Expert consensus on priority research gaps in dietary and lifestyle factors in hidradenitis suppurativa: a Delphi consensus study.

Hidradenitis suppurativa (HS) is a debilitating systemic inflammatory disease with limited treatment options. Although management through dietary and lifestyle changes is a primary interest of the HS patient community, there is lack of consensus regarding recommendations due to the paucity of evidence. To establish the priority research gaps on this topic, we performed and moderated a Delphi consensus study by integrating expert opinions and the relevant literature. Based on a literature review, research questions on dietary and lifestyle interventions in HS were constructed. HS dietary and lifestyle research questions were sent to an expert panel, consisting of 22 international members, including dermatologists, dietitians, pharmacists, and endocrinologists. Voting on the research questions was conducted using a modified Delphi technique. The primary outcome measure was whether participants could reach consensus on the priority of each research question in the HS dietary and lifestyle factors. After three rounds of surveys investigating the relationships between HS and various diet and lifestyle factors, "BMI", "Obesity", and "Smoking", reached consensus as high priority research questions. Low research priorities per consensus included "effects of iron supplements", "effects of magnesium supplements", "alcohol consumption" and "limiting Brewer's yeast intake. Smoking and obesity were identified as important research questions, concurrent to the literature indicating their association with more significant impact on disease activity. By shedding light on high priority research questions, our study provides a roadmap for further research on dietary and lifestyle modifications in HS and will help determine evidence-based lifestyle and dietary recommendations for patients with HS.

Fish Pedicure: Review of Its Current Dermatology Applications.

Ichthyotherapy or fish pedicure is a unique form of biotherapy in which the species Garra rufa or doctor fish is used to exfoliate the skin and potentially aid in healing diseases, such as psoriasis. The practice has gained popularity since its origins in Kangal Fish Spring in Turkey; however, safety concerns, especially among immunocompromised patients, remain. This article reviews the studied dermatological benefits of ichthyotherapy and theorized mechanisms of action. Included are cases examining both infectious and noninfectious complications of this procedure. This review highlights the need to educate susceptible patients about possible adverse effects and the need for more studies assessing this procedure.