Jurr Boer

The Effect of Combined Treatment with Oral Clindamycin and Oral Rifampicin in Patients with Hidradenitis Suppurativa

Background: A previous limited study showed promising results of combined oral treatment with rifampicin 600 mg and clindamycin 600 mg for 10 weeks. Objective: To expand and to validate the basis for this therapy, we reviewed the response to different treatment durations. Method: A retrospective study in 34 patients. Results: Twenty-eight of 34 patients (82%) experienced at least partial improvement, and 16 (47%) showed a total remission. The maximum effect of treatment appeared within 10 weeks. Following total remission, 8 of 13 (61.5%) patients treated as mentioned above experienced a relapse after a mean period of 5.0 months. Nonresponders were predominantly patients with severe disease. Conclusion: Combination treatment with oral rifampicin and clindamycin is a promising treatment option for hidradenitis suppurativa, despite the frequent occurrence of diarrhea as a side effect. The length and the dosage of treatment are not yet firmly established.

Hidradenitis suppurativa: viewpoint on clinical phenotyping, pathogenesis and novel treatments

Hidradenitis suppurativa (HS) is an inflammatory, debilitating follicular skin disease with recurring flare‐ups. The painful, deep‐seated, inflamed lesions in the inverse areas of the body cause severe discomfort, and hence, serious psycho‐social and economic costs. HS is common, but often misdiagnosed and mechanistically poorly understood. Furthermore, HS is notoriously difficult to treat resulting in a high unmet medical need. To provoke debate, rational experimentation and initiate strategic studies, we here present a concise viewpoint on seven topics: the diagnosis of HS, the role of mechanical friction, the critical importance of accurate clinical subgrouping, smoking and obesity, the role of bacteria, and our comprehensive view on HS pathogenesis with a central role for keratin clearance, and novel treatment approaches.

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.

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.

Diagnostic delay in hidradenitis suppurativa is a global problem.

DEAR EDITOR, Hidradenitis suppurativa (HS) is clinically defined with recognized diagnostic criteria and recognizable physical characteristics. Untreated, the disease causes significant morbidity. The prevalence varies between 0 0003% and 4% depending on the study population. Estimates from insurance databases suggest a prevalence of < 0 1%. This variation strongly suggests a significant selection bias or misclassification, and it may be speculated that not all patients present for care. This is reinforced by clinical experience and published evidence indicating a significant delay in diagnosis. This study explores the delay in diagnosis for patients with HS on an international level. The study (survey) was conducted in 2013. Observational data were collected during routine visits or extracted from case records. Because of the simple and obvious symptomatology of recurrent painful lesions present in restricted welldefined areas of the body, patients’ self-reported history was considered valid regarding onset of symptoms. Consecutive patients with HS and psoriasis were included from each participating centre during a period of 4 months or less. The data were anonymized by removing any names, addresses and social security numbers, and included age, sex, age at disease onset, age at diagnosis, delay in diagnosis, time from onset of symptoms to first physician contact, age at first medical contact, number of physicians seen prior to the diagnosis, family history and disease severity. If the diagnosis was made by a primary care physician or by a specialist other than a dermatologist prior to seeing a dermatologist, this was recorded as the date of the diagnosis. Individual centres were responsible for and obtained any locally required permissions and signed informed consent forms, for example ethics committee approval, in accordance with national registry and data protection rules. Patients diagnosed with HS or psoriasis (and confirmed by the investigator) were included. The primary outcome was quantification of the delay in diagnosis. Additionally, documentation was made of both the delay in visiting a physician (and so gaining access to specialist treatment) and the relative delay in diagnosis of HS compared with psoriasis with/without a family history. The severity of HS was determined by Hurley’s staging criteria: stage I, mild; stage II, moderate and stage III, severe. In patients with psoriasis, severity was evaluated by the Psoriasis Area and Severity Index: score < 7, mild; 7–12, moderate and > 12, severe. The t-test, Wilcoxon rank sum test and v-test were used where appropriate. Univariate and multivariate logistic regression analyses were used to identify factors predictive of significant diagnostic delay. Diagnostic delay > 2 years was defined as significant. Diagnosis, sex, age of onset, family history and disease severity were selected as potentially important

Dapsone Therapy for Hidradenitis Suppurativa: A Series of 24 Patients

Background: Hidradenitis suppurativa (HS) is an inflammatory skin disease with a chronic intermittent course. HS is difficult to treat, and the evidence for the effect of most treatments consists of smaller open studies. The use of dapsone in the treatment of HS is based on a few published cases successfully treated. Objective: To evaluate the potential of dapsone treatment for HS in an open case series. Methods: An exploratory and retrospective review of case notes from HS patients treated with dapsone was performed. Patients were included irrespective of treatment outcome. Prior to the treatment the level of glucose-6-phosphate dehydrogenase in the blood was tested for all patients. Results: A total of 24 HS patients were included and treated with dapsone. Improvement was seen in 9 out of 24 (38%) treated patients, whereas 15 out of 24 (62%) did not experience any improvement. None of the 4 cases with severe disease experienced improvement. Side effects leading to discontinuation of the treatment occurred in 2 of 24 patients (8%). Recurrence of disease at the cessation of treatment was described as rapid. Limitations: The study is limited by lacking a control group. Conclusion: Therapy with dapsone for patients with HS is possible, particularly in milder cases. The effect may be due to either antibacterial or anti-inflammatory effects of the drug, or both. Rapid recurrence after stopping treatment however suggests that anti-inflammatory effects may predominate. The effect appears to be smaller than that reported with combination therapy using clindamycin and rifampicin. To clarify the true effect of dapsone future randomized controlled trials are necessary.

Resorcinol peels as a possible self‐treatment of painful nodules in hidradenitis suppurativa

Background.  Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease characterized by abscess formation localized to apocrine sweat gland‐bearing skin. The most important factor in patients’ overall assessment of disease severity is pain. The duration of abscesses takes days to weeks and are always painful.

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.

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.

Effect of short-contact anthralin therapy on ultraviolet B irradiation of psoriasis

The influence of short-contact anthralin on the therapeutic effect of ultraviolet B irradiation (Sylvania UV-21 tubes) was investigated with the half-body comparison method in fifteen outpatients with plaque-type psoriasis. The lesions on the right or left half of the body were exposed to one of the topically applied compounds (either anthralin and 2% salicylic acid in petrolatum or 2% salicylic acid in petrolatum alone) for 10 to 30 minutes daily. Of the fifteen patients, five (Group I) were given 0.3% anthralin and five (Group II) received increasing concentrations of anthralin (0.3, 1, 3%); the other five (Group III) were patients who had failed to respond to ultraviolet B therapy alone, and for them a new clearing treatment was started with the addition of anthralin in increasing concentrations (0.3%, 1%, 3%). Only two patients in Group I, one patient in Group II, and one in Group III showed a moderately better clearance of psoriasis on the short-contact anthralin side. Irritation of nonaffected skin by anthralin was common only during the first week of the treatment. Staining of clothes and bedding occurred.