Summary
Hidradenitis suppurativa (HS) influences patients’ lives in many ways. The most troublesome symptom of HS is chronic pain, of mild‐to‐moderate intensity, which is reported by almost all ...patients. With reference to psychosocial evaluation, HS appears to be a highly debilitating disease. The major factors influencing patients’ well‐being are disease severity, the number of flares or affected skin areas, and the lesion location. The mean Dermatology Life Quality Index scores of 8·3–12·7 points obtained among patients with HS are typical for severe dermatoses, which have a large impact on patients’ quality of life (QoL). HS not only affects skin‐related QoL issues, but also has a profound impact on general QoL measures – it causes substantial deterioration of both physical and mental health. Considering the impaired QoL due to HS and HS‐associated, nonpsychiatric comorbidities, it is not surprising that patients with HS experience psychological disturbances. In both observational and registry studies, depression and anxiety were significantly related to HS. The prevalences were estimated as 1·6–42·9% and 0·8–3·9%, respectively. HS was also linked to feelings of loneliness and stigmatization. Moreover, these patients have a significantly increased suicide risk (hazard ratio 2·42). HS, with its frequent involvement of the genital area, causes a pronounced impairment of sex life (66·7% of patients with HS reported sexual difficulties). Finally, HS causes significant financial burden, not only through the costs of healthcare, but also due to a substantial impact on patients’ professional careers. This is a reason for absenteeism from work for approximately half of patients, and a relatively high unemployment rate.
What's already known about this topic?
Hidradenitis suppurativa (HS) has a substantial negative influence on the quality of life of patients.
Although more attention has been paid to the impact of HS, only a dozen articles have been published on this issue, mostly in the last decade.
What does this study add?
The burden of disease of HS is usually greater than that reported for other common dermatoses, with mean Dermatology Life Quality Index scores indicating a moderate‐to-large effect on patients’ lives.
The prevalences of depression and anxiety in HS are estimated to be up to 42·9% and 3·9%, respectively.
Two‐thirds of patients report profound consequences on their sex life.
There is a 2·5‐times increased risk of suicide among patients with HS compared with the general population.
Summary
Background
The management of hidradenitis suppurativa (HS) is still challenging, and new treatment methods are necessary. Acitretin seems to be a promising agent in HS management; however, ...literature data are limited.
Objectives
To investigate the clinical efficacy of acitretin monotherapy in 17 patients with long‐standing and recalcitrant HS. Simultaneously, an assessment of quality of life was carried out.
Methods
The study was conducted with a group of 17 patients with HS. Patients were treated with acitretin for up to 9 months and examined at baseline, after 1 month, and then every 3 months from baseline. The clinical extent of disease severity was measured with the HS Severity Index (HSSI), Hurley scoring system, Physician's Global Assessment and Dermatology Life Quality Index (DLQI).
Results
Nine patients (53%) finished the whole 9 months of acitretin treatment. The mean acitretin dose was 0·56 ± 0·08 mg kg−1 daily. A significant improvement of clinical manifestation (HSSI, DLQI) was observed after only 1 month of therapy, and further improvement was recorded during the next few months. Overall, eight subjects (47%) fulfilled the criteria for response (HSSI ≥ 50% reduction from baseline). The dropout rate was 47%, due mostly to drug ineffectiveness and adverse events. Discontinuation of treatment resulted in deterioration or relapse of HS 2–8 months after acitretin cessation, in all but one patient.
Conclusions
HS treatment with acitretin seems to be a promising method of disease management. However, due to the high daily dosage, its usage may be limited.
What's already known about this topic?
In contrast to isotretinoin, acitretin seems to be a promising treatment for management of hidradenitis suppurativa.
What does this study add?
This study is the largest open‐label trial to date on acitretin treatment for hidradenitis suppurativa.
Evaluation of quality‐of‐life aspects during acitretin therapy was also conducted.
Psychosocial burden of Hidradenitis Suppurativa patients’ partners Włodarek, K.; Głowaczewska, A.; Matusiak, Ł. ...
Journal of the European Academy of Dermatology and Venereology,
August 2020, 2020-Aug, 2020-08-00, 20200801, Letnik:
34, Številka:
8
Journal Article
Recenzirano
Background
Hidradenitis suppurativa is a debilitating disease related to a great psychosocial burden in affected patients and subsequently also people around them. Patients’ partners as caregivers ...may indirectly experience wide range of devastating effects of the disease on their emotional and social life.
Objective
The purpose of this study was to determine the QoL impairment in HS patients’ partners and to identify its aspects that are affected the most. Correlation between QoL burden and disease severity, duration, sex, age and smoking was also assessed.
Methods
A total of 50 HS sufferers were assessed according to disease severity and their partners’ QoL was determined using the Family Dermatology Life Quality Index questionnaire.
Results
The mean FDLQI for patients’ partners was 8.7 ± 6.8 points, indicating generally a moderate effect of HS on their life. Quality of partners’ life correlated significantly with disease severity but no correlation was found according to other factors.
Conclusion
Hidradenitis suppurativa is a highly psychologically devastating disease not only for patients but also for their partners. It occurred to diminish partners’ QoL mostly by increasing daily expenditure but also other problems were often reported. Clinicians should be aware of these psychosocial implications, in order to provide optimal therapy of HS affected families by a multidisciplinary specialized management addressing both, patients and their cohabitants simultaneously.
Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep‐seated, ...inflamed lesions in the apocrine gland‐bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. A mean disease incidence of 6.0 per 100 000 person‐years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The central pathogenic event in HS is believed to be the occlusion of the upper part of the hair follicle leading to a perifollicular lympho‐histiocytic inflammation. A highly significant association between the prevalence of HS and current smoking (Odds ratio 12.55) and overweight (Odds ratio 1.1 for each body mass index unit) has been documented. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by classical surgery or LASER techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus rifampicine, tetracyclines), acitretin and biologics (adalimumab, infliximab). A Hurley severity grade‐relevant treatment of HS is recommended by the expert group following a treatment algorithm. Adjuvant measurements, such as pain management, treatment of superinfections, weight loss and tobacco abstinence have to be considered.
The current study involved the completion of two distinct experiments. Experiment 1 compared fibre specific and whole muscle responses to acute bouts of either low-volume high-intensity interval ...training (LV-HIT) or moderate-intensity continuous endurance exercise (END) in a randomized crossover design. Experiment 2 examined the impact of a six-week training intervention (END or LV-HIT; 4 days/week), on whole body and skeletal muscle fibre specific markers of aerobic and anaerobic capacity. Six recreationally active men (Age: 20.7 ± 3.8 yrs; VO2peak: 51.9 ± 5.1 mL/kg/min) reported to the lab on two separate occasions for experiment 1. Following a muscle biopsy taken in a fasted state, participants completed an acute bout of each exercise protocol (LV-HIT: 8, 20-second intervals at ∼ 170% of VO2peak separated by 10 seconds of rest; END: 30 minutes at ∼ 65% of VO2peak), immediately followed by a muscle biopsy. Glycogen content of type I and IIA fibres was significantly (p<0.05) reduced, while p-ACC was significantly increased (p<0.05) following both protocols. Nineteen recreationally active males (n = 16) and females (n = 3) were VO2peak-matched and assigned to either the LV-HIT (n = 10; 21 ± 2 yrs) or END (n = 9; 20.7 ± 3.8 yrs) group for experiment 2. After 6 weeks, both training protocols induced comparable increases in aerobic capacity (END: Pre: 48.3 ± 6.0, Mid: 51.8 ± 6.0, Post: 55.0 ± 6.3 mL/kg/min LV-HIT: Pre: 47.9 ± 8.1, Mid: 50.4 ± 7.4, Post: 54.7 ± 7.6 mL/kg/min), fibre-type specific oxidative and glycolytic capacity, glycogen and IMTG stores, and whole-muscle capillary density. Interestingly, only LV-HIT induced greater improvements in anaerobic performance and estimated whole-muscle glycolytic capacity. These results suggest that 30 minutes of END exercise at ∼ 65% VO2peak or 4 minutes of LV-HIT at ∼ 170% VO2peak induce comparable changes in the intra-myocellular environment (glycogen content and signaling activation); correspondingly, training-induced adaptations resulting for these protocols, and other HIT and END protocols are strikingly similar.
Summary
Background
Monitoring disease activity over time is a prerequisite for clinical practice and research. Valid and reliable outcome measurement instruments (OMIs) and staging systems provide ...researchers and clinicians with benchmark tools to assess the primary and secondary outcomes of interventional trials and to guide treatment selection properly.
Objectives
To investigate inter‐rater reliability and agreement in instruments currently used in hidradenitis suppurativa (HS), with dermatologists experienced in HS as the rater population of interest.
Methods
In a prospective completely balanced design, 24 patients with HS underwent a physical examination by 12 raters (288 assessments) using nine instruments. The results were analysed using generalized linear mixed models.
Results
For the staging systems, the study found good inter‐rater reliability for Hurley staging in the axillae and gluteal region, moderate inter‐rater reliability for Hurley staging in the groin and for Physician's Global Assessment, and fair inter‐rater reliability for refined Hurley staging and the International HS Severity Scoring System. For all the tested OMIs, the observed intervals for limits of agreement were very wide relative to the ranges of the scales.
Conclusions
The very wide intervals for limits of agreement imply that substantial changes are needed in clinical research in order to rule out measurement error. The results illustrate a difficulty, even for experienced HS experts, to agree on the type and number of lesions when evaluating disease severity. The apparent caveats call for global efforts, such as the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC) to reach consensus on how best to measure physical signs of HS reliably in randomized trials.
What's already known about this topic?
Without valid and reliable instruments to measure outcomes, researchers and clinicians lack the necessary benchmarks to assess primary and secondary end points of interventional trials properly.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease.
Several outcome measure instruments exist for HS, but their validation is generally incomplete or of relatively low methodological quality.
What does this study add?
Using a prospective completely balanced design this study examined inter‐rater reliability with HS‐experienced dermatologists as the rater population of interest.
The study did not find very good reliability for any included instrument or lesion counts.
This study illustrates the difficulty in finding agreement on the type and number of HS lesions, even among experts.
The results question whether physical signs are best measured by a traditional physician lesion count instrument.
What are the clinical implications of this work?
For staging, Hurley staging and physician global visual analogue scale proved to be acceptable instruments in terms of inter‐rater reliability.
For the instruments designed to measure changes in health status, our study illustrates how difficult it is, even for experts, to measure the physical signs of HS using a simple rater counting.
Consequently, other assessment methods of physicals signs, such as ultrasound evaluation, require consideration.
Linked Comment: Oosterhaven. Br J Dermatol 2019; 181:438–439.
Plain language summary available online
Respond to this article
Background There are many situations in integument surgery in which secondary intention healing (SIH) may bring results comparable or even superior to those obtained with primary intention healing.
...Objective To present our own methods of employing SIH in surgical treatment of different skin lesions. Moreover, to delineate the extended indications for SIH as a first‐line method of wound treatment.
Methods Between 1999 and 2009, we conducted 236 operations followed by SIH in the group of 195 patients. Two independent investigators and the patients carried out post‐operative assessment (at 12 months) of both cosmetic and functional results of operations (data for 142 patients). Moreover, at 3 and 12 months, patients were asked for self‐evaluation of the outcomes of surgical procedures using the visual analogue scale (VAS).
Results The most frequent indications for SIH were defects after the excision of non‐melanoma skin cancers and hidradenitis suppurativa lesions. Depending on localization, the mean extent of the post‐operative wounds prepared for SIH ranged from 0.8to 85.7 cm2. The healing lasted 2–12 weeks. The most important factor was the size of the wound (r = 0.59; P < 0.001). The assessment at 12 months revealed that cosmetic/functional outcomes were evaluated as ‘good’ or ‘excellent’ in 89/83% and 72/70% cases, according to patients and physicians respectively. VAS showed that evaluation scores at 3 months post‐surgery were significantly lower than at 12 months (P < 0.0001).
Conclusion SIH is a safe and efficient form of treatment for various post‐operative skin defects. In certain areas of the body, SIH shows favourable cosmetic and functional effects. In these cases, it may even be regarded as the method of choice.
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