Relationship Disturbances in Hidradenitis Suppurativa: A Patient Perspective.

Introduction: Hidradenitis suppurativa (HS) can significantly impact patients' relationships. Methods: Using an anonymous electronic survey, we aimed to determine what aspects of sexual relationships are affected by HS discomfort and patients' reluctance to discuss HS with their partner. Results: Among the 873 participants, 60.9% reported that some aspect of their relationship was affected by HS discomfort, with the greatest being their sexual encounters with spouse (49.1%). Furthermore, 43.0% (320) of participants reported feeling reluctant to discuss HS with their spouse/significant other, with the more common reason being fear of partner seeing boils and scars (84.7%). Multiple aspects of relationships can be affected by HS such as sexual encounters, overall relationship, and finding a relationship. Additionally, several communication barriers are present, such as fear of partner seeing boils and scars, partner thinking they had an infection such as a sexually transmitted disease, and fear of bloody or malodorous drainage, among others. The presence of anogenital pain, Hurley stage, gender, and age significantly affect these findings. Conclusion: Addressing HS-related relationship disturbances should be included in HS management.

Bibliometric analysis of the 50 most cited publications in atopic dermatitis.

Atopic dermatitis (AD) affects up to 20% of children worldwide. We identified the top 50 cited AD articles in the last seven decades and examined their characteristics. The majority were discussing the pathogenesis of AD and have paved the way for discovering targeted immunomodulatory treatments. A lack of geographic diversity was noted, thus encouraging more countries to be involved in AD research can further progress the future of AD management.

Bibliometric Analysis of Hidradenitis Suppurativa Publication Trends from Asia and Australasia.

INTRODUCTION: Hidradenitis suppurativa (HS), once an orphan disease, has gained increased interest world-wide. The most highly cited works in HS are from North America and Europe despite known phenotypic and epidemiological differences globally. Herein, we perform a bibliometric analysis to characterize HS publication trends in Asia and Australasia (AA) over the last decade. METHODS: PubMed database was searched to identify HS-related articles and were analyzed for senior authorship, country of origin, article topic, and study design. RESULTS: The search criteria yielded 163 articles from AA. Rapid increase in publications started in 2015 with 75% (123/163) of total articles published in the last half of the decade. Case reports/series were consistently the most published study type yearly and overall (49%, 80/163). Efforts were made to increase high level of evidence publications with both randomized controlled trials from Japan and Turkey including all Asian patients. China, Japan, and India were the leading publishing countries with Australia, Israel, and Turkey increasingly contributing in the last half of the decade. CONCLUSIONS: Advancements in HS research are encouraging with increases in publication numbers and diversity; however, more geographical diversity is needed in order to garner a better understanding of the disease and treatment options.

Pain management modalities for hidradenitis suppurativa: a patient survey.

BACKGROUND: Pain is one of the most common and debilitating symptoms of hidradenitis suppurativa (HS). OBJECTIVE: We sought to identify pain management therapies used in HS and assess patient-perceived effectiveness. METHODS: An anonymous online survey was posted to Facebook HS support groups. Participants selected all that applied from a list of 20 therapies to indicate which ones they have tried for HS pain. For each therapy used, participants were asked to rate effectiveness on a 5-point scale: not successful (1), mildly successful (2), moderately successful (3), very successful (4), and extremely successful (5). Mean effectiveness ratings were calculated by averaging the corresponding numbers. RESULTS: Of the 438 participants, 93.8% were female. Participants classified themselves as Hurley stage I (8.2%), II (53.4%), and III (38.4%). Warm compresses were the most commonly used therapy (82.4%), followed by ibuprofen/naproxen (74.7%), Epsom salt baths (57.8%), cold compresses (45.4%), and acetaminophen (44.7%). Marijuana smoking received the highest mean effectiveness rating (2.92 ± 1.10), followed by marijuana edibles (2.87 ± 1.10), and opioids (2.83 ± 0.98). Mean effectiveness ratings were lowest for bleach baths (1.52 ± 0.80), sitz baths (1.53 ± 0.56), massage (1.61 ± 0.92), gabapentin (1.64 ± 0.73), and acetaminophen (1.71 ± 0.75). CONCLUSIONS AND RELEVANCE: Even the highest-rated pain management modalities are considered only moderately effective by HS patients.

Medicaid and Medicare Part B spending on immunomodulators and biosimilars.

INTRODUCTION: Prices for immunomodulators used in dermatological conditions are rising in the United States. While Medicare Part-D solely covers medication costs, Medicare Part-B covers outpatient infusion and injection costs given by medical professionals. We aim to analyze recent trends in Medicare Part-B spending on immunomodulators and their biosimilars used in the treatment of common chronic inflammatory dermatoses. METHODS: The 2012-2018 Medicare Part-B spending data on immunomodulators commonly used for dermatologic conditions were extracted from the Centers for Medicare and Medicaid Services database. Inflation was adjusted to reflect 2012-dollar amounts using the Consumer Price Index. RESULTS: Medicare Part-B spending has increased by 27.5% from 2012 to 2018 ($2.5B, $3.2B). Average annual total spending (AATS) is greatest for rituximab ($1,522,757,520), and average annual spending per maintenance dose (AASPMD) is greatest for ustekinumab-90 mg ($12,976). The percent change in AASPMD increased for all immunomodulators with Etanercept-50 mg having the greatest percent change (+64.6%, +$285.70). Infliximab had a greater AATS and AASPMD than its biosimilars. DISCUSSION: Medicare Part-B spending is often overlooked but plays a big role in federal healthcare spending. Exploring the strategic use of less expensive biosimilars could help mitigate spending.

Improving hidradenitis suppurativa patient education using written action plan: a randomized controlled trial.

The waxing-and-waning nature of hidradenitis suppurativa (HS), complex treatment plans, along with variable responsiveness to therapy, can create management challenges for patients. In this pilot cross-over randomized controlled trial, we aim to evaluate the effectiveness a HS-written action plan (HSWAP) on patient disease understanding and confidence in recognizing flares and adjusting management. Participants were randomized into a pre-crossover control group that received a verbal consultation (VC)-only, and an intervention group which received the VC + HSWAP. The pre-crossover control group then crossed over (post-crossover control) to also receive the VC + HSWAP (ClinicalTrials.gov Identifier: NCT04600375). Patient comprehension of their disease and management steps was high after both a thorough VC and HSWAPs. However, the majority of patients prefer receiving both a VC and a HSWAP. After the addition of the HSWAP, pre-crossover control group patients' understanding and confidence of their disease and management plan increased across all surveyed questions.

Impact of Pregnancy on Hidradenitis Suppurativa Disease Course: A Systematic Review and Meta-Analysis.

BACKGROUND: Hormones are thought to play a role in hidradenitis suppurativa (HS). However, data on the HS disease course during pregnancy and the postpartum period has not been well established. The objective of this study is to analyze the available literature to determine HS disease activity during pregnancy and the postpartum period. METHODS: The PubMed and Embase databases were systematically searched for relevant articles from database inception until November 22, 2020. The inclusion criteria were a study population with the diagnosis of HS and discussion of pregnancy impact on the HS disease course or postpartum flare. Study characteristics, patient demographics, HS severity, and HS disease course during pregnancy and the postpartum period were extracted by 2 independent reviewers. The quality of included studies was assessed using the Newcastle-Ottawa Scale for observational studies. Heterogeneity was assessed using Cochran's Q statistic and I2 index. The random-effects meta-analytical model was used. The primary study outcome was the pooled odds ratio of improvement or of worsening of HS disease activity during pregnancy. RESULTS: The systematic search identified 8 studies for analysis. There was a total of 672 cases for which data on the patient-reported HS disease course during pregnancy were available, and 164 cases for which data on patient-reported postpartum flare were available. In the meta-analyses, the rate of HS disease improvement was 24% (95% CI 0.13-0.40) and the rate of HS disease worsening was 20% (95% CI 0.11-0.34). Sixty percent (99/164) of patients experienced a postpartum flare. CONCLUSION: While about a quarter of women will experience an improvement in HS during pregnancy, the majority will have a stable or worsened disease course, and over half of patients will experience a postpartum flare. Close monitoring of HS patients is needed during pregnancy and postpartum periods, as patients may need continued, or even escalated, disease management.

Gender gaps in National Institutes of Health dermatology grant recipients.

BACKGROUND: Understanding the demographics and scholarly merit among National Institutes of Health (NIH) award recipients can help guide future applicants in the field of dermatology. OBJECTIVE: Herein, we aimed to explore gender gaps in NIH award recipient demographics and scholarly merits for dermatology-related projects. METHODS: Projects funded by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases between 2015 and 2019 related to dermatology were extracted using the NIH Research Portfolio Online Reporting Tools database. The number of publications and h-index of each award recipient were collected using the Scopus database. The 2019 Blue Ridge Institute for Medical Research report was used to determine the top 20 NIH-funded dermatology departments/divisions. RESULTS: Between 2015 and 2019, there were 35.1% more unique male than unique female recipients. Award recipients had an average of 116.7 total publications and an average h-index of 37.1. However, men also had more than half as many publications and a >37% higher average h-index. Gender gaps in research merit, as well as number and type of awards, are reduced among recipients affiliated with a top 20 NIH-funded institution. CONCLUSION: A higher number of awards were granted to male recipients. Men had a higher mean publication number and h-index compared with their female counterparts. Increased support, resources, and mentorship opportunities to women in research may help mitigate these gaps.

Bibliometric Analysis of the 50 Most Cited Publications in Hidradenitis Suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) has historically been a neglected disease. However, research in this field has grown exponentially in the past decade. METHODS: The top-cited HS articles from 1950 to 2020 were analyzed for authorship, study topic, study design, and senior author country of origin. RESULTS: We found that nearly half of the top 50 cited articles were published in the last decade, with a recent increase in the number of highly cited randomized controlled trials. Medical treatment is the most cited topic, with more attention on biologics over time. The past decade has seen an increase in highly cited articles on HS comorbidities, pathogenesis, and clinical practice guidelines. There has been a predominance of highly cited HS research from Europe; highly cited studies from Africa, Asia, Australia, and South America are lacking. CONCLUSIONS: Recent advances in HS research have focused on investigating HS pathogenesis and drug development, highlighting disease comorbidities, and improving evidence-based care. Studies in pathogenesis have translated into a paradigm shift in medical treatment from antibiotics to incorporation of targeted therapies in recent years. Encouraging growth of HS research in countries outside of North America and Europe may help to optimize HS care globally.

Radiotherapy for Hidradenitis Suppurativa: A Systematic Review.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis characterized by painful nodules, abscesses, sinus tracts, and scarring mainly in the intertriginous areas. Patients with HS often experience inadequate responses to traditional treatment consisting of lifestyle modification, topical and systemic antibiotics, hormonal modulators, biologics, and procedural modalities. Low-dose radiotherapy has been used in benign cutaneous conditions, including HS; however, there is a paucity of literature summarizing its evidence. Herein, we systematically review the current literature on the efficacy of radiotherapy for patients with HS. SUMMARY: This systematic review of the published literature reports the patient demographics, treatment regimens, efficacy, and adverse effects of radiotherapy in the treatment of HS. The historic timeline of these publications highlights the changes in management recommendations, introduction of more standardized outcome measures, and enhancements in treatment options. Radiotherapy appears to be an option for patients with treatment-resistant HS or who are poor surgical candidates. However, there remains a paucity of consensus on proper candidate selection, dosing, efficacy, and safety of the short- and long-term effects of radiotherapy.