Potential role of serum amyloid A in hidradenitis suppurativa

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Sensors and Biosensors for C-Reactive Protein, Temperature and pH, and Their Applications for Monitoring Wound Healing: A Review

Wound assessment is usually performed in hospitals or specialized labs. However, since patients spend most of their time at home, a remote real time wound monitoring would help providing a better care and improving the healing rate. This review describes the advances in sensors and biosensors for monitoring the concentration of C-reactive protein (CRP), temperature and pH in wounds. These three parameters can be used as qualitative biomarkers to assess the wound status and the effectiveness of therapy. CRP biosensors can be classified in: (a) field effect transistors, (b) optical immunosensors based on surface plasmon resonance, total internal reflection, fluorescence and chemiluminescence, (c) electrochemical sensors based on potentiometry, amperometry, and electrochemical impedance, and (d) piezoresistive sensors, such as quartz crystal microbalances and microcantilevers. The last section reports the most recent developments for wearable non-invasive temperature and pH sensors suitable for wound monitoring

Hidradenitis suppurativa: advances in diagnostic and therapeutic work-up

The aim of the project was to better characterize hidradenitis suppurativa (HS), which is a chronic, recurrent, inflammatory disease with a main diagnostic delay of 7 years and a strong impact in the patient’s quality of life. We evaluated the comorbidities, the complications, the impact in the quality of life, the better diagnostic tools and the treatment outcomes. Considering that the global estimates of prevalence ranges from 0.03% to 4% of the population, the comorbidities and the sex-related differences in HS were analyzed in multicentric studies, collecting 234 and 124 patients respectively. The disease generally appears after puberty and there are only few cases reported in the literature in younger children. The pediatric population was evaluated in collaboration with the Hospital for Sick Children (Toronto, Canada) and other 8 centers in a multicentric retrospective study which included 481 pediatric patients. For evaluating the best way to diagnose and manage HS, we analyzed the role of High Frequency Ultrasound (HFUS) and Ultra High Frequency Ultrasound (UHFUS). The comparison of clinical and ultrasound scores using HFUS in the HS patients was performed in collaboration with the Italian ultrasound working group, showing that the severity of HS assessed only by clinical examination can be underestimated. The UHFUS (Vevo®MD, Visualsonics, Toronto, Canada) is provided by three different probes (22-48-70 MHz) and is characterized by a very high resolution (30 micron). Sonographic criteria for diagnosis HS using HFUS have been described (SOS-HS score), but UHFUS showed the detection of early signs and small sub-clinical changes in HS, which were not previously detectable. These new findings can help to better understand the evolution of the diseases from early to advanced stages and to perform an early diagnosis. The identification of early findings may also allow a better treatment monitoring of the patients and a detailed pre-surgical mapping in patients who are candidate for surgery. We also evaluated the topical treatments, analysing both the pre-surgical lesions and the post-surgical lesions. In particular, in order to better assess the topical management of HS, we described a new tool based on the main principles of the wound bed preparation in wound healing, called HS-TIME. We moreover described the efficacy of adalimumab in 11 adult patients and the case of a young girl suffering from HS, treated with a combination of surgical procedures and adalimumab for 4 years, with good results. The prevalence of HS is underestimated and a correct early diagnosis may help to prevent severe complications. Further investigations studies are needed to determine the efficacy of the new diagnostic tools and the different treatments in HS. In order to promote a multidisciplinary approach on diseases which may be better managed by the use of cutaneous ultrasonography we founded the first international society of cutaneous ultrasound (ISCU). The main aim of the society is to encourage muti-centric, interdisciplinary research projects, based on the ultrasonographic study of skin and subcutaneous tissue

Skin Physiology of the Neonate and Infant: Clinical Implications

Significance: The skin is a complex and dynamic organ that performs several vital functions. The maturation process of the skin starts at birth with the adaption of the skin to the comparatively dry environment compared to the in utero milieu. This adaptive flexibility results in the unique properties of infant skin. To deliver appropriate care to infant skin, it is necessary to understand that it is evolving with unique characteristics. Recent Advances: The role of biophysical noninvasive techniques in the assessment of skin development underlines the importance of an objective evaluation of skin physiology parameters. Skin hydration, transepidermal water loss, and pH values are measurable with specific instruments that give us an accurate and reproducible assessment during infant skin maturation. The recording of these values, following standard measurement procedures, allows us to evaluate the integrity of the skin barrier and to monitor the functionality of the maturing skin over time. Critical Issues: During the barrier development, impaired skin function makes the skin vulnerable to chemical damage, microbial infections, and skin diseases, possibly compromising the general health of the infant. Preterm newborns, during the first weeks of life, have an even less developed skin barrier and, therefore, are even more at risk. Thus, it is extremely important to evaluate the risk of infection, skin breakdown, topical agent absorption, and the risk of thermoregulation failure. Future Directions: Detailed and objective evaluations of infant skin maturation are necessary to improve infant skin care. The results of these evaluations should be formed into general protocols that will allow doctors and caregivers to give more personalized care to full-term newborns, preterm newborns, and infants

Hidradenitis Suppurativa and Wound Management

Hidradenitis suppurativa (HS) is a chronic, burdensome, debilitating disease of the hair follicle. It presents with recurrent painful inflamed and noninflamed lesions usually in specific body areas such as axillary, inguinal, perineal, and genital areas. It is associated with a large range of other diseases and conditions, such as obesity, arthropathy, inflammatory bowel diseases, and sqaumous cell carcinoma. Medical therapy may be systemic or topical, mainly based on antibiotics, retinoids, hormones and immunosuppressive drugs, including biological therapies. Surgical and laser therapies may be a valid therapeutic approach in order to treat locally recurring lesions. The aim of this article is to review the wound healing options after skin excision and laser treatments, with a focus on lesions left to heal by secondary intention, analyzing the efficacy of moist wound dressings, negative pressure wound therapy, bioactive dressings, such as platelet-rich plasma gel and hylarunoic acid scaffold, or autologous keratinocyte suspension in platelet concentrate and skin-grafting tecniques

HS-TIME: A Modified TIME Concept in Hidradenitis Suppurativa Topical Management

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by lesions such as abscesses and fistulas. The disease may require medical and/or surgical treatment, and the role of wound care is crucial. The acronym TIME (tissue nonviable, inflammation/infection, moisture imbalance, edge of wound) is widely recognized as a standardized approach to wound bed preparation

Long-Term Outcome of Adalimumab in a Young Girl with Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, burdensome inflammatory skin disorder mainly affecting adults with an infrequent onset during childhood or adolescence. Guidelines regarding the therapeutic drugs in pediatric HS patients are lacking. We describe the case of a 16-year-old girl affected by HS with a massive impact of the disease on her daily activities. She underwent antibiotics, estroprogestinics, isotretinoin, and drainage procedures with partial and short-term improvement. We treated the patient with adalimumab and assessed disease severity using BMI, pain VAS, Hurley, m-Sartorius, and HS-PGA. The treatment has been continued for 4 years with a strong improvement of clinical and psychological outcome. No side effects were recorded throughout the treatment period