Doppler ultrasound protocol for patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. OBJECTIVE: To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. METHODS: A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. RESULTS: Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. STUDY LIMITATIONS: The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. CONCLUSIONS: The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life.

Efeitos do adalimumabe, clindamicina e/ou rifampicina no tratamento da hidradenite supurativa: um protocolo de revisão sistemática / Effects of adalimumab, clindamycin, and/or rifampicin in the treatment of hidradenitis suppurativa: a systematic review protocol

OBJETIVO: Avaliar a efetividade, segurança, níveis de dor e qualidade de vida associados ao uso de adalimumabe, clindamicina e/ou rifampicina no tratamento da hidradenite supurativa. MÉTODO: Serão incluídos estudos do tipo coorte prospectiva e retrospectiva, ensaios clínicos randomizados e de equivalência, bem como análises econômicas realizadas com adultos diagnosticados com hidradenite supurativa, que tenham utilizado pelo menos uma das seguintes alternativas terapêuticas: adalimumabe, clindamicina ou rifampicina. Os estudos devem abordar um ou mais desfechos, tais como contagem de abscessos e/ou nódulos, presença de nódulos inflamatórios, níveis de dor, qualidade de vida, segurança e custos. As bases de dados consultadas serão: Medical Literature Analysis and Retrieval System Online (MEDLINE, Interface OVID), Excerpta Medica DataBASE (EMBASE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL, interface EBSCO), Psychological Abstracts (PsycINFO, interface EBSCO), Web of Science (WoS) e Source-Neutral Abstract and Citation Database (Scopus). Os processos de triagem, seleção e extração serão conduzidos por pesquisadores independentes e previamente treinados. O risco de viés será avaliado por meio dos instrumentos Risk of Bias 2.0 e ROBINS-I. Os resultados serão combinados em uma síntese qualitativa e quantitativa, com a realização de análises de especificidade e subgrupos.

OBJECTIVE: To evaluate the efficacy, safety, pain, and quality of life associated with the use of adalimumab, clindamycin, and/or rifampicin in the treatment of hidradenitis suppurativa. METHOD: Prospective and retrospective cohort studies randomized clinical trials and equivalence studies, and economic analyses, conducted in adults diagnosed with hidradenitis suppurativa who have used at least one of the following therapeutic alternatives: adalimumab, clindamycin, or rifampicin, will be included. Studies should address one or more outcomes such as abscess and/or nodule counts, presence of inflammatory nodules, pain levels, quality of life, safety, and cost. Databases consulted will include Medical Literature Analysis and Retrieval System Online (MEDLINE, OVID interface), Excerpta Medica DataBASE (EMBASE), Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO interface), Psychological Abstracts (PsycINFO, EBSCO interface), Web of Science (WoS), and Source-Neutral Abstract and Citation Database (Scopus). Screening, selection, and extraction processes will be conducted by independent and previously trained researchers. The risk of bias will be assessed using the Risk of Bias 2.0 and ROBINS-I tools. Results will be summarized in a qualitative and quantitative synthesis, including specificity and subgroup analyses.

Update on Ultrasound Diagnostic Criteria and New Ultrasound Severity and Activity Scorings of Hidradenitis Suppurativa: Modified SOS-HS and US-HSA.

Hidradenitis suppurativa (HS) is a devasting autoimmune cutaneous disease that affects the hair follicles and can clinically present palpable nodules, abscesses, and tunnels (fistulas), usually in the intertriginous regions. It has been widely reported that color Doppler ultrasound can detect subclinical abnormalities and stage the severity of the disease more accurately. Nevertheless, the ultrasound diagnostic criteria were reported with 15 MHz 10 years ago, and now it is possible to detect early anatomical abnormalities in HS using 70 MHz. Thus, an update of the ultrasonographic diagnostic criteria is needed. The most widely used sonographic staging of severity of HS (SOS-HS) includes the number of affected regions, besides counting the number of key lesions like pseudocysts, fluid collections, and tunnels; however, the total number of affected regions may fit better in an activity scoring. Furthermore, a high number of tunnels or communicated tunnels can complicate the management and may indicate an even more urgent treatment, which should be considered in the severity classification. To date, no hidradenitis scoring of activity has been reported in the literature, making it difficult to track the degree of inflammation under treatment objectively. Therefore, two new scorings are proposed. The first is an updated sonographic scoring of severity called modified SOS-HS (mSOS-HS), and the second is an activity ultrasound scoring of HS called US-HSA. Both staging systems can provide better anatomical information for discriminating the categories and, therefore, selecting more appropriate treatments and supporting research and clinical trials by giving more objective anatomical tools in real-world settings.

Hidradenitis supurativa glútea y perineal: diagnóstico y manejo terapéutico / Gluteal and perineal hidradenitis suppurativa: diagnosis and therapeutic management / Hidradenite suppurativa glútea e perineal: diagnóstico e manejo terapêutico

La hidradenitis supurativa (HS) es una enfermedad inflamatoria crónica de la piel que afecta a las glándulas sudoríparas apocrinas y causa nódulos inflamatorios, abscesos y fistulas dolorosas en áreas como las axilas, la ingle y los glúteos. Su impacto en la calidad de vida de los pacientes es significativo. La HS afecta al 1- 4% de la población mundial y se asocia con factores como el sobrepeso, el tabaquismo y antecedentes familiares. Su patogenia es compleja, involucrando inflamación y disfunción inmunológica. Su diagnóstico y tratamiento son desafiantes, especialmente en casos graves. El diagnóstico se basa en la presentación clínica, que a menudo se confunde con otras afecciones cutáneas. Se clasifica en etapas de Hurley según la gravedad. El tratamiento se centra en controlar los síntomas y prevenir recurrencias. Incluye educación del paciente, tratamiento médico y cirugía. La elección de la terapia antibiótica depende de la severidad y las cepas bacterianas presentes. Para casos graves, se investigan terapias biológicas. La cirugía, como la escisión simple o con injertos de piel, es efectiva en el control de la enfermedad. Presentamos un caso clínico de un paciente con HS, revisamos la epidemiología, etiopatogenia y su diagnóstico acompañado de las opciones terapéuticas existentes

A hidradenite supurativa (HS) é uma doença inflamatoria crônica da pele que afeta as glândulas sudoríparas apócrinas e causa nódulos inflamatórios, abscessos e fístulas dolorosas em áreas como axilas, virilha e nádegas. Seu impacto naqualidade de vida dos pacientes é significativo. A EH afeta de 1 a 4% da população mundial e está associada a fatores como excesso de peso, tabagismo e histórico familiar. Suapatogênese é complexa, envolvendoinflamação e disfunçãoimunológica, sendoseu diagnóstico e tratamento desafiadores, principalmente nos casos graves. O diagnóstico é baseadonaapresentação clínica, que muitasvezes é confundida comoutrasdoenças da pele. É classificado em estágios de Hurley com base nagravidade. O tratamento se concentra no controle dos sintomas e naprevenção de recorrências. Incluieducação do paciente, tratamento médico e cirurgia. A escolha da antibioticoterapia depende da gravidade e das cepas bacterianas presentes. Para casos graves, terapias biológicas são investigadas. A cirurgia, como excisão simples ouenxertos de pele, é eficaz no controle da doença. Apresentamosum caso clínico de umdoentecom HS, revisamos a epidemiologia, a etiopatogenia e o seu diagnóstico acompanhado das opçõesterapêuticas existentes.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects the apocrine sweat glands and causes inflammatory nodules, abscesses, and painful fistulas in areas such as the armpits, groin, and buttocks. Its impact on patients' quality of life is significant. HS affects 1-4% of the world's population and is associated with factors such as overweight, smoking, and family history. Its pathogenesis is complex, involving inflammation and immune dysfunction. Its diagnosis and treatment are challenging, especially in severe cases. Diagnosis is based on clinical presentation, which is often confused with other skin conditions. It is classified into Hurley stages based on severity. Treatment focuses on controlling symptoms and preventing recurrences. Includes patient education, medical treatment and surgery. The choice of antibiotic therapy depends on the severity and the bacterial strains present. For severe cases, biological therapies are investigated. Surgery, such as simple excision or skin grafts, is effective in controlling the disease. We present a clinical case of a patient with HS, we review the epidemiology, etiopathogenesis and its diagnosis accompanied by the existing therapeutic options.

A loss-of-function NCSTN mutation associated with familial Dowling Degos disease and hidradenitis suppurativa.

Dowling Degos disease (DDD) is a rare autosomal dominant genodermatosis characterized by acquired, slowly progressive reticulated pigmented lesions primarily involving flexural skin areas. Mutations in KRT5, POGLUT-1 and POFUT-1 genes have been associated with DDD, and loss-of-function mutations in PSENEN, a subunit of the gamma-secretase complex, were found in patients presenting with DDD or DDD comorbid with hidradenitis suppurativa (HS). A nonsense mutation in NCSTN, another subunit of the gamma-secretase, was already described in a patient suffering from HS and DDD but whether NCSTN could be considered a novel gene for DDD is still debated. Here, we enrolled a four-generation family with HS and DDD. Through Whole Exome Sequencing (WES) we identified a novel nonsense mutation in the NCSTN gene in all the affected family members. To study the impact of this variant, we isolated outer root sheath cells from patients' hair follicles. We showed that this variant leads to a premature stop codon, activates a nonsense-mediated mRNA decay, and causes NCSTN haploinsufficiency in affected individuals. In fact, cells treated with gentamicin, a readthrough agent, had the NCSTN levels corrected. Moreover, we observed that this haploinsufficiency also affects other subunits of the gamma-secretase complex, possibly causing DDD. Our findings clearly support NCSTN as a novel DDD gene and suggest carefully investigating this co-occurrence in HS patients carrying a mutation in the NCSTN gene.

The novel use of cryopreserved human allograft in extensive Hurley stage III hidradenitis suppurativa.

INTRODUCTION: HS is a debilitating dermatologic condition in which apocrine sweat glands become occluded, leading to severe inflammation. Treatment usually ranges from conservative management to surgical intervention with the goal of treating existing lesions while reducing the rate of recurrence, progression, and scarring. Depending on the surface area involved, autologous skin grafting may be difficult when donor sites are limited due to the extent of disease, previous surgery, or scarring. This case report examines the efficacy of cryopreserved human allograft as a surgical treatment of extensive HS. CASE REPORT: A 37-year-old man presented with severe, refractory Hurley stage III HS in which cryopreserved human allograft was used to aid in wound contracture and granulation tissue formation. In addition, its use improved contour deformities and served as a bridge to autologous skin grafting, minimizing donor site size and morbidity. CONCLUSIONS: While autologous skin grafting is necessary for final wound closure, the use of cryopreserved human allograft provides biologic wound management that aids as a bridge to autologous skin grafting. As such, the authors advocate its use as a tissue scaffold in the management of severe, extensive HS and other dermatologic conditions requiring skin excision.

Can Ultrasound Examinations Generate Pain in Hidradenitis Suppurativa Patients? Results from a Multicentric Cross-Sectional Study.

BACKGROUND: Pain is not a trivial issue for hidradenitis suppurativa (HS) patients and has been considered a domain in the Core Outcome Set. To date, there is no evidence about pain caused by the ultrasound examinations. OBJECTIVE: The aim of the study was to assess the presence of pain generated by the ultrasound examinations of HS patients. METHODS: A multicentric cross-sectional study for detecting pain during the ultrasound examinations of HS patients using a validated verbal questionnaire immediately after the imaging studies. Statistical analysis included demographic data and possible associations with sex, age, location, clinical (Hurley), and ultrasonographic scoring (SOS-HS). The statistical tests were two proportions Z test, χ2 test, Student's t test, and ANOVA. A p < 0.05 was considered significant. RESULTS: 317 patients met the criteria. 77.3% of them did not present pain. Of cases with pain, 59.8% were mild, 16.7% moderate, and 23.6% severe. No significant association was found with sex, age, staging, location, or the number of affected regions. Although nonsignificant, severe pain cases were more frequent in the clinical Hurley III and ultrasonographic SOS-HS III stages. CONCLUSION: Pain generated by the ultrasound examination of HS patients is infrequent.

Transcriptome Meta-Analysis Confirms the Hidradenitis Suppurativa Pathogenic Triad: Upregulated Inflammation, Altered Epithelial Organization, and Dysregulated Metabolic Signaling.

Hidradenitis suppurativa (HS) is an inflammatory skin condition clinically characterized by recurrent painful deep-seated nodules, abscesses, and sinus tracks in areas bearing apocrine glands, such as axillae, breasts, groins, and buttocks. Despite many recent advances, the pathophysiological landscape of HS still demands further clarification. To elucidate HS pathogenesis, we performed a meta-analysis, set analysis, and a variant calling on selected RNA-Sequencing (RNA-Seq) studies on HS skin. Our findings corroborate the HS triad composed of upregulated inflammation, altered epithelial differentiation, and dysregulated metabolism signaling. Upregulation of specific genes, such as KRT6, KRT16, serpin-family genes, and SPRR3 confirms the early involvement of hair follicles and the impairment of barrier function in HS lesioned skin. In addition, our results suggest that adipokines could be regarded as biomarkers of HS and metabolic-related disorders. Finally, the RNA-Seq variant calling identified several mutations in HS patients, suggesting potential new HS-related genes associated with the sporadic form of this disease. Overall, this study provides insights into the molecular pathways involved in HS and identifies potential HS-related biomarkers.

Hidradenitis suppurativa.

THE COMPARISONSevere longstanding hidradenitis suppurativa (Hurley stage III) with architectural changes, ropy scarring, granulation tissue, and purulent discharge in the axilla of A 35-year-old Black man. A 42-year-old Hispanic woman with a light skin tone.

Immunobiologicals in dermatology.

Immunobiologicals are a reality in current clinical practice and have increasingly gained space in the inflammatory disease scenario, especially in dermatology, with approved drugs for psoriasis, atopic dermatitis, and hidradenitis suppurativa, in addition to many others undergoing study. It is important for dermatologists to have knowledge of the medications approved in Brazil, for the best management of dermatoses, in addition to the fact that they represent hope for improvement in patients with chronic diseases.

Cardiovascular Disease-Associated Skin Conditions.

According to data from the American Heart Association and the World Health Organization, cardiovascular disease (CVD) is the most frequent cause of premature death. Several inflammatory and non-inflammatory skin diseases have been associated with metabolic syndrome and cardiovascular risk (CVR). Here, we classified these conditions into traditionally CVR-associated and those that have been linked to a lesser degree. Psoriasis and hidradenitis suppurativa are commonly associated with CVD, sharing common inflammatory pathways and a higher prevalence of traditional cardiovascular risk factors. Many other diseases could be associated indirectly - with no common pathogenic features with the atheromatous disease - but share a higher prevalence of standard cardiovascular risk and chronic inflammatory state. This review aims to highlight the associated cardiovascular risk that exists for some dermatologic diseases and sensitize cardiologists, dermatologists, and first care providers to implement risk factor control promptly.

Spironolactone in dermatology.

Spironolactone is a drug, similar in structure to aldosterone and acts as an aldosterone receptor antagonist with an anti-androgenic effect. This drug has proven to be useful in several dermatological entities, however its use has not been well explored. Its use in diseases such as acne has opened the door to the possibility of new therapies depending on the clinical manifestations of the patients, as well as its possible to use it as a first line treatment. Other diseases associated with the use of spironolactone where its effects have been shown to be useful are hidradenitis suppurativa, hirsutism, and female pattern androgenetic alopecia. In this review, we discuss the use of spironolactone in different skin diseases that are common in our environment, dosage according to different studies, treatment recommendations and adverse effects; all of the above mentioned in order to use this drug in a daily clinical practice.

Alterations in mental health and quality of life in patients with skin disorders: a narrative review.

The presence of lesions in visible areas of skin may cause emotional troubles in patients, including low self-worth, embarrassment, sorrow, and social isolation. Those alterations may predispose to psychiatric disorders such as anxiety, depression, and even suicidal ideation, severely affecting patients' health state and quality of life (QoL). In this article, we focus on dermatologic patients that present with secondary mental health alterations. Thus, we offer a detailed description of mental disorders observed in patients with acne vulgaris, atopic dermatitis, psoriasis, ichthyosis, vitiligo, and hidradenitis suppurativa. Moreover, we point out the relationship between the severity of the cutaneous symptoms with mental illnesses and QoL decline. Our objective was to highlight the importance of mental health care for patients with skin diseases. The impact of skin alterations on the mental health of dermatological patients should be a central concern. Likewise, the timely identification and treatment of mental disorders are essential for the comprehensive management of these skin diseases.

Prevalence of Hidradenitis Suppurativa in Colombia According to Data from the National Health Registry.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, with a low prevalence worldwide. There is little epidemiologic information available on this disease in Latin America, including Colombia. The aim of this study was to estimate the prevalence and describe the main demographic characteristics of HS in Colombia. This was a cross-sectional descriptive study using the code of the International Classification of Diseases (ICD-10) for HS (L732). For this study, data from the Comprehensive Social Protection Information System of the Ministry of Health of Colombia, which is the database on diagnoses made by physicians in all medical institutions of the country, were analyzed for the period 2013-2017. A total of 3,667 patients of HS were reported in Colombia, with a prevalence of 7.4/100,000 inhabitants; 68% of the patients affected were women, with a woman to man ratio of 2.1:1. The highest prevalence was in the age group of 35-39 years. Among the departments of Colombia, the highest prevalence was in Caldas, with 17 patients per 100,000 inhabitants. Ours was the second study conducted in Latin America on the epidemiology of HS. We found a low prevalence of HS, which was even lower than that reported in studies from other countries.

Eficacia y seguridad del tratamiento adalimumab en pacientes mayores de 12 años con hidradenitis supurativa severa con respuesta insuficiente al tratamiento sistémico convencional / Efficacy and safety of adalimumab treatment in patients older than 12 years with severe hidradenitis suppurativa with insufficient response to conventional systemic treatment

INTRODUCCIÓN: El presente dictamen expone la evaluación de la eficacia y seguridad del tratamiento con adalimumab en pacientes mayores de 12 años con diagnóstico de hidradenitis supurativa severa con respuesta insuficiente al tratamiento sistémico convencional (drenaje de abscesos y cobertura de antibióticos). La hidradenitis supurativa (HS) o acné inverso es una enfermedad folicular cutánea crónica, inflamatoria, recurrente y debilitante que suele presentar lesiones dolorosas e inflamadas en zonas del cuerpo que tienen glándulas apocrinas como axilas, zona inguinal y anogenital. La prevalencia de esta enfermedad se ha reportado entre 0.05 % y 4 % entre los años 2005 y 2014 en España, USA, Dinamarca y Francia. Los pacientes con HS moderada a severa reciben terapia inicial de antibióticos orales como tetraciclinas o combinación de clindamicina y rifampicina. El Petitorio Farmacológico de EsSalud incluye a clindamicina, rifampicina, isotretinoina, acitretina, meropenem, vancomicina, ciprofloxacino, las cuales forman parte del tratamiento sistémico convencional para el paciente con HS Hurley III. Sin embargo, existen pacientes que no alcanzan respuesta clínica de HS (HiSCR1 ) en el tiempo asignado para evaluar esta respuesta, para quienes los médicos especialistas de la institución sugieren el uso de adalimumab, un anticuerpo recombinante monoclonal IgG1. METODOLOGÍA: Se realizó la búsqueda sistemática de literatura con respecto a la eficacia y seguridad de adalimumab en pacientes con HS con respuesta insuficiente a tratamiento sistémico convencional. La búsqueda se realizó en las bases de datos bibliográfica: PubMed, The Cochrane Library y Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS). Adicionalmente, se buscó evidencia manualmente en páginas web de grupos que se dedican a la elaboración de guías de práctica clínica, tales como, el National Institute for Health and Care Excellence (NICE), la Agency for Healthcare Research and Quality (AHRQ), la Guidelines International Network (GIN), la New Zealand Guidelines Group (NZGG), la National Health and Medical Research Council (NHMRC), la Canadian Medical Association (CMA), la Hidradenitis Suppurativa Foundation (HSF), la Canadian Hidradenitis Suppurativa Foundation (CHSF), la European Hidradenitis Suppurativa Foundation, la British Association of Dermatologists (BAD); así como en entidades que realizan evaluación de tecnologías sanitarias como la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA), la Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (CONITEC), el Scottish Medicines Consortium (SMC), la Canadian Journal of Health Technologies (CADTH), la Haute Autorité de Santé (HAS), el Institute for Clinical and Economic Review (ICER), el Centro Colaborador do Sus: Avaliação de Tecnologias e Excelência em Saúde (CATES), entre otras. Finalmente, se buscaron registros de ensayos clínicos en la página web www.clinicaltrials.gov, con el fin de identificar resultados aún no publicados y así disminuir el riesgo de sesgo de publicación. RESULTADOS: Se llevó a cabo una búsqueda de evidencia científica relacionada al uso de adalimumab como tratamiento de pacientes con HS severa con respuesta insuficiente al tratamiento sistémico convencional. En la presente sinopsis se describe la evidencia disponible según el tipo de publicación, siguiendo lo indicado en los criterios de elegibilidad (GPC, ETS, RS, MA y ECA fase III). CONCLUSIONES: El presente documento técnico recoge la mejor evidencia disponible hasta setiembre de 2021 con relación a la eficacia y seguridad del uso de adalimumab en paciente mayor a 12 años con diagnóstico de HS severa con respuesta insuficiente a tratamiento sistémico convencional. Se identificaron: una GPC de la BAD; cuatro ETS de SMC, CADTH, NICE y CONITEC y dos ECA de fase III (PIONEER I y PIONEER II). - Para el tratamiento de pacientes con HS que no responden al tratamiento sistémico, la GPC de la BAD recomienda la escisión quirúrgica y el uso de adalimumab; sin embargo, solo este último está dirigido a pacientes con HS severa. Las conclusiones de las cuatro ETS (SMC, CADTH, NICE,a CONITEC) fueron a favor del uso de adalimumab. Todas las ETS se basaron principalmente en los resultados de los ECA PIONEER I y PIONEER II. Aunque las ETS de NICE y CONITEC identificaron limitaciones afectan la validez de los resultados; también señalaron que dichas limitaciones afectaron particularmente el segundo periodo de seguimiento. Así, las ETS de la CADTH y NICE, condicionaron el uso de adalimumab a un descuento confidencial. Los resultados de los ECA PIONEER I y PIONEER II mostraron que, comparado con placebo, el uso de adalimumab (durante 12 semanas) estuvo asociado a una mayor tasa de respuesta (según el HiSCR), pero no mostró diferencia en la calidad de vida o el perfil de seguridad. La ausencia de información sobre la cantidad de datos imputados introduce riesgo de sesgo y afecta la validez de los resultados; particularmente después de las 12 semanas de tratamiento. Entre las semanas de tratamiento 12 y 36, las tasas de respuesta disminuyeron progresivamente hasta el 50 %, aproximadamente. Los especialistas de EsSalud enfatizan que las cicatrices producidas tras la escisión quirúrgica amplia (alternativa disponible en EsSalud) pueden afectar la funcionalidad de los pacientes; además, de haberse reportado en la evidencia científica que, luego de la cirugía, la recurrencia de la enfermedad ocurre entre el 27 % y el 69 % de los pacientes. Por lo expuesto, el Instituto de Evaluación de Tecnologías en Salud e Investigación aprueba el uso de adalimumab para el tratamiento de los pacientes adultos con diagnóstico de HS severo (Hurley III) con respuesta insuficiente al tratamiento sistémico convencional, como producto farmacéutico no incluido en el Petitorio Farmacológico de EsSalud. Dado que la evidencia está limitada a la población adulta, el IETSI no aprueba el uso de adalimumab para los pacientes menores de 18 años. La vigencia del presente dictamen es de un año, según lo establecido en el Anexo N° 1 y la continuación de dicha aprobación estará sujeta a la evaluación de los resultados obtenidos y de mayor evidencia que pueda surgir en el tiempo.

Guía clínica chilena para el estudio y tratamiento de hidradenitis supurativa. Resumen ejecutivo / Chilean clinical guideline for the management of hidradenitis suppurativa - executive summary

Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle characterized by recurrent painful and inflamed lesions, predominantly affecting intertriginous regions. Due to its physical sequelae and impact on quality of life, we should be familiarized with this disease to make an appropriate diagnosis and implement an early treatment. This executive summary of the clinical guideline, elaborated by the hidradenitis suppurativa workgroup of the Chilean Society of Dermatology and Venereology (SOCHIDERM), reviews its definition, epidemiology, pathophysiology, risk factors, comorbidities, psycho-emotional impact, clinical presentation, diagnosis, classifications, ultrasonographic evaluation, and its medical and surgical treatments. Finally, a therapeutic approach algorithm is proposed.

Monitoramento do horizonte tecnológico: Adalimumabe para hidradenite supurativa / Technological horizon monitoring: Adalimumab for hidradenitis suppurativa

CONTEXTO: A incorporação no SUS do adalimumabe para hidradenite supurativa ocorreu em outubro de 2018 para a população de pacientes com falha ou intolerância a terapia com antibióticos sistêmicos, após avaliação e recomendação pela Comissão Nacional de Incorporação de Tecnologias no Sistema Único de Saúde (Conitec). O objetivo deste relatório é analisar os dados de utilização do adalimumabe para hidradenite supurativa e comparar o impacto orçamentário estimado no relatório de incorporação e o impacto orçamentário observado. MÉTODO: Para avaliar a utilização do medicamento no âmbito do SUS, foram utilizados os dados da Sala Aberta de Inteligência em Saúde (SABEIS) relacionados à hidradenite supurativa (CID-10: L73.2) e ao adalimumabe (SIGTAP: 06.04.38.001-1, 06.04.38.006-2, 06.04.38.009-7). Para comparar o impacto orçamentário estimado e o observado, foram utilizados os dados do relatório de incorporação, a média do valor de compra disponível no Banco de Preços em Saúde (BPS) e a quantidade aprovada do medicamento no SABEIS. RESULTADOS: O Protocolo Clínico e Diretrizes Terapêuticas (PCDT) que normatizou a utilização do adalimumabe para hidradenite supurativa foi publicado em setembro de 2019. A implementação da tecnologia foi iniciada em novembro de 2019, totalizando 12 meses de intercurso entre a incorporação e a efetiva dispensação do medicamento. Visto a implementação recente, o medicamento está em processo de difusão inicial, com aumento mensal na quantidade de indivíduos utilizando o medicamento. A idade dos usuários variou de 9 a 88 anos, com predominância do sexo feminino. Apenas 90 municípios, dentre os 5.570, apresentaram registro de pelo menos um usuário de adalimumabe para hidradenite supurativa. Mais de 60% dos usuários mantiveram o tratamento por mais de um ano. A estimativa para o percentual de difusão da tecnologia para o primeiro ano após a incorporação e a população em uso do medicamento foram semelhantes aos valores observados em 2020. O valor da aquisição do medicamento pelo Ministério da Saúde foi inferior ao estimado na incorporação, o que implicou em um impacto orçamentário menor que o previsto para o primeiro ano de incorporação, de R$ 13.349.689 para atender 505 pacientes, para R$ 10.912.294 (18% menor) para o atendimento de 670 pacientes. CONCLUSÃO: Esse estudo demonstrou que a implementação do adalimumabe ocorreu 12 meses após sua incorporação, período no qual foi elaborado Protocolo Clínico e Diretrizes Terapêuticas para a doença. Como é um medicamento de incorporação recente e uso contínuo, há previsão de aumento mensal de indivíduos em uso do fármaco nos próximos 12 meses. A idade dos usuários variou de 9 a 88 anos, com maior prevalência em adultos jovens e indivíduos do sexo feminino. Os municípios com IDHM baixo ou muito baixo não tiveram nenhum registro do medicamento em 2020, indicando a possibilidade de que a distribuição do medicamento não ocorre de forma equitária entre os municípios. A maioria dos usuários mantem o tratamento por mais de um ano. Em relação ao impacto orçamentário, a quantidade de usuários prevista no cenário base foi próxima ao observado e o valor de compra do medicamento pelo Ministério da Saúde foi inferior ao proposto pela empresa para a incorporação. Assim, o impacto orçamentário observado apresentou-se menor que o estimado para o primeiro ano de utilização do adalimumabe para hidradenite supurativa.