North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management.

Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.

New and traditional surgical approaches to hidradenitis suppurativa.

When the prevention of new lesions fails and when medical therapy of established and growing lesions is ineffective, surgery is the accepted method of dealing with hidradenitis suppurativa/acne inversa. The rationale and preferred techniques of mini-unroofing using a biopsy punch, deroofing using scissors, electrosurgery or laser, and classical wide excision and closure are discussed. The situation in which incision and drainage is considered for temporary pain relief would be best considered an opportunity for deroofing, as illustrated in the accompanying online videos.

Recurrence of hidradenitis suppurativa after surgical management: A systematic review and meta-analysis.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine-bearing skin. Treatment is challenging and long-standing. Surgery is one of the treatment options with varying reported success rates. OBJECTIVE: This study provides a comprehensive systematic review of surgical approaches in the management of HS. METHODS: A systematic literature search and meta-analysis of proportions were performed on the included studies. RESULTS: Of a total of 1147 retrieved articles, 22 were included in the analysis. These were the estimated average recurrences: wide excision, 13.0% (95% confidence interval [CI], 5.0-22.0%); local incision, 22.0% (95% CI, 10.0-37.0%); and deroofing, 27.0% (95% CI, 23.0-31.0%). In the wide excision group, recurrence rates were as follows: 15% (95% CI, 0-72%) for primary closure, 8% (95% CI, 2.0-16.0%) for using flaps, and 6.0% (95% CI, 0.0-24.0%) for grafting. The secondary intention healing option was most commonly chosen after local excision and deroofing. LIMITATIONS: There was poor quality evidence and potential improper reporting of the results. CONCLUSION: This systematic review found lower recurrence rates with wide excision, using skin flaps or skin grafts as the closure methods. The heterogeneity of the patient populations was high and statistically significant within and across all types of excisions.

Outcome Measures for the Evaluation of Treatment Response in Hidradenitis Suppurativa for Clinical Practice: A HiSTORIC Consensus Statement.

Importance: Although several clinician- and patient-reported outcome measures have been developed for trials in hidradenitis suppurativa (HS), there is currently no consensus on which measures are best suited for use in clinical practice. Identifying validated and feasible measures applicable to the practice setting has the potential to optimize treatment strategies and generate generalizable evidence that may inform treatment guidelines. Objective: To establish consensus on a core set of clinician- and patient-reported outcome measures recommended for use in clinical practice and to establish the appropriate interval within which these measures should be applied. Evidence Review: Clinician- and patient-reported HS measures and studies describing their psychometric properties were identified through literature reviews. Identified measures comprised an item reduction survey and subsequent electronic Delphi (e-Delphi) consensus rounds. In each consensus round, a summary of outcome measure components and scoring methods was provided to participants. Experts were provided with feasibility characteristics of clinician measures to aid selection. Consensus was achieved if at least 67% of respondents agreed with use of a measure in clinical practice. Findings: Among HS experts, response rates for item reduction, e-Delphi round 1, and e-Delphi round 2 surveys were 76.4% (42 of 55), 90.5% (38 of 42), and 92.9% (39 of 42), respectively; among patient research partners (PRPs), response rates were 70.8% (17 of 24), 100% (17 of 17), and 82.4% (14 of 17), respectively. The majority of experts across rounds were practicing dermatologists with 18 to 19 years of clinical experience. In the final e-Delphi round, most PRPs were female (12 [85.7%] vs 2 males [11.8%]) and aged 30 to 49 years. In the final e-Delphi round, HS experts and PRPs agreed with the use of the HS Investigator Global Assessment (28 [71.8%]) and HS Quality of Life score (13 [92.9%]), respectively. The most expert-preferred assessment interval in which to apply these measures was 3 months (27 [69.2%]). Conclusions and Relevance: An international group of HS experts and PRPs achieved consensus on a core set of HS measures suitable for use in clinical practice. Consistent use of these measures may lead to more accurate assessments of HS disease activity and life outcomes, facilitating shared treatment decision-making in the practice setting.

Hidradenitis suppurativa: successful treatment using carbon dioxide laser excision and marsupialization.

BACKGROUND: Hidradenitis suppurativa (HS) is a disease associated with significant patient morbidity and less-than-ideal therapies. OBJECTIVES: To determine the long- and short-term benefits of carbon dioxide (CO(2)) laser excision and marsupialization in the management of persisent lesions of HS. METHODS: Patients with long-standing lesions of HS were treated using a CO(2) laser to excise inflammatory and draining masses. RESULTS: One hundred eighty-five areas were treated in 61 patients using the CO(2) laser excision and marsupialization technique in 154 sessions. Local anesthesia was used for all but three sessions. Healing occurred primarily through secondary intention. In follow-up from 1 to 19 years, acceptable to excellent qualities of healing occurred. Recurrence within the treated area occurred in two of 185 sites treated. CONCLUSION: CO(2) laser excision and marsupialization appears to be an effective therapy for management of persisent or late-stage HS. There was good patient comfort during and after treatment, lower costs than with inpatient modalities, good healing, and minimal risk of recurrence within the treated areas.

Medical emergencies in the dermatology office: incidence and options for crisis preparedness.

Medical emergencies may occur in any setting, including dermatology offices. We examined the incidence of medical emergencies in a survey of 34 dermatologists northeast Ohio. Fifty-five events occurred over 565 combined years of clinical practice, an incidence of 1 episode every 10.3 years. We also review options for better preparedness for medical emergencies in dermatology practices, ranging from an emergency action plan for emergency personnel, basic life support (BLS) certification, advanced cardiac life support (ACLS) certification, and on-site automatic electronic defibrillators (AEDs).

Familial ichthyosiform keratoderma in newly out-of-pouch Bennett's wallabies (Macropus rufogriseus) and report of two cases.

Primary inherited disorders of cornification in veterinary medicine are uncommon and rarely reported. Herein described is a unique syndrome associated with keratoderma that occurred in two Bennett's wallaby siblings (Macropus rufogriseus), and was characterized by profound thickening of the pad skin of all feet, generalized scaling of haired skin, and death within 7 weeks of out-of-pouch experience. The male also had depressed serum zinc levels. In addition, the male had, on electron microscopic exam of his skin, the presence of abnormal lipid deposits within the stratum corneum and stratum granulosum. The combination of clinical features and electron microscopic findings strongly suggests a syndrome analogous to harlequin ichthyosis or lamellar ichthyosis in humans.

Proliferating hemangioma of infancy: successful treatment with topical 5% imiquimod cream.

A 4-month-old girl had a proliferating hemangioma of infancy (infantile hemangioma) affecting the chest wall. The lesion had appeared 1 week after birth, demonstrating both superficial and deep components, and was rapidly enlarging. It had become painful and superficially eroded. Treatment with topical 5% imiquimod cream three times a week was associated with signs of involution after 10 days, and complete resolution after 10 weeks of therapy. The treatment was well tolerated.