Complementary and Alternative Medicine for Hidradenitis Suppurativa Discussed on TikTok: A Cross-Sectional Analysis.

BACKGROUND: Hidradenitis suppurativa (HS) is a painful, chronic inflammatory skin disease that negatively affects patient quality of life, and conventional treatments are variably effective. As a result, patients often turn to complementary and alternative medicine (CAM) for pain relief. Social media enables HS patients to share treatment recommendations. TikTok is a popular social media platform, but little is known about the HS treatments discussed in TikTok videos.  Objective: To evaluate the content and quality of information on TikTok regarding CAM HS therapies.  Methods: A cross-sectional analysis was conducted by performing a search in TikTok using the terms #hidradenitissuppurativa, #hswarrior, #naturalremedy, #complementarymedicine, #alternativemedicine, and #HStreatment. Two independent reviewers evaluated video quality using the DISCERN and AVA instruments. Linear regressions compared the engagement, DISCERN, and AVA scores among different uploader types. RESULTS: In total, 91 TikTok videos were analyzed. Videos were uploaded by non-physicians (82.4), dermatologists (6.6%), and private companies (11.0%). The average DISCERN and AVA scores were 36.2 and 1.6, respectively (poor quality). Common CAM therapies were natural salves, turmeric, Epsom salts, elimination diets, and zinc supplements. Physician-uploaded videos were of significantly higher quality than videos by other uploader types, with an average DISCERN and AVA score of 44.3 (P<0.009) and 2.6 (P<0.001), respectively (fair quality). CONCLUSION: TikTok videos were poor quality (low DISCERN and AVA scores); physician-uploaded videos were fair quality. Dermatologists can improve video quality by adequately discussing the supporting evidence, mechanisms of action, and remaining questions for HS treatments.  J Drugs Dermatol. 2024;23(3):e93-96. doi:10.36849/JDD.7738e.

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.

Effects of Exercise and Dietary Modifications on Hidradenitis Suppurativa: A Systematic Review.

BACKGROUND: Hidradenitis suppurativa affects up to 4% of the population worldwide. Many treatment options exist but these come with a significant side-effect profile. Exercise, weight loss, and dietary modifications may be simple inexpensive alternatives and/or adjuncts to treating this disease. OBJECTIVES: We aimed to summarize published evidence on the effects of dietary, weight loss, and exercise interventions on the clinical course, severity, or subjective improvement of hidradenitis suppurativa and to provide a framework regarding dietary changes and exercise modalities for clinicians treating this disease. METHODS: A literature search of Scopus (1993 onwards), PubMed (1986 onwards), and MEDLINE (OVID interface, 1946 onwards) was conducted on 22 October, 2022. Case-control studies, cohort studies, and randomized controlled trials with five or more subjects conducted on adult participants (aged >18 years) were included; case reports, case series, and review papers were excluded. RESULTS: Fifteen studies involving 2829 patients were included, encompassing nine cohort studies, five cross-sectional studies, and one cross-over study. Patients who were female, lost more than 50 pounds (22.7 kg), or were obese prior to weight loss saw improvement in hidradenitis suppurativa severity with weight loss. There was evidence for beneficial effects of diets, such as the Mediterranean diet that minimizes sugar, highly processed carbohydrates, and dairy, and emphasizes chicken, fruits, and vegetables, in patients with hidradenitis suppurativa. Evidence also supported benefit from oral zinc and vitamin D supplementation. CONCLUSIONS: More evidence is needed in the form of randomized controlled trials or well-designed controlled trials to evaluate the effect of exercise and dietary manipulation on the hidradenitis suppurativa disease course. Overall, there is significant but weak evidence to support improvement in hidradenitis suppurativa severity with weight loss, dietary changes, and micronutrient supplementation. There is no significant evidence to support improvement in hidradenitis suppurativa symptomology with any type of exercise intervention. CLINICAL TRIAL REGISTRATION: This protocol was registered with PROSPERO with the registration number CRD4202235099.

[Guidelines for the Management of Patients with Hidradenitis Suppurativa]. / Recomendações na Abordagem do Doente com Hidradenite Supurativa.

Hidradenitis suppurativa is a chronic and recurrent inflammatory dermatosis characterized by the presence of inflammatory nodules and abscesses in the apocrine gland-rich areas that may progress to suppurative fistulas and scars. Despite being considered one of the dermatological conditions with the greatest impact on patient quality of life, it is often underdiagnosed. Hidradenitis suppurativa, especially in its severe forms, is associated with numerous comorbidities, so a holistic and multidisciplinary perspective is crucial for the management of these patients. The therapeutic approach is complex and challenging. The medical treatment options are diverse and must be adapted to clinical presentation and disease severity. Surgical therapy should be considered as an adjuvant to medical treatment, particularly in refractory cases and in the presence of scars or anatomical and/or functional mutilation. These recommendations reflect the main aspects of the management of the patient with hidradenitis suppurativa and are addressed to all healthcare professionals who take part in their follow-up.

A hidradenite supurativa é uma dermatose inflamatória crónica e recorrente que se caracteriza pela presença de nódulos inflamatórios e abcessos nas áreas ricas em glândulas apócrinas, que podem evoluir para fístulas supurativas e cicatrizes. Apesar de ser considerada uma das patologias dermatológicas com maior impacto na qualidade de vida dos doentes, é frequentemente subdiagnosticada. A hidradenite supurativa, sobretudo nas suas formas mais graves, associa-se a diversas comorbilidades, pelo que é fundamental adotar uma perspetiva holística e multidisciplinar na gestão destes doentes. A abordagem terapêutica é complexa e desafiante. A terapêutica médica é multifacetada e deve ser adaptada à apresentação clínica e gravidade da doença. A terapêutica cirúrgica deverá ser equacionada como adjuvante à terapêutica médica, em particular nos casos refratários e perante cicatrizes ou mutilação anatómica e/ou funcional. As presentes recomendações pretendem reunir os principais aspetos da abordagem ao doente com hidradenite supurativa e destinam-se a todos os profissionais de saúde envolvidos no seu acompanhamento.

Holistic health record for Hidradenitis suppurativa patients.

Hidradenitis suppurativa (HS) is a recurrent inflammatory skin disease with a complex etiopathogenesis whose treatment poses a challenge in the clinical practice. Here, we present a novel integrated pipeline produced by the European consortium BATMAN (Biomolecular Analysis for Tailored Medicine in Acne iNversa) aimed at investigating the molecular pathways involved in HS by developing new diagnosis algorithms and building cellular models to pave the way for personalized treatments. The objectives of our european Consortium are the following: (1) identify genetic variants and alterations in biological pathways associated with HS susceptibility, severity and response to treatment; (2) design in vitro two-dimensional epithelial cell and tri-dimensional skin models to unravel the HS molecular mechanisms; and (3) produce holistic health records HHR to complement medical observations by developing a smartphone application to monitor patients remotely. Dermatologists, geneticists, immunologists, molecular cell biologists, and computer science experts constitute the BATMAN consortium. Using a highly integrated approach, the BATMAN international team will identify novel biomarkers for HS diagnosis and generate new biological and technological tools to be used by the clinical community to assess HS severity, choose the most suitable therapy and follow the outcome.

Hidradenitis Suppurativa International Online Community: Patient Characteristics and a Novel Model of Treatment Effectiveness.

Treatment for hidradenitis suppurativa is diverse, yet frequently unsatisfactory. The aims of this study were to create a reproducible artificial intelligence-based patient-reported outcome platform for evaluation of the clinical characteristics and comorbidities of patients with hidradenitis suppurativa, and to use this to grade treatment effectiveness. A retrospective patient- reported outcome study was conducted, based on online questionnaires completed by English-speaking patients registered to the hidradenitis suppurativa StuffThatWorks® online community. Data collected included patient characteristics, comorbidities and treatment satisfaction. These were recoded into scalable labels using a combination of machine learning algorithm, manual coding and validation. A model of treatment effectiveness was generated. The cohort included 1,050 patients of mean ± standard deviation age 34.3 ± 10.3 years. Greater severity of hidradenitis suppurativa was associated with younger age at onset (p < 0.001) and male sex (p < 0.001). The most frequent comorbidities were depression (30%), anxiety (26.4%), and polycystic ovary syndrome (16.6%). Hurley stage I patients rated topical agents, dietary changes, turmeric, and pain relief measures more effective than tetracyclines. For Hurley stage II, adalimumab was rated most effective. For Hurley stage III, adalimumab, other biologic agents, systemic steroids, and surgical treatment were rated more effective than tetracyclines. Patients with hidradenitis suppurativa often have comorbid psychiatric and endocrine diseases. This model of treatment effectiveness provides a direct comparison of standard and complementary options.

Physician perspectives on complementary and alternative medicine in hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic and often debilitating inflammatory condition characterized by frequent nodules, abscesses, sinus tracts, and scars impacting the intertriginous areas. Many patients with HS often report limited treatment success and symptom coverage with conventional therapies. Recent studies have reported the widespread use of complementary and alternative medicine (CAM) among patients with HS. In this study, our aim was to examine current physician practice patterns, opinions, and comfort with recommending CAM. Our results indicate that provider comfort and opinions on CAM varied based on the provider's experiences, demographics, and the CAM modality itself. Overall, nearly two-thirds (n = 30, 61.2%) of respondents agreed that CAM and conventional medicine were more effective together than either alone. Meanwhile, 44.9% (n = 22) of respondents routinely recommend CAM while 64.6% (n = 31) of respondents reported that they are routinely asked about CAM. The majority (n = 41, 83.7%) of respondents indicated a lack of scientific evidence in the medical literature as a barrier to recommending CAM along with efficacy concerns (n = 34, 69.4%) and ability to recommend reputable CAM products (n = 32, 65.3%) and practitioners (n = 32, 65.3%). Future investigations are warranted to establish a better understanding of the efficacy and benefit of CAM methods in conjunction with conventional methods.

Combined treatment of hidradenitis suppurativa with intense pulsed light (IPL) and radiofrequency (RF).

BACKGROUND: Hidradenitis suppurativa is a chronic inflammatory disease with high burden. Treatment options are often unsatisfactory. We assessed the effect of a combination therapy of intense pulsed light (IPL) and radiofrequency (RF). METHODS: The explorative study included 47 patients and was performed as a prospective, monocentric, randomized, three-arm parallel-group design trial with a prior 12 weeks observation period. Treatment arms were IPL and RF monotherapies or IPL + RF combination therapy. After 12 weeks, all patients received IPL + RF for additional 12 weeks (cross-over). Primary endpoint was the change in active lesion numbers, secondary endpoint the change in Dermatology Quality of Life Index (DLQI). RESULTS: After 12 weeks, active lesion counts of the IPL + RF group decreased more than in the IPL group (p = .044); the decrease in DLQI was significantly higher in the IPL + RF and RF groups compared to IPL. Prolonged 24-week treatment with IPL + RF obtained better results as 12 weeks. Overall, disease burden after 24 weeks of treatment compared to disease fluctuation during the observation period was significantly lower (change in active lesions -3.6, p = .001; in DLQI -5.2, p = .003). CONCLUSIONS: IPL + RF treatment appears to represent a promising therapeutic option that leads to reduction of disease activity without severe side effects.

Non-pharmacologic approaches for hidradenitis suppurativa - a systematic review.

Importance: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition presenting with painful nodules and sinus tracts primarily in intertriginous regions. The persistent nature of HS and challenges in symptom management lead many patients to seek non-pharmacologic approaches due to the paucity and limited efficacy of conventional HS therapeutic options.Objective: To evaluate the existing evidence for non-pharmacologic modalities in treatment of HS.Findings: Discussed in this review are non-pharmacologic modalities with evidence of efficacy in HS treatment, including weight loss, vitamin B12, vitamin D and zinc supplementation, and dietary avoidance of brewer's yeast. Limitations of the available data on non-pharmacologic therapies in HS include the predominance of pilot and single-armed studies, as well as heterogeneity in study design, subject disease severity, concomitant treatment and comorbid conditions.Conclusions and relevance: HS patients are becoming increasingly interested in the use of non-pharmacologic approaches to augment conventional treatments. Strength of evidence for non-pharmacologic therapies in HS is limited by small study size and lack of randomized controlled trials. Future large-scale investigations should be pursued to better establish efficacy and dosing regimens for the use of non-pharmacologic treatments in HS.

[Intense pulsed light treatment for hidradenitis suppurativa: a within-person randomized controlled trial]. / Intense pulsed light treatment for hidradenitis suppurativa: a within-person randomized controlled trial.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of the intertriginous areas. HS affects hair follicles causing perifollicular inflammation, resulting in the formation of nodules and painful abscesses. Intense pulsed light (IPL) uses selective photothermolysis to destroy the hair follicles. OBJECTIVES: To evaluate the effect of IPL hair removal as treatment for mild-to-moderate HS. MATERIALS & METHODS: We conducted a single-blinded, clinical randomized trial with patients with Hurley Stage I-II. Patients with symmetrical disease were randomized to monthly unilateral treatment of the axilla or groin. The contralateral side served as internal control. Concomitant treatment modalities for HS were not permitted throughout the study. Efficacy was assessed using Hidradenitis Suppurativa Clinical Response (HiSCR), modified Sartorius score (MSS) and patient-reported outcomes. RESULTS: A total of 17 patients completed the trial and were included in the analysis. HiSCR was not evaluated in patients without abscesses or inflammatory nodules pre-treatment. HiSCR was insignificantly different between the intervention side (8/12) and control side (4/10), P=0.467. There was, however, a significant reduction in regional MSS on the intervention side with a median score decreasing from 8.5 (IQR: 6.3-13.5) to 4.5 (IQR 1.8-8.0) post-treatment, P=0.006, and an insignificant score reduction in the control side from 6.0 (IQR: 4.5-8.3) to 5.0 (IQR: 2.5-9.0), post-treatment P=0.492. CONCLUSION: IPL hair removal resulted in a significant reduction on MSS on the treated area with no significant reduction on the control side. Our study suggests that IPL may be an effective treatment for mild-to-moderate HS.

The most recent advances in understanding and managing hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, and debilitating skin disease of the hair follicle unit that typically develops after puberty. HS has a significant negative impact on both the quality of life (QOL) of patients affected by this disease as well as family members and caregivers. However, the pathogenesis of HS is multifactorial and still remains to be fully elucidated, which makes the development of treatments difficult. The last 10 years have seen a surge in HS research, and many new findings have come to light, yet much more remains to be elucidated. Physicians must employ a multidisciplinary approach to maximally address all facets of HS. Clinical characteristics of the disease that differ between females and males as well as across different races and ethnic groups must be considered. Targeted topical, oral, and injectable therapies continue to be developed for HS as a greater understanding of the pathogenesis is reached. However, randomized controlled trials regarding dietary factors that may contribute to HS are needed to meet our patients' growing concerns and questions about the role of diet in HS pathogenesis. Finally, improved outcome measures are needed to standardize HS severity and grading between physicians and clinical trials, and a more diverse representation of HS populations is needed in clinical trials.

Laser hair reduction for hidradenitis suppurativa warrants insurance coverage.

Hidradenitis suppurativa is a chronic, painful disease that significantly reduces quality of life. Laser hair reduction is one modality that can be used in combination with other treatments to ameliorate the condition. We argue that insurance should provide coverage for this necessary service.

Photobiomodulation as potential novel third line tool for non-invasive treatment of hidradenitis suppurativa.

Hidradenitis Suppurativa (HS) is a severe inflammatory pathology of the skin characterized by chronic recurrent inflamed lesions, nodules, sinus tracts and abscesses usually manifests after puberty, which involves scalp, neck, axillae, perineum and infra-mammary areas. Nowadays treatment options range from short or long courses of antibiotics, anti-inflammatory and biologic drugs, to surgery. Other suggested treatments consider the employment of laser devices, mainly microsurgical lasers (such as CO2 and intense pulsed lasers) and photodynamic therapy. This review explores the potential use of photobiomodulation (PBM), already used for the treatment of other skin conditions, such as acne, hypertrophic scars, wrinkles, and burns, as potential novel therapy for HS. PBM has been reported to have beneficial effects on promoting wound healing, angiogenesis, vasodilation, and relieving from pain and inflammation, as recently demonstrated in an in-vitro model mimicking HS disease. In addition, PBM, specifically set at the blue wavelength, has been recently reported as exerting an anti-bacterial activity. Therefore, considering all these PBM features especially its ability to decrease pain and inflammation and to lead to faster wound healing, thus improving patients' quality of life, we hypothesize its employment as adjuvant third line treatment for the management of HS both in young and adult patients.

Laser and Light-Based Treatment Modalities for the Management of Hidradenitis Suppurativa.

Hidradenitis suppurativa is a chronic inflammatory skin disease characterized by inflammatory nodules, abscesses, and sinus tracts in intertriginous areas that has a significant impact on patient quality of life. Treatments range from topical, intralesional, systemic, and surgical. Furthermore, laser and light-based treatment options have become increasingly popular because of the limitations of adverse effects associated with systemic therapy and decreased down-time associated with laser and light therapy. These modalities are thought to work through a variety of mechanisms including decreasing inflammation, destroying hair follicles, targeting sebaceous glands, killing bacteria, and debulking lesions through ablation. This review explores these laser and light-based treatment modalities for the treatment of hidradenitis suppurativa.

Systematic Review of Light-Based Treatments for Hidradenitis Suppurativa. / Revisión sistemática de las terapias con luz en el tratamiento de la hidradenitis supurativa.

Treatment options for hidradenitis suppurativa include light-based therapy. This systematic review aimed to update our understanding of the efficacy, effectiveness and safety of these treatments for hidradenitis suppurativa by evaluating the literature published since the 2015 Cochrane review on this topic. We conducted an electronic search of the following databases: MEDLINE, EMBASE, University of York Centre for Reviews and Dissemination database, Cochrane Database of Systematic Reviews, Cochrane Skin Group Specialised Skin Register, University of Nottingham's Centre of Evidence Based Dermatology database, and TESEO. The systematic review included 6 case series, 3 systematic reviews, and 2 clinical trials on the use of conventional and intralesional photodynamic therapy, intense pulsed light therapy, and Nd:YAG, carbon dioxide, and diode laser therapy for hidradenitis suppurative in 248 patients.

Recognition, diagnosis, and treatment of hidradenitis suppurativa.

Hidradenitis suppurativa is a chronic skin condition characterized by recurrent painful abscesses usually limited to the intertriginous areas. Global prevalence has been estimated at up to 4% of the population. The exact pathogenesis of hidradenitis suppurativa is yet to be elucidated; however, recent research has shown that the disease occurs under the influence of multiple genetic, environmental, and lifestyle factors. Repeated insults result in sinus tract formation and disfigurement, which can have a significant psychosocial effect on patients. A wide range of treatments are available but none are curative. A combination antibiotic regimen is considered first line, and research into the use of biologics has been promising. Early recognition and treatment is paramount to achieving a better prognosis and improving patient quality of life.