Interesting Open Access Hidradenitis Suppurativa (HS) Reads – October 2024
Some interesting #openaccess #HidradenitisSuppurativa (HS) reads that appeared in PubMed during October 2024
Links Between Hidradenitis Suppurativa and Plastics Use, Processed Food, and Sweating?
Noting a dramatic rise in HS in comparison to other skin conditions over the past two decades, the authors of this study investigated the relationship between HS and potential environmental associations, particularly dietary habits and lifestyle factors focusing on food types, plastic containers use, and sweating. The researchers recruited 40 patients from their dermatology clinic (20 with HS and 20 unaffected by HS) and administered surveys covering demographics, lifestyle factors, and disease history. In comparison to the controls, patients with HS reported a higher frequency of microwaving foods in plastic containers as well as using single-use plastic water bottles and higher frequency sweating. When asked about lifestyle changes, diet modifications were reported as the most effective way to manage HS symptoms. The study team’s findings suggest potential correlations that merit further exploration. They hypothesize that lipophilic substances from plastic containers or processed foods may accumulate in the body and be excreted through sweat, triggering the inflammatory cascade that characterizes HS.
Link: https://www.jidonline.org/article/S0022-202X(24)02874-4/fulltext
Citation: Haddad NR, Badiei B, Curvin-Aquilla SL, Johnson AY, Willis A, Minsky HB, Williams KL, Garza LA. Links Between Plastics Use, Processed Food, Sweating, and Hidradenitis Suppurativa. J Invest Dermatol. 2024 Oct 29:S0022-202X(24)02874-4. doi: 10.1016/j.jid.2024.09.019. Epub ahead of print. PMID: 39481530.
The Copenhagen Hidradenitis Suppurativa Cohort
Registries of hospital-based outpatient cohorts allow exploration of aetiology, epidemiology, and co-morbidities in patients with HS. The study team describe the establishment and first 8 years of ‘The Copenhagen Hidradenitis Suppurativa Cohort’, a clinical registry with ongoing recruitment of newly referred outpatients with HS fulfilling the modified Dessau criteria. The registry was established at the Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Denmark in 2016 with the aim of advancing research into the aetiology, natural history, and treatment of HS. During the first 8 years, some 760 patients have been recruited and the most common comorbidities reported are acne vulgaris (16.4%), psychiatric disease (28.2%), hypertension (10.7%), type 2 diabetes (8.2%), dyslipidaemia (7.5%), Crohn’s disease (6.8%) and ulcerative colitis (3.2%). The authors stress that global collaborations through standardized data collection is important for advancing HS research and addressing the disease’s multifaceted challenges. The sustained growth of the Copenhagen Hidradenitis Suppurativa Cohort enables future investigations into the nature of HS as well as the molecular aspects of disease to improve patient outcomes globally.
Citation: Holgersen N, Nielsen VW, Rosenø NAL, Ring HC, Holm Nielsen S, Maul JT, Thyssen JP, Egeberg A, Thomsen SF. The Copenhagen Hidradenitis Suppurativa Cohort: Insights from the first 8 years. Dermatology. 2024 Oct 30:1-7. doi: 10.1159/000541612. Epub ahead of print. PMID: 39476814.
Therapeutic Burden in HS
Therapeutic burden is defined as “the workload of healthcare and its effect on patient functioning and well-being”. In the HS context, therapeutic burden has been identified as a potential predictor of response to biologic therapy. This study aimed to analyse the determinants of therapeutic burden in clinical settings among patients with HS to explain this concept and its use as an additional tool for guiding therapeutic decision-making. The researchers conducted a cross-sectional study including all consecutive patients attending a specialized HS clinic in Spain between 2017 and 2024. The team defined therapeutic burden as the cumulative sum of prior systemic treatment cycles and surgical interventions for HS and analysed whether sociodemographic or clinical factors were associated with a higher therapeutic burden. In their analysis of 557 patients with HS, the study team found that referral from general dermatology or other hospital departments, older age, longer disease duration, greater HS severity, presence of pilonidal sinus, and prior biological therapy were significantly associated with higher therapeutic burden. They state that therapeutic burden captures HS severity and progression factors, and that therapeutic burden could prove valuable in aiding decision-making for patients by indicating when a change in therapy might be necessary.
Link: https://onlinelibrary.wiley.com/doi/10.1111/ijd.17517
Citation: Haselgruber S, Muñoz-Barba D, Leon-Pérez FJ, Cuenca-Barrales C, Arias-Santiago S, Molina-Leyva A. Therapeutic burden in hidradenitis suppurativa: a cross-sectional study of 557 patients. Int J Dermatol. 2024 Oct 15. doi: 10.1111/ijd.17517. Epub ahead of print. PMID: 39407357.
Prevalence of HS in Algeria
While there have been many reports on HS prevalence from Western countries, few relevant African or Asian studies have been published to date. The Global Hidradenitis Suppurativa Atlas (GHiSA; https://www.ghisa.org/) aims to address this using a standardised questionnaire to report prevalence globally. This latest study from GHiSA asked 1434 adults accompanying patients undergoing care in non-dermatological wards to complete a self-administered questionnaire. the team report a prevalence of HS in Algeria at 0.78%. No significant difference was found regarding gender, age, body mass index, and smoker status. Sensitivity of the GHiSA questionnaire was reported at 100% and the specificity at 97%, indicating the GHISA questionnaire seems to be a reliable tool for screening patients with HS in Algeria.
Citation: Chehad AS, Zobiri S, Bouazzi D, Medianfar CE, Christensen R, Jemec GBE, Serradj A. Hidradenitis suppurativa prevalence in Algeria: A multicenter cross-sectional study. Dermatology. 2024 Jun 1. doi: 10.1159/000539599. Epub ahead of print. PMID: 39397636.
Racial and Ethnic Disparities in the Disease Journey of Patients with HS
People from racial and ethnic minority groups may experience greater disease severity and delay to diagnosis. This study assessed the impact of race/ethnicity on HS diagnosis and management in clinical settings. Data were derived from the Adelphi Real World Hidradenitis Suppurativa Disease Specific Programme, a survey of dermatologists and their patients with HS in five European countries (France, Germany, Italy, Spain, the UK) and the USA in 2020/2021. Data on 1787 patients was collected, with 57.6% female and 77.7% White. Analysis revealed that when compared to White people, those from racial and ethnic minority groups were younger and reported symptoms at earlier ages, experienced longer times to first consultation, took longer to receive a correct diagnosis following first consultation, and were more likely to be misdiagnosed with boils. Furthermore, people from racial and ethnic minority groups had a greater disease awareness at diagnosis and reported wanting greater support and reported a greater impact on life, more severe pain, and a greater level of activity impairment in the Work Productivity and Activity Impairment: General Health, highlighting health disparities in HS.
Link: https://onlinelibrary.wiley.com/doi/10.1111/1346-8138.17386
Citation: Jaleel T, Mitchell B, Burge R, Cohee A, Wallinger H, Truman I, Keal A, Middleton-Dalby C, Barlow S, Patel D. Exploring racial and ethnic disparities in the hidradenitis suppurativa patient disease journey: Results from a real-world study in Europe and the USA. J Dermatol. 2024 Oct 14. doi: 10.1111/1346-8138.17386. Epub ahead of print. PMID: 39400427.
Prevalence and Predictors of Inflammatory Arthritis in HS
HS is often associated with inflammatory arthritis, which can significantly impact patients’ quality-of-life. Early diagnosis of both conditions is key for optimal management. This study team aimed to determine the prevalence and factors associated with the development of inflammatory arthritis among patients with HS. Fifty-two adult patients with HS consented to participate and completed assessments in this cross-sectional study that examined age, sex, HS severity, treatment, ethnicity, family history, lifestyle factors, and comorbidities. Approx. 23% were found to also have inflammatory arthritis. The team report that White ethnicity and older age at HS onset were positively associated with inflammatory arthritis, while smoking, hypertension, and depression were negatively associated.
Link: https://onlinelibrary.wiley.com/doi/10.1111/exd.15194
Citation: Sy SMT, Eder L, Jerome D, Obetta C, McKee H, Mirza R, Pek E, Piguet V, Alhusayen R. Prevalence and Predictors of Inflammatory Arthritis in Hidradenitis Suppurativa. Exp Dermatol. 2024 Oct;33(10):e15194. doi: 10.1111/exd.15194. PMID: 39397373.
Secukinumab Efficacy in Patients with HS: Post-Hoc Analysis of the SUNSHINE and SUNRISE Trials
The SUNSHINE and SUNRISE clinical trials assessed subcutaneous secukinumab administration every 2 or every 4 weeks in adults with moderate to severe HS and formed the basis of the approval in many countries in 2023 of secukinumab for use in patients with HS. In this study, data from these trials were analysed to evaluate drug efficacy using The International Hidradenitis Suppurativa Severity Score System (IHS4), a validated tool that measures inflammatory lesions, including draining tunnels, in HS. Assessments included changes from baseline in IHS4 and severity classification up to Week 52; IHS4-55, IHS4-75, IHS4-90 responses (corresponding to 55%, 75%, and 90% reduction in IHS4, respectively) and concordance between IHS4-55 and another validated assessment tool, the HS clinical response (HiSCR), at Weeks 16 and 52. Data from 1084 patients were analysed and IHS4-55 was observed in both dosing regimens at levels significantly higher than placebo at Week 16, with further improvement at Week 52. Similar trends were observed for IHS4-75 and IHS4-90. Strong concordance (>85%) was observed between IHS4-55 and HiSCR. The data demonstrated efficacy in improving treatment response as measured by IHS4 and reducing disease severity versus placebo at Week 16 with these improvements sustained through Week 52.
Link: https://onlinelibrary.wiley.com/doi/10.1111/jdv.20369
Citation: Zouboulis CC, Kyrgidis A, Alavi A, Jemec GBE, Martorell A, Marzano AV, van der Zee HH, Wozniak MB, Martinez AL, Kasparek T, Bachhuber T, Ortmann CE, Lobach I, Thomas N, Ravichandran S, Tzellos T. Secukinumab efficacy in patients with hidradenitis suppurativa assessed by the International Hidradenitis Suppurativa Severity Score System (IHS4): A post hoc analysis of the SUNSHINE and SUNRISE trials. J Eur Acad Dermatol Venereol. 2024 Oct 19. doi: 10.1111/jdv.20369. Epub ahead of print. PMID: 39425517.
ASH Syndrome in HS
Acne fulminans (AF) is a very rare and severe variant of acne, with explosive ulceration of inflammatory nodules over the face and trunk. Several isolated cases of AF and HS co-occurrence have been reported. In this report, the authors noted a higher number of AF cases in a cohort of some 1600 patients with HS at Pasteur Institute in Paris, when compared to the general population, which led them to probe further. Medical file reviews were used with targeted next generation sequencing was used to try to identify genetic links in conjunction with. Genetic testing identified 26 different variants with genes involved in the pathogenesis of autoinflammatory diseases and acne; furthermore, four other rare variants were identified with possible links. Functional investigations are now required to support a possible implication of these variants in the disease. The authors state that the co-occurrence of AF and HS could correspond either to an incomplete PASH (pyoderma gangrenosum [PG], acne, and HS) or PAPASH (pyogenic arthritis, PG, acne, and HS) syndrome or to a new entity, for which they propose the acronym of ASH (A for Acne fulminans, SH for suppurative hidradenitis).
Link: https://www.jaad.org/article/S0190-9622(24)02996-7/pdf
Citation: Miskinyte S, Duchatelet S, Delage M, Ungeheuer M, Auffret N, Binois R, Guillem P, Join-Lambert O, Nassif A, Hovnanian A. Clinical characteristics and genetic analysis of 14 patients affected with acne fulminans and hidradenitis suppurativa: ASH syndrome, a new phenotypic entity. J Am Acad Dermatol. 2024 Oct 12:S0190-9622(24)02996-7. doi: 10.1016/j.jaad.2024.07.1533. Epub ahead of print. PMID: 39401609.
Validation of HiSQOL
Hidradenitis Suppurativa Quality of Life Questionnaire (HiSQOL) is a HS-specific patient-reported outcome measure developed by the Hidradenitis Suppurativa Core Outcomes Set International Collaboration (HiSTORIC), an international stakeholder group comprising patients, physicians, and others. HiSQOL specifically captures the unique impact of HS on quality of life. In this study, the authors compared HiSQOL with Dermatological Life Quality Index (DLQI), a general patient-reported outcome measure, in clinical settings using a cross-sectional survey of physicians and patients conducted in France, Germany, Italy, Spain, and the US between 2020 and 2021. A total of 677 patients with HS completed both the HiSQOL and DLQI. The team report strong correlation between HiSQOL and DLQI total scores. The HiSQOL items that had the biggest impact on quality of life related to “Embarrassment”, “Depression” and “Anxiety”, items that also had among the lowest relationship to total DLQI score. The study team concludes that HiSQOL is a valid tool for assessing QoL in HS patients in clinical settings and that HiSQOL better captures those aspects of HS that have the highest impact on QoL, including depression and anxiety, which are not captured by the DLQI.
Link: https://academic.oup.com/bjd/advance-article/doi/10.1093/bjd/ljae367/7815052
Citation: Garg A, Burge R, Cohee A, Wallinger H, Truman I, Keal A, Strunk A, Barlow S. Validation of the Real-World Application of the Hidradenitis Suppurativa Quality of Life (HiSQOL) Score to Adults with Hidradenitis Suppurativa. Br J Dermatol. 2024 Oct 7:ljae367. doi: 10.1093/bjd/ljae367. Epub ahead of print. PMID: 39374841.
HS and Tetracyclines
Antibiotics have been the mainstay of treating people with HS for many years and are first-line treatments recommended in many of the HS treatment guidelines. In this review, the authors focus on tetracyclines, a class of broad-spectrum antibiotics widely used in dermatology for many indications, including HS. In their focus on HS, they review the current evidence supporting tetracycline use in HS,
Citation: Kim YS, Kim HS. Tetracyclines revisited: tetracyclines in the field of dermatology. Dermatology. 2024 Oct 18:1-22. doi: 10.1159/000542006. Epub ahead of print. PMID: 39427643.
