C. Ferreli

D. Agosta

J. Anedda

L. Atzori

S. Mertoli

English

Archivio istituzionale della ricerca - Università di Cagliari

     This is the Author’s [accepted] manuscript version of the following contribution: D. Agosta, C. Ferreli, J. Anedda, S. Mertoli and L. Atzori 2019. Efficacy and tolerability of an antiperspirant cream in hidradenitis suppurativa patients. Journal of Applied Cosmetology. 37, 1 (Jun. 2019), 33/39.  The publisher's version is available at: SCOPUS: 2-s2.0-85103206766 NO DOI ASSIGNED  When citing, please refer to the published version.         This full text was downloaded from UNICA IRIS https://iris.unica.it/  For approvalJournal of Applied CosmetologyCopyright © by Journal of Applied Cosmetology ISSN 0392-8543.This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder.Unauthorized reproduction may result in financial and other penaltiesDISCLOSURE: ALL AUTHORS REPORT NO CONFLICTS OFINTEREST RELEVANT TO THIS ARTICLE.For approvalEfficacy and tolerability of an antiperspirant cream in hidradenitis suppurativa patientsD. Agosta, C. Ferreli, J. Anedda, S. Mertoli, L. Atzori 1Dermatology Clinic, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, ItalyCorresponding Author:Prof.ssa Ferreli CaterinaClinica DermatologicaVia Ospedale 5409124 Cagliari (Italy)Phone: +393408918912Fax: +3907051092303Email: ferreli@unica.it key words: hidradenitis suppurativa, antiperspirant product, agaricin, deodorants, efficacyIntroductionHidradenitis suppurativa (HS) is a chronic, progressive, inflammatory and relapsing skin disease of the follicular unit of the apocrine gland-rich intertriginous areas, that significantly affects the quality of life of an active, young adult population (1-4). The axillary (Fig. 1), inguinal, inframammary, genital areas of the body are the most affected sites and the lesions are characterized by recurrent painful inflamed deep-seated nodules, that result in abscesses and chronic draining sinus tract formation and eventual disfiguring scars (5). Estimates of global prevalence range between 1% and 4%, without racial differences and with a higher incidence in female population. The etiology is still unclear, but the onset of HS is related to a combination of genetic and environmental factors, such as bacterial infection, hormones, smoking, obesity, mechanical and immune factors.Journal of Applied Cosmetology, Vol. 37 iss. 1 (Jan-Jun 2019)For approvalFig. 1. Hidradenitis suppurativa involvement of the armpit in 2 patients accepting to apply the tested product: a mild form in the man, and a Hurley 3 stage in the woman.Quality of life is seriously compromised by the chronic pain, malodorous abscesses, scarring, and disfigurement. Anxiety and depression are very common in this patient, resulting in a higher risk of suicidal ideation (6). Aesthetic complains worsen the embarrassment and limitations to social, sexual and working life. Often the patient hides the problem even to their relatives and avoids seeking medical care. A mean delay of 7 years from onset to diagnosis is reported (1). Moreover, medical indications for the management of the disease are often in contrast with daily patients’ needs, with further compromising of social attendance. In fact, it is generally recommended to avoid deodorants, sweating, rubbing, occlusive or adherent clothing, razor blade shaving (4). Purpose of our study was to test the efficacy and tolerability of an antiperspirant cream composed of agaricin and chloridol in voluntary patients, with mild to moderate HS. Materials and methodsAn interventional open study was proposed to hidradenitis suppurativa patients consecutively visited at the dermo-cosmetics outpatient ambulatory of the Dermatology Clinic of Cagliari University Hospital, and 15 patients (9 males and 6 females, mean age 26 years) gave consent to recruitment. The study consisted on the daily application for three months of an antiperspirant and anti-odor cream composed of agaricin (a natural substance obtained from Fomes Officinalis, a hard and woody mushroom that grows on the trunk of de larch) and Chlorhydrol, Journal of Applied CosmetologyFor approvalFor approvalwith antibacterial and antiperspirant properties. Severity of disease was classified following Hurly staging. All patients were under topical and/or systemic treatment following standard HS guidelines. Only required exclusion criteria was the use of other deodorants or antiperspirants during the study period. At the 3-month-follow up a questionnaire was administered to evaluate efficacy, cosmetology pleasantness, and tolerability of the cream. Each item was assigned a score from 0 (minimum value) to 5 (maximum value).ResultsAll 15 patients returned to visit after 3 months and reported not having skipped the daily application or used other deodorant products. As regards disease severity (Fig. 2), only 2 cases were considered severe (Hurley 3), the majority being moderate (8 cases) and mild (5 cases).   Fig.2. Severity of disease following Hurley staging according to sex, and total cases.  012345678Hurley I Hurley II Hurley IIIMales Females TotalFig. 2. Severity of disease following Hurley staging according to sex, and total cases.Table I shows the patients’ answer to the 9 items investigated at the 3-month-follow-up, regarding efficacy, cosmetic characteristics, and possible unpleasant complaints. The overall effectiveness of the product was maximal for all patients, reducing sweating and improving odor of the axillary regions for a duration of at least 24 hours (Fig. 3).  The cosmetology of the tested product, understood as comfort, applicability, pleasantness of texture and fragrance was reported as maximal (Fig. 4).Journal of Applied Cosmetology, Vol. 37 iss. 1 (Jan-Jun 2019)For approvalItems of investigation 0 1 2 3 4 5Sweating control 0 0 0 0 0 15Odour Control 0 0 0 0 0 15Confortable application0 0 0 0 0 15Texture 0 0 0 0 0 15Fragrance 0 0 0 0 0 15Redness 14 1 0 0 0 0Burning 15 0 0 0 0 0Itching 14 1 0 0 0 0Other discomfort 15 0 0 0 0 0Table I. Questionnaire items investigated at the 3-month-follow-up with a 5-point-scale, where 0 is absence of effect and 5 maximum effect of the tested product.   Fig. 3. Overall rating for the items related with efficacy after24-hour-application.   02468101214160 1 2 3 4 5Efficacy on sweating and odourMales Females TotalFig. 3. Overall rating for the items related with efficacy after24-hour-application.Journal of Applied CosmetologyFor approvalFor approval Fig.4. Overall rating for the items related to cosmetic pleasantness.   02468101214160 1 2 3 4 5Texture –Fragrance – ApplicabilityMales Females TotalFig. 4. Overall rating for the items related to cosmetic pleasantness.Finally, tolerability was also optimal, only the patient affected with severe disease reporting mild erythema and itching (Fig. 5), but not limiting the use of the product, as the effects on perspiration and odor were prevalent on mild discomfort. Fig.5. Overall rating for the items related with local adverse events (irritation, redness, itching, burning sensation, or others).   02468101214160 1 2 3 4 5Local adverse eventsMales Females TotalFig. 4. Overall rating for the items related to cosmetic pleasantness.Journal of Applied Cosmetology, Vol. 37 iss. 1 (Jan-Jun 2019)For approvalThe general visit confirmed that no patients had signs of disease worsening or irritation related with the tested product application.DiscussionHidradenitis suppurativa is a pathology with a high impact on self-esteem, compromising relationship, social and sexual life (1,6) Malodorous intertriginous areas severely impact on normal daily activities, as well as playing sports. For a long time, the convincement that antiperspirants could cause or worsen the disease led to advise the patients not to use them. Of course, certain aggressive commercial products might cause excessive occlusion, interfere with trans-epidermal water loss (TEWL), thereby increasing skin surface moisture, and favoring bacterial proliferation (4).  Other potential deleterious impacts of these cosmetics on the HS skin are related to chemical irritant effects on cut, nicked or irritated skin (7,8). It is otherwise noteworthy that sweat represents a pabulum for bacterial proliferation, in particular for those involved in HS, so the use of antiperspirants can be complementary to therapy. In our study 15 patients affected with mild to moderate hidradenitis suppurativa reported good efficacy and tolerability of an antiperspirant cream applied in the axillary regions every 24 hours for 3 months. No worsening of the underlying disease was observed, and only mild erythema and itching occurred in the only severe case participating in the study, not requiring discontinuation of the application. No differences were observed between men and women and between the various Hurley stages. Main limitation of the study was the number of patients, and prevalence of mild to moderate disease. However, male’s participation was valuable for a major physiological sweating and physical activity in respect to females.  Our study confirms that the use of mild antiperspirants, free of irritating chemicals, can be applied to damaged and inflamed skin, improving a very important cause of discomfort in HS patients. ConclusionsIn a chronic pathology so difficult to treat and with so many psychological and social repercussions, resolution of even an apparently small aesthetic discomfort can make the difference. Antiperspirants should not be avoided for the mis-concept of worsening hidradenitis suppurativa. They are necessary complements to therapy, to improve normal living unmet needs. Of course, tested efficacy and tolerability of the cosmetic products is necessary, suitably selected for such disadvantaged patients.References 1. Revuz J. (2009) Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 23(9):985-98.2. Wang S.C., Wang S.C., Alavi A., Alhusayen R., Ba-shash M., Sibbald R.G. (2015) Hidradenitis Sup-purativa: A Frequently Missed Diagnosis, Part 2: Treatment Options. Adv Skin Wound Care 28(8):372-80; quiz 381-2.3. Calao M., Wilson J.L., Spelman L., Billot L., Ru-bel D., Watts A.D., Jemec G.B.E. (2018) Hidrade-nitis Suppurativa (HS) prevalence, demographics Journal of Applied CosmetologyFor approvalFor approvaland management pathways in Australia: A po-pulation-based cross-sectional study. PLoS One 24;13(7):e0200683.4. Scheinfeld N. (2013) Hidradenitis suppurativa: A practical review of possible medical treatments ba-sed on over 350 hidradenitis patients. Dermatol Online J 15;19(4):1.5. Margesson L.J., Danby F.W. (2014) Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol 28(7):1013-27. 6. Patel Z.S., Hoffman L.K., Buse D.C., et al. (2017) Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Sup-purativa [corrected]. Curr Pain Headache Rep 1;21(12):49. 7. Edlich R.F., Silloway K.A., Rodeheaver G.T., Cooper P.H. (1986) Epidemiology, pathology, and treat-ment of axillary hidradenitis suppurativa. J Emerg Med 4(5):369-78.8. Morgan W.P., Leicester G. (1982) The role of depi-lation and deodorants in hidradenitis suppurativa. Arch Dermatol 118(2):101-2. 

Efficacy and tolerability of an antiperspirant cream in hidradenitis suppurativa patients

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Efficacy and tolerability of an antiperspirant cream in hidradenitis suppurativa patients.

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