Hidradenitis suppurativa (HS)/acne inversa is a debilitating chronic disease that remains poorly understood and difficult to manage. Clinical practice is variable, and there is a need for ...international, evidence‐based and easily applicable consensus on HS management. We report here the findings of a systematic literature review, which were subsequently used as a basis for the development of international consensus recommendations for the management of patients with HS. A systematic literature review was performed for each of nine clinical questions in HS (defined by an expert steering committee), covering comorbidity assessment, therapy (medical, surgical and combinations) and response to treatment. Included articles underwent data extraction and were graded according to the Oxford Centre for Evidence‐based Medicine criteria. Evidence‐based recommendations were then drafted, refined and voted upon, using a modified Delphi process. Overall, 5310 articles were screened, 171 articles were analysed, and 65 were used to derive recommendations. These articles included six randomized controlled trials plus cohort studies and case series. The highest level of evidence concerned dosing recommendations for topical clindamycin in mild disease (with systemic tetracyclines for more frequent/widespread lesions) and biologic therapy (especially adalimumab) as second‐line agents (following conventional therapy failure). Good‐quality evidence was available for the hidradenitis suppurativa clinical response (HiSCR) as a dichotomous outcome measure in inflammatory areas under treatment. Lower‐level evidence supported recommendations for topical triclosan and oral zinc in mild‐to‐moderate HS, systemic clindamycin and rifampicin in moderate HS and intravenous ertapenem in selected patients with more severe disease. Intralesional or systemic steroids may also be considered. Local surgical excision is suggested for mild‐to‐moderate HS, with wide excision for more extensive disease. Despite a paucity of good‐quality data on management decisions in HS, this systematic review has enabled the development of robust and easily applicable clinical recommendations for international physicians based on graded evidence.
Cow's milk allergy (CMA), one of the main types of childhood allergy, considerably impairs patient quality of life. Allergen avoidance is difficult, and mistakes are common. Therefore, new treatment ...strategies such as oral immunotherapy (OIT) have been sought for patients with CMA. Our objective was to review current evidence on immunological changes, efficacy, and safety when using OIT as an alternative to an avoidance diet in the treatment of children with IgE-mediated CMA.
We performed a systematic review and subsequent meta-analysis of all randomized controlled studies published to date in which OIT is used to treat CMA in children.We evaluated immunological effects, acquisition of desensitization, and adverse events. Immunological changes were examined by means of a meta-analysis of individual patient data.
Desensitization using OIT to cow's milk is 10.2 times more likely than in non-0IT-treated patients. The decrease in cow's milk-specific IgE levels was found to differ by 8.1 kUA/L between OIT-treated patients and those on an avoidance diet. This difference was not statistically significant (P=.318). Although side effects are common, they usually involve mild reactions that are easy to manage without parenteral epinephrine.
OIT can be considered safe and effective (in terms of acquiring desensitization) and reasonably safe (mild-to-moderate adverse events, little need for parenteral epinephrine) in patients with CMA. Although OIT leads to changes in cow's milk-specific IgE levels, the differences between OIT-treated and non-0IT-treated patients are not significant. More studies are needed to evaluate other immunological changes that may occur, such as the increase in IgG4 levels.
Background
It has been proposed that two main phenotypes of hidradenitis suppurativa (HS) exist. This proposal is based upon different elementary structures detected in the skin, namely follicular ...subtypes and inflammatory subtypes. Having an accurate definition of these two variants could help us to better identify patients who may require an early intervention with currently approved targeted immunomodulatory therapies.
Objective
To define and distinguish between the epidemiological, clinical and analytic characteristics of these two HS phenotypes.
Methods
An observational, descriptive, non‐randomized and prospective study was conducted. Patients diagnosed with HS between May 2012 and April 2017 by a specialized unit were included. Ultrasound evaluation was performed in all cases.
Results
About 197 patients were included, 100 women and 97 men, aged between 25 and 47 years. The mean age of onset was significantly different between phenotypes, ranging between 26.69 ± 9.05 in the inflammatory subtype and 17.62 ± 6.42 in the follicular subtype. Follicular subtype patients exhibited a significantly higher number of nodules combined with the presence of multiple commedons (5.65 ± 3.38 versus 0.89 ± 2.72). This contrasted with the higher count of abscesses and fistulas detected in the inflammatory subtype (respectively, 4 ± 2.74 and 3.11 ± 2.56 versus 0.56 ± 1.02 and 0.26 ± 0.56). IgA levels were significantly higher in the inflammatory subtype (497.71 ± 262.26 versus 232.38 ± 84.06). Mean IHS4 score evaluation was higher in the inflammatory subtype (21.04 ± 11.9) compared with the follicular phenotype (7.54 ± 4.66). The inflammatory subtype was found to be an independent risk factor for disease aggressiveness in the multivariate analysis (OR 0.034 95% CI 0.015–0.072).
Limitations
Small sample size.
Conclusion
Preliminary data suggest the existence of an inflammatory HS phenotype that is associated with higher aggressiveness and major risk of progression during natural history of the disease.
Introduction
Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain ...dissatisfied with systemic treatment, and more than one‐third are dissatisfied with surgical procedures.
Objectives
A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications.
Methods
HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post‐surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated.
Results
The mean closure time of the post‐deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post‐op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9–10 points).
Conclusion
Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post‐op pain and should be part of holistic HS management.
Anaphylaxis After Cutaneous Application of Argan Oil de Las Marinas Alvarez, M D; Martorell Calatayud, C; Castillo Fernandez, M ...
Journal of investigational allergology & clinical immunology,
01/2021, Letnik:
31, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Argan oil is an edible oil that is obtained by pressing mature seeds from the berry of the argan tree (Argania spinosa), which is endemic to Morocco. It is used in food, cosmetics, and hair care and, ...since 1980, has become an increasingly popular ingredient in the international cosmetics industry. Consequently, argan oil is increasingly used in Spain. Only 1 case of anaphylaxis to argan oil and 2 cases of allergic contact dermatitis have been described to date. Cutaneous sensitization to foods can induce food allergy through skin care treatments containing food products in adults. Here, a case of anaphylaxis triggered by the topical application of a product containing argan oil is described.
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