Treatment Of Hidradenitis Suppurativa Research Articles

Gold-Polypyrrole-Loaded Eosin in Photo-Mediated Treatment of Hidradenitis Suppurativa: In Vivo Trans-Epidermal Permeation Study and Clinical Case Report.

This study reports a new protocol for the management of Hidradenitis Suppurativa (HS), depending on the synergistic photodynamic and photothermal effect of eosin yellow-gold-polypyrrole hybrid nanoparticles (E-G-Ppy NPs). E-G-Ppy NPs and gold-polypyrrole NPs (G-Ppy NPs) were synthesized, characterized, and formulated in topical hydrogels. Then, in vivo trans-epidermal permeation study, under both dark and white light-irradiation conditions, was done on albino mice. The E-G-Ppy hydrogel was then applied on a twenty-four years old female with recurrent axillary HS lesions pretreated with fractional CO2 laser. Thereafter, the treated lesions were irradiated sequentially, using an IPL system, in the visible (~550 nm) and NIR band (630–1100 nm) to activate the synthesized nanoparticles. Results showed that, upon application to mice skin, E-G-Ppy exhibited good tolerance and safety under dark conditions and induced degenerative changes into dermal layers after white-light activation, reflecting deep penetration. Photo-activation of E-G-Ppy hydrogel to a severe Hidradenitis Suppurativa case showed an improvement of 80% of the lesions according to average HS-LASI scores after 4 sessions with no recurrence during a follow-up period of six months. In summary, the dual photodynamic/photothermal activation of E-G-Ppy NPs can represent a promising modality for management of HS. Further expanded clinical studies may be needed.

Communicating with health providers and romantic partners: The impact of negative emotions on quality of life for individuals with hidradenitis suppurativa.

Background:Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease that impacts an estimated 1 to 4% of the population; women are twice as likely to be diagnosed as men. There is no cure for HS, and many patients face a lifetime of various healthcare appointments, medical interventions, and personal experiences living with the disease.Objective:This study aimed to explore social, emotional, and medical experiences for individuals with HS, and to understand connections between those experiences and quality of life.Methods:Participants (n = 243) in the community-based convenience sample completed a cross-sectional survey about their experiences and quality of life and reported high rates of anxiety, embarrassment, and depressed mood. These and other negative emotions were commonly experienced during interactions with healthcare providers and romantic partners.Results:Participants who had more negative interactions with providers and partners surrounding their HS tended to experience a lower quality of life.Limitations:Limited generalizability due to convenience sampling.Conclusion:Providers should consider how patients experience patient -provider communication about HS, and how this communication impacts other areas of patients' lives, including quality of life, mental health, and romantic relationships. Future care approaches should prioritize mental health strategies in HS patients' care plans, and establish partnerships between dermatology practices and mental health professionals to aid in the multidisciplinary approach recommended for the treatment of HS.

Complications of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the apocrine glands in the axillary, groin, and breast regions, with apparent physiological and psychosocial sequelae. As many studies have reported, surgical management is one of the treatment options. A comprehensive systematic review of surgical treatment for HS is provided in this study. Literature retrieval was conducted on MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure (CNKI) and clinical registries from their inception to 1 May 2022. The principles of the PRISMA were adhered to in the process of literature search and the reference lists of the articles retrieved were also checked for further reference. Heterogeneity was assessed in meta-analysis by means of the Q-test and I2 index. A total of 13 studies were finally included which involved 535 participants in total. The average estimated complication rate was 11.1% (95% confidence interval [CI], 6.4%-16.9%). The meta-analysis was conducted on pooled complication sample studies and pooled recurrence sample studies. The recurrence was 16.2% (95% CI, 9.1%-24.9%). Subgroup analysis revealed significant differences in HS complications among different closure types. Among different locations, the highest rate of 16.0% (95% CI, 6.8%-28.2%) was multiple locations. Besides, differences were also observed in diverse excision methods and the highest was deroofing 13.9% (95% CI, 2.2%-33.2%). Extensive resection, using skin flaps or skin grafts as a closure method, was associated with a higher incidence of complications. Providers should consider carefully the use of extensive resection or using skin flaps or skin grafts as a closure method so as to minimise the risk of adverse events.

Switching from Adalimumab Originator to Biosimilar in Patients with Hidradenitis Suppurativa Results in Losses of Response-Data from the German HS Registry HSBest.

Since 2021, adalimumab biosimilar ABP 501 can be used alternatively to adalimumab originator (ADAO) in the treatment of hidradenitis suppurativa (HS). Effectiveness and safety data remain scarce. We investigated the impact of switching from ADAO to ABP 501 on disease severity and the occurrence of adverse events (AEs) in patients with HS. We analyzed clinical data on patients enrolled in the German HSBest registry. Evaluation outcomes were assessed at three time points (baseline of originator (t0), prior to switching to biosimilar (t1) and 12 to 14 weeks after switching (t2)) and included patient-reported AEs and disease severity using the International Hidradenitis Suppurativa Severity Score System (IHS4) score. In total, 94 patients were switched from ADAO to ABP 501. Overall, 33.3% (n = 31/94) of the patients developed AEs and/or loss of response (LoR) within 12 to 14 weeks after switching. Of these, 61.3% (n = 19/31) experienced LoR but no AEs, 22.6% (n = 7/31) LoR combined with AEs and 16.1% (n = 5/31) AEs only. Our study showed that switching HS patients from ADAO to ABP 501 does significantly affect treatment effectiveness. Switching patients who are on remission maintenance therapy should be viewed critically.

Patient perspectives on diagnosis and management of hidradenitis suppurativa: A web-based survey

Patient perspectives on diagnosis and management of hidradenitis suppurativa: A web-based survey

Drug Survival of Oral Retinoids in Hidradenitis Suppurativa: A Real-Life Cohort Study.

IntroductionCohort studies on the use of retinoids for hidradenitis suppurativa (HS) have yielded contradicting results. As the clinical presentation of HS is heterogeneous, with different predilection sites and hallmark features, it can be hypothesized that HS phenotypes are associated with the effectiveness of specific retinoid treatments.ObjectivesThe aim of this study was to evaluate the drug survival of oral retinoids in the treatment of HS and to establish predictors for longer treatment duration.MethodsA retrospective, dual-center study was conducted in the Netherlands in adult HS patients treated with oral retinoids between 2011 and 2021. Drug survival analyses were performed through Kaplan-Meier survival curves. Additionally, Cox regression models were used to determine predictors for a longer drug survival.ResultsIn total, 102 patients were included. Overall drug survival of (low-dose) isotretinoin (n = 66) at 12 and 24 months was 44.2% and 15.5%, respectively. Termination of treatment was mostly due to ineffectiveness (26%). Presence of widespread comedones (p = 0.03) and the use of concomitant systemic medication (p = 0.04) were associated with a prolonged treatment duration. For acitretin (n = 36), the overall drug survival was 42.0% at 12 months and 37.4% at 24 months, and was also predominantly determined by ineffectiveness (28%). Interestingly, the scarring folliculitis phenotype (p < 0.05) was associated with prolonged drug survival time for acitretin treatment relative to the regular phenotype.ConclusionComparable drug survival rates at 12 months for isotretinoin and acitretin were found. HS patients with widespread comedones and the scarring folliculitis phenotype could benefit from treatment with isotretinoin or acitretin, respectively.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40257-022-00725-9.

33431 Efficacy of 80 mg/week dose of adalimumab (Humira) in treatment of hidradenitis suppurativa

Hidradenitis suppurativa (HS) is an inflammatory skin condition involving the apocrine gland-bearing regions, such as the axillae, groin, anogenital, and inframammary areas. Though its etiology is unknown, disease manifests when hair follicles become obstructed, leading to the release of inflammatory mediators, such as TNF-α and IL-17. Levels of TNF-α have been found to be elevated in lesions of HS, providing a basis for the use of biologics in treatment of severe HS. Adalimumab is a recombinant human IgG1 anti-TNF monoclonal antibody which acts via antagonism of TNF-α.

33431 Efficacy of 80 mg/week dose of adalimumab (Humira) in treatment of hidradenitis suppurativa

Hidradenitis suppurativa (HS) is an inflammatory skin condition involving the apocrine gland-bearing regions, such as the axillae, groin, anogenital, and inframammary areas. Though its etiology is unknown, disease manifests when hair follicles become obstructed, leading to the release of inflammatory mediators, such as TNF-α and IL-17. Levels of TNF-α have been found to be elevated in lesions of HS, providing a basis for the use of biologics in treatment of severe HS. Adalimumab is a recombinant human IgG1 anti-TNF monoclonal antibody which acts via antagonism of TNF-α. Although adalimumab has been studied in phase 2 and 3 trials and has been approved as a treatment modality for HS at a 40 mg weekly dose, numerous patients still suffer on a day-to-day basis due to the severity of their disease and do not respond to this conventional dosing. We present a series of 6 such patients whose response to an 80 mg/week dose of adalimumab has been positive, with a decrease in severity and number of HS lesions, leading to improvement in the Hidradenitis Suppurativa Clinical Response (HiSCR) in the absence of serious adverse effects. Although this dosing regimen has not been well-documented in literature, it is important to consider the lasting benefits of treatment with a higher dose in individuals afflicted with treatment-resistant HS, including a decreased likelihood of comorbidities and complications and an improved quality of life.

Immunomodulatory Drugs in the Treatment of Hidradenitis Suppurativa-Possibilities and Limitations.

Hidradenitis suppurativa, also known as acne inversa, is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. Treatment is rather difficult and typically requires the use of multiple modalities. Regardless of the presence of several therapeutic options, treatment often turns out to be ineffective or poorly selected concerning the clinical picture of the disease. Thus, the search for new biologics and other target treatments of hidradenitis suppurativa is ongoing. The safety and efficacy of adalimumab, still the only U.S. Food and Drug Administration approved biologic in the hidradenitis suppurativa treatment, paved the way for new drugs to be compared with it. Several more drugs with new immunological targets are currently under investigation for the treatment of acne inversa. The aim of the article was to present the current and future targets of acne inversa treatment, simultaneously providing insights into the molecular pathomechanisms of the disease.

Effectiveness and Safety of Acitretin for the Treatment of Hidradenitis Suppurativa, Predictors of Clinical Response: A Cohort Study

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle which presents with painful nodules, abscesses, and fistulae in apocrine gland-bearing areas of the skin. Approved treatments include antibiotics and biologic drugs such as adalimumab. Despite these treatments, HS management is challenging. Acitretin is an oral retinoid used for its management as 3rd or 4th line therapy. There is little evidence regarding the effectiveness and safety of acitretin treatment for HS, and no reports have previously explored the potential clinical predictors associated with the response to the treatment. Methods: Retrospective cohort study to assess the effectiveness and safety of acitretin treatment in HS patients who failed to respond to topical therapies. Results: Sixty-two patients with moderate to severe HS were included. A significant decrease in the International HS Severity Scoring System (IHS4) score was found over time. Higher basal IHS4 score, family history of HS, follicular phenotype, and history of follicular plugging conditions were potential predictors of response. Most patients did not suffer any adverse events, and no severe side effects were observed. The main cause of discontinuation was lack of efficacy. Conclusion: Acitretin can be considered as a therapeutic option for patients with HS. The presence of follicular phenotype or a history of components of follicular occlusion syndrome is associated with better outcomes.

Co-Graft of Acellular Dermal Matrix and Split Thickness Skin Graft-A New Reconstructive Surgical Method in the Treatment of Hidradenitis Suppurativa.

Hidradenitis suppurativa is a chronic disease that significantly reduces patients’ quality of life. Patients are chronically treated with systemic therapies, which are often ineffective. Surgical treatment for severe cases of hidradenitis suppurativa is one option for affected patients. Surgical treatment has its limitations, and wound closure may be particularly problematic. This requires the use of reconstructive techniques. The methods of choice for wound closure are split-thickness skin grafts or local flaps reconstructions. However, each method has its limitations. This is a presentation of a new reconstructive surgical method in hidradenitis suppurativa surgery: the use of a co-graft of Acellular dermal matrix and split thickness skin graft as a novel method in wound closure after wide excisions, based on two cases. The results of this method are very promising: we achieved very fast wound closure with good aesthetic results regarding scar formation. In this paper, we used several examinations: laser speckle analysis, cutometer tests, and health-related quality of life (QoL) questionnaire to check the clinical impact of this method. Our initial results are very encouraging. ADM with STSG as a co-graft could be widely used in reconstructive surgery. This is a preliminary study, which should be continued in further, extended research.

Real-world safety and clinical response of Janus kinase inhibitor upadacitinib in the treatment of hidradenitis suppurativa: A retrospective cohort study

To the Editor: Hidradenitis suppurativa (HS) is a chronic relapsing autoinflammatory disease in desperate need of novel therapeutic options.1 Janus kinase inhibition has been identified as a potential novel strategy in the management of HS, with ongoing clinical trials evaluating safety and efficacy.2 Upadacitinib is a Janus kinase 1-selective inhibitor currently used in the treatment of inflammatory arthropathies and inflammatory bowel disease, conditions that share immunological similarities with HS.

341 Hidradenitis suppurativa: Patient perspectives on biologic use

Hidradenitis suppurativa (HS) was once considered an orphan disease with limited therapeutic options. With the emergence of pipeline biologic treatments for HS, the treatment paradigm for HS is expanding. We aim to identify HS patient use and perspectives of biologic medications. Between 10/2021 to 1/2022 an anonymous survey was disseminated through online HS support groups. Data regarding demographics and perspectives on biologic medications were collected and assessed using Spearman rank correlation.

312 Efficacy of infliximab in hidradenitis suppurativa: A meta-analysis

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis that is often recalcitrant to treatments. Adalimumab is the only medication for HS that is approved by the FDA/EMA. The tumor necrosis factor inhibitor infliximab is an established treatment for HS, but its evidence is limited. Objective: Systematically conduct a meta-analysis of existing literature on the efficacy of infliximab in HS. Method: MEDLINE and EMBASE databases were systematically searched in September 2021.

LB929 Opioid use disorder in a cohort of hidradenitis suppurativa patients

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. While HS treatment consists of a multi-tiered approach, many patients also seek therapy for debilitating pain. An increased risk of long-term opioid use disorder (OUD) has been intensively explored in patients with HS; however, there is a paucity of information associated with ‘screening’ for OUD. The Prescription Opioid Misuse Index (POMI), a 6-point questionnaire, is a specific and sensitive instrument for identifying patients with OUD.

Use of lasers in hidradenitis suppurativa treatment – case report

Acne inverse sometimes known as hidradenitis suppurativa is a long-term dermatological condition. Due to the poorly examined nature of the disease the effectiveness of its treatments is unclear. More than 50 interventions have been described and therefore its diagnostic and the treatment can be challenging. The aim of this case report is to draw attention to the possible use of laser therapy in the treatment of hidradenitis suppurativa.&#x0D; A case report.&#x0D; We report the case of 27-year-old woman that has been successfully treated with laser after years of an ineffective treatment. Due to the failure of systemic and local antibiotic therapy, hormone therapy, surgical drainage and orally and externally applied retinoids, removal of lesions using a CO2 laser knife and a fractional laser therapy combining a CO2 laser and a 1570 nm wavelength laser on the surface of the affected skin was performed.&#x0D; Conclusions.&#x0D; The use of laser therapy, with particular emphasis on the CO2 laser, may be an important and effective element of hidradenitis suppurativa treatment.

A complication in a patient with hidradenitis suppurativa taking adalimumab

A 54-year-old man with a 25-year history of Hurley stage III hidradenitis suppurativa (HS) and inflammatory arthritis presented to the emergency department with worsening groin lesions with increasing pain and drainage. His treatment for HS and arthritis included 40-mg adalimumab weekly and 17.5-mg methotrexate weekly for 5 years. He had not seen a dermatologist in 2 years. His prescriptions were filled by another provider. On physical examination, the patient appeared cachectic. He was both tachycardic and tachypneic.

The Value of Negative-Pressure Wound Therapy and Flap Surgery in Hidradenitis Suppurativa - A Single Center Analysis of Different Treatment Options.

BackgroundHidradenitis suppurativa is manifested by painful abscesses and scarring of sweat glands. Axillary, inguinal and genital regions are mostly affected. Multiple options exist in the treatment of hidradenitis suppurativa. The aim of this retrospective, mono-center cohort study was to analyze the outcome of different treatment methods after radical excision of hidradenitis suppurativa.MethodsWe retrospectively evaluated the treatment strategy and recurrence rate of hidradenitis suppurativa. We included all eligible patients of legal age between February 2003 and October 2021, with the diagnosis of Hidradenitis suppurativa and the necessity for surgical treatment. All patients with surgical treatment and direct wound closure by suture were excluded. Bacterial load and flora were analyzed for primary and secondary reconstruction in combination with negative-pressure wound therapy. Patient data were analyzed for recurrence rate and remission time according to different reconstructive techniques.ResultsIn 44 affected anatomical sites (n = 23 patients) we treated 15 patients with negative-pressure wound therapy. Bacterial load and flora were lower in the last wound swab of patients with multi-surgical procedures (22 localizations) compared to the first wound swab independent of the use of negative-pressure wound therapy.Wound closure, independent of a direct and multi-stage procedure was achieved by local fasciocutaneous flaps (n = 12), secondary intention healing (n = 7), secondary intention healing with buried chip skin grafts (n = 10), or split-thickness skin grafts (n = 15). Radical excision combined with split-thickness skin grafts showed the lowest recurrence rate in the follow-up (16%; n = 4).ConclusionRadical excision of hidradenitis suppurativa as gold standard for surgical treatment combined with negative-pressure wound therapy as multi-stage procedures ultimately reduced bacterial load and flora in our study. The use of split-thickness skin grafts showed the lowest recurrence rate.

Comparison of Negative Pressure Wound Therapy with or without a Split-Thickness Skin Graft in the Surgical Management of Axillary Hidradenitis Suppurativa: A Retrospective Cohort Study

Introduction: Negative pressure wound therapy (NPWT) alone or with the addition of a split-thickness skin graft (STSG) are 2 reconstructive options available after surgical excision of axillary hidradenitis suppurativa (HS). The aim of this study was to retrospectively examine patients undergoing these treatments and to assess clinical and patient-related outcome measures. Methods: A single-centre, retrospective analysis was conducted, evaluating surgical excision of axillary HS, with STSG and NPWT, or NPWT alone. Data collected included No. of post-operative clinic visits, time to heal, size of wound, disease recurrence, follow-up time, Dermatology Life Quality Index (DLQI), the Generalised Anxiety Disorder Assessment (GAD-7), the Patient Health Questionnaire Depression Scale (PHQ-9), Pain Visual Analogue Scale (PAINVAS2), the Brief Illness Perception Questionnaire (BIPQ), and Dermatology Visual Analogue Scale (DERMVAS). Two-tailed t-test and Mann–Whitney Wilcoxon U-tests were used to assess for significant relationships. Results: One hundred five patients were included in the study, 44 who received NPWT alone, and 61 who received NPWT + STSG. There was no significant difference in follow-up time ( P = .934) or No. of follow-up appointments between groups ( P = .287). There was a significant difference in time to heal between groups, with STSG + NPWT observing a mean time of 2.77 months and NPWT alone observing a mean time of 4.40 months ( P = .0006). There was no difference in patient-reported outcomes between the 2 groups. Conclusion: There is no difference in patient-reported outcomes with the addition of an STSG to NPWT after surgical excision of HS. Wide excision and use of NPWT alone is an effective procedure for the treatment of axillary HS.

State of the art of blue light effects on hidradenitis suppurativa: a concise systematic review

Introduction: In the setting of inflammatory diseases, hidradenitis suppurativa (HS), or acne inversa, is an immune-mediated skin disease with a prevalence of 0.1-1% and characterized by nodules and abscesses in the armpits, groin, and inframammary areas, which may evolve for fistulas and scars. Still, an update is needed on the recent understanding of the pathogenesis of HS, including the central role of inflammatory cytokines and other contributing factors such as genetics, hormones, and pathogenic microorganisms. As an innovative approach, antimicrobial blue light in the 400-470 nm spectrum has demonstrated its intrinsic antimicrobial properties resulting from the presence of endogenous photosensitizing chromophores in pathogenic microorganisms. Objective: To carry out a narrative and systematic review of the literature to explore the main clinical and experimental results of the use of photobiomodulation with blue light for the treatment of hidradenitis suppurativa by antibacterial action. Methods: The present study followed a model of narrative and systematic review, according to PRISMA rules, to gather the main information about the efficiency and safety of blue light in the treatment of HS. The research was carried out from January 2018 to May 2019 and developed based on Google Scholar, Scopus, PubMed, Scielo, and Cochrane Library. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: Microorganisms are less able to develop resistance to antimicrobial blue light than to traditional antibiotics, due to the multi-targeting characteristics of antimicrobial blue light. Furthermore, it is well accepted that antimicrobial blue light is much less harmful to host cells than UV irradiation. Clinical studies have presented scientific evidence of treatment for HS with light-based therapy, showing efficacy and safety through articles published in quality journals in scientific evidence. A meta-analysis published in 2019, based on the quality of the evidence, showed that the most recommended treatments for HS include adalimumab and laser (blue light) therapy. For intense pulsed light with blue light, two RCTs reported improvements in HS-LASI scores and the Dermatology Quality of Life Index. Conclusion: The use of blue light for dermal treatments, particularly for HS, is finding an increasing role in dermatology. However, more robust and consistent studies are still needed to better demonstrate the antibacterial effects of blue light on HS.