Hidradenitis suppurativa in children: The Henry Ford experience.

BACKGROUND: Although recent hidradenitis suppurativa studies have shown that early-onset disease is associated with a positive family history and more widespread disease, research in pediatric hidradenitis suppurativa is limited. METHODS: Thirty-three children diagnosed with hidradenitis suppurativa during an 18-month period were included in this institutional review board-approved, retrospective chart review. Information on demographic characteristic, family history, and timing of onset (prepubescent vs postpubescent) was extracted. The Fisher exact test, Cochran-Armitage exact trend test, and chi-square test were used to examine the association between prepubescent or postpubescent onset of hidradenitis suppurativa and sex, disease severity, and family history. RESULTS: A significantly higher percentage of patients with postpubescent onset were female (85.7%) than male (14.3%), whereas those with prepubescent onset were more likely to be male (58.3%) than female (41.7%; P = .02). Associations between disease onset and positive family history of hidradenitis suppurativa (P = .47) or higher Hurley stage of disease (P = .15) were not statistically significant. CONCLUSION: Boys are more likely to have prepubescent onset of hidradenitis suppurativa and girls to have postpubescent onset. This shift in sex distribution is unexplained, but we hypothesize that, whereas the role of ovarian hormones in the pathogenesis of HS may underlie much of adult-onset disease, it is less important in prepubescent disease.

New and Emerging Treatments for Rosacea.

Rosacea is a common chronic inflammatory disorder that affects approximately 16 million Americans. The multifactorial pathophysiology of rosacea is not fully understood. Several new treatment options were recently US Food and Drug Administration approved or are in clinical trials. This paper reviews new treatment options including ivermectin, brimonidine, the new foam formulation of azelaic acid, and oxymetazoline. The potential role in therapy, patient selection, and adverse effects of these agents are discussed.

Gender differences in treatment of heart failure and acute myocardial infarction: a question of quality or epidemiology?

Recent articles have inquired about the quality of care for women presenting with cardiovascular disease. The Cooperative Cardiovascular Project and the National Heart Failure Project, 2 Medicare databases, provide national data to address concerns that women receive poorer quality care than men. In these databases, sex was not independently associated with the use of beta-blockers, assessment of left ventricular ejection fraction, or use of fibrinolytic therapy for acute myocardial infarction (MI), nor of angiotensin-converting enzyme (ACE) inhibitor prescription for heart failure. Women with MI were slightly less likely to receive aspirin and slightly more likely to receive ACE inhibitors. Among patients with equivocal indications, men were significantly more likely than women to undergo cardiac catheterization, whereas there were no sex differences among patients with strong indication. Women were more likely than men to undergo percutaneous coronary intervention and less likely to receive coronary artery bypass graft surgery. Short-term mortality rates after MI and readmission rates after heart failure did not vary significantly by gender; however, risk of mortality after heart failure was slightly lower for women. Within multivariate models, gender differences in treatment were small and in many cases insignificant. These national datasets fail to reveal a strong sex bias in treatment among patients aged > or = 65 years.