A Patient-Centered Guide to Hidradenitis Suppurativa Flare Prevention.

Hidradenitis suppurativa (HS) is a chronic debilitating skin disease characterized by painful dermal abscesses, subcutaneous inflammatory nodules, draining sinuses and hypertrophic scars. Prompt recognition and management of the disease is of the utmost importance as prolonged disease can have long-standing physical and psychological consequences. Quality of life and symptom improvement are viable outcomes from preventative interventions in patients with HS. While there is not a cure for HS, symptoms can be managed, and recurrence can be reduced following various lifestyle changes. Treatment should be focused on prevention of disease progression, reducing the frequency of recurrence, and treating existing lesions to minimize pain and drainage. J Drugs Dermatol. 2021;20(12):1295-1300. doi:10.36849/JDD.5838.

Métodos referidos por los pacientes para aliviar el dolor asociado a la hidradenitis supurativa / Self-Reported Pain Alleviating Methods in Patients with Hidradenitis Suppurativa

INTRODUCCIÓN: El dolor es un síntoma común e importante que afectará negativamente el bienestar y la calidad de vida de los pacientes con hidradenitis supurativa (HS). El objetivo del presente estudio fue valorar los métodos utilizados para aliviar el dolor asociado a la HS, referidos por los pacientes ambulatorios provenientes de un centro de referencia terciario. MÉTODOS: Se seleccionaron de manera consecutiva pacientes con el diagnóstico de HS. Posteriormente se les invitó a que completasen un cuestionario acerca de cuáles eran los métodos que utilizaban para aliviar el dolor asociado a la HS. Así mismo, los pacientes completaron el cuestionario del Índice de Calidad de Vida en Dermatología y la escala visual analógica acerca de las molestias generales que presentaban en relación con la HS, así como el dolor asociado a la aparición de forúnculos en el último mes. La información sobre la gravedad y la forma de presentación de la enfermedad se obtuvo mediante la anamnesis y el examen clínico. RESULTADOS: Se incluyeron un total de 134 pacientes con una edad media de 38,3 años (DE 12,8). El 32% (n = 43) tenía un estadio i, el 52% (n = 70) un estadio II y el 16% (n = 21) un estadio III de Hurley. Para lograr el alivio del dolor el 82% (n = 110) de los pacientes refirieron que habían drenado el pus de las lesiones inflamatorias usando la presión de los dedos. En comparación con los pacientes que no habían usado ningún método para aliviar el dolor, los pacientes que sí lo habían hecho tuvieron en general un mayor grado de angustia en relación con la enfermedad (7,43 [DE 2,81] frente a 5,47 [DE 3,37], p < 0,003), así como un mayor grado de dolor asociado a la presencia de forúnculos durante el último mes (6,56 [DE 3,07] frente a 4,39 [DE 3,88], p = 0,007). CONCLUSIÓN: El presente estudio demuestra que una elevada proporción de los pacientes con HS intentarán aliviar el dolor por sí mismos utilizando diversos métodos caseros y alternativos. Estos resultados reflejan la importancia del dolor en la HS y que posiblemente el manejo de este por los dermatólogos sea insuficiente

BACKGROUND: Pain is a common, important symptom negatively affecting the well-being and quality of life of patients with hidradenitis suppurativa (HS). The aim of this study was to examine self-reported pain alleviating methods among outpatients attending a tertiary referral center. METHODS: Consecutive patients with HS were invited to complete a questionnaire regarding their self-reported pain alleviating methods for HS associated pain. Additionally, the patients filled out the Dermatology Life Quality Index questionnaire and a visual analog scale for overall distress related to HS and for boil-associated pain in the past month. Information on disease severity and onset was obtained by interview and clinical examination. RESULTS: A total of 134 patients with a mean age of 38.3 years (SD 12.8) participated; 32% (n = 43) had Hurley stage i, 52% (n = 70) had Hurley stage ii, and 16% (n = 21) had Hurley stage III. Overall, to achieve pain relief, 82% (n = 110) of the patients had previously drained pus from the lesions by manual pressure. Compared to patients who did not alleviate pain, patients who attempted to alleviate pain had a higher mean overall disease related distress score (7.43 [SD 2.81] vs. 5.47 [SD 3.37], P < .003), and a higher boil-associated pain score in the past month (6.56 [SD 3.07] vs. 4.39 [SD 3.88], P = .007). CONCLUSION: This study demonstrates that a large proportion of HS patients attempt to alleviate pain through various alternative and homespun methods. These results may reflect a major role of pain in HS and its potential insufficient management by dermatologists

Hidradenitis supurativa: necesidad de un diagnóstico e intervención precoz sobre la enfermedad y sus comorbilidades / Hidradenitis Suppurativa: Need for Early Diagnosis and Management of the Disease and Associated Conditions

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Arguments for a national questionnaire-based screening for hidradenitis suppurativa in Denmark.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease. HS patients develop painful subcutaneous nodules, primarily in the intertriginous regions. Early diagnosis is crucial to initiate appropriate treatment, which may prevent disease progression. The cost of treatment increases with disease severity. Studies have found a considerable diagnostic delay in HS. Screening programs may reduce diagnostic delay and allow for better utilization of resources. METHODS: Arguments for implementing an HS screening program were explored based on the 10 WHO criteria for implementing screening programs. RESULTS: HS is an important health problem due to its prevalence and the adverse effects of the disease. Facilities for treatment and diagnosis exist, and the validated screening questionnaire is considered acceptable to the population. HS patients should be seen by a dermatologist and treated accordingly. Medical expenses increase with disease severity, and finding patients with early-stage HS is considered cost-effective. CONCLUSIONS: We consider a screening program as valuable for public healthcare. Patients can avoid extensive surgery or treatment with biologics if disease progression is prevented, and this will reduce medical expenses for the public healthcare system. Politicians should consider implementing a screening program for HS.

Optimal wound care management in hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa (HS) presents the problem of a chronic, relapsing, painful, draining wound. There is a myriad of HS wound care management strategies implemented by clinicians and patients centered around which dressings to use. Many factors affect which HS wound care dressing is the most appropriate to use such as the type of HS wound, cost, ease of application, patient comfort, absorbency and odor management among many others. AIM: In this work, the authors aim to prepare a set of guidelines for optimal HS wound care dressing use based on a tier system, ideal characteristics of HS dressings and the type of HS lesion. The dressing recommendations focus on cost-effectiveness for patients, ease of accessibility and ultimately, improvement in the quality of life of patients suffering from HS. METHODS: PubMed was utilized to search the terms 'wound care + HS'; 'non-surgical wound care + HS'; 'optimal wound care + HS'; 'HS wounds'; and 'optimal wound dressings'. RESULTS: Silver-impregnated foam is considered the most optimal HS wound care dressing because it contains nearly all characteristics of an ideal wound care dressing. CONCLUSION: However, silver-impreganted foam is expensive and difficult to access for patients, so lower-tier HS wound care dressings must be considered prior to utilizing this tier 4 dressing.

Actualización en hidradenitis supurativa (II): aspectos terapéuticos / Update on Hidradenitis Suppurative (Part II): Treatment

A pesar de la importancia y de la gravedad de la hidradenitis supurativa, el tratamiento de esta enfermedad no se encuentra bien definido. Hoy en día, la hidradenitis es considerada una enfermedad cutánea que principalmente en las formas moderadas y severas se asocia a un marcado componente inflamatorio sistémico. Por lo tanto, el tratamiento de esta enfermedad irá enfocado hacia un manejo sistémico del control de la inflamación, que ocasionalmente irá acompañado de la intervención quirúrgica para reducir la carga de inflamación localizada en la piel. Los recientes avances en el conocimiento de la enfermedad se han acompañado de novedades terapéuticas, especialmente representadas por el desarrollo de ensayos clínicos de determinadas terapias biológicas, principalmente adalimumab, orientados al tratamiento específico de esta enfermedad. En la presente revisión se pretende analizar las diferentes alternativas terapéuticas existentes en el manejo de la hidradenitis supurativa

Although hidradenitis suppurativa is a common and serious skin condition, its treatment is not well established. It is now accepted that the moderate and severe forms of the disease are associated with marked systemic inflammation. The goal of treatment in hidradenitis suppurative is therefore to achieve systemic control of inflammation. In some cases, surgery may also be necessary to reduce the severity of the manifestations of cutaneous inflammation. Recent advances in our understanding of hidradenitis suppurativa have been accompanied by the emergence of novel approaches to its treatment, including the use of certain biologic drugs. Several clinical trials have been undertaken to test the effects of biologics (mainly adalimumab) in this setting. In this review, we analyze the different treatments available for hidradenitis suppurativa

Diet in the prevention of hidradenitis suppurativa (acne inversa).

Full control of hidradenitis suppurativa requires the prevention of new lesions. These appear to be induced by a complex series of hormonally driven molecular activities that lead to obstruction of the follicular duct, rupture and destruction of the sebaceous glands, the development of deep dermal sinuses that subsequently rupture to the surface, and production of an invasive subcutaneous mass that is resistant to medical therapy. Preliminary observations suggest that the use of a healthy and fully natural zero dairy and low glycemic-load diet may provide relief from progression of the lesions and possibly prevention of new lesions, even when medications fail.