P. Theut Riis

Severe hidradenitis suppurativa responding to treatment with secukinumab: A case report

An inappropriate immunological response to an unknown antigen has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Studies have identified elevated levels of several proinflammatory cytokines, including interleukin (IL)‐17A and tumour necrosis factor‐α, nominating these as possible therapeutic targets.1 Secukinumab is an IL‐17A monoclonal antibody, which binds to IL‐17A and inhibits the cytokine interaction with the IL‐17 receptors, inhibiting the inflammatory cascade. Here we report a case of a 47‐year‐old man, with Hurley stage III lesions on the neck, axillae, breasts, genital skin and buttocks, who had experienced only temporary benefit from different medical treatments over several years. After 12 weeks of treatment with secukinumab, the number of lesions reported by the patient within the period of the last 4 weeks was reduced from 23 to seven, his pain visual analogue scale (VAS) score was reduced from 5 to 3 and pain/utility/handicap VAS score was reduced from 7 to 4. These results may be taken to imply that IL‐17 blockade could provide a possible therapeutic approach in the treatment of HS.

A pilot study of unemployment in Hidradenitis Suppurativa Patients in Denmark

Hidradenitis Suppurativa (HS) is a chronic, inflammatory and relapsing skin disease, characterized by repeated outbreaks of painful inflamed nodules in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and perianal region). These nodules can progress to abscesses, sinus tracts (tunnels) and scarring. (1) The estimated prevalence is 1-4% worldwide and HS is approximately three times more common in women than in men. (1) HS is associated with significant disability and handicap. The lesions are often painful and lead to loss of mobility. This article is protected by copyright. All rights reserved.

Patients with hidradenitis suppurativa have no increased risk of Alzheimer disease

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease and 30-40% of patients report first-degree relatives with HS [1]. Both familial HS and Alzheimers disease (AD) are linked to mutations in the γ-secretase complex. [2] The γ-secretase complex consists of presenilin (PS), nicastrin (NCSTN), anterior pharynx defective-1 (APH-1), and pesenilin enchancer-2 (PEN-2). The complex cleaves substrates in the lipid bilayer, most notably amyloid precursor protein (APP) and Notch. [3] Amyloid plaques of the brain are a key step in the pathogenesis of AD [3] and amyloidosis has been described in HS patients [4]. Due to causal mutations in the same complex, researchers have speculated if AD and HS are caused by the same mutations or mutually exclusive. [5] We have therefore studied the risk of AD in patients with HS. This article is protected by copyright. All rights reserved.

Low and high body mass index in hidradenitis suppurativa patients-different subtypes?

Overweight is a well‐established risk factor for hidradenitis suppurativa (HS). In this cross‐sectional study, we compare HS patients with a high body mass index (BMI) with HS patients with a low BMI to investigate differences in disease characteristics.

Towards global consensus on core outcomes for Hidradenitis Suppurativa research: An update from the HISTORIC consensus meetings I and II

A core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed‐upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of the literature and a healthcare professional survey, and initial votes had been cast in two e‐Delphi surveys. In this manuscript, we describe two in‐person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items.

Recognizing syndromic hidradenitis suppurativa: a review of the literature

Hidradenitis suppurativa (HS) is an inflammatory skin disease causing painful inflammation and suppuration. It may occur in rare syndromes: follicular occlusion, Bazex–Dupré–Christol, Downs, KID, PAPASH, PASS, PASH, and SAPHO syndromes, as well as Dowling‐Degos disease. An overview of syndromic HS may inform the search for aetiological factors in HS. PubMed, Ovid and Web of Science were systematically searched using ‘(hidradenitis OR acne invers*) AND (syndrome OR KID OR PASS OR PAPA OR PASH OR SAPHO OR bazex‐dupre OR ‘dowling degos’ OR triad OR tetrad)’ and Cochrane Library using ‘hidradenitis OR acne invers*’. A total of 82 articles were included in the final review. We summarize 134 cases collected from the 82 included articles. The syndromes are discussed, focusing on etiopathogenesis, clinical presentation and treatment. This study is based on case reports; therefore, conclusions may be subject to the selection bias. These syndromes are rare; however, it is important to recognize them, as treating them may require a different approach. Three subtypes of syndromic hidradenitis are suggested: syndromes with known genetic abnormalities, syndromes characterized by follicular plugging or structural defects, and syndromes with possible autoinflammatory pathogenesis. There was no universally effective treatment for syndromic HS, and treatment was individualized.

Prodromal symptoms in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease, which presents as recurrent nodules and sinus tracts (tunnels) with subsequent scarring, predominantly involving the intertriginous regions. Although prodromal symptoms (i.e. various symptoms preceding the eruption of the HS lesions) are often mentioned, there have been no formal investigations into this aspect. Insight into prodromal symptoms may enable patients with HS or dermatologists in choosing a more targeted treatment at a much earlier stage, potentially increasing treatment efficacy and quality of life.

Self‐reported pain management in Hidradenitis Suppurativa

DEAR EDITOR, Hidradenitis suppurativa (HS) is a chronic, inflammatory and often painful skin disease. It presents as recurrent nodules and tunnels (sinus tracts) with subsequent scarring involving predominantly the intertriginous regions. The nodules progress from being noninflamed to overinflamed, then to abscesses that may rupture causing suppuration and severe malodour. Prevalence estimates ranges from 0 05% to 4%. Although it has been shown that the hair follicle is central to the pathogenesis of the disease, the exact aetiology remains enigmatic. Medical management may alleviate the symptoms; however, many patients require surgery. Pain is an important aspect of HS, and several studies have continuously demonstrated a significant reduction in quality of life among patients with HS, using the Dermatology Life Quality Index. The adverse effects on utility as measured by EuroQol-5D in patients with HS are attributed primarily to pain and discomfort. The characteristics of pain have previously been described as hot, burning, pressure, stretching, sharp and splitting. Although the Hidradenitis Suppurativa Priority Setting Partnership recently included pain management in its top 10 list of HS research priorities, no guidelines or studies on pain control in HS exist. In addition, according to our own clinical experience, alternative ways of relieving pain are often reported by patients attending our own department, reflecting the desperate desire of patients with HS to alleviate or control the sensation of pain. Knowledge on self-reported pain management in HS may provide valuable insight into this problem and possibly help to identify new management strategies that potentially might benefit patients with HS. The Danish Data Protection Agency of Region Zealand approved this study (REG-135-2014), which was conducted at Roskilde Hospital, Department of Dermatology, from January to June 2015. We were informed by the regional ethical committee that ethical committee approval is not required for questionnaire studies in Denmark. The inclusion criteria were a verified diagnosis of HS (International Classification of Diseases, 10th revision code L732) and age > 18 years. A descriptive study was conducted of 46 outpatients with HS attending for routine visits at the Department of Dermatology, Roskilde Hospital, Denmark (Table 1). A qualified dermatologist assessed patients during physical examination using Hurley staging and Sartorius score to classify HS severity as part of the routine consultation. Both score systems rely on physical findings such as involvement of specific anatomical sites, number of nodules, sinus tracts and scars. The Hurley system is a classification of three levels (mild, moderate and severe: I–III). The Sartorius system allows calculation of a numerical score for each body area involved, and points are awarded for each skin manifestation, with the score ranging from 4 to infinity.

In vivo measurements of blood vessels’ distribution in non-melanoma skin cancer by dynamic optical coherence tomography — a new quantitative measure?

Skin biopsies only provide point‐in‐time data making longitudinal studies difficult. Using Dynamic optical coherence tomography (D‐OCT) in vivo, non‐invasive imaging of the microvasculature becomes possible. The current OCT literature is almost exclusively based on qualitative information but quantitative data may offer additional advantages, for example, by reducing observer variation. The objective of this study was to evaluate the in vivo superficial distribution of blood vessels, defined as the surface‐to‐first‐vessel distance, in actinic keratosis, basal cell carcinoma, squamous cell carcinoma and normal skin.

Hidradenitis suppurativa treated with secukinumab

Hidradenitis suppurativa (HS) is a serious skin disease. The cause of HS not known, but it is thought that a disturbance in the immune systems response plays an important role. Studies have found elevated levels of small proteins called cytokines in HS skin. Cytokines are signalling molecules that cells of the immune system use to communicate with each other. Some cytokines cause more inflammation in the skin and others reduce it. IL‐17A is one of the cytokines that cause inflammation, and it was found to be elevated in HS skin. If you remove IL‐17A from the skin tissue, inflammation is reduced and may even disappear. Secukinumab is an antibody that binds and destroys IL‐17A. Because there is a lot of IL‐17A in the skin of HS patients, we have tried this new treatment in a patient with severe disease. Our patient is a 47‐year‐old man, with severe HS. He has been treated for many years and only had temporary benefit from several other treatments that have been tried. We carefully recorded the patients experience of the treatment, comparing the results at the start of treatment with those after 12 weeks of treatment. After treatment with secukinumab the patient reported fewer boils (going from 23 to 7); less pain (going from 5 to 3 on a ten point scale) and less pain/utility loss/handicap (going from 7 to 4 on a ten point scale). The results may be taken to imply that medications targeting IL‐17A could provide a possible treatment approach for HS in the future.