Deirdre Nathalie Dufour

A double‐blind placebo‐controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa

Background  Hidradenitis suppurativa (HS) has an impact on patients’ quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed.

Depression in patients with hidradenitis suppurativa

Background Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL). It is hypothesized that depression is more common in HS patients than among other dermatological patients.

Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease

Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty. The primary clinical presentation is painful inflamed nodules or boils in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and buttocks/anus) that progress to abscesses, sinus tracts and scarring. Severity is typically described according to three Hurley categories, with most patients having mild or moderate disease. Estimated prevalence is 1–4% worldwide and HS is three times more common in women than men. Patients’ disease burden includes intense pain, work disability and overall poor quality of life. Although the clinical signs of the disease can often be hidden by clothing, active HS is associated with a malodorous discharge that contributes to the disabling social stigma. Risk factors include smoking and obesity. Comorbidities include inflammatory bowel disease and spondyloarthropathies. The presentation of the disease is distinct, yet HS is not well-recognised except in dermatology clinics.

Questionnaire-based diagnosis of hidradenitis suppurativa: specificity, sensitivity and positive predictive value of specific diagnostic questions

Background  Estimates of the prevalence of hidradenitis suppurativa (HS) range from 0·33% to 4%. Further epidemiological data are therefore needed. Because of the hidden nature of the disease, physical screening may be cumbersome and questionnaire‐based screening may be more appropriate.

Hidradenitis Suppurativa Complicating Naevus Comedonicus: The Possible Influence of Mechanical Stress on the Development of Hidradenitis Suppurativa

Naevus comedonicus is a rare, benign hamartoma consisting of grouped abnormal hair follicles and, occasionally, associated with other diseases. We describe an infant who developed hidradenitis-like lesions in an inguinal naevus comedonicus following increased mechanical stress on the region. It is speculated that the degree of strain on a hair follicle is increased when its diameter is increased, leading to wall ruptures. We hypothesise that this serendipitous observation provides a model for the way mechanical stress can account for the development of hidradenitis suppurativa in some patients.

Expert Advice Provided through Telemedicine Improves Healing of Chronic Wounds: Prospective Cluster Controlled Study

Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.

A clinical-pathological review of hidradenitis suppurativa: using immunohistochemistry one disease becomes two.

Fismen S, Ingvarsson G, Moseng D, Dufour ND, Jørgensen L. A clinical‐pathological review of hidradenitis suppurativa: Using immunohistochemistry one disease becomes two. APMIS 2012; 120: 433–40.

Development of a Clinical Scandinavian Registry for Hidradenitis Suppurativa; HISREG

Hidradenitis suppurativa (HS; or acne inversa) is a scar -ring and frequently persistent inflammatory disorder of the terminal hair follicles of apocrine gland-bearing skin in adults. Treatments include local or systemic antibiotics, hormones, retinoids and systemic immunosuppressive agents (1), although on evaluation these have been shown to have only limited or temporary effect. In refractory cases, surgery is necessary, and should be radical and performed as early as possible (2, 3). It is essential to establish a registry of HS in order to address the following important issues: to assess the safety and effectiveness of different treatments; to identify which specific patient subgroups have the best risk/benefit ratio for a given treatment; and to create benchmark data for quality assurance of the medical service. This manuscript presents the Scandinavian Registry for HS, HISREG.METHodS

Treatment of hidradenitis suppurativa: Is oral isoniazid an option?

Sirs, Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating follicular skin disease that usually presents after puberty with painful deepseated, inflamed lesions in the apocrine glandbearing areas of the body, most commonly the axillary, inguinal and anogenital regions (1). The prevalence is approximately 1% and quality of life is severely affected (2–4). The pathogenesis remains unclear. However, involvement of the apocrine glands, dysregulated immune response in the hair follicles, occlusion of the follicular infundibulum, bacterial infection and bacteria-induced immunomodulation are all suspected to play a role. Microorganisms such as Staphylococcus aureus and anaerobe bacteria can be isolated from lesions, but often the lesions appear sterile. HS is currently considered a sterile inflammation, and the bacteria are suspected to act as immunomodulators in the inflammationprocess (5–8). Management of HS is a challenge. Topical antibiotics (clindamycin) and peeling agents/keratolytics (resorcinol, azelaic acid), systemic antibiotics (tetracycline, erythromycine, doxycycline, minocycline), the combination of rifampicine and clindamycin, oral retinoids, hormones, anti-inflammatory therapy (e.g cyclosporine, dapson, methotrexate, prednisolone) and recently biologics are all used in the management of HS (9–11). Foreign body-type granulomas are found in the active HS areas in up to 25% of HS patients and must be considered a common histiopathological finding in HS (6,12). An association with other granulomatous diseases such as Crohn’s disease has been suggested (13). Tuberculosis is an infectious disease histopathologically characterized by granuloma formation. It has been suggested that the anti-tuberculosis agent rifampicin in combination with the antibiotic clindamycin may be used to treat HS. Isoniazid is an anti-tuberculosis drug with antibacterial, antigranulomatous as well as immunomodulatory effects (14). It may therefore be speculated that this drug also proves efficacious in the treatment of HS. The antituberculosis agent rifampicin has previously shown a good clinical effect on HS when combined with clindamycin (9,10). Isoniazid is also an antituberculosis agent, and has been suggested to have effects similar to rifampicin. The case records of four HS patients (three women, one man) with a minimum of Hurley 2 stage and who had previously unsuccessfully tried topical treatment and at least one kind of systemic treatment were offered oral isoniazid 300 mg daily for 3 months in an open study. In addition, three of the patients were offered oral pyridoxine 20 mg daily to prevent any neurological side effects of isoniazid. A modified Sartorius score was assessed before and after the isoniazid treatment (15). The patients’ subjective assessment of the treatment effect was systemically recorded. The patients were monitored with blood samples approximately every other week. One patient discontinued isoniazid after 1 week due to malaise, fever and elevated liver enzymes. A second patient decided to discontinue isoniazid after 1 month of treatment due to general pruritus. The pruritus subsequently disappeared. None of the patients felt any subjective improvement in their skin condition during isoniazid treatment. A clinically insignificant reduction in the Sartorius score (36 to 32 and 75 to 68) was seen in two

Teledermatology: The Atlantic Experience

It is beneficial if teledermatology is integrated in an existing structure for optimum utilisation of resources. Teledermatology has been used to redistribute the workload of specialists. Teledermatology provides continuous access to specialist assessment of patients in collaboration with local physicians. Simple store-and-forward teledermatology is well suited for follow-up of patients initially seen by a specialist. Milder cases of some clinically characteristic diseases such as acne are well suited to management through teledermatology. Teledermatology offers the possibility of case-based continued medical education of non-specialists. Teledermatology generally follows the life curve of other successful new organisational models and does not affect demand for health services.