Safety and Efficacy of Intense Pulsed Light With Radiofrequency in United States Hidradenitis Suppurativa Patients.

Copy: The combination of intense pulsed light and radiofrequency has been described in German populations to be a noninvasive therapy option for patients with hidradenitis suppurativa, demonstrating significant improvements in the quality of life and reduction in number of inflammatory lesions. OBJECTIVE: To evaluate the efficacy and safety of combination intense pulsed light and radiofrequency therapy in patients with hidradenitis suppurativa in the United States. METHODS: A prospective split body was conducted in the United States on patients with bilateral hidradenitis suppurativa. Subjects received 3 passes of intense pulsed light and radiofrequency per treatment session to a single involved body region on a randomized side of the body at least 2 weeks apart over 9 to 10 treatment sessions. RESULTS: When measured from baseline to final visit, the overall mean difference in Dermatology Life Quality Index was found to be statistically significant (-2.8, P=0.043, n = 9). Patients reported mild discomfort during therapy and no adverse events occurred during or after treatment sessions. CONCLUSIONS: Although statistically significant, the mean difference in Dermatology Life Quality Index in treated patients found in this study did not reach the minimal clinically important difference for inflammatory skin disease. J Drugs Dermatol. 2022;21(4):430-432. .doi:10.36849/JDD.6562.

Importance of and instruction for starting a vitiligo patient support group.

Starting and maintaining a vitiligo support group can appear to be a daunting task. However, with proper planning and organization, the process can become manageable and rewarding. Our guide details the reasons to start a vitiligo support group, how to start a group, how to run a group, and how to promote a group. Legal protections and details regarding retention and funding are also discussed. The authors have extensive experience leading and/or assisting support groups for vitiligo and other disease states and we also sought out other current vitiligo support leaders for their valuable insights. Previous research has found that support groups for various medical conditions may have a protective effect and membership can build resilience among participants as well as foster a sense of hope regarding their disease. Further, groups can provide a network for those living with vitiligo to connect with, uplift, and learn from one another. These groups provide the opportunity to initiate lifelong connections with those facing similar circumstances and provide members with new insight and coping strategies. Members can share perspectives with one another and empower one another. We encourage dermatologists to provide vitiligo patients with support group information and to consider being involved in, starting, or otherwise supporting them.

Ultraviolet-C and other methods of decontamination of filtering facepiece N-95 respirators during the COVID-19 pandemic.

During global health emergencies such as the current COVID-19 pandemic, the decontamination of single-use personal protective equipment (PPE) becomes a necessary means to keep up with the growing demand from healthcare workers and patients alike. Many unverified methods are being considered, which can pose the risk of incomplete decontamination and lead to catastrophic results. Several factors come into play when determining the suitability of such methods including the quality of the decontamination technique, the targeted pathogen, cost, ease of installation and use, rate of sterilization, and the surface or material to be sterilized. The germicidal properties of ultraviolet-C are well known. This review will cover the most commonly described methods for the sterilization of N95 respirators, namely, ultraviolet germicidal irradiation, hydrogen peroxide vaporization, microwave-generated steaming, and dry heating. These techniques have been tested previously and have demonstrated efficacy in reducing or inactivating viral and bacterial pathogens, although testing against SARS-CoV-2 specifically has not been done. Moreover, it must be emphasized that proper disposal after a single use is still ideal under normal circumstances.

Hidradenitis suppurativa in children: The Henry Ford experience.

BACKGROUND: Although recent hidradenitis suppurativa studies have shown that early-onset disease is associated with a positive family history and more widespread disease, research in pediatric hidradenitis suppurativa is limited. METHODS: Thirty-three children diagnosed with hidradenitis suppurativa during an 18-month period were included in this institutional review board-approved, retrospective chart review. Information on demographic characteristic, family history, and timing of onset (prepubescent vs postpubescent) was extracted. The Fisher exact test, Cochran-Armitage exact trend test, and chi-square test were used to examine the association between prepubescent or postpubescent onset of hidradenitis suppurativa and sex, disease severity, and family history. RESULTS: A significantly higher percentage of patients with postpubescent onset were female (85.7%) than male (14.3%), whereas those with prepubescent onset were more likely to be male (58.3%) than female (41.7%; P = .02). Associations between disease onset and positive family history of hidradenitis suppurativa (P = .47) or higher Hurley stage of disease (P = .15) were not statistically significant. CONCLUSION: Boys are more likely to have prepubescent onset of hidradenitis suppurativa and girls to have postpubescent onset. This shift in sex distribution is unexplained, but we hypothesize that, whereas the role of ovarian hormones in the pathogenesis of HS may underlie much of adult-onset disease, it is less important in prepubescent disease.

Uncovering burden disparity: A comparative analysis of the impact of moderate-to-severe psoriasis and hidradenitis suppurativa.

BACKGROUND: Psoriasis and hidradenitis suppurativa (HS) exhibit distinct clinical features, but no studies have directly compared the health-related quality of life (HRQoL) in patients with moderate-to-severe manifestations of these conditions. OBJECTIVE: To determine which disease is associated with more severe HRQoL impairment. METHODS: Weighted averages of each of the following baseline HRQoL measures were determined and compared between HS and psoriasis populations from 5 clinical trials: Visual Analog Scale (VAS) for pain, Total Work Productivity Impairment, Dermatology Life Quality Index; EuroQOL 5D VAS, and Short Form-36 Health Survey. RESULTS: Compared with patients with psoriasis, patients with HS reported higher scores for VAS-pain (54.3 vs 36.1 [P < .0001]), Dermatology Life Quality Index (15.3 vs 11.3 [P < .0001]), EuroQOL 5D VAS (58.8 vs 50.8 [P < .0002]), and Total Work Productivity Impairment (35.4 vs 18.2). Patients with HS had lower Short Form-36 Health Survey scores than did patients with psoriasis (physical, 39.6 vs 49.0; mental, 41.5 vs 47.5 [both P < .0001]). LIMITATIONS: This analysis was performed using published summary data rather than patient-level data, and weighted pooled averages were compared. CONCLUSIONS: Patients with HS have a higher HRQoL burden than patients with psoriasis. This study clearly documents the needs of patients with HS and the potential impact of medical, scientific, and societal consensus for the development of more effective HS treatments.

Evaluating the Impact of Exclusion Criteria on the Generalizability of Hidradenitis Suppurativa Treatment Research.

Exclusion criteria can limit the generalizability and translation of research findings into clinical practice. The objective of this study is to characterize the trends of exclusion criteria and explore the impact of exclusion criteria on participant diversity, length of enrollment, and the number of enrolled participants. A detailed search was performed using PubMed and clinicaltrials.gov. Nineteen published randomized controlled trials were included, where 2,664 patients were screened, and 2,234 patients (mean age: 37.6 years, 56.6% female) were enrolled from 25 countries. On average, there were 10.1 (standard deviation: 6.14, range: 3-25) exclusion criteria per randomized controlled trial. There was a weak to moderate positive correlation between the number of exclusion criteria and the proportion of enrolled participants (R = 0.49, P value = 0.040). However, no association was seen between the number of exclusion criteria, number of enrolled Black participants (R = 0.86, p value = 0.08), and enrollment length (R = 0.083, P value = 0.74). In addition, there was no discernable trend in the number of exclusion criteria over time (R = -0.18, P value = 0.48). Although the number of exclusion criteria appeared to impact the number of enrolled participants, the lack of skin of color representation in hidradenitis suppurativa randomized controlled trials does not appear to be influenced by the number of exclusion criteria.

Skin and eye protection against ultraviolet C from ultraviolet germicidal irradiation devices during the COVID-19 pandemic.

With the COVID-19 pandemic depleting personal protective equipment worldwide, various methods including ultraviolet C (UVC) germicidal irradiation (UVGI) have been implemented to decontaminate N95 filtering facepiece respirators. These devices pose a risk for UVC exposure to the operator with reported adverse effects generally limited to the eyes and skin. Our hospitals are currently using UVC devices for N95 decontamination with a few reported cases of face and neck erythema from exposure. Because sunscreens are designed and tested for UVA and UVB protection only, their effects on blocking UVC are largely unknown. Therefore, our objective was to determine if various sunscreens, UV goggles, and surgical mask face shields minimize UVC exposure from UVGI devices. Our study clearly demonstrated that healthcare workers responsible for the disinfection of PPE using UVGI devices should always at least utilize clear face shields or UV goggles and sunscreen to protect against side effects of UVC exposure.

UVC Germicidal Units: Determination of Dose Received and Parameters to be Considered for N95 Respirator Decontamination and Reuse.

The COVID-19 pandemic has resulted in an international shortage of personal protective equipment including N95 filtering facepiece respirators (FFRs), resulting in many institutions using ultraviolet germicidal irradiation (UVGI) technology for N95 FFR decontamination. To ensure proper decontamination, it is crucial to determine the dose received by various parts of the FFR in this process. Recently, our group customized a UVGI unit for N95 decontamination. With experimental and theoretical approach, this manuscript discusses the minimum dose received by various parts of the N95 respirator after one complete decontamination cycle with this UVGI unit. The results demonstrate that all parts of the N95 FFR received at least 1 J cm-2 after one complete decontamination cycle with this unit. As there are a variety of UVGI devices and different types of FFRs, this study provides a model by which UVC dose received by different areas of the FFRs can be accurately assessed to ensure proper decontamination for the safety of healthcare providers.

Ertapenem - a potent treatment for clinical and quality of life improvement in patients with hidradenitis suppurativa.

BACKGROUND: A paucity of knowledge exists regarding the use of ertapenem in hidradenitis suppurativa. Our retrospective chart review and telephone interview aims to investigate the utility of intravenous ertapenem in severe, refractory hidradenitis suppurativa. METHODS: This retrospective chart review and telephone interview included patients with severe, refractory hidradenitis suppurativa treated with intravenous ertapenem between March 2013 and December 2016. Data were obtained from medical charts. During the telephone interview, patients were asked questions relating to satisfaction, quality of life changes, and disease state changes with ertapenem therapy. RESULTS: A total of 36 patients including 22 females and 14 males with Hurley stage II or III hidradenitis suppurativa were included. Thirty-five patients (97.2%), demonstrated improvements in hidradenitis suppurativa with ertapenem treatment. In total, 28 patients participated in our telephone interview. Twenty patients (71.4%) were very satisfied (n = 12) or satisfied (n = 8). Quality of life improved in 85.7% of patients (n = 24). CONCLUSION: Following ertapenem therapy, patients reported improvements in quality of life. This treatment appears promising as an adjunct to biologics or as a bridge to surgery in the treatment of severe, refractory hidradenitis suppurativa.

Hidradenitis suppurativa: an update on connecting the tracts.

Hidradenitis suppurativa (HS) is a devastating disease involving abscesses, sinus tracts, and inflammation classically affecting the axilla, groin, and/or anogenital region. Although the disease pathogenesis is not fully understood, recent advances suggest that HS pathology runs much deeper than the cutaneous manifestations. It is now believed that HS is a systemic inflammatory disease that gives rise to the characteristic cutaneous manifestations. This disease is problematic for both patients and physicians to manage because of a variety of diagnostic and management difficulties. This article seeks to provide updates on the current understanding of HS to increase awareness and improve management.