Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

Topical application of bevacizumab as an adjunct to recurrent pterygium surgery.

PURPOSE: To evaluate the clinical outcomes of topical bevacizumab as adjunctive to the surgical excision for treatment of recurrent pterygium. METHODS: The 44 patients who underwent recurrent pterygium excision with conjunctival autograft transplantation were enrolled in this prospective and interventional study. The patients were randomized in 2 groups: study group, 1 month after surgery, 22 patients received only topical bevacizumab (5 mg/mL) 4 times daily for 2 months; control group, 1 month after surgery, 22 patients were administered only an artificial tear 4 times daily for 2 months. Patients were prospectively followed for 6 months after pterygium surgery. The main outcome measures were pterygium recurrence, corneal neovascularization, and other postoperative complications. RESULTS: No statistically significant differences were observed between the 2 groups in terms of age, gender distributions, laterality, length of pterygium, and number of recurrence. A pterygium recurrence was not noted in any patients in the study group but was noted in 2 of 22 eyes (9%) in the control group during the follow-up after surgery (P = 0.244). Although none of the patients developed corneal neovascularization in the study group, 5 of 22 eyes (22.7%) developed this condition in the control group during the follow-up after surgery (P = 0.024). No serious complications were observed during the follow-up period in both the groups. CONCLUSIONS: Topical bevacizumab therapy 1 month after surgical excision of recurrent pterygium is well tolerated and effective to prevent neovascularization. Although the recurrence rate is lower in the study group without significant difference, further studies are required to support this result.

Characterization of aroma-active compounds, sensory properties, and proteolysis in Ezine cheese.

Ezine cheese is a white pickled cheese ripened in tinplate containers for at least 8 mo. A mixture of milk from goat, sheep, and cow is used to make Ezine cheese. Ezine cheese has geographical indication status. The purposes of this study were to determine and compare the changes in basic composition, aroma, and sensory characteristics, and proteolytic activity of Ezine cheese stored in tinplate containers and plastic vacuum packages during storage. Aroma-active compounds were determined by thermal desorption gas chromatography olfactometry. To evaluate the proteolytic activity, casein and nitrogen fractions were determined. The results indicated that compounds identified at high intensities were dimethyl sulfide, ethyl butyrate, hexanal, ethyl pentanoate, (Z)-4-heptenal, 1-octen-3-one, acetic acid, butyric acid, and p-cresol. Characteristic descriptive terms were cooked, whey, creamy, animal-like, sour, and salty. The level of proteolysis increased in Ezine cheese during storage. Ezine cheese can be ripened in small-size packaging after 3 mo of storage. Approximately 6 mo is sufficient to produce the characteristic properties of Ezine cheese.

The effect of transcutaneous electrical nerve stimulation in the treatment of lichen simplex: a prospective study.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) has recently emerged as a possible effective treatment for pruritic dermatoses. Lichen simplex (LS) is one such condition, which may persist despite intensive topical treatments. AIM: To investigate the efficacy of TENS treatment in relieving pruritus in lichen simplex. METHODS: In total, 22 patients with LS unresponsive to topical corticosteroids underwent TENS treatment. The patients rated the pruritus intensity on a visual analogue scale (VAS). RESULTS: The mean reduction in VAS score from baseline to the end of 4 weeks treatment was 4.50 (95% CI 3.65-5.34) for all patients. The difference between the baseline and at the end of the study was significant (P < 0.01). By the end of the study, 18 (80%) of the subjects experienced a reduction in pruritus intensity of > 50%. CONCLUSION: From our clinical observation, we suggest that TENS may prove to be a useful and well-tolerated treatment modality for the treatment of pruritus in patients with LS.

The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria.

BACKGROUND: Chronic idiopathic urticaria (CIU) is associated with severely impaired quality of life (QoL). OBJECTIVE: To determine the levels of depression, anxiety and QoL in CIU patients. PATIENTS AND METHODS: This study included 73 patients with CIU, and 34 healthy subjects matched for age and sex were used as controls. The levels of depression, anxiety and QoL were assessed with the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF), respectively. The reliability and validity of the Turkish versions of these instruments have been examined. RESULTS: When compared with healthy controls, patients with CIU had significantly higher BDI and BAI scores and significantly lower physical health and psychological health subscale scores of the WHOQOL-BREF. BDI, BAI and all domains of WHOQOL-BREF were unrelated to age, duration of illness, urticaria activity score (UAS) and visual analogue score (VAS). There was a negative significant correlation between all domains of WHOQOL-BREF and BDI and BAI. CONCLUSION: Our data confirm that QoL is markedly reduced in CIU patients. Physical health and psychological health were found to be the areas QoL most affected in CIU patients. And also we have found that CIU patients frequently suffer from depression and anxiety. The severity of these parameters was found to be positively correlated with the extent of QoL decrease.

Prospective randomized non-blinded clinical trial on the use of dapsone plus antihistamine vs. antihistamine in patients with chronic idiopathic urticaria.

BACKGROUND: Treatment of chronic idiopathic urticaria (CIU) is difficult. OBJECTIVE: The purpose of this study was to evaluate the efficacy and safety of dapsone in CIU. METHODS: The response to dapsone was evaluated in 65 CIU patients with a randomized, two armed study: 3-month dapsone + desloratadin and 3-month desloratadin. All were followed for up to 3 months and 3 months after; all took desloratadine 10 mg daily throughout the study. The primary measure of efficacy was a daily urticaria activity score (UAS) of weal numbers and itch (maximum score, 42 per week). RESULTS: Sixty-five patients completed the randomized 3-month trial medication. Mean reduction in UAS from baseline at 3 months was 7 [95% confidence interval (95% CI), 6.92-7.08] for active group and 5.77 (95% CI, 5.47-6.08) for control subjects (P < 0.001). The reduction in visual analogue score (VAS) at 3 months for active group (mean, 2.58; 95% CI, 2.33-2.83) and control subjects (mean, 2.55; 95% CI, 2.38-2.73) was also significant (P < 0.001). The reduction of UAS and VAS at 3 months compared between active group and control subjects showed no significant difference. Mean reduction in UAS from the end of the study at 3 months after was 1.16 and -4.8 for active and control subjects, respectively. These results were compared with each other, and it was statistically significant (P

Intralesional 5-fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo-controlled, single-blind randomized study.

BACKGROUND: The treatment of viral warts remains challenging. A variety of treatment modalities have been used with a range of success. Fluorouracil has been shown to be effective in treating warts but the method of its delivery directly onto the affected tissue has been of little efficacy. We evaluated the safety and efficacy of intralesional 5-fluorouracil in the treatment of verrucae. METHODS: Seventy-six patients with a total 315 verrucae were randomized to receive either a 5-fluorouracil, lidocaine and epinephrine (5-FU + LE) mixture or serum saline injection into the paired verrucae in the same patient. The mixture of 5-FU (4 cm(3), 50 mg/mL), lidocaine (1 cm(3), 20 mg/mL) and epinephrine (0.0125 mg/mL) was injected into the base of the wart using a mantoux needle. Each lesion was infiltrated with either of the solutions once a week for up to a maximum of 4 weeks, and the patients were followed up for 6 months. RESULTS: Complete response was noted in an average of 70% of the verrucae treated with the 5-FU + LE mixture and in 29% of those in the placebo group (P < 0.001). No clinically significant systemic and local adverse effects occurred. Pain and burning were noted as an immediate injection pain. Recurrence rates were evaluated and no statistically significant difference between the two groups was found. CONCLUSIONS: The results demonstrate that treatment of verrucae with 5-FU + LE mixture is safe and effective.