Treatment Of Hidradenitis Suppurativa Research Articles

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.

Clinical Implementation of Biologics and Small Molecules in the Treatment of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic, recurrent, auto-inflammatory skin disease originating from the hair follicles. The typical inflammatory nodules, abscesses, and draining sinus tracts (tunnels) are characterized by a massive influx of neutrophils, macrophages, B-cells, plasma cells, T helper (Th)1, Th17 cells and upregulation of pro-inflammatory cytokines such as IL-1, IL-17, IL-12/23, and TNF-α. Over the last decades, several clinical trials evaluated the clinical efficacy of different biologics targeting these pro-inflammatory cytokines, in particular TNF-α and IL-1. However, adalimumab is still the only registered drug for HS. This review discusses biologics and small molecules with high level of evidence for their clinical application, provides guidance on when and how to use these biologics and small molecules in clinical practice, and elaborates on the combination with medical and surgical treatment options beyond the current guidelines. Furthermore this review provides an overview of potential biologics and small molecules currently under investigation for novel targets in HS such as IL-36, C5a, Janus kinase family members, CD-40, LTA4 and CXCR1/2.

Need for real-world data studies on hidradenitis suppurativa/acne inversa treatment

Publication of real world data on the results of treatment with (approved) drugs is important to allow for areasonable judgement about the efficacy of amedication, especially since due to the nature of controlled clinical studies certain patient groups, who in daily clinical routine would best benefit from such new treatments, are excluded from study inclusions. In the present review, real-world data on the treatment of hidradenitis suppurativa (HS) are summarized. It appears that adalimumab, as the only approved biological treatment so far, represents acost-efficient and effective therapy. Patient education is important to increase treatment adherence and efficacy. The baseline IHS4 score has proven to be ameaningful predictor for recurrences during adalimumab therapy. Additional publications on real-world data including high numbers of patients with different risk factors are required to meaningly evaluate the evolving therapeutic spectrum of treatment options for HS in clinical practice.

Should We Scan Hidradenitis Suppurativa Patients? A Systematic Review of Radiologic Findings.

To bring awareness and close gaps between dermatologists and radiologists about the contribution of imaging techniques for diagnosis, treatment, and follow-up of hidradenitis suppurativa (HS). Investigators searched the PubMed database for articles on HS and radiology techniques. Databases were searched up to December 2018. The query retrieved 257 publications, of which 103 were unique; of these, 7 were inaccessible. From the remaining 96, 33 were irrelevant (did not discuss HS lesion features). After applying the inclusion criteria, 63 studies were relevant to this study. A standardized form was constructed to extract data from eligible studies by two independent authors. Imaging techniques are significant and useful tools in HS management. Imaging should be carried out to evaluate disease severity, subclinical features, treatment success, and intraoperative patient assessment. Providers should consider nonconventional radiology techniques, which are underused in clinical management of HS. Further, dermatology and radiology require a shared terminology of disease features to better understand patient status. Publications on HS lesion imaging have increased over the years. Imaging techniques have proven useful for determining HS severity and treatment effectiveness, as well as intraoperative patient assessment. These authors strongly recommend the use of these techniques in routine clinical practice for patients with HS.

Long-Term Follow-Up after Radiotherapy of Hidradenitis Suppurativa

Background: Patients with hidradenitis suppurativa (HS) are still often disappointed with the current treatments offered and there is a clear demand for more effective options. Since the late 1990s there has been a revival in the use of radiotherapy (RT) for different benign diseases, including HS. During the past 20 years one case series and some scattered case reports have described promising results of RT. Objectives: To evaluate the long-term efficacy of RT in early-stage HS. Methods: A postal survey-based long-term follow-up with simple factual questions of partly retrospective and partly contemporary characteristics was performed. Sixty-four patients (96 axillae), diagnosed with mild to moderate HS were irradiated with a orthovoltage unit with 100 kV, 3 mm Al or 200 kV, 0.5 Cu filtering, respectively. Four to six biweekly fractional doses ranging from 0.75 to 1 Gy up to a total dose of 6 Gy in one series, and in chronic cases followed by four daily fractions of 2 Gy up to a total dose of 14 Gy, were given. Late treatment toxicity and the rate of remission of the disease were evaluated. Results: The overall response rate of the survey was 64.1% with 40.6% (26/64) valid, complete questionnaires. In total, 40 axillae were irradiated in these 26 patients. After a median follow-up of 40 years (range 32–52) complete remission of the lesions occurred in 34 of the 40 sites (85%). None of the 26 patients with 40 irradiated sites reported adverse effects at the time of the survey. Conclusions: RT appears to be an effective treatment for early and mild HS in the majority of patients. In this case series, no side effects were reported after a median follow-up period of 40 years.

Golimumab for the Treatment of Hidradenitis Suppurativa in Patients with Previous TNF-α Treatment Failure

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin presenting with recurrent inflammatory nodules, cysts, abscesses, sinus tracts, and scar formation. Combined medical and surgical management is often required. The only Food and Drug Administration‒approved treatment for HS, adalimumab, is a mAb targeting TNF-α (Alikhan et al., 2019a, 2019b; Kimball et al., 2016). The use of golimumab, another fully humanized TNF-α inhibitor, has been described in two cases of HS with mixed results (Tursi, 2016; van der Zee and Prens, 2013).

当科における化膿性汗腺炎に対するアダリムマブの使用経験

当科における化膿性汗腺炎に対するアダリムマブの使用経験

CME Dermatology 23/Answers: Hidradenitis suppurativa

CME Dermatology 23/Answers: Hidradenitis suppurativa Abstract. Hidradenitis suppurativa (Acne inversa) is a chronic skin disease characterized by recurrent inflammatory nodules, abscesses, and scarring mainly in the intertriginous areas. The prevalence is estimated to be 0.05 to 4.1 % worldwide, with women being more commonly affected. The exact pathogenesis remains unknown, but hair follicle occlusion and inflammation seem to be the initiating events. Several epidemiological correlations with smoking and obesity as well as mutations in gamma secretase genes were described. The therapy depends on the extension of the disorder and should respect the current guidelines. Topical clindamycin is suitable for mild forms of the disease whereas moderate to severe disease requires systemic anti-inflammatory treatment. Surgical intervention is currently the only definitive treatment for hidradenitis suppurativa.

Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine during Ixekizumab treatment for hidradenitis suppurativa

Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine during Ixekizumab treatment for hidradenitis suppurativa

Intralesional photodynamic therapy in hidradenitis suppurativa: Getting closer to the target

BackgroundThe successful treatment of hidradenitis suppurativa (HS) with intralesional photodynamic therapy (IL-PDT) has been previously reported in some case series published a few years ago. We present additional data and patient outcome for this form of PDT. MethodsThis is an observational retrospective study including all patients diagnosed with HS and treated with IL-PDT in the Hospital Universitari Son Espases from February 2019 to February 2020. Under local or general anesthesia, 5-aminolevulinic acid (5ALA) in gel 2 % or solution 1 % was introduced in the lesion. After two hours, the lesion was intralesionally irradiated (1.4 W, fluence 168 J/cm2) with the tip of a 0.4-mm thick optical fiber connected to a continuous 630-nm diode laser. The main outcome variable was the result (remission, improvement or no change) for each lesion 3 months after the therapy. The result at 6 months and the side effects were secondary outcomes. A multivariate analysis was carried out in order to obtain adjusted odds ratios for no change vs improvement or remission at 3 months for significant variables. ResultsA total of 117 lesions (28 nodules and 89 fistulae) were treated in 42 patients. At 3 months, 26 lesions (22.2 %) had resolved, 73 (62.4 %) had improved in size or symptoms, and 18 (15.4 %) experienced no change. The most frequent side effects were skin burns (53 lesions, 45.3 %), and abscess formation (8 lesions, 6.8 %). In the multivariate analysis, significant variables for no benefit were: a higher International Hidradenitis Suppurativa (IHS4) score, active smoking and gluteal and inguinal location. ConclusionsAlthough our results did not present the level of remission of the previous studies, IL-PDT was useful in most of our patients. Early interventions in patients with lower inflammatory burden were the most valuable.

Adalimumab and infliximab survival in patients with hidradenitis suppurativa: a daily practice cohort study.

SummaryBackgroundBiologics are often required for the treatment of hidradenitis suppurativa (HS). However, data on the drug survival of biologics in daily practice are currently lacking.ObjectivesTo assess the drug survival of antitumour necrosis factor biologics in a daily practice cohort of patients with HS and to identify predictors for drug survival.MethodsA retrospective multicentre study was performed in two academic dermatology centres in the Netherlands. Adult patients with HS using biologics between 2008 and 2020 were included. Drug survival was analysed with Kaplan–Meier survival curves and predictors of survival with univariate Cox regression analysis.ResultsThe overall drug survival of adalimumab (n = 104) at 12 and 24 months was 56·3% and 30·5%, respectively, which was predominantly determined by infectiveness. Older age (P = 0·02) and longer disease duration (P < 0·01) were associated with longer survival time. For infliximab (n = 44), overall drug survival was 58·3% and 48·6% at 12 and 24 months, respectively, and was predominantly determined by infectiveness and side‐effects. Surgery during treatment was associated with a longer survival time (P = 0·01).ConclusionsSurvival rates were comparable for adalimumab and infliximab at 12 months, and were mainly determined by ineffectiveness. Age, disease duration (adalimumab) and surgery (infliximab) are predictors for longer survival.

Factors related to the onset and recurrence of flares in hidradenitis suppurativa patients treated with adalimumab.

Hidradenitis suppurativa (HS) is characterized by periodic worsening of symptoms. However, clinical parameters associated with flare are still to be established. The aim of this study was to investigate factors associated with flare outbreak in HS patients in treatment with adalimumab. Moderate-severe HS patients were included in this retrospective analysis. In total, 115 HS patients treated with adalimumab from 5 Italian centers were reviewed. Gender, ages at onset/baseline, therapeutic delay, family history, Body Mass Index, smoking, comorbidities, phenotypes, body areas involved, Hurley stage, International Hidradenitis Suppurativa Severity Score System (IHS4), Dermatology Life Quality Index (DLQI) and Visual Analogue Scale for pain (pain-VAS) were collected at baseline. Flares were modelled with baseline features using univariate and multivariate Cox regression. The factors significantly correlated with flares in the univariate model were analyzed using a recurrent event survival analysis (Andersen-Gill model) to assess the relation between them and flares recurrence. During the observation period 80.9% of patients developed flares, detecting 252 flares, overall. A univariate model identified five risk factors associated with the outbreak of flares: age, therapeutic delay, groin involvement, Hurley III, higher IHS4, whereas, from multivariate model, only IHS4 resulted to be significantly correlated. Additionally, flares were positively associated with higher DLQI and pain-VAS. Finally, the Andersen-Gill model showed four factors correlated with flares recurrence: age, therapeutic delay, Hurley III and higher IHS4. An early treatment of HS may prevent both the disease progression and reduce the recurrence of flares.

CME Dermatology 23: Hidradenitis suppurativa

CME Dermatology 23: Hidradenitis suppurativa Abstract. Hidradenitis suppurativa (Acne inversa) is a chronic skin disease characterized by recurrent inflammatory nodules, abscesses, and scarring mainly in the intertriginous areas. The prevalence is estimated to be 0.05 to 4.1 % worldwide, with women being more commonly affected. The exact pathogenesis remains unknown, but hair follicle occlusion and inflammation seem to be the initiating events. Several epidemiological correlations with smoking and obesity as well as mutations in gamma secretase genes were described. The therapy depends on the extension of the disorder and should respect the current guidelines. Topical clindamycin is suitable for mild forms of the disease whereas moderate to severe disease requires systemic anti-inflammatory treatment. Surgical intervention is currently the only definitive treatment for hidradenitis suppurativa.

565 Epidermal remodeling and immunogenicity within sinus tracts in hidradenitis suppurativa at the single-cell resolution

Hidradenitis suppurativa (HS) is a severe chronic inflammatory skin disease affecting human apocrine sweat gland-bearing skin regions. The overall prevalence of HS ranges from 0.05-4.1% with higher occurrence among females and African Americans, and strong associations with smoking and obesity. One unique feature of HS is the development of highly immunogenic keratinized sinus tracts that grow deeply in the dermis which further complicate HS pathogenesis and treatment. Using single cell transcriptomic analyses, we finely dissected different epidermal cell types in the HS lesional skin and revealed significant dysregulation of skin barrier function in the sinus tracts. We demonstrated that sinus tract keratinocytes exhibit dual cell fates of surface epidermis and skin appendages, and derived from progenitors in infundibulum of the apocrine-pilosebaceous unit. By analyzing ligand-receptor expressions between different skin appendages and immune cells, we highlighted Th17 and TNF responses at early and late stages during HS progression, respectively. Our work provides unprecedented understanding of pathological epidermal remodeling in human inflammatory diseases and important implications for therapeutics.

Modified Posterior Arm Flap for Axillary Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition of the apocrine sweat glands present in 1% to 4% of the adult population, with twice greater prevalence in females. Surgical excision is the criterion-standard treatment for advanced, grade III disease, characterized by extensive and recurrent abscesses and interconnected sinus tracts. Numerous reconstructive methods have been used to cover the resulting defects, including secondary intention healing, use of skin grafts, and a wide range of locoregional flaps. The modified posterior arm flap has been developed for reconstruction of axillary defects after radical excision of HS. Based on perforating vessels from the axillary artery first identified by Masquelet, a brachioplasty-like incision is used to keep the donor site closure relatively hidden on the posteromedial aspect of the inner arm. Eight modified posterior arm flaps have been undertaken in 6 patients, all women (mean age, 35 years; range, 22-51 years) from 2014 to 2019. All patients had complete resolution of their HS symptoms with no incidences of recurrence at mean follow-up of 15 months. All reported satisfaction with the aesthetic and functional outcomes of the procedure. We present a novel modification of the posterior arm flap for the treatment of advanced axillary HS with good functional and aesthetic outcomes and no incidences of recurrence.

Clinical Epidemiology and Management of Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic immune-mediated inflammatory skin disease with a prevalence of 0.1-1%, characterized by nodules and abscesses in the axillae, groin, and inframammary areas, sometimes developing into tunnels (or fistulas) and scars. Because hidradenitis suppurativa is more common in women and in those aged 18-40 years, obstetrician-gynecologists (ob-gyns) have the opportunity to diagnose, educate, initiate treatment, and coordinate care with ancillary health care professionals. The recently published North American treatment guidelines, along with management information for patients with hidradenitis suppurativa who are pregnant or breastfeeding, are summarized. By diagnosing and optimizing hidradenitis suppurativa treatment early in the disease course, ob-gyns can reduce morbidity, with the potential to favorably alter disease trajectory.

Treatment of hidradenitis suppurativa with tetracycline, doxycycline, or lymecycline: a prospective study.

To evaluate the clinical efficacy of tetracycline, doxycycline, and lymecycline in patients with hidradenitis suppurativa (HS). A prospective study of three different treatment regimens in patients with HS; oral tetracycline 500mg twice daily, oral doxycycline 100mg twice daily, and oral lymecycline 300mg twice daily were administered in patients with HS. Outcomes were change in Hidradenitis Suppurativa Score (HSS), Dermatology Life Quality Life index (DLQI), overall disease-related distress, boil-related pain, number of boils in the preceding month, fraction of patients with no boils in the preceding month, and Physician's Global Assessment (PGA) score at follow-up. In total, 108 patients, 73 (67.6%) women and 35 (32.4%) men, were included. Mean duration of treatment was 4.3months. The mean HSS at baseline was 26.10 (SD 20.18) points, improving to 17.97 (SD 17.88) at follow-up, difference is 8.13 (95% CI 5.21-10.93), P<0.0001. Highest improvement in HSS was observed in the tetracycline group. After multivariate adjustment, higher reduction in HSS was significantly associated with lower BMI, Hurley stage III, higher HSS at baseline, and higher number of boils in the preceding month at baseline. Oral treatment with tetracycline, doxycycline, and lymecycline appears effective and safe in HS patients. Tetracycline provided the greatest clinical improvement measured by HSS.