Hidradenitis Suppurativa Patients Research Articles

Trends of Metformin Use in Patients with Hidradenitis Suppurativa, 2016-2021

Introduction: Hidradenitis Suppurativa (HS) is a dermatologic condition that is comorbid with diabetes mellitus (DM) and polycystic ovarian syndrome (PCOS). Metformin has been used as a therapy in DM and PCOS but little research has been done to see if it is being used in patients with HS. Methods: Using MarketScan, information on HS, DM, and PCOS diagnoses were collected from January 1, 2016--December 31, 2021. Metformin prescription information was also collected on these patients. Results: During the study, the percentage of HS patients with a metformin prescription increased (Z = -9.6, p<0.001). Metformin prescriptions in patients with HS but without DM or PCOS diagnoses also increased (Z= -13.1, p<0.001). Discussion: Metformin offers promising therapeutic options for the treatment of patients with HS, even if they do not have comorbid conditions.

To what Extent does Vitamin D and its Serum Levels Influence the Severity of Hidradenitis Suppurativa: A Literature Review.

Vitamin D plays a role in inflammatory skin conditions and can improve them. Hidradenitis suppurativa (HS) is an autoinflammatory chronic skin disease in which most patients exhibit a hypovitaminosis D. However, it is uncertain whether vitamin D supplementation could relieve the severity of HS. A systematic literature search of PubMed and Web of Science was conducted on 4 September 2023. Studies that investigated vitamin D and its potential implications for the severity of HS were included. In contrast, studies that focused on the prevalence of vitamin D deficiency were excluded, as well as studies on syndromic HS. Seven studies with a total of 575 patients were included in the qualitative synthesis, of which 3 utilized a cross-sectional design, 2 were pilot studies, 1 a controlled cohort study, and 1 a prospective case-control study. In all included studies, HS patients were vitamin D deficient. There was evidence indicating that serum vitamin D levels negatively correlated with the severity of the disease, and at least suggestive evidence that vitamin D supplementation could have a positive impact on the course of HS. To better understand these correlations, conducting a randomized controlled trial study on vitamin D and its effects on HS severity is imperative.

Association of hidradenitis suppurativa (HS) with waist circumference: A bidirectional two-sample Mendelian randomization study of HS with metabolic syndrome.

Observational studies have suggested an associations between hidradenitis suppurativa (HS) and metabolic syndrome (MetS) and its components. However, it remains unclear whether the relationship is causal or not. Our study aimed to investigate the causal association of HS with MetS and its components. We performed a bidirectional, two-sample Mendelian randomization study using summary-level data from the most comprehensive genome-wide association studies of HS (n = 362 071), MetS (n = 291 107), waist circumference (n = 462 166), hypertension (n = 463 010) fasting blood glucose (FBG, n = 200 622), triglycerides (n = 441 016), and high-density lipoprotein cholesterol (HDL-C, n = 403 943). Genetic instrumental variables were constructed by identifying single nucleotide polymorphisms associated with the corresponding factors. The random-effects inverse-variance weighted method was applied as the primary method. The results showed that genetically predicted HS was positively associated with waist circumference risk in both directions. High waist circumference increased the risk of HS (odds ratio [OR] 4.147; 95% confidence interval [CI] 2.610-6.590; p = 1.746 × 10-9). In addition, HS was also affected by waist circumference (OR 1.009; 95% CI 1.006-1.012; p = 3.08 × 10-7). No causal relationships were found between HS and MetS or its components other than waist circumference. The findings highlight the importance of early intervention for obesity in HS patients. Further studies are needed to determine the pathophysiology of HS associated with MetS and its components.

Cancer and Hidradenitis Suppurativa

Hidradenitis suppurativa patients have an increased risk of developing cancer. This includes not only hematologic malignancies and solid tumors, but also cutaneous squamous cell carcinoma originating within the hidradenitis suppurativa lesions. The development of squamous cell carcinoma is most commonly associated with Caucasian men who smoke and have severe gluteal or perianal lesions of more than 25 years duration. Other factors that have occasionally been associated with hidradenitis suppurativa-related squamous cell carcinoma include treatment with a tumor necrosis factor-alpha inhibitor (such as infliximab and adalimumab), genodermatoses (such as keratitis-ichthyosis-deafness syndrome and Dowling-Degos disease), and paraneoplastic syndromes (such as hypercalcemia, hypercalcemia-leukocytosis, and paraneoplastic neuropathy). The tumor may demonstrate the presence of human papillomavirus; even after treatment, patients have a poor prognosis since cancer metastasis, or recurrence, or both commonly occurs. The potential role of human papillomavirus vaccination for cancer prevention and early treatment of squamous cell carcinoma with targeted therapy (with an epidermal growth factor inhibitor such as cetuximab) and/or checkpoint inhibitor immunotherapy (such as cemiplimab and pembrolizumab) remains to be determined. Rarely, hidradenitis suppurativa lesions have mimicked cutaneous metastases in patients with visceral malignancy by demonstrating an increased uptake of fluorine-18 fluorodeoxyglucose on positron emission tomography and/or computerized tomography scans. Also, both primary cancers (such as cutaneous squamous cell carcinoma and mucinous adenocarcinoma) and breast cancer skin metastases can masquerade as hidradenitis suppurativa lesions. Therefore, when a lesion is located at a current or prior site of hidradenitis suppurativa that is new or rapidly growing and/or does not respond to hidradenitis suppurativa-directed therapy, prompt evaluation to establish or exclude the diagnosis of cancer should be considered.

54849 Leaving against medical advice among hidradenitis suppurativa patients: A retrospective cohort study

54849 Leaving against medical advice among hidradenitis suppurativa patients: A retrospective cohort study

54355 Increased suicidal ideation and suicide attempts among hidradenitis suppurativa patients: A propensity-matched real-world study in 55,805 patients.

54355 Increased suicidal ideation and suicide attempts among hidradenitis suppurativa patients: A propensity-matched real-world study in 55,805 patients.

54651 Impact of BMI and Obesity on Hospital Length of Stay in Hidradenitis Suppurativa Patients: Implications for Surgical Management

54651 Impact of BMI and Obesity on Hospital Length of Stay in Hidradenitis Suppurativa Patients: Implications for Surgical Management

50398 A New Tool to Improve Communication Between Hidradenitis Suppurativa Patients and Health Care Providers

50398 A New Tool to Improve Communication Between Hidradenitis Suppurativa Patients and Health Care Providers

53279 The association of depressive disorders in hidradenitis suppurativa patients treated with tetracyclines: A cross-sectional study utilizing the NIH AllofUs research database

53279 The association of depressive disorders in hidradenitis suppurativa patients treated with tetracyclines: A cross-sectional study utilizing the NIH AllofUs research database

51916 Associations between Obesity, Disease Severity, Comorbidities, and Medications in Pediatric and Adolescent Hidradenitis Suppurativa Patients: A Cohort and Cross-Sectional Analysis

51916 Associations between Obesity, Disease Severity, Comorbidities, and Medications in Pediatric and Adolescent Hidradenitis Suppurativa Patients: A Cohort and Cross-Sectional Analysis

53232 Therapeutic drug monitoring and management of hidradenitis suppurativa patients with suboptimal adalimumab response: a retrospective case series

53232 Therapeutic drug monitoring and management of hidradenitis suppurativa patients with suboptimal adalimumab response: a retrospective case series

54158 The Effect of Mindfulness Training on the Quality of Life of Hidradenitis Suppurativa Patients

54158 The Effect of Mindfulness Training on the Quality of Life of Hidradenitis Suppurativa Patients

Interleukin-1 family cytokines and soluble receptors in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic skin disease, characterized by clinical inflammation of the hair follicle with the recurrence of abscesses, nodules, and tunnels. Recently, several studies suggested a role of IL-1 family (IL-1F) cytokines in eliciting and sustaining the disease. The aim of this work is to perform a comprehensive analysis of IL-1F cytokines, soluble inhibitors and receptors in a cohort of HS patients not treated with biological agents. Sixteen patients affected by HS and 16 healthy controls were recruited; clinical data were collected and disease severity evaluated by means of the International HS Severity Score System (IHS4). Serum levels of IL-1F cytokines, inhibitors and receptors were measured using a Multiplex Assays. IL-18 and free IL-18 levels were significantly higher in patients vs controls. Among soluble inhibitors, IL-1Ra, IL-1R2 and ST2/IL-1R4 were significantly increased. IL-18, free IL-18 and IL-33 levels are strongly correlated with IHS4. Also the inhibitors IL-1Ra and IL-18BP show a correlation with IHS4. The data obtained in this study confirm the involvement of IL-1F cytokines in mediating the disease and determining its severity and suggest a possible role for IL-18 as novel serum biomarker of active disease.

Comparing antibiotic prescribing patterns for hidradenitis suppurativa between dermatology and non‐dermatology ambulatory providers

AbstractBackgroundOral antibiotics are a mainstay of treatment for hidradenitis suppurativa (HS) primarily due to their anti‐inflammatory and anti‐microbial properties. Because antibiotics are frequently prescribed to treat HS, concerns exist regarding antibiotic stewardship. There is a paucity of literature comparing how antibiotic prescribing patterns for HS differ between dermatology and non‐dermatology clinicians in the ambulatory setting.ObjectiveThis study aims to compare the antibiotic prescribing patterns of dermatology versus non‐dermatology clinicians treating HS in the ambulatory setting.MethodsWe utilised the National Ambulatory Medical Care Survey (NAMCS) to identify visits for HS patients from 2005 to 2016. We performed multivariate logistic regression analysis to compare the likelihood of prescribing (1) antibiotics and (2) tetracyclines between dermatology and non‐dermatology clinicians in the ambulatory setting.ResultsWe identified a total of 2 424 125 (weighted) HS visits. Approximately 28.0% of visits were conducted by dermatology clinicians, while 72.0% were conducted by non‐dermatology clinicians. Antibiotics were prescribed in 51.9% of visits. Tetracyclines were the most commonly prescribed antibiotics among visits with dermatology clinicians (33.4%), while penicillins/cephalosporins were the most commonly prescribed antibiotic among visits with non‐dermatology clinicians (14.9%). Multivariate logistic regression analysis demonstrated no difference in the overall likelihood of prescribing antibiotic therapy between dermatology and non‐dermatology clinicians (p = 0.35). However, dermatology clinicians were significantly more likely to prescribe tetracyclines than non‐dermatology clinicians (OR 5.48, 95% CI 1.19–25.26, p = 0.03).ConclusionIn conclusion, dermatology clinicians were significantly more likely to prescribe tetracyclines than non‐dermatology clinicians for HS patient visits.

Addressing the unmet care needs of people with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) can have a devastating impact on the lives of patients. Challenges and unmet needs in the management of HS can further exacerbate low well-being and poor quality of life among patients. This article provides the perspective of patients and healthcare professionals on these challenges and provides suggestions for how clinicians can help ensure HS patients receive the care they need.

Evaluation of Cannabis-Related Product Use Among Patients With Hidradenitis Suppurativa: A Narrative Review.

The use of cannabis and cannabis-related products among patients with hidradenitis suppurativa (HS) is increasing globally. Given the potential anti-inflammatory, therapeutic, and pain management benefits of cannabis-related products, we reviewed primary literature to evaluate the prevalence and possible purpose for cannabis use among patients with HS and to provide recommendations to patients and physicians. A narrative review of original studies was conducted using Embase and Ovid Medline databases. The search strategy was confirmed by a librarian and conducted on September 1, 2023, using a detailed list of subject headings and keywords tailored to cannabis, cannabis-related products, HS, and both adult and pediatric populations. Among 43 identified studies, 6 met the eligibility criteria and encompassed 34,435 patients. Patients were mostly female, and studies were conducted across the United States, Canada, and France. Findings show higher cannabis use among HS patients, demonstrating efficacy in pain management, sleep, anxiety relief, itch relief, and improved quality of life. Cannabis may play a role in analgesia, improved quality of life, pain, itch, and overall mental health in patients with HS and healthcare providers including dermatologists should increase their familiarity in appropriate use of cannabis-related products.

Adopting adalimumab combined surgery in the management of moderate to severe hidradenitis suppurativa: Experience from a single medical center in southern Taiwan.

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder primarily affecting the intertriginous and anogenital regions. Guidelines recommend various treatments for HS, including biologic agents like adalimumab for moderate to severe cases. Adalimumab is a type of human monoclonal IgG1 antibody designed to target tumor necrosis factor α. Recent studies have shown the effectiveness of adalimumab, either alone or combined with surgery, in managing HS. We retrospectively analyzed the medical chart of HS patients in a southern Taiwan medical center from 2019 to 2022 and investigated clinical features and treatment response. The institutional review board at Chang Gung Medical Foundation granted approval for the study. We primarily focused on moderate to severely affected patients. One hundred and two clinically diagnosed HS patients participated, with a male-to-female ratio of 2:1 and an average age of 31.8 at diagnosis. Among them, 41.2% were in Hurley stage III and 32.4% in stage II. Nineteen patients received excision with pre-surgical adalimumab; their average age at diagnosis was 31.1, with a gender ratio of 5.3:1. Surgery was most common on the buttocks (68%), axillae (21%), and groin (10%). Excision patients were primarily in advanced stages (Hurley III 94.7%, II 5.3%) with high body mass index. Adalimumab and surgery combined yielded a 68.4% improvement rate, while 15.8% remained stable and 15.8% did not respond as expected. In addition, smoking and obesity were prevalent among patients. Adalimumab showed promising results in moderate to severe HS, with significant improvement observed in our cases. The combination of adalimumab and surgery appeared effective in advanced HS patients with larger involved areas and more tunnels. No severe adverse events were reported. However, our study was limited by its retrospective nature and the lack of a control group. Despite these limitations, our study revealed the benefits of integrating adalimumab with suitable surgical procedures in managing patients experiencing moderate to severe HS in real-world scenarios.

Hidradenitis Suppurativa in the SARS-CoV-2 Pandemic: Investigation of Trigger Factors in a Single Center.

Background: Hidradenitis suppurativa (HS) is a debilitating, chronic inflammatory disease associated with multiple triggers. As the world struggles with the global COVID-19 pandemic, it is important to review the trigger factors for chronically ill HS patients during the COVID-19 pandemic. This work investigates the self-described trigger factors of HS patients that emerged during the COVID-19 outbreak. Methods: We anonymously surveyed 110 HS patients during the SARS-CoV-2 pandemic using a 25-question questionnaire that included trigger factors for deterioration. Demographic, personal, and HS-specific information was also collected to identify potential trigger factors for HS exacerbation. All HS patients were asked if their HS had worsened compared to the time before the pandemic. Results: Compared to before the pandemic, 20% of HS patients (n = 22) reported a worsening of HS. Patients with an HS exacerbation were significantly more likely to avoid contact with a doctor than those without an exacerbation (45.5% vs. 18.2%; p = 0.007). HS involvement, severity, exercise activity, and BMI had no association with worsening HS (p > 0.05). Interestingly, dietary changes and increased consumption of sweets and treats were associated with worsening HS (p = 0.011 and p = 0.013). Specifically, eating more sweets and treats was associated with a 6-fold increased risk of worsening HS. The results suggest that diet has an important influence on HS relapses. Further investigation is needed to determine whether diet is a triggering factor independent of the SARS-CoV-2 pandemic. In addition, gluteal HS involvement was associated with a more than 4.3-fold risk of HS exacerbation. Conclusions: In the management of HS patients, it is important to consider that gluteal involvement and the consumption of sweets are more often associated with deterioration.

Comorbidities, Clinical Presentation, Subtypes, and Treatment of HS Patients in Lithuania.

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.

Eosinophils in hidradenitis suppurativa patients exhibit pro-inflammatory traits, implicating a potential pathogenic role in the disease.

Hidradenitis suppurativa (HS) is an inflammatory skin disease characterized by painful nodules, abscesses and purulent secretions in intertriginous regions. Intense pruritus frequently accompanies HS lesions, adding further discomfort for patients. While Th17 pathway activation is implicated in HS pathogenesis, disease mechanisms are still not fully understood, and therapeutics are lacking. Previous reports raise a potential role for eosinophils in HS, showing a strong association of eosinophil levels with disease severity. To investigate eosinophils in HS, we recruited patients and matched healthy controls and then performed flow-cytometry studies, eosinophil stimulation assays, and lesional skin staining for eosinophils. We found that HS patients reported similar levels of pain and itch. Compared to matched controls, HS blood exhibited decreased mature eosinophils and increased numbers of immature eosinophils, coupled with a significant increase in dermal eosinophilic infiltrates. Additionally, IL-17RA+ eosinophils were highly and significantly correlated with multiple HS-related clinical scores. In both stimulated and unstimulated conditions, HS eosinophils showed an inflammatory phenotype versus controls, including an increase in costimulatory T- and B-cell markers (e.g. CD5 and CD40) following all stimulations (TNFα/IL-17A/IL-17F). These findings highlight the significance of pruritus in HS and suggest a higher turnover of eosinophils in HS blood, potentially due to the consumption of eosinophils in skin lesions. Our data delineate the features and functions of eosinophils in HS and suggest that eosinophils participate in disease pathogenesis, advancing Th17-related inflammation. Further studies are needed to investigate eosinophils' response to current HS treatments and their potential as a therapeutic target in the disease.