1
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Singh S, Desai K, Gillern S. Management of Pilonidal Disease and Hidradenitis Suppurativa. Surg Clin North Am 2024; 104:503-515. [PMID: 38677816 DOI: 10.1016/j.suc.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
Pilonidal disease and hidradenitis suppurativa affect healthy young adults, causing discomfort and pain that leads to loss of work productivity and should be approached in a personalized manner. Patients with pilonidal disease should engage in hair removal to the sacrococcygeal region and surgical options considered. Hidradenitis suppurativa can be a morbid and challenging disease process. Medical management with topical agents, antibiotics, and biologics should be used initially but wide local excision should be considered in severe or refractory cases of the disease.
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Affiliation(s)
- Sneha Singh
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA
| | - Kaushal Desai
- Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA
| | - Suzanne Gillern
- Colon & Rectal Surgery, Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, Honolulu, HI 96859, USA.
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2
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Krajewski PK, Sanz-Motilva V, Flores Martinez S, Solera M, Ochando G, Jfri A, Martorell A. Deroofing: A safe, effective and well-tolerated procedure in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2024; 38:931-936. [PMID: 38279608 DOI: 10.1111/jdv.19810] [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: 09/13/2023] [Accepted: 11/24/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. OBJECTIVES A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. METHODS HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. RESULTS The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). CONCLUSION Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.
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Affiliation(s)
- P K Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
| | - V Sanz-Motilva
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | | | - M Solera
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | - G Ochando
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
| | - A Jfri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - A Martorell
- Servicio de Dermatologia, Hospital de Manises, Valencia, Spain
- European Hidradenitis Suppurativa Foundation (EHSF), Dessau-Roßlau, Germany
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3
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Vilarrasa E, Camiña-Conforto G, Cabo F, Fernández-Vela J, Pousa M, Romaní J. Drainage setons for the management of sinus tracts in hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:e157-e158. [PMID: 37634739 DOI: 10.1016/j.jaad.2023.08.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023]
Affiliation(s)
- Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Fernando Cabo
- Department of Dermatology, Complexo Hospitalario de Ourense, Orense, Spain
| | | | - María Pousa
- Department of Dermatology, Complexo Hospitalario de Ourense, Orense, Spain
| | - Jorge Romaní
- Department of Dermatology, Hospital General de Granollers, Barcelona, Spain
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Chierici A, Bulsei J, De Fatico S, Alromayan M, Alamri A, Pavone G, Liddo G, Fontas E, Iannelli A. Effects of bariatric surgery on severe suppurative hidradenitis: Results of a nationwide administrative data study in France. J Eur Acad Dermatol Venereol 2024; 38:e359-e361. [PMID: 38041567 DOI: 10.1111/jdv.19649] [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: 07/17/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Andrea Chierici
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Julie Bulsei
- Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Serena De Fatico
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Mohamed Alromayan
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
- Security Forces Medical City, Riyadh, Saudi Arabia
| | - Abdelrahmane Alamri
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
- Department of Surgery, Medical College, Najran University, Najran, Saudi Arabia
| | - Giovanna Pavone
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Guido Liddo
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Eric Fontas
- Department of Clinical Research and Innovation, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Antonio Iannelli
- Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
- Université Côte d'Azur, Nice, France
- Inserm, U1065, Team 8 "Hepatic Complications of Obesity and Alcohol", Nice, France
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5
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Ly S, Manjaly P, Kamal K, Theodosakis N, Charrow A, Mostaghimi A. Insurance coverage among the largest insurers per state for laser hair removal in the treatment of hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:859-862. [PMID: 38128832 DOI: 10.1016/j.jaad.2023.12.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Sophia Ly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Priya Manjaly
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Kanika Kamal
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Nicholas Theodosakis
- Harvard Medical School, Harvard University, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
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6
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Malvaso D, Chiricozzi A, Fossati B, Antonelli F, Peris K. Efficacy and safety of a combined pharmacological and surgical approach in patients affected by hidradenitis suppurativa: data from a retrospective real-world clinical study. Ital J Dermatol Venerol 2024; 159:190-195. [PMID: 38650499 DOI: 10.23736/s2784-8671.24.07620-5] [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: 04/25/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a debilitating chronic skin disease; its therapeutic approach often requires combined medical and surgical treatment. METHODS The aim of this study was to assess the efficacy and safety of the surgical approach combined with different pharmacological treatments, evaluating the proportion of patients achieving the hidradenitis suppurativa clinical response (HiSCR), along with the incidence of postoperative complications, and local recurrence. A retrospective study of HS patients (Hurley I-III) presenting at least one skin lesion requiring surgery was performed. Demographic and clinical data were collected (kind and anatomical location of lesion excised, type of surgical procedure). Further data included: Hurley stage and IHS4 at baseline and week 16, HiSCR at week 16 after surgery, ongoing therapy at the time of surgery (topical, systemic antibiotic, biologics), postoperative complications and local recurrence at week 16. RESULTS Forty-two patients with female predominance (66.7%, 28/42), with a mean age of 30.3 (SD±10.5) years, were enrolled. At week 16, 53% of patients achieved HiSCR, with baseline Hurley III inversely related to HiSCR achievement (P<0.05). No increased incidence of postoperative complications was detected. Three cases of local recurrence were reported at week 16. CONCLUSIONS The results support the efficacy and safety of the combined therapy in the management of HS; no increased risk of complications emerged among patients concomitantly treated with biologics, compared to those on conventional systemic therapy or exclusively treated with surgery.
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Affiliation(s)
- Dalma Malvaso
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Andrea Chiricozzi
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy -
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Barbara Fossati
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Flaminia Antonelli
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Ketty Peris
- Unit of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
- Unit of Dermatology, Department of Medical and Surgical Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
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7
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Fernández-Vela J, Romaní J, Cabo F, Pousa M, Camiña G, Guilabert A, Vilarrasa E. Management of hidradenitis suppurativa tunnels using drainage setons: A retrospective multicentric study. J Am Acad Dermatol 2024; 90:868-870. [PMID: 38160809 DOI: 10.1016/j.jaad.2023.12.033] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/10/2023] [Accepted: 12/16/2023] [Indexed: 01/03/2024]
Affiliation(s)
| | - Jorge Romaní
- Department of Dermatology, Hospital General de Granollers, Granollers, Spain
| | - Fernando Cabo
- Department of Dermatology, Complexo Hospitalario de Ourense, Ourense, Spain
| | - María Pousa
- Department of Dermatology, Complexo Hospitalario de Ourense, Ourense, Spain
| | - Gemma Camiña
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonio Guilabert
- Department of Dermatology, Hospital General de Granollers, Granollers, Spain
| | - Eva Vilarrasa
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
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8
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Hengy M, Daveluy S. A simple video demonstrating the deroofing technique for hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:e89. [PMID: 36370900 DOI: 10.1016/j.jaad.2022.11.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Meredith Hengy
- Wayne State University School of Medicine, Detroit, Michigan
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, Michigan.
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9
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Miller A, Shahzeidi P, Bernhardt M. An Update on Current Clinical Management and Emerging Treatments in Hidradenitis Suppurativa. Skin Therapy Lett 2024; 29:1-6. [PMID: 38574201] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Hidradenitis suppurativa (HS) is a severe, debilitating, chronic inflammatory skin disease characterized by recurrent painful nodules, abscesses and draining sinus tracts in intertriginous areas. While this condition appears to stem from follicular unit dysfunction, its cause is multifactorial and the exact pathogenesis has yet to be fully elucidated. These factors make treatment selection challenging and contribute to variable therapeutic response among affected patients. Typical regimens consist of a combination of medical and surgical modalities, tailored to individual responses. However, HS is often refractory to traditional treatments, prompting the need for newer and more effective therapies. Herein, we review current and emerging HS therapies.
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Affiliation(s)
- Austinn Miller
- University of Central Florida/HCA Consortium, Tallahassee, FL, USA
- Dermatology Associates of Tallahassee, Tallahassee, FL, USA
| | | | - Michael Bernhardt
- University of Central Florida/HCA Consortium, Tallahassee, FL, USA
- Dermatology Associates of Tallahassee, Tallahassee, FL, USA
- Florida State University College of Medicine, Tallahassee, FL, USA
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10
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Ingram JR, Bates J, Cannings-John R, Collier F, Evans J, Gibbons A, Harris C, Howells L, Hood K, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study (THESEUS): a prospective cohort study. Br J Dermatol 2024; 190:382-391. [PMID: 37823414 DOI: 10.1093/bjd/ljad388] [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: 02/18/2023] [Revised: 07/21/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, painful disease affecting flexures and other skin regions, producing nodules, abscesses and skin tunnels. Laser treatment targeting hair follicles and deroofing of skin tunnels are standard HS interventions in some countries but are rarely offered in the UK. OBJECTIVES To describe current UK HS management pathways and influencing factors to inform the design of future randomized controlled trials (RCTs). METHODS THESEUS was a nonrandomized 12-month prospective cohort study set in 10 UK hospitals offering five interventions: oral doxycycline 200 mg daily; oral clindamycin and rifampicin both 300 mg twice daily for 10 weeks, extended for longer in some cases; laser treatment targeting hair follicles; deroofing; and conventional surgery. The primary outcome was the combination of clinician-assessed eligibility and participant hypothetical willingness to receive each intervention. The secondary outcomes were the proportion of participants selecting each intervention as their final treatment option; the proportion who switch treatments; treatment fidelity; and attrition rates. THESEUS was prospectively registered on the ISRCTN registry: ISRCTN69985145. RESULTS The recruitment target of 150 participants was met after 18 months, in July 2021, with two pauses due to the COVID-19 pandemic. Baseline demographics reflected the HS secondary care population: average age 36 years, 81% female, 20% non-White, 64% current or ex-smokers, 86% body mass index ≥ 25, 68% with moderate disease, 19% with severe disease and 13% with mild disease. Laser was the intervention with the highest proportion (69%) of participants eligible and willing to receive treatment, then deroofing (58%), conventional surgery (54%), clindamycin and rifampicin (44%), and doxycycline (37%). Laser was ranked first choice by the greatest proportion of participants (41%). Attrition rates were 11% and 17% after 3 and 6 months, respectively. Concordance with doxycycline was 52% after 3 months due to lack of efficacy, participant choice and adverse effects. Delays with procedural interventions were common, with only 43% and 26% of participants starting laser and deroofing, respectively, after 3 months. Uptake of conventional surgery was too small to characterize the intervention. Switching treatment was uncommon and there were no serious adverse events. CONCLUSIONS THESEUS has established laser treatment and deroofing for HS in the UK and demonstrated their popularity with patients and clinicians for future RCTs.
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Affiliation(s)
| | - Janine Bates
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | - Judith Evans
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | | | | | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Rachel Howes
- Department of Plastic Surgery, John Radcliffe Hospital, Oxford NHS Trust, Oxford, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare Trust, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Emma Thomas-Jones
- Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University, Cardiff, UK
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11
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Yaman A, Borman P, Eşme P, Çalışkan E. Complex decongestive therapy in hidradenitis suppurativa-related genital lymphoedema: a case report. J Wound Care 2024; 33:xxviii-xxxi. [PMID: 38324423 DOI: 10.12968/jowc.2024.33.sup2a.xxviii] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Genital lymphoedema is a rare but debilitating and disfiguring complication of longstanding hidradenitis suppurativa (HS). Despite the existence of medical and surgical methods that offer varying success rates in a limited number of cases, no data exist about the use of complex decongestive therapy (CDT) in HS-related genital lymphoedema. This case report describes the treatment and outcome of a 56-year-old male patient with severe scrotal lymphoedema due to underlying HS (Hurley stage 3). The patient was unresponsive to various topical and systemic antibiotics and biological agents, including adalimumab and certolizumab pegol. When the patient was assessed, ixekizumab treatment for his HS was planned. He had progressive oedema in the genital area for two years with difficulty in wearing trousers and having sexual intercourse, and painful urination. CDT was recommended for three days a week concurrently with ixekizumab treatment. The patient and his wife were also educated about self-drainage techniques and skincare maintenance. After six sessions of CDT over 14 days, the patient demonstrated a significant reduction in scrotal measurements. He achieved a better scrotal contour, the degree of the buried penis was decreased, and urination was easier and painless. The findings of this case report showed that CDT was an easily applicable, practical and promising method that offered a rapid treatment response for HS-related genital lymphoedema.
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Affiliation(s)
- Ayşegül Yaman
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Pınar Borman
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Pelin Eşme
- Department of Dermatology and Venereology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Ercan Çalışkan
- Department of Dermatology and Venereology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey
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12
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Bi W, Fu H, Huang Y, Zeng X, Li X, Guo Y, Wu T. The treatment of perianal hidradenitis suppurativa complicated with complex anal fistula by loose combined cutting seton surgery: A case letter. J Dermatol 2024; 51:e33-e34. [PMID: 37658711 DOI: 10.1111/1346-8138.16939] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/21/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Wei Bi
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hao Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yumei Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoyu Zeng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yukun Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ting Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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13
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Tripathi R, Ezaldein HH. Surgical management of seasonal flares in hidradenitis suppurativa. J Am Acad Dermatol 2024; 90:e21-e22. [PMID: 36935016 DOI: 10.1016/j.jaad.2023.02.038] [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: 01/20/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Raghav Tripathi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Harib H Ezaldein
- Miami Dermatology and Mohs Surgery, Miami, Florida; Bennett Surgery Center, Santa Monica, California
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14
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Meroni M, Scaglioni MF. Pedicled circumflex scapular artery perforator flap with intra-axillary tunneling for axillary defect coverage after surgical excision of hidradenitis suppurativa: A case report and literature review. Microsurgery 2024; 44:e31102. [PMID: 37626471 DOI: 10.1002/micr.31102] [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: 04/17/2023] [Revised: 07/04/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Axillary defects represent a rather common issue in plastic surgery practice. Surgical resections related to skin disease are frequent in this region and their extension often requires soft tissue transfer for coverage. In this setting, locoregional pedicled flaps are usually preferred. The nearby tissues offer pliable but still resistant skin, which satisfy the "like-with-like" reconstructive principle. Over the years different procedures have been described for this purpose. Among them, a valuable and often underestimated technique is the circumflex scapular artery perforator flap (CSAP). This technique might be particularly suitable for thin but relatively large defects. Its main advantages are a low donor site morbidity, a very reliable anatomy, and a perforator pedicle able supply a large skin paddle. In the present work, we report the use of a pedicled vertical CSAP flap passed through the axillary canal in order to cover a 9 cm × 7 cm axillary defect after surgical excision of hidradenitis suppurativa resistant to conservative treatment. The perforator-based pedicled presented two branches, which allowed us to harvest safely a large skin paddle, which limited its range of motion. For this reason, we opted for a passage through the axillary canal for the flap inset. The postoperative course was uneventful and full shoulder range of motion was obtained at 3 months follow-up. Despite most of the descriptions of this flap available so far showed its employment for limb's reconstructions, we believe that it is a very useful tool also for locoregional coverage. Moreover, the unconventional passage below the axillary muscles allowed reaching the recipient site even with a shorter pedicle, such as the one encountered in this case.
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Affiliation(s)
- Matteo Meroni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Brunetti B, Camilloni C, Putti A, Petrucci V, Pazzaglia M, Papalia R, Persichetti P. Use of superficial circumflex iliac artery perforator flap for soft tissues and lymphatic genital reconstruction after hidradenitis suppurativa resection. J Plast Reconstr Aesthet Surg 2024; 88:122-124. [PMID: 37976679 DOI: 10.1016/j.bjps.2023.10.140] [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: 10/13/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Chiara Camilloni
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Alessandra Putti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Valeria Petrucci
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Matteo Pazzaglia
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy.
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Rome, Italy.
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16
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Alshammary RH, Hbib Allaha EH, Fakhruddin MS, Bakhiet M. Use of multiple fasciocutaneous flaps for the management of extensive hidradenitis suppurativa. BMJ Case Rep 2023; 16:e255037. [PMID: 38061844 PMCID: PMC10711826 DOI: 10.1136/bcr-2023-255037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/18/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a relapsing nature that has a significant impact on the patient's quality of life. The clinical presentation of the disease includes deep dermal abscesses and sinus tracts. Long-term affliction of the disease may lead to contractures, scars and fibrosis. Management is still challenging and varies from medical to surgical options. We report the following case of a man in his 30s who presented with severe HS in the axillae, groins, perineum and lower sacral region. The patient has been treated by excision of the whole lesions followed by using multiple fasciocutaneous flaps as a reconstructive method.
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Affiliation(s)
- Rawan Humaidy Alshammary
- Plastic Surgery Department, Prince Mutaib bin Abdulaziz Hospital, Saudi Arabia Ministry of Health, Aljouf, Saudi Arabia
| | - Elbadawi Hassan Hbib Allaha
- Plastic Surgery Department, Prince Mutaib bin Abdulaziz Hospital, Saudi Arabia Ministry of Health, Aljouf, Saudi Arabia
| | - Muawya Sufyan Fakhruddin
- Plastic Surgery Department, Prince Mutaib bin Abdulaziz Hospital, Saudi Arabia Ministry of Health, Aljouf, Saudi Arabia
| | - Mohammed Bakhiet
- Department of Surgery, Al Baha University, AL Baha, Saudi Arabia
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17
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Ingram JR, Bates J, Cannings-John R, Collier F, Gibbons A, Harris C, Hood K, Howells L, Howes R, Leighton P, Riaz M, Rodrigues J, Stanton H, Thomas KS, Thomas-Jones E. Treatment of Hidradenitis Suppurativa Evaluation Study: the THESEUS prospective cohort study. Health Technol Assess 2023; 27:1-107. [PMID: 38149635 PMCID: PMC11017627 DOI: 10.3310/hwnm2189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background Hidradenitis suppurativa is a chronic inflammatory skin disease characterised by recurrent inflammatory lesions and skin tunnels in flexural sites such as the axilla. Deroofing of skin tunnels and laser treatment are standard hidradenitis suppurativa interventions in some countries but not yet introduced in the United Kingdom. Objective To understand current hidradenitis suppurativa management pathways and what influences treatment choices to inform the design of future randomised controlled trials. Design Prospective 12-month observational cohort study, including five treatment options, with nested qualitative interviews and an end-of-study consensus workshop. Setting Ten United Kingdom hospitals with recruitment led by dermatology and plastic surgery departments. Participants Adults with active hidradenitis suppurativa of any severity not adequately controlled by current treatment. Interventions Oral doxycycline 200 mg once daily; oral clindamycin and rifampicin, both 300 mg twice daily for 10 weeks initially; laser treatment targeting the hair follicle (neodymium-doped yttrium aluminium garnet or alexandrite); deroofing; and conventional surgery. Main outcome measures Primary outcome was the proportion of participants who are eligible, and hypothetically willing, to use the different treatment options. Secondary outcomes included proportion of participants choosing each of the study interventions, with reasons for their choices; proportion of participants who switched treatments; treatment fidelity; loss to follow-up rates over 12 months; and efficacy outcome estimates to inform outcome measure instrument responsiveness. Results Between February 2020 and July 2021, 151 participants were recruited, with two pauses due to the COVID-19 pandemic. Follow-up rates were 89% and 83% after 3 and 6 months, decreasing to 70% and 44% at 9 and 12 months, respectively, because pandemic recruitment delays prevented all participants reaching their final review. Baseline demographics included an average age of 36 years, 81% female, 20% black, Asian or Caribbean, 64% current or ex-smokers and 86% with a raised body mass index. Some 69% had moderate disease, 19% severe disease and 13% mild disease. Regarding the study's primary outcome, laser treatment was the intervention with the highest proportion (69%) of participants who were eligible and hypothetically willing to receive treatment, followed by deroofing (58%), conventional surgery (54%), the combination of oral clindamycin and rifampicin (44%) and doxycycline (37%). Considering participant willingness in isolation, laser was ranked first choice by the greatest proportion (41%) of participants. The cohort study and qualitative study demonstrated that participant willingness to receive treatment was strongly influenced by their clinician. Fidelity to oral doxycycline was only 52% after 3 months due to lack of effectiveness, participant preference and adverse effects. Delays receiving procedural interventions were common, with only 43% and 26% of participants commencing laser therapy and deroofing, respectively, after 3 months. Treatment switching was uncommon and there were no serious adverse events. Daily pain score text messages were initiated in 110 participants. Daily responses reduced over time with greatest concordance during the first 14 days. Limitations It was not possible to characterise conventional surgery due to a low number of participants. Conclusion The Treatment of Hidradenitis Suppurativa Evaluation Study established deroofing and laser treatment for hidradenitis suppurativa in the United Kingdom and developed a network of 10 sites for subsequent hidradenitis suppurativa randomised controlled trials. Future work The consensus workshop prioritised laser treatment and deroofing as interventions for future randomised controlled trials, in some cases combined with drug treatment. Trial registration This trial is registered as ISRCTN69985145. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/35/64) and is published in full in Health Technology Assessment; Vol. 27, No. 30. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Janine Bates
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Angela Gibbons
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ceri Harris
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Laura Howells
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rachel Howes
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Muhammad Riaz
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jeremy Rodrigues
- Burns and Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - Helen Stanton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
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18
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Ezanno AC, Guillem P, Gorin C, Gabison G, Malgras B, Fougerousse AC. What should a surgeon know about hidradenitis suppurativa? J Visc Surg 2023; 160:444-455. [PMID: 37722942 DOI: 10.1016/j.jviscsurg.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Otherwise known as Verneuil's disease, hidradenitis suppurative (HS) is a severe dermatosis of heterogeneous appearance affecting 1% of the population. Its pathophysiology is multifactorial, involving genetic predisposition, inflammatory disorder and environmental elements. Its diagnosis is based on the association of three clinical characteristics: characteristic lesions, typical localizations, and the chronic and recurrent nature of the lesions. Given its diversified aspects, diagnosis can be difficult to achieve. As its manifestations often include abscesses, it is important for the surgeon to know how to detect this pathology. The development of biologics has improved treatment of this disease, treatment that necessitates a multidisciplinary medical and surgical approach involving dermatologists and proctologists as well as surgeons. The objective of this report is to synthesize what a surgeon will need to know so as effectively treat HS patients.
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Affiliation(s)
- Anne Cecile Ezanno
- Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - Philippe Guillem
- Val d'Ouest Clinic, 39, chemin de la Vernique, 69130 Écully, France
| | - Cécile Gorin
- Psychiatry Department, HIA Sainte-Anne, 2, boulevard Sainte-Anne BP600, 83000 Toulon, France
| | - Germaine Gabison
- Dermatology, 32, avenue du Maréchal-de-Lattre-de-Tassigny, 94410 Saint-Maurice, France
| | - Brice Malgras
- Digestive Surgery Department, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France; Val de Grâce School, Army Health Service, 75005 Paris, France
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19
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Fortoul MC, Macias Martinez B, Ventura Rodriguez D, Dallara M, Stelnicki EJ, Kamel G. A Retrospective Review of Laser Therapy for Treatment of Hidradenitis Suppurativa. Ann Plast Surg 2023; 91:758-762. [PMID: 37856194 DOI: 10.1097/sap.0000000000003690] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
PURPOSE Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful and foul-smelling cystic nodules and sinus tracts in the apocrine gland-bearing regions. The treatment options include topical, intralesional, systemic, and surgical modalities. Currently, the most novel therapy is laser therapy to provide localized treatment without systemic adverse effects. However, data regarding patient outcomes after laser treatment are limited because of the low prevalence of this disease. This study aimed to evaluate the efficacy of laser therapy as a treatment modality for patients with HS. METHODS A retrospective review cohort analysis of patients with HS undergoing laser treatment between 2016 and 2021 was conducted. Patient demographics, lesion location(s), Hurley stage, age of onset and diagnosis, treatment length, type, outcomes, and complications were analyzed. RESULTS Ninety-four patients met the inclusion criteria; on average, patients were treated with 5.8 laser sessions for 14.8 months with no complications and minor blood loss. Hidradenitis suppurativa progression commonly starts during puberty, with a median onset of 13.8 years and diagnosis of HS at 16.2 years. All patients (n = 94) showed an improvement in HS disease severity: 59.6% completed treatment, 12.0% are currently undergoing treatment, and 26.0% were lost to follow-up. CONCLUSIONS Laser therapy is an effective and safe therapy for HS leading to improved quality of life and should be considered in the treatment and management of HS.
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Affiliation(s)
- Marla C Fortoul
- From the Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
| | - Brian Macias Martinez
- From the Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
| | | | - Marissa Dallara
- From the Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University
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20
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Maghfour J, Dzuali F, Ezekwe N, Gordon J, Hamzavi IH. Evaluating the efficacy of continuous wave carbon dioxide laser therapy in conjunction with biologics for the management of hidradenitis suppurativa. Br J Dermatol 2023; 189:764-783. [PMID: 37467744 DOI: 10.1093/bjd/ljad246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Jalal Maghfour
- Photobiology and Photomedicine Research Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
| | - Fiatsogbe Dzuali
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Nnemaka Ezekwe
- Department of Dermatology, University of Colorado Anschutz, Aurora, CO
| | | | - Iltefat H Hamzavi
- Photobiology and Photomedicine Research Unit, Department of Dermatology, Henry Ford Health System, Detroit, MI
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21
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Revankar RR, Blum F, Yeung H, Patel HA, Holahan H, Vedak P, Sayed CJ. Factors influencing patient experience during incision and drainage procedures in hidradenitis suppurativa: an analysis of patient-reported outcomes. Br J Dermatol 2023; 189:779-780. [PMID: 37671642 DOI: 10.1093/bjd/ljad327] [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: 02/21/2023] [Revised: 07/24/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
Patients with hidradenitis suppurativa who undergo incision and drainage experience higher levels of dread and lower levels of benefit due to poor anaesthesia and wound packing practices, and lower levels of provider compassion. Higher levels of dread were associated with increased pain during incision (coefficient 0.3, 95% CI 0.19–0.42) and wound packing or drain vs. simple bandaging (coefficient 2.25, 95% CI 0.61–3.90). Higher perceived benefits over drawbacks were associated with higher physician compassion (coefficient 0.21, 95% CI 0.06–0.36) and decreased pain during incision (coefficient 0.14, 95% CI 0.03–0.27).
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Affiliation(s)
| | - Franklin Blum
- Department of Dermatology, UNC School of Medicine, Chapel Hill, NC
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Heli A Patel
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Heather Holahan
- Department of Dermatology, University of California at Los Angeles, CA, USA
| | - Priyanka Vedak
- Department of Dermatology, UNC School of Medicine, Chapel Hill, NC
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22
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Wang Y, Han C, Wang X. Advances in surgical treatment of hidradenitis suppurative. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:795-801. [PMID: 37986703 PMCID: PMC10764190 DOI: 10.3724/zdxbyxb-2023-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Hidradenitis suppurative is a chronic, refractory and recurrent dermatological disease. The disease should be managed by targeted surgical intervention on the basis of medical treatment. Currently, the surgical treatment methods include local treatments like incision and drainage, unroofing, laser therapy, intense pulsed light therapy, photodynamic therapy, as well as complete lesion resection such as skin-tissue saving excision with electrosurgical peeling and extended excision. The clearance range, therapeutic effect, postoperative complications, and recurrence risk vary among the different treatment methods. Local treatments cause less damage, but have high recurrence rates, and are mainly for mild to moderate hidradenitis suppurative patients. Complete lesion resections have relatively low recurrence rates, but may bring more surgical injuries, and postoperative reconstructions are needed, which are mainly for moderate to severe hidradenitis suppurative patients. In this article, the surgical treatment principles and various surgical treatment methods of hidradenitis suppurative are reviewed, to provide a reference for the diagnosis and treatment of this disease in clinical practice.
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Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Chunmao Han
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xingang Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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23
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La Padula S, Pensato R, Pizza C, D'Andrea F, Roccaro G, Meningaud JP, Hersant B. The Thoracodorsal Artery Perforator Flap for the Treatment of Hidradenitis Suppurativa of the Axilla: A Prospective Comparative Study. Plast Reconstr Surg 2023; 152:1105-1116. [PMID: 36946904 DOI: 10.1097/prs.0000000000010435] [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: 03/23/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a common chronic condition that is often resistant to conservative treatment and requires a wide and aggressive surgical approach to prevent recurrence. A prospective study was performed comparing the outcomes of thoracodorsal artery perforator (TDAP) flap-based reconstruction and secondary intention closure (SIC) after wide local excision (WLE) of axillary HS. METHODS A prospective study was conducted on 68 patients with stage 3 axillary HS. Thirty-three patients underwent a WLE procedure and were left to heal by secondary intention (SIC group), and 35 patients underwent immediate reconstruction with a homolateral TDAP flap (TDAP group). Inpatient stay, healing time, postoperative complications rate, and pain were analyzed in both groups, comparing preoperative shoulder function (using Constant-Murley shoulder outcome score) and quality of life (using a dermatology life quality index) with postoperative shoulder function and quality of life. RESULTS Patients receiving TDAP flaps had significantly faster recovery, fewer complications, and fewer overall number of procedures than those who underwent SIC. All patients reported an improved quality of life after their operation. The TDAP group showed significantly more improvement than the SIC group ( P < 0.001). Patients receiving TDAP flaps reported a significant reduction in pain and discomfort and better shoulder function compared with patients in the SIC group ( P < 0.001). CONCLUSIONS WLE and TDAP flap-based reconstruction for axillary stage 3 HS provide optimal postprocedural functional results with a low complication rate. Complete remission of the disease was observed after the procedure. Despite the relatively slow learning curve of this procedure, the authors strongly recommend this technique as a very good option for the management of stage 3 axillary HS. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Simone La Padula
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II
| | - Rosita Pensato
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II
| | - Chiara Pizza
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
| | - Francesco D'Andrea
- Department of Plastic and Reconstructive Surgery, Università degli Studi di Napoli Federico II
| | - Giovanni Roccaro
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
| | - Jean Paul Meningaud
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
| | - Barbara Hersant
- From the Department of Plastic, Reconstructive, and Maxillofacial Surgery, Henri Mondor Hospital, University Paris XII
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24
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Elston DM. Combined medical and surgical therapy for hidradenitis suppurativa. J Am Acad Dermatol 2023; 89:671. [PMID: 37169295 DOI: 10.1016/j.jaad.2023.05.008] [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: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina.
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25
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Aarts P, van Huijstee JC, van der Zee HH, van Doorn MBA, van Straalen KR, Prens EP. Adalimumab in conjunction with surgery compared with adalimumab monotherapy for hidradenitis suppurativa: A Randomized Controlled Trial in a real-world setting. J Am Acad Dermatol 2023; 89:677-684. [PMID: 37116615 DOI: 10.1016/j.jaad.2023.04.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Adalimumab, the only biologic registered for hidradenitis suppurativa, shows clinical response in up to 60% of patients, leaving many patients in need for other treatment options such as surgery. OBJECTIVE To compare the clinical effectiveness of adalimumab combined with surgery vs adalimumab monotherapy in patients with moderate to severe hidradenitis suppurativa. METHODS A pragmatic Randomized Controlled Trial was performed from August 2018 to July 2022. Primary outcome was the difference in mean International Hidradenitis Suppurativa Severity Score System reduction after 12 months of treatment with the difference in mean Dermatology Life Quality Index reduction as a key secondary outcome. RESULTS Thirty-one patients were included per arm. The mean International Hidradenitis Suppurativa Severity Score System at baseline was 23.9 ± 10.7 in the surgery group and 20.9 ± 16.4, in the monotherapy group. After 12 months of treatment the surgery group had a significantly greater reduction in International Hidradenitis Suppurativa Severity Score System compared with the monotherapy group (-19.1 ± 11.3 vs -7.8 ± 11.8, P < .001). Moreover, the surgery group showed a greater reduction in Dermatology Life Quality Index after treatment compared with the monotherapy group (-8.2 ± 6.2 vs -4 ± 7.7, P = .02). LIMITATIONS The study follow-up was too short to assess surgical recurrence rates. DISCUSSION Combining adalimumab with surgery resulted in greater clinical effectiveness and improved quality of life after 12 months in patients with moderate to severe hidradenitis suppurativa.
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Affiliation(s)
- Pim Aarts
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Johanna C van Huijstee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kelsey R van Straalen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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26
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Jafry M, Novice T, Mohammad TF. Cutaneous Malignancy in Hidradenitis Suppurativa. Dermatol Surg 2023; 49:892-893. [PMID: 37389919 DOI: 10.1097/dss.0000000000003871] [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: 07/01/2023]
Affiliation(s)
- Mustufa Jafry
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
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27
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Saunte DML, Jemec GBE. Laser and intense pulsed light in the treatment of hidradenitis suppurativa. Clin Dermatol 2023; 41:628-638. [PMID: 37659574 DOI: 10.1016/j.clindermatol.2023.08.024] [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: 09/04/2023]
Abstract
Treatment of hidradenitis suppurativa (HS) requires a combination of medical, surgical, and lifestyle interventions. Intense pulsed light (IPL) and lasers have been reported to be useful. The aim of this review is to find the evidence supporting IPL and laser treatment of HS and to provide guidance for the management of specific HS lesions. We searched PubMed and Web of Science for "laser" and "hidradenitis suppurativa" on April 6, 2022. Inclusion criteria were >10 patients, reported follow-up, English language, and human subjects with a diagnosis of HS. A total of 724 articles were screened, but only 17 studies qualified for inclusion (IPL (n = 4), Nd:YAG (n = 6), CO2 laser (n = 6), and intralesional treatment (n = 2). The majority of the studies had a low (n = 10) or moderate (n = 7) evidence level. Treatment effect was noticed in studies using IPL and Nd:YAG (hair reduction). CO2 laser was used for surgery with a success rate ranging from 70.7% to 96.7%. CO2 laser is useful for surgery of stationary HS lesions, but it is difficult to draw a conclusion on the use of IPL and Nd:YAG (hair reduction) as the studies were too heterogeneous to perform a meta-analysis.
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Affiliation(s)
- Ditte Marie L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Sciences, University of Copenhagen, Copenhagen, Denmark
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Nosrati A, Torpey ME, Andriano TM, Benesh G, Babbush KM, Hosgood HD, Campton KL, Cohen SR. Importance of a multi-tiered treatment approach for intellectually and developmentally disabled patients with hidradenitis suppurativa. Arch Dermatol Res 2023; 315:1827-1829. [PMID: 36745196 DOI: 10.1007/s00403-023-02543-3] [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: 12/01/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/07/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, debilitating skin condition that is characterized by painful pustules, nodules, abscesses, and sinus tracts. The complicated and fast-evolving treatment of HS consists of a multi-tiered approach that includes, antibacterial, antihormonal, anti-inflammatory, and surgical options. Studies have demonstrated an earlier age of onset and increased prevalence of HS in patients with intellectual and developmental disability (IDD) compared to patients without IDD. To explore the use of an intensive multi-tiered HS management algorithm that requires monthly office visits, monthly intravenous therapy, and several daily treatment modalities in an HS population with IDD, we conducted an IRB-approved retrospective chart review of HS patients treated at the Albert Einstein College of Medicine-Montefiore HS Center (HSC) with diagnoses of concurrent IDD to investigate their demographic and diagnostic characteristics, as well as the spectrum of therapies employed in this cohort. A total of 22 HS patients with concomitant IDD, including trisomy 21, unspecified intellectual disability, autism spectrum disorder, and trisomy 13 were identified. Therapies utilized in this cohort for HS included topical and oral antibiotics, spironolactone, finasteride, oral contraceptive pills, infliximab, adalimumab, isotretinoin, intralesional and intramuscular triamcinolone injections, and excisional surgery. In conclusion, our findings indicate that despite the practical challenges, daily oral antibiotic regimens, anti-androgen combinations, oral retinoids, infliximab, adalimumab, and surgery collectively play important roles in treating HS patients with IDD. Our cases underscore the importance of utilizing the full range of modalities as the HS treatment algorithm continues to evolve.
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Affiliation(s)
- Avigdor Nosrati
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - McCall E Torpey
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - Tyler M Andriano
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - Gabrielle Benesh
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - Kayla M Babbush
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - H Dean Hosgood
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - Kristina L Campton
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA
| | - Steven R Cohen
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, 3411 Wayne Ave 2Nd Floor, Bronx, New York, NY, 10461, USA.
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Romanowski KS, Galet C, Torres M, Wibbenmeyer L. Evaluation of Outcomes Following Surgical Treatment of Hidradenitis Suppurativa. J Burn Care Res 2023; 44:880-886. [PMID: 36573669 PMCID: PMC10321394 DOI: 10.1093/jbcr/irac189] [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] [Indexed: 07/20/2023]
Abstract
Hidradenitis suppurativa (HS), a chronic disease of the apocrine bearing skin causing induration, pain, draining sinuses, and subcutaneous abscesses, significantly impairs patients' quality of life (QOL). Full-thickness excision followed by skin grafting of the involved area can be curative. Herein, we evaluated the impact of this surgical treatment on QOL and depression symptomatology. Adult patients (≥18 years) who consented to participate filled out the dermatology quality of life (DLQI) and the Patient History Questionnaire (PHQ-9) at consent and at 1, 6, and 12 months post-initial evaluation and surgery. Demographics, HS, admission, and operative information were collected. Sixteen patients were included. Subjects were mainly white (81.3 %) and female (56.3%) with a median age of 38.2 (Interquartile range: 34.2-54.5); 62.5% were obese (BMI= 39.7 [28.4-50.6]). Half of the subjects presented with HS in 2 or more areas. Six patients were still undergoing surgeries at 6 months. One-, six-, and 12-month follow-up surveys were obtained from 14, 11, and 8 subjects for DQLI and from 14, 9, and 5 subjects for PHQ9. DLQI scores significantly decreased at 6 months compared to baseline, which indicates QOL improvement (10 [4-20] vs 15.5 [12-21.8], P = .036). Although not significant, PHQ9 scores tended to decrease. For those with the worst disease, DLQI significantly decreased at both 6 (P = .049) and 12 months (P = .047) compared to baseline. Despite a small sample size, our data suggest that aggressive surgical treatment improves the QOL of HS patients. Further studies are warranted to confirm our findings.
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Affiliation(s)
- Kathleen S Romanowski
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Colette Galet
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Marlon Torres
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
| | - Lucy Wibbenmeyer
- Acute Care Surgery Division, Department of Surgery, University of Iowa, Iowa City, IA 52242, USA
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Tchernev G. LOSS OF EFFICACY OF ADALIMUMAB IN HIDRADENITIS SUPPURATIVA: FOCUS ON ALTERNATIVES. Georgian Med News 2023:297-300. [PMID: 37805915] [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] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
The loss of efficacy of adalimumab, one of the most commonly used biologics for the treatment of hidradenitis suppurativa/acne inversa, is not news to the scientific community, and it should be noted that the number of cases not responding to this agent has been progressively increasing in recent years. We present a 45-year-old patient with hidradenitis suppurativa/acne inversa (Hurley II-III) with a complaint duration of 3 years who has been on adalimumab 40 mg weekly for 9 months. The lack of improvement in the clinical condition as well as the progression of the disease within the ongoing biologic therapy led to the need for repeated hospitalizations and the additional introduction of intravenous treatment with a regimen of antibiotics (Ertapenem, Metronizadol, Ceftriaxone), zinc, colchicine, and pain relievers. During these hospitalizations, a partial improvement was found, which was not durable and required the parallel administration of antibiotics, colchicine and zinc in combination with adalimumab in an outpatient regimen. Several attempts at surgical treatment/incision in non-specialized units were also made, and these too remained generally unsuccessful or with a nondurable, unsatisfactory clinical outcome. Due to the subsequent consecutive worsening of the symptomatology, the patient was admitted for evaluation of the clinical condition and optimization of treatment. Surgical treatment was performed by surgical deroofing under general anaesthesia, concurrent with discontinuation of adalimumab/antibiotic application and long-term remission was achieved. Surgical deroofing has also been shown to be an effective therapeutic option in the loss/lack of efficacy of adalimumab in patients with hidradenitis suppurativa (Hurley II-III). In the case of therapeutic resistance or worsening of symptomatology in patients with acne inversa within adalimumab therapy, other advanced alternatives such as golimumab, anakinra, etanercept are available. The efficacy of these second-line agents is also questionable due to the development of resistance to them as well, which in turn necessitates the frequent switch to third-line agents such as: Ustekinumab, Tildarkizumab, Certolizumab or Ixekizumab. The future will show to what extent this "trust" could be justified and whether in practice the surgical approach will once again displace the so-called "modern options" as the reasonable next basic and reliable alternative. The disadvantage of modern biological therapy is mainly due to the loss of efficacy/development of resistance over time, multiple side effects and frequent recurrence after discontinuation of treatment. In contrast, in the case of specific, stage-oriented, specialized surgical treatment of hidradenitis suppurativa/ acne inversa, in the form of surgical deroofing, for example, the results are long-lasting and in the case of recurrences: the latter are much more easily managed by dermatosurgery/surgery again. The effect achieved after this type of manipulation is essential for the patients' quality of life and guarantees to a large extent also prevention of the development of keratinocyte tumours in the areas affected by chronic inflammation. Precisely because of the aforementioned facts, in a serious number of patients this type of treatment could be considered as a priority. The rethinking of the guideline and the staging of surgical modalities as first-line therapy could, in a serious number of patients, have a positive effect. Swap for surgery seems to be a good alternative.
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Affiliation(s)
- G Tchernev
- Onkoderma - Clinic for Dermatology, Venereology and Dermatologic Surgery, Sofia; Department of Dermatology and Venereology, Medical Institute of Ministry of Interior, Sofia, Bulgaria
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Ezekwe N, Neelam R, Jones BA, Ozog DM, Hamzavi IH. Retrospective study of keloid formation after CO 2 excision therapy for hidradenitis suppurativa. J Am Acad Dermatol 2023; 89:181-182. [PMID: 36905960 DOI: 10.1016/j.jaad.2023.03.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 01/11/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Nneamaka Ezekwe
- The Department of Dermatology, University of Colorado, Aurora, Colorado
| | - Rasna Neelam
- Internal Medicine, AMITA Health Saint Joseph Chicago, Chicago, Illinois
| | - Brittani A Jones
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - David M Ozog
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Iltefat H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan.
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García-Martínez FJ, de Cabo Francés F. Contrast-enhanced ultrasound with peroxide hydrogen for hidradenitis suppurativa and pilonidal sinus presurgical mapping. J Am Acad Dermatol 2023; 88:e163-e164. [PMID: 33428974 DOI: 10.1016/j.jaad.2020.12.074] [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: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | - Francisco de Cabo Francés
- Instituts Guirado Radiología, Barcelona, Spain; Aesthetic Ultrasound Unit, Centro Médico De Cabo-Bové, Martorell, Spain
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Wang L, Qi W, Gao J, Tian M, Sun H, Xu W. Perineal burn injury with hidradenitis suppurativa: A case report. Medicine (Baltimore) 2022; 101:e32525. [PMID: 36595817 PMCID: PMC9794327 DOI: 10.1097/md.0000000000032525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which usually presents with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas. Severe HS has interconnecting sinus tracts and when it occurs in the perianal region, perianal fistulas can form. Obesity and smoking are 2 risk factors for the development of HS. PATIENT CONCERNS We report a case of a 33-year-old male diagnosed with perianal HS and perianal fistula following a burn injury to the area that occurred during childhood. DIAGNOSIS Through integration of the clinical signs and imaging results, the patient was diagnosed with HS, Hurley stage III with perianal fistulas. INTERVENTIONS The patient accepted surgical therapy. Performed under the general anesthesia, the procedure comprised sinus tracts excision and drainage. OUTCOMES The patient was discharged from the hospital 6 weeks after surgery. LESSONS The pathogenesis of the HS in this case was the burn injury interfering with sweat gland formation around the anus. Moreover, the scar from the burn made surgical treatment difficult.
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Affiliation(s)
- Linyue Wang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, China
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Wenyue Qi
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, China
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Jihua Gao
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
- Key Laboratory of Integrated Chinese Medicine and Western Medicine for Gastroenterology Research (Hebei), Shijiazhuang, China
- * Correspondence: Jihua Gao, Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, 389, Zhongshan East Road, Shijiazhuang, Hebei Province 050000, China (e-mail: )
| | - Maosheng Tian
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Hongyuan Sun
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, China
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Wencong Xu
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, China
- Anorectal Department, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, China
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Di Guida A, Forgione P, Fornaro L, Marasca D, Fabbrocini G, Marasca C. Step by step surgery for hidradenitis suppurativa. Dermatol Ther 2022; 35:e15938. [PMID: 36239203 DOI: 10.1111/dth.15938] [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: 07/25/2022] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Adriana Di Guida
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Patrizia Forgione
- UOSD Dermatologia, Centro Rif. Regionale Malattia di Hansen e Lyme, P.O. dei Pellegrini, Naples, Italy
| | - Luigi Fornaro
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Dario Marasca
- Department of Dentistry, University Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Claudio Marasca
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Gasslitter I, Häfner HM, Kofler K, Kofler L. [Postoperative wound care with custom-made wound dressings for hidradenitis suppurativa : Wound care after radical excision with secondary wound closure]. Dermatologie (Heidelb) 2022; 74:994-996. [PMID: 37910227 DOI: 10.1007/s00105-023-05247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/03/2023]
Abstract
Hidradenitis suppurativa is a chronic, recurrent, autoinflammatory skin disease of the hair follicle and sebaceous glands in intertriginous skin areas. Treatment is based on clinical severity (typically classified according to Hurley stage). In advanced stages, radical excision of affected skin areas with secondary wound closure remains first-line treatment. Postoperative care in this setting should comprise nonadhesive wound dressings. The purpose of this article is to illustrate postoperative wound care after radical excision with secondary wound closure using nonadhesive, absorbent dressings for economical and effective care.
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Affiliation(s)
- Irina Gasslitter
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a. d. R, Deutschland
| | - Hans-Martin Häfner
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Studienzentrum für Operative Dermatologie der Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Katrin Kofler
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a. d. R, Deutschland
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
- Studienzentrum für Operative Dermatologie der Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - Lukas Kofler
- Hautzentrum skin+more MVZ, Holzmarkt 6, 88400, Biberach a. d. R, Deutschland.
- Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
- Studienzentrum für Operative Dermatologie der Universitätshautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
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Claessens AAE, van Alphen TC, Lapid O, Hoogbergen MM, Ovadja ZN. Use of Patient-Reported Outcome Measures in the Surgical Treatment of Hidradenitis Suppurativa: A Systematic Review. Dermatol Surg 2022; 48:411-417. [PMID: 35333200 DOI: 10.1097/dss.0000000000003431] [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: 11/26/2022]
Abstract
BACKGROUND Surgery is considered to be the best treatment for recurrent hidradenitis suppurativa (HS). Although it is necessary to assess the effect on health-related quality of life (HR-QoL), patient-reported outcome measures (PROMs) are scarce and heterogeneously used in the literature about the surgical treatment of HS. OBJECTIVE The aim of this study was to provide a review of the complete literature for different PROMs used in the surgical treatment of HS and to assess their methodological qualities. METHODS A systematic literature search of PubMed, Medline, Cochrane, CINAHL, and Embase with an assessment following the COnsensus-based standards for the Selection of health status Measurement INstrument criteria. RESULTS The search identified 218 articles, with the inclusion of 6 studies for analysis. Identified PROMs were as follows: the Dermatology Life Quality Index (DLQI), the Derriford Appearance Scale-24 (DAS-24), and the Work Productivity and Activity Impairment (WPAI). These non-disease-specific PROMs seem to have poor results concerning development and content validation. CONCLUSION The DLQI, WPAI, and DAS-24 are generic PROMs with poor methodological qualities for PROM development and content validation. Hidradenitis suppurativa-specific instruments are not used in available studies because they have been developed recently and, therefore, partially validated. More research is needed to further investigate methodological qualities of HS-specific instruments.
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Affiliation(s)
- Anouk A E Claessens
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Tert C van Alphen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, the Netherlands
| | - Maarten M Hoogbergen
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Zachri N Ovadja
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht (UMC Utrecht), Utrecht, the Netherlands
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Abstract
Hidradenitis suppurativa (HS) is an under-reported, poorly understood and often mismanaged inflammatory skin condition that manifests itself as painful, inflamed areas or boils. Although blind at first, it develops into exuding lesions often with tracking sinuses, leaving painfully stretched and scarred skin. While advances have been made in surgical and pharmaceutical interventions to interrupt the disease and prevent infection, effective wound management, evidence and guidelines remain limited. This article describes the experiences of an HS sufferer, in her quest for a satisfactory and acceptable wound management solution. It is hoped that the author's criteria for the ideal wound management system for HS will be the starting point for discussion and development of sound HS wound care guidelines.
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Abstract
INTRODUCTION Hidradenitis suppurativa can be a debilitating condition, particularly in the pediatric population. Axillary hidradenitis can be particularly challenging because of the risk of scar contracture and limited range of motion after definitive resection and reconstruction. A dermal regeneration template (DRT) and skin grafting have been used to reduce scar contracture in other areas of the body and may benefit this population. OBJECTIVE This case series retrospectively reviewed and evaluated outcomes using DRT and skin grafting for axillary hidradenitis reconstruction to report the authors' initial experience. MATERIALS AND METHODS After institutional review board approval, a retrospective review was conducted of a single surgeon's experience for all patients undergoing axillary hidradenitis resection and immediate reconstruction with DRT and skin grafting from 2015 through 2018. Preoperative characteristics, surgical details, and postoperative results were collected. RESULTS Five patients undergoing 7 procedures were eligible for inclusion. The average age at the time of surgery was 18.2 years. Patients underwent an average of 4.9 negative pressure wound therapy changes prior to skin grafting. No complications, DRT loss, or skin graft loss occurred. All patients were reported to have normal range of motion of the surgically managed extremity after skin grafting. The average follow-up was 273.4 days after the last procedure. As of this writing, no patients had experienced any recurrence of hidradenitis in the surgically managed axilla. CONCLUSIONS The use of DRT and subsequent skin grafting for the definitive management of axillary hidradenitis resulted in no recurrence and full range of motion of the affected extremity without complications. Surgeons should consider using this method of reconstruction for axillary hidradenitis, particularly in the pediatric population.
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Affiliation(s)
- Casey Kraft
- Ohio State University Wexner Medical Center, Columbus, OH
| | - Gregory Pearson
- Ohio State University Wexner Medical Center, Columbus, OH; Nationwide Children's Hospital, Columbus, OH
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Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the apocrine sweat glands present in 1% to 4% of the adult population, with twice greater prevalence in females. Surgical excision is the criterion-standard treatment for advanced, grade III disease, characterized by extensive and recurrent abscesses and interconnected sinus tracts. Numerous reconstructive methods have been used to cover the resulting defects, including secondary intention healing, use of skin grafts, and a wide range of locoregional flaps. METHODS The modified posterior arm flap has been developed for reconstruction of axillary defects after radical excision of HS. Based on perforating vessels from the axillary artery first identified by Masquelet, a brachioplasty-like incision is used to keep the donor site closure relatively hidden on the posteromedial aspect of the inner arm. RESULTS Eight modified posterior arm flaps have been undertaken in 6 patients, all women (mean age, 35 years; range, 22-51 years) from 2014 to 2019. All patients had complete resolution of their HS symptoms with no incidences of recurrence at mean follow-up of 15 months. All reported satisfaction with the aesthetic and functional outcomes of the procedure. DISCUSSION We present a novel modification of the posterior arm flap for the treatment of advanced axillary HS with good functional and aesthetic outcomes and no incidences of recurrence.
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Affiliation(s)
- David R Thomson
- From the Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead
| | | | - Syed Mehdi
- Department of Plastic Surgery, St George's Hospital, London, United Kingdom
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Dick J, Kröhl V, Enk A, Hartschuh W, Gholam P. Improvement in Quality of Life and Pain in Patients With Hidradenitis Suppurativa After Wide Local Excision: A Prospective Study. Dermatol Surg 2021; 47:1556-1561. [PMID: 34537785 DOI: 10.1097/dss.0000000000003235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects patients' quality of life (QoL). OBJECTIVE To investigate changes in QoL in patients with HS after wide local excision (WLE) and to examine the level of pain, rate of postoperative complications, recurrences, and the time to complete wound closure. METHODS Fifty-five patients were enrolled in this prospective study. All patients underwent WLE of HS, followed by secondary wound healing. Dermatologic Life Quality Questionnaire, pain, and wound size were measured 1 day, 3 weeks, 3 months, and 6 months after surgery. RESULTS Dermatologic Life Quality Questionnaire and pain scores (mean ± SD) improved significantly (both p < .001) from 14.5 ± 7.3 and 3.7 ± 2.8 at baseline to 5.8 ± 6.9 and 0.8 ± 1.7, 6 months postoperatively, respectively. Wounds were closed completely by secondary intention after 4.4 ± 2.8 months. Sixteen patients (29.1%) experienced postoperative complications, local recurrences in the treated sites were observed in 11 patients (20%), and new lesions in untreated sites were observed in 5 cases (9.1%). CONCLUSION Wide local excision significantly improves patients' QoL and pain, and, given its low rate of recurrence and complications, should be considered as a first-line therapy, especially in patients with higher Hurley stages.
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Affiliation(s)
- Julika Dick
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Hartschuh
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
- Haut-und Laserzentrum Heidelberg, Heidelberg, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
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El-Shebly AM, El-Hadidy MR, Shehabeldin SA, El Din AB, Zeina AM, Zayed AE, El Fahar MH. Outcome comparison between thoracodorsal artery perforator flap and muscle-sparing latissimus dorsi flap in axillary reconstruction after hidradenitis suppurativa excision. Microsurgery 2021; 42:143-149. [PMID: 34783373 DOI: 10.1002/micr.30837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 08/28/2021] [Accepted: 10/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thoracodorsal artery perforator (TDAP) flap and muscle-sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results. METHODS A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm-chest interval. RESULTS The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p = .009), respectively. Flap complications were significantly higher in the TDAP group (p = .034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm-chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p = .001). CONCLUSIONS TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.
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Affiliation(s)
- Ahmed M El-Shebly
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed R El-Hadidy
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Samy A Shehabeldin
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Bahaa El Din
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed M Zeina
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed E Zayed
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed H El Fahar
- Plastic and Reconstructive Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Molinelli E, Sapigni C, Simonetti O, Brisigotti V, Giuliodori K, Offidani A. Alexandrite laser as an adjuvant therapy in the management of mild-moderate hidradenitis suppurativa: a controlled prospective clinical study. J Am Acad Dermatol 2021; 87:674-675. [PMID: 34774922 DOI: 10.1016/j.jaad.2021.10.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/06/2021] [Accepted: 10/13/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Elisa Molinelli
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Claudia Sapigni
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Oriana Simonetti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy.
| | - Valerio Brisigotti
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Katia Giuliodori
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
| | - Annamaria Offidani
- Dermatological Unit, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, Italy
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43
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Orita A, Kitamura S, Maeda T, Yanagi T, Iwata H, Shiba-Tokuchi K, Nomura T, Ujiie H. Hidradenitis suppurativa successfully treated with two-stage surgery under disease control with adalimumab. J Dermatol 2021; 49:e1-e2. [PMID: 34505716 DOI: 10.1111/1346-8138.16143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/05/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Akihiro Orita
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinya Kitamura
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Maeda
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Teruki Yanagi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Keiko Shiba-Tokuchi
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshifumi Nomura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Hsiao SC, Chang CH, Huang SH. Recycled Split-Thickness Skin Grafting: A Novel Treatment for Axillary Hidradenitis Suppurativa. Dermatol Surg 2021; 47:1142-1143. [PMID: 33587371 DOI: 10.1097/dss.0000000000002935] [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: 11/25/2022]
Affiliation(s)
- Shih-Chi Hsiao
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chih-Hau Chang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regeneration Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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45
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Canard C, Diaz Cives A, Gaubil-Kaladjian I, Bertin E, Viguier M. Impact of Bariatric Surgery on Hidradenitis Suppurativa. Acta Derm Venereol 2021; 101:adv00471. [PMID: 34003299 PMCID: PMC9380277 DOI: 10.2340/00015555-3830] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Clothilde Canard
- Department of Dermatology and Venereology, Robert Debré Hospital, FR-51100 Reims, France
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46
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Lelonek E, Bieniek A, Matusiak Ł, Szepietowski JC. Improved Psychosocial Status after Surgery for Genital Elephantiasis due to Hidradenitis Suppurativa: A Prospective Study of a Case Series. Acta Derm Venereol 2021; 101:adv00389. [PMID: 33470416 PMCID: PMC9366703 DOI: 10.2340/00015555-3743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Edyta Lelonek
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, 50-368 Wrocław, Poland
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47
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Ovadja ZN, Bartelink SAW, Hadi K, van de Kar AL, van der Horst CMAM, Lapid O. A Multicenter Analysis of Wide Excision and Reconstruction for Severe Anogenital Hidradenitis Suppurativa. Ann Plast Surg 2021; 86:193-200. [PMID: 33449465 DOI: 10.1097/sap.0000000000002554] [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: 11/25/2022]
Abstract
BACKGROUND An appropriate reconstruction strategy after wide excision for severe cases of anogenital hidradenitis suppurativa (aHS) is important to optimize outcomes, but there is no consensus on which reconstruction strategy should be preferred. OBJECTIVE Evaluate which reconstruction strategy after wide excision in patients with severe aHS is associated with the best outcomes in terms of recurrence rate, complications and patient-reported outcomes on range of motion, pain, appearance, sexual health and satisfaction. METHODS Multicenter retrospective analysis between 2009 and 2019 of wide excision and reconstruction by primary closure, secondary intention healing, split-thickness skin grafts or fasciocutaneous flaps (FCF). The recurrence rate was the primary endpoint of multivariable logistic regressions to determine variables with an independent effect on recurrence. RESULTS A total of 93 patients were included. The overall recurrence rate was 62% after a median follow-up of 43 months, without statistical significance between reconstruction strategies (P = 0.737). The number of interventions during follow-up was an independent risk factor for recurrence (odds ratio, 2.55; confidence interval, 1.24-5.25; P = 0.011). Complications (37%) were more severe after FCF (P = 0.007). The mean score regarding patient-reported outcomes was 14.9 ± 2.8, of 24, with best appearance after FCF (P = 0.042). CONCLUSIONS These long-term follow-up data on severe aHS demonstrate a high recurrence rate after wide excision and reconstruction. Patients should be informed that treatment consists of long-term medicinal and surgical interventions with high recurrence rates, and surgeons may choose their own preferred reconstruction methods. Furthermore, more attention should be paid to the sexual health of patients with aHS.
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Affiliation(s)
| | - Sophieke A W Bartelink
- From the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam
| | - Kany Hadi
- From the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam
| | | | - Chantal M A M van der Horst
- From the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam
| | - Oren Lapid
- From the Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centre (Amsterdam UMC), University of Amsterdam
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Marchesi A, Amendola F, Garieri P, Steinberger Z, Vaienti L. Wide Local Excisions and Pedicled Perforator Flaps in Hidradenitis Suppurativa: A Study of Quality of Life. Ann Plast Surg 2021; 86:201-205. [PMID: 32881748 DOI: 10.1097/sap.0000000000002482] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/12/2023]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin pathology characterized by the occurrence of inflamed and swollen lesions, with a devastating impact of the disease on patient's quality of life. Wide local excision (WLE) of the affected tissue is the criterion-standard treatment, but there is no general consensus on the best reconstructive technique. The aim of this article is to evaluate the quality of life before and after WLE combined with pedicled perforator flap reconstruction, in patients suffering from HS. METHODS We analyzed 26 consecutive patients suffering from Hurley stage III HS. Every patient underwent WLE, followed by reconstruction with pedicled perforator flap. Dermatology Quality of Life Index (DLQI) tests were administered to every patient preoperatively and 6 months after surgery, when the clinical condition was considered stable. Dermatology Quality of Life Index scores were compared in terms of means with Student t test. Linear regression studies were used to compare the changes in DLQI score with the surgical and clinical variables. RESULTS Axillary area involvement was found in 21 of 27 patients; 6 patients had more than 1 body region involved. Thirty-two pedicled perforator flaps were performed, and 22 were thoracodorsal artery perforator flaps. Mean DLQI test score before the first operation was 21.31 ± 4.79; the average DLQI score after the last follow-up was 5 ± 2.95 (P < 0.0001). Dermatology Quality of Life Index scores were not influenced by complications including reoperation. There were also no correlations found between DLQI score delta and number of reoperation (-0.18) or days of hospital stay (-0.13). CONCLUSIONS Wide local excision followed by pedicled perforator flap reconstruction allows a radical excision of HS areas with short postoperative healing periods. Dermatology Quality of Life Index scores confirmed high levels of patients' satisfaction. Disadvantages of this technique include difficult learning curve, long operating time, and a nonnegligible complications rate.
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Affiliation(s)
- Andrea Marchesi
- From the Plastic Surgery, Hand Surgery and Reconstructive Microsurgery Department, Ospedale San Gerardo, Monza
| | - Francesco Amendola
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Pietro Garieri
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Luca Vaienti
- Plastic and Reconstructive Surgery Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Kocinec V, Bártlová A, Salavec M, Jackanin S, Havrlentová L, Örhalmi J, Šerclová Z. Surgical treatment of extensive perianal hidradenitis. Rozhl Chir 2020; 99:408-412. [PMID: 33242970 DOI: 10.33699/pis.2020.99.9.409-413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. CASE REPORTS There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.
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50
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Salvador-Rodriguez L, Cuenca-Barrales C, Arias-Santiago S, Molina-Leyva A. Neoadjuvant Biologic Therapy in the Surgical Management of Patients with Hidradenitis Suppurativa: A Cohort Study. Acta Derm Venereol 2020; 100:adv00257. [PMID: 32830282 PMCID: PMC9234998 DOI: 10.2340/00015555-3616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Luis Salvador-Rodriguez
- Hidradenitis Suppurativa Clinic, Dermatology, Hospital Universitario Virgen de las Nieves, ES-18012 Granada, Spain
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