Treatment Of Hidradenitis Suppurativa Research Articles

Patient Impressions and Outcomes After Clinic-Based Hidradenitis Suppurativa Surgery

Surgical intervention is frequently needed to treat hidradenitis suppurativa (HS). Patient satisfaction is high based on previous studies, but reports of patient impressions of clinic-based operative experiences and postoperative recovery are limited. To characterize patient impressions, outcomes, and recovery time after clinic-based surgical treatment of HS and examine patient characteristics associated with outcomes. This retrospective cohort study included patients 12 years or older who underwent clinic-based surgical procedures for treatment of HS at a single subspecialty HS clinic at the University of North Carolina Department of Dermatology from April 2014 to December 2018. Data analysis was performed from January to September 2021. Clinic-based deroofing and excisional procedures performed as part of routine care. The primary outcomes were patient-reported recurrence of HS at the site of surgery, patient satisfaction with the procedures and outcomes, and patient-reported pain and recovery associated with surgery obtained from electronic medical record review and patient questionnaires. Outcomes of 194 procedures for 78 patients (65 [83%] female; mean [SD] age, 35.1 [12.1] years) were analyzed. Self-reported rate of recurrence was 41% (79 procedures). Despite recurrence, most patients (148 procedures [76%]) were very satisfied with their surgical results. The median number of missed days of work or school was 2 (IQR, 1-7 days), and the median number of days until return to normal activity was 10 (IQR, 3-14 days). In addition, for 126 of the 194 procedures (65%), patients stated that pain during an HS flare was worse than pain during surgical recovery. In this cohort study, patients reported high rates of satisfaction with clinic-based HS surgery. Recovery was typically rapid, with most patients rating postsurgical pain as less severe than their HS pain.

New approaches in management and treatment of 'Hidradenitis suppurativa'

Background / Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that most often affects apocrine gland-bearing areas of the skin. The treatment depends on the severity of the clinical presentation. The paper objective was to present new modalities in management and treatment of HS. Methods: The subjects in this research included the patients suffering from the severe form of HS, who were treated in the University Clinical Centre of the Republic of Srpska for the past three years. The effect of treatment of HS were monitored. In four patients, biologic therapy with adalimumab or adalimumab biosimilars was administered, while four patients received radiotherapy and 17 of them, were treated surgically. Depending on the type of treatment, the effects of therapy were monitored after 6-12 weeks by using clinical examination and by assessing the disease stage according to the Hurley staging. Due to a small number of subjects, especially in patients treated with biologic and radiotherapy, it was not possible to perform any statistical analysis and the results were presented by description, in tables and photographs. Results: Biologic therapy: Adalimumab was administered subcutaneously 80 mg, twice a month. After 12 weeks, in 4 patients was observed a regression of changes by 60-70 % when compared to previous skin changes. Radiotherapy: the total radiation dose was 5 Gy, distributed in 5 or 10 fractions. After 12 weeks an improvement by 60-70 % was observed. Surgical treatment: after 6-8 weeks, the patients were fully recovered. Conclusions: Application of biologic and radiotherapy after 12 weeks had similar results, ie it brought to regression of changes by 60-70 %. The best results were achieved after surgical treatment of HS.

YouTube as a source of information for hidradenitis suppurativa treatment

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by a significant decrease in the patients' quality of life. Patients are increasingly looking for information about HS on social media, including YouTube (YT). However, the quality of the videos in some other diseases has been often scored as poor. Objectives: The aim of this study was to evaluate the usefulness and the quality of the most viewed acne inversa videos on YT. Methods: YT was searched for the keywords “HS” and “acne inversa.” For videos, quality assessment validated DISCERN instrument and the global quality score (GQS) were applied. Furthermore, the popularity of each video using the video power index (VPI) score was evaluated. Results: After applying the exclusion criteria, 34 videos were analyzed. We found that video quality was poor regardless of video type. The mean DISCERN score between the raters was 34.65 ± 10.7, and the mean GQS score was 2.6 ± 0.98. There was no significant correlation between the DISCERN, GQS and VPI, the number of views, likes, dislikes, comments, and video duration. Conclusion: Our study highlights the gaps in knowledge regarding HS treatment on YT. Hence, this information can be used to create superior educational content in the future.

Guiding the Treatment of Hidradenitis Suppurativa: A Role for Therapeutic Drug Monitoring

Background: Although the precise pathophysiology of Hidradenitis Suppurativa (HS) is yet to be elucidated, involvement of various cytokines has been proposed. Accordingly, the use of biologics has been introduced in the armamentarium and adalimumab is currently the only registered biologic for this indiciation. However, case series for IL-12/23 and IL 23-inhibitors are emerging. In case of therapeutic failure or loss of response to a biological, therapy is often blindly adapted, whereas Therapeutic Drug Monitoring (TDM) might assist in a personalized approach to optimize treatment. TDM has shown to be effective in other inflammatory diseases with overlapping pathogenesis.

Impact of Psoriasis and Hidradenitis Suppurativa in Pregnancy, a Systematic Review.

Psoriasis and hidradenitis suppurativa (HS) are chronic inflammatory skin diseases that frequently develop in young women. The aim of this study is to evaluate how hidradenitis suppurativa and psoriasis impact women desiring to conceive, and their influence on fertility and gestation. A systematic review of articles dating from January 2015 to April 2021 was performed using the Scopus (Elsevier) database. The search terms were (psoriasis and (birth or pregnancy or fertility)) and ((hidradenitis suppurativa or acne inversa) and (birth or pregnancy or fertility)). The search was limited to human data. Systematic reviews, case reports, clinical practice guidelines, expert consensus and conference papers were excluded. The impact of HS on pregnancy includes an impaired desire for pregnancy, a decrease in fertility, the worsening of the disease during pregnancy and potential adverse events during pregnancy. Moreover, the pregnancy might imply a change on the treatment of HS. The impact of psoriasis on pregnancy includes a decrease in fertility, potential adverse events during pregnancy and an unpredictable evolution of the disease. Moreover, the pregnancy might imply a change on the treatment of psoriasis, although biologic therapies do not appear to increase the risk of adverse events. In conclusion, both HS and psoriasis have an impact on pregnancy. A decrease of fertility has been reported. Moreover, both diseases have an unpredictable evolution during pregnancy. Pregnant women who are under biologic therapy do not seem to have a higher rate of adverse events. Treatment of both conditions is usually halted during pregnancy since scientific evidence about their safety is not conclusive, or teratogenic risk has been proven.

Plant Antimicrobial Peptides as Potential Tool for Topic Treatment of Hidradenitis Suppurativa.

Among chronic skin autoinflammatory diseases, Hidradenitis Suppurativa (HS) stands out for its chronicity, highly variable condition, and profound impact on the patients’ quality of life. HS is characterized by suppurative skin lesions in diverse body areas, including deep-seated painful nodules, abscesses, draining sinus, and bridged scars, among others, with typical topography. To date, HS is considered a refractory disease and medical treatments aim to reduce the incidence, the infection, and the pain of the lesions. For this purpose, different classes of drugs, including anti-inflammatory molecules, antibiotics and biological drugs are being used. Antimicrobial peptides (AMPs), also called defense peptides, emerge as a new class of therapeutic compounds, with broad-spectrum antimicrobial action, in addition to reports on their anti-inflammatory, healing, and immunomodulating activity. Such peptides are present in prokaryotes and eukaryotes, as part of the innate eukaryotic immune system. It has been proposed that a deregulation in the expression of AMPs in human epithelial tissues of HS patients may be associated with the etiology of this skin disease. In this scenario, plant AMPs stand out for their richness, diversity of types, and broad antimicrobial effects, with potential application for topical systemic use in patients affected by HS.

Extensive hidradenitis suppurativa treatment with wide radical excision and skin grafting: a case report

Acne inversa, also referred to as purulent apocrine gland inflammation (hidradenitis suppurativa – HS), is a chronic inflammation of the skin, causing painful and purulent lesions that usually appear in the areas with a large number of apocrine glands, such as axillae, inguinal regions and inframammary folds. This study involves the case of a 46-year-old woman suffering from the treatment resistant Hurley Stage III HS. The patient underwent a series of surgeries using wide radical excision of the entire involved tissue, as well as graft procedures to treat extensive HS lesions in various body areas. Numerous treatment modalities regarding HS have been established, although their effects are not permanent enough to prevent recurrence. Therefore, surgery is regarded as the most effective, or even the only effective treatment of severe HS. Nevertheless, following the standard pharmacological and surgical treatment, it is crucial to ensure optimization of the nutritional parameters, reduction of friction and pressure in the affected area, appropriate wound care, weight loss and smoking cessation.

Management of mild hidradenitis suppurativa: our greatest challenge yet.

Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory, disease originating from the hair follicles. When thinking of this disease, images of a patient with extensive tunnel formation and continuous foul-smelling drainage spring to mind. The immense impact on the quality of life in these patients is evident.

Refining how we measure as we test: new insights using adalimumab in patients with hidradenitis suppurativa.

In the SOLACE study, Gulliver et al.1 evaluate the real-world effectiveness of adalimumab, the first, and, to date, only medication approved for treatment of hidradenitis suppurativa (HS), a debilitating condition characterized by recurrent inflammatory nodules, abscesses, and fistulas. In this large open-label cohort of 138 patients treated with adalimumab, 68.9% achieved HiSCR (a 50% reduction in inflammatory lesion counts) at week 24, higher than the results seen in the PIONEER studies at week 12. Patients with medium to high inflammatory lesion counts (abscesses and inflammatory nodules AN) counts experienced the best response. During the pivotal adalimumab clinical trials, primary endpoints were based on the HiSCR,2 a measure that was analytically derived from the convergence of clinical and patient-reported data in an adalimumab trial. HiSCR does not incorporate improvements in fistulae. Since then, additional tools have emerged including the International HS Severity Score System (IHS4)3 which designates higher weights to draining fistulas and abscesses and, therefore, measures something different than HiSCR. As there is an overlap in the measures, it is not surprising that Gulliver et al. demonstrated that HiSCR responders also had a decrease in IHS4 scores. The best IHS4 responders were those with high AN counts, which seem most responsive to adalimumab. This finding is consistent with work by Frew et al.,4 who did not demonstrate a significant change in the IHS4 category when retrospectively applying the IHS4 to the PIONEER 1 data. Fistulas are an extremely important part of HS, and better treatment options as well as ways to measurement the impact of improvement may still emerge. In the meantime, it seems reasonable to use both scores. It is hard to get HS under control. The first studies with adalimumab showed successful treatment required relatively high doses. Taking into account the open-label design and some population differences, this study confirms that a long duration of treatment may be important to achieve desired clinical effect: the proportion of patients who achieved HiSCR increased from 69% at week 24 to 82% and 75% at week 52 for patients.2 It is difficult to maintain placebo groups past a few months in placebo controlled studies. Given the advances in the field, now is the time to move into an era with more head-to-head comparisons, which will also allow the use of longer primary endpoints. In the meantime, the guidance that it takes time to attain desired effects with adalimumab and other treatments is important for patients and physicians. HS is still hard to treat, but we are continuing to improve both our approach and our results. Dr. Kimball is a consultant and investigator for Abbvie, Bristol Meyers Squibb, Janssen, Eli Lilly, Novartis, Pfizer, and UCB, Incyte; consultant for Regeneron and Bayer, receives fellowship funding from Janssen and Abbvie; and is on the Board of Directors of Almirall. None.

Light and Laser-based Treatments for Hidradenitis Suppurativa: A Systematic Review

Background: Hidradenitis suppurativa (HS) is characterized by painful, recurrent lesions occurring mainly in intertriginous areas. The pain, odor, and disfigurement caused by HS significantly impacts quality of life and is challenging to treat. A comprehensive systematic review evaluating the use of light and laser-based treatments for HS is lacking. Methods: We performed a systematic review by searching Cochrane, MEDLINE and Embase. Title, abstract and full text screening, and data abstraction were done in duplicate. Results: Forty studies met the inclusion criteria, representing a total of 821 patients. Included studies were comprised of 5 randomized within-patient controlled trials, 1 randomized controlled trial, and 34 case series. Overall, treatments with the most reported cases were laser surgery, photodynamic therapy (PDT), and laser field treatments which showed a response in 80% (n=344/431), 73% (n=122/167) and 71% (n=84/101) of treated patients respectively. The pooled response rate for psoralen plus ultraviolet A was 69% (n=9/13). Conclusion: Our results suggest that laser surgery using carbon dioxide (CO2) laser or a combination of CO2 and Nd:YAG lasers has a moderate response rate for HS with the most reported cases. Laser for field treatment and PDT also had moderate response rates with a large number of reported cases. However, extrapolation of these results may be limited due to the majority of the studies being case series, lack of standardized outcomes being assessed, and insufficient long term follow up results.

Management of Acute and Chronic Pain Associated With Hidradenitis Suppurativa: A Comprehensive Review of Pharmacologic and Therapeutic Considerations in Clinical Practice.

Hidradenitis suppurativa (HS), a chronic, inflammatory, recurrent cutaneous disorder of the hair follicles, is debilitating and has substantial morbidity. Hidradenitis suppurativa-related pain has a profound effect on patient quality of life, yet at present, there are no established pain management algorithms. This comprehensive review provides an update on current treatment of HS-associated pain, including a summary of existing literature surrounding pharmacologic treatments of acute, perioperative, and chronic pain. Additionally, the epidemiology, pathophysiology, and clinical features of the disease are summarized.

Dapsone in hidradenitis suppurativa: A case series of 56 patients.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a challenging treatment. Current guidelines reserve dapsone as a third line agent for patients with mild to moderate HS. To our knowledge, only four small case series have been reported. The objective of this study was to assess the effectiveness and safety of dapsone in our clinical practice. A retrospective observational single-center study of 56 HS patients who underwent treatment with dapsone from May 1, 2015, to June 1, 2021, was performed. The Hidradenitis Suppurativa Clinical Response (HiSCR) scale was used to evaluate the response to treatment. Fifty-six patients were included, 66% of which were men, with a median age of 33 years. Most of them had mild or moderate disease and belonged to LC2 follicular phenotype. All patients had been refractory to first-line treatments. Dapsone was prescribed at doses of 50-150 mg/day. 62.5% of the patients achieved HiSCR after 12 weeks of treatment. No serious adverse reactions were detected. The median duration of treatment was 8months. After multivariate analysis, an association was found between the presence of fistulous tracts and the risk of non-response to the drug. In four of the dapsone responders, oral retinoids were added to achieve a sustained response. Limitations include the retrospective and non-controlled nature of this study. In conclusion, dapsone is an effective and well-tolerated option for long-term HS treatment, and in this series, it was mainly chosen for patients with LC2 phenotype. It would be interesting to study combination with retinoids and other management options.

Vulvoperineal Hidradenitis Suppurativa: Diagnosis, Treatment, and Management of Deformities.

Hidradenitis suppurativa (HS) is a chronic, inflammatory disorder affecting skin of intertriginous areas that is often encountered and treated by nondermatologic specialists. The purpose of this literature review is to provide a comprehensive, clinical source of information on HS as it relates to incidence of disease, pathophysiology, diagnosis, and overall management of this condition. Sources were obtained through a comprehensive literature search using PubMed and PMC. Various terms were used to query the database, including "hidradenitis suppurativa," "pathogenesis," "prevalence," "management," "surgery," "perineal," and "vulva." Underreported prevalence and unknown pathogenesis have subsequently led to variable approaches in clinical management, often employing a combination of medical and surgical management. Early diagnosis and treatment of HS may lead to better disease control and minimize patients' associated morbidity related to disease. Knowledge of vulvoperineal hidradenitis is necessary for gynecologists and primary care physicians to ensure early diagnosis, management, and referral for optimal patient outcomes.

Biologic Use in Pediatric Patients With Hidradenitis Suppurativa: A Systematic Review

BackgroundThere is currently at least 1 biologic (adalimumab) approved in North America for treatment of Hidradenitis Suppurativa in the pediatric population. However, no reviews or clinical trials have specifically analyzed the effectiveness and safety data of biologic use in this population. The objective of this systematic review is to identify and summarize the outcomes of biologic therapy in pediatric patients with HS.MethodsMEDLINE and EMBASE databases were used to conduct the search on Sept 18, 2020.ResultsThe 15 included studies consisted of 26 patients, with the mean age of 15 ± 2.3 years. Females accounted for 53.8% (n = 14/26) of cases. The mean duration of HS prior to biologic initiation was 3.5 ± 2.9 years, with the majority having Hurley Stage II. The 26 patients received 34 biologics in total: 85.3% treated with TNF alpha inhibitors (adalimumab n = 17, infliximab n = 10, etanercept n = 1, unspecified n = 1), 5.9% with IL-12/23 inhibitors (ustekinumab n = 2), 5.9% with IL-1 inhibitors (i.e., anakinra n = 2) and 2.9% received IL-23 inhibitors (i.e., guselkumab n = 1) biologics. Of the 26 patients, 23.1% (n = 6/26) experienced complete resolution (CR), 73.1% (n = 19/26) experienced partial resolution (PR), and 3.8% (n = 1/26) had no resolution outcomes reported. The time to resolution of HS lesions after biologic initiation ranged from 10 days to 11.5 months (mean: 5.1 months). No adverse events were reported in the studies.ConclusionAlthough anti-TNF alpha were the most common biologics used for HS in pediatric cases, large-scale trials specific to pediatric patients with HS are needed to confirm these findings.

Biologic therapy is not associated with increased COVID-19 severity in patients with hidradenitis suppurativa: Initial findings from the Global Hidradenitis Suppurativa COVID-19 Registry

Biologic therapy is not associated with increased COVID-19 severity in patients with hidradenitis suppurativa: Initial findings from the Global Hidradenitis Suppurativa COVID-19 Registry

Single-Cell RNA Sequencing Reveals Cellular and Transcriptional Changes Associated With M1 Macrophage Polarization in Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent abscesses, nodules, and sinus tracts in areas of high hair follicle and sweat gland density. These sinus tracts can present with purulent drainage and scar formation. Dysregulation of multiple immune pathways drives the complexity of HS pathogenesis and may account for the heterogeneity of treatment response in HS patients. Using transcriptomic approaches, including single-cell sequencing and protein analysis, we here characterize the innate inflammatory landscape of HS lesions. We identified a shared upregulation of genes involved in interferon (IFN) and antimicrobial defense signaling through transcriptomic overlap analysis of differentially expressed genes (DEGs) in datasets from HS skin, diabetic foot ulcers (DFUs), and the inflammatory stage of normal healing wounds. Overlap analysis between HS- and DFU-specific DEGs revealed an enrichment of gene signatures associated with monocyte/macrophage functions. Single-cell RNA sequencing further revealed monocytes/macrophages with polarization toward a pro-inflammatory M1-like phenotype and increased effector function, including antiviral immunity, phagocytosis, respiratory burst, and antibody-dependent cellular cytotoxicity. Specifically, we identified the STAT1/IFN-signaling axis and the associated IFN-stimulated genes as central players in monocyte/macrophage dysregulation. Our data indicate that monocytes/macrophages are a potential pivotal player in HS pathogenesis and their pathways may serve as therapeutic targets and biomarkers in HS treatment.

No increased incidence of Clostridium difficile infection among patients with hidradenitis suppurativa treated with systemic clindamycin

No increased incidence of Clostridium difficile infection among patients with hidradenitis suppurativa treated with systemic clindamycin

Identifying Unmet Care Needs and Important Treatment Attributes in the Management of Hidradenitis Suppurativa: A Qualitative Interview Study.

Background and ObjectiveHidradenitis suppurativa (HS) is an inflammatory skin disease with a profound effect on patients’ quality of life. The patient’s journey to manage HS is often complex and unsuccessful, which motivates the aim of this research to gain insight into unmet needs and relevant treatment considerations from the perspective of patients and healthcare professionals (HCPs).MethodsIndividual semi-structured interviews were conducted with patients and HCPs experienced in treating HS to understand the perceived unmet care needs and to identify important treatment attributes. Prioritization of the five most important treatment attributes allowed elicitation of their relative importance.ResultsInterviews with 12 patients and 16 HCPs revealed 16 areas of unmet needs either related to treatment outcomes or the care process and 13 important treatment attributes. The most frequently reported unmet needs by patients and HCPs were lacking quality-of-life improvement, low treatment effectiveness, inadequate pain control, low disease awareness, and delayed diagnosis. Patients expressed unique concerns relating to pain management, access to HS specialists, and wound care guidance and costs, which HCPs did not. Treatment attributes related to effectiveness were considered most important by patients and HCPs. Patients additionally emphasized a strong preference for improved pain management.ConclusionsCurrent HS treatments and care processes leave patients and HCPs with a high level of unmet need. It is critical to consider patients’ and HCPs’ perspectives when designing appropriate HS care as perceived unmet needs differ. Further quantitative preference elicitation studies are needed to assess the trade-offs between important care needs and treatment attributes.

26914 Ustekinumab-induced myositis: A case series

Ustekinumab (UST) is a monoclonal antibody that blocks proinflammatory cytokines IL-12 and IL-23. Off-label use of UST has shown promising results for moderate to severe hidradenitis suppurativa (HS) in patients who have failed to respond to or unable to tolerate adalimumab, the only Food and Drug Administration (FDA) approved treatment for HS. Previously, myositis has not been reported as an adverse effect of UST. We present two patients with poorly controlled HS who experienced new onset myositis shortly after beginning treatment with UST.

25230 Apremilast for the treatment of hidradenitis suppurativa in real life: Case series and systematic review

Introduction: Systemic treatment of hidradenitis suppurativa (HS) is challenging due to limited options and little evidence reported. Apremilast is a phosphodiesterase 4 inhibitor that exerts an immunomodulatory action. Based on the hypothesis that apremilast acts on various pathways involved in the pathogenesis of HS, only two clinical trials and one case series have been published before.