Inge Deckers

Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study

Hidradenitis suppurativa (HS) causes considerable morbidity. The long‐term prognosis is of obvious interest to both patients and physicians. We conducted this study to determine the prognosis and risk factors in patients diagnosed with HS.

Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement

BACKGROUND The reported mean age of onset of hidradenitis suppurativa (HS) is between 20 and 24 years. Prepubertal onset is thought to be rare. OBJECTIVE We sought to determine the prevalence of early-onset HS and to compare clinical characteristics between early-onset and normal-onset HS in a retrospective study. METHODS Data were collected from 855 patients with HS. Early-onset HS was defined as onset before the thirteenth birthday. Clinical characteristics were analyzed in relation to the age of onset. RESULTS In all, 66 patients (7.7%) reported early-onset HS. A family history for HS was significantly higher in early-onset patients (55.6% vs 34.2%; odds ratio 2.1, 95% confidence interval 1.2-3.6, P = .006). They developed inflammatory lesions at more body sites than patients with normal-onset HS (odds ratio 3.0, 95% confidence interval 1.8-4.9, P < .001). Distribution of the Hurley stages of severity showed no differences between the 2 groups (odds ratio 1.1, 95% confidence interval 0.7-1.8, P = .72). LIMITATIONS Some data were based on patient-reported information. CONCLUSION Early-onset HS occurs more frequently than previously believed. Patients with early-onset HS often report a family history for HS and develop lesions at more body sites.

The Handicap of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a chronic skin disease, with painful, foul-smelling, recurring inflammation, leading to a diminished quality of life. Patients with HS also often suffer from depression, have an impaired sexual health, and may have difficulty performing their work duties.

Inflammatory bowel disease is associated with hidradenitis suppurativa: Results from a multicenter cross-sectional study

Background: Hidradenitis suppurativa (HS) is often associated with inflammatory bowel disease (IBD; Crohns disease or ulcerative colitis). However, the prevalence of IBD in HS patients is unknown. Objective: To determine the prevalence of IBD in HS patients, and determine if patients with HS and IBD have a distinct HS phenotype. Methods: For this multicenter, cross‐sectional study, HS patients were asked during their first consultation if they had IBD. The diagnosis of IBD was checked in the medical files, and clinical characteristics were collected. Results: IBD had a prevalence of 3.3% (95% CI 2.3‐4.4) in 1076 HS patients. The prevalence of Crohns disease was 2.5% (95% CI 1.6‐3.4) and the prevalence of ulcerative colitis was 0.8% (95% CI 0.3‐1.4). HS‐IBD patients were less frequently obese (13.9% vs 31.2%, P = .04) than HS‐only patients, but there were no differences in gender, family history of HS, disease severity, body areas affected by HS, or smoking status. Limitations: The prevalence might be underestimated since HS patients might still develop IBD. Conclusion: The prevalence of IBD in HS patients (3.3%) is 4‐8 times higher than the prevalence in the general northern European population (0.41%‐0.74%), however HS‐IBD patients do not have a distinct HS phenotype.

Sexual health and quality of life are impaired in hidradenitis suppurativa: a multicentre cross-sectional study

Hidradenitis suppurativa (HS) has a major impact on patients’ quality of life (QoL). Although it has commonly been assumed that HS impairs sexual health, only a single case–control study has been performed on sexual functioning in a small group of patients with HS.

An Update on Medical Treatment Options for Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple anti-inflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission.

Fumarates, a new treatment option for therapy-resistant hidradenitis suppurativa: a prospective open-label pilot study

Dermatology and are currently being edited and typeset. Readers should note that articles published below have been fully refereed, but have not been through the copy-editing and proof correction process. Wiley-Blackwell and the British Association of Dermatologists cannot be held responsible for errors or consequences arising from the use of information contained in these articles; nor do the views and opinions expressed necessarily reflect those of Wiley-Blackwell or the British Association of Dermatologists This article is protected by copyright. All rights reserved.

Severe fatigue based on anaemia in patients with hidradenitis suppurativa: report of two cases and a review of the literature.

Editor Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease. Patients often report fatigue, which is generally attributed to the debilitating psychosocial impact of HS. However, sometimes severe anaemia causes the fatigue. The co-occurrence of HS and anaemia is mentioned in reviews on the disease, but they refer to a single case series from 1968. Since, no studies have been published on this subject. Therefore, we present two representative cases of severe HS with fatigue, based on chronic marked anaemia. The first case is a 46-year-old, otherwise healthy, man with a 6-year history of HS, Hurley stage III, on his buttocks, groin and peri-genital area. He presented with purulent blood loss from his HS lesions and intense fatigue (Fig. 1a). Previous treatments with isotretinoin and multiple antibiotics were ineffective. Laboratory tests revealed a microcytic anaemia (haemoglobin (Hb): 4.5 mmol/L) (Table 1), for which he received three packed cells and was referred to internal medicine. Colonoscopy revealed no abnormalities, gastroscopy was discontinued because of patient’s anxiety. Helicobacter Pylori-breathing test was negative. Iron supplementation was started, temporarily improving his haemoglobin level. Clindamycin 3dd200 mg yielded minor effect on his HS. Extensive wide excision was performed of all HS affected skin with closure by split-skin grafting. Six months postoperatively the wounds were healed (Fig. 1b), his fatigue resolved and his haemoglobin level normalized (Hb: 9.4 mmol/L) (Table 1). The second case is a 61-year-old woman, suffering from HS since the age of 14, Hurley stage III, located in the axillae, groin, pubic and gluteal area. She had a medical history of fatigue, diabetes and hypertension. Previous treatments with antibiotics were ineffective. Laboratory testing revealed normocytic anaemia (Hb: 5.0 mmol/L) (Table 1). She was referred to internal medicine who concluded that her anaemia was caused by iron deficiency and chronic disease, since no other cause was found. She received multiple blood transfusions, temporarily increasing her haemoglobin. Adalimumab was started for her HS, with modest efficacy. Multiple extensive surgical excisions were performed on her axillae, groin and gluteal area, with subsequent blood loss requiring blood transfusions. Hereafter infliximab infusions were started. The remaining HS lesions improved and the haemoglobin level normalized (Hb 8.5 mmol/L) (Table 1). HS patients often report fatigue, which is attributed to the debilitating course and great psychological impact of HS. However, a more general underlying cause, chronic marked anaemia, is sometimes overlooked. In 1968, Tennant et al. reported on anaemia associated with HS. In their population, 10 of 42 (24%) patients with severe HS had marked anaemia (Hb < 6.3 mmol/L). They concluded that anaemia was probably caused by chronic inflammatory processes. Anaemia as consequence of chronic disease is believed to be caused by the effects of elevated levels of pro-inflammatory cytokines. Interferon-c, interleukin (IL)1 and tumour necrosis factor alpha (TNF-a) can inhibit renal production of erythropoietin and reduce its physiological effect on the bone marrow. In addition, these (a)

Hidradenitis suppurativa: a pilot study to determine the capability of patients to self-assess their Hurley stage.

DEAR EDITOR, Hidradenitis suppurativa (HS) is a chronic skin disease of the inverse areas of the body such as the axillary, inguinal, genital and perineal regions. Estimates of the prevalence of HS range from 0 33% to 4%. Information pertaining to the prevalence of HS is partly derived from large questionnaire-based studies. However, the severity of the disease could not be determined using these questionnaires. In studies on acne, chronic hand dermatitis and rosacea, coloured pictures have been used as a guide to determine disease severity. However, these pictures were analysed by physicians rather than patients. In a recent study of HS in patients with inflammatory bowel disease, the Hurley stage was assessed by patients using colour pictures showing the three Hurley stages. Although this provides a valuable example, no validation of the scores that were given by the patients has been provided. Therefore, this pilot study was conducted in order to determine the capability of patients with HS to carry out a self-assessment of their disease severity using colour photographs. A total of 111 consecutive patients with HS who were seen by a single physician (J.B.) at the Department of Dermatology, Deventer Hospital, the Netherlands, were included in the study. Six patients were excluded because of incomplete forms. The severity of the disease was assessed using the Hurley staging system. Patients scored their own disease severity using photographs of the Hurley stages. In total, four photographs were used: two for Hurley stage I disease, one for Hurley stage II and one for Hurley stage III disease (Fig. 1). We chose to use two pictures for Hurley I, as this stage has a broad spectrum of presentation, varying from a single nodule to multiple nodules. The patients were asked to select and mark the photo that showed the closest resemblance to their own disease severity. In addition, all patients were scored by the same physician (J.B.) based on the clinical characteristics of their disease. The patients and the physician carried out their scoring independently. The data analysis was implemented by the 20th version of IBM-SPSS statistics (IBM, Armonk, NY, U.S.A.). Agreement was analysed by weighted kappa. The continuous variables were presented as mean SD and range. The categorical variables were presented as numbers and their corresponding percentages. In total, 105 patients were included, 25 were men and 80 were women, with a mean age of 38 9 13 1 years (17– 86). Seventy-three patients (69 5%) were scored by the physician as Hurley stage I, 28 patients (26 7%) as Hurley stage II and four patients (3 8%) as Hurley stage III (Table 1). When comparing the scores of the patients’ self-assessment with the scores assessed by the physician, we found that in 80 patients (76 2%) the self-assessed Hurley scores were similar to the physician’s assessment. Twenty patients (19 0%) scored their disease severity higher than the physician, and five patients (4 8%) gave their disease severity a lower score than the physician. The agreement between the score given by the physician and the score given by the patient had a weighted kappa of 0 63, which corresponds to a substantial agreement. This pilot study shows that patients are capable of scoring their own disease severity according to the Hurley staging system using photographs. In 76% of the patients’ self-assessments, the scores given by the patients were similar to those given by the physician. In addition, a weighted kappa of 0 63

Establishment of a European Registry for hidradenitis suppurativa/acne inversa by using an open source software

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