Objective
To evaluate the safety and efficacy of adalimumab for the management of hidradenitis suppurativa (HS).
Methods
In a prospective open-label phase II study, adalimumab was administered subcutaneously in a dose of 160 mg induction regimen at week 0, followed by 80 mg at week 1, and 40 mg at alternate weeks for 12 weeks in 10 patients. The patients were followed up to 13 weeks and their disease activity was assessed using the HS Severity Index (HSSI) as well as with the numbers of daily dressing changes, the Visual Analogue Scale (VAS), Dermatologic Life Quality Index (DLQI), and Physician’s Global Assessment of disease severity (PGA).
Results
Ten patients were enrolled in this study. Of these, six patients completed the 12-week treatment period. A ≥ 50% decrease of HSSI score was not found in any of the patients at week 2, 4, 8, and 12. None of the 10 patients was classified as a responder at week 12 compared with baseline. Statistically significant difference in HSSI score was found between baseline and week 8 (P < 0.05) only but no significant differences were found between baseline and week 2, 4, and 12. Comparison of baseline with week 12 VAS and DLQI scores failed to show statistically significant improvement. Adalimumab was well tolerated and there were no serious adverse events reported.
Conclusions
Our study demonstrated statistically clinical improvement is not observed in the treatment of HS with adalimumab. Future studies using higher doses of adalimumab are warranted.
References
Amano, Masahiro; Grant, Annika; Kerdel, Francisco A
Source: IngentaConnect
Objectives
Hidradenitis suppurativa (HD) is a chronic disorder characterized from dilatation of sweat glands and recurrent bacterial infections. Vitamin E was administered in several patients as an antioxidant in an attempt to relieve tissue function probably altered by the locally increased oxidant status.
Methods
Twenty nine patients with HD, 15 male and 19 female, were enrolled over a period of twelve months. All have presented with more than three episodes of bacterial exacerbations for at least two years. A detailed medical history was taken upon first evaluation and patients were examined for areas affected by the disease. They were asked to self-evaluate the severity of their condition on a scale of 1 to 10 (1 representing intact skin and 10 maximum severity). Patients were divided into three groups of treatment: A (n = 6), controls; B (N = 8), vitamin E orally 200 mg bid; and C (N = 15), vitamin E 200 mg tid orally. Patients were withhold from any antimicrobial regime. Patients were followed-up at three-month intervals; they were asked to re-evaluate their condition, and to provide details regarding frequency of relapses before and after the initiation of treatment.
Results
Mean ± SE duration of the disease was 11.7 ± 1.9) years and of involved areas 3.84 ± 035, with axillas and groin being involved in the majority of cases. Mean interval between exacerbations before initiation of therapy with vitamin E was 33.98 ± 9.43 days and after initiation of therapy 91.35 ± 21.64 days (p: 0.042). For group B, mean ± SE time interval between exacerbations before initiation of treatment was 45.00 ± 27.39 days and after initiation of treatment 69.00 ± 38.42 days. For group C, respective values were 36.30 ± 9.42 days and 132 ± 12 days. Mean ± SE of self-evaluation scores before therapy with vitamin E was 9.00 ± 0.71 and 4.33 ± 1.76 for patients of groups B and C respectively. They were 4.75 ± 1.31 and 2.75 ± 1.55 respectively after twelve months of follow-up. The latter changes constituted a significant improvement (p: 0.027).
Conclusion
Vitamin E seems to improve the overall clinical condition of patients with HD substantially. Further placebo-controlled studies are necessary to confirm these results.
References
Antonopoulou A., Mouktaroudi M., Kyriakopoulou M., Raftogiannis M., Baziaka F., Plachouras D., Giamarellou H., Giamarellos-Bourboulis E.J.
Source: European Congress of Clinical Microbiology and Infectious Diseases
Purpose
To report a patient who presented with bilateral interstitial keratitis in association with severe hidradenitis suppurativa.
Methods
Case report.
Results
An 18-year-old African American woman with severe active hidradenitis suppurativa of the axillae and groin presented with a 2-week history of bilateral blurry vision. On examination, best-corrected visual acuity was counting fingers in the right eye and 20/70 in the left eye. Slit-lamp examination revealed diffuse vascularization of the corneal stroma with surrounding infiltrates bilaterally. In the left eye, corneal thinning and an epithelial defect were present in an area of infiltrate. Our clinical impression at that time was bilateral interstitial keratitis with secondary bacterial keratitis in the left eye. Topical therapy, prednisolone acetate 1% in the right eye, and ofloxacin in the left eye, was instituted. A systemic workup, including antinuclear antibody, rheumatoid factor, Lyme titer, cytoplasmatic staining antineutrophil cytoplasmic antibodies, perinuclear staining antineutrophil cytoplasmic antibodies, erythrocyte sedimentation rate, Venereal Disease Research Laboratory, rapid plasma reagin, basic metabolic panel, angiotensin-converting enzyme level, and a chest x-ray was negative. Topical steroids were used in the left eye after resolution of the bacterial keratitis. The interstitial keratitis responded to topical steroids and remained in remission after steroid taper. However, bilateral interstitial keratitis recurred coincident with a severe flare of hidradenitis suppurativa within 1 month of discontinuing the topical steroids. A course of subcutaneous adalimumab injections (40 mg/mL every 2 weeks) for hidradenitis suppurativa was implemented. Both her dermatological and ocular conditions responded to this therapy and have remained in remission through 7 months of follow-up.
Conclusions
Hidradenitis suppurativa is a rare cause of bilateral interstitial keratitis. Patients may experience simultaneous exacerbations of both dermatological and ocular manifestations. Systemic treatment with adalimumab can improve both dermatological and ocular conditions.
References
Alzaga Fernandez AG, Demirci H, Darnley-Fisch DA, Steen DW.
Source: PubMed
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.
References
Florence Polia, Pierre Wolkenstein, Jean Revuz
Source: Karger Dermatology
Vulvar lymphangioma circumscriptum is a rare, benign proliferation of the lymphatic system that presents a diagnostic and management challenge. It may be confused with condyloma acuminata, molluscum contagiosum, or other vulvar disorders. Treatment options include observation, surgical excision, laser ablation, or sclerosing therapy. We report 3 cases, 2 associated with vulvar squamous cell carcinoma and 1 with hidradenitis suppurativa.
References
Sims SM, McLean FW, Davis JD, Morgan LS, Wilkinson EJ
Source: PubMed
Hidradenitis suppurativa is a chronic and recurrent inflammatory disease of the apocrine glands characterized by recurrent abscesses, draining sinus tracts, and scarring that can be located in the groin, axilla, perineal, and perianal areas and less frequently in the scalp area. The chronic and relapsing nature of hidradenitis suppurativa leads to physical and psychological damage because it frequently causes disabling pain, diminished range of motion, and social isolation. Surgical removal of all apocrine glands in the affected region is the definitive treatment because conservative treatment usually does not prevent recurrence of hidradenitis suppurativa. The resultant defect can be either left to heal secondarily or closed primarily. Secondary healing in the axilla may cause contractures and stiffening of the shoulder. Primary healing requires direct closure, split-skin grafting, or locoregional flap transposition. The majority of the listed surgical procedures cause long hospital stays and leave contour defects in both the axilla and the arm. This report presents a series of 16 cases managed between March 2006 and June 2008. All the patients had endured a long period of medical treatment and subsequently required surgery for long-term relief of symptoms. The functional and aesthetic outcomes were very satisfactory in all cases despite the final scar. The initial reconstructive aims were achieved for these patients. The authors consider the thoracodorsal artery perforator flap a useful option for the surgical treatment of axillary hidradenitis suppurativa.
References
Laredo Ortiz C, López Castillo V, Solesio Pilarte F, Lorda Barraguer E
Source: PubMed
Purpose
To enhance the clinician’s knowledge of the diagnosis and treatment of hidradenitis suppurativa (HS).
Target Audience
This continuing education activity is intended for physicians and nurses with an interest in skin and wound care.
Objectives
After participating in this educational activity, the participant should be better able to:
1. Assess and diagnose the pathophysiology and prevalence of HS.
2. Interpret the diagnostic process for HS.
3. Evaluate treatment options for HS.
References
Beshara MA
Source: Advances in Skin & Wound Care
A 29-year-old man with painless ulcers on the lumbar and inguinal regions associated with purulent discharge of 1.5 years’ duration presented to our outpatient clinic. Dermatological examination revealed palpable nodules, discharging sinuses and scars on the left lumbar, gluteal and inguinal regions. According to the clinical, histopathological, scintigraphy, and magnetic resonance imaging findings as well as mycobacteriological examinations, the patient was diagnosed with Pott’s disease with scrofuloderma and psoas abscess. Herein, we present an interesting case of Pott’s disease with scrofuloderma and psoas abscess mistreated as hidradenitis suppurativa for a long time.
References
Aylin Türel Ermertcan, Ferdi Öztürk, Gülsüm Gençoğlan, Işil İnanir, Nuri Özkütük2 & Peyker Temiz
Source: Informa Healthcare
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease that affects the hair follicles in the axillary, perianal and inguinal area. Its cause and pathogenesis are unknown, but cigarette smoking increases the risk of developing HS conceivably by accumulating toxic metabolites in sweat. The xenobiotic compounds from tobacco are metabolized by the cytochromes P-450. The cytochrome P-450 1A1 (CYP1A1), one of the most active isoenzymes, harbours several polymorphisms. Two of them, MspI and Ile462Val single nucleotide polymorphism (SNP), are associated with enhanced activity and inducibility. Performing direct DNA sequencing, we investigated the frequencies of these SNP in 51 patients with HS, 45 of these were smokers. We found similar overall SNP rates in our patients in comparison with previous data for Caucasian or German controls. Obviously, there is no relation between the occurrence of these SNPs and the risk of developing HS.
References
Lukowsky, Ansgar; Sterry, Wolfram; Schneider-Burrus, Sylke
Source: IngentaConnect
Hidradenitis suppurativa is a chronic disease characterized by chronic or recurrent abscesses, sinus tracts and scarring of apocrine gland-bearing skin. Key areas of different treatment options for hidradenitis suppurativa have been addressed and outlined in this review. Management should be individualized according to the extent of the disease, frequency of exacerbation and risk status. The treatment consists of medical (local or systemic), surgical and laser therapy. New treatments, such as TNF-α inhibitors, have provided clinicians with more options against this difficult disease.
References
Shiva Yazdanyar and Gregor BE Jemec
Source: Expert Reviews
