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Journal of the American Academy of... Jul 2019Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches,... (Review)
Review
North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management.
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
Topics: Administration, Oral; Administration, Topical; Androgen Antagonists; Anti-Bacterial Agents; Canada; Evidence-Based Medicine; Female; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Injections, Intralesional; Male; North America; Practice Guidelines as Topic; Prognosis; Publications; Risk Assessment; Treatment Outcome; United States
PubMed: 30872149
DOI: 10.1016/j.jaad.2019.02.068 -
Journal of the American Academy of... Jul 2019Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing... (Review)
Review
North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.
Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.
Topics: Anti-Bacterial Agents; Biological Products; Canada; Complementary Therapies; Dermatologic Surgical Procedures; Drug Therapy, Combination; Evidence-Based Medicine; Female; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Male; North America; Practice Guidelines as Topic; Publishing; Risk Assessment; Severity of Illness Index; United States
PubMed: 30872156
DOI: 10.1016/j.jaad.2019.02.067 -
Cells Aug 2021Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which... (Review)
Review
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. It is a multifactorial disease in which genetic and environmental factors play a key role. The primary defect in HS pathophysiology involves follicular occlusion of the folliculopilosebaceous unit, followed by follicular rupture and immune responses. Innate pro-inflammatory cytokines (e.g., IL-1β, and TNF-α); mediators of activated T helper (Th)1 and Th17 cells (e.g., IFN-γ, and IL-17); and effector mechanisms of neutrophilic granulocytes, macrophages, and plasma cells are involved. On the other hand, HS lesions contain anti-inflammatory mediators (e.g., IL-10) and show limited activity of Th22 cells. The inflammatory vicious circle finally results in pain, purulence, tissue destruction, and scarring. HS pathogenesis is still enigmatic, and a valid animal model for HS is currently not available. All these aspects represent a challenge for the development of therapeutic approaches, which are urgently needed for this debilitating disease. Available treatments are limited, mostly off-label, and surgical interventions are often required to achieve remission. In this paper, we provide an overview of the current knowledge surrounding HS, including the diagnosis, pathogenesis, treatments, and existing translational studies.
Topics: Anti-Inflammatory Agents; Biomarkers; Combined Modality Therapy; Cytokines; Hidradenitis Suppurativa; Humans; Inflammation; Skin
PubMed: 34440863
DOI: 10.3390/cells10082094 -
Canadian Family Physician Medecin de... Feb 2017To provide family physicians with an understanding of the epidemiology, clinical features, diagnosis, and management of hidradenitis suppurativa (HS). (Review)
Review
OBJECTIVE
To provide family physicians with an understanding of the epidemiology, clinical features, diagnosis, and management of hidradenitis suppurativa (HS).
SOURCES OF INFORMATION
A PubMed literature search was performed using the MeSH term .
MAIN MESSAGE
Hidradenitis suppurativa is a chronic, recurrent, and debilitating skin condition. It is an inflammatory disorder of the follicular epithelium, but secondary bacterial infection can often occur. The diagnosis is made clinically based on typical lesions (nodules, abscesses, sinus tracts), locations (skin folds), and nature of relapses and chronicity. Multiple comorbidities are associated with HS, including obesity, metabolic syndrome, inflammatory bowel disease, and spondyloarthropathy. Although the lack of curative therapy and the recurrent nature makes HS treatment challenging, there are effective symptomatic management options.
CONCLUSION
Family physicians should be suspicious of HS in patients presenting with recurrent skin abscesses at the skin folds. Family physicians play an important role in early diagnosis, initiation of treatment, and referral to a dermatologist before HS progresses to debilitating end-stage disease.
Topics: Anti-Bacterial Agents; Biological Products; Hidradenitis Suppurativa; Hormones; Humans; Immunosuppressive Agents; Keratolytic Agents; Life Style; Male; Middle Aged; Resorcinols; Retinoids
PubMed: 28209676
DOI: No ID Found -
The Chinese Journal of Physiology 2021Hidradenitis suppurativa is a cutaneous chronic inflammatory disease that is estimated to affect about 1% of the population and caused pain, malodorous discharge,... (Review)
Review
Hidradenitis suppurativa is a cutaneous chronic inflammatory disease that is estimated to affect about 1% of the population and caused pain, malodorous discharge, disfigurement, and poor quality of life with psychosocial problems. The typical features are recurrent painful nodules, abscesses, and sinus tracts on the axillae, groins, gluteal areas, and anogenital regions since postpuberty. Smoking and obesity are two major triggering factors of hidradenitis suppurativa. Women are prone to have hidradenitis suppurativa than men in Western countries, but the male-to-female ratio is reversed in oriental countries. The disease severity can be affected by menstruation, pregnancy, and menopause. Furthermore, the phenotypes are different among men and women with hidradenitis suppurativa. Men are prone to have buttock involvement while women are prone to have axillary, groins, and submammary lesions. This review introduces the skin appendages and pathophysiology of hidradenitis suppurativa and then focuses on the sex difference and the effects of sex hormones on hidradenitis suppurativa and current hormone-associated treatments.
Topics: Female; Gonadal Steroid Hormones; Hidradenitis Suppurativa; Humans; Inflammation; Male; Quality of Life; Skin
PubMed: 34975118
DOI: 10.4103/cjp.cjp_67_21 -
Journal of the American Academy of... May 2022Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk. (Review)
Review
BACKGROUND
Hidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.
OBJECTIVE
To provide evidence-based screening recommendations for comorbidities linked to HS.
METHODS
Systematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.
RESULTS
Screening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.
LIMITATIONS
Screening recommendations represent one component of a comprehensive care strategy.
CONCLUSIONS
Dermatologists should support screening efforts to identify comorbid conditions in HS.
Topics: Canada; Comorbidity; Female; Hidradenitis Suppurativa; Humans; Metabolic Syndrome; Pyoderma Gangrenosum
PubMed: 33493574
DOI: 10.1016/j.jaad.2021.01.059 -
Clinical and Experimental Dermatology Dec 2022In this second part of a four-part review, we examine the effect of menopause on the skin. Menopause and the associated hypo-oestrogenic state have implications for the... (Review)
Review
In this second part of a four-part review, we examine the effect of menopause on the skin. Menopause and the associated hypo-oestrogenic state have implications for the structure and function of the skin. We performed a literature review to investigate the impact of the menopause on common dermatoses. There is evidence that oestrogen is implicated in transepidermal water loss and reduction in dermal collagen. There are associations with menopause and multiple common dermatoses, including xerosis and pruritus, hidradenitis suppurativa and psoriasis. Menopause has a clear impact on the skin and common dermatological conditions. Further research to understand the mechanisms and explore therapeutic options is needed.
Topics: Humans; Female; Skin; Menopause; Psoriasis; Estrogens; Hidradenitis Suppurativa
PubMed: 35727900
DOI: 10.1111/ced.15308 -
Indian Journal of Dermatology,... 2019Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat... (Meta-Analysis)
Meta-Analysis Review
Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analysis. Meta-analysis was conducted using the comprehensive meta-analysis software to generate pooled standardized mean differences or risk ratios. Numerous medical treatments are available for hidradenitis suppurativa such as antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents and radiotherapy for early lesions. Adalimumab, an anti-tumor necrosis factor antibody, was superior to placebo in reducing Sartorius score (standardized mean difference = -0.32, confidence interval [-0.46, -0.18], P < 0.0001) and pain (risk ratio = 1.42, confidence interval [1.07, 1.9], P = 0.02), when given weekly (not every other week). Combination therapies (such as antibiotics and hyperbaric oxygen therapy) have been tested, which have shown promising results that are yet to be confirmed. Based on the quality of evidence, the most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy. Surgery (either by simple excision or complete local excision followed by skin graft) is the first choice for intractable disease presenting in the late stages. However, the evidence on most of these treatments is deficient and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management.
Topics: Anti-Bacterial Agents; Combined Modality Therapy; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Laser Therapy; Randomized Controlled Trials as Topic; Retinoids
PubMed: 30924446
DOI: 10.4103/ijdvl.IJDVL_69_18 -
Experimental Dermatology Dec 2020The 14 authors of the first review article on hidradenitis suppurativa (HS) pathogenesis published 2008 in EXPERIMENTAL DERMATOLOGY cumulating from the 1st International... (Review)
Review
The 14 authors of the first review article on hidradenitis suppurativa (HS) pathogenesis published 2008 in EXPERIMENTAL DERMATOLOGY cumulating from the 1st International Hidradenitis Suppurativa Research Symposium held March 30-April 2, 2006 in Dessau, Germany with 33 participants were prophetic when they wrote "Hopefully, this heralds a welcome new tradition: to get to the molecular heart of HS pathogenesis, which can only be achieved by a renaissance of solid basic HS research, as the key to developing more effective HS therapy." (Kurzen et al. What causes hidradenitis suppurativa? Exp Dermatol 2008;17:455). Fifteen years later, there is no doubt that the desired renaissance of solid basic HS research is progressing with rapid steps and that HS has developed deep roots among inflammatory diseases in Dermatology and beyond, recognized as "the only inflammatory skin disease than can be healed". This anniversary article of 43 research-performing authors from all around the globe in the official journal of the European Hidradenitis Suppurativa Foundation e.V. (EHSF e.V.) and the Hidradenitis Suppurativa Foundation, Inc (HSF USA) summarizes the evidence of the intense HS clinical and experimental research during the last 15 years in all aspects of the disease and provides information of the developments to come in the near future.
Topics: Autoimmunity; B-Lymphocytes; Bacterial Infections; Complement C5a; Cytokines; Genotype; Hidradenitis Suppurativa; Humans; Mutation; Pain; Phenotype; Pruritus; Risk Factors; Skin; Smoking; T-Lymphocytes; Transcriptome
PubMed: 33058306
DOI: 10.1111/exd.14214 -
American Journal of Clinical Dermatology Mar 2022Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and... (Review)
Review
Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body. The disease can often result in disfigurement and adversely impact patient quality of life. The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities. Management can often be clinically challenging and may involve the combination of medical and surgical approaches for optimal results. The purpose of this review is to present an update on non-biologic and non-interventional modalities published in 2019-2021 in the clinical management of HS. With emerging therapies, ongoing clinical trials, and heightened awareness about HS, there is hope that new treatment options will revolutionize the management of patients suffering from HS.
Topics: Abscess; Comorbidity; Hair Follicle; Hidradenitis Suppurativa; Humans; Quality of Life
PubMed: 34990004
DOI: 10.1007/s40257-021-00667-8