Clinical and Power-Doppler ultrasound features related with persistence of fistulous tracts under treatment with adalimumab in hidradenitis suppurativa: 4 years of follow-up

Fistulous tracts are the hallmark lesions of hidradenitis suppurativa (HS) and respond poorly to the currently available medical treatments. To evaluate the clinical and ultrasound features related with both healing and persistence of fistulous tracts in patients under treatment with adalimumab, a retrospective analysis of power-Doppler ultrasound (PD-US) images with fistulas in HS patients was performed. The clinical and sonographic staging of HS, body areas involved, and anatomic characteristics of the fistulous tracts were registered and graded. Chi-square test, univariate/multivariate Cox-regression analysis with clustered error, and Kaplan-Meier analysis were computed to analyze data. In total, 151 fistulous tracts from 33 HS patients were included. Age, BMI, length, thickness, subcutaneous pattern, high intensity of PD-US signal, and a high grade of fibrosis/edema were all related to a lower possibility of healing and a high risk of longer persistence at binomial Cox-regressions. Whereas, multivariate regressions showed that high fibrosis, was the variable with the highest risk of poor response and longer survival. Survival-analysis showed that fistulas with high fibrosis or PD-US signal have longer survival time than those with absent/low fibrosis or signal. Limitations include the impossibility to detect with ultrasound lesions less than 0.1 mm and smaller sample size. In conclusion, an accurate assessment of fibrosis may be crucial to define better when a surgical approach-besides the medical treatment-could be required. PD-US may assess the decrease of vascularization in HS lesions and consequently the reduction of inflammation due to immunomodulatory therapies

The Quality of Life impairment in Hidradenitis Suppurativa

Background. Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory disease of terminal hair follicles with a profound impact on the patient’s daily life, probably one of the worst that has been analysed and evaluated in dermatology. Aim. The aim of this study was to evaluate the QoL impairment in HS and identify the factors that influence it. Methods. The study was conducted with a group of forty-two patients affected by HS, aged 10–62 years, referred to the HS consultation service of Dermatology Clinic of Tor Vergata. All patients filled out the Dermatology Life Quality Index (DLQI questionnaire). The DLQI’ questions are categorized into six heading items: symptoms and feelings, daily activities, leisure, personal relationships, work and school, and treatment. The severity of the HS disease was evaluated with the Hurley staging classification, the modified Sartorius score and the Acne Inversa Severity Index (AISI score). A visual analog scale was used for pain (PAIN VAS). Patients were divided into three groups according to AISI index score: mild (4 male, 8 female), moderate (2 male, 9 female) and severe patients (6 male, 13 female). Results. Our findings are in agreement with existing literature who claims that patients with HS have a significant impairment in QoL, expressed by high DLQI score (12,6 ± 8). The most compromised elements were clinical symptoms (1,60), feelings (1,64) and daily activities (1,71). The clinical stage of disease is the most important factor related to the DLQI. The significant positive correlation between the AISI scores and DLQI scores (Pearson's r = 0,53) confirms disease severity as a predictor of worsening QoL. Pain, discomfort and embarrassment are also involved. Presence of higher PAIN VAS score was associated with an increase in DLQI (Pearson's r = 0,6). QoL was affected by age: between 26 and 49 years, an increase of the DLQI values is observed; moreover, in this group of patients, HS is a limitation in study and work activities much more than in the other categories. In patients with severe forms, the choice of clothes to wear is an important cause of discomfort. This study does not reveal a correlation between disease severity and impact on sex life. Conclusion. HS is a profoundly debilitating disease which affects patient’ lives physically, emotionally and psychologically. The average recorded of the DLQI score is higher than those found in other chronic dermatologic conditions traditionally regarded as causing significant disability. For this reason, the need to measure the quality of life of HS patients becomes particularly significant, and therefore it could be helpful design a new evaluation method or score able to specifically monitor the HS impact on QoL and evidence clearly and enclosing yet overlooked aspects

A new therapeutic for the treatment of moderate to severe plaque psoriasis: apremilast

Psoriasis is a common, chronic, inflammatory skin disease. Being a life-long condition, a prolonged and safe control of the disease is needed. Current anti-psoriatic treatments show some limits in terms of tolerability and route of administration. Recently, a new oral small molecule, apremilast, has been approved for the treatment of patients with moderate-to-severe plaque psoriasis. Apremilast is a phosphodiesterase 4 (PDE4) inhibitor that regulates the transduction of intracellular signals, including pro-inflammatory and anti-inflammatory pathways. Because of the favorable safety profile and the oral route of administration, apremilast may represent a promising therapeutic target for moderate-to-severe psoriasis. In this review, we report an updated overview about clinical trials testing apremilast in the treatment of psoriasis and seek to provide comprehensive information about this anti-psoriatic drug and a future perspective of the therapeutic algorithm for psoriasis

AISI: A New Disease Severity Assessment Tool for Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, disabling, skin disorder. Because of renewed scientific interest in HS, different aspects of the condition, such as disease severity assessment, are being investigated and better defined. The aim of this study is to provide a novel tool for the assessment of disease severity

Acne fulminans following isotretinoine therapy

Acne vulgaris is a common inflammatory disease, provoked by several factors, including hormonal influences, follicular plugging, Propionibacterium acnes (PA) colonization, and increased sebum production

Hard as a rock: a case of massive rupioid psoriasis

Psoriasis is a common dermatosis characterized by several clinical features. It can also show unusual clinical presentations, including inverse, photosensitive, elephantine, and rupioid psoriasis. In the literature it has been described only few cases of rupioid psoriasis, also known as ostraceous psoriasis. This rare variant of psoriasis is characterized by hard, well-defined, cone-shaped lesions. Most cases of rupioid psoriasis were associated with arthropathy. Here we reported a case of extensive rupioid psoriasis in a 50 years old homeless without arthropathy. Although psoriasis is a common and well-described disease, it could show atypical and uncommon presentation, that could represent a pitfall for clinicians. For this reason, it is of capital importance to know how proteiform psoriasis could be, in order to evaluate properly the patients and better treat them

Shiitake mushroom dermatitis

Shiitake mushrooms (Lentinula edodes are a worldwide known type of mushroom, employed in the traditional Asiatic medicine for healthy effects, such as immune modulation, reduction of blood pressure and anti inflammatory activity However, this mushroom may provoke allergic reactions and a peculiar dermatosis, known as shiitake dermatitis We reported a case of shiitake dermatitis in 54 year old Caucasian woman, who developed acute lesions 2 days after eating a raw shiitake mushroom for the first tim

Pediatric Hidradenitis Suppurativa: A Cross-Sectional Study on Clinical Features and Treatment Approaches

Background Hidradenitis suppurativa is uncommon in patients of pediatric age, and differentiation with adult-onset disease is controversial. Treatment of pediatric hidradenitis suppurativa is scarcely standardized, and specific guidelines are lacking. Objective We report the clinical features, relevant risk-factors, comorbidity profile, and treatment patterns of a hospital-based cohort of pediatric hidradenitis suppurativa Methods In a cross-sectional study data on patients' demographics, disease-specific characteristics, early/pre-pubertal onset of disease, comorbidities, and treatment management were retrieved. Reference population data and clinical data from the national hidradenitis suppurativa disease registry were used for comparison. Results From a database of 870 patients with hidradenitis, 71 (15 males and 56 females) patients aged <18 years (mean age: 15.3 years; range 8-17 years), with mild (Hurley I, 45.1%) and moderate-severe disease (Hurley II-III, 54.9%), were retrieved. Smoking (23.9%) and overweight/obese frequencies (59.2%) were higher than reference population standards. Patient's older age at baseline (OR 1.43, 95% CI: 1.01 to 2.02) and higher BMI (OR 1.26, 95% CI: 1.07-1.48) were the only factors associated with moderate-severe disease. Family history and early/pre-pubertal onset of disease were not associated with severity or extent of disease. Sebaceous-follicular comorbid conditions were associated with cigarette smoking (P = .002). Among 81 treatment courses, clindamycin-based and zinc-sulphate-based combination regimens were most frequently used (59.3%). Female preponderance, family history of disease and extensive involvement were significantly different from the general hidradenitis suppurativa population. Conclusions Pediatric hidradenitis suppurativa presents a clinical spectrum comparable to adult-onset disease. Increased preventive measures should target obesity and smoking in this population