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Wainman HE, Chandran NS, Frew JW, Garg A, Gibbons A, Gierbolini A, Horvath B, Jemec GB, Kirby B, Kirby J, Lowes MA, Martorell A, McGrath BM, Naik HB, Oon HH, Prens E, Sayed CJ, Thorlacius L, Van der Zee HH, Villumsen B, Ingram JR. Global consensus process to establish a core dataset for hidradenitis suppurativa registries. Br J Dermatol 2024; 190:510-518. [PMID: 37976235 DOI: 10.1093/bjd/ljad454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Several registries for hidradenitis suppurativa (HS) already exist in Europe and the USA. There is currently no global consensus on a core dataset (CDS) for these registries. Creating a global HS registry is challenging, owing to logistical and regulatory constraints, which could limit opportunities for global collaboration as a result of differences in the dataset collected. The solution is to encourage all HS registries to collect the same CDS of information, allowing registries to collaborate. OBJECTIVES To establish a core set of items to be collected by all HS registries globally. The core set will cover demographic details, comorbidities, clinical examination findings, patient-reported outcome measures and treatments. METHODS Beginning in September 2022, 20 participants - including both clinicians with expertise in HS and patient advocates - from eight countries across three continents participated in a Delphi process consisting of four rounds of voting, with all participants completing each round. A list of potential items for inclusion in the core set was generated from the relevant published literature, including systematic reviews of comorbidities in HS, clinical and examination findings, and epidemiology. For disease severity and progression items, the Hidradenitis SuppuraTiva Core outcome set International Collaboration (HiSTORIC) core set and other relevant instruments were considered for inclusion. This resulted in 47 initial items. Participants were invited to suggest additional items to include during the first round. Anonymous feedback was provided to inform each subsequent round of voting to encourage consensus. RESULTS The eDelphi process established a CDS of 48 items recommended for inclusion in all HS registries globally. CONCLUSIONS The routine adoption of this CDS in current and future HS registries should allow registries in different parts of the world to collaborate, enabling research requiring large numbers of participants.
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Affiliation(s)
- Hannah E Wainman
- Department of Dermatology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Nisha S Chandran
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA
| | - Angela Gibbons
- Patient Representative, The HS Support Network UK and Ireland, UK
| | | | - Barbara Horvath
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gregor B Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Brian Kirby
- Charles Department of Dermatology, St. Vincent's University Hospital, Dublin, Ireland
- Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Joselyn Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | | | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Hazel H Oon
- Department of Dermatology, National Skin Centre, Singapore, Singapore
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H Van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bente Villumsen
- Patient Representative, The Patients' Association HS Denmark, Denmark
| | - John R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
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Rinderknecht FAB, Naik HB. Access to dermatologic care and provider impact on hidradenitis suppurativa care: global survey insights. Int J Womens Dermatol 2024; 10:e130. [PMID: 38240011 PMCID: PMC10796138 DOI: 10.1097/jw9.0000000000000130] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Background Hidradenitis suppurativa (HS) is an understudied disease, and current HS studies have focused on participants already connected to dermatologic care. Objective We surveyed participants in online HS support communities to gain a comprehensive understanding of how provider type impacts HS disease management and the issues individuals with HS face when accessing care. Methods From June 13 to June 30, 2021, we administered an anonymous cross-sectional online survey to HS Facebook support group participants who had a self-confirmed diagnosis of HS. Survey items assessed respondent demographics, primary HS provider, and barriers to HS care and pain management. Descriptive analyses are presented. Results The survey was viewed 5,168 times and 1,040 surveys met eligibility criteria (20.1%). Survey participants were 97% female and 72% White. Seventy-two percentage resided in the United States and 22% in Europe. Forty-seven percentage reported having a dermatologist as their primary HS provider, 38% reported a nondermatologist, and 15% reported no HS provider. We found that Asian race, full-time employment, private health insurance, and urban setting were each associated with higher rates of having a dermatologist as a primary HS provider. However, 43.7% of those with a dermatologist reported biologic use, as compared with 14.5% with nondermatologist HS providers. Our cohort was notably more severely impacted by comorbid diseases; 55.9% of our cohort had anxiety, 53.6% had depression, and 50.7% had obesity. Overall, 74.2% of our cohort reported experiencing stigma while accessing care for their HS. Limitations Participant recruitment via social media platform facilitates recruitment of individuals across the spectrum of healthcare access, but may introduce selection bias and favor well-resourced areas. Self-reported data may be subject to recall bias. Conclusion Our study provides unique insights into the characteristics and experiences of individuals with HS across the spectrum of health care access.
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Affiliation(s)
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco, California
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Naik HB. Balancing Ertapenem Therapy in Recalcitrant Hidradenitis Suppurativa With Antibiotic Stewardship. JAMA Dermatol 2024; 160:319. [PMID: 38353969 DOI: 10.1001/jamadermatol.2023.6197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco
- Associate Editor, JAMA Dermatology
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Bouazzi D, Andersen RK, Vinding GR, Medianfar CE, Nielsen SM, Saunte DML, Chandran NS, van der Zee HH, Zouboulis CC, Benhadou F, Villumsen B, Alavi A, Ibekwe PU, Hamzavi IH, Ingram JR, Naik HB, Garg A, Boer J, Christensen R, Jemec GBE. The Global Hidradenitis Suppurativa Atlas (GHiSA) Methodology: Combining Global Proportions in a Pooled Analysis. Dermatology 2024:000536389. [PMID: 38354718 DOI: 10.1159/000536389] [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] [Received: 08/03/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Data concerning the global burden of Hidradenitis Suppurativa (HS) are limited. Reported prevalence estimates vary between 0.0003% and 4.1%, and data from various geographical regions are still to be collected. Previously reported prevalence rates have been limited by the methodological approach and source of data. This has resulted in great heterogeneity as prevalence data from physician-diagnosed cases poorly match those of self-reported apparent HS disease. METHODS The Global Hidradenitis Suppurativa Atlas (GHiSA) introduces an innovative approach to determine the global prevalence of HS. This approach involves using a previously validated questionnaire to screen apparently healthy adults accompanying a patient to a non-dermatological outpatient clinic visit in a hospital. The screening questionnaire (i.e., the index test) is combined with a subsequent physician-based in-person validation (i.e., the reference standard) of the participants who screen positive. Ten percent of the screen-negative participants are also clinically assessed to verify the diagnostic precision of the test. The local prevalence (pi) will be estimated from each country that submits the number of patients who are HS positive according to the index test and clinical examination (n), and the corresponding total number of observations (N). CONCLUSION The GHiSA Global Prevalence studies are currently running simultaneously in 58 countries across six continents (Africa, Europe, Australia, North America, South America, and Asia). The goal of the combined global proportion is the generation of a single summary (i.e., proportional meta-analysis), which will be done after a logit transformation, and synthesized using a random-effects model. The novel standardization of the Global Prevalence studies conducted through GHiSA enables direct international comparisons, which were previously not possible due to substantial heterogeneity in past HS prevalence studies.
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Lowe MM, Cohen JN, Moss MI, Clancy S, Adler JP, Yates AE, Naik HB, Yadav R, Pauli M, Taylor I, McKay A, Harris H, Kim E, Hansen SL, Rosenblum MD, Moreau JM. Tertiary lymphoid structures sustain cutaneous B cell activity in hidradenitis suppurativa. JCI Insight 2024; 9:e169870. [PMID: 38113104 DOI: 10.1172/jci.insight.169870] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic skin condition affecting approximately 1% of the US population. HS skin lesions are highly inflammatory and characterized by a large immune infiltrate. While B cells and plasma cells comprise a major component of this immune milieu, the biology and the contribution of these cells in HS pathogenesis are unclear. We aimed to investigate the dynamics and microenvironmental interactions of B cells within cutaneous HS lesions. Combining histological analysis, single-cell RNA sequencing, and spatial transcriptomics profiling of HS lesions, we defined the tissue microenvironment relative to B cell activity within this disease. Our findings identified tertiary lymphoid structures (TLSs) within HS lesions and described organized interactions among T cells, B cells, antigen-presenting cells, and skin stroma. We found evidence that B cells within HS TLSs actively underwent maturation, including participation in germinal center reactions and class switch recombination. Moreover, skin stroma and accumulating T cells were primed to support the formation of TLSs and facilitate B cell recruitment during HS. Our data definitively demonstrated the presence of TLSs in lesional HS skin and point to ongoing cutaneous B cell maturation through class switch recombination and affinity maturation during disease progression in this inflamed nonlymphoid tissue.
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Affiliation(s)
- Margaret M Lowe
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Jarish N Cohen
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Madison I Moss
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Sean Clancy
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - James P Adler
- Bioinformatics and Genomics master's program, University of Oregon, Eugene, Oregon, USA
- Cancer Early Detection Advanced Research Center, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | - Ashley E Yates
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Rashi Yadav
- Cancer Early Detection Advanced Research Center, Oregon Health & Science University (OHSU), Portland, Oregon, USA
| | | | - Ian Taylor
- TRex Bio, South San Francisco, California, USA
| | | | - Hobart Harris
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Esther Kim
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Scott L Hansen
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Michael D Rosenblum
- Department of Dermatology, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Joshua M Moreau
- Cancer Early Detection Advanced Research Center, Oregon Health & Science University (OHSU), Portland, Oregon, USA
- Division of Oncological Sciences
- Department of Dermatology, and
- Department of Cell, Developmental and Cancer Biology, OHSU, Portland, Oregon, USA
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Fonjungo FE, Barnes LA, Cai ZR, Naik HB, Eid E, Aleshin MA, Nava V, Johnson T, Chren MM, Linos E. Longitudinal remote monitoring of hidradenitis suppurativa: a pilot study. Br J Dermatol 2024; 190:274-276. [PMID: 37823362 PMCID: PMC10805523 DOI: 10.1093/bjd/ljad385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/07/2023] [Accepted: 10/29/2023] [Indexed: 10/13/2023]
Abstract
We sought to investigate the feasibility of longitudinal monitoring of disease activity from home in people with hidradenitis suppurativa (HS). Over 6 months, our novel digital tool collected 421 photos of HS-affected skin from 27 participants and captured trends in pain and quality of life scores. We found that participants with mild disease were more likely to share their progress than those with more severe disease, which is favourable as it may suggest a role for remote monitoring in tracking disease progression. This pilot provides proof of concept that will support future studies.
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Affiliation(s)
- Fonette E Fonjungo
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
- Meharry Medical College, Nashville, TN
- Vanderbilt University School of Medicine, Nashville, TN
| | | | - Zhuo Ran Cai
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA
, USA
| | - Edward S Eid
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
| | | | - Vanessa Nava
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
| | | | | | - Eleni Linos
- Department of Dermatology, Stanford Medicine, Palo Alto, CA
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Rinderknecht FAB, Naik HB. Female sex and younger age are associated with hidradenitis suppurativa diagnostic delay. Int J Womens Dermatol 2023; 9:e114. [PMID: 37927367 PMCID: PMC10619890 DOI: 10.1097/jw9.0000000000000114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/11/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California
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8
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Mastacouris N, Tannenbaum R, Strunk A, Koptyev J, Aarts P, Alhusayen R, Bechara FG, Benhadou F, Bettoli V, Brassard A, Brown D, Choon SE, Coutts P, da Silva DLF, Daveluy S, Dellavalle RP, Del Marmol V, Emtestam L, Gebauer K, George R, Giamarellos-Bourboulis EJ, Goldfarb N, Hamzavi I, Hazen PG, Horváth B, Hsiao J, Ingram JR, Jemec GBE, Kirby JS, Lowes MA, Marzano AV, Matusiak L, Naik HB, Okun MM, Oon HH, Orenstein LAV, Paek SY, Pascual JC, Fernandez-Peñas P, Resnik BI, Sayed CJ, Thorlacius L, van der Zee HH, van Straalen KR, Garg A. Outcome Measures for the Evaluation of Treatment Response in Hidradenitis Suppurativa for Clinical Practice: A HiSTORIC Consensus Statement. JAMA Dermatol 2023; 159:1258-1266. [PMID: 37755725 DOI: 10.1001/jamadermatol.2023.3282] [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: 09/28/2023]
Abstract
Importance Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines. Objective To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied. Evidence Review Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice. Findings Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]). Conclusions and Relevance An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting.
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Affiliation(s)
| | | | | | | | - Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, Ruhr-University, Bochum, Germany
| | - Farida Benhadou
- Department of Dermatology, Hôpital Universitaire de Bruxelles, CUB Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - Vincenzo Bettoli
- Department of Medical Sciences, O.U. of Dermatology, Azienda Ospedaliera, University of Ferrara, Ferrara, Italy
| | | | - Debra Brown
- Medical Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Siew Eng Choon
- Hospital Sultanah Aminah and Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia
| | | | | | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz School of Medicine, Aurora, Colorado
- Dermatology Service, Eastern Colorado Health Care System, US Department of Veterans Affairs, Aurora, Colorado
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Universite Libre de Bruxelles, Brussels, Belgium
| | - Lennart Emtestam
- Section of Infectious Diseases and Dermatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kurt Gebauer
- University of Western Australia, Perth, Western Australia, Australia
| | - Ralph George
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Noah Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Paul G Hazen
- Case-Western Reserve University School of Medicine, Cleveland, Ohio
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennifer Hsiao
- Department of Dermatology, University of Southern California, Los Angeles
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Joslyn S Kirby
- Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | | | - Hazel H Oon
- National Skin Centre, Singapore, Singapore City, Singapore
- Lee Kong Chian School of Medicine, Singapore City, Singapore
| | - Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - So Yeon Paek
- Baylor University Medical Center, Dallas, Texas A&M University School of Medicine, Dallas
| | - José C Pascual
- Dermatology Department, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain
| | - Pablo Fernandez-Peñas
- Department of Dermatology, Westmead Hospital, The University of Sydney, Westmead, New South Wales, Australia
| | - Barry I Resnik
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Christopher J Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Amit Garg
- Northwell Health, New Hyde Park, New York
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Williams JC, Alhusayen R, Guilbault S, Ingram JR, Lowes MA, Yannuzzi CA, Naik HB. Patient-reported influences on COVID-19 vaccine acceptance and hesitancy in people with hidradenitis suppurativa. Br J Dermatol 2023; 189:351-353. [PMID: 37210215 PMCID: PMC10449532 DOI: 10.1093/bjd/ljad166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/10/2023] [Accepted: 05/20/2023] [Indexed: 05/22/2023]
Abstract
COVID-19 continues to pose a risk to patients with hidradenitis suppurativa (HS) due to the high prevalence of comorbidities associated with severe COVID-19 disease. We aimed to characterize perspectives on COVID-19 vaccination among patients with HS. International respondents from 20 online HS support groups were recruited to complete a voluntary, anonymous, online cross-sectional survey from 25 October to 21 November 2021 to obtain perspectives from people with HS who may and may not access healthcare. We report higher rates of COVID-19 vaccine hesitancy among patients with HS who expressed dissatisfaction with their dermatological care.
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Affiliation(s)
| | - Raed Alhusayen
- Dermatology Division, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology and Academic Wound Healing, Cardiff University, Cardiff, UK
| | | | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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Barnes LA, Shukla N, Paul M, de Vere Hunt I, Halley MC, Linos E, Naik HB. Patient Perspectives of Health System Barriers to Accessing Care for Hidradenitis Suppurativa: A Qualitative Study. JAMA Dermatol 2023; 159:510-517. [PMID: 37017984 PMCID: PMC10077133 DOI: 10.1001/jamadermatol.2023.0486] [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: 10/27/2022] [Accepted: 02/09/2023] [Indexed: 04/06/2023]
Abstract
Importance Patient-perceived barriers to hidradenitis suppurativa (HS) care are poorly understood. Understanding health care barriers is a critical first step toward improving care for this population. Objective To characterize the health care experiences of people living with HS, including perceived barriers and facilitators to health care access, and to elucidate potential associations among these barriers and facilitators, health care access, and disease activity. Design, Setting, and Participants In this qualitative study, an inductive thematic analysis was conducted on 45 in-depth, 60- to 90-minute semistructured interviews of 45 people with HS from diverse sociodemographic backgrounds that took place between March and April 2020. Individuals were eligible if they could speak English, were 18 years or older, and were diagnosed with HS. A diagnosis of HS was confirmed through physician diagnosis or through self-reported, affirmative response to the validated screening question, "Do you experience boils in your armpits or groin that recur at least every six months?" Main Outcomes and Measures Interviews were audio recorded and transcribed verbatim. A modified grounded theory approach was used to develop the codebook, which investigators used for inductive thematic analysis. Results Among the 45 participants included, the median (IQR) age was 37 (16) years, 33 (73%) were female, and 22 (49%) were White. There were 6 interrelated themes associated with participant-perceived barriers to accessing HS care: (1) bidirectional associations of disease activity and employment, (2) association of employment with health care coverage, (3) association of health care coverage with costs and perceived access to care, (4) association of costs with access to patient-centered care, (5) health care professional attitudes and knowledge influence patient-centered care and perceived access to care and disease activity, and (6) health system characteristics influence patient-centered care and associated costs, perceived access to care, and disease activity. Conclusions and Relevance This qualitative study highlights themes that generate a conceptual model for understanding barriers that may act synergistically to limit health care access and influence disease activity. The disease activity of HS may be reduced when cycle elements are optimized. This study also highlights areas for future investigations and potential systems-level changes to improve access to patient-centered HS care.
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Affiliation(s)
- Leandra A. Barnes
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
| | - Neha Shukla
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Maia Paul
- Department of Dermatology, School of Medicine, University of California, San Francisco
| | - Isabella de Vere Hunt
- Program for Clinical Research and Technology, Stanford University, Stanford, California
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, United Kingdom
| | - Meghan C. Halley
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California
| | - Eleni Linos
- Department of Dermatology, Stanford University School of Medicine, Palo Alto, California
- Program for Clinical Research and Technology, Stanford University, Stanford, California
| | - Haley B. Naik
- Department of Dermatology, School of Medicine, University of California, San Francisco
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Naik HB. The Critical Need for Reliable and Clinically Meaningful Outcome Measures for Hidradenitis Suppurativa. JAMA Dermatol 2023:2804251. [PMID: 37099321 DOI: 10.1001/jamadermatol.2023.0784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco
- Associate Editor, JAMA Dermatology
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12
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Garg A, Rawal S, Akilov O, Alavi A, Ardon C, Bechara FG, Cohen AD, Cohen SR, Daveluy S, Del Marmol V, Delage M, Esmann S, Fisher S, Giamarellos-Bourboulis EJ, Glowaczewska A, Goldfarb N, Gonzalez Brant E, Grimstad Ø, Guilbault S, Hamzavi I, Hughes R, Ingram JR, Jemec GBE, Ju Q, Kappe N, Kirby B, Kirby JS, Lowes MA, Matusiak L, Micha S, Micheletti RG, Miller AP, Moseng D, Naik HB, Nassif A, Nikolakis G, Paek SY, Pascual JC, Prens E, Resnik B, Riad H, Sayed C, Smith SD, Soliman Y, Szepietowski JC, Tan J, Thorlacius L, Tzellos T, van der Zee HH, Villumsen B, Wang L, Zouboulis CC, Strunk A. Factors associated with disease-specific life impact in patients with hidradenitis suppurativa: results from the Global VOICE project. Br J Dermatol 2023; 188:808-810. [PMID: 36891871 DOI: 10.1093/bjd/ljad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/30/2023] [Accepted: 03/12/2023] [Indexed: 03/10/2023]
Abstract
Patients with hidradenitis suppurativa experience significant life impact related to their disease. Younger age, Black race, high BMI, active smoking, flares, depression, anxiety, high comorbidity burden, disability, and difficult access to a dermatologist adversely influence life impact related to having hidradenitis suppurativa. Attention to these factors, particularly modifiable ones, may reduce overall impact of disease.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Sahil Rawal
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
| | - Oleg Akilov
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Christine Ardon
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Falk G Bechara
- Department of Dermatology, Venereology and Allergology, International Center for Hidradenitis suppurativa/Acne inversa (ICH), St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Arnon D Cohen
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Science, Ben-Gurion University, Israel
| | - Steven R Cohen
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Steven Daveluy
- Department of Dermatology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Véronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Maïa Delage
- Centre Médical, Institut Pasteur, Paris, France
| | - Solveig Esmann
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Shani Fisher
- Dermatology Department, Emek Medical Center, Afula, Israel
| | | | - Amelia Glowaczewska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Noah Goldfarb
- Departments of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | | | - Øystein Grimstad
- Department of Dermatology, NLSH Bodø, Institute of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | | | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Rosalind Hughes
- Department of Dermatology, St Vincent's University Hospital, and Charles Institute, University College Dublin, Dublin, Ireland
| | - John R Ingram
- Division of Infection and Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Qiang Ju
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, China
| | - Naomi Kappe
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Brian Kirby
- Department of Dermatology, St Vincent's University Hospital, and Charles Institute, University College Dublin, Dublin, Ireland
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, PA, USA
| | | | - Lukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Stella Micha
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela P Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - Dagfinn Moseng
- Department of Dermatology, NLSH Bodø, Institute of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Aude Nassif
- Centre Médical, Institut Pasteur, Paris, France
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - So Yeon Paek
- Department of Dermatology, Baylor University Medical Center, Texas A&M College of Medicine, Dallas, TX, USA
| | - Jose Carlos Pascual
- Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Errol Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Barry Resnik
- Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hassan Riad
- Dermatology Department, Al Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Saxon D Smith
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Yssra Soliman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Poland
| | - Jerry Tan
- Department of Medicine, Western University, Windsor campus, Ontario, Canada
| | - Linnea Thorlacius
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Thrasyvoulos Tzellos
- Department of Dermatology, NLSH Bodø, Institute of Clinical Medicine, UiT- The Arctic University of Norway, Tromsø, Norway
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Lanqi Wang
- Department of Dermatology, Renji Hospital School of Medicine, Shanghai Jiaotong University, China
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Andrew Strunk
- Department of Dermatology, Donald & Barbara Zucker School of Medicine at Hofstra Northwell, Hempstead, NY, USA
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Naik HB, Cowen EW. Reply-Response to Anakinra for refractory pustular psoriasis: A phase II, open label, dose-escalation trial. J Am Acad Dermatol 2023; 88:743-744. [PMID: 36370903 DOI: 10.1016/j.jaad.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco, California.
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
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Lowe MM, Cohen JN, Moss MI, Clancy S, Adler J, Yates A, Naik HB, Pauli M, Taylor I, McKay A, Harris H, Kim E, Hansen SL, Rosenblum MD, Moreau JM. Tertiary Lymphoid Structures Sustain Cutaneous B cell Activity in Hidradenitis Suppurativa. bioRxiv 2023:2023.02.14.528504. [PMID: 36824918 PMCID: PMC9949072 DOI: 10.1101/2023.02.14.528504] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Background Hidradenitis suppurativa (HS) skin lesions are highly inflammatory and characterized by a large immune infiltrate. While B cells and plasma cells comprise a major component of this immune milieu the biology and contribution of these cells in HS pathogenesis is unclear. Objective We aimed to investigate the dynamics and microenvironmental interactions of B cells within cutaneous HS lesions. Methods We combined histological analysis, single-cell RNA-sequencing (scRNAseq), and spatial transcriptomic profiling of HS lesions to define the tissue microenvironment relative to B cell activity within this disease. Results Our findings identify tertiary lymphoid structures (TLS) within HS lesions and describe organized interactions between T cells, B cells, antigen presenting cells and skin stroma. We find evidence that B cells within HS TLS actively undergo maturation, including participation in germinal center reactions and class switch recombination. Moreover, skin stroma and accumulating T cells are primed to support the formation of TLS and facilitate B cell recruitment during HS. Conclusion Our data definitively demonstrate the presence of TLS in lesional HS skin and point to ongoing cutaneous B cell maturation through class switch recombination and affinity maturation during disease progression in this inflamed non-lymphoid tissue.
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15
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Garg A, Naik HB, Alavi A, Hazen P, Hsiao JL, Shi VY, Weisman J, Tran T, Rudnik J, Jedrzejczyk A, Pansar I, Kimball AB. Real-World Findings on the Characteristics and Treatment Exposures of Patients with Hidradenitis Suppurativa from US Claims Data. Dermatol Ther (Heidelb) 2023; 13:581-594. [PMID: 36585607 PMCID: PMC9884733 DOI: 10.1007/s13555-022-00872-1] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, debilitating, and painful inflammatory skin disease that significantly and negatively impacts patients' quality of life. The prevalence of HS in the USA is estimated to be 0.10%, with worldwide reports suggesting a prevalence closer to 1%. There is limited real-world evidence available on the care of patients with HS. We aimed to evaluate the trends in clinical care and treatment in the patient population with HS in the USA in a real-world setting. METHODS A cohort study was conducted using claims data from IBM MarketScan Databases, including the US Commercial Claims and Encounters with Medicare Supplemental and Coordination of Benefits (CCAE+MDCR) database and IBM US Medicaid database. RESULTS The annual prevalence of HS increased from 0.06% (2008) to 0.14% (2017), and from 0.17% (2008) to 0.31% (2017) among CCAE+MDCR and Medicaid patients, respectively. Dermatologist visits increased from 31.9% (2008) to 47.8% (2019) in CCAE+MDCR patients, and decreased from 10.9% (2008) to 8.5% (2018) in Medicaid patients. Opioid use decreased from 45.4% (2008) to 25.5% (2019) among CCAE+MDCR patients, and from 71.3% (2008) to 48.1% (2018) among Medicaid patients. Only 8.4% of CCAE+MDCR patients and 5.8% of Medicaid patients were exposed to any biologic in 2018. CONCLUSIONS Improved care and treatment of HS over the last decade, including the emergence of new treatments, have been accompanied by an increase in awareness and reported prevalence of the disease. However, there are still gaps in access to dermatologic care and low utilization of biologic therapies among patients with HS. INFOGRAPHIC.
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Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, USA.
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Paul Hazen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer L Hsiao
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | | | | | | | | | - Alexa B Kimball
- Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Williams JC, Alhusayen R, Guilbault S, Hills NK, Ingram JR, Kudlinski MV, Lowes MA, Marzano AV, Paul M, Villumsen B, Yannuzzi CA, Naik HB. Biologic Therapy Is Not Associated with Increased COVID-19 Severity in Patients with Hidradenitis Suppurativa: Updated Findings from the Global Hidradenitis Suppurativa COVID-19 Registry. Dermatology 2023; 239:283-286. [PMID: 36566748 PMCID: PMC9808885 DOI: 10.1159/000527401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jazzmin C Williams
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA,
| | - Raed Alhusayen
- Dermatology Division, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | | | - Nancy K Hills
- Department of Neurology, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology and Academic Wound Healing, Cardiff University, Cardiff, UK
| | - Margaret V Kudlinski
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Maia Paul
- Reify Health, Boston, Massachusetts, USA
| | | | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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Kittler NW, Williams JC, Kudlinski MV, Lester J, Hills N, Abuabara K, Naik HB. Evaluation of Hidradenitis Suppurativa Diagnostic Criteria in Pediatric Patients. JAMA Dermatol 2022; 158:1404-1408. [PMID: 36287577 PMCID: PMC9607937 DOI: 10.1001/jamadermatol.2022.4564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/28/2022] [Indexed: 01/13/2023]
Abstract
Importance Hidradenitis suppurativa (HS) is associated with considerable diagnostic delay. Although most patients report adolescent onset, existing HS diagnostic criteria may not adequately capture disease in pediatric populations. Objectives To determine the proportion of physician-diagnosed pediatric patients with HS who met diagnostic criteria, and describe demographics, disease characteristics, and diagnostic patterns among pediatric patients with HS. Design, Setting, and Participants In this retrospective, cross-sectional study, electronic medical records from 2 sites of a single academic tertiary care center were included. Eligible patients were those born after January 1, 1993, and assigned International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/10) codes for HS (ICD-9 705.83/ICD-10 L73.2) between January 1, 2012, and July 1, 2021. Patients were excluded if they were older than 18 years at diagnosis, had inaccessible diagnostic visit notes, or were unintentionally assigned an HS ICD code. Exposures Pediatric patients with HS. Main Outcomes and Measures Fulfillment of diagnostic criteria in pediatric patients with HS. Results A total of 297 adolescents with HS were included in the study; 123 patients were female (78.1%), 78 self-identified as Black (26.3%), and 116 self-identified as Hispanic (39.1%). The median (IQR) age at diagnosis was 14.0 (13.0-16.0) years. Documentation from the diagnostic visit demonstrated that 127 (42.8%) patients did not meet all 3 major HS diagnostic criteria. Of these patients, 122 (96.1%) did not meet the recurrence interval criterion (≥2 lesions within 6 months). Overall, 96 patients who did not meet the recurrence interval criterion had documentation from additional visits in the health system; 59 (61.5%) had documentation of 1 or more additional lesions consistent with HS. Review of these additional records demonstrated that 26 of these 59 (44.1%) patients met the recurrence interval criterion after diagnosis, and 44 (74.6%) had recurrent lesions within a 1-year interval (median, 6.5 months; interquartile range, 3.5-12.2 months). Medical chart review was conducted from November 22, 2021, to January 12, 2022. Analysis was conducted from January 12, 2022, to January 15, 2022. Conclusions and Relevance Overall, 118 (40%) of 297 pediatric patients with HS in this retrospective cross-sectional study did not meet all major diagnostic criteria at the time of diagnosis, largely due to failure to fulfill the 6-month recurrence interval criterion. Future studies are needed to determine the appropriate recurrence interval to facilitate timely diagnosis and promote clinical trial eligibility for pediatric patients with HS.
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Affiliation(s)
| | | | | | - Jenna Lester
- Department of Dermatology, University of California, San Francisco
| | - Nancy Hills
- Department of Neurology, University of California, San Francisco
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco
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Naik HB, Pichard DC, Schwartz DM, O'Brien M, Masciocchi M, Thompson J, Sen HN, Steinberg SM, Mitchell SA, de Jesus AA, McCalmont TH, Dey A, Rosenstein RK, Deng Z, Goldbach-Mansky R, Mehta NN, Cowen EW. Anakinra for refractory pustular psoriasis: A phase II, open-label, dose-escalation trial. J Am Acad Dermatol 2022; 87:1380-1383. [PMID: 36116584 PMCID: PMC10673680 DOI: 10.1016/j.jaad.2022.07.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco, California.
| | - Dominique C Pichard
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Daniella M Schwartz
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Michelle O'Brien
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Matthew Masciocchi
- Radiation Oncology Branch, National Cancer Institute, Bethesda, Maryland
| | - Julie Thompson
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - H Nida Sen
- Clinical and Translational Immunology Unit, Laboratory of Immunology, National Eye Institute, Bethesda, Maryland
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, Outcomes Research Branch, National Cancer Institute, Rockville, Maryland
| | - Adriana A de Jesus
- Translational Autoinflammatory Diseases Section (TADS), LCIM, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Amit Dey
- Section of Inflammation and Cardiovascular Diseases, National Institute of Heart, Lung and Blood Diseases, Bethesda, Maryland
| | - Rachel K Rosenstein
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Zuoming Deng
- Biodata Mining and Discovery Section, Office of Science and Technology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Diseases Section (TADS), LCIM, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Nehal N Mehta
- Section of Inflammation and Cardiovascular Diseases, National Institute of Heart, Lung and Blood Diseases, Bethesda, Maryland
| | - Edward W Cowen
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, Maryland
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Lowe MM, Naik HB, Clancy S, Pauli M, Smith KM, Bi Y, Dunstan R, Gudjonsson JE, Paul M, Harris H, Kim E, Shin US, Ahn R, Liao W, Hansen SL, Rosenblum MD. Immunopathogenesis of hidradenitis suppurativa and response to anti-TNF-α therapy. JCI Insight 2022; 7:165502. [PMID: 36278491 PMCID: PMC9744256 DOI: 10.1172/jci.insight.165502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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20
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Collier EK, Sachdeva M, Yazdani S, Hogeling M, Okun M, Naik HB, Lowes MA, Hsiao JL, Shi VY. Diagnosing and Managing Hidradenitis Suppurativa in Pediatrics. Pediatr Ann 2022; 51:e123-e127. [PMID: 35293815 DOI: 10.3928/19382359-20220222-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease that presents as exquisitely tender abscesses, draining fistulae, and sinus tracts. HS can lead to significant impairments in patients' quality of life, especially for children and adolescents who face challenges related to self-esteem and physical and emotional development. Severe long-term physical sequelae of inadequately treated HS include extensive scarring, urogenital strictures, immobility, and squamous cell carcinoma; emotional sequelae include depression, anxiety, and suicidal ideation. Many of the devastating long-term sequelae associated with HS can be prevented with early recognition and proper collaborative management. This article reviews strategies to aid pediatricians in early diagnosis of HS and provides clinical pearls for management and prevention of disease flares. [Pediatr Ann. 2022;51(3):e123-e127.].
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21
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Ghanian S, Yamanaka-Takaichi M, Naik HB, Alavi A. Medical Management of Hidradenitis Suppurativa with Non-Biologic Therapy: What's New? Am J Clin Dermatol 2022; 23:167-176. [PMID: 34990004 DOI: 10.1007/s40257-021-00667-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2021] [Indexed: 11/25/2022]
Abstract
Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body. The disease can often result in disfigurement and adversely impact patient quality of life. The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities. Management can often be clinically challenging and may involve the combination of medical and surgical approaches for optimal results. The purpose of this review is to present an update on non-biologic and non-interventional modalities published in 2019-2021 in the clinical management of HS. With emerging therapies, ongoing clinical trials, and heightened awareness about HS, there is hope that new treatment options will revolutionize the management of patients suffering from HS.
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Affiliation(s)
- Soha Ghanian
- Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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22
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Der Sarkissian S, Hessam S, Kirby JS, Lowes MA, Mintoff D, Naik HB, Ring HC, Suyien NC, Frew JW. Identification of Biomarkers and Critical Evaluation of Biomarker Validation in Hidradenitis Suppurativa: A Systematic Review. JAMA Dermatol 2022; 158:300-313. [PMID: 35044423 DOI: 10.1001/jamadermatol.2021.4926] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The identification and validation of biomarkers in hidradenitis suppurativa (HS) has potential to improve the understanding and management of this chronic, burdensome disease. Objective To systematically identify all known HS biomarkers, categorize them by biomarker type, and critically evaluate their validity according to established criteria. Evidence Review Eligibility criteria for this review (PROSPERO Registration 230830) included randomized clinical trials, uncontrolled clinical trials, cohort studies, case-control studies, and other observational studies with no restrictions of patient age, sex, race or ethnicity, or language of publication up until December 31, 2020. All articles were categorized into biomarker type, defined using the US Food and Drug Administration Biomarkers, Endpoints, and other Tools (BEST) glossary. Assessment of each identified biomarker was undertaken in line with the US Food and Drug Administration and European Medicines Agency guidelines for the validation of proposed biomarkers. Assessment of the strength of overall data regarding individual biomarkers was undertaken using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Findings A total of 3953 nonduplicate articles were screened, of which 1429 articles were retrieved based on the include/exclusion criteria applied. After full-text screen and data extraction, 106 articles were included in this review. The evidence of strength of 6 categories of biomarkers (susceptibility/risk, diagnostic, monitoring, predictive, prognostic, and pharmacodynamic/response biomarkers) was assessed using GRADE criteria. A total of 48 biomarkers were identified with a minimum GRADE rating of moderate. Only 1 diagnostic (serum IL-2R), 1 monitoring (dermal Doppler vascularity), and 2 predictive biomarkers (epithelialized tunnels and positive family history of HS) achieved a GRADE rating of high. None of the identified biomarkers had sufficient clinical validity to be recommended for routine use in the clinical setting. Conclusions and Relevance Major barriers to the identification, validation, and introduction of routine biomarkers in the management of HS include lack of independent biomarker validation studies (especially assumption-free "omics"-based techniques); insufficient assessment of collinearity between identified or proposed biomarkers; and a lack of routine integration of biomarkers into the structure of clinical trials. International consensus among researchers, clinicians, and pharmaceutical stakeholders is required to standardize goals and methods and encourage biomarker integration into future HS clinical trials. This systematic review presents a number of priorities for near-term future research to overcome such barriers and limitations of biomarkers in HS.
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Affiliation(s)
| | - Schapoor Hessam
- Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, Bochum, Germany
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | - Dillon Mintoff
- Department of Dermatology, Mater Dei Hospital, Msida, Malta
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco.,Associate Editor, JAMA Dermatology
| | - Hans Christian Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nisha Chandran Suyien
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore
| | - John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia.,Laboratory of Translational Cutaneous Medicine, Ingham Institute of Applied Medical Research, Sydney, Australia
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23
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Rick JW, De DR, Shih T, Alavi A, Kirby JS, Naik HB, Frew JW, Sayed CJ, Hsiao JL, Shi VY. Guidance on COVID-19 Vaccination in Hidradenitis Suppurativa Patients: A Modified Delphi Consensus of Experts. Skin Appendage Disord 2022; 8:287-290. [PMID: 35979524 PMCID: PMC9274824 DOI: 10.1159/000521268] [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: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Hidradenitis suppurativa (HS) patients may be at increased risk of COVID-19 infection and complications from their medications and comorbidities. There is a lack of expert consensus on recommendations for the COVID-19 vaccine for HS patients. Herein, we aim to provide expert-driven consensus recommendations regarding COVID-19 vaccinations in HS patients. Methods A modified Delphi consensus survey developed by a core committee of 7 dermatologist HS experts consisting of 4 demographic questions and 12 practice statements was distributed to the US HS Foundation-sponsored provider listserv. Participants were attending physician HS experts. Survey results were to be reviewed by the core group and revised and resubmitted until consensus (≥70% agreement) was achieved. Results Among the 33 survey participants, there were 30 (87%) dermatologists, 1 general surgeon, 1 plastic surgeon, and 1 rheumatologist. Consensus for all 12 statements on vaccine counseling and HS treatment counseling was achieved after the first round. Discussion/Conclusion For now, this consensus can serve as a resource for clinicians discussing COVID-19 vaccination with their HS patients. These recommendations will need to be updated as new evidence on COVID-19 emerges.
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Affiliation(s)
- Jonathan W. Rick
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Devea R. De
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Terri Shih
- David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joslyn S. Kirby
- Department of Dermatology Hershey, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Haley B. Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
| | - John W. Frew
- Department of Dermatology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Christopher J. Sayed
- Department of Dermatology Chapel Hill, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer L. Hsiao
- Division of Dermatology, Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vivian Y. Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- *Vivian Y. Shi,
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24
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Naik HB, Alhusayen R, Frew J, Guilbault S, Hills NK, Ingram JR, Kudlinski MV, Lowes MA, Marzano AV, Paul M, Villumsen B, Yannuzzi CA. Biologic therapy is not associated with increased COVID-19 severity in patients with hidradenitis suppurativa: Initial findings from the Global Hidradenitis Suppurativa COVID-19 Registry. J Am Acad Dermatol 2022; 86:249-252. [PMID: 34537252 PMCID: PMC8443529 DOI: 10.1016/j.jaad.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/17/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco, California.
| | - Raed Alhusayen
- Dermatology Division, Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - John Frew
- Department of Dermatology, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | | | - Nancy K Hills
- Department of Neurology, Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology & Academic Wound Healing, Cardiff University, Cardiff, United Kingdom
| | | | | | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Maia Paul
- Department of Dermatology, University of California, San Francisco, California
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25
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Noe MH, Wan MT, Mostaghimi A, Gelfand JM, Agnihothri R, Armstrong AW, Bhutani T, Bridges A, Brownstone N, Butt M, Duffin KPC, Carr C, Creadore A, DeNiro KL, Desai S, Dominguez AR, Duffy EK, Fairley JA, Femia A, Gudjonsson JE, Kaffenberger JA, Katz KL, Kirby JS, Le ST, Martinez E, Maverakis E, Myers B, Naik HB, Nelson CA, Ortega-Loayza AG, Plovanich ME, Rangel LK, Ravi V, Reddy VD, Saleh JZ, Sandhu JK, Shakshouk H, Shields BE, Sharif-Sidi Z, Smith J, Steahr A, Toussi A, Wanat KA, Wang B, Wei BM, Weinhammer A, Worswick SD, Yang A. Evaluation of a Case Series of Patients With Palmoplantar Pustulosis in the United States. JAMA Dermatol 2021; 158:68-72. [PMID: 34878495 DOI: 10.1001/jamadermatol.2021.4635] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Palmoplantar pustulosis (PPP) is a is a chronic, orphan disease with limited epidemiological data. Objective To describe the clinical characteristics, treatments, longitudinal disease course, and health care utilization in adults with PPP across the US. Design, Setting, and Participants This retrospective, longitudinal case series from 20 academic dermatology practices in the US included a consecutive sample of 197 adults who met the European Rare and Severe Psoriasis Expert Network consensus definition for PPP between January 1, 2007, and December 31, 2018. Data analysis was performed June 2020 to December 2020. Main Outcomes and Measures The primary outcome was to describe the patient characteristics, associated medical comorbidities, treatment patterns, complications, and PPP-specific health care utilization. Results Of 197 patients, 145 (73.6%) were female, and the mean (SD) age at presentation was 53.0 (12.6) years, with a mean (SD) follow-up time of 22.1 (28.0) months. On initial presentation, 95 (48.2%) patients reported skin pain, and 39 (19.8%) reported difficulty using hands and/or feet. Seventy patients (35.5%) were treated with systemic treatments, and use of more than 20 different systemic therapies was reported. In patients with at least 6 months of follow-up (n = 128), a median (IQR) of 3.7 (4-10) dermatology visits per year were reported; 24 (18.8%) patients had 5 or more visits during the study period. Conclusions and Relevance In this case series, PPP was associated with persistent symptoms, continued health care utilization, and a lack of consensus regarding effective treatments, emphasizing the unmet medical need in this population. Additional research is necessary to understand treatment response in these patients.
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Affiliation(s)
- Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marilyn T Wan
- Department of Internal Medicine, Memorial Hospital West, Pembroke Pines, Florida
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | - Ritesh Agnihothri
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - April W Armstrong
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Tina Bhutani
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Alina Bridges
- Department of Dermatology, Mayo Clinic Graduate School of Education, Rochester, Minnesota.,Richfield Laboratory of Dermatopathology, Dermpath Diagnostics, Cincinnati, Ohio
| | - Nicholas Brownstone
- Department of Dermatology, Psoriasis and Skin Treatment Center, University of California San Francisco
| | - Melissa Butt
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Andrew Creadore
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Katherine L DeNiro
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Sheena Desai
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| | - Arturo R Dominguez
- Departments of Dermatology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Emily K Duffy
- Division of Dermatology, Department of Medicine, University of Washington, Seattle
| | - Janet A Fairley
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Alisa Femia
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | | | | | - Kimberly L Katz
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Joslyn S Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Stephanie T Le
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | | | - Emanual Maverakis
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Bridget Myers
- University of California San Francisco School of Medicine
| | - Haley B Naik
- Department of Dermatology, UCSF Medical Center, University of California San Francisco School of Medicine
| | - Caroline A Nelson
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland
| | - Molly E Plovanich
- Department of Dermatology, University of Rochester, School of Medicine & Dentistry, Rochester, New York
| | - Lauren K Rangel
- Ronald O. Perelman Department of Dermatology, NYU Langone Hospitals, New York University Grossman School of Medicine, New York, New York
| | - Vignesh Ravi
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
| | | | - Jamal Z Saleh
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Jeena K Sandhu
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California.,Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Bridget E Shields
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | | | - Jacob Smith
- Oregon Health and Science University School of Medicine, Portland
| | - Amanda Steahr
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City
| | - Atrin Toussi
- Department of Dermatology, University of California, Davis School of Medicine, Sacramento
| | - Karolyn A Wanat
- Department of Dermatology, Medical College of Wisconsin, Milwaukee
| | - Bo Wang
- Department of Dermatology, University of Michigan, Ann Arbor
| | - Brian M Wei
- Yale School of Medicine, New Haven, Connecticut
| | - Annika Weinhammer
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison
| | - Scott D Worswick
- Department of Dermatology, Keck Hospital of USC, University of Southern California Keck School of Medicine, Los Angeles, California
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26
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Bergman M, Saffore CD, Kim KJ, Patel PA, Garg V, Xuan S, Naik HB. Healthcare Resource Use in Patients with Immune-Mediated Conditions Treated with Targeted Immunomodulators During COVID-19 Pandemic: A Retrospective Claims Analysis. Adv Ther 2021; 38:5302-5316. [PMID: 34515976 PMCID: PMC8436009 DOI: 10.1007/s12325-021-01906-4] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The impact of the COVID-19 pandemic on routine medical care may result in altered healthcare resource use in patients with immune-mediated conditions. The aim of this study was to determine the impact of treatment interruptions in patients with and without COVID-19 infections who were treated with targeted immunomodulators (TIMs) in the USA. METHODS Data from the IBM® MarketScan® Research Databases were analyzed in patients with immune-mediated conditions from January 1, 2018, through December 31, 2020. Healthcare resource use (HCRU) including hospitalizations, emergency department (ED) visits, in-person outpatient visits, and respiratory outcomes was assessed in a cohort of patients without COVID-19 who had uninterrupted versus interrupted TIM use. The impact of treatment interruption on HCRU and respiratory outcomes was also evaluated in a cohort of patients with COVID-19. Results from adjusted logistic regression were reported as adjusted odds ratios (aORs) with 95% confidence intervals. RESULTS Approximately 25% of patients in both the COVID-19 (N = 787) and non-COVID-19 cohorts (N = 77,178) experienced interruptions in TIM therapy. In the non-COVID-19 cohort, the likelihood of being hospitalized was 20% less in patients with uninterrupted versus interrupted TIM use (aOR = 0.80, 95% CI 0.71-0.90). Patients with uninterrupted TIM use had a similar likelihood of an ED visit (aOR = 0.99, 95% CI 0.91-1.08) and respiratory outcome (aOR = 0.97, 95% CI 0.71-1.31) versus patients with interrupted TIM use. The likelihood of having an in-person outpatient visit was 87% greater in patients with uninterrupted versus interrupted TIM use (aOR = 1.87, 95% CI 1.81-1.94). Similar findings were observed in the COVID-19 cohort. CONCLUSION This analysis of real-world claims data showed that uninterrupted TIM use was not associated with an increased likelihood of hospitalizations, ED visits, or negative respiratory outcomes compared to interrupted TIM use among patients with immune-mediated conditions, regardless of COVID-19 diagnosis.
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Affiliation(s)
- Martin Bergman
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | | | | | | | | | - Si Xuan
- AbbVie Inc., North Chicago, IL, USA
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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27
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Freeman EE, Chamberlin GC, McMahon DE, Hruza GJ, Wall D, Meah N, Sinclair R, Balogh EA, Feldman SR, Lowes MA, Marzano AV, Naik HB, Castelo-Soccio L, Lara-Corrales I, Cordoro KM, Mahil SK, Griffiths CEM, Smith CH, Irvine AD, Spuls PI, Flohr C, French LE. Dermatology COVID-19 Registries: Updates and Future Directions. Dermatol Clin 2021; 39:575-585. [PMID: 34556247 PMCID: PMC8165090 DOI: 10.1016/j.det.2021.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
| | - Grace C Chamberlin
- Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - George J Hruza
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland; National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland
| | - Nekma Meah
- St Helens & Knowsley NHS Trust, Marshalls Cross Road, St. Helens WA9 3DA, UK; Manchester University, Faculty of Biology, Medicine and Health, Oxford Road, Manchester, UK
| | - Rodney Sinclair
- Sinclair Dermatology, East Melbourne, Victoria 3002, Australia
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston Salem, NC, USA
| | | | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Leslie Castelo-Soccio
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Irene Lara-Corrales
- Section of Pediatric Dermatology, Hospital for Sick Children, Toronto, Canada
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Satveer K Mahil
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Catherine H Smith
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany; Dr. Philip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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28
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Wall D, Alhusayen R, Arents B, Apfelbacher C, Balogh EA, Bokhari L, Bloem M, Bosma AL, Burton T, Castelo-Soccio L, Fagan N, Feldman SR, Fletcher G, Flohr C, Freeman E, French LE, Griffiths CEM, Hruza GJ, Ingram JR, Kappelman MD, Lara-Corrales I, Lim HW, Meah N, McMahon DE, Mahil SK, McNicoll I, Musters A, Naik HB, Sinclair R, Smith CH, Spuls P, Tobin DJ, York K, Irvine AD. Learning from disease registries during a pandemic: Moving toward an international federation of patient registries. Clin Dermatol 2021; 39:467-478. [PMID: 34518006 PMCID: PMC8432911 DOI: 10.1016/j.clindermatol.2021.01.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
High-quality dermatology patient registries often require considerable time to develop and produce meaningful data. Development time is influenced by registry complexity and regulatory hurdles that vary significantly nationally and institutionally. The rapid emergence of the coronavirus disease 2019 (COVID-19) global pandemic has challenged health services in an unprecedented manner. Mobilization of the dermatology community in response has included rapid development and deployment of multiple, partially harmonized, international patient registries, reinventing established patient registry timelines. Partnership with patient organizations has demonstrated the critical nature of inclusive patient involvement. This global effort has demonstrated the value, capacity, and necessity for the dermatology community to adopt a more cohesive approach to patient registry development and data sharing that can lead to myriad benefits. These include improved utilization of limited resources, increased data interoperability, improved ability to rapidly collect meaningful data, and shortened response times to generate real-world evidence. We call on the global dermatology community to support the development of an international federation of patient registries to consolidate and operationalize the lessons learned during this pandemic. This will provide an enduring means of applying this knowledge to the maintenance and development of sustainable, coherent, and impactful patient registries of benefit now and in the future.
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Affiliation(s)
- Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland; National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland; School of Medicine, University College Dublin, Dublin, Ireland.
| | - Raed Alhusayen
- Division of Dermatology and Sunnybrook Research Institute, University of Toronto, Ontario, Canada
| | - Bernd Arents
- Dutch Association for People with Atopic Dermatitis, Nijkerk, the Netherlands
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany; Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | | | - Manja Bloem
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - Angela L Bosma
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | | | - Leslie Castelo-Soccio
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nicole Fagan
- University of Dublin, Trinity College, Dublin, Ireland
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
| | - Godfrey Fletcher
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Esther Freeman
- Massachusetts General Hospital Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Christopher E M Griffiths
- Dermatology Centre, The University of Manchester and NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - George J Hruza
- St. Louis University Department of Dermatology, St. Louis, Missouri, USA
| | - John R Ingram
- Department of Dermatology, Division of Infection & Immunity, Cardiff University, Cardiff, UK
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Irene Lara-Corrales
- Section of Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan, USA
| | - Nekma Meah
- Sinclair Dermatology, Melbourne, Australia
| | - Devon E McMahon
- Massachusetts General Hospital Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Satveer K Mahil
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Ian McNicoll
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
| | - Annelie Musters
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
| | | | - Catherine H Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Phyllis Spuls
- Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, Amsterdam, The Netherlands
| | - Desmond J Tobin
- The Charles Institute of Dermatology, School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Katherine York
- Netcare Greenacres Hospital, Port Elizabeth, South Africa
| | - Alan D Irvine
- National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland; Clinical Medicine, Trinity College, Dublin, Ireland
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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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Jedrzejczak MJ, Ingram JR, Lowes MA, Naik HB, McKenzie-Brown AM, Chen SC, Orenstein LAV. Expert Knowledge, Attitudes, and Practices in Management of Hidradenitis Suppurativa Pain. JAMA Dermatol 2021; 157:464-466. [PMID: 33625467 DOI: 10.1001/jamadermatol.2020.5857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology and Wound Healing, Cardiff University, Cardiff, United Kingdom
| | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco.,Associate Editor, JAMA Dermatology
| | | | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Lauren A V Orenstein
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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31
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Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco
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32
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Naik HB, Piguet V. Standardizing Hidradenitis Suppurativa Skin Microbiome Research: The Methods Matter. J Invest Dermatol 2021; 140:1688-1690. [PMID: 32800181 DOI: 10.1016/j.jid.2020.03.946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 02/01/2023]
Abstract
Cutaneous dysbiosis is implicated in hidradenitis suppurativa (HS) pathogenesis. Previous studies reveal skin microbiota shifts in HS lesional skin. In their report, Riverain-Gillet et al. (2020) extended these findings and reported skin microbiota shifts in unaffected HS skinfolds as well. Their study suggests that skin microbial shifts may precede clinical lesions and draws attention to study methods important for skin microbiome research.
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Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco, California, USA.
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, Ontario, Canada
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33
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Lyons AB, Peacock A, McKenzie SA, Jacobsen G, Naik HB, Shi VY, Hamzavi IH, Hsiao JL. Evaluation of Hidradenitis Suppurativa Disease Course During Pregnancy and Postpartum. JAMA Dermatol 2021; 156:681-685. [PMID: 32347884 DOI: 10.1001/jamadermatol.2020.0777] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Hidradenitis suppurativa (HS) disproportionately affects women of childbearing potential. There is a paucity of data regarding the HS disease course during pregnancy and in the postpartum period. Objective To explore the HS disease course during pregnancy and in the postpartum period. Design, Setting, and Participants A retrospective cohort study was conducted on patients in the Henry Ford Health System, Detroit, Michigan-a large, academic, urban referral center. Women with a diagnosis of HS who became pregnant between January 1, 2008, and December 31, 2018, were included. International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, were used for identification of the diagnosis. Exposures Pregnancy in patients with HS. Main Outcomes and Measures Hidradenitis suppurativa disease status during pregnancy and the postpartum period. Results A total of 127 women with HS were included in this study and accounted for 202 pregnancies. Of the 202 pregnancies, 171 were in black women, 25 in white women, 3 in women of other race/ethnicity, and 3 had unreported data. Mean (SD) age at HS onset was 19.3 (5.6) years; at time of HS diagnosis, 24.4 (5.3) years; and at time of pregnancy, 25.9 (5.0) years. The disease worsened during pregnancy in 70 pregnancies (61.9%), did not change in 34 pregnancies (30.1%), and improved in 9 pregnancies (8.0%). Hidradenitis suppurativa exacerbated in the postpartum period after 82 of 124 pregnancies (66.1%). Dermatologists were involved in managing HS in 28 pregnancies (14.4%) and for a higher proportion of patients with more severe Hurley stage as compared with cases of mild disease (stage 3: 7 of 18 [38.9%] vs stage 1: 10 of 100 [10.0%] or stage 2: 11 of 67 [16.4%]; P = .004). In addition, HS medical treatment was administered during 77 pregnancies (38.1%), while HS procedural treatment was administered during 34 pregnancies (16.8%). A significantly higher proportion of patients whose care was managed by dermatologists vs those without dermatologist involvement received any HS medication (22 [78.6%] vs 53 [31.7%], P < .001) or any HS procedure (14 [50%] vs 19 [11.4%], P < .001) during pregnancy. Conclusions and Relevance Despite a high rate of HS exacerbation during pregnancy and postpartum, this cohort study found that most of the patients did not receive HS-directed medical treatment or care from a dermatologist during pregnancy. Close monitoring and improved collaborative care between dermatology and obstetrics-gynecology services is warranted.
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Affiliation(s)
- Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Anjelica Peacock
- Department of Internal Medicine, St Mary Mercy Hospital, Livonia, Michigan
| | - Shanice A McKenzie
- Department of Dermatology, University of California, Los Angeles, Santa Monica
| | - Gordon Jacobsen
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco
| | - Vivian Y Shi
- Department of Dermatology, University of Arizona, Tucson
| | | | - Jennifer L Hsiao
- Department of Dermatology, University of California, Los Angeles, Santa Monica
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34
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Collier EK, Parvataneni RK, Lowes MA, Naik HB, Okun M, Shi VY, Hsiao JL. Diagnosis and management of hidradenitis suppurativa in women. Am J Obstet Gynecol 2021; 224:54-61. [PMID: 32980357 PMCID: PMC8163033 DOI: 10.1016/j.ajog.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/20/2020] [Revised: 08/15/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022]
Abstract
Hidradenitis suppurativa is a chronic inflammatory disease that disproportionately affects women of childbearing age. Hidradenitis suppurativa is characterized by painful nodules, abscesses, draining dermal tunnels, and scarring with a predilection for intertriginous sites, such as the axilla, groin, and breast regions. Delay in diagnosis and treatment of hidradenitis suppurativa often results in long-term sequelae leading to significant morbidity, and rarely mortality, in these patients. This clinical opinion suggests that obstetrician-gynecologists are uniquely poised to recognize early signs of hidradenitis suppurativa during routine well-woman examinations and initiate treatment or referral to dermatology. Herein, we provide clinical pearls for obstetrician-gynecologists caring for female patients with hidradenitis suppurativa, including strategies for comprehensive management and recommendations to improve the comfort of patients with hidradenitis suppurativa during examinations.
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Affiliation(s)
- Erin K Collier
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Ram K Parvataneni
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA
| | - Michelle A Lowes
- Department of Dermatology, The Rockefeller University, New York, NY
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, CA
| | | | - Vivian Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
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35
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Collier EK, Price KN, Grogan TR, Naik HB, Shi VY, Hsiao JL. Characterizing perimenstrual flares of hidradenitis suppurativa. Int J Womens Dermatol 2020; 6:372-376. [PMID: 33898701 PMCID: PMC8060664 DOI: 10.1016/j.ijwd.2020.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/15/2020] [Accepted: 09/04/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) predominantly affects women of childbearing age, and sex hormones are thought to play a role in HS pathogenesis. However, there is a paucity of data regarding the pattern of HS perimenstrual flares, as well as patient responses to hormone-based therapies. OBJECTIVE We aimed to characterize the temporal pattern of perimenstrual flares, as well as factors associated with perimenstrual flares. We also sought to investigate responses to hormonal therapies in women with HS. METHODS An anonymous web-based questionnaire was distributed to various online HS support groups in May 2020. RESULTS A total of 283 participants met the inclusion criteria as adult women who self-reported having HS and menstrual cycles. The majority (176 of 282 women; 62.4%) reported HS worsening with menses, and 86.9% (153 of 176 women) noted that perimenstrual HS flares occurred always or often. Most women (138 of 175 women; 78.9%) reported that their HS flared in the week preceding menses. Perimenstrual HS flares were more likely in women with a family history of HS compared with those without (49.6% vs. 28.2%; p = .019). More than a third of respondents who had been treated with spironolactone reported improvement of HS symptoms, but more than a quarter of participants who used medroxyprogesterone acetate or used a hormonal intrauterine device reported worsened HS symptoms. CONCLUSION Female patients with HS have high rates of perimenstrual HS flares, specifically during the week preceding the onset of menses. Additional investigations on the role of sex hormones in HS pathogenesis and the efficacy of hormone-based therapies are warranted.
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Affiliation(s)
- Erin K. Collier
- David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Kyla N. Price
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Tristan R. Grogan
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Haley B. Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, United States
| | - Vivian Y. Shi
- Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Jennifer L. Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
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36
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Lowe MM, Naik HB, Clancy S, Pauli M, Smith KM, Bi Y, Dunstan R, Gudjonsson JE, Paul M, Harris H, Kim E, Shin US, Ahn R, Liao W, Hansen SL, Rosenblum MD. Immunopathogenesis of hidradenitis suppurativa and response to anti-TNF-α therapy. JCI Insight 2020; 5:139932. [PMID: 32841223 PMCID: PMC7566733 DOI: 10.1172/jci.insight.139932] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/20/2020] [Indexed: 01/15/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a highly prevalent, morbid inflammatory skin disease with limited treatment options. The major cell types and inflammatory pathways in skin of patients with HS are poorly understood, and which patients will respond to TNF-α blockade is currently unknown. We discovered that clinically and histologically healthy appearing skin (i.e., nonlesional skin) is dysfunctional in patients with HS with a relative loss of immune regulatory pathways. HS skin lesions were characterized by quantitative and qualitative dysfunction of type 2 conventional dendritic cells, relatively reduced regulatory T cells, an influx of memory B cells, and a plasma cell/plasmablast infiltrate predominantly in end-stage fibrotic skin. At the molecular level, there was a relative bias toward the IL-1 pathway and type 1 T cell responses when compared with both healthy skin and psoriatic patient skin. Anti–TNF-α therapy markedly attenuated B cell activation with minimal effect on other inflammatory pathways. Finally, we identified an immune activation signature in skin before anti–TNF-α treatment that correlated with subsequent lack of response to this modality. Our results reveal the fundamental immunopathogenesis of HS and provide a molecular foundation for future studies focused on stratifying patients based on likelihood of clinical response to TNF-α blockade. Hidradenitis suppurativa lesions are characterized by alterations in cDC2s, relatively reduced Tregs, an influx of memory B cells and plasma cells, and biases towards IL1 pathway activation and type 1 T cell responses.
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Affiliation(s)
- Margaret M Lowe
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Haley B Naik
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Sean Clancy
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Mariela Pauli
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | | | - Yingtao Bi
- AbbVie Cambridge Research Center, Cambridge, Massachusetts, USA
| | - Robert Dunstan
- AbbVie Bioresearch Center, Worcester, Massachusetts, USA
| | | | - Maia Paul
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Hobart Harris
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Esther Kim
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Uk Sok Shin
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Richard Ahn
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA.,Institute for Quantitative and Computational Biosciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Wilson Liao
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
| | - Scott L Hansen
- Department of Surgery, UCSF, San Francisco, California, USA
| | - Michael D Rosenblum
- Department of Dermatology, University of California at San Francisco (UCSF), San Francisco, California, USA
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Naik HB, Alhusayen R, Frew J, Guilbault S, Ingram JR, Lowes MA, Marzano AV, Paul M, Villumsen B, Yannuzzi CA. Global Hidradenitis Suppurativa COVID-19 Registry: a registry to inform data-driven management practices. Br J Dermatol 2020; 183:780-781. [PMID: 32597495 PMCID: PMC7361290 DOI: 10.1111/bjd.19345] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 12/19/2022]
Affiliation(s)
- H B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - R Alhusayen
- Sunnybrook Research Institute, Dermatology Division, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - J Frew
- Department of Dermatology, Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia
| | | | - J R Ingram
- Department of Dermatology & Academic Wound Healing, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - M A Lowes
- The Rockefeller University, New York, NY, USA
| | - A V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - M Paul
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - B Villumsen
- Patientforeningen HS Danmark, Copenhagen, Denmark
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38
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Kang NYC, Hsiao J, Shi V, Naik HB, Lowes MA, Alavi A. Remote management of hidradenitis suppurativa in a pandemic era of COVID-19. Int J Dermatol 2020; 59:e318-e320. [PMID: 32578210 PMCID: PMC7361922 DOI: 10.1111/ijd.15022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Na-Young C Kang
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vivian Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
| | | | - Afsaneh Alavi
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada.,Department of Dermatology, University of Toronto, Toronto, ON, Canada
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39
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Freeman EE, McMahon DE, Hruza GJ, Irvine AD, Spuls PI, Smith CH, Mahil SK, Castelo-Soccio L, Cordoro KM, Lara-Corrales I, Naik HB, Alhusayen R, Ingram JR, Feldman SR, Balogh EA, Kappelman MD, Wall D, Meah N, Sinclair R, Beylot-Barry M, Fitzgerald M, French LE, Lim HW, Griffiths CEM, Flohr C. International collaboration and rapid harmonization across dermatologic COVID-19 registries. J Am Acad Dermatol 2020; 83:e261-e266. [PMID: 32562840 PMCID: PMC7833847 DOI: 10.1016/j.jaad.2020.06.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - George J Hruza
- Department of Dermatology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Phyllis I Spuls
- Department of Dermatology, Public Health and Epidemiology; Immunity and Infections, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, the Netherlands
| | - Catherine H Smith
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Satveer K Mahil
- St John's Institute of Dermatology, King's College London and Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Leslie Castelo-Soccio
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kelly M Cordoro
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Irene Lara-Corrales
- Section of Pediatric Dermatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Raed Alhusayen
- Sunnybrook Research Institute, Dermatology Division, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John R Ingram
- Division of Infection and Immunity, Department of Dermatology & Academic Wound Healing, Cardiff University, Cardiff, United Kingdom
| | - Steven R Feldman
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Esther A Balogh
- Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Michael D Kappelman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dmitri Wall
- Hair Restoration Blackrock, Dublin, Ireland; National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, Dublin, Ireland
| | - Nekma Meah
- Sinclair Dermatology, East Melbourne, Victoria, Australia
| | | | - Marie Beylot-Barry
- French Society of Dermatology and Department of Dermatology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lars E French
- Department of Dermatology, University Hospital, Munich University of Ludwig Maximilian, Munich, Germany
| | - Henry W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal Hospital, National Institute for Health Research, Manchester Biomedical Research Centre, University of Manchester, Manchester, United Kingdom
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas' National Health Service Foundation Trust, London, United Kingdom
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40
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Martins DB, Ayanruoh L, Paul M, Shukla N, Naik HB. Hidradenitis suppurativa publications are sparse in frontline specialties. Br J Dermatol 2020; 183:770-771. [PMID: 32294228 DOI: 10.1111/bjd.19131] [Citation(s) in RCA: 2] [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] [Indexed: 12/01/2022]
Affiliation(s)
- D B Martins
- University of California, San Francisco, CA, USA
| | - L Ayanruoh
- State University of New York, Brooklyn, NY, USA
| | - M Paul
- University of California, San Francisco, CA, USA
| | - N Shukla
- University of California, San Francisco, CA, USA
| | - H B Naik
- University of California, San Francisco, CA, USA
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41
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Lyons AB, Peacock A, McKenzie SA, Jacobsen G, Naik HB, Shi VY, Hamzavi IH, Hsiao JL. Retrospective cohort study of pregnancy outcomes in hidradenitis suppurativa. Br J Dermatol 2020; 183:945-947. [PMID: 32333790 PMCID: PMC8174655 DOI: 10.1111/bjd.19155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - A Peacock
- Department of Internal Medicine, St Mary Mercy Hospital, Livonia, MI, USA
| | - S A McKenzie
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
| | - G Jacobsen
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - V Y Shi
- Department of Dermatology, University of Arizona, Tucson, AZ, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
| | - J L Hsiao
- Department of Dermatology, University of California Los Angeles, Los Angeles, CA, USA
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Saylor DK, Brownstone ND, Naik HB. Office-Based Surgical Intervention for Hidradenitis Suppurativa (HS): A Focused Review for Dermatologists. Dermatol Ther (Heidelb) 2020; 10:529-549. [PMID: 32435998 PMCID: PMC7367977 DOI: 10.1007/s13555-020-00391-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 12/28/2022] Open
Abstract
Easily accessible office-based procedures that require minimal resources may facilitate timely surgical management of hidradenitis suppurativa (HS). This review focuses on excision and unroofing as two surgical HS treatments that can be tailored to the outpatient setting. Fifty-five articles were included in our review, representing 3914 patients. The majority were retrospective studies (58%, n = 32), and the studies reported data both across patients and by number of treated lesions. Recurrence rates for unroofing (14.5%) were found to be half that of excision (30%) across patients (p = 0.015) and slightly lower across lesions [20% recurrence vs 26% for excision (p = 0.023)]. Complication rates at the lesion level were also significantly associated with procedure, with rates after excision more than double those after roofing (26% vs. 12%, p < 0.001). The complication rate after combined medical and surgical therapy did not differ between procedures. Studies also suggest that continuing medical therapy in the perioperative period may be associated with improved recurrence rates, although delayed wound healing with biologic therapy has been reported. The existing data are limited by low-quality uncontrolled studies with small sample sizes, variable reporting of outcomes, and lack of uniform definitions for recurrence and remission. Further systematic prospective studies are needed to better compare complication and recurrence rates across these procedures in HS, especially in the context of concomitant medical therapy.
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Affiliation(s)
- Drew K Saylor
- Department of Dermatology, University of California, San Francisco, CA, USA.
| | | | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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Shah M, Naik HB, Alhusayen R. Hidradenitis suppurativa: The importance of virtual outpatient care during COVID-19 pandemic. J Am Acad Dermatol 2020; 83:e81-e82. [PMID: 32360857 PMCID: PMC7252061 DOI: 10.1016/j.jaad.2020.04.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Monica Shah
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Raed Alhusayen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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44
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Collier EK, Hsiao JL, Shi VY, Naik HB. Comprehensive approach to managing hidradenitis suppurativa patients. Int J Dermatol 2020; 59:744-747. [PMID: 32250448 DOI: 10.1111/ijd.14870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/27/2019] [Revised: 01/28/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Erin K Collier
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jennifer L Hsiao
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vivian Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA, USA
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45
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Naik HB, Lowes MA. Creation of a Registry to Address Knowledge Gaps in Hidradenitis Suppurativa and Pregnancy-Reply. JAMA Dermatol 2020; 156:354. [PMID: 31913415 DOI: 10.1001/jamadermatol.2019.3652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California, San Francisco
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46
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Shukla N, Paul M, Halley M, Lowes MA, Hester V, Aguilar C, Guilbault S, Long TS, Taylor A, Thompson AC, Yannuzzi CA, Linos E, Naik HB. Identifying barriers to care and research in hidradenitis suppurativa: findings from a patient engagement event. Br J Dermatol 2020; 182:1490-1492. [PMID: 31883104 DOI: 10.1111/bjd.18818] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- N Shukla
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - M Paul
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - M Halley
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, U.S.A.,Department of Dermatology, Stanford School of Medicine, Palo Alto, CA, U.S.A
| | - M A Lowes
- The Rockefeller University, New York, NY, U.S.A
| | - V Hester
- Community Partnerships Team, Facebook, Menlo Park, CA, U.S.A
| | | | | | | | | | | | | | - E Linos
- Department of Dermatology, Stanford School of Medicine, Palo Alto, CA, U.S.A
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
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47
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Wehner MR, Micheletti R, Noe MH, Linos E, Margolis DJ, Naik HB. Hidradenitis suppurativa encounters in a national electronic health record database notable for low dermatology utilization, infrequent biologic prescriptions, and frequent opiate prescriptions. J Am Acad Dermatol 2019; 82:1239-1241. [PMID: 31866261 DOI: 10.1016/j.jaad.2019.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/28/2019] [Accepted: 12/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Megan H Noe
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Eleni Linos
- Department of Dermatology, Stanford University, Stanford, California
| | - David J Margolis
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco.
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48
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Naik HB, Jo JH, Paul M, Kong HH. Skin Microbiota Perturbations Are Distinct and Disease Severity-Dependent in Hidradenitis Suppurativa. J Invest Dermatol 2019; 140:922-925.e3. [PMID: 31539533 DOI: 10.1016/j.jid.2019.08.445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California.
| | - Jay-Hyun Jo
- Cutaneous Microbiome and Inflammation Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Maia Paul
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Heidi H Kong
- Cutaneous Microbiome and Inflammation Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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49
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Goldfarb N, Ingram JR, Jemec GBE, Naik HB, Piguet V, Hyde MJ, Freese R, Lowes MA, Alavi A. Hidradenitis Suppurativa Area and Severity Index (HASI): a pilot study to develop a novel instrument to measure the physical signs of hidradenitis suppurativa. Br J Dermatol 2019; 182:240-242. [PMID: 31286486 DOI: 10.1111/bjd.18335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Goldfarb
- Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, U.S.A.,Departments of Medicine and Dermatology, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, U.S.A
| | - J R Ingram
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Dermatology, University of Copenhagen, Copenhagen, Denmark
| | - H B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, U.S.A
| | - V Piguet
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - M J Hyde
- The Rockefeller University, New York, NY, U.S.A
| | - R Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, U.S.A
| | - M A Lowes
- The Rockefeller University, New York, NY, U.S.A
| | - A Alavi
- Department of Medicine, Division of Dermatology, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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50
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Remedios KA, Zirak B, Sandoval PM, Lowe MM, Boda D, Henley E, Bhattrai S, Scharschmidt TC, Liao W, Naik HB, Rosenblum MD. The TNFRSF members CD27 and OX40 coordinately limit T H17 differentiation in regulatory T cells. Sci Immunol 2019; 3:3/30/eaau2042. [PMID: 30578350 DOI: 10.1126/sciimmunol.aau2042] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 11/01/2018] [Indexed: 12/13/2022]
Abstract
Regulatory T cells (Tregs) are closely related to TH17 cells and use aspects of the TH17-differentiation program for optimal immune regulation. In several chronic inflammatory human diseases, Tregs express IL-17A, suggesting that dysregulation of TH17-associated pathways in Tregs may result in either loss of suppressive function and/or conversion into pathogenic cells. The pathways that regulate the TH17 program in Tregs are poorly understood. We have identified two TNF receptor superfamily (TNFRSF) members, CD27 and OX40, that are preferentially expressed by skin-resident Tregs Both CD27 and OX40 signaling suppressed the expression of TH17-associated genes from Tregs in a cell-intrinsic manner in vitro and in vivo. However, only OX40 played a nonredundant role in promoting Treg accumulation. Tregs that lacked both CD27 and OX40 were defective in controlling skin inflammation and expressed high levels of IL-17A, as well as the master TH17 transcription factor, RORγt. Last, we found that CD27 expression was inversely correlated with Treg IL-17 production in skin of patients with psoriasis and hidradenitis suppurativa. Together, our results suggest that TNFRSF members play both redundant and distinct roles in regulating Treg plasticity in tissues.
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Affiliation(s)
- Kelly A Remedios
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | - Bahar Zirak
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | | | - Margaret M Lowe
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | - Devi Boda
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | - Evan Henley
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | - Shrishti Bhattrai
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | | | - Wilson Liao
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | - Haley B Naik
- Department of Dermatology, University of California, San Francisco, CA 94143, USA
| | - Michael D Rosenblum
- Department of Dermatology, University of California, San Francisco, CA 94143, USA.
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