Hidradenitis Suppurativa Physician Global Assessment Research Articles

808nm diode laser in the treatment of Hidradenitis Suppurativa: a retrospective study.

Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease characterized by painful lesions such as nodules, abscesses, and sinus tracts, primarily affecting intertriginous areas. Traditional treatments range from antibiotics and hormonal therapies to biologics and surgical options. Recently, lasers and light-based treatments has gained attention as a non-systemic treatment for HS, targeting hair follicles to potentially alleviate symptoms and improve quality of life. This study evaluated the efficacy of 808nm Diode laser therapy in managing HS by retrospectively reviewing data from 16 patients (13 men, 3 women) aged 23-61 who underwent between two and four sessions. Patients had not received systemic treatment in the three months preceding or during the therapy. Key outcome measures included the Modified Hidradenitis Suppurativa Score (MHSS), Hidradenitis Suppurativa Physician's Global Assessment (HS-PGA), Hidradenitis Suppurativa Clinical Response (HiSCR), and Dermatology Life Quality Index (DLQI). Results indicated a significant reduction in MHSS from a median of 20.0 before treatment to 9.0 at six months (p = 0.001). The HS-PGA score also significantly decreased from a median of 3.0 to 2.0 (p = 0.012). Of the 10 patients evaluated for HiSCR, 8 showed a positive response. DLQI scores improved from a median of 4.5 to 1.0 (p = 0.002). The treatment was well-tolerated, with only mild pain reported and no severe adverse effects. In conclusion, 808nm Diode laser therapy appears to be an effective modality for reducing disease severity and enhancing quality of life in HS patients, likely due to its anti-inflammatory effects. These findings suggest that Diode laser therapy could be a valuable addition to current HS management strategies, with further research needed to explore its long-term efficacy.

Combined Biologic and Surgical Interventions for Hidradenitis Suppurativa: A Systematic Review

Introduction. Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent painful or suppurative lesions due to follicular occlusion. Biologics and other treatment modalities such as surgical excision are commonly used in the treatment of severe HS. However, despite the frequent use of biologics and surgical interventions in the treatment of patients with HS, an assessment of their combined effects is lacking. This systematic review aims to qualitatively analyze the efficacy of combined biologic and surgical treatment for HS. Methods. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. The databases PubMed (MEDLINE), Embase, Cochrane (CENTRAL), ClinicalTrials.gov, MedRxiv.org, and the International Clinical Trial Registry were searched from inception until May 1, 2023. Results. A total of 1,145 studies were screened, with eight studies included for data extraction. Patients receiving combined biologic and surgical treatment showed greater improvement in the severity measurements of HS, including HS Impact Assessment, HS Physician Global Assessment, HS Sartorius Score, International Hidradenitis Suppurative Severity Score, HS recurrence rate, and Dermatology Life Quality Index. However, three studies reported a prolongation of wound healing with combined biologic and surgical treatment. Conclusion. Our systematic review highlights the additive effects of using biologics and surgery together to treat HS compared to either treatment alone. However, when both treatment modalities are used simultaneously, the potential risk of prolonged wound healing must be considered. Due to the limited number and heterogeneity of the included studies, more clinical trials are needed to establish diagnostic conclusions.

Efficacy and Durability of Intravenous Ertapenem Therapy for Recalcitrant Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a debilitating follicular skin disorder in which bacterial colonization is typical. Oral antibiotic efficacy can be unreliable; however, selective intravenous antibiotics, specifically ertapenem, may provide favorable clinical outcomes. To explore optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem for HS. This retrospective review of the medical records of 98 patients with HS between 2018 and 2022 measured and evaluated patient outcomes before and after treatment with intravenous ertapenem. Participants were followed up in a telephone survey assessing patient perspectives and satisfaction. All of those included in this study received medical care from the Albert Einstein College of Medicine's Montefiore HS Center. Patients were treated with 1 g of ertapenem that was self-administered at home through a peripheral intravenous central catheter using an elastomeric pump for 12 to 16 weeks. Antiandrogens and immunomodulatory biologic therapies initiated prior to ertapenem were maintained throughout the treatment course. The primary outcomes, encompassing clinical severity (evaluated through the HS Physician Global Assessment score [a 6-point scale ranging from clear to very severe] and a numerical rating scale for pain [an 11-point scale in which a score of 0 indicates no pain and a score of 10 indicates the worst possible pain]) and markers of inflammation (such as leukocytes, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6), were measured at baseline, the midcourse of intravenous ertapenem treatment, at the end of the course, and posttherapy. Bacterial abundance was also examined at these 4 points, and patient satisfaction was assessed during follow-up. A total of 98 patients (mean [SD] age, 35.8 [13.0] years; 61 [62.2%] female) with HS were treated with intravenous ertapenem. The self-reported racial distribution included 3 individuals identifying as Asian (3.1%), 59 as Black/African American (60.2%), 13 as White (13.3%), and 23 as either other or unknown (23.5%). Additionally, 24 participants (24.5%) reported Spanish/Hispanic/Latino ethnicity. The mean (SD) treatment duration spanned 13.1 (4.0) weeks, with posttherapy follow-up occurring after 7.8 (3.6) weeks. From baseline to posttherapy follow-up, significant reductions were found in the mean (SD) HS Physician Global Assessment scores (3.9 [1.0] vs 2.7 [1.2]; P < .001) and the numerical rating scale for pain (4.2 [3.3] vs 1.8 [2.7]; P < .001), C-reactive protein (5.4 [11.4] vs 2.4 [2.0] mg/dL; P < .001), interleukin-6 (25.2 [21.1] vs 13.7 [13.9]; P < .001), and leukocytes (11.34 [3.9] vs 10.0 [3.4]; P < .001). At follow-up, 76 patients (78.0%) participated in the telephone survey, where 63 (80.3%) reported medium to high satisfaction; further, 69 (90.8%) would recommend ertapenem to other patients. In this retrospective review of medical records and telephone survey, treating HS with intravenous ertapenem, administered for a mean of 13 weeks, was associated with improvement in clinical and inflammatory markers, as well as heightened patient satisfaction. Nonetheless, this approach should be monitored for the emergence of antimicrobial resistance given a longer than standard treatment course.

Worst area local Hidradenitis suppurativa Activity and Severity Index-Revised (W-HASI-R): a study evaluating construct validity.

Current validated hidradenitis suppurativa (HS) severity assessment tools are time-consuming and impractical in fast-paced, ambulatory clinic settings. This study evaluated the construct validity of the most severe or ‘worst’ area local Hidradenitis suppurativa Activity and Severity Index-Revised (W-HASI-R) as a novel target area assessment tool for clinical setting use. W-HASI-R had strong association with the International Hidradenitis Suppurativa Severity Score System and abscess and nodule count, moderate association with Hurley stage and HS physician global assessment and weak, negative association with reverse-scored Dermatology Quality Life Index. The resulting data suggest that W-HASI-R may be an option as an efficient target area assessment tool for fast-paced, ambulatory settings.

Overview and comparison of the clinical scores in hidradenitis suppurativa: A real-life clinical data.

Partly due to its clinical heterogeneity, hidradenitis suppurativa (HS) is difficult to score accurately; illustrated by the large number of disease scores. In 2016, a systematic review by Ingram et al. reported the use of about thirty scores, and since then, this number has increased further. Our aim is twofold: to provide a succinct but detailed narrative review of the scores used to date, and to compare these scores with each other for individual patients. The review of the literature was done among articles in English and French, on Google, Google scholar, Pubmed, ScienceDirect and Cochrane. To illustrate the differences between scores, data from some Belgian patients included in the European Registry for HS were selected. A first series of patients compares the severity of the following scores: Hurley, Hurley Staging refined, three versions of Sartorius score (2003, 2007, 2009), Hidradenitis Suppurativa Physician Global Assessment (HS-PGA), International Hidradenitis Suppurativa Severity Scoring System (IHS4), Severity Assessment of Hidradenitis Suppurativa (SAHS), Hidradenitis Suppurativa Severity Index (HSSI), Acne Inversa Severity Index (AISI), the Static Metascore, and one score that is not specific to HS: Dermatology Life Quality Index (DLQI). A second set of patients illustrates how some scores change over time and with treatment: Hurley, Hurley Staging refined, Sartorius 2003, Sartorius 2007, HS-PGA, IHS4, SAHS, AISI, Hidradenitis Suppurativa Clinical Response (HiSCR), the very new iHS4-55, the Dynamic Metascore, and DLQI. Nineteen scores are detailed in this overview. We illustrate that for some patients, the scores do not predictably and consistently correlate with each other, either in an evaluation of the severity at a time-point t, or in the evaluation of the response to a treatment. Some patients in this cohort may be considered responders according to some scores, but non-responders according to others. The clinical heterogeneity of the disease, represented by its many phenotypes, seems partly to explain this difference. These examples illustrate how the choice of a score can lead to different interpretations of the response to a treatment, or even potentially change the results of a randomized clinical trial.

Investigation of thiol-disulfide homeostasis and ischemia-modified albumin levels in patients with hidradenitis supurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. The pathogenesis of HS is not clear, and the triggering mechanism for the initiation of the disease is still a controversy. The present study aims to investigate the relationship between thiol-disulfide homeostasis (TDH), ischemia-modified albumin (IMA), and HS. To our knowledge, this will be the first report evaluating TDH and IMA status in HS. The study included 30 patients with HS as the patient group and 30healthy individuals as the control group. For determination of HS severity, Hurley and Hidradenitis suppurativa physician global assessment (PGA) scores were used. One tube venous blood specimen from every participant was obtained. IMA and TDH tests were analyzed in sera of participants. The results were evaluated statistically. Disulfide (p<0.001), Index I (p=0.001), and Index II (p=0.001) levels in HS group were significantly higher than control group. IMA levels in patients with higher Hurley scores are significantly higher (p=0.032, r=0.39). A positive correlation was observed between IMA level and disease duration (p=0.021, r=0.42). The shift in thiol/disulfide balance toward disulfide and significant increase in IMA levels put out the importance of oxidation status in HS etiopathogenesis.

Assessment of inter-rater reliability of clinical hidradenitis suppurativa outcome measures using ultrasonography.

Hidradenitis suppurativa (HS) staging and severity is typically based upon physical examination findings, which can result in misclassification of severity based on subclinical disease activity and significant variation between healthcare providers. Ultrasonography (US) is an objective tool to help evaluate subclinical disease and to more accurately classify disease severity. To evaluate inter-rater reliability in HS disease severity assessment using clinical and US techniques. In total, 20 subjects underwent clinical evaluation of HS, independently by two physicians, using clinical outcome measures, including Hurley, Sartorius, HS Physician Global Assessment (HS-PGA) and Hidradenitis Suppurativa Clinical Response (HiSCR). US was subsequently performed, and clinical assessments were repeated. Intraclass correlation coefficients (ICC) were obtained to evaluate inter-rater agreement of each outcome measure before and after US. Pre-US to post-US improvement in ICC was seen with the Sartorius, HiSCR nodule and abscess count, and the HiSCR draining fistula count. The scores went from having 'good' rater agreement for Sartorius and HiSCR nodule and abscess count, to 'poor' rater agreement for HiSCR draining fistula count, to 'excellent' rater agreement among these scores. US improved inter-rater agreement and should be used in conjunction with physical examination findings to evaluate disease severity to ensure uniform staging of HS.

Clinical and psychosocial factors affecting work productivity among patients with hidradenitis suppurativa: A cluster analytical investigation

To the Editor: The presence of hidradenitis suppurativa (HS) affects patients' psychosocial work functionality.1Shlyankevich J. Chen A.J. Kim G.E. Kimball A.B. Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis.J Am Acad Dermatol. 2014; 71: 1144-1150Google Scholar This cross-sectional study, conducted from October 2018 to December 2019, aimed to correlate work presenteeism and absenteeism with psychosocial and disease severity parameters. Adult patients ≥ 18 years, literate in English or French, and attending the HS clinic at the McGill University Health Centre participated in the study. Participants completed validated questionnaires on clinical characteristics, quality of life and psychiatric morbidity, HS severity, and work productivity. Psychiatric health was assessed using the Dermatology Life Quality Index (DLQI) and the Beck Depression Inventory. HS severity was assessed using Hurley staging, HS Physician Global Assessment (PGA), Severity Assessment of Hidradenitis Suppurativa (SAHS), and the International Hidradenitis Suppurativa Severity Score System (IHS4) (Supplemental Tables I and II, available at https://doi.org/10.1016/j.jaad.2021.02.066). Absenteeism was measured by the number of workdays missed in the previous 4 weeks due to HS. Presenteeism was gauged by the number of days in the preceding 4 weeks that a patient worked but was disturbed by HS during work. Patients graded the impact of HS on their work performance on a scale of 0-10. This rating was self-reported and liable to subjective reporting and recall bias. Most of the 131 participants were female (n = 76; 58.02%) and Caucasian (n = 82; 62.6%), with a mean age of 38.11 ± 14.32 years. Of 102 employed patients, 81 (79.41%) worked in office settings and 21 (20.59%) worked in field jobs. Absenteeism was reported in 44 (43.14%) with mean missed workdays of 1.76 (standard deviation [SD], 2.11). Presenteeism was more prevalent, reported by 79 (77.45%) with mean bothered days at work of 5.13 (SD, 5.11). A 2-step clustering algorithm (Fig 1) revealed a fair quality clustering solution with a poor productivity cluster comprising 55 (53.9%) participants and a high productivity cluster comprising 47 (46.1%) participants. Over the previous 4 weeks, poor productivity patients reported disturbance by HS on a mean of 6.51 (SD, 5.55) days compared with 3.23 (SD, 3.78) for high productivity patients. Poor productivity patients missed a mean of 2.13 (SD, 2.34) workdays, compared with 1.23 (SD, 1.55) days by high productivity patients. Poor productivity patients reported significantly worse scores on the DLQI and higher scores on the Beck Depression Inventory, body mass index, visual analog score for pain, Hurley staging, HS-PGA, IHS4, and SAHS scores. (Table I). HS impact on productivity correlated closest with Hurley staging and DLQI scores (Table I).Table IComparison of clinical and psychosocial characteristics of poor productivity and high productivity among hidradenitis suppurativa patientsVariablesPoor productivity clusterHigh productivity clusterP valueMeanSDMeanSDClinical profile Age35.9311.90539.0414.059.23 Delay in diagnosis (years)9.057.22511.5512.961.22 Hurley staging2.700.451.400.53<.001 DLQI18.207.5246.705.676<.001 Beck depression inventory15.8410.8327.776.789<.001 BMI30.9537.786928.5236.0472.09 VAS5.872.4572.812.410<.001 PGA3.641.1921.790.999<.001 IHS411.357.1392.532.244<.001 SAHS8.403.2294.001.732<.001Work productivity profile Missed days2.132.3561.231.547.07 Bothered days6.515.5543.233.779.002 Productivity on bothered days∗Productivity on bothered days 0-10 (self-reported).6.961.3097.041.835.83BMI, Body mass index; DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; PGA, Physician Global Assessment; SAHS, Severity Assessment of Hidradenitis Suppurativa; SD, Standard deviation; VAS, visual analog score.∗ Productivity on bothered days 0-10 (self-reported). Open table in a new tab BMI, Body mass index; DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; PGA, Physician Global Assessment; SAHS, Severity Assessment of Hidradenitis Suppurativa; SD, Standard deviation; VAS, visual analog score. Although presenteeism was more prevalent, only absenteeism was a significant predictor of perceived loss of productivity. In bivariate correlations, Hurley staging was significantly associated with bothered workdays (r = 0.28, P < .001) but not with missed days (r = 0.19, P = .09) or subjectively measured productivity (r = -0.13, P = .25). Chi-squared analysis revealed that patients in office-based settings most often reported bothered work (χ2 = 19.7, P < .001). In a multivariable regression analysis (Table I) adjusted for age and gender and controlling for both presenteeism and absenteeism, only absenteeism was a significant predictor of perceived productivity loss (B = -0.26, P = .01). This model revealed 21% variance in perceived productivity loss (F = 4.84, P < .01). Our data illustrate that the HS impact on work productivity correlates with the standard indicators of clinical severity, quality of life, and depression. None disclosed.

Clindamycin Mono-Therapy of Hidradenitis Suppurativa Patients: A Single-Center Retrospective Study.

BackgroundA rifampicin (RF)-clindamycin (CL) combination therapy is recommended as the first-line treatment for moderate to severe hidradenitis suppurativa (HS). Although the long-term use of RF requires caution due to the possibility of developing resistant bacteria, only a few studies have investigated alternatives for this combination therapy.ObjectiveTo evaluate the efficacy of systemic CL mono-therapy and assess the prevalence and CL resistance of bacterial growth in HS patients.MethodsA total of 53 HS patients treated with CL mono-therapy were included. The efficacy was evaluated by identifying the rate of HS Clinical Response (Hi-SCR) achievers and comparing HS Physician’s Global Assessment (HS-PGA) before (W0) and after (W8) the treatment. Purulent material from HS skin lesions was collected on the W0. Bacterial flora and antibiotic sensitivity were determined by bacterial cultures.ResultsOf 53 HS patients, 34 were eligible for evaluation of the efficacy of the therapy. Twenty-one patients (61.76%) achieved Hi-SCR. The mean scoring of HS-PGA had significantly decreased from 3.24 to 2.15 (p=0.001). The prevalence of CL resistance was 15.00%. No significant differences in the efficacy of the therapy according to the presence of CL-resistant bacteria on the W0 were observed (p=0.906). Adverse events occurred in 26.42% of patients.ConclusionSystemic CL mono-therapy may be a safe and useful alternative to RF-CL combination therapy, and no significant difference in the efficacy of the therapy depending on the presence of CL-resistant bacteria was observed.

483 Hidradenitis suppurativa in a cohort of sixty years and older

Hidradenitis suppurativa (HS) is a chronic, recurrent skin disorder characterized by painful nodules, pustules, purulent abscesses, and sinus tracts (“tunnels”) leading to progressive disability. While the epidemiology of HS has been reported, this has not been explored in patients 60 years and older. Our study examines this cohort. We identified 51 patients aged 60 and older with HS who were seen Montefiore Medical Center between 2015 and 2019. There were 39 females (76.5%); 26 (50.9%) self-identified as black or African-American, 7 (13.7%) as white, 11 (21.6%) as other, and 7 (13.7%) declined to respond or were unsure. Ethnic analysis revealed 7 (13.7%) were Spanish/Latino/Hispanic, and 33 (64.7%) were non-Spanish/Latino/Hispanic , while 11 (21.6%) declined to respond or did not know. Body mass index (BMI) was available for 37 patients: 7(18.9%) were normal BMI, 6 (16.2%) were overweight, 12 (32.4% ) were obese, and 12 (32.4%) were very obese. Of 49 patients who reported smoking history: 16 (32.6%) were current smokers, 18 (36.7%) were former smokers, 15 (30.6%) were never smokers. Forty-one patients reported information about temporal landmarks: the average age of symptom onset was 45.3 years (±19.7) and the average age at diagnosis was 65.2 (±5.0). Family history was documented for 32 patients: 17 (53.1%) reported a family history of HS and 15 (46.9% ) did not. HS Physician Global Assessment (HS-PGA) and Hurley Scores were recorded at the initial visit for 26 patients and 37 patients, respectively. The average HS-PGA was 2.5 (±1.1), while the average Hurley stage was 2.1 (±0.92). Hidradenitis suppurativa occurs frequently among patients aged 60 and older. Our findings suggest there may be tertiary peak later in life. It appears that smoking status, BMI, and family history parallel the findings in the general HS population; however these findings indicate a need for further investigation of this cohort. Naik HB, Paul M, Cohen SR, Alavi A, Suàrez-Farñas M, Lowes MA. Distribution of self-reported hidradenitis suppurativa age at onset. JAMA Dermatol. 2019.

Methotrexate shows benefit in a subset of patients with severe hidradenitis suppurativa.

BackgroundMethotrexate is an immunomodulatory therapy that may offer benefit to patients with hidradenitis suppurativa (HS). Despite its theoretical advantages, there is a paucity of available data regarding long-term methotrexate use in patients with HS.ObjectiveThis study aimed to assess whether methotrexate treatment leads to improvement in HS disease severity.MethodsWe conducted an institutional review board–approved, single-center, retrospective chart review of patients with HS who were treated with methotrexate between 2000 and 2018. Primary outcome measurements included the HS Physician's Global Assessment (HS PGA), Hurley staging, abscess count, fistula count, and inflammatory nodule count.ResultsA total of 29 patients were identified; 14 were excluded for reasons including never starting methotrexate and missing follow-up data. For remaining patients (n = 15), the average cumulative dose of methotrexate was 520.1 mg (range, 30–1665 mg) and the average length of treatment was 11.7 months (range, 1–38 months). Patients taking methotrexate as a primary therapy had a higher cumulative dose and length of treatment (520.13 mg; 14.6 months) compared with those taking biologics concomitantly (468.44 mg; 9.1 months). Patients using methotrexate as primary therapy demonstrated nonsignificant reductions in HS PGA, inflammatory nodule count, and abscess count. Patients on concomitant biologic therapy failed to demonstrate any change in HS PGA, inflammatory nodule count, and abscess count.LimitationsLimitations of the study include its retrospective nature, small sample size, length of time on methotrexate between groups, and homogeneity of the patient population.ConclusionMethotrexate may represent an effective treatment option in older patients with lower body mass indices but fails to offer benefit in patients taking concurrent biologic therapy.

Clinical Characteristics of Hidradenitis Suppurativa Patients from a Reference Centre in Kaunas, Lithuania

Introduction: Clinical data on hidradenitis suppurativa (HS) derived mainly from studies in Western Europe and the USA, raising the risk of potential selection bias. According to the official data, during 2006–2015 the incidence of HS in Lithuania was 23.5 cases per 100,000 population with a female-to-male ratio of 2:1. A more fine-grained data set would however be of great relevance to further understanding this disease. Collection of standardized data enables the comparison of populations of patients across samples. Objectives: To present a cohort of HS patients with uniformly collected data according to European Hidradenitis Suppurativa Foundation/European Reference Network–Skin recommendations. Methods: The demographic and clinical data of a total of 37 HS patients, included over a 3-year period (from 2016 to January 2019) in a local database of the reference centre of Rare Skin Diseases in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos, were analysed. Non-parametric tests such as χ² and Mann-Whitney were used for assessing interdependence between qualitative data. Logistic regression analysis was performed to find out the factors statistically related with significant diagnostic delay. Results: The mean duration of diagnosis delay was 5.5 (±5.9) years in females and 6.6 (±8.2) years in males. A significant delay (>2 years) was reported in 29/37 (78.4%) cases and was not related with sex, age at HS diagnosis or disease severity. The groin area was more affected in females than in males. There was no statistically significant difference between sex and Hurley stage, HS Physician Global Assessment, International Hidradenitis Suppurativa Severity Score System, visual analogue scale and Dermatology Life Quality Index scores. Combined (medical and surgery) HS treatment was applied to 46.0% and monotherapy (medical or surgery) to 54.0% of patients. Conclusions: Standardized collection of epidemiological and clinical data is required to improve the quality of HS patient data and allow for international comparisons and pooling of data for research purposes.

HIDRAdisk: validation of an innovative visual tool to assess the burden of hidradenitis suppurativa.

BackgroundHidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland–bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used.ObjectiveThe objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome.MethodsA multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex‐16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment–General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS‐PGA).ResultsA total of 140 patients (59% women; mean age 34.9 ± 11.0 years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex‐16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS‐PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test–retest reliability (Spearman correlation coefficient, 0.8331; P < 0.0001) and responsiveness to changes were demonstrated.ConclusionOur study shows that HIDRAdisk, a short and innovative visual HS QoL instrument, has been psychometrically validated in Italian language and it may help improve the management of HS once implemented in routine clinical practice.

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa.

The rifampicin (RF)-clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy. The aim of the present study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS. In the period January 2017-May 2018, 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by Revuz, Hidradenitis Suppurativa Physician Global Assessment [HS-PGA] and International Hidradenitis Suppurativa Severity Score System [IHS4]) before (W0) and after (W12) CL oral therapy. CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12-week period (p ≤ .01). There was also a statistically significant change in the mean visual analogue scale for pain. The present study demonstrates the efficacy of oral CL monotherapy as RF-sparing regimen alternative to RF-CL combination in a selected group of patients.

Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

Hormonal therapy is a potential treatment for hidradenitis suppurativa (HS). However, fewdata exist describing the efficacy of spironolactone in treatment of HS. To assess whether spironolactone treatment improves HS disease severity and patient-reported pain. We performed a single-center chart review of female patients with HS who were treated with spironolactone between 2000 and 2017. Primary outcome measurements included the HS Physician's Global Assessment (HS-PGA), Hurley staging, inflammatory lesion count, fistula count, and a numeric rating scale for pain. On average, subjects were exposed to 75mg of spironolactone daily over a 7.1-month follow-up period. Patients achieved significant disease improvement with regard to pain (Δ-1.5 [P= .01]), inflammatory lesions (Δ-1.3 [P= .02]), and HS-PGA score (Δ-0.6 [P<.001]). As expected, no change was found for Hurley stage (Δ0 [P= .32]) or fistulas (Δ0 [P= .73]). There was no difference in improvement between subjects who received less than 75mg of spironolactone daily (n=25; average dose, 45mg/d) and those who received more than 100mg daily (n=21; average dose, 112 mg/d). Retrospective nature, limited sample size, and variations in severity measures documented were limiting factors. Management of HS with spironolactone reduces lesion count, HS-PGA score, and pain. Lower doses appear to be effective and may be an appropriate option for patients with tolerability concerns.

The Clinical Significance of Increased Serum Proinflammatory Cytokines, C-Reactive Protein, and Erythrocyte Sedimentation Rate in Patients with Hidradenitis Suppurativa.

Objectives To assess inflammatory serum markers including serum proinflammatory cytokines, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) according to the clinical inflammatory activity of patients with hidradenitis suppurativa (HS). Patients and Methods Seventy-four patients with HS were studied based on the Hidradenitis Suppurativa-Physician Global Assessment (HS-PGA) score and Hurley staging system. Proinflammatory cytokines were measured using a multiplex cytokine assay. Twenty-two healthy volunteers were recruited. Results Serum interleukin- (IL-) 6, IL-23, soluble tumour necrosis factor alpha (TNF-α) receptor I (sTNF-RI), CRP, and ESR were different in the patients with HS compared with those in the healthy controls (P < 0.05). The levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70, IL-17A, sTNF-RII, CRP, and ESR were significantly elevated according to inflammatory activity based on HS-PGA scores (r > 0.25, P < 0.05). The levels of IL-6 (r = 0.53, P < 0.001), CRP (r = 0.54, P < 0.001), and ESR (r = 0.60, P < 0.001) were especially well correlated with clinical inflammatory activity based on HS-PGA scores. The levels of IL-6, IL-8, sTNF-RI, sTNF-RII, CRP, and ESR were significantly elevated according to Hurley staging system. Conclusions Serum proinflammatory cytokines, CRP, and ESR are increased in relation to the clinical inflammatory activity of patients with HS compared with healthy controls. Serum IL-6, CRP, and ESR are effective biomarkers for evaluating the severity of HS.

HiSCR (Hidradenitis Suppurativa Clinical Response): a novel clinical endpoint to evaluate therapeutic outcomes in patients with hidradenitis suppurativa from the placebo‐controlled portion of a phase 2 adalimumab study

BackgroundDetermining treatment response for patients with hidradenitis suppurativa (HS) can be challenging due to limitations of current disease activity evaluations.ObjectiveEvaluate the novel, validated endpoint, Hidradenitis Suppurativa Clinical Response (HiSCR) and its utility as an outcome measure.MethodsPatients with baseline total abscess and inflammatory nodule count (AN count) of at least three and draining fistula count of 20 or fewer comprised the post hoc subpopulation analysed. HiSCR (at least a 50% reduction in total AN count, with no increase in abscess count, and no increase in draining fistula count relative to baseline) and HS‐PGA Response [Hidradenitis Suppurativa‐Physician's Global Assessment score of clear, minimal, or mild, with at least a 2‐grade improvement from baseline] were used to evaluate patient response after adalimumab treatment weekly, every other week, or placebo (1 : 1 : 1).ResultsThe subpopulation included 132 (85.7%) patients; 70.5% women and 73.5% white. At week 16, HiSCR was achieved by 54.5% receiving weekly adalimumab, 33.3% every other week, and 25.6% placebo and HS‐PGA Response was achieved by 20.5% receiving weekly adalimumab, 6.7% every other week and 2.3% placebo.ConclusionHiSCR was more responsive to change than HS‐PGA Response in this subpopulation.

Adalimumab for the Treatment of Moderate to Severe Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, painful skin disease characterized by abscesses, nodules, and draining fistulas in the axilla and groin of young adults. To evaluate the efficacy and safety of adalimumab, an anti-tumor necrosis factor-α antibody, in patients with moderate to severe HS. Phase 2, parallel, randomized, placebo-controlled trial consisting of a blinded 16-week period (period 1) and an open-label 36-week period (period 2). All study personnel, investigators, and patients remained blinded to treatment group throughout the study. (ClinicalTrials.gov: NCT00918255) 26 academic and private practice medical centers in the United States and Europe. 154 adult patients with moderate to severe HS who were unresponsive or intolerant to oral antibiotics. Patients were assigned in a 1:1:1 ratio to adalimumab, 40 mg/wk; adalimumab, 40 mg every other week (EOW); or placebo. All patients received adalimumab, 40 mg EOW, at the beginning of period 2 but switched to weekly dosing if the response was suboptimal (HS Physician's Global Assessment [PGA] score of moderate or worse) at weeks 28 or 31. The primary outcome measure (clinical response) was the proportion of patients achieving an HS-PGA score of clear, minimal, or mild with at least a 2-grade improvement relative to baseline at week 16. At week 16, 3.9% of placebo patients (2 of 51), 9.6% of EOW patients (5 of 52), and 17.6% of weekly patients (9 of 51) achieved clinical response (EOW vs. placebo strata-adjusted difference, 5.6% [95% CI, -4.0% to 15.3%]; P = 0.25; weekly vs. placebo strata-adjusted difference, 13.7% [CI, 1.7% to 25.7%]; P = 0.025). Serious adverse event rates were 3.9%, 5.8%, and 7.8% for placebo, EOW, and weekly patients, respectively (EOW vs. placebo difference, 1.8% [CI, -6.4% to 10.1%]; weekly vs. placebo difference, 3.9% [CI, -5.2% to 13.0%]). Significantly greater improvements in patient-reported outcomes and pain were seen in the weekly dosing group than in the placebo group. A decrease in response was seen after the switch from weekly to EOW dosing in period 2. Weeks 16 to 52 of the study were open-label. The study was not powered to assess the risk for known serious adverse effects of adalimumab, such as tuberculosis, other serious infections, and demyelinating disorders. Adalimumab dosed once per week alleviates moderate to severe HS. Abbott Laboratories.