Updates on the hidradenitis suppurativa from the USA

Background: There has been so much progress in hidradenitis suppurativa across the world. Objectives: The focus of this talk will be the American contributions to this effort but very few of these efforts involve any one nation. Methods/Results: Updates from American institutions will be provided with a focus on immunology, the microbiome, genetics, outcome measures, antibiotics, biologics, lasers, surgery multidisciplinary clinics, big data and support groups. Updates about the efforts of the American HS foundation will also be discussed. Conclusion: There is much to celebrate about the advances in HS across the world. North America and the United States are doing their part to reduce the suffering of our patients and their families. However, no one country can help make the strides that are needed. Our American groups recognize that we are partners with the EHSF and countries across the world in this effort

Multifocal Myositis and Elevated CPK associated with the use of Ustekinumab for Hidradenitis Suppurativa

ustekinumab (UST) is a human interleukin (IL)-12/IL-23 monoclonal antibody that has been approved by the Food and Drug Administration (FDA) to treat moderate to severe plaque psoriasis, psoriatic arthritis, and Crohn\u27s disease. Off-label use of UST has shown promising results for hidradenitis suppurativa (HS) in patients that have failed therapy with adalimumab, the only FDA approved treatment for HS

26914 Ustekinumab-induced myositis: A case series

Ustekinumab (UST) is a monoclonal antibody that blocks proinflammatory cytokines IL-12 and IL-23. Off-label use of UST has shown promising results for moderate to severe hidradenitis suppurativa (HS) in patients who have failed to respond to or unable to tolerate adalimumab, the only Food and Drug Administration (FDA) approved treatment for HS. Previously, myositis has not been reported as an adverse effect of UST. We present two patients with poorly controlled HS who experienced new onset myositis shortly after beginning treatment with UST. Abnormal electromyography (EMG) demonstrated myopathic appearing motor units in the bilateral biceps in patient 1. Creatinine kinase was elevated greater than three times normal in patient 1, and normal in patient 2. Patient 2 had marked reduction in ambulation requiring use of a cane. Both patients experienced a sequela of symptoms such as generalized muscle weakness, muscle swelling with warmth to the areas, and myalgias with improvement of symptoms shortly after discontinuation of UST. A proposed mechanism may be related to the overexpression of IL-12 and IL-23 secondary to UST’s receptor blockade. IL-12 can initiate IL-32 production, a cytokine that has been shown to be overexpressed in HS.3 Il-32 induces the production of IFNy and IL-17, byproducts of TH1 and TH17 helper cells which have been implicated in autoimmune myositis. As the use of UST increases in HS patients, it is important for clinicians to consider the potential risk of drug-induced myositis. Long-term clinical surveillance is needed to evaluate the significance and frequency of this occurrence

28522 The impact of the SARS-CoV-2 pandemic on phototherapy utilization

Phototherapy is a mainstay of treatment for several dermatologic conditions. Patients often require multiple treatments per week for several weeks to months to achieve treatment efficacy. The SARS-CoV-2 global pandemic caused many dermatology clinics to close completely or significantly reduce patient volumes, which may have limited patient access to this beneficial treatment. This retrospective study examines the pandemic’s impact on phototherapy treatment rates and reimbursement at one major tertiary care center and five locations of a private dermatology clinic in Southeast Michigan. Phototherapy CPT reimbursement data from March 1-June 30, 2020 was compared with the same timeframe in 2019. Units of phototherapy performed decreased by an average of 84%, and there was an average decrease of 43% in the number of unique patients receiving treatments. Reimbursement for phototherapy decreased by an average of 83%. The drastic decline in phototherapy reimbursement is a reflection of the pandemic’s financial impact and likely correlates to a larger scale of revenue loss in dermatology practices. Adequate phototherapy treatment was also likely delayed for many patients. As the pandemic continues, implementation of home phototherapy treatments may be necessary for patients to receive proper treatment and to minimize the impact of loss of revenue due to limited in-office phototherapy. Precautions will need to be taken to guarantee the safety of patients and the care team for patients to receive optimal in-office phototherapy treatment. The pandemic’s impact on medical dermatology finances could potentially destabilize access to patients who need this safe and effective treatment

633 Comparison of soluble proteins from skin sections of acne and TCA induced postinflammatory hyperpigmentation and erythema

Postinflammatory hyperpigmentation (PIH) is an acquired hypermelanosis occurring after cutaneous inflammation or injury that can arise in all skin types, but more frequently affects skin-of-color. The differences in the ethology of PIH and Postinflammatory erythema (PIE) in skin of color were evaluated from soluble protein extracts collected from skin section samples, using Somascan protein kit1.3 k (n=5). The skin samples were collected from selected gluteal TCA-induced lesions and truncal acne pustules, of either PIH or PIE, at day 28 post initial evaluation. Differences between proteins (FDR\u3c0.05) from PIH and PIE were analyzed with STRING version 11.5 and analysis points toward involvement of JAK/STAT signaling pathway and enhanced IL17 signaling in PIH compared to PIE lesions (OSM, CSF3, IL10RA, IL12RB2, IL10RB, IL3, CSF2, IL17D, IL17F, IFNA2, IFNA10, CRLF2, IL5RA, TYK2, IL12RB1, PRLR, GHR). The involvement of JAK/STAT signaling pathway has been described for some chronic cutaneous inflammatory conditions and acne. A higher occurrence of dermal remodeling proteases and inhibitors were found in PIE (MMP1, MMP2, MMP7, TIMP2) indicating a dermal remodeling phase at the time of excision. Concurrently, elevated levels of IL-1β, and TGF-β (critical for triggering and continuing differentiation programs of naïve CD4+ T cells to IL-17 secreting Th17 cells) in PIH samples suggests continuing promotion of macrophage infiltration and sustained inflammation. In addition to MMP13 and MMP16, the protein Keap1 was found to be increased in the PIH samples. Keap1, a repressor of master cellular defense against oxidative and electrophilic stresses, has been reported to be involved in the imbalance of proteolysis that can lead towards premature aging and in a senescent phenotype of endothelial cells. The sustained inflammation with excess of Keap1 protein might contribute to an altered proteostasis and ethology of PIH