Background and objectives Hidradenitis suppurativa (HS) significantly affects the patient`s quality of life and leads to multiple medical consultations. Aim of this study was to assess the ...utilization of medical care of HS patients. Patients and methods All patients presenting in 2017 for an outpatient, day patient and / or inpatient treatment with leading claim type HS at the Department of Dermatology, University Hospital Würzburg, were included. Primary outcome was the economic burden of HS patients, measured by resource utilization in euro. Results The largest share of the direct medical costs for HS were the inpatient costs with a leading surgical diagnosis-related group (DRG). Antiseptics were the predominant topical prescription. While doxycycline was the most frequently prescribed systemic therapy, adalimumab was the main cost driver. The difference between in-patient (euro 110.25) and outpatient (euro 26.34) direct non-medical costs was statistically significant (p < 0.001). With regards to indirect medical costs, a statistically significantly higher loss of gross value added (inpatient mean euro 1,827.00; outpatient mean euro 203.00) and loss of production (inpatient mean euro 1,026.00; outpatient mean euro 228.00) could be noted (p < 0.001), respectively. Conclusions The present study on disease-specific costs of HS confirms that the hospital care of patients with this disease is cost-intensive. However, the primary goal of physicians is not and should not be to save costs regarding their patients`treatment, but rather the premise to utilize the existing resources as efficient as possible. Reducing the use of costly therapeutics and inpatient stays therefore requires more effective therapy options with an improved cost-benefit profile.
The role of sweat glands in hidradenitis suppurativa has been largely neglected, despite the fact that its original designation, as “hidrosadénite phlegmoneuse”, implied an inflammatory malfunction ...of the apocrine sweat glands as the underlying pathogenic driver. The aim of this study was to evaluate the role of apocrine sweat glands with respect to the proinflammatory environment of hidradenitis suppurativa. Therefore, gravimetric assessment and multiplex cytokine assays from sweat obtained from patients with hidradenitis suppurativa along with immunofluorescence cytokine/chemokine analysis of lesional apocrine glands- bearing hidradenitis suppurativa skin were performed. Gravimetric assessment of 17 patients with hidradenitis suppurativa revealed that the condition is not associated with hyperhidrosis. However, patients seem to be more affected by subjective sweating. The current data identified a complex proinflammatory signature in hidradenitis suppurativa sweat characterized by a significant upregulation of monocyte chemoattractant protein-1, interleukin-8 (CXCL8), and interferon-γ. In agreement with this, a strong in situ expression of these mediators could be observed in apocrine glands of lesional hidradenitis suppurativa skin. These data shed new light on the proinflammatory capacity of apocrine sweat glands in hidradenitis suppurativa, which may lead to reconsideration of the role of sweat glands in hidradenitis suppurativa pathology.
Since 2021, adalimumab biosimilar ABP 501 can be used alternatively to adalimumab originator (ADAO) in the treatment of hidradenitis suppurativa (HS). Effectiveness and safety data remain scarce. We ...investigated the impact of switching from ADAO to ABP 501 on disease severity and the occurrence of adverse events (AEs) in patients with HS. We analyzed clinical data on patients enrolled in the German HSBest registry. Evaluation outcomes were assessed at three time points (baseline of originator (t0), prior to switching to biosimilar (t1) and 12 to 14 weeks after switching (t2)) and included patient-reported AEs and disease severity using the International Hidradenitis Suppurativa Severity Score System (IHS4) score. In total, 94 patients were switched from ADAO to ABP 501. Overall, 33.3% (n = 31/94) of the patients developed AEs and/or loss of response (LoR) within 12 to 14 weeks after switching. Of these, 61.3% (n = 19/31) experienced LoR but no AEs, 22.6% (n = 7/31) LoR combined with AEs and 16.1% (n = 5/31) AEs only. Our study showed that switching HS patients from ADAO to ABP 501 does significantly affect treatment effectiveness. Switching patients who are on remission maintenance therapy should be viewed critically.
Giant cell arteritis (GCA) is a systemic vasculitis associated with severe complications such as loss of vision and, rarely, scalp necrosis. We present a patient with GCA who had bilateral scalp ...necrosis and an erythrocyte sedimentation rate of only 21 mm after the first hour. Therapy with systemic steroids, which were slowly tapered over 1 year, led to secondary wound healing without recurrence. As there are no systematic reviews on the occurrence of scalp necrosis in patients with GCA, we performed a literature research and meta-analysis and discovered 78 cases published between 1946 and 2007. Analysis of the data revealed that GCA with scalp necrosis is associated with a higher incidence of vision loss (32%) and other visual defects (37.3%) than GCA without scalp necrosis (visual disturbances in up to 20%). GCA with scalp necrosis is also associated with an increased mortality (standard mortality ratio SMR, 4.2) in contrast to GCA without scalp necrosis, which has no significantly higher mortality than age-matched controls (SMR 0.8-1.034). In patients with scalp necrosis, the diagnosis of GCA was made about 1 month later than in patients without scalp necrosis, and scalp necrosis was never reported to occur after onset of therapy with glucocorticoids. Thus, for reasons beyond potential loss of vision, physicians should be alert for symptoms of GCA as only timely diagnosis and immediate therapy may prevent serious complications and increased mortality.
Recently, convolutional neural networks (CNNs) systematically outperformed dermatologists in distinguishing dermoscopic melanoma and nevi images. However, such a binary classification does not ...reflect the clinical reality of skin cancer screenings in which multiple diagnoses need to be taken into account.
Using 11,444 dermoscopic images, which covered dermatologic diagnoses comprising the majority of commonly pigmented skin lesions commonly faced in skin cancer screenings, a CNN was trained through novel deep learning techniques. A test set of 300 biopsy-verified images was used to compare the classifier's performance with that of 112 dermatologists from 13 German university hospitals. The primary end-point was the correct classification of the different lesions into benign and malignant. The secondary end-point was the correct classification of the images into one of the five diagnostic categories.
Sensitivity and specificity of dermatologists for the primary end-point were 74.4% (95% confidence interval CI: 67.0–81.8%) and 59.8% (95% CI: 49.8–69.8%), respectively. At equal sensitivity, the algorithm achieved a specificity of 91.3% (95% CI: 85.5–97.1%). For the secondary end-point, the mean sensitivity and specificity of the dermatologists were at 56.5% (95% CI: 42.8–70.2%) and 89.2% (95% CI: 85.0–93.3%), respectively. At equal sensitivity, the algorithm achieved a specificity of 98.8%. Two-sided McNemar tests revealed significance for the primary end-point (p < 0.001). For the secondary end-point, outperformance (p < 0.001) was achieved except for basal cell carcinoma (on-par performance).
Our findings show that automated classification of dermoscopic melanoma and nevi images is extendable to a multiclass classification problem, thus better reflecting clinical differential diagnoses, while still outperforming dermatologists at a significant level (p < 0.001).
•A convolutional neural network (CNN) received enhanced training with 11,444 dermoscopic images of >90% of lesions faced in a skin cancer screening setting.•The performance of 112 dermatologists from 13 university hospitals was then compared with the CNN on a test set of 300 biopsy-verified images.•The CNN achieved systematic outperformance of the dermatologists (p < 0.001) regardless of their clinical experience.
Background
Hidradenitis suppurativa (HS) causes a significantly compromised quality of life. Assessment of the psychological burden of HS is crucial for evidence-based allocation of resources.
...Objectives
We examined methods to easily assess the psychological burden in HS patients.
Materials and Methods
A total of 110 HS patients were assessed with respect to sociodemographic data, Hurley scale, and modified Sartorius score. Patients were asked to provide information on time of first diagnosis, previous therapies, surgical intervention, and pre-existing conditions. Distributed questionnaires were the Dermatology Life Quality Index (DLQI) and the Skindex-29, the Visual Analogue Scale (VAS) for pain, and the German version of the Hospital Anxiety and Depression Scale (HADS-D) for evaluation of anxiety (HADS-D/A) and depression (HADS-D/D).
Results
Of the 110 patients with HS (mean age: 38±12 years; range: 18 to 75), 61 were female and 49 were male. We found a statistically significant correlation between HADS-D/A and VAS (
p
= 0.009), between Skindex-29 and Sartorius score (symptoms:
p
= 0.024; emotions:
p
= 0.019; functional status:
p
= 0.002), as well as between Skindex-29 and VAS (symptoms:
p
= 0.000; emotions:
p
= 0.001; functional status:
p
= 0.000). Additionally, VAS correlated significantly with DLQI (
p
= 0.000) and body mass index with Sartorius score (
p
= 0.038). Conclusion: Our study shows that HS patients experience a high level of psychological distress. Interestingly, a clear correlation between psychological burden and HS patients was inferred by the VAS for pain. HS patients require active management for their physical as well as psychological health.
PDF
