | - H.C. Ring
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| | - R. Huber
- Novartis Institutes for BioMedical Research Basel Switzerland
| | - M. Sultan
- Novartis Institutes for BioMedical Research Basel Switzerland
| | - C. Loesche
- Novartis Institutes for BioMedical Research Basel Switzerland
| | - D.M.L. Saunte
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
| | - G.B.E. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
- Department of Clinical Medicine Health Sciences Faculty University of Copenhagen Copenhagen Denmark
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19
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Anemüller W, Langan EA, Recke A. [Paediatric vulval clinic]. Hautarzt 2021; 72:207-14. [PMID: 33591405 DOI: 10.1007/s00105-021-04770-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
In 2008 a vulval clinic was established at the University Clinic of Schleswig Holstein, Campus Luebeck, Department of Dermatology. A total of 1227 patients were referred to the clinic between 2008 and October 2020, including 91 children (age range 1-13 years) and 17 adolescents (age range 14-17 years). The most common paediatric vulval conditions encountered were lichen sclerosus (33%), vulvitis (23%) and vulval psoriasis (7%). Quality of life was measured in 81 children using the paediatric version of the Dermatology Life Quality Index (DLQI). Of a maximum 30 points, the mean score was 7.2, confirming the association between vulval diseases and impaired quality of life in children and adolescents.
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20
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Mavrogiorgou P, Juckel G, Reimelt A, Hessam S, Scholl L, Frajkur JL, Stockfleth E, Bechara FG. [Psychiatric comorbidities in hidradenitis suppurativa/acne inversa]. Hautarzt 2021; 72:426-34. [PMID: 33398389 DOI: 10.1007/s00105-020-04742-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The findings of most studies suggest that depression and anxiety disorders are the most common psychiatric comorbidities in patients with hidradenitis suppurativa/acne inversa (HS/AI). METHODS In a prospective study, 51 patients with HS/AI were further examined for psychiatric comorbidity using a standardized interview and questionnaires. RESULTS In psychiatric examination, 29.4% of HS/AI patients had additional mental symptoms, mainly manifested as depressive disorder. The HS/AI patients were rather young and female, and they showed a high incidence of nicotine and alcohol use, and a positive family history of paternal alcohol dependence. In addition, HS/AI patients experienced more severe psychosocial impairments in the form of lack of partnership and lower school attainment. CONCLUSIONS Acne inversa is a severe chronic inflammatory skin disease that, like other inflammatory dermatoses, is associated with mental comorbidity and psychosocial impairments. Since especially young patients are affected, a psychiatric-psychotherapeutic cotreatment should be considered already at an early stage.
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Özkur E, Karadağ AS, Üstüner P, Aksoy B, Eşme P, Çalışkan E, Akoğlu G, Kalkan G, Demirseren DD, Polat M, Ozden MG, Kılınç F, Yalçınkaya İyidal A, Kıvanç Altunay İ, Türkmen M, Uğurer E, Baysak S, Fettahlıoğlu Karaman B, Mammadlı K, Baykal Selçuk L, Türkoğlu Z, Atcı T, Didar Balcı D, Adışen E, Temel B, Aktan Ş, Kaçar N, Gündüz K, Türel Ermertcan A, Özdemir M, Ünal Çakıter A, Çölgeçen E, Uçmak D, Kelekçi H, Ataseven A, Durmaz K, Kaya Özden H, Engin B, Yazıcı S, Alpsoy E. Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity. Clin Exp Dermatol 2021; 46:532-540. [PMID: 33030217 DOI: 10.1111/ced.14478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.
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Affiliation(s)
- E Özkur
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - A S Karadağ
- Department of Dermatology, Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - P Üstüner
- Department of Dermatology, Demiroğlu Bilim University, Faculty of Medicine, Istanbul, Turkey
| | - B Aksoy
- Department of Dermatology, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey.,VM Medical Park Kocaeli Hospital, Kocaeli, Turkey
| | - P Eşme
- Department of Dermatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - E Çalışkan
- Department of Dermatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - G Akoğlu
- Department of Dermatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - G Kalkan
- Department of Dermatology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - D D Demirseren
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - M Polat
- Department of Dermatology, Bolu Abant İzzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - M G Ozden
- Department of Dermatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - F Kılınç
- Department of Dermatology, Bolu Abant İzzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - A Yalçınkaya İyidal
- Department of Dermatology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - İ Kıvanç Altunay
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - M Türkmen
- Department of Dermatology, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - E Uğurer
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - S Baysak
- Department of Dermatology, Sultan Abdülhamit Han Training and Research Hospital, Istanbul, Turkey
| | | | - K Mammadlı
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - L Baykal Selçuk
- Department of Dermatology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Z Türkoğlu
- Department of Dermatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - T Atcı
- Department of Dermatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - D Didar Balcı
- Department of Dermatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - E Adışen
- Department of Dermatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - B Temel
- Department of Dermatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ş Aktan
- Department of Dermatology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - N Kaçar
- Department of Dermatology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - K Gündüz
- Department of Dermatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - A Türel Ermertcan
- Department of Dermatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - M Özdemir
- Department of Dermatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - A Ünal Çakıter
- Department of Dermatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - E Çölgeçen
- Department of Dermatology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - D Uçmak
- Department of Dermatology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - H Kelekçi
- Department of Dermatology, Izmir Katip Celebi University, Faculty of Medicine, Izmır, Turkey
| | - A Ataseven
- Department of Dermatology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - K Durmaz
- Department of Dermatology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - H Kaya Özden
- Department of Dermatology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - B Engin
- Department of Dermatology, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - S Yazıcı
- Department of Dermatology, Uludağ University, Faculty of Medicine, Bursa, Turkey
| | - E Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Dahmen RA, Lautenschlager S. [CME Dermatology 23: Hidradenitis suppurativa]. Praxis (Bern 1994) 2021; 110:363-372. [PMID: 34019444 DOI: 10.1024/1661-8157/a003693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CME Dermatology 23: Hidradenitis suppurativa Abstract. Hidradenitis suppurativa (Acne inversa) is a chronic skin disease characterized by recurrent inflammatory nodules, abscesses, and scarring mainly in the intertriginous areas. The prevalence is estimated to be 0.05 to 4.1 % worldwide, with women being more commonly affected. The exact pathogenesis remains unknown, but hair follicle occlusion and inflammation seem to be the initiating events. Several epidemiological correlations with smoking and obesity as well as mutations in gamma secretase genes were described. The therapy depends on the extension of the disorder and should respect the current guidelines. Topical clindamycin is suitable for mild forms of the disease whereas moderate to severe disease requires systemic anti-inflammatory treatment. Surgical intervention is currently the only definitive treatment for hidradenitis suppurativa.
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Affiliation(s)
- Robert A Dahmen
- Institut für Dermatologie und Venerologie, Stadtspital Waid und Triemli, Zürich
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Yang CC, Tsai SJ, Chu CB, Li WL, Lin SH, Hsu CK. The influence of gender and smoking on hidradenitis suppurativa: A retrospective study of 161 patients in Taiwan. DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_32_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fernandez JM, Rizvi OH, Marr KD, Hendricks AJ, Maarouf M, Price KN, Ludwig CM, Hsiao JL, Shi VY. Topography of lesion progression in hidradenitis suppurativa. Int J Dermatol 2020; 60:e323-e325. [PMID: 33369730 DOI: 10.1111/ijd.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Omar H Rizvi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Kendra D Marr
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Melody Maarouf
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Kyla N Price
- College of Medicine, University of Illinois, Chicago, Chicago, IL, USA
| | | | | | - Vivian Y Shi
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Cuenca-Barrales C, Molina-Leyva A. Sexuality in Patients with Hidradenitis Suppurativa: Beliefs, Behaviors and Needs. Int J Environ Res Public Health 2020; 17:E8808. [PMID: 33260862 DOI: 10.3390/ijerph17238808] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/20/2022]
Abstract
Little is known about the impact of hidradenitis suppurativa (HS) on patients’ sexuality. The aim of this research is to investigate the impact of HS on several previously unexplored aspects of sexuality. In March 2018, we conducted a crowd-sourced cross-sectional online survey hosted by the Spanish association of patients with HS (ASENDHI) and available in Spanish. A panel of experts and patients from ASENDHI designed various questions in order to explore the extent to which HS influenced participants’ sex lives. The final sample consisted of 386 participants, 79.27% (306/386) of which were women and 20.73% (80/306) of which were men. Seventy-seven point one percent (236/306) of women and 67.5% (54/80) of men were in stable relationships; the rest of the participants were single. Forty-seven point nine percent (185/386) admitted to feeling fear of rejection. Pain was the symptom that most interfered with sexual relations in women and suppuration in men. Forty-four point three percent (171/386) of the participants considered themselves to be less attractive than average. Considering the participants in a stable relationship, women described receiving more emotional support from their partners, while men received more help with lesion dressing in intimate areas. Seventy-one point four percent (207/290) of participants stated that HS negatively affected their relationship. Among single patients, women experienced greater fear of rejection and were less willing to meet new people because of HS. Ninety-four point three percent (66/70) of women and 80.8% (21/26) of men stated that HS had a negative influence on their chances of having a relationship or sexual relations. In conclusion, HS has a significant, unrecognized and misunderstood impact on sexuality which must be addressed.
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Choi E, Ooi XT, Chandran NS. Hidradenitis suppurativa in pediatric patients. J Am Acad Dermatol 2020:S0190-9622(20)32436-1. [PMID: 32822788 DOI: 10.1016/j.jaad.2020.08.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/12/2020] [Accepted: 08/14/2020] [Indexed: 12/11/2022]
Abstract
Interest in and research on hidradenitis suppurativa (HS) have increased during the past decade, resulting in expanded knowledge about associated comorbidities and treatment efficacy. Knowledge about pediatric-onset HS is still limited, based on case studies, small case series, and extrapolation from adult studies. With increasing prevalence of childhood obesity, decreasing pubertal age, and increasing awareness of HS, physicians may start encountering younger HS patients. This review presents an updated discussion on the epidemiology, pathophysiology, and associated comorbidities in HS, with a focus on pediatric and adolescent patients. It also suggests recommendations for investigation and treatment based on current evidence.
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Vaiopoulos AG, Nikolakis G, Zouboulis CC. Hidradenitis suppurativa in paediatric patients: a retrospective monocentric study in Germany and review of the literature. J Eur Acad Dermatol Venereol 2020; 34:2140-2146. [PMID: 32324936 DOI: 10.1111/jdv.16520] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle affecting apocrine glands-rich areas of the body. The disease usually occurs after puberty leading to painful nodules, abscesses, tunnels and scarring. Although uncommonly, HS can also occur in children and adolescents. OBJECTIVE Our objective was to describe the epidemiology, characteristics, predisposing factors and clinical course of HS in paediatric patients. METHODS The retrospective cohort study included patients with HS, who have been diagnosed in Dessau Medical Center and reported development of HS during childhood or adolescence, fulfilled the diagnostic criteria for HS and had a follow-up period of at least one year. A systematic review was conducted on MEDLINE, EMBASE and CENTRAL on 19 March 2020 using the terms 'hidradenitis' or 'acne inversa' together with the terms 'children', 'paediatric' and 'adolescence'. RESULTS Twenty paediatric patients [1 child (0.22%), 19 adolescents (4.25%)] were detected out of 447 patients evaluated (4.5%) with a male to female ratio of 1.86 : 1. The median age at diagnosis was 17 years [interquartile range (IQR) 16-18] and the median age at onset 15 years (IQR: 14-16.5). The majority of the patients suffered from moderate disease were overweight or obese and non-smokers. The most common comorbid disorder was acne vulgaris. The systematic review revealed reports with data heterogeneity and lack of systematic documentation of specific demographic characteristics. Most paediatric patients were female, obese and non-smokers, with considerable comorbid disorders. CONCLUSIONS Hidradenitis suppurativa in Germany may affect children and adolescents exhibiting a particular phenotype of mainly male non-smokers.
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Affiliation(s)
- A G Vaiopoulos
- 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
| | - G Nikolakis
- 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
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany.,European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany
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Hayama K, Fujita H, Hashimoto T, Terui T. Questionnaire-based epidemiological study of hidradenitis suppurativa in Japan revealing characteristics different from those in Western countries. J Dermatol 2020; 47:743-748. [PMID: 32441411 PMCID: PMC7818453 DOI: 10.1111/1346-8138.15378] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/07/2020] [Indexed: 01/14/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic relapsing skin disease localized mainly on the apocrine gland‐bearing areas. In Japan, HS is yet to be fully understood, and no criteria have been established for its diagnosis or severity assessment. The purpose of this study was to investigate and characterize HS in Japan. We conducted a nationwide questionnaire‐based study, in which Japanese diagnostic criteria were proposed. Question items included age, sex, disease duration, past history, family history, smoking status, disease severity scores (Hurley stage, modified Sartorius score and Physician Global Assessment [PGA] score), treatments, comorbidities and prognosis. We analyzed 300 patients (219 males and 81 females) diagnosed with HS based on our criteria. Average disease duration was 92.3 ± 6.82 months. Only 12 (4%) patients had a family history of HS. Disease severity was classified by PGA score (mild, 100 [33.3%]; moderate, 133 [44.3%]; severe, 34 [11.3%]; most severe, 29 [9.7%]) and Hurley stage (I, 69 [23%]; II, 109 [36.3%]; III, 121 [40.3%]). Disease severities based on PGA score and Hurley stage were positively correlated to modified Sartorius score using the Kruskal–Wallis test (P < 0.001, respectively). Patients with diabetes mellitus showed higher PGA scores (χ2 = 10.977, P = 0.01185). Presence of axillary lesions related to higher PGA scores (χ2 = 8.6378, P = 0.03452). The results in this study and previous studies indicate that Japanese HS patients have different backgrounds from those in Western countries, and are characterized by male predominance, higher incidence of Hurley stages II and III, higher PGA scores in patients with axillary lesions and much fewer familial cases.
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Affiliation(s)
- Koremasa Hayama
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Hideki Fujita
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Terui
- Division of Cutaneous Science, Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan
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Riis PT, Saunte DM, Sigsgaard V, Villani AP, Guillem P, Pascual JC, Kappe NN, Vanlaerhoven AMJD, van der Zee HH, Prens EP, El-domyati M, Abdel-wahab H, Moftah N, Abdelghani R, Agut-busquet E, Romaní J, Hlela C, van den Worm L, Bettoli V, Calamo G, Gürer MA, Beksaç B, Matusiak L, Glowaczewska A, Szepietowski JC, Emtestam L, Lapins J, Kottb HR, Fatani M, Weibel L, Theiler M, Delage-toriel M, Lam TTH, Nassif A, Becherel P, Dolenc-voljc M, Doss N, Bouazzi D, Benhadou F, del Marmol V, Jemec GBE. Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients. Arch Dermatol Res 2020; 312:715-24. [DOI: 10.1007/s00403-020-02053-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
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Abstract
Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disorder, which affects the intertriginous skin and is associated with numerous systemic comorbidities. The estimated prevalence of HS is ~1% in most studied countries. Typically starting in early adulthood, cutaneous inflamed nodules, abscesses and pus-discharging tunnels develop in axillary, inguinal, gluteal and perianal body sites. The comorbidities of HS include metabolic and cardiovascular disorders, which contribute to reduced life expectancy. A genetic predisposition, smoking, obesity and hormonal factors are established aetiological factors for HS. Cutaneous changes seem to start around hair follicles and involve activation of cells of the innate and adaptive immune systems, with pivotal roles for pro-inflammatory cytokines such as tumour necrosis factor, IL-1β and IL-17. The unrestricted and chronic immune response eventually leads to severe pain, pus discharge, irreversible tissue destruction and scar development. HS has profound negative effects on patients' quality of life, which often culminate in social withdrawal, unemployment, depression and suicidal thoughts. The therapeutic options for HS comprise antibiotic treatment, neutralization of tumour necrosis factor and surgical intervention together with lifestyle modification. Nevertheless, there is an enormous need for awareness of HS, understanding of its pathogenesis and novel treatments.
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Kucinskiene V, Jariene V, Valiukeviciene S. Clinical Characteristics of Hidradenitis Suppurativa Patients from a Reference Centre in Kaunas, Lithuania. Dermatology 2020; 236:66-70. [PMID: 31940646 DOI: 10.1159/000505742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Clinical data on hidradenitis suppurativa (HS) derived mainly from studies in Western Europe and the USA, raising the risk of potential selection bias. According to the official data, during 2006-2015 the incidence of HS in Lithuania was 23.5 cases per 100,000 population with a female-to-male ratio of 2:1. A more fine-grained data set would however be of great relevance to further understanding this disease. Collection of standardized data enables the comparison of populations of patients across samples. OBJECTIVES To present a cohort of HS patients with uniformly collected data according to European Hidradenitis Suppurativa Foundation/European Reference Network-Skin recommendations. METHODS The demographic and clinical data of a total of 37 HS patients, included over a 3-year period (from 2016 to January 2019) in a local database of the reference centre of Rare Skin Diseases in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos, were analysed. Non-parametric tests such as χ2 and Mann-Whitney were used for assessing interdependence between qualitative data. Logistic regression analysis was performed to find out the factors statistically related with significant diagnostic delay. RESULTS The mean duration of diagnosis delay was 5.5 (±5.9) years in females and 6.6 (±8.2) years in males. A significant delay (>2 years) was reported in 29/37 (78.4%) cases and was not related with sex, age at HS diagnosis or disease severity. The groin area was more affected in females than in males. There was no statistically significant difference between sex and Hurley stage, HS Physician Global Assessment, International Hidradenitis Suppurativa Severity Score System, visual analogue scale and Dermatology Life Quality Index scores. Combined (medical and surgery) HS treatment was applied to 46.0% and monotherapy (medical or surgery) to 54.0% of patients. CONCLUSIONS Standardized collection of epidemiological and clinical data is required to improve the quality of HS patient data and allow for international comparisons and pooling of data for research purposes.
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Affiliation(s)
- Vesta Kucinskiene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) member, Kaunas, Lithuania
| | - Vaiva Jariene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) member, Kaunas, Lithuania,
| | - Skaidra Valiukeviciene
- Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, European Reference Network for Rare and Complex Diseases of the Skin (ERN-Skin) member, Kaunas, Lithuania
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Lindsø Andersen P, Kromann C, Fonvig CE, Theut Riis P, Jemec GBE, Holm JC. Hidradenitis suppurativa in a cohort of overweight and obese children and adolescents. Int J Dermatol 2020; 59:47-51. [PMID: 31498890 DOI: 10.1111/ijd.14639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/03/2019] [Accepted: 08/08/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory, and recurring disease mainly observed in adults. Obesity is considered an important independent factor in HS development and is associated with a higher prevalence of HS in children. We aimed to characterize the clinical presentation of HS in overweight and obese children and adolescents. METHODS We performed a cross-sectional observational study during January 2007-April 2015. Overweight and obese patients (5-17 years of age, BMI> 90th percentile) referred to The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Denmark, underwent screening for dermatological conditions. A dermatologist ascertained the diagnosis of HS, and disease severity was assessed using Hurley staging and Sartorius score. Tobacco smoke exposure, body mass index (BMI) standard deviation score (SDS), and psychiatric comorbidities were recorded. Our cohort was compared with a reference cohort recruited in a previous study. RESULTS A total of 195 children and adolescents underwent screening for dermatological conditions. Nine patients screened positive, and six of these patients were available for examination of whom five presented with HS. All HS cases were mild (median Sartorius score of 9). Four of the five patients (with varying constellations) reported tobacco exposure, a positive family history of HS, and exhibited psychiatric comorbidities. CONCLUSION Our findings support that the presence of pediatric HS is correlated with familial disposition to HS and psychiatric comorbidities.
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Affiliation(s)
- Pernille Lindsø Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Charles Kromann
- Department of Dermatology, Zealand University Hospital, Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Cilius E Fonvig
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Peter Theut Riis
- Department of Dermatology, Zealand University Hospital, Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jens-Christian Holm
- The Children's Obesity Clinic, Department of Paediatrics, Copenhagen University Hospital Holbaek, Holbaek, Denmark.,The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Constantinou CA, Fragoulis GE, Nikiphorou E. Hidradenitis suppurativa: infection, autoimmunity, or both? Ther Adv Musculoskelet Dis 2019; 11:1759720X19895488. [PMID: 31908656 PMCID: PMC6937531 DOI: 10.1177/1759720x19895488] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease mainly affecting areas rich in apocrine glands. Clinically, is characterized by painful subcutaneous nodules and if left untreated to pus secretion, abscess and fistula formation. Its frequency is estimated to be 0.5-4% of the general population, affecting women more often. Pathogenesis of HS is still not clearly defined. It seems to be a combination of genetic factors with alterations in the skin microbiome. Furthermore, at tissue (i.e. skin) as well as at serum level, several inflammatory cytokines are upregulated. The most important of the latter are tumor necrosis factor (TNF), interleukin (IL)-1, IL-17, and IL-23. Adding another level of complexity, it has been suggested that keratinocytes might be intrinsically activated, contributing also to the observed inflammation. Interestingly, it has been noted that frequency of HS is increased in some autoimmune rheumatic diseases, such as spondyloarthropathies (SpA). Of note, both HS and SpA have relatively strong association with metabolic diseases and obesity implying that there are indeed some common underlying pathophysiological pathways. Although no specific microbe has been identified, alterations in the microbiome of the skin of these patients have been reported. Of note, microbes with a capability for biofilm formation are abundant. Treatment of HS among others, include antibiotics as well as biologic drugs targeting TNF and other cytokines and used for autoimmune rheumatic diseases. Herein, we review the current evidence on links between HS and autoimmune diseases and infectious diseases with a focus on epidemiology and pathophysiology.
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Affiliation(s)
- Costas A Constantinou
- Internal Medicine Department and Tuberculosis Unit, Kyperounta Rural Hospital, Kyperounta, Cyprus
- Communicable Diseases Surveillance and Control Unit, Medical and Public Health Services, Cyprus Ministry of Heath, Nicosia, Cyprus
| | - George E Fragoulis
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
- First Department of Propaedeutic and Internal Medicine, “Laiko” General Hospital, Athens, Greece
| | - Elena Nikiphorou
- Academic Rheumatology Department, King’s College London, Cutcombe Road, London, SE5 9RJ, UK
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Offidani A, Molinelli E, Sechi A, Brisigotti V, Campanati A, Raone B, Neri I, Patrizi A. Hidradenitis suppurativa in a prepubertal case series: a call for specific guidelines. J Eur Acad Dermatol Venereol 2019; 33 Suppl 6:28-31. [DOI: 10.1111/jdv.15827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A. Offidani
- Dermatological Unit Department of Clinical and Molecular Sciences Polytechnic Marche University Ancona Italy
| | - E. Molinelli
- Dermatological Unit Department of Clinical and Molecular Sciences Polytechnic Marche University Ancona Italy
| | - A. Sechi
- Department of Experimental, Diagnostic and Specialty Medicine Division of Dermatology University of Bologna Bologna Italy
| | - V. Brisigotti
- Dermatological Unit Department of Clinical and Molecular Sciences Polytechnic Marche University Ancona Italy
| | - A. Campanati
- Dermatological Unit Department of Clinical and Molecular Sciences Polytechnic Marche University Ancona Italy
| | - B. Raone
- Department of Experimental, Diagnostic and Specialty Medicine Division of Dermatology University of Bologna Bologna Italy
| | - I. Neri
- Department of Experimental, Diagnostic and Specialty Medicine Division of Dermatology University of Bologna Bologna Italy
| | - A. Patrizi
- Department of Experimental, Diagnostic and Specialty Medicine Division of Dermatology University of Bologna Bologna Italy
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Cuenca-Barrales C, Molina-Leyva A. Risk Factors of Sexual Dysfunction in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study. Dermatology 2019; 236:37-45. [PMID: 31434072 DOI: 10.1159/000501905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) has a high impact on quality of life. However, sexual health has scarcely been investigated. OBJECTIVE To describe the frequency of sexual dysfunction (SD) in women and erectile dysfunction (ED) in men with HS and to explore potential risk factors. PATIENTS AND METHODS We conducted a cross-sectional study using a crowd-sourced online questionnaire spread by the Spanish hidradenitis suppurativa patients' association (ASENDHI). RESULTS In total, 393 participants answered the questionnaire. SD was found in 51% (95% CI 45-57%) of women and ED in 60% (95% CI 49-70%) of men. Factors related to SD were education status, patient's global assessment for disease activity, numeric rating scale for pain and unpleasant odour and the absence of a stable relationship. Factors related to ED were increasing age, the presence of active lesions in the genital area and the number of areas affected by active lesions. CONCLUSIONS There is a high prevalence of SD and ED in HS patients. Being in a stable relationship has been a protective factor of SD in women. The results suggest that sexual impairment in HS patients is due, at least in part, to disease activity, symptoms and active lesions.
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Affiliation(s)
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain, .,European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany, .,Instituto de Investigación Biosanitaria Granada, Granada, Spain,
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Sechi A, Guglielmo A, Patrizi A, Savoia F, Cocchi G, Leuzzi M, Chessa MA. Disseminate Recurrent Folliculitis and Hidradenitis Suppurativa Are Associated Conditions: Results From a Retrospective Study of 131 Patients With Down Syndrome and a Cohort of 12,351 Pediatric Controls. Dermatol Pract Concept 2019; 9:187-194. [PMID: 31384491 DOI: 10.5826/dpc.0903a03] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2019] [Indexed: 12/25/2022] Open
Abstract
Background Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disease of the pilosebaceous unit characterized by protean manifestations. Several studies have found an increased incidence and earlier presentation of this disease in patients carrying trisomy 21. Patients with Down syndrome (DS) have a higher risk of developing a wide range of cutaneous manifestations, including HS and chronic folliculitis. Recently, disseminate recurrent folliculitis (DRF) has been reported as an atypical monosymptomatic feature of HS at its onset. Objective To assess the prevalence of HS and DRF by comparing a cohort of patients carrying trisomy 21 vs pediatric controls. Methods A retrospective 2-year monocentric clinical study was performed by collecting clinical data of 131 patients with DS, aged 4-36 years, followed at the Dermatology Unit and Down Syndrome Regional Center of Bologna University. Data were matched with those coming from 12,351 pediatric controls. Results In DS patients, DRF and HS showed a prevalence of, respectively, 6.8% and 24.4%, while 5.3% of patients presented both diseases. In the control group the prevalence for HS+ and DRF+ was 0.5% and 1.2%, respectively, with a 0.14% of overlap cases. The association between HS and DRF proved to be statistically significant in both groups (P < 0.05). In the DS cohort the mean age of symptoms onset was 15.67 (SD: 2.29) years for HS and 13.11 (SD: 4.93) years for DRF. Buttocks were the most frequently affected body area for DRF followed by the inguinocrural area, while in HS buttocks were less frequently involved than groins and upper thighs. Conclusions Because of the later onset of HS, patients with DRF at an early age should be monitored for the possible onset of HS in the apocrine-bearing areas.
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Affiliation(s)
- Andrea Sechi
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Alba Guglielmo
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Francesco Savoia
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Guido Cocchi
- Neonatology Unit, Sant'Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Miriam Leuzzi
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Marco A Chessa
- Division of Dermatology, Sant'Orsola-Malpighi Polyclinic, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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Tavora IG, Bissoli GC, Miot HA, Schmitt JV. Clinical manifestations and quality of life in hidradenitis suppurativa patients: survey of participants from an internet support group. An Bras Dermatol 2019; 94:298-303. [PMID: 31365658 PMCID: PMC6668954 DOI: 10.1590/abd1806-4841.20197687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/09/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa is a complex and infrequent autoinflammatory disease that impacts on quality of life. Its pathogenesis is not fully understood, which limits the development of curative treatments. OBJECTIVES To evaluate clinical and quality of life aspects of hidradenitis suppurativa patients from a social group on the Internet. METHODS A cross-sectional, Internet-based survey study among participants in a discussion group (Facebook) of individuals with hidradenitis suppurativa. Patients were asked to answer a questionnaire about clinical-demographic aspects and quality of life (DLQI-BRA). RESULTS A total of 390 individuals agreed to participate in the study, 82% of them female, median age (p25-p75), of 31 (25-37) years old, disease onset at 15 (13-23) years, family member affected in 20% of cases, overweight (BMI 29 [25-33]) kg/m2 and severe impact on quality of life (DLQI 20 [13-25]). Regarding Hurley's classification, the participants provided information that enabled classification into: I (19%), II (52%) and III (29%). More severe cases were associated with males (OR = 1.69), higher weight (BMI: OR = 1.03) non-white color (OR = 1.43) and higher frequency of other autoinflammatory diseases (OR = 1.37). STUDY LIMITATIONS Voluntary adherence survey with self-completion of the questionnaire by 390 from about 1600 group members. CONCLUSIONS Hidradenitis suppurativa patients who participated in a social network group had onset of the disease after puberty, with a predominance in females and overweight people, with great impact on the quality of life.
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Affiliation(s)
- Isabel Greco Tavora
- Medical school student, Universidade Estadual Paulista, Botucatu
(SP), Brazil
| | | | - Hélio Amante Miot
- Department of Dermatology and Radiotherapy, Universidade Estadual
Paulista, Botucatu (SP), Brazil
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Posso-De Los Rios CJ, Sarfo A, Ghias M, Alhusayen R, Hamzavi I, Lowes MA, Alavi A. Proceeding report of the third symposium on Hidradenitis Suppurativa advances (SHSA) 2018. Exp Dermatol 2019; 28:769-775. [PMID: 30924968 PMCID: PMC6800012 DOI: 10.1111/exd.13928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 03/18/2019] [Indexed: 01/11/2023]
Abstract
The 3rd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 12-14 October 2018 at the Women's College Hospital in Toronto, Ontario, Canada. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF) founded in the USA and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This cross-disciplinary meeting with experts from around the world was an opportunity to discuss the most recent advances in the study of hidradenitis suppurativa pathogenesis, epidemiology, classification, scoring systems, radiologic diagnosis, treatment approaches and psychologic assessment. Two special sessions this year were HS as a systemic disease and HS management guidelines. There were focused workshops on wound healing and ultrasound. There were two sessions primarily for patients and their families in the HS School programme: One workshop focused on mindfulness, and the second involved discussion among clinicians and patients about various disease aspects and the latest management. To facilitate networking between clinical and research experts and those early in their career, a mentoring breakfast was held.
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Affiliation(s)
| | - Akua Sarfo
- Department of Dermatology, Pennsylvania State University
College of Medicine, Hershey, PA, USA
| | - Mondana Ghias
- Albert Einstein College of Medicine, Montefiore Medical
Center, Bronx, NY, USA
| | - Raed Alhusayen
- Division of Dermatology, Sunnybrook Research Institute,
Toronto, ON, Canada
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit,
MI, USA
| | | | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University
of Toronto, Toronto, ON, Canada
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol 2019; 81:91-101. [PMID: 30872149 PMCID: PMC9131892 DOI: 10.1016/j.jaad.2019.02.068] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniel B Eisen
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada
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Vankeviciute RA, Polozovaite B, Trapikas J, Raudonis T, Grigaitiene J, Bylaite-Bucinskiene M. A 12-Year Experience of Hidradenitis Suppurativa Management. Adv Skin Wound Care 2019; 32:1-7. [PMID: 30570558 DOI: 10.1097/01.ASW.0000549611.06727.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although treatment recommendations for hidradenitis suppurativa (HS) are well known, practical experience implementing them in Lithuania has not been reported yet. OBJECTIVE To review clinical findings and treatment options used in patients with HS in the largest center of dermatology and venereology in Lithuania from 2005 to 2016. METHODS A retrospective single-center medical file analysis was conducted on 46 patients with HS. Demographic information, patient history, and treatment results were included in the final analysis. χ Tests were used. Statistical significance was set at P ≤ .05. MAIN RESULTS Of the 46 patients, 52.2% were male. Percentages of patients with Hurley stages I, II, and III were 41.3%, 30.4%, and 28.3%, respectively. Patients with Hurley III HS were more likely to be smokers and obese. The most commonly prescribed medications were systemic antibiotics (76.1%) and systemic retinoids (37.0%). Systemic corticosteroids (19.6%) were more often prescribed to patients with Hurley III. Surgical procedures were performed in 54.3% of patients. The most common complication of the disease was contracture (13.0%). CONCLUSIONS This study revealed an association between smoking and obesity and the most severe stage of HS. Results showed that traditional medications used in this study were not effective for severe HS.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rodríguez-zuñiga M, García-perdomo H, Ortega-loayza A. Association Between Hidradenitis Suppurativa and Metabolic Syndrome: A Systematic Review and Meta-analysis. Actas Dermo-Sifiliográficas (English Edition) 2019; 110:279-288. [DOI: 10.1016/j.adengl.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Cuenca-Barrales C, Ruiz-Villaverde R, Molina-Leyva A. Sexual Distress in Patients with Hidradenitis Suppurativa: A Cross-Sectional Study. J Clin Med 2019; 8:jcm8040532. [PMID: 31003427 PMCID: PMC6518250 DOI: 10.3390/jcm8040532] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/22/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic auto-inflammatory skin disease with a great impact in quality of life. However, there is little research about the impact of HS on sex life. The aims of this study are to describe the frequency of sexual distress (SD) in patients with HS and to explore potentially associated epidemiological and clinical factors. We conducted a cross-sectional study by means of a crowd-sourced online questionnaire hosted by the Spanish hidradenitis suppurativa patients’ association (ASENDHI). Sexual distress (SD) was evaluated with a Numeric Rating Scale (NRS) for HS impact on sex life. A total of 393 participants answered the questionnaire. The mean NRS for HS impact on sex life was 7.24 (2.77) in women and 6.39 (3.44) in men (p < 0.05). Variables significantly associated (p < 0.05) with SD in the multiple linear regression model were sex, with a higher risk in females, the presence of active lesions in the groin and genitals and NRS for pain and unpleasant odor; being in a stable relationship was an important protector factor. Regarding these results, it seems that SD in HS patients is due, at least in part, to disease symptoms and active lesions in specific locations, emphasizing the importance of disease control with a proper treatment according to management guidelines. Women and single patients are more likely to suffer from sexual distress.
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Affiliation(s)
- Carlos Cuenca-Barrales
- Dermatology, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016 Granada, Spain.
| | - Ricardo Ruiz-Villaverde
- Dermatology, Hospital Universitario San Cecilio, Avenida de la Investigación s/n, 18016 Granada, Spain.
| | - Alejandro Molina-Leyva
- Dermatology, Hidradenitis Suppurativa Clinic, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain.
- European Hidradenitis Suppurativa Foundation (EHSF), 06847 Dessau-Roßlau, Germany.
- Instituto de Investigación Biosanitaria Granada, 18016 Granada, Spain.
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Rodríguez-Zuñiga MJM, García-Perdomo HA, Ortega-Loayza AG. Association Between Hidradenitis Suppurativa and Metabolic Syndrome: A Systematic Review and Meta-analysis. Actas Dermosifiliogr (Engl Ed) 2019; 110:279-88. [PMID: 30846164 DOI: 10.1016/j.ad.2018.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/05/2018] [Accepted: 10/21/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recent studies have shown a relationship between hidradenitis suppurativa (HS) and metabolic syndrome (MS), but the literature offers no meta-analysis restricted to studies that have been adjusted for confounders. OBJECTIVE To determine the association between HS and MS. METHODS A systematic review and meta-analysis of observational studies on HS and MS in adults. We searched MEDLINE, SCOPUS, SCIELO, Google Scholar, Science Direct, and LILACS from the inception of the databases to January 2016. We performed a random effects model meta-analysis for studies reporting adjusted and crude odds ratios (ORs) with 95% CIs. A subgroup analysis was related to the type of HS patient (general patients vs hospital patients) and age group (adults vs children and adults). RESULTS Five studies including 3950 HS patients were analyzed. We found that MS was pres-ent in 9.64% of HS patients (OR, 1.82; 95%, CI 1.39-2.25). Studies from tertiary care hospital dermatology clinics (OR, 2.82; 95% CI, 0.58-5.06) reported a greater risk for MS than studies carried out in patients treated outside hospitals (OR, 1.78; 95% CI, 1.34-2.22). Studies that included pediatric populations reported a significant association (OR, 2.10; 95% CI, 1.58-2.62). LIMITATION Few of the included studies reported adjusted ORs. CONCLUSIONS HS patients have an increased risk for MS. Clinicians should consider screening HS patients for metabolic risk factors.
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Tricarico PM, Zupin L, Ottaviani G, Pacor S, Jean-Louis F, Boniotto M, Crovella S. Photobiomodulation therapy promotes in vitro wound healing in nicastrin KO HaCaT cells. J Biophotonics 2018; 11:e201800174. [PMID: 29968387 DOI: 10.1002/jbio.201800174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/01/2018] [Indexed: 06/08/2023]
Abstract
Mutations in NCSTN gene (encoding for nicastrin protein) are associated with hidradenitis suppurativa (HS), a chronic inflammatory disease involving hair follicles. HS is clinically handled with drugs but the most severe cases are treated with surgery. Photobiomodulation (PBM) therapy, already used in the treatment of skin diseases such as acne, herpes virus lesions, ultraviolet damage, vitiligo, hypertrophic scar, keloid, burn, psoriasis and diabetic chronic wounds, could be beneficial as an adjuvant supportive treatment to promote and foster the healing process after skin excision in HS. The effects of PBM therapy in promoting the wound closure are evaluated in a HaCaT cells NCSTN-/-, assessing cell metabolism, migration rate, proliferation and cell cycle progression. In our experimental model, PBM exerts a potent action on metabolism of mutated keratinocytes, incrementing adenosine triphosphate (ATP) production at 2 hours, while after 24 hours an increase of metabolism with a decrement of intracellular ATP levels were recorded. Moreover, PBM speeds up the wound closure, inducing cells' migration without affecting their proliferation.Based on our findings, we suggest the use of PBM in HS patients, who undergo major surgery with large skin excision.
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Affiliation(s)
| | | | | | | | - Francette Jean-Louis
- INSERM U955 Eq.16, Institut Mondor de Recherche Biomédicale and VRI (Vaccine Research Institute), Créteil, France
| | - Michele Boniotto
- INSERM U955 Eq. 16, Institut Mondor de Recherche Biomédicale and Université Paris Est-Créteil (UPEC), Faculté de Médecine, Créteil, France
| | - Sergio Crovella
- University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health "Burlo Garofolo", Trieste, Italy
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Molina-Leyva A, Cuenca-Barrales C. Adolescent-Onset Hidradenitis Suppurativa: Prevalence, Risk Factors and Disease Features. Dermatology 2018; 235:45-50. [DOI: 10.1159/000493465] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
Background/Aims: Hidradenitis suppurativa (HS) is a chronic inflammatory and destructive skin disorder. Early diagnosis and treatment are critical to stop its progression. Data concerning adolescent-onset HS are scarce. The aims of this study are to describe the prevalence of adolescent-onset HS and to explore potential risk factors and the disease features of these patients. Patients and Methods: A cross-sectional study including 134 patients was performed. Results: Adolescent-onset HS occurred in 51.5% (69/134) of patients. Adolescent-onset HS was associated with female sex, positive family history, presence of pilonidal sinus, acne conglobata, longer disease duration and a worse perception of disease severity. Conclusion: Adolescent-onset HS might be more frequent than previously reported. Female sex, positive family history and the presence of elements of the follicular occlusion tetrad identify individuals with a higher risk of early onset. These patients experience a longer disease duration and perceive their disease as severer.
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47
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Garg A, Wertenteil S, Baltz R, Strunk A, Finelt N. Prevalence Estimates for Hidradenitis Suppurativa among Children and Adolescents in the United States: A Gender- and Age-Adjusted Population Analysis. J Invest Dermatol 2018; 138:2152-6. [DOI: 10.1016/j.jid.2018.04.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 02/04/2023]
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Loo CH, Tan WC, Tang JJ, Khor YH, Manikam MT, Low DE, Chan KH, Chan KH, Teoh YM, Sohot NQA, Tang MM, Chan LC. The clinical, biochemical, and ultrasonographic characteristics of patients with hidradenitis suppurativa in Northern Peninsular Malaysia: a multicenter study. Int J Dermatol 2018; 57:1454-1463. [DOI: 10.1111/ijd.14210] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/05/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Chai Har Loo
- Department of Dermatology; Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - Wooi Chiang Tan
- Department of Dermatology; Hospital Pulau Pinang; Penang Malaysia
| | - Jyh Jong Tang
- Department of Dermatology; Hospital Raja Permaisuri Bainun; Ipoh Malaysia
| | - Yek Huan Khor
- Department of Dermatology; Hospital Pulau Pinang; Penang Malaysia
| | | | - Dyoi-E Low
- Department of Dermatology; Hospital Raja Permaisuri Bainun; Ipoh Malaysia
| | - Kam Hong Chan
- Department of Radiology; Hospital Pulau Pinang; Penang Malaysia
| | - Kok Hoe Chan
- Department of Radiology; Hospital Raja Permaisuri Bainun; Ipoh Malaysia
| | - Yuen Mey Teoh
- Department of Radiology; Hospital Sultanah Bahiyah; Kedah Malaysia
| | | | - Min Moon Tang
- Department of Dermatology; Hospital Kuala Lumpur; Kuala Lumpur Malaysia
| | - Lee Chin Chan
- Department of Dermatology; Hospital Pulau Pinang; Penang Malaysia
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Tiri H, Jokelainen J, Timonen M, Tasanen K, Huilaja L. Somatic and psychiatric comorbidities of hidradenitis suppurativa in children and adolescents. J Am Acad Dermatol 2018. [DOI: 10.1016/j.jaad.2018.02.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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50
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Braunberger TL, Nicholson CL, Gold L, Nahhas AF, Jacobsen G, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa in children: The Henry Ford experience. Pediatr Dermatol 2018; 35:370-373. [PMID: 29575194 DOI: 10.1111/pde.13466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although recent hidradenitis suppurativa studies have shown that early-onset disease is associated with a positive family history and more widespread disease, research in pediatric hidradenitis suppurativa is limited. METHODS Thirty-three children diagnosed with hidradenitis suppurativa during an 18-month period were included in this institutional review board-approved, retrospective chart review. Information on demographic characteristic, family history, and timing of onset (prepubescent vs postpubescent) was extracted. The Fisher exact test, Cochran-Armitage exact trend test, and chi-square test were used to examine the association between prepubescent or postpubescent onset of hidradenitis suppurativa and sex, disease severity, and family history. RESULTS A significantly higher percentage of patients with postpubescent onset were female (85.7%) than male (14.3%), whereas those with prepubescent onset were more likely to be male (58.3%) than female (41.7%; P = .02). Associations between disease onset and positive family history of hidradenitis suppurativa (P = .47) or higher Hurley stage of disease (P = .15) were not statistically significant. CONCLUSION Boys are more likely to have prepubescent onset of hidradenitis suppurativa and girls to have postpubescent onset. This shift in sex distribution is unexplained, but we hypothesize that, whereas the role of ovarian hormones in the pathogenesis of HS may underlie much of adult-onset disease, it is less important in prepubescent disease.
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Affiliation(s)
| | | | - Lauren Gold
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Amanda F Nahhas
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
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