|
1
|
Byrd AS, Moreau JM, Petukhova L, Frew J. Differentiating the Role of Inflammation in Hidradenitis Suppurativa from that in Other Inflammatory Skin Diseases. J Invest Dermatol 2025:S0022-202X(25)00450-6. [PMID: 40411510 DOI: 10.1016/j.jid.2025.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2025] [Revised: 03/27/2025] [Accepted: 04/15/2025] [Indexed: 05/26/2025]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by nodules, abscesses, and sinus tunnels, primarily in intertriginous areas. Symptoms of HS are associated with reduced psychosocial health and physical function. HS shares some pathogenic, cellular, and molecular features with other inflammatory skin diseases, highlighting its heterogeneity and complexity. This heterogeneity in disease presentation may contribute to the diagnosis delay observed with HS. The primary objective of this review is to highlight the initiating events, inflammatory signature, molecular features, and clinical features that differentiate HS from other inflammatory skin diseases to improve outcomes for patients with HS.
Collapse
Affiliation(s)
- Angel S Byrd
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia, USA.
| | - Joshua M Moreau
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA; Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Lynn Petukhova
- Ronald O. Perelman Department of Dermatology, Grossman School of Medicine, New York University Langone Health, New York, New York, USA; Department of Population Health, Grossman School of Medicine, New York University Langone Health, New York, New York, USA
| | - John Frew
- University of New South Wales, Sydney, Australia; Laboratory of Translational Cutaneous Medicine, Ingham Institute for Applied Medical Research, Liverpool, Australia; Department of Dermatology, Liverpool Hospital, Liverpool, Australia
| |
Collapse
|
|
2
|
Vecin N, Balukoff NC, Yaghi M, Gonzalez T, Sawaya AP, Strbo N, Tomic-Canic M, Lev-Tov H, Pastar I. Hidradenitis Suppurativa Tunnels: Unveiling a Unique Disease Entity. JID INNOVATIONS 2025; 5:100350. [PMID: 40034103 PMCID: PMC11872476 DOI: 10.1016/j.xjidi.2025.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 12/17/2024] [Accepted: 01/07/2025] [Indexed: 03/05/2025] Open
Abstract
Hidradenitis suppurativa tunnel structures lined with epithelium within the dermis are unique features of advanced disease stages that significantly impair patients' QOL. The presence of hidradenitis suppurativa tunnels is associated with a decreased likelihood of achieving a clinical response, even when receiving biological therapy. The cellular and molecular mechanisms underlying tunnel formation and pathology are only partially understood, which hampers the development of more effective targeted therapies. Tunnels create a unique microenvironment that drives a vicious cycle of hidradenitis suppurativa inflammation, with tunnel keratinocytes exhibiting an activated phenotype characterized by distinct gene expression signatures. In this review, we summarize the current literature and discuss aspects of the pathophysiology of tunnels, including the role of hair follicle epidermal stem cells in tunnel formation, potential role of fibroblast-mediated epithelial-mesenchymal transition, role of dermal papilla fibroblasts, and aberrant proinflammatory repair response contributing to the observed fibrosis and scarring. Finally, tunnel structures are characterized by unique microbial dysbiosis and an overabundance of Gram-negative anaerobes that are not targeted by current therapeutics. In addition to outlining the possible mechanisms of tunnel formation, we provide perspectives on the translation of current knowledge into more effective treatment approaches for patients with hidradenitis suppurativa tunnels.
Collapse
Affiliation(s)
- Nicole Vecin
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nathan C. Balukoff
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marita Yaghi
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tammy Gonzalez
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Andrew P. Sawaya
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Natasa Strbo
- Departament of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar Lev-Tov
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Irena Pastar
- Miami HS Center, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
|
3
|
Wafae BGO, Charrow AP, Noe MH. Noncutaneous Infections in Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study. JID INNOVATIONS 2025; 5:100349. [PMID: 40092717 PMCID: PMC11910360 DOI: 10.1016/j.xjidi.2025.100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 12/17/2024] [Accepted: 12/23/2024] [Indexed: 03/19/2025] Open
Abstract
Adults with hidradenitis suppurativa (HS) have comorbidities and are exposed to treatments that may increase their risk of serious infections. Therefore, our study aims to determine the prevalence and risk factors for noncutaneous infections (NCIs) related hospitalizations in adults with HS and analyze their patterns of healthcare utilization. This retrospective cohort included patients with dermatologist-confirmed HS from a single healthcare system between 2018 and 2022. Primary/secondary diagnostic codes identified NCI-related hospitalizations. Multivariable logistic regression assessed risk factors. Data on nonpsychiatric hospitalizations and emergency department visits were collected for overall healthcare utilization. Among the 834 patients with HS, 6.4% were hospitalized for NCI during the study period. The most common infections were urinary tract infections (18.2%), musculoskeletal infections (13%), and COVID-19 (11.7%). The main factors associated with NCIs were public insurance (OR = 2.06, confidence interval = 1.09-3.83), chronic kidney disease (OR = 7.73, confidence interval = 2.03-29.09), and anxiety (OR = 3.27, confidence interval = 1.58-6.67). Prevalence of nonpsychiatric hospitalization was 24.6%, and that of emergency department visits was 45.3%. In conclusion, patients with HS had a significant prevalence of hospitalizations from NCIs, with urinary tract infections being the most prevalent. The risk was higher in patients with anxiety or chronic kidney disease. Future research should focus on interventions and measures to prevent infections.
Collapse
Affiliation(s)
- Bruna G O Wafae
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alexandra P Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Sanofi Pharmaceuticals, Boston, Massachusetts, USA
| |
Collapse
|
|
4
|
Siuka D, Rakusa M. Combined adalimumab and etonogestrel/ethinylestradiol therapy associated with hypertriglyceridemia-induced pancreatitis in a young woman with hidradenitis suppurativa. ENDOCRINOL DIAB NUTR 2025; 72:101536. [PMID: 40221190 DOI: 10.1016/j.endien.2025.101536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Accepted: 10/25/2024] [Indexed: 04/14/2025]
Affiliation(s)
- Darko Siuka
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Rakusa
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| |
Collapse
|
|
5
|
Midgette B, Garg A. Comorbidities and Quality of Life in Hidradenitis Suppurativa. Dermatol Clin 2025; 43:173-178. [PMID: 40023619 DOI: 10.1016/j.det.2024.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2025]
Abstract
Hidradenitis suppurativa (HS) is a debilitating, chronic inflammatory disease that results in painful nodules, abscess, and draining tunnels which eventuate in morbid scarring. Patients with HS are at risk for various cutaneous and systemic comorbid diseases including inflammatory bowel disease, cardiovascular, endocrine, and psychiatric conditions. Given its high symptom burden, chronic and progressive course, and association with comorbid conditions, HS has a profound life impact on patients.
Collapse
Affiliation(s)
| | - Amit Garg
- Department of Dermatology, Northwell Health.
| |
Collapse
|
|
6
|
Garg A, Koptyev J, Butt M, Kirby J, Strunk A. Development and External Validation of the Hidradenitis Suppurativa Cutaneous Abscess Prediction Score-2: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess. Dermatology 2025; 241:194-202. [PMID: 39788111 DOI: 10.1159/000543130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 12/08/2024] [Indexed: 01/12/2025] Open
Abstract
INTRODUCTION Patients with hidradenitis suppurativa (HS) experience a 10-year diagnosis delay, on average. Accordingly, time to diagnosis represents one of the greatest unmet needs in HS, which to date has not been adequately addressed. A general lack of awareness about HS in the medical community and a notable heterogeneity in clinical presentation, which is most often confused with cutaneous abscess (CA), forms the basis of poor disease recognition and diagnosis delay. Our objective was to develop and validate a prediction model for diagnosis of HS versus site-specific CA. METHODS We performed a cross-sectional study in which the model was developed using a large clinical database and externally validated using a sample of clinical records at Penn State Health. Prediction model discrimination and calibration were evaluated using the c-statistic, calibration intercept/slope, and a flexible calibration curve. RESULTS Variable selection identified 15 predictors, 7 of which remained after model simplification. The following characteristics were predictive of HS relative to site-specific CA: female sex, increasing age up to 44 years, African American race, race other than white or African American, increasing body mass index, polycystic ovarian syndrome, and acne. The c-statistic of the 7-variable model in validation was 0.77 (95% CI: 0.73-0.80). Calibration intercept and slope were 0.29 (95% CI: 0.14, 0.43) and 1.09 (95% CI: 0.90, 1.28). CONCLUSION Clinical characteristics can predict diagnosis of HS over CA in practice without reliance on a specialty-specific examination to identify disease and potentially reduce diagnosis delay.
Collapse
Affiliation(s)
- Amit Garg
- Northwell, New Hyde Park, New York, USA
| | | | - Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Joslyn Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | | |
Collapse
|
|
7
|
Köktürk U, Güdül NE, Erbay İ, Doğan PE, Hazinedar E, Kısa F, Koca R, Avcı A. A marker of systemic inflammation in hidradenitis suppurativa patients without cardiovascular disease: aortic arch calcification. Arch Dermatol Res 2024; 316:709. [PMID: 39460803 DOI: 10.1007/s00403-024-03461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 10/01/2024] [Accepted: 10/16/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND In this study, we aimed to investigate whether there is a relationship between aortic arch calcification (AAC) and hidradenitis suppurativa (HS) in HS patients without cardiovascular disease. METHODS In this study, patients over 18 years of age who applied to the dermatology outpatient clinic between January 2023 and February 2024 were followed up with the diagnosis of HS without cardiovascular disease, and a healthy control group matched in terms of age and gender were included retrospectively. RESULTS In total, 130 patients with HS without cardiovascular disease and 130 control patients were included in the study. AAC was significantly higher in the HS group compared to the control group (p = 0.028). In the multivariate analysis, we found that age and HS were independent predictors of AAC (OR: 1.048 (1.009-1.089); p = 0.015, OR: 3.158 (1.181-8.445); p = 0.022, respectively). When we divided the groups as having AAC (grade 1-3) and not having AAC (grade 0), the rate of HS disease was significantly higher in the group with AAC compared to the group without AAC (75.0% vs. 47.5% p = 0.010). CONCLUSIONS AAC is observed more frequently in patients with HS without cardiovascular disease than in healthy individuals. Moreover, HS can be considered as an independent predictor of AAC. AAC may contribute to developing treatment strategies in HS patients without cardiovascular disease.
Collapse
Affiliation(s)
- Uğur Köktürk
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey.
| | - Naile Eriş Güdül
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| | - İlke Erbay
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| | - Pelin Ertop Doğan
- Department of Dermatology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Emel Hazinedar
- Department of Dermatology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Furkan Kısa
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| | - Rafet Koca
- Department of Dermatology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Ahmet Avcı
- Department of Cardiology, Faculty of Medicine, Zonguldak Bülent Ecevit University, Esenköy, Kozlu, Zonguldak, 67000, Turkey
| |
Collapse
|
|
8
|
Daoud M, Suppa M, Benhadou F, Heudens S, Sarkis AS, Njimi H, Saunte SK, Desmarest L, Orte Cano C, Dandoy C, Nobile L, Fontaine M, Daxhelet M, Karama J, White JM, Jemec GBE, Del Marmol V. Factors Associated with Severe Hidradenitis Suppurativa, Using Hurley Staging and Metascore. Dermatology 2024; 240:713-731. [PMID: 39396514 DOI: 10.1159/000541052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/16/2024] [Indexed: 10/15/2024] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease for which certain risk factors are well known: obesity and smoking (in particular). However, the factors associated with more severe conditions, and therefore potential aggravators of the disease, remain a matter of debate. Our study aims to determine the clinical factors associated with severe HS using several severity scores. METHODS The data were obtained via the ERHS questionnaire from patients exclusively recruited at Erasme Hospital in Brussels. The severity of HS was firstly estimated by the Hurley score, and secondly by a metascore, a system combining the iHS4, HS-PGA, SAHS, and DLQI. Univariable and multivariable analyses were performed. RESULTS Six hundred and forty-seven patients were included in the Hurley analysis, and 456 patients in the metascore analysis. In multivariable analysis, men have a more severe metascore than women (odds ratio [OR] = 1.89, p = 0.022), smoking was associated with a more severe disease according to metascore, especially in mild cases (OR = 0.76, p = 0.043), and an elevated body mass index was associated with having Hurley stage III disease compared to Hurley I or II disease (OR = 1.09, p = 0.001). A significant association is also shown between blood pressure and Hurley stage (OR = 0.97, p = 0.025). Self-reports of nonsteroidal anti-inflammatory drugs aggravating the disease is also a factor associated with greater severity according to the metascore (OR = 0.12, p = 0.008). Finally, several locations of HS lesions were associated with greater severity, in particular the armpits according to the metascore (OR = 0.29, p < 0.001), and the perianal area according to the Hurley score (OR = 0.15, p < 0.001). CONCLUSION HS seems to be more severe in men; smoking seems to aggravate mild cases of HS, while increased body mass index plays a major role in the transition from Hurley II to Hurley III.
Collapse
Affiliation(s)
- Mathieu Daoud
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Mariano Suppa
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphanie Heudens
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Sophie Sarkis
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Hassane Njimi
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Sara K Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Lila Desmarest
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Carmen Orte Cano
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Céline Dandoy
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Laura Nobile
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Margot Fontaine
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Mathilde Daxhelet
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Jalila Karama
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Jonathan M White
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Véronique Del Marmol
- Dermatology, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
|
9
|
Graceffa D, Silvestri M, Cameli N, Lora V, Cristaudo A, Bonifati C, Cota C, Saraceni PL. Can hydradenitis suppurativa be associated with inflammatory joint involvement? Report of a case series and review of the literature. Dermatol Reports 2024; 16:9815. [PMID: 39635570 PMCID: PMC11616584 DOI: 10.4081/dr.2024.9815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 12/07/2024] Open
Affiliation(s)
- Dario Graceffa
- Clinical Dermatology, San Gallicano Dermatological Institute, Rome
| | | | - Norma Cameli
- Clinical Dermatology, San Gallicano Dermatological Institute, Rome
| | - Viviana Lora
- Clinical Dermatology, San Gallicano Dermatological Institute, Rome
| | | | - Claudio Bonifati
- Clinical Dermatology, San Gallicano Dermatological Institute, Rome
| | - Carlo Cota
- Dermatopathology Research Unit, San Gallicano Dermatological Institute, Rome, Italy
| | | |
Collapse
|
|
10
|
Demir O, Yondem OZ, Doganay M. A Neglected Disease: Hidradenitis Suppurativa a Rare Cause of Amyloidosis Complicated With Sepsis and Renal Failure: A Case Report. Case Rep Crit Care 2024; 2024:4893040. [PMID: 39229360 PMCID: PMC11371454 DOI: 10.1155/2024/4893040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 07/08/2024] [Accepted: 08/16/2024] [Indexed: 09/05/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a painful relapsing inflammatory disease characterized with subcutaneous nodules, abscesses, tunnels, and deforming scars. We present a case of HS complicated with amyloidosis who was admitted with sepsis and acute renal failure. Case Report: A 53-year-old male patient with a history of HS and amyloidosis was accepted to the intensive care unit suffering from acute kidney failure and sepsis symptoms. He was receiving adalimumab during admission. He received hemodialysis and piperacillin-tazobactam antibiotherapy. After 15 days of hospitalization, his sepsis was treated, but he was taken to a routine hemodialysis programme. Conclusion: In the presence of amyloidosis with intervenient infections, the risk of chronic renal failure in HS cases can be kept in mind even if the patient is receiving TNF inhibitors.
Collapse
Affiliation(s)
- Orhun Demir
- Department of AnesthesiologyFaculty of MedicineLokman Hekim University, Ankara, Türkiye
| | - Omer Zuhtu Yondem
- Department of AnesthesiologyFaculty of MedicineLokman Hekim University, Ankara, Türkiye
| | - Mehmet Doganay
- Department of Infectious DiseasesFaculty of MedicineLokman Hekim University, Ankara, Türkiye
| |
Collapse
|
|
11
|
Cohn E, Palma G, Mastacouris N, Strunk A, Garg A. Incidence of anxiety disorder in adults with hidradenitis suppurativa. Br J Dermatol 2024; 191:351-356. [PMID: 38564268 DOI: 10.1093/bjd/ljae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/30/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND There are limited data on the risk of new-onset anxiety disorders in patients with hidradenitis suppurativa (HS). OBJECTIVES To compare the risk of new-onset anxiety disorder in patients with HS and controls, and to describe risk factors for the development of anxiety in patients with HS. METHODS We carried out a retrospective cohort analysis of a US electronic health records database between 2011 and 2020. Adults newly diagnosed with HS at a dermatology or primary care visit and control participants were included. The primary outcome was a new diagnosis of generalized anxiety disorder, phobic disorders, panic disorder or unspecified anxiety. Cox proportional hazards regression was used to compare the crude risk of any anxiety disorder between groups and to assess the independent association with HS while controlling for potential demographic, clinical and healthcare-related confounders. RESULTS Among 9597 patients with HS and 959 493 controls, the incidence rate (IR) of anxiety was 5.74 and 3.86 per 100 person-years (PY), respectively. The crude risk among all patients was 48% higher for those with HS vs. controls [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.40-1.55]. When stratified by index encounter type, patients with HS had 2.43 (95% CI 2.13-2.77) times the risk of anxiety disorder than dermatology controls and 1.46 (95%CI 1.38-1.55) times the risk than primary care controls. The adjusted HR for patients with HS vs. controls was 1.11 (95% CI 1.05-1.17) overall, 1.26 (95% CI 1.07-1.48) in the dermatology subgroup and 1.07 (95% CI 1.01-1.13) in the primary care subgroup. Risk factors for an incident anxiety diagnosis among patients with HS included depression (HR 1.69, 95% CI 1.48-1.93), female sex (HR 1.41, 95% CI 1.23-1.60), younger age (HR 0.87 per 10-year increase, 95% CI 0.84-0.90), White race, in the Medicaid insurance programme (HR 1.22, 95% CI 1.07-1.40), tobacco smoking (HR 1.16, 95% CI 1.03-1.31) and having one or more emergency department visits in the year before a HS diagnosis. Absolute IRs of anxiety disorders were highest among patients with HS who were aged 18-29 years (7.10 per 100 PY), female (6.34 per 100 PY) and White (6.79 per 100 PY). CONCLUSIONS HS is independently associated with an increased risk of anxiety disorders. An increased risk remains but is attenuated when confounders are controlled for. The relative risk may be particularly high in patients managed by dermatologists.
Collapse
Affiliation(s)
- Erica Cohn
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Gabriela Palma
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Nicole Mastacouris
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Andrew Strunk
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Amit Garg
- Northwell, New Hyde Park, NY, USA
- Department of Dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| |
Collapse
|
|
12
|
Raudonis T, Šakaitytė A, Vileikis TP, Černel V, Gancevičienė R, Zouboulis CC. Comorbidities, Clinical Presentation, Subtypes, and Treatment of HS Patients in Lithuania. J Clin Med 2024; 13:3900. [PMID: 38999466 PMCID: PMC11242771 DOI: 10.3390/jcm13133900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Hidradenitis suppurativa (HS) is a persistent, recurring skin inflammatory condition linked to various comorbidities. Management involves antibiotics, hormone therapy, immune-modulating drugs, surgery, and treatment of comorbidities. The objectives of the study were to assess the comorbidities, clinical presentation subtypes, and applied treatment of patients with HS. Methods: Patients with HS who visited the Centre of Dermatovenereology at Vilnius University Hospital Santaros Klinikos in Lithuania underwent evaluation based on the guidelines of the European Hidradenitis Suppurativa Foundation Registry questionnaire. Results: The study included 49 patients, and 61.22% (n = 30) had comorbidities. A strong positive correlation was found between a family history of inflammatory diseases (69.38% (n = 34)) and the severity of HS according to Hurley stage (r = 0.71 p < 0.05). A statistically significant correlation (r = 0.944, p = 0.02) was found between metabolic comorbidities and Hurley stage. Patients on biologic treatment had a mean IHS4 of 7.38 at the beginning of treatment and 3.22 at follow-up (p < 0.05). For patients not on biologics, the initial IHS4 score was 6.21 and 5.42 at follow-up (p > 0.05). Conclusions: A family history of inflammatory diseases and metabolic comorbidities showed a strong correlation with HS severity. Treatment with biologics showed significant improvement in HS scores compared to systemic antibiotics.
Collapse
Affiliation(s)
- Tadas Raudonis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Austėja Šakaitytė
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (V.Č.)
| | - Tomas Petras Vileikis
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
| | - Vitalij Černel
- Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (A.Š.); (V.Č.)
| | - Rūta Gancevičienė
- Clinic of Infectious Disease and Dermatovenereology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21, 03101 Vilnius, Lithuania; (T.P.V.); (R.G.)
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
| | - Christos C. Zouboulis
- European Hidradenitis Suppurativa Foundation e.V., 06847 Dessau, Germany;
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, 06847 Dessau, Germany
| |
Collapse
|
|
13
|
Erol Mart HM, Bostanci S, Caliskan Odabas D. Demographic and Clinical Features and Factors Affecting the Quality of Life of Patients With Hidradenitis Suppurativa: A Cross-sectional Study. Dermatol Surg 2024; 50:630-635. [PMID: 38563434 DOI: 10.1097/dss.0000000000004185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-known adverse effects on quality of life (QoL). Improving patients' QoL has become an important objective of treatment. OBJECTIVE The purpose of this study was to evaluate the demographic and clinical characteristics and factors affecting the QoL of patients with HS. MATERIALS AND METHODS One hundred seventy-six patients with HS aged between 18 and 65 years were included in the study. The patients' demographic and clinical characteristics, treatments, and comorbidities were recorded. The disease stage was determined based on the Hurley staging system. The Dermatology Life Quality Index (DLQI) was used to evaluate QoL. RESULTS Mean DLQI scores were significantly higher in patients with advanced Hurley stages, lesions in the gluteal region and legs, and with more than 2 affected areas ( p < .001). Correlations between patient-reported treatment outcomes and clinical characteristics of the patients were assessed. Findings of this study indicate the existence of a potential "window of opportunity" for laser epilation and wide local surgical excision, similar to anti-tumor necrosis factor therapy. CONCLUSION Timely and appropriate treatment can only be provided for patients with HS by evaluating objective disease severity measures and subjective patient data in combination.
Collapse
Affiliation(s)
| | - Seher Bostanci
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Deniz Caliskan Odabas
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
- Department of Public Health, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
|
14
|
Haferland I, Pinter A, Rossmanith T, Diehl S, Buerger C, Ickelsheimer T, Kaufmann R, Koenig A. A Novel Epidermis Model Using Primary Hidradenitis Suppurativa Keratinocytes. J Tissue Eng Regen Med 2024; 2024:4363876. [PMID: 40225748 PMCID: PMC11918907 DOI: 10.1155/2024/4363876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/02/2024] [Accepted: 02/12/2024] [Indexed: 04/15/2025]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Patients can present with inflammatory nodules, abscesses up to fistulas, or sinus tracts in intertriginous body parts. Occlusion of the sebaceous gland unit leads to its rupture, with a subsequent exuberant immune response. Given there is still no causative therapy, to better understand HS and develop novel therapeutic concepts, research activities in the HS field are constantly growing. Primary skin cells, blood cells, and ex vivo explant cultures from HS patients have been previously used as HS cell culture models. In vitro reconstituted epidermal models are established to study inflammatory dermatoses, such as psoriasis or atopic dermatitis. For HS, the exploration of epidermis models would be an excellent addition, e.g., biomarkers or barrier function in testing new topic treatment options. We therefore established a stratified in vitro HS epidermis model based on primary cells from HS lesions. After isolating keratinocytes from lesional skin, we cultured them submerged in a transwell system. To induce differentiation, we then lifted them to the air-liquid interface. Immunohistochemical staining demonstrated that our HS-epidermis model meets the expected differentiation pattern. In addition, we detected the secretion of the inflammatory cytokines interleukin-1β and TNF-α.
Collapse
Affiliation(s)
- Isabel Haferland
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Andreas Pinter
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Tanja Rossmanith
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Theodor-Stern-Kai 7, Frankfurt am Main 60596, Germany
| | - Sandra Diehl
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Claudia Buerger
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Tanja Ickelsheimer
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Roland Kaufmann
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| | - Anke Koenig
- Goethe University Frankfurt, University Hospital, Department of Dermatology, Venereology and Allergology, Theodor-Stern-Kai 7, Frankfurt am Main 60590, Germany
| |
Collapse
|
|
15
|
Kridin K, Shihade W, Weinstein O, Zoller L, Onn E, Cohen A, Solomon-Cohen E. A history of asthma is associated with susceptibility to hidradenitis suppurativa: a population-based longitudinal study. Arch Dermatol Res 2023; 315:2845-2851. [PMID: 37642698 PMCID: PMC10615903 DOI: 10.1007/s00403-023-02693-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/24/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
The association of hidradenitis suppurativa (HS) and asthma remains to be investigated. To assess the bidirectional association between HS and asthma. A population-based study was conducted to compare HS patients (n = 6779) with age-, sex-, and ethnicity-matched control subjects (n = 33,259) with regard to the incidence of new onset and the prevalence of preexisting asthma. Adjusted hazard ratios (HRs) and adjusted odds ratios (ORs) were calculated. The prevalence of preexisting asthma was higher in patients with HS relative to controls (9.6% vs. 6.9%, respectively; P < 0.001). The odds of HS were 1.4-fold greater in patients with a history of asthma (fully adjusted OR 1.41; 95% CI 1.27-1.55; P < 0.001). The incidence rate of new-onset asthma was estimated at 9.0 (95% CI 6.3-12.7) and 6.2 (95% CI 5.1-7.5) cases per 10,000 person-years among patients with HS and controls, respectively. The risk of asthma was not statistically different in patients with HS and controls (fully adjusted HR 1.53; 95% CI 0.98-2.38; P = 0.062). Relative to other patients with HS, those with HS and comorbid asthma were younger at the onset of HS (30.7 [14.7] vs. 33.3 [15.1], respectively; P < 0.001) and had a comparable risk of all-cause mortality (adjusted HR 0.86; 95% CI 0.44-1.68; P = 0.660). A history of asthma confers susceptibility to subsequent development of HS. This observation is of importance for clinicians managing both patients with HS and asthma. Further research is warranted to elucidate the pathomechanism underlying this finding.
Collapse
Affiliation(s)
- Khalaf Kridin
- Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Nahariya, Israel.
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
- Lübeck Institute of Experimental Dermatology, University of Lübeck, University of Lübeck, Ratzeburger Allee 160, 23562, LübeckLübeck, Germany.
| | - Wesal Shihade
- School of Public Health, University of Haifa, Haifa, Israel
| | - Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | | | - Erez Onn
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Baruch Padeh Medical Center, Poriya, Israel
| | - Arnon Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Efrat Solomon-Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Division of Dermatology, Rabin Medical Center, Petah-Tiqva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
|
16
|
Garg A, Geissbühler Y, Houchen E, Choudhary N, Arora D, Vellanki V, Srivastava A, Priyanka, Darcy J, Richardson C, Kimball AB. Disease Burden and Treatment Patterns Among US Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study. Am J Clin Dermatol 2023; 24:977-990. [PMID: 37378875 PMCID: PMC10570206 DOI: 10.1007/s40257-023-00796-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval. METHODS This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12-17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018. RESULTS Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively). CONCLUSION In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.
Collapse
Affiliation(s)
- Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, 11042, USA.
| | | | | | | | - Disha Arora
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | | | | | - Priyanka
- Novartis Pharmaceuticals Corporation, Hyderabad, India
| | - John Darcy
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Alexa B Kimball
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
|
17
|
Bellei EA, de Carvalho AVE, Eng BM, Tozato C, de Barros DH, Tamashiro EY, Duarte GV, de Fátima RTR, Magalhães RF, da Silva RS, Cesar WGG, Thies FG. Navigating the Multidimensional Impact of Living with Hidradenitis Suppurativa: An In-Depth Netnographic Study on Social Media Platforms. Dermatol Ther (Heidelb) 2023; 13:2797-2815. [PMID: 37794274 PMCID: PMC10613171 DOI: 10.1007/s13555-023-01032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic skin condition causing considerable distress. It impacts mobility, social interaction, and quality of life. In Brazil, there is a notable gap in epidemiological data and patient experiences regarding HS. METHODS This study, spanning 2019 to 2022, employed netnography to probe the experiences of Brazilian patients with HS. This approach gleans insights from online interactions, offering a direct view into patients' lives. RESULTS Notably, the data illuminated the challenges patients face, such as difficulties in obtaining a diagnosis and the complexities involved in managing a chronic, and often debilitating, condition. Furthermore, patients' experiences with various treatments, encompassing antibiotics, biologic agents, lifestyle alterations, surgical procedures, and alternative remedies, were also examined. CONCLUSION By undertaking a longitudinal analysis of patient interactions, the study aimed to offer a richer understanding of HS, from its diagnosis to its treatment. It underscores the necessity for a more patient-centered approach when managing this condition. We hope that this enhanced understanding can facilitate better care for those affected by HS.
Collapse
Affiliation(s)
| | | | | | - Carla Tozato
- Value and Access Division, Novartis, São Paulo, Brazil
| | | | | | | | | | | | - Roberto Souto da Silva
- Department of Dermatology, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | | | | |
Collapse
|
|
18
|
Ureña-Paniego C, Gamissans-Cañada M, Molina-Leyva A, Romaní J. Pilonidal Sinus Disease is Associated with Severe Hidradenitis Suppurativa in a Spanish Cohort. Acta Derm Venereol 2023; 103:adv6569. [PMID: 37766657 PMCID: PMC10549763 DOI: 10.2340/actadv.v103.6569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/19/2023] [Indexed: 09/29/2023] Open
Abstract
Hidradenitis suppurativa is a chronic inflammatory disorder of the hair follicle with a high level of morbidity. Pilonidal sinus disease is a comorbid disorder and may be the reason for first contact with the healthcare system of patients with hidradenitis suppurativa. The aim of this study was to evaluate the frequency of association of pilonidal sinus disease and hidradenitis suppurativa and to explore whether pilonidal sinus disease defines a different clinical profile for patients with hidradenitis suppurativa. A cross-sectional study in which data regarding past history of pilonidal sinus disease, clinical and sociodemographic information were recorded during the first visit to the Hidradenitis Suppurativa Clinic of 2 tertiary hospitals. A total of 839 patients were included in the study. Of these, 51.7% (434/839) were male and mean age was 37.3 ± 13.6 years. Pilonidal sinus disease was present in 32.6% (269/839) of the patients and was associated with an early debut of hidradenitis suppurativa, a higher Hurley stage, inflammatory phenotype and a greater number of fistulas and perianal involvement. Elapsed time between pilonidal sinus disease and diagnosis of hidradenitis suppurativa was associated with higher disease severity. Pilonidal sinus disease is a frequent comorbidity and risk marker for hidradenitis suppurativa disease severity. Pilonidal sinus disease could be a sentinel event to identify patients who would benefit from close treatment and follow-up.
Collapse
Affiliation(s)
- Clara Ureña-Paniego
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Marta Gamissans-Cañada
- Hidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| | - Alejandro Molina-Leyva
- Hidradenitis Suppurativa Clinic, Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain; European Hidradenitis Suppurativa Foundation (EHSF). Dessau-Roßlau, Germany.
| | - Jorge Romaní
- HHidradenitis suppurativa Clinic, Hospital Universitari Parc Taulí, Autonomous University of Barcelona, Sabadell, Barcelona, Spain
| |
Collapse
|
|
19
|
Revankar R, Rojas M, Walsh S, Patel H, Revankar N, Han J, Parameswaran A. Anemia in patients with hidradenitis suppurativa : A systematic review with meta-analysis. Arch Dermatol Res 2023; 315:1639-1648. [PMID: 36781458 DOI: 10.1007/s00403-023-02559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/02/2022] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
IMPORTANCE Hidradenitis suppurativa (HS) is associated with a number of physical and psychological comorbidities. Studies have suggested an association between HS and anemia; however, this association is not widely understood and may result in delayed diagnosis and treatment and possible increase in morbidity and mortality. OBJECTIVE To systematically review and perform a meta-analysis regarding the association between HS and anemia, and to characterize the subtypes of anemia associated with HS. DATA SOURCES A search of the EMBASE, Medline, Web of Science Core Collection, and Cochrane Central Register of Controlled Trials databases from the time of database inception to September 25, 2022, yielded 313 unique articles. STUDY SELECTION All observational studies and randomized controlled trials published in English that examined the odds ratio (OR) of anemia in patients with HS were screened by 2 independent reviewers. Case reports were excluded. Among 313 unique articles, 7 were deemed eligible. DATA EXTRACTION AND SYNTHESIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines facilitated data extraction. The Newcastle-Ottawa Scale (NOS) was used to analyze risk of bias of included studies. In addition to OR and 95% confidence intervals, relevant data on patient demographics and anemia subtypes were also extracted. MAIN OUTCOMES AND MEASURES The primary outcome was the OR of anemia in HS patients. This study also attempted to characterize anemia subtypes associated with HS. RESULTS In total, 2 case-control and 5 cross-sectional studies featured a total of 11,693 patients. Among the studies, 4 of 7 demonstrated a statistically significant positive association between anemia and HS (ORs, 2.20 [1.42-3.41], 2.33 [1.99-2.73], 1.87 [1.02-3.44], and 1.50 [1.43-1.57]), with macrocytic and microcytic subtypes being most common. After adjusting for publication bias, meta-analysis with random effects revealed HS to be associated with increased odds of anemia compared to non-HS groups (OR 1.59 [1.19, 2.11]). CONCLUSIONS AND RELEVANCE There is a statistically significant positive association between HS and anemia, particularly for the aforementioned subtypes. Patients with HS should be screened for anemia. In case of lower hemoglobin concentration, the anemia of HS patients should be subdivided according to mean corpuscular volume of the red blood cells and further investigated depending on subtype.
Collapse
Affiliation(s)
- Rishab Revankar
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA.
| | - Mary Rojas
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha Walsh
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA
| | - Heli Patel
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nikita Revankar
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Joseph Han
- The Icahn School of Medicine at Mount Sinai, 50 E 9th St., Apt 7B3, New York, NY, 10029, USA
| | | |
Collapse
|
|
20
|
Almuhanna N, Tobe SW, Alhusayen R. Risk of Chronic Kidney Disease in Hospitalized Patients with Hidradenitis Suppurativa. Dermatology 2023; 239:912-918. [PMID: 37487485 DOI: 10.1159/000531960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 06/23/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is associated with several comorbidities such as diabetes mellitus and cardiovascular diseases. These comorbidities are also risk factors for chronic kidney disease (CKD), yet little is known about the risk of CKD in HS patients. OBJECTIVES The objective was to study the prevalence of CKD in HS patients. METHODS Cross-sectional population-based study using the United States National Inpatient Sample database between January 1, 2002 and December 31, 2012 was performed. RESULTS We identified 23,767 hospital admissions for HS patients and 95,068 admissions for age- and gender-matched controls. The prevalence of CKD in HS patients was 6.3% (1,497/23,767) compared to non-HS controls which was 4.3% (4,052/95,068). The association of CKD was strongest in HS patients, who were ≥60 years old, 16.9% (475/2,811), male 7.3% (695/9,556), obese 7.8% (407/5,209), diabetic 12.5% (890/7,105), hyperlipidemic 13.3% (416/3,126), and had cardiovascular diseases 12.5% (631/5,045). The crude odds ratio of CKD in HS patients was 1.5 (95% CI: 1.420-1.605) compared to non-HS patients. The association remained significant after adjusting for important covariates with adjusted odds ratio of CKD in HS patients of 1.1 (95% CI: 1.014-1.176) compared to non-HS patients. CONCLUSIONS Our findings show that there is a possible association of HS with CKD. Any signs of CKD should be assessed by a nephrologist as early diagnosis can hopefully prevent further progression.
Collapse
Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sheldon W Tobe
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
|
21
|
Nowowiejska J, Baran A, Flisiak I. Lipid Alterations and Metabolism Disturbances in Selected Inflammatory Skin Diseases. Int J Mol Sci 2023; 24:ijms24087053. [PMID: 37108216 PMCID: PMC10138531 DOI: 10.3390/ijms24087053] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Lipidomics is a term used to define the field that analyzes the structure, functions, and interactions of lipids. Inflammatory dermatoses and lipid disturbances are interrelated, especially due to chronic inflammatory conditions. This review discusses lipidomics in selected inflammatory skin diseases: psoriasis, lichen planus, and atopic dermatitis, as well as the less commonly mentioned hidradenitis suppurativa, rosacea, and acne vulgaris. Lipid homeostasis disorders are common; they are especially well-documented in psoriasis, lichen planus, and atopic dermatitis. Future studies are required for better insight into this issue, particularly on the skin lipidome. Understanding lipidomics, in particular skin diseases, increases our knowledge about their pathogenesis, and may become useful in adjusting tailored management for each patient as well establishing prognosis. Noteworthily, it seems advisable to alert doctors to the need to analyze lipid parameters and the complications of abnormal lipid metabolism in dermatological patients, which could decrease their comorbidities and improve the life quality and health condition of dermatological patients.
Collapse
Affiliation(s)
- Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
| | - Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St., 15-540 Bialystok, Poland
| |
Collapse
|
|
22
|
Lee JW, Heo YW, Lee JH, Lee S. Epidemiology and comorbidity of hidradenitis suppurativa in Korea for 17 years: A nationwide population-based cohort study. J Dermatol 2023. [PMID: 36806098 DOI: 10.1111/1346-8138.16747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/22/2023]
Abstract
Hidradenitis suppurativa (HS) is associated with various metabolic and autoimmune diseases. The epidemiology has been analyzed in various studies worldwide. However, epidemiological data on HS for Asian populations are limited. This study aimed to analyze the change in the prevalence and incidence of HS over 17 years in South Korea using the Korean National Health Insurance Service (NHIS) database. This study also evaluated the comorbidities in patients with HS. Population-based data from the NHIS database of Korea were obtained between January 2003 and December 2019. Odds ratios were estimated to determine the association between comorbidities and HS during the study period. Hazard ratios for the risk of incident comorbidities in patients with HS were obtained using the multivariable Cox proportional hazard analysis. This study included 45 511 patients with HS and 910 220 controls matched for age, sex, insurance type, and income level. The incidence rate of HS per 1 000 000 person-years in Korea increased from 11.69 in 2003 to 78.78 in 2019. The annual prevalence per 1 000 000 people also increased from 34.68 in 2003 to 140.10 in 2019, showing a similar trend. Many comorbidities, including atopic, metabolic and end-organ, autoimmune/inflammatory, and psychiatric diseases were associated with HS at baseline. In many diseases, the risk of incident comorbidities in patients with HS was higher than that in controls. The incidence and prevalence of HS in Korea have increased over the past 17 years. Various comorbidities, including allergic diseases, hypertension, diabetes mellitus, dyslipidemia, myocardial infarction, chronic hepatitis and cirrhosis, chronic kidney disease, inflammatory bowel diseases, rheumatoid arthritis, vitamin D deficiency, and psychiatric diseases, were associated with HS. Physicians need to keep in mind and closely monitor these comorbidities in patients with HS.
Collapse
Affiliation(s)
- Jong Won Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Ji Hae Lee
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| |
Collapse
|
|
23
|
Adjei NN, Yung N, Towers G, Caty M, Solomon D, Vash-Margita A. Establishing an Association between Polycystic Ovarian Syndrome and Pilonidal Disease in Adolescent Females. J Pediatr Adolesc Gynecol 2023; 36:39-44. [PMID: 35995086 DOI: 10.1016/j.jpag.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 01/18/2023]
Abstract
STUDY OBJECTIVE We sought to determine whether pilonidal disease (PD) is associated with polycystic ovarian syndrome (PCOS) in adolescent females. DESIGN Retrospective cohort study SETTING: Urban tertiary children's hospital PARTICIPANTS: All girls aged 12 to 21 who received a diagnosis of PD and/or PCOS from 2012 to 2019 INTERVENTIONS: Treatment for PCOS and PD MAIN OUTCOME MEASURES: The variables analyzed included age, race/ethnicity, body mass index, age at menarche, tobacco use, payer status, treatment of PCOS and PD, and serum markers of hyperandrogenism and metabolic syndrome. RESULTS During the study period, 100,043 patients presented to an urban tertiary medical center. Of these patients, 966 were diagnosed with PD, and 219 were diagnosed with both PD and PCOS. Compared with patients with only PD, patients with both diagnoses had a higher body mass index (31.4 vs 27.4 kg/m2; P < .01) and were older (18.76 vs 18.30 years; P = .003). The prevalence ratio for patients with PD having PCOS per the original Rotterdam criteria was 26.1 (CI, 22.0-31.0) and 28.7 (CI, 24.3-33.9) for having PCOS per the modified Rotterdam criteria. Patients with both diagnoses were less likely to receive intervention for PD (OR = 0.22; CI, 0.13-0.37; P < .001). CONCLUSIONS Adolescent females diagnosed with PD are likely to demonstrate features of PCOS. PCOS treatment could positively alter the disease course of PD. As such, surgical providers should consider referring adolescent females with PD to endocrinologists, gynecologists, and adolescent medicine specialists for evaluation of PCOS.
Collapse
Affiliation(s)
- Naomi N Adjei
- Yale New Haven Hospital, Department of Obstetrics, Gynecology and Reproductive Sciences, New Haven, Connecticut.
| | - Nicholas Yung
- Yale New Haven Hospital, Department of Surgery, New Haven, Connecticut
| | | | - Michael Caty
- Yale New Haven Hospital, Department of Surgery, New Haven, Connecticut
| | - Daniel Solomon
- Yale New Haven Hospital, Department of Surgery, New Haven, Connecticut
| | - Alla Vash-Margita
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
|
24
|
A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med 2023; 136:42-53. [PMID: 36252715 DOI: 10.1016/j.amjmed.2022.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
Collapse
|
|
25
|
Wark KJL, Der Sarkissian SA, Tatian A, Woods J, Cains GD. The association between pilonidal sinus disease and hidradenitis suppurativa: a systematic review and meta-analysis. Br J Dermatol 2022; 188:673-675. [PMID: 36724988 DOI: 10.1093/bjd/ljac166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/27/2022] [Accepted: 02/13/2023] [Indexed: 01/22/2023]
Abstract
We performed a systematic review and meta-analysis examining the association between hidradenitis suppurativa (HS) and pilonidal sinus disease (PSD). We found a strong association between HS and PSD, with an increased occurrence of PSD in individuals with HS compared with unaffected controls. Given this strong association, patients with HS should be assessed for PSD.
Collapse
Affiliation(s)
- Kirsty J L Wark
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Sciences, Liverpool, NSW, Australia
| | - Samuel A Der Sarkissian
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Sciences, Liverpool, NSW, Australia
| | - Artiene Tatian
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Sciences, Liverpool, NSW, Australia.,University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - Jane Woods
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Sciences, Liverpool, NSW, Australia
| | - Geoffrey D Cains
- Department of Dermatology, Liverpool Hospital, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Sciences, Liverpool, NSW, Australia.,University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| |
Collapse
|
|
26
|
Gau SY, Hsiao YP, Liao WC, Ma KSK, Wu MC. Risk of liver dysfunction and non-alcoholic fatty liver diseases in people with hidradenitis suppurativa: A systematic review and meta-analysis of real-world evidences. Front Immunol 2022; 13:959691. [PMID: 36591267 PMCID: PMC9794989 DOI: 10.3389/fimmu.2022.959691] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To date, evidences with high evidence-level evaluating the association between liver diseases and hidradenitis suppurativa was lacking. Given that inconsistency exists in some of the previous observational studies, evaluating the prevalence of liver diseases in HS patients could potentially serve as a reference of future guidelines for HS comorbidity screening. The aim of the current study was to evaluate potential association between hidradenitis suppurativa and liver diseases and provide integrated evidences. METHODS A search in PubMed, Web of Science and Embase based on the syntaxes ''hidradenitis suppurativa'' or ''acne inversa'' with "comorbidities", "liver diseases", "fatty liver" or "hepatitis" was performed. Observational studies evaluating epidemiological association between hidradenitis suppurativa and the risk of all liver diseases, including specific diseases as non-alcoholic fatty liver disease, hepatitis B, hepatitis C were targeted to be extracted in this systematic review and meta-analysis. RESULTS Within the initial 702 records, there were finally 8 real-world observational studies extracted. Results suggest that patients with HS are associated with all liver diseases (OR= 1.50; 95% CI, 1.27, 1.76), non-alcoholic fatty liver disease (OR= 1.78; 95% CI, 1.28, 2.48) and hepatitis B (OR=1.48; 95% CI, 1.12, 1.94), but not hepatitis C (OR= 1.27; 95% CI, 0.78, 2.07). HS patients were associated with significantly increased risk of liver diseases, especially the risk of non-alcoholic fatty liver disease and hepatitis B. CONCLUSIONS Clinicians should be alert to the clinical relationship while caring people with hidradenitis suppurativa and the screening of liver function should be recommended to HS patients. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42022296034.
Collapse
Affiliation(s)
- Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Ping Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chieh Liao
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Meng-Che Wu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Division of Gastroenterology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
|
27
|
Abu Rached N, Gambichler T, Dietrich JW, Ocker L, Seifert C, Stockfleth E, Bechara FG. The Role of Hormones in Hidradenitis Suppurativa: A Systematic Review. Int J Mol Sci 2022; 23:ijms232315250. [PMID: 36499573 PMCID: PMC9736970 DOI: 10.3390/ijms232315250] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disease manifesting in inverse body regions. In a systematic review, the role of hormones in HS will be presented to better understand the pathomechanisms of HS. The review is based on the PRISMA criteria. Systematic research was carried out using keywords. Subsequently, the data were analyzed based on the clinical response and other relevant information. The main focus of our systematic review was on HS manifestation, exacerbation, sex hormones, antiandrogen therapy, thyroid function, polycystic ovary syndrome, insulin resistance, and adipokines. In HS, there appears to be a dysregulated adipokine release that is shifted towards pro-inflammatory adipokines. Insulin resistance is significantly more common in HS than in healthy patients regardless of BMI, age, and gender. Insulin resistance in HS patients leads to further cardiovascular disease. The mechanism of insulin resistance and role of adipokines should be investigated in future studies to better provide the pathomechanisms of HS. The role of androgens seems to be important in a certain subgroup of female patients. Anti-androgenic therapy can be useful and helpful in some patients. However, further studies are needed to better understand the hormonal relationship in HS.
Collapse
Affiliation(s)
- Nessr Abu Rached
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
- Correspondence: (N.A.R.); (F.G.B.); Tel.: +49-234-509-3420 (N.A.R.)
| | - Thilo Gambichler
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, NRW, Gudrunstr. 56, 44791 Bochum, Germany
- Diabetes Centre Bochum-Hattingen, St. Elisabeth-Hospital Blankenstein, Im Vogelsang 5-11, 45527 Hattingen, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Alexandrinenstr. 5, 44791 Bochum, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Gudrunstr. 56, 44791 Bochum, Germany
| | - Lennart Ocker
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Caroline Seifert
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Eggert Stockfleth
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Falk G. Bechara
- International Centre for Hidradenitis Suppurativa/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology, Ruhr-University Bochum, 44791 Bochum, Germany
- Correspondence: (N.A.R.); (F.G.B.); Tel.: +49-234-509-3420 (N.A.R.)
| |
Collapse
|
|
28
|
Gau SY, Preclaro IAC, Wei JCC, Lee CY, Kuan YH, Hsiao YP, Juang SE, Ma KSK. Risk of psoriasis in people with hidradenitis suppurativa: A systematic review and meta-analysis. Front Immunol 2022; 13:1033844. [PMID: 36532043 PMCID: PMC9752046 DOI: 10.3389/fimmu.2022.1033844] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/07/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa were associated with comorbidities in various organ systems. Inflammatory dermatological diseases such as pyoderma gangrenosum were reported to be associated with hidradenitis suppurativa. Nevertheless, as for the association between hidradenitis suppurativa and psoriasis, evidences were insufficient. In many studies, the association between psoriasis and hidradenitis suppurativa has been reported. However, some evidence seems to be controversial. The purpose of the systematic review and meta-analysis was to assess whether there was significant association between HS and psoriasis. METHODS On June 01, 2022, we appraised 2,795 articles from databases including PubMed, Web of Science and Embase. Search syntaxes were based on 'hidradenitis suppurativa' or 'acne inversa' with "psoriasis", "comorbidities" or 'epidemiology'. Synonyms were determined based on MeSH terms and Emtree. Observational results that evaluated the odds ratio for people with hidradenitis suppurativa who had psoriasis were extracted for qualitative synthesis. RESULTS After the selection process of the initial 2,795 studies, ten observational studies, including 3 cohort studies, 1 case-control study, and 6 cross-sectional studies, were extracted for critical appraisal. Based on the integration of 7 studies (with more than 560,000 participants included), people with hidradenitis suppurativa had a higher risk of having psoriasis, with a 2.67-fold risk (95% CI, 1.84, 3.87). The association remained in the sensitivity analyses utilizing strict adjustment models. In the analysis that only included studies with a similar study design and adjustments in obesity-related factors, the risk of people with hidradenitis suppurativa having psoriasis was 3.24 (95% CI, 2.27, 4.62). In male patients with HS, the risk of having psoriasis was 4.30-fold higher than male patients without HS (95% CI, 2.37, 7.78). Likewise, in an analysis including 3 cross-sectional studies, the risk of female HS patients having psoriasis was 3.94-fold higher than female HS-free patients (95% CI, 2.34, 6.63). CONCLUSIONS The co-occurrence of hidradenitis suppurativa and psoriasis can greatly increase the burden of the disease. Psoriasis could be one of the critical comorbidities of hidradenitis suppurativa and should be recommended for future screening and follow up. The association between the two diseases should be kept in mind in managing hidradenitis suppurativa patients. More prospective studies are needed to establish the true magnitude of the association between psoriasis and hidradenitis suppurativa.
Collapse
Affiliation(s)
- Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ivan Arni C. Preclaro
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chien-Ying Lee
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Ping Hsiao
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sin-Ei Juang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kevin Sheng-Kai Ma
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| |
Collapse
|
|
29
|
Hardin J, Murray G, Swerdel J. Phenotype Algorithms to Identify Hidradenitis Suppurativa Using Real-World Data: Development and Validation Study. JMIR DERMATOLOGY 2022; 5:e38783. [PMID: 37632892 PMCID: PMC10334943 DOI: 10.2196/38783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a potentially debilitating, chronic, recurring inflammatory disease. Observational databases provide opportunities to study the epidemiology of HS. OBJECTIVE This study's objective was to develop phenotype algorithms for HS suitable for epidemiological studies based on a network of observational databases. METHODS A data-driven approach was used to develop 4 HS algorithms. A literature search identified prior HS algorithms. Standardized databases from the Observational Medical Outcomes Partnership (n=9) were used to develop 2 incident and 2 prevalent HS phenotype algorithms. Two open-source diagnostic tools, CohortDiagnostics and PheValuator, were used to evaluate and generate phenotype performance metric estimates, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value. RESULTS We developed 2 prevalent and 2 incident HS algorithms. Validation showed that PPV estimates were highest (mean 86%) for the prevalent HS algorithm requiring at least two HS diagnosis codes. Sensitivity estimates were highest (mean 58%) for the prevalent HS algorithm requiring at least one HS code. CONCLUSIONS This study illustrates the evaluation process and provides performance metrics for 2 incident and 2 prevalent HS algorithms across 9 observational databases. The use of a rigorous data-driven approach applied to a large number of databases provides confidence that the HS algorithms can correctly identify HS subjects.
Collapse
Affiliation(s)
- Jill Hardin
- Janssen Research and Development, Titusville, NJ, United States
- Observational Health Data Sciences and Informatics, New York, NY, United States
| | - Gayle Murray
- Janssen Research and Development, Titusville, NJ, United States
| | - Joel Swerdel
- Janssen Research and Development, Titusville, NJ, United States
- Observational Health Data Sciences and Informatics, New York, NY, United States
| |
Collapse
|
|
30
|
Hidradenitis suppurativa and sleep: a systematic review. Arch Dermatol Res 2022; 315:1409-1415. [DOI: 10.1007/s00403-022-02460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
|
|
31
|
Sokumbi O, Hodge DO, Ederaine SA, Alavi A, Alikhan AM. Comorbid diseases of hidradenitis suppurativa: a 15-year population-based study in Olmsted County, Minnesota, USA. Int J Dermatol 2022; 61:1372-1379. [PMID: 35485975 PMCID: PMC10835602 DOI: 10.1111/ijd.16228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders. OBJECTIVE Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions. METHODS From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups. RESULTS A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others. LIMITATIONS Our study was limited by its retrospective design. CONCLUSIONS Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.
Collapse
Affiliation(s)
- Olayemi Sokumbi
- Departments of Dermatology and Laboratory Medicine & Pathology, Mayo Clinic, Jacksonville, FL
| | - David O. Hodge
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Sophia A. Ederaine
- Student, Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale, AZ
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN
| | - Ali M. Alikhan
- Department of Dermatology, Sutter Medical Foundation, Sacramento, CA
| |
Collapse
|
|
32
|
Johnston LA, Alhusayen R, Bourcier M, Delorme I, George R, O'Brien E, Wong SM, Poelman SM. Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update. J Cutan Med Surg 2022; 26:2S-24S. [PMID: 36000460 DOI: 10.1177/12034754221116115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.
Collapse
Affiliation(s)
- Leah A Johnston
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Raed Alhusayen
- 282299 Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, ON, Canada
| | | | - Isabelle Delorme
- Dr Isabelle Delorme Inc, Dermatologue, Drummondville, QC, Canada
| | - Ralph George
- 7938 Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth O'Brien
- 12367 Faculty of Medicine, Dermatology, McGill University, Montreal, QC, Canada
| | - Se Mang Wong
- 12358 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Susan M Poelman
- 70401 Cumming School of Medicine, Division of Dermatology, University of Calgary, Calgary, AB, Canada.,Beacon Dermatology, Calgary, AB, Canada
| |
Collapse
|
|
33
|
Haferland I, Wallenwein CM, Ickelsheimer T, Diehl S, Wacker MG, Schiffmann S, Buerger C, Kaufmann R, Koenig A, Pinter A. Mechanism of anti-inflammatory effects of Rifampicin in an ex vivo culture system of Hidradenitis Suppurativa. Exp Dermatol 2022; 31:1005-1013. [PMID: 35048417 DOI: 10.1111/exd.14531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of the hair follicles leading to painful lesions, associated with increased levels of pro-inflammatory cytokines. Numerous guidelines recommend antibiotics like clindamycin and rifampicin in combination, as first-line systemic therapy in moderate to severe forms of inflammation. HS has been proposed to be mainly an auto-inflammatory disease associated with but not initially provoked by bacteria. Therefore, it has to be assumed that the pro-inflammatory milieu previously observed in HS skin is not solely dampened by the bacteriostatic inhibition of DNA-dependent RNA polymerase. To further clarify the mechanism of anti-inflammatory effects of rifampicin, ex vivo explants of lesional HS from 8 HS patients were treated with rifampicin, and its effect on cytokine production, immune cells as well as the expression of Toll-like receptor 2 (TLR2) were investigated. Analysis of cell culture medium of rifampicin treated HS explants revealed an anti-inflammatory effect of rifampicin that significantly inhibiting interleukin (IL)-1β, IL-6, IL-8, IL-10, and tumour necrosis factor (TNF) -α production. Immunohistochemistry of the rifampicin-treated explants suggested a tendency for it to reduce the expression of TLR2 while not affecting the number of immune cells.
Collapse
Affiliation(s)
- Isabel Haferland
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Chantal M Wallenwein
- Fraunhofer Insitute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Tanja Ickelsheimer
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Sandra Diehl
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias G Wacker
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore
| | - Susanne Schiffmann
- Fraunhofer Insitute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany
| | - Claudia Buerger
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Anke Koenig
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Pinter
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| |
Collapse
|
|
34
|
Jørgensen AHR, Yao Y, Nielsen VW, Ring HC, Thomsen SF. Arthritis in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2021; 36:e352-e354. [PMID: 34897827 DOI: 10.1111/jdv.17865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/10/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022]
Affiliation(s)
- A-H R Jørgensen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - Y Yao
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - V W Nielsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - H C Ring
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
|
35
|
Hua VJ, Kilgour JM, Cho HG, Li S, Sarin KY. Characterization of comorbidity heterogeneity among 13,667 patients with hidradenitis suppurativa. JCI Insight 2021; 6:151872. [PMID: 34546979 PMCID: PMC8663549 DOI: 10.1172/jci.insight.151872] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disorder characterized by recurrent abscesses in the groin and flexural areas. HS is associated with a wide range of comorbidities that complicate the disease course. Although these comorbidities have been well described, it remains unclear how these comorbidities coassociate and whether comorbidity profiles affect disease trajectory. In addition, it is unknown how comorbidity associations are modulated by race and sex. In this comprehensive analysis of 77 million patients in a large US population–based cohort, we examined coassociation patterns among HS comorbidities and identified clinically relevant phenotypic subtypes within HS. We demonstrated that these subtypes not only differed among races, but also influenced clinical outcomes as measured by HS-related emergency department visits and cellulitis. Taken together, our findings provide key insights that elucidate the unique disease trajectories experienced by patients with HS and equip clinicians with a framework for risk stratification and improved targeted care in HS.
Collapse
|
|
36
|
Hanna N, Silverberg OM, Reaume M, Gladman D, Davis MDP, Piguet V, Alavi A. Incidence, prevalence, and predictors of inflammatory arthritis in patients with hidradenitis suppurativa: a systematic review and meta-analysis. Int J Dermatol 2021; 61:1069-1079. [PMID: 34432308 DOI: 10.1111/ijd.15860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
An increasing amount of evidence has emerged suggesting that hidradenitis suppurativa (HS) is associated with inflammatory arthritis. This study reviewed the incidence, prevalence, and predictors of inflammatory arthritis in patients with HS. A comprehensive literature search was conducted in CINAHL, Embase, and Medline from inception to February 14, 2020. Articles were included in the review if they provided data on disease epidemiology or predictors of adult or pediatric HS patients with comorbid inflammatory arthritis. There are no validated diagnostic criteria for HS, thus we considered patients as having HS if they had at least one diagnostic code in a hospital or claims database or a diagnosis of HS/inflammatory arthritis in a medical record. The same criteria were used to confirm presence of inflammatory arthritis. We identified an increased incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in HS patients when compared with estimates in the general population. We identified a relatively high prevalence of RA, spondyloarthritis (SpA), and PsA in HS patients when compared with estimates in the general population. There was evidence to suggest that patients who are younger than 30, male, have severe HS, or are taking infliximab or adalimumab (which may also be confounded by HS disease severity) may be at greater risk for specific subtypes of inflammatory arthritis. However, further data are needed to confirm these associations. The increased incidence and prevalence of inflammatory arthritis within HS patients underscore the need for increased awareness and interdisciplinary partnership within rheumatology and dermatology.
Collapse
Affiliation(s)
- Nardin Hanna
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Michael Reaume
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dafna Gladman
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Vincent Piguet
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
|
37
|
Almuhanna N, Finstad A, Alhusayen R. Association between Hidradenitis Suppurativa and Inflammatory Arthritis: A Systematic Review and Meta-Analysis. Dermatology 2021; 237:740-747. [PMID: 33774640 DOI: 10.1159/000514582] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies report a high prevalence of inflammatory arthritis among hidradenitis suppurativa (HS) patients. OBJECTIVES To study the association between HS and inflammatory arthritis. METHODS The systematic review and meta-analysis were performed according to the PRISMA guidelines to identify the association between HS and inflammatory arthritis, spondyloarthritis, ankylosing spondylitis (AS), and rheumatoid arthritis (RA). RESULTS Seven studies were entered in the analysis, with 200,361 HS patients and 385,599 controls. Pooled analysis illustrated a significantly increased risk of inflammatory arthritis in HS patients compared to controls (odds ratio [OR] 3.44; 95% confidence interval [CI] 1.92-6.17). There was also a statistically significant association between HS and spondyloarthritis (OR 2.10; 95% CI 1.40-3.15), and between HS and AS (OR 1.89; 95% CI 1.14-3.12). Moreover, pooled analysis showed a statistically significant association between HS and RA (OR 1.96; 95% CI 1.28-2.98). CONCLUSIONS Our findings show that HS patients have a 3-fold increased risk of developing inflammatory arthritis. HS patients are specifically at a higher risk for spondyloarthritis, its subtype AS, and RA.
Collapse
Affiliation(s)
- Nouf Almuhanna
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
|
38
|
Mansitó López C, Torres Laboy P, Ortiz Bou M, Quintero Noriega A, Cintron Rivera V. Fatal New-Onset Congestive Heart Failure Related to Adalimumab Use in a Patient with Relapsing Hidradenitis Suppurativa: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929148. [PMID: 33563886 PMCID: PMC7883937 DOI: 10.12659/ajcr.929148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tumor necrosis factor (TNF)-alpha inhibitors are essential treatments in several inflammatory conditions such as hidradenitis suppurativa (HS). However, they are not without associated risks. In rare cases, new-onset and exacerbations of heart failure have been associated with their use. The purpose of this report is to raise awareness of the need for further study of adalimumab for this adverse effect, as well as to recognize the need for research to find new HS treatment modalities for better care of the broad patient population. CASE REPORT We report the case of a 67-year-old man with a history of severe HS and major depressive disorder who came to our hospital complaining of dyspnea, fatigue upon exertion, and lower-extremity edema of 2 weeks' evolution. Symptoms began after the re-initiation of adalimumab for his severe HS. During hospitalization, he was diagnosed with decompensated congestive heart failure (CHF). Extensive studies, looking for ischemic or infectious etiology, yielded negative results. Being aware of adalimumab's potential adverse effects, the team discontinued the medication as a probable cause of his condition. Unfortunately, the patient died secondary to heart failure and septicemia. CONCLUSIONS The unusual but potentially life-threatening appearance of heart failure secondary to adalimumab use merits thorough attention by primary care doctors and specialists. This adverse event's rare occurrence can underestimate the number of fatalities associated with adalimumab and congestive heart failure.
Collapse
Affiliation(s)
- Claudia Mansitó López
- Department of Family Medicine Residency Program, Manatí Medical Center, Manatí, Puerto Rico
| | - Paola Torres Laboy
- Ponce Health Sciences University, School of Medicine, Ponce, Puerto Rico
| | - Miguel Ortiz Bou
- Department of Family Medicine Residency Program, Manatí Medical Center, Manatí, Puerto Rico
| | - Aida Quintero Noriega
- Department of Dermatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Vielka Cintron Rivera
- Department of Family Medicine Residency Program, Manatí Medical Center, Manatí, Puerto Rico
| |
Collapse
|
|
39
|
Comorbidity screening in hidradenitis suppurativa: Evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol 2021; 86:1092-1101. [PMID: 33493574 PMCID: PMC8298595 DOI: 10.1016/j.jaad.2021.01.059] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/07/2021] [Accepted: 01/18/2021] [Indexed: 12/21/2022]
Abstract
Background: Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk. Objective: To provide evidence-based screening recommendations for comorbidities linked to HS. Methods: Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria. Results: Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity. Limitations: Screening recommendations represent one component of a comprehensive care strategy. Conclusions: Dermatologists should support screening efforts to identify comorbid conditions in HS.
Collapse
|
|
40
|
Özkur E, Karadağ AS, Üstüner P, Aksoy B, Eşme P, Çalışkan E, Akoğlu G, Kalkan G, Demirseren DD, Polat M, Ozden MG, Kılınç F, Yalçınkaya İyidal A, Kıvanç Altunay İ, Türkmen M, Uğurer E, Baysak S, Fettahlıoğlu Karaman B, Mammadlı K, Baykal Selçuk L, Türkoğlu Z, Atcı T, Didar Balcı D, Adışen E, Temel B, Aktan Ş, Kaçar N, Gündüz K, Türel Ermertcan A, Özdemir M, Ünal Çakıter A, Çölgeçen E, Uçmak D, Kelekçi H, Ataseven A, Durmaz K, Kaya Özden H, Engin B, Yazıcı S, Alpsoy E. Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity. Clin Exp Dermatol 2021; 46:532-540. [PMID: 33030217 DOI: 10.1111/ced.14478] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.
Collapse
Affiliation(s)
- E Özkur
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - A S Karadağ
- Department of Dermatology, Medeniyet University Göztepe Training and Research Hospital, Istanbul, Turkey
| | - P Üstüner
- Department of Dermatology, Demiroğlu Bilim University, Faculty of Medicine, Istanbul, Turkey
| | - B Aksoy
- Department of Dermatology, Bahcesehir University, Faculty of Medicine, Istanbul, Turkey.,VM Medical Park Kocaeli Hospital, Kocaeli, Turkey
| | - P Eşme
- Department of Dermatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - E Çalışkan
- Department of Dermatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - G Akoğlu
- Department of Dermatology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - G Kalkan
- Department of Dermatology, Ankara Yıldırım Beyazıt University, Faculty of Medicine, Ankara, Turkey
| | - D D Demirseren
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - M Polat
- Department of Dermatology, Bolu Abant İzzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - M G Ozden
- Department of Dermatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - F Kılınç
- Department of Dermatology, Bolu Abant İzzet Baysal University, Faculty of Medicine, Bolu, Turkey
| | - A Yalçınkaya İyidal
- Department of Dermatology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - İ Kıvanç Altunay
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - M Türkmen
- Department of Dermatology, İzmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - E Uğurer
- Department of Dermatology, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - S Baysak
- Department of Dermatology, Sultan Abdülhamit Han Training and Research Hospital, Istanbul, Turkey
| | | | - K Mammadlı
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - L Baykal Selçuk
- Department of Dermatology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Z Türkoğlu
- Department of Dermatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - T Atcı
- Department of Dermatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - D Didar Balcı
- Department of Dermatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - E Adışen
- Department of Dermatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - B Temel
- Department of Dermatology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ş Aktan
- Department of Dermatology, Dokuz Eylül University, Faculty of Medicine, Izmir, Turkey
| | - N Kaçar
- Department of Dermatology, Pamukkale University, Faculty of Medicine, Denizli, Turkey
| | - K Gündüz
- Department of Dermatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - A Türel Ermertcan
- Department of Dermatology, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - M Özdemir
- Department of Dermatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - A Ünal Çakıter
- Department of Dermatology, Medipol University, Faculty of Medicine, Istanbul, Turkey
| | - E Çölgeçen
- Department of Dermatology, Yozgat Bozok University, Faculty of Medicine, Yozgat, Turkey
| | - D Uçmak
- Department of Dermatology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - H Kelekçi
- Department of Dermatology, Izmir Katip Celebi University, Faculty of Medicine, Izmır, Turkey
| | - A Ataseven
- Department of Dermatology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - K Durmaz
- Department of Dermatology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
| | - H Kaya Özden
- Department of Dermatology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - B Engin
- Department of Dermatology, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - S Yazıcı
- Department of Dermatology, Uludağ University, Faculty of Medicine, Bursa, Turkey
| | - E Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| |
Collapse
|
|
41
|
Jørgensen AR, Holm JG, Thomsen SF. Guselkumab for hidradenitis suppurativa in a patient with concomitant Crohn's disease: Report and systematic literature review of effectiveness and safety. Clin Case Rep 2020; 8:2874-2877. [PMID: 33363841 PMCID: PMC7752321 DOI: 10.1002/ccr3.3090] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/20/2020] [Accepted: 06/26/2020] [Indexed: 12/26/2022] Open
Abstract
Guselkumab appears to be safe and effective in the treatment of patients with HS, who do not respond to adalimumab and other systemic therapies. Guselkumab can be used in patients with comorbid Crohn's disease.
Collapse
Affiliation(s)
| | - Jesper Grønlund Holm
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
| | - Simon Francis Thomsen
- Department of Dermato‐Venereology & Wound Healing CentreBispebjerg HospitalCopenhagenDenmark
- Department of Biomedical SciencesUniversity of CopenhagenCopenhagenDenmark
| |
Collapse
|
|
42
|
Chang JE, Choi MS. A Molecular Perspective on the Potential Benefits of Metformin for the Treatment of Inflammatory Skin Disorders. Int J Mol Sci 2020; 21:ijms21238960. [PMID: 33255783 PMCID: PMC7728327 DOI: 10.3390/ijms21238960] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Due to its anti-hyperglycemic effect, metformin is the first-line medication for the treatment of type 2 diabetes, particularly in people who are obese. However, metformin is a drug with a very wide range of pharmacological properties and reports of its therapeutic effect on diseases including inflammation and cancer are increasing. Numerous research groups have reported that metformin has beneficial effects on a variety of inflammatory skin disorders including psoriasis, acanthosis nigricans, acne, hidradenitis suppurativa, and allergic contact dermatitis. According to these reports, in addition to the well-known action of metformin, that is, its anti-hyperglycemic effect, NF-kB inhibition and the resulting alteration to the cytokine network may be the potential targets of metformin. Its anti-hyperandrogenism effect has also been confirmed as the major action of metformin in some inflammatory skin diseases. Moreover, novel regulatory mechanisms, including autophagy and antioxidant processes, have been suggested as promising mechanisms of action for metformin in inflammatory skin disorders.
Collapse
Affiliation(s)
- Ji-Eun Chang
- Lab of Pharmaceutics, College of Pharmacy, Dongduk Women’s University, Seoul 02748, Korea;
| | - Min Sik Choi
- Lab of Pharmacology, College of Pharmacy, Dongduk Women’s University, Seoul 02748, Korea
- Correspondence:
| |
Collapse
|
|
43
|
Jalenques I, Ciortianu L, Pereira B, D'Incan M, Lauron S, Rondepierre F. The prevalence and odds of anxiety and depression in children and adults with hidradenitis suppurativa: Systematic review and meta-analysis. J Am Acad Dermatol 2020; 83:542-553. [DOI: 10.1016/j.jaad.2020.03.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/15/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
|
|
44
|
Nguyen T, Damiani G, Orenstein L, Hamzavi I, Jemec G. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol 2020; 35:50-61. [DOI: 10.1111/jdv.16677] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/03/2020] [Indexed: 12/11/2022]
Affiliation(s)
- T.V. Nguyen
- Bellevue Dermatology Clinic & Clinical Research Center Bellevue WA USA
| | - G. Damiani
- Department of Dermatology Emory University School of Medicine Atlanta GA USA
| | - L.A.V. Orenstein
- Dipartimento di Fisiopatologia Medico‐Chirurgica e dei Trapianti Università degli Studi di Milano Unità Operativa di Dermatologia IRCCS Fondazione Ca' GrandaOspedale Maggiore Policlinico Milano Italy
| | - I. Hamzavi
- Department of Dermatology Henry Ford Hospital Detroit MI USA
| | - G.B. Jemec
- Department of Dermatology Zealand University Hospital Roskilde Denmark
| |
Collapse
|
|
45
|
Frew JW, Jiang CS, Singh N, Grand D, Navrazhina K, Vaughan R, Krueger JG. Malignancy and infection risk during adalimumab therapy in hidradenitis suppurativa. Clin Exp Dermatol 2020; 45:859-865. [DOI: 10.1111/ced.14264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/12/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Affiliation(s)
- J. W. Frew
- Laboratory of Investigative Dermatology Rockefeller University New York NY USA
| | - C. S. Jiang
- Department of Biostatistics Rockefeller University New York NY USA
| | - N. Singh
- Department of Biostatistics Rockefeller University New York NY USA
| | - D. Grand
- Laboratory of Investigative Dermatology Rockefeller University New York NY USA
- Albert Einstein College of Medicine Bronx, New York NY USA
| | - K. Navrazhina
- Laboratory of Investigative Dermatology Rockefeller University New York NY USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri‐Institutional MD‐PhD Program Weill Cornell University New York NY USA
| | - R. Vaughan
- Department of Biostatistics Rockefeller University New York NY USA
| | - J. G. Krueger
- Laboratory of Investigative Dermatology Rockefeller University New York NY USA
| |
Collapse
|
|
46
|
Alhawsawi EMF, Hariri GA, Alzuhayri RJ, Makhdoom Y. Knowledge about and determinants for diagnosing hidradenitis suppurativa by ministry of health primary healthcare physicians in Jeddah city 2019: An analytical cross-sectional study. J Family Med Prim Care 2020; 9:1448-1452. [PMID: 32509631 PMCID: PMC7266209 DOI: 10.4103/jfmpc.jfmpc_1151_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/01/2022] Open
Abstract
Context: Hidradenitis suppurativa is a noncontagious, inflammatory, chronic and recurrent disease. The prevalence of HS is estimated to be between less than 1 and 4%. It is more common in females than males at a 2:1 ratio. Many cases of HS are either misdiagnosed or remain undiagnosed. Aims: To assess knowledge of diagnosing hidradenitis suppurativa by Ministry of Health primary health care physicians in Jeddah city, 2019 and to identify the determinants and knowledge of diagnosing hidradenitis suppurativa. Settings and Design: An analytical cross-sectional study conducted in Jeddah city, 2019, among primary health care physicians of the MOH. Methods and Material: Estimated sample size was 114. The required primary health care centers were 38 centers. The centers were chosen by a simple random sampling technique. A reliable self-administered questionnaire was used. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross tabulation and charts). Categorical variables were compared using the chi–square test to determine significant relationships between variables. Results: 65.4% (68) diagnosed the disease correctly. Most of their knowledge came from clinical practice (39.4%). There was a significant relationship with current job title and medical degree (P-value < 0.0005). Conclusion: The present study showed good knowledge about and ability to diagnose HS. A more advanced medical degree and more years of clinical experience was positively associated with the ability to diagnose HS.
Collapse
Affiliation(s)
- Ebtisam M F Alhawsawi
- Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ghufran A Hariri
- Department of Family Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Randa J Alzuhayri
- Department of Family Medicine, Ministry of Health, Jeddah, Saudi Arabia
| | - Yahya Makhdoom
- Department of Family Medicine, Ministry of Health, Jeddah, Saudi Arabia
| |
Collapse
|
|
47
|
Epicardial fat thickness is ıncreased and associated with disease severity in hidradenitis suppurativa. Arch Dermatol Res 2020; 312:467-472. [DOI: 10.1007/s00403-019-02032-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 12/21/2022]
|
|
48
|
Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and acne vulgaris and conglobata—systematic review and meta-analysis. BIOMEDICAL DERMATOLOGY 2019. [DOI: 10.1186/s41702-019-0045-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder which involves painful nodules and draining abscesses in flexural areas. Acne vulgaris and its more severe variants including acne conglobata and acne fulminans are also disorders involving the follicular unit. Given that follicular obstruction, dilatation and inflammation feature in both HS and acne vulgaris/conglobata, it has been suggested that HS is associated with acne vulgaris/conglobata.
Methods
The present systematic review and meta-analysis was performed according to recommended PRISMA guidelines. All eligible case-control studies comparing patients with HS vs non-HS were included in the present review. All studies must have included either the proportion of patients with acne vulgaris/conglobata in each group, or the summary effect size for association between HS and acne vulgaris/conglobata. The odds ratio (OR) was used as a summary statistic.
Results
From pooled unadjusted meta-analysis, we found a significantly higher proportion of patients with acne vulgaris/conglobata in HS cases compared to controls (OR 3.44, 95% CI 1.95–6.07, P < 0.0001, I2 = 100%). Pooled meta-analysis was also performed with adjusted effect sizes. This demonstrated that HS was significantly associated with acne vulgaris/conglobata after adjustment for potential confounders (OR 3.44, 95% CI 2.43–4.87, P < 0.00001, I2 = 99%).
Conclusions
In summary, a significant association was found between HS and acne vulgaris/conglobata. This has implications in terms of understanding the burden of disease on patient quality of life as well as consideration of optimal management strategies to target both disorders. Physicians taking care of patients with HS should be aware of this association.
Collapse
|
|
49
|
Horissian M, Maczuga S, Kirby JS, Nelson AM. Increased risk of alopecia areata for people with hidradenitis suppurativa in a cross-sectional study. J Am Acad Dermatol 2019; 81:1431-1432. [DOI: 10.1016/j.jaad.2019.05.093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/15/2019] [Accepted: 05/30/2019] [Indexed: 11/24/2022]
|
|
50
|
Phan K, Huo YR, Charlton O, Smith SD. Hidradenitis Suppurativa and Thyroid Disease: Systematic Review and Meta-Analysis. J Cutan Med Surg 2019; 24:23-27. [DOI: 10.1177/1203475419874411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful nodules, sinus tracts, and significant scarring. Although the pathogenesis of this disease is not well established, there is increasing evidence to suggest that it is an immune-mediated disorder. Previous studies have suggested a relationship between HS and thyroid disease, which is also driven by an autoimmune process. We sought to assess whether an association exists between HS and thyroid disease. Objectives: To determine whether HS is associated with thyroid disease via meta-analysis of case-control studies. Methods: A systematic review and meta-analysis was performed according to recommended PRISMA guidelines. Electronic searches were performed using 6 electronic databases from their inception until August 2018. Data were extracted and analyzed according to predefined clinical endpoints. Odds ratio (OR) was used as the summary effect size. Results: We identified 5 case-controls studies included for meta-analysis. There were a total of 36 103 HS cases compared with 170 517 control cases. We found a significant association between HS and thyroid disease (OR 1.36, 95% CI 1.13-1.64, I 2 = 78%, P = .001). Conclusions: This pooled analysis of existing case-control studies to date supports an association between HS and any thyroid disease. Clinicians treating patients with HS should be aware of this potential association with thyroid disease.
Collapse
Affiliation(s)
- Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ya Ruth Huo
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Olivia Charlton
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Saxon D. Smith
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
- Northern Clinical School, Sydney Medical School, University of Sydney, Australia
- The Dermatology and Skin Cancer Centre, Gosford and St Leonards, Sydney, Australia
| |
Collapse
|