A retrospective study of the characteristics of patients with early-onset compared to adult-onset hidradenitis suppurativa

Background: The mean age of onset of hidradenitis suppurativa (HS) is between 20 and 24 years. Very few data about patients with early-onset HS exist. Objective: To investigate the association of early-onset HS with the clinical characteristics: age, gender, body mass index (BMI), smoking, family history of HS, Hurley stage, and number of areas affected. Methods: This was a retrospective study of the reported early age at HS onset (≤17 years old) with clinical characteristics and with the severity of HS at first consultation visit. Results: In 166 patients, 42 patients (25.3%) reported early-onset HS. Compared to adult-onset HS, patients with early-onset HS were younger (mean age: 37 years vs. 27 years, P < 0.0001), had a significantly younger mean age of onset (28.2 years old vs. 14.5 years old, respectively, P < 0.0001), longer mean disease duration (8.8 years vs. 12.6 years, respectively, P = 0.011) and were less frequently smokers (P < 0.001), whereas there was no association with gender (P = 0.177) or BMI (0.086). Patients with a family history had increased risk for early-onset HS (OR: 2.45, 95% CI: 1.08–5.56). Early-onset HS was not associated with Hurley stage (OR: 1.12, 95% CI: 0.33–3.74) or with the number of body areas affected (OR: 1.54, 95% CI: 0.49–4.83). Conclusion: Early-onset HS was frequent and associated with a family history of HS. There was no difference in the severity of HS in adult life for patients with an onset of HS at ≤17 years, compared to patients with adult-onset, which may be reassuring information for these younger patients. © 2018 The International Society of Dermatolog

Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up

Background: Limited data exist on the use of systemic antibiotic treatment for hidradenitis supportive (HS). Aim: To investigate the effectiveness, safety and relapse rate of HS treated with a combination of daily oral clindamycin and rifampicin. Methods: This was a prospective, hospital-based study of oral clindamycin 600 mg and rifampicin 600 mg daily for 12 weeks for treatment of HS. Patients were followed up for 1 year to monitor for relapse. Results: In total, 26 patients with HS received oral clindamycin and rifampicin. Most were overweight or obese (73%), and most were smokers (88%). After 12 weeks, clinical response was noted in 19 patients (73%). Response was associated only with female sex (P = 0.02), and not with body mass index, Hurley stage or lesion location. Eight patients (31%) experienced adverse events. At the 1-year follow-up, there was sustained efficacy in 7 (41%) patients, while 10 (59%) had disease relapse after a mean time of 4.2 months. Conclusions: Oral clindamycin with oral rifampicin for 12 weeks is an effective and tolerable regimen for HS. © 2016 British Association of Dermatologist

Supplementary Material for: Quality of Life and Psychosocial Implications in Patients with Hidradenitis Suppurativa

<p><b><i>Background:</i></b> Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact. <b><i>Objective:</i></b> To evaluate the quality of life, depression, anxiety, loneliness, and self-esteem in patients with HS. <b><i>Methods:</i></b> Ninety-four patients with HS were enrolled in the study. The quality of life, depression, anxiety, loneliness, and self-esteem of the patients were assessed using the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS), the UCLA Loneliness Scale (UCLA-Version 3), and the Rosenberg Self-Esteem Scale (RSES), respectively. <b><i>Results:</i></b> The DLQI mean score was 11.43 ± 6.61 in patients with HS. The patients with HS presented statistically significantly higher anxiety (6.41 ± 3.31 vs. 5.00 ± 1.59, <i>p</i> < 0.001), depression (5.45 ± 2.79 vs. 4.16 ± 1.54, <i>p</i> < 0.001), and loneliness and social isolation scores (42.86 ± 8.63 vs. 35.57 ± 6.17, <i>p</i> < 0.001) and lower self-esteem scores (18.91 ± 1.79 vs. 19.77 ± 2.53, <i>p</i> = 0.008) than the healthy controls. <b><i>Conclusions:</i></b> HS is a distressing, recurrent disease that impairs quality of life. We can suggest services that allow an integrated approach, which includes psychosocial support, offering the patients relief from isolation and an opportunity to share common experiences.</p

Pilonidal sinus disease:an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients

BACKGROUND: Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses). The association with pilonidal sinus disease (PSD) is frequently reported but not well documented. OBJECTIVES: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS. METHODS: This was an international multicentre retrospective cross-sectional study based on data collection from a large cohort of patients with HS with and without histopathology. Results From a total of 2465 patients with HS included in the study, 661 (27%) reported lesions in the IGF. These patients were significantly more often smokers and had more severe HS. Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%). IG-HS was associated with the localization of HS in the proximity of the IGF, including the buttocks, genitals and the anus. There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available. CONCLUSIONS: The high prevalence of PSD suggests a strong link between both entities. Therefore, it may be useful to identify common pathophysiological mechanisms and develop common therapeutic strategies. What's already known about this topic? The occurrence of pilonidal sinus disease has not been clearly reported among patients with hidradenitis suppurativa/acne inversa. What does this study add? This is the first study that investigated the prevalence of pilonidal sinus disease among a large cohort of patients and identified the patient characteristics. Risk factors that might help to improve the management of patients were identified

Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients

Background: Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses). The association with pilonidal sinus disease (PSD) is frequently reported but not well documented. Objectives: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS. Methods: This was an international multicentre retrospective cross-sectional study based on data collection from a large cohort of patients with HS with and without histopathology. Results From a total of 2465 patients with HS included in the study, 661 (27%) reported lesions in the IGF. These patients were significantly more often smokers and had more severe HS. Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%). IG-HS was associated with the localization of HS in the proximity of the IGF, including the buttocks, genitals and the anus. There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available. Conclusions: The high prevalence of PSD suggests a strong link between both entities. Therefore, it may be useful to identify common pathophysiological mechanisms and develop common therapeutic strategies. What&apos;s already known about this topic?. The occurrence of pilonidal sinus disease has not been clearly reported among patients with hidradenitis suppurativa/acne inversa. What does this study add?. This is the first study that investigated the prevalence of pilonidal sinus disease among a large cohort of patients and identified the patient characteristics. Risk factors that might help to improve the management of patients were identified. © 2019 British Association of Dermatologist

Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity

Background: A validated tool for the dynamic severity assessment of hidradenitis suppurativa/acne inversa (HS) is lacking. Objectives: To develop and validate a novel dynamic scoring system to assess the severity of HS. Methods: A Delphi voting procedure was conducted among the members of the European Hidradenitis Suppurativa Foundation (EHSF) to achieve consensus towards an initial HS Severity Score System (HS4). Strengths and weaknesses of HS4 were examined by a multicentre prospective study. Multivariate logistic regression, discriminant analysis and receiver operating characteristic curves, as well as examination for correlation (Spearman's rho) and agreement (Cohen's kappa) with existing scores, were engaged to recognize the variables for a new International HS4 (IHS4) that was established by a second Delphi round. Results: Consensus HS4 was based on number of skin lesions, number of skin areas involved and Dermatology Life Quality Index (DLQI), and was evaluated by a sample of 236 patients from 11 centres. Subsequently, a multivariate regression model calculated adjusted odds ratios for several clinical signs. Nodules, abscesses and draining tunnels resulted as the scoring variables. Three candidate scores were presented to the second Delphi round. The resulting IHS4 score is arrived at by the number of nodules (multiplied by 1) plus the number of abscesses (multiplied by 2) plus the number of draining tunnels (multiplied by 4). A total score of 3 or less signifies mild, 4\u201310 signifies moderate and 11 or higher signifies severe disease. Cohen's kappa was fair (\u3ba = 0\ub732) compared with Hurley classification, and moderate (\u3ba = 0\ub749) compared with Expert Opinion. Correlation was good (\u3c1 &gt; 0\ub76) with Hurley classification, Expert Opinion, Physician's Global Assessment and Modified Sartorius score, and moderate for DLQI (\u3c1 = 0\ub736). Conclusions: The novel IHS4 is a validated tool to dynamically assess HS severity and can be used both in real-life and the clinical trials setting