Florence Poli

Prevalence and factors associated with hidradenitis suppurativa: Results from two case-control studies

BACKGROUND Conflicting opinions have been reported regarding the epidemiology of hidradenitis suppurativa. OBJECTIVE We sought to evaluate the prevalence of hidradenitis suppurativa and to identify associated factors. METHODOLOGY Prevalence was evaluated using a representative sample of the French population (n=10,000). Associated risk factors were assessed using two case-control studies, one population-based with 67 self-reported patients and 200 control subjects, and the other clinic-based with 302 medically assessed patients and 906 control subjects. RESULTS The prevalence was 1% of the French population. Multivariate analyses showed a strong association with current smoking in self-reported (odds ratio=4.16, 95% confidence interval [2.99-8.69]) and in medically assessed (odds ratio=12.55 [8.58-18.38]) populations. Association with body mass index was significant in medically assessed patients (odds ratio=1.12 [1.08-1.15]) for each increase of 1 U of BMI. LIMITATIONS A causal relationship could not be established with such a cross-sectional study. CONCLUSION Hidradenitis suppurativa is a common disease, frequently associated with smoking and being overweight.

Combination Therapy with Clindamycin and Rifampicin for Hidradenitis Suppurativa: A Series of 116 Consecutive Patients

Background: Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available. Objective: To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS. Methods: Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment. Results: The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects. Conclusion: The combination of clindamycin and rifampicin is effective in the treatment of severe HS.

Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity

BACKGROUND Factors associated with the severity of hidradenitis suppurativa (HS) are not known. OBJECTIVE We sought to identify factors associated with the severity of HS. METHODOLOGY The severity of disease in a series of 302 consecutive patients with HS was assessed using the Sartorius score. RESULTS Atypical locations were more common in men than in women (47.1% vs 14.8%; P < .001). Men also had more severe disease (median Sartorius score: 20.5 vs 16.5; P = .02). Increased body mass index (P < .001), atypical locations (P = .002), a personal history of severe acne (P = .04), and absence of a family history of HS (P = .06) were associated with an increased Sartorius score. The Sartorius score was highly correlated with the intensity and duration of pain and suppuration (all P values < .001). LIMITATIONS The referral center base of the study may have biased recruitment. CONCLUSION Our data showed a significant association between the severity of HS and several clinical and behavioral factors. Prospective studies are needed to confirm the prognostic role of these factors.

Multicenter Randomized Comparative Double-Blind Controlled Clinical Trial of the Safety and Efficacy of Zinc Gluconate versus Minocycline Hydrochloride in the Treatment of Inflammatory Acne vulgaris

Background: In addition to tetracyclines, zinc may constitute an alternative treatment in inflammatory lesions of acne. Objective: To evaluate the place of zinc gluconate in relation to antibiotics in the treatment of acne vulgaris. Methods: Zinc was compared to minocycline in a multicenter randomized double-blind trial. 332 patients received either 30 mg elemental zinc or 100 mg minocycline over 3 months. The primary endpoint was defined as the percentage of the clinical success rate on day 90 (i.e. more than 2/3 decrease in inflammatory lesions, i.e. papules and pustules). Results: This clinical success rate was 31.2% for zinc and 63.4% for minocycline. Minocycline nevertheless showed a 9% superiority in action at 1 month and one of 17% at 3 months, with respect to the mean change in lesion count. Regarding safety, the majority of the adverse effects of zinc gluconate and of minocycline concerned the gastrointestinal system and weremoderate (5 dropouts with zinc gluconate and 4 with minocycline). Conclusion: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but minocycline has a superior effect evaluated to be 17% in our study.

Absence of Efficacy of Oral Isotretinoin in Hidradenitis Suppurativa: A Retrospective Study Based on Patients’ Outcome Assessment

Background: In analogy to acne, oral isotretinoin has been considered in the treatment of hidradenitis suppurativa (HS). Objectives: To assess the efficacy of oral isotretinoin according to patients. Methods: From 1999 to 2006, 358 consecutive HS patients were interviewed and examined. A standardized record of the data was performed for each patient during the first consultation. Patients were questioned regarding the effect of previous treatment with oral isotretinoin: patients had to grade the effect as either ‘improved’, ‘no effect’ or ‘worse’. Results: Fourteen patients (16.1%) declared an improvement, 67 patients (77%) no effect and 6 patients (6.9%) worsening of HS. Conclusion: According to our patients, oral isotretinoin is not effective in the treatment of HS.

Living with Acne

Background: Acne can have important psychological repercussions. Objectives: We studied adolescents’ perceptions of acne, in a nonmedical context. Methods: Between November 2004 and January 2005, a questionnaire was presented to adolescents calling a youth helpline. It focused on perceptions of acne and, among callers with personal experience of acne, its severity and treatment. Callers were divided into those with acne, those having had acne and those never having had acne. Results: The questionnaire was completed by 1,566 callers. It showed that 51% of respondents with acne did not seek medical help; acne has as big a psychological impact as some far severer diseases; many respondents with no history of acne said they were very worried that they would develop this skin disorder. Conclusions: This study underlines the major psychological impact of acne. Young people need to be informed that acne can be treated.

Creation of a Tool to Assess Adherence to Treatments for Acne

Background: Acne is a disorder in which adherence has a major impact on treatment outcome. Objective: To create an easy-to-use tool to assess treatment adherence, based on a questionnaire that can be used on a daily basis by dermatologists. Methods: First, we evaluated adherence by comparing responses to a self-administered questionnaire with the dermatologist’s prescription. Second, concordance was assessed between adherence and each question of a dermatologist-directed questionnaire (DDQ) administered during the consultation. Third, DDQ questions were combined to construct a mini-questionnaire, and these combinations were tested to maximize specificity. Results: The study included 246 patients, who were prescribed topical treatment alone, combined treatment (excluding oral isotretinoin) or oral isotretinoin alone. The mini-questionnaires for oral and topical treatments had 89% specificity for detecting poor adherence. An inappropriate answer to one question classified the patient as a probable poor complier. Conclusions: Our mini-questionnaires provide dermatologists with specific tools to rapidly identify poor compliers.

Back and Face Involvement in Hidradenitis Suppurativa

Background: Hidradenitis suppurativa (HS) may be associated with face and back lesions which are considered as acne. Objective: To describe the skin lesions of a group of patients with HS. Methods: Twelve patients were selected from a series of 648 patients on the basis of their specific skin lesions. Results: The patients (mostly male) had typical hidradenitis. On their face or back they had one or several of the following skin lesions which are not seen in acne: hypertrophic rope-like bridged scars, raised plaques with multiple carbuncle-like openings or with ulcerations, ‘worm-eaten scars’ and coalescent nodules with round ulcerations. All patients had deep round scars. Several had a pilonidal cyst or large epidermal cysts. Isotretinoin had been used by 7 patients with no effect. Conclusion: Some HS patients have specific lesions of the face and back which are not acne and have to be treated differently.

Corrélation clinique et psychologique dans l’acné : utilisation des grilles ECLA et CADI

Resume Introduction Le retentissement psychologique de l’acne est souvent independant de l’intensite des lesions d’acne. Ainsi, certaines echelles ont ete construites et validees dans le but de quantifier la severite de l’acne telle que l’Echelle de Cotation des Lesions d’Acne (ECLA) alors que d’autres ont pour objectif d’evaluer la qualite de vie comme le questionnaire Cardiff Acne Disability Index (CADI) recemment valide en francais. L’objectif de ce travail a ete d’utiliser ces deux echelles chez un meme patient acneique afin de determiner s’il existait une correlation ou non entre ces deux echelles specifiques de l’acne et de determiner les groupes de malades influences par l’acne. Methodes Cent vingt-huit patients acneiques (21 ± 6,8 ans) vus par sept dermatologues ont ete inclus dans cette etude. La severite de l’acne a ete evaluee a l’aide de la grille ECLA, les sept dermatologues ayant ete formes a cette echelle. Par ailleurs, les patients remplissaient le questionnaire de qualite de vie CADI apres la consultation. Chaque facteur de l’echelle ECLA a ete croise avec chaque item du questionnaire CADI a l’aide d’une analyse de variance. Resultats Il n’existait pas de correlation entre les scores globaux des deux echelles ECLA et CADI (r 2 = 0.0242). Cependant une correlation positive etait observee entre le score global CADI et les facteurs F1 et F3 de la grille ECLA (p = 0,0085 et p = 0,0373 respectivement). Inversement, le score global de l’echelle ECLA etait significativement correle a l’item 5 du questionnaire CADI c’est-a-dire la perception de l’acne (p = 0,0035). Conclusion L’acne a un impact sur la composante psychologique du patient meme dans des formes minimes. La grille ECLA associee au CADI apparaissent deux outils interessants et complementaires pour le dermatologue dans sa prise en charge complete du patient acneique.

Lymphœdème compliquant une hidradénite suppurée : trois observations

Resume Introduction Nous rapportons les observations de deux femmes et un homme âges de 36 a 52 ans souffrant d’hidradenite suppuree depuis de nombreuses annees, compliquee d’un lymphœdeme sus-pubien. Observations L’aspect clinique etait celui d’une tumefaction en ballon de rugby, retombant en besace sur les organes genitaux dans un cas, a consistance ferme voire dure. Il n’y avait pas d’atteinte ganglionnaire ou de blocage des voies lymphatiques abdominales. Une exerese chirurgicale large des lesions suivie secondairement de greffe a entraine la guerison chez un malade. L’examen de la piece operatoire revelait des lymphangiectasies et de la fibrose. Discussion La survenue de lymphœdeme est due au blocage et/ou a la destruction des voies lymphatiques secondaire a l’inflammation et a la suppuration chronique. Une fois la maladie presente, aucun traitement medical n’est efficace.