Treatment Of Hidradenitis Suppurativa Research Articles

Hidradenitis suppurativa: A comparison of guidelines

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the folliculopilosebaceous unit (FPSU) in the intertriginous skin areas, especially axilla, groin, perineum, and peri- or sub-mammary fold in women, with secondary inflammation of eccrine and apocrine glands. HS disease activity and severity can be divided into three different stages according to the Hurley staging system. Stage I disease consists of single or multiple abscesses, while in Stage II, additional sinus tract formation or scarring can be seen, and in Stage III, interconnected tracts and abscesses have developed over a complete anatomic area. Due to its high disease burden, the extent to which HS negatively impacts patients' quality of life is higher than that of most other chronic dermatological conditions. Pain is considered one of the worst aspects of HS. In this article, we compare different guidelines for the management of HS between hospitals in Europe and the U.S. for Hurley Stage I, II, and III. Existing treatment guidelines were identified through systematic review of medical databases, including PubMed, using the search terms “hidradenitis suppurativa treatment guidelines” as well as “acne inversa treatment guidelines” for the European and German treatment guidelines, as well as American hospital-specific treatment algorithms, including Henry Ford Hospital, Detroit, Michigan, and Mayo Clinic, Rochester, Minnesota. In the German S1 guidelines, the goal is an improvement of one Hurley stage and/or a 25% improvement of the Sartorius score or the dermatology life quality index within 12 weeks. Radical surgical or laser excision, oral combination therapy of clindamycin and rifampin, or alternatively tetracycline, topical clindamycin, and hormonal therapy are recommended, while topical resorcinol, dapsone, finasteride, zinc gluconate, and acitretin are the treatment options that can be taken into consideration. Unlike the European or German S1 guidelines or the algorithm proposed by the Henry Ford Hospital, more systemic antibiotic therapy options are suggested in the Mayo Clinic algorithm before the addition of immunosuppressive therapy. Evaluation for efficacy happens every 3 months, and in case of treatment failure, the antibiotic regimen is changed and reevaluated 3 months later. Options include Trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, fluoroquinolones, clindamycin, and rifampin, as well as rifampin plus moxifloxacin plus metronidazole. If none of the proposed antibiotic therapies help, acitretin, dapsone, or cyclosporine may be used instead. In refractory HS, infliximab or adalimumab is added to the regimen. For Stage III disease or in case of treatment failure so far, wide local excision as an addition to medical therapies can be considered. With the literature of the existing treatment options mostly being low evidence, scarce new randomized controlled trials, and the existing guidelines leaving room to interpretation, a gold standard for the treatment of HS does not yet exist. Further large-scale, randomized studies are necessary to continue treatment exploration and improve treatment regimens.

Squamous cell carcinoma of the cervix arising in a patient on adalimumab � a need for cervical screenings in patients on tumor necrosis factor inhibitors

Adalimumab, a tumor necrosis factor (TNF) inhibitor, has been approved for treatment of hidradenitis suppurativa. We report a case of cervical cancer in a patient with hidradenitis suppurativa taking adalimumab, which prompted discontinuation of the medication. Physicians should obtain a detailed cervical medical history before putting a female patient on a TNF inhibitor. Patients on TNF inhibitors who have pre-existing cervical issues such as human papillomavirus (HPV), dysplasia, or high grade intraepithelial lesions should be counseled about an increased risk of developing squamous cell carcinoma (SCC) of the cervix while on a TNF inhibitor. Furthermore, patients on TNF inhibitors should comply with the national screening guidelines for cervical cancer and be tested for human papillomavirus.

Surgical treatment of hidradenitis suppurativa of genitofemoral area, description of four cases

Surgical treatment of hidradenitis suppurativa of genitofemoral area, description of four cases

Hidradenite Supurativa: Compreender para Tratar

A hidradenite supurativa é uma doença inflamatória cutânea, de caráter crónico e altamente debilitante, causada por oclusão folicular e consequente inflamação pilossebácea, manifestando-se através de nódulos, abcessos, fibrose e trajetos fistulosos. O profundo impacto que a hidradenite supurativa tem na qualidade de vida dos doentes levou a que, na última década, se tenha assistido a um crescente interesse da comunidade médica e científica. Este trabalho tem por objetivo a abordagem global da hidradenite supurativa tendo, para tal, sido conduzida uma pesquisa na base de dados bibliográfica PubMed/MEDLINE. Foram incluídos artigos originais, artigos de revisão e meta-análises, escritos apenas em língua inglesa. Da pesquisa efetuada, concluímos que existem questões fundamentais que carecem de esclarecimento, essencialmente no que diz respeito à definição dos mecanismos fisiopatológicos e fatores de risco associados, história natural e abordagem terapêutica da hidradenite supurativa.

Uncovering burden disparity: A comparative analysis of the impact of moderate-to-severe psoriasis and hidradenitis suppurativa

Psoriasis and hidradenitis suppurativa (HS) exhibit distinct clinical features, but no studies have directly compared the health-related quality of life (HRQoL) in patients with moderate-to-severe manifestations of these conditions. To determine which disease is associated with more severe HRQoL impairment. Weighted averages of each of the following baseline HRQoL measures were determined and compared between HS and psoriasis populations from 5 clinical trials: Visual Analog Scale (VAS) for pain, Total Work Productivity Impairment, Dermatology Life Quality Index; EuroQOL 5D VAS, and Short Form-36 Health Survey. Compared with patients with psoriasis, patients with HS reported higher scores for VAS-pain (54.3 vs 36.1 [P<.0001]), Dermatology Life Quality Index (15.3 vs 11.3 [P<.0001]), EuroQOL 5D VAS (58.8 vs 50.8 [P<.0002]), and Total Work Productivity Impairment (35.4 vs 18.2). Patients with HS had lower Short Form-36 Health Survey scores than did patients with psoriasis (physical, 39.6 vs 49.0; mental, 41.5 vs 47.5 [both P<.0001]). This analysis was performed using published summary data rather than patient-level data, and weighted pooled averages were compared. Patients with HS have a higher HRQoL burden than patients with psoriasis. This study clearly documents the needs of patients with HS and the potential impact of medical, scientific, and societal consensus for the development of more effective HS treatments.

Recognizing syndromic hidradenitis suppurativa: a review of the literature.

Hidradenitis suppurativa (HS) is an inflammatory skin disease causing painful inflammation and suppuration. It may occur in rare syndromes: follicular occlusion, Bazex-Dupré-Christol, Down's, KID, PAPASH, PASS, PASH, and SAPHO syndromes, as well as Dowling-Degos disease. An overview of syndromic HS may inform the search for aetiological factors in HS. PubMed, Ovid and Web of Science were systematically searched using '(hidradenitis OR acne invers*) AND (syndrome OR KID OR PASS OR PAPA OR PASH OR SAPHO OR bazex-dupre OR 'dowling degos' OR triad OR tetrad)' and Cochrane Library using 'hidradenitis OR acne invers*'. A total of 82 articles were included in the final review. We summarize 134 cases collected from the 82 included articles. The syndromes are discussed, focusing on etiopathogenesis, clinical presentation and treatment. This study is based on case reports; therefore, conclusions may be subject to the selection bias. These syndromes are rare; however, it is important to recognize them, as treating them may require a different approach. Three subtypes of syndromic hidradenitis are suggested: syndromes with known genetic abnormalities, syndromes characterized by follicular plugging or structural defects, and syndromes with possible autoinflammatory pathogenesis. There was no universally effective treatment for syndromic HS, and treatment was individualized.

A New Perspective on Isotretinoin Treatment of Hidradenitis Suppurativa: A Retrospective Chart Review of Patient Outcomes

Background: Hidradenitis suppurativa (HS) is a disease characterized by the development of painful, deep-seeded nodules and abscesses. Treatment guidelines include a combination of lifestyle, surgical, and medical interventions. Isotretinoin has not been included in the treatment guidelines due to the limited number of studies and conflicting reports of efficacy. Objectives: The purpose of this study is to evaluate the clinical response to isotretinoin in HS patients and to determine whether there is a particular patient population that may benefit more from this treatment. Methods: A retrospective chart review was conducted on all HS patients treated with isotretinoin within the years of 2014-2016. Sex, age, weight, history of acne, Hurley stage, and treatment dose and duration were extracted from patient charts. Results: Of the 25 patients included in the study, 32% (8/25) had no response, 32% (8/26) showed partial response, and 36% (9/25) demonstrated complete response to isotretinoin treatment. Complete response was seen only in Hurley stage I and II patients. Hurley III patients made up 50% of the non-responders. Those with any sort of treatment response were more likely to be female, younger, weigh less, and have a higher prevalence of acne compared to non-responders. Limitations: This is a retrospective chart review with a small sample size of 25 patients. Conclusions: Physicians should consider isotretinoin as a potential treatment for HS, as it may be beneficial in patients with mild and moderate disease and patients who are female, younger, weigh less, and have a personal history of acne.

Approach to the Management of Patients With Hidradenitis Suppurativa: A Consensus Document.

Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse. To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS. An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%. Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education. These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti-tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.

35-Year Experience with Surgical Treatment of Hidradenitis Suppurativa.

Hidradenitis suppurativa is a painful and disfiguring chronic inflammatory condition affecting both men and women. Medical treatments, such as antibiotics and immunosuppressive agents, are often ineffective. Over time, patients can suffer from recurrent abscesses, chronic purulent drainage, scarring, and contractures that can only be corrected by surgical excision. There is no agreement, however, on the best way for the surgeon to manage this condition. The purpose of this review is to describe the results of surgical treatment of this condition in a large cohort of patients managed by local excision of hidradenitis, healing by secondary intention and reoperation as needed. A retrospective review was conducted of all patients operated on by the author for hidradenitis over a 35-year period. Specific data abstracted included patient age, weight, admission, length of stay, wound size, type of wound care, number of post-op visits, time to heal, and recurrence. Most wounds healed by secondary intention and were managed using simple tap water-moistened plain gauze dressings changed three times a day. From 1979 through 2014, 122 patients (56 men and 66 women), median age 38, underwent 245 operations for hidradenitis suppurativa. Patients underwent from 1 to 10 procedures; 61 patients (50%) underwent two or more procedures; and 26 (21%) underwent three or more. Wound sizes at operation ranged from quite small to over 1500cm2. Men were older (42 vs 34years, p<0.001) and had larger median wound size (98 vs 55cm2, p<0.001). A total of 197 wounds healed by secondary intention: 83 of these (median size 159cm2) were left completely open at the time of surgery; 117 (median size 100cm2) were partially closed. A total of 30 wounds (median size 38cm2) were closed primarily; 15 (median size 196cm2) were closed by skin graft. Patients undergoing 139 procedures were admitted to the hospital for the initial wound care. Their median combined total wound size was 160cm2; length of stay was 5.5days; and median time to heal was 60days. In total, 106 procedures were ambulatory; median wound size was 30cm2; and median time to heal was 40days. Recurrent or new disease was common, with some patients requiring multiple procedures over many years to maintain control of symptoms. Although wound healing can take up to several months, patients quickly learned how to care for themselves and were usually pain-free after the first two or three weeks. Surgical treatment of hidradenitis suppurativa by wide local excision with healing by secondary intention using tap water-moistened plain gauze dressings changed 2-3 times per day is a simple, practical approach that has good results. Recurrence of disease is common and should not be thought of as a failure of surgical treatment, but rather as a feature of the disease that must be anticipated and managed.

Major gaps in understanding and treatment of hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a complex dermatological disease characterized by recurrent painful nodules and suppuration in areas such as the axilla and groin. The disease is poorly understood and treatment is not satisfactory. In October 2016, the Canadian and United States Hidradenitis Suppurativa Foundations organized the inaugural Symposium on Hidradenitis Suppurativa Advances (SHSA) in Toronto, Canada. This meeting brought together experts from Canada, the United States, and Europe to discuss the latest advances in HS. After this important event, we considered that it would be helpful to outline current HS knowledge and to identify important gaps in treatment and research in order to move forward more efficiently. This paper briefly summarizes current knowledge in key areas including epidemiology, clinical presentation and morphological classification, natural history and prognosis, genotype-phenotype correlations, clinico-pathological correlation, pathogenesis, optimal treatment and outcome measures. General and initial suggestions for addressing these gaps are presented.

Non-surgical treatments for hidradenitis suppurativa: A systematic review

The management of hidradenitis suppurativa is multidisciplinary, involving general measures, medical treatment and surgery. Non-surgical treatments, often first-line procedures, mainly concern forms of low-to-moderate severity or, conversely, very severe forms in non-operable patients or those refusing surgery. While many treatments have been attempted, few randomized controlled trials have been conducted, so the choice of treatments is most often based on the personal experience of the clinicians. The objective of this systematic review is to propose a synthetic analysis of the currently available non-surgical procedures. This systematic review of the literature was conducted in accordance with the PRISMA criteria. We searched for articles in the Medline®, PubMed Central, Embase and Cochrane databases published between January2005 and September2015. Sixty-four articles were included. They generally had a low level of evidence; indeed, the majority of them were retrospective observational studies. They involved biotherapy (44%), dynamic phototherapy (16%), antibiotics (11%), Laser (8%), retinoids (6%) and immunosuppressive therapies, anti-inflammatory drugs, zinc, metformin, gammaglobulins and fumarates. None of the non-surgical treatments can treat all stages of the disease and offer long-term remission. Antibiotics and biotherapy seem to have real effectiveness but their effect remains suspensive and the disease is almost certain to reappear once they are stopped. As regards antibiotics, no association has shown their superiority in a study with a high level of evidence. And while some biotherapies seem quite effective, due to their side effects they should be reserved for moderate-to-severe, resistant or inoperable forms of the disease. Randomized controlled studies are needed before valid conclusions can be drawn. In the resistant or disabling forms, it is consequently advisable to orientate to the greatest possible extent towards radical surgery, which is the only treatment allowing hope for cure.

Adalimumab for Treating Moderate-to-Severe Hidradenitis Suppurativa: An Evidence Review Group Perspective of a NICE Single Technology Appraisal.

As part of its single technology appraisal (STA) process, the UK National Institute for Health and Care Excellence (NICE) invited the manufacturer of adalimumab (AbbVie) to submit evidence on the clinical effectiveness and cost effectiveness of adalimumab for the treatment of moderate-to-severe hidradenitis suppurativa (HS). The appraisal assessed adalimumab as monotherapy in adult patients with an inadequate response to conventional systemic HS therapy. The School of Health and Related Research Technology Appraisal Group was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical effectiveness and cost effectiveness of the technology based on the company's submission to NICE. The evidence was mainly derived from three randomised controlled trials comparing adalimumab with placebo in adults with moderate-to-severe HS. The clinical-effectiveness review found that significantly more patients achieved a clinical response in the adalimumab groups than in the control groups but that the treatment effect varied between trials and there was uncertainty regarding its impact on a range of other relevant outcomes as well as long-term efficacy. The company's submitted Markov model assessed the incremental cost effectiveness of adalimumab versus standard care for the treatment of HS from the perspective of the UK NHS and Personal Social Services (PSS) over a lifetime horizon. The original submitted model, including a patient access scheme (PAS), suggested that the incremental cost-effectiveness ratio (ICER) for adalimumab versus standard care was expected to be £16,162 per quality-adjusted life-year (QALY) gained. Following a critique of the model, the ERG's preferred base case, which corrected programming errors and structural problems surrounding discontinuation rules and incorporated a lower unit cost for HS surgery, resulted in a probabilistic ICER of £29,725 per QALY gained. Based on additional analyses undertaken by the company and the ERG following the publication of the appraisal consultation document (ACD), the Appraisal Committee concluded that the maximum possible ICER for adalimumab compared with supportive care was between £28,500 and £33,200 per QALY gained but was likely to be lower. The Appraisal Committee recommended adalimumab (with the PAS) for the treatment of active moderate-to-severe HS in adults whose disease has not responded to conventional systemic therapy.

Surgery combined with photodynamic therapy for the treatment of Hidradenitis Suppurativa: A report of 7 cases

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease in the area of the apocrine sweat glands. The treatment of HS is relatively difficult. Therefore, surgery combined with PDT was applied to treat 7 cases of patients in this study, and treatment efficacy was observed. Simple surgical incisions and drainage were performed for patients with Hurley grade I. Surgical incisions and drainage as well as the removal of necrotic tissues were performed for patients with grades II and III. Immediately after surgery, PDT was performed. Their average Dermatology Life Quality Index (DLQI) was 24.14±4.26 before the surgery and 4.86±2.79 5 months after treatment, respectively. Scale (VSS) scores for evaluating scar formation were low to moderate after surgery and PDT. The experience of treating these 7 patients suggests that surgery combined with PDT might have a more pronounced effect, with the possible advantages of faster healing and less scarring.

Hidradenitis suppurativa treated with tetracycline in combination with colchicine: a prospective series of 20 patients.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the follicular epithelium. The objective of the present study was to evaluate the effectiveness of the combination of tetracycline with colchicine in the treatment of HS. Twenty patients (10 women and 10 men) with HS were included in an open, prospective, pilot study. All patients were treated with 100 mg minocycline administered orally once per day in combination with 0.5 mg colchicine administered twice per day for 6 months followed by a maintenance regimen of 0.5 mg colchicine administered orally twice per day for 3 months. Patients were examined at baseline and thereafter every 3 months for a total of 9 months. The efficacy of the treatment was evaluated using a physician's global assessment (PGA) scale, the Hurley scoring system, and the Dermatology Life Quality Index (DLQI). A significant improvement in clinical manifestation was reflected in scores on the Hurley scoring system and DLQI. According to the PGA, patients achieved substantial improvement or complete remission. Clinically, all patients started to show signs of improvement within the first 3 months of therapy and continued to improve over the next 6 months. This study indicates that the combination of the anti-inflammatory actions of colchicine and minocycline is effective in disease control in HS. Colchicine emerged as a safe option for the maintenance of the obtained result.

Surgical Management of Hidradenitis Suppurativa: A 14-Year Retrospective Review of 98 Consecutive Patients.

Hidradenitis suppurativa (HS) is a debilitating suppurative disease of the apocrine/follicular glands. Medical treatment has some efficacy in early-stage disease but is costly and requires frequent physician visits. Advanced disease usually requires surgical intervention. This treatment has not been well described in the literature. We sought to review our experience with HS treatment in a large surgical cohort. A retrospective review of 98 consecutive HS patients from 2000 to 2014 was performed. A two-stage operative approach was used. The first stage involved the removal of all the hair-bearing skin in the affected areas down to healthy tissue followed by the application of split-thickness skin grafts 48 to 72 hours later. Descriptive statistics were performed to describe the population and assess outcomes. The study population was young (36 ± 12 years) and predominately female (65, 66%). The patients were obese (body mass index, 36 ± 8.3 kg/m) and smokers (73, 73.7%). The majority presented with axillary disease (73%). There were 144 debridement procedures and 146 grafting procedures performed with a mean area grafted being 416 ± 500 cm (90-3400 cm). Only nine (9%) required regrafting, with the mean area regrafted being 140 ± 93 cm. Graft failure of less than 30% did not require regrafting. At 30 days after the initial procedure, 94.7% of all wounds were fully grafted and closed. Advanced stages of HS require ablation of the infected distorted glands for control of recurrent infections. Ablative excision of HS-affected skin and wound closure with split-thickness skin grafts is a safe, reliable, and effective therapy.

Treatment of hidradenitis suppurativa with intralesional photodynamic therapy with 5-aminolevulinic acid and 630 nm laser beam

BackgroundHidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease with multiple treatment options that have been used with mixed results. ObjectivesTo evaluate the effectiveness, safety and tolerability of intralesional photodynamic therapy (I-PDT) in the management of HS. Also, to assess the effect of this technique on the different areas treated. MethodsCase series of 38 HS patients treated with I-PDT between 2011-2015 following a standardized protocol to assess response at the treated areas Results29 patients achieved a complete response, while persistence was noted on 8 cases and only 1 suffered a recurrence. Difference between basal (median 28.5) and final (0) Hidradenitis Severity Score showed a significant reduction of 24.5 points (p<0.001, 95% OR 19.5-31). Basal (median 10) and final (1) Dermatology Life Quality Index scores reached a reduction of 10 points (p<0.001, 95%OR 8-12). Complete response was achieved in 68.2% of armpits, 88.5% of groins, 88.9% of buttocks and 100% of other locations. 18 out of 38 patients needed only a session to achieve a complete response, while maintaining a good tolerability. ConclusionWe believe that I-PDT might be an alternative treatment option for localized HS lesions, achieving a high rate of remission with an adequate maintenance of response i and few complications.

Use of biological treatments in patients with hidradenitis suppurativa.

Pilosebaceous unit occlusion and secondary inflammatory perifollicular lympho-histiocytic infiltration seem to be the underlying etiopathogenic mechanisms giving rise to hidradenitis suppurativa (HS). Increased levels of tumor necrosis factor (TNF)-alpha and other cytokines such as interleukins 12 and 23 (IL12/23) and interleukins 10 and 17 have been observed in HS lesional skin. Biological drugs have been reported to be effective for HS, but the level and duration of the response are quite variable. Among anti-TNF drugs, adalimumab and infliximab seem to obtain better results in HS. Adalimumab is the only registered systemic agent for HS and results from multicenter clinical trials demonstrate that 58.9% of patients may achieve clinical response without significant adverse events. Continuous treatment seems to maintain the therapeutic response, but discontinuation of the treatment usually results in a rapid relapse of the disease. Infliximab may also obtain a good response profile with 50% improvement of HS lesions. Treatment with ustekinumab for HS resulted in variable results showing a moderate-to-marked improvement in 82% of patients. Anakinra, a recombinant IL-1 receptor antagonist, has been also been postulated as a potential systemic treatment for HS. A reduction in the disease activity in 67% of patients has been reported. Biological drugs seem to represent an effective therapeutic option for HS, but complete and persistent resolution of the disease is rarely achieved. Flares of the disease usually develop regardless the prescribed treatment. Combined treatments including antibiotics and retinoids seem to be a potential additional therapeutic approach. In chronic and severe cases, a surgical approach is mandatory in order to remove persistent scarring tissue. New drugs are currently being evaluated as new insights in the pathogenesis of the disease are elucidated. Several clinical trials with apremilast, anti-IL17 drugs and anti-interleukin-1 alpha are currently ongoing.

Quality of Care: The Challenges, The Solutions

Psoriatic arthritis (PsA) and hidradenitis suppurativa (HS) are both immune-mediated diseases with common cellular and cytokine pathways involved in their pathogenesis.1 Both are characterised by chronic and systemic inflammation and both involve elevated levels of the cytokines tumour necrosis factor-α (TNF-α), interleukin-17, and interleukin-23.1-5 PsA and HS are associated with substantial unmet needs and are sub-optimally managed. This educational session discussed ways to improve the quality of care and patient outcomes in PsA and HS. Dr Kim Papp opened the symposium with an overview of the current unmet needs in PsA and HS and the key barriers to improving the management of both diseases. Prof Hilary Thomas discussed the Quantum initiative and how it could assist dermatologists in the treatment of PsA and HS. Dr Papp and Prof Christos C. Zouboulis then discussed the challenges of achieving optimal management in PsA and HS, as well as the solutions.

Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa

Antibiotic therapy is commonly used to treat hidradenitis suppurativa (HS). Although concern for antibiotic resistance exists, data examining the association between antibiotics and antimicrobial resistance in HS lesions are limited. We sought to determine the frequency of antimicrobial resistance in HS lesions from patients on antibiotic therapy. A cross-sectional analysis was conducted on 239 patients with HS seen at the Johns Hopkins Medical Institutions from 2010 through 2015. Patients using topical clindamycin were more likely to grow clindamycin-resistant Staphylococcus aureus compared with patients using no antibiotics (63% vs 17%; P=.03). Patients taking ciprofloxacin were more likely to grow ciprofloxacin-resistant methicillin-resistant S aureus compared with patients using no antibiotics (100% vs 10%; P=.045). Patients taking trimethoprim/sulfamethoxazole were more likely to grow trimethoprim/sulfamethoxazole-resistant Proteus species compared with patients using no antibiotics (88% vs 0%; P<.001). No significant antimicrobial resistance was observed with tetracyclines or oral clindamycin. Data on disease characteristics and antimicrobial susceptibilities for certain bacteria were limited. Antibiotic therapy for HS treatment may be inducing antibiotic resistance. These findings highlight the importance of stewardship in antibiotic therapy for HS and raise questions regarding the balance of antibiotic use versus potential harms associated with antibiotic resistance.

The effect of smoking and age on the response to first-line therapy of hidradenitis suppurativa: An institutional retrospective cohort study

Treatment for hidradenitis suppurativa is often empiric and inadequate, and determining which patients will respond is difficult. We sought to determine which patient factors are associated with a positive response to first-line medical therapy. A single-center retrospective cohort study of all patients with hidradenitis suppurativa seenbetween January 1, 1992, and October 1, 2014, was conducted. Response to first-line medical therapy (oral/topical antibiotics, intralesional corticosteroids, and topical washes) was examined at follow-up within 6months of initiating therapy. A multivariate binary logistic regression model was built examining response to treatment and the interplay of patient factors and treatment initiated. In all, 198 patients were included in the final model. Nonsmokers (odds ratio 2.634, 95% confidence interval 1.301-5.332, P=.007) and older individuals (odds ratio 1.046 for each additional year, 95% confidence interval 1.020-1.072, P<.001) were more likely to have improvement at follow-up. In addition, current smokers differed significantly from nonsmokers in several regards. The retrospective nature of this study is a limitation, as is relying on classification of disease severity from physical examination findings in some patients. The results of this study suggest that clinicians may be able to more accurately predict which patients with hidradenitis suppurativa will respond to first-line medical therapy, and which patients may require therapy escalation.