ArticlePublisher preview available

Hidradenitis suppurativa is associated with acne keloidalis nuchae: a population-based study

Authors:
Khalaf Kridin at Universität zu Lübeck
Khalaf Kridin
Payal M Patel at Massachusetts General Hospital
Payal M Patel
Virginia Jones at UCSF University of California, San Francisco
Virginia Jones
Giovanni Damiani at University of Milan
Giovanni Damiani
Show all 6 authorsHide
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The association between acne keloidalis nuchae (AKN) and hidradenitis suppurativa (HS) is yet to be investigated. To determine the link between AKN and HS using a large computerized health maintenance database. A cross-sectional study design was used to assess the prevalence of HS in patients with AKN and in control participants matched by age, sex, and ethnicity. A total of 2677 participants with AKN and 13,190 control participants were studied. An increased prevalence of HS was observed in the AKN group compared to the control group (1.0% vs. 0.3%, respectively; OR, 3.6; 95% CI 2.2–5.8; P < 0.001), especially among those younger than 20 years (OR, 10.2; 95% CI 3.1–34.2; P < 0.001), and females (OR, 15.7; 95% CI 3.1–78.8; P < 0.001). After adjusting for confounding factors, the multivariate analysis demonstrated a persistent association of AKN with HS (adjusted OR, 3.6; 95% CI 2.1–5.9; P < 0.001). This study demonstrated a significant association between AKN and HS in an Israeli population. The threshold for diagnosis of HS among patients with AKN must be lowered in patients presenting with concerning symptoms. Further observational studies in other patient populations will help confirm this relationship.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Archives of Dermatological Research
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
1 3
Archives of Dermatological Research (2021) 313:333–337
https://doi.org/10.1007/s00403-020-02105-x
ORIGINAL PAPER
Hidradenitis suppurativa isassociated withacne keloidalis nuchae:
apopulation‑based study
KhalafKridin1 · PayalM.Patel2· VirginiaA.Jones2· GiovanniDamiani4,5,6· KyleT.Amber2· ArnonD.Cohen3
Received: 27 March 2020 / Revised: 12 June 2020 / Accepted: 1 July 2020 / Published online: 16 July 2020
© Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract
The association between acne keloidalis nuchae (AKN) and hidradenitis suppurativa (HS) is yet to be investigated. To
determine the link between AKN and HS using a large computerized health maintenance database. A cross-sectional study
design was used to assess the prevalence of HS in patients with AKN and in control participants matched by age, sex, and
ethnicity. A total of 2677 participants with AKN and 13,190 control participants were studied. An increased prevalence of
HS was observed in the AKN group compared to the control group (1.0% vs. 0.3%, respectively; OR, 3.6; 95% CI 2.2–5.8;
P < 0.001), especially among those younger than 20years (OR, 10.2; 95% CI 3.1–34.2; P < 0.001), and females (OR, 15.7;
95% CI 3.1–78.8; P < 0.001). After adjusting for confounding factors, the multivariate analysis demonstrated a persistent
association of AKN with HS (adjusted OR, 3.6; 95% CI 2.1–5.9; P < 0.001). This study demonstrated a significant associa-
tion between AKN and HS in an Israeli population. The threshold for diagnosis of HS among patients with AKN must be
lowered in patients presenting with concerning symptoms. Further observational studies in other patient populations will
help confirm this relationship.
Keywords Acne keloidalis nuchae· Hidradenitis suppurativa· Cross-sectional· Prevalence
Introduction
Acne keloidalis nuchae (AKN) is a chronic inflammatory
disorder that presents with pruritic follicular papules, hyper-
trophic scarring, and scarring alopecia, typically on the
scalp and neck [1, 2]. Since it was first described in 1860
as sycosis framboesiformis [3], AKN has been documented
under various names until Bazin coined the term acne keloi-
dalis in 1872 [4]. Histologically, AKN lesions neither resem-
ble acne nor keloids: Comedones are generally absent from
the disease presentation [1, 5]. The pathogenesis behind
AKN remains elusive as multiple factors seem to play a role
in disease development, especially concerning the follicu-
lar injury followed by an aberrant inflammatory response
[1, 5–7]. AKN has been associated with pseudofollicultis
barbae, chronic scalp folliculitis, metabolic syndrome, and
hypertension [8]. An association with follicular occlusion
diseases has not been studied.
Hidradenitis suppurativa is another example of a chronic
inflammatory disorder affecting the hair follicle unit [9,
10]. HS lesions are characterized by painful, recurring, and
draining abscesses with associated sinus tract formation
affecting the intertriginous and anogenital regions [11–13].
Disease pathogenesis consists of a multitude of proposed
theories including, but not limited to, follicular occlusion,
autoinflammation, and genetic predisposition [14–16]. HS
has been associated with obesity, metabolic syndrome,
inflammatory bowel disease, and other inflammatory skin
conditions, including acne [12, 13, 17–19].
Kyle T. Amber and Arnon D. Cohe contributed equally to this
study.
* Khalaf Kridin
dr_kridin@hotmail.com
1 Lűbeck Institute ofExperimental Dermatology, University
ofLűbeck, RatzeburgerAllee 160, 23562Lübeck, Germany
2 Department ofDermatology, University ofIllinois
atChicago, Chicago, IL, USA
3 Clalit Healthcare Services, TelAviv, Israel
4 Department ofDermatology, Case Western Reserve
University, Cleveland, OH, USA
5 Young Dermatologists Italian Network, GISED, Bergamo,
Italy
6 Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi,
Milan, Italy
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... folliculitis barbae, cicatricial alopecia, folliculitis decalvans, and hidradenitis suppurativa, especially in people younger than 20 years. [9,[13][14][15] It has also been associated with metabolic syndrome (hypertension, diabetes mellitus, and dyslipidemia), and increased fasting blood testosterone. [9,14,16,17] Clinical features vary from itching, bleeding, papules, pustules, nodular scars to huge tumors on the nape and occipital region, depending on the duration of affectation. ...
... [9,[13][14][15] It has also been associated with metabolic syndrome (hypertension, diabetes mellitus, and dyslipidemia), and increased fasting blood testosterone. [9,14,16,17] Clinical features vary from itching, bleeding, papules, pustules, nodular scars to huge tumors on the nape and occipital region, depending on the duration of affectation. Keloidal lesions are associated with an onset greater than 5 years. ...
Folliculitis keloidalis in an urban market in Lagos, Nigeria: A community survey
Article
Full-text available
  • Jan 2022
Background: Folliculitis keloidalis (FK) also known as acne keloidalis nuchae is a follicular scalp disease found predominantly in males of African origin. Studies suggested that FK is associated with hair care practices and shaving. This study aimed to determine the prevalence of FK in a community in Lagos. Methods: This was a community-based, cross-sectional study at the Sandgrouse market in Lagos Island, Nigeria. Self-administered questionnaires were used to obtain demographic and clinical information. Diagnosis of FK was clinical and included follicular and keloidal papules, pustules, nodules, and tumors at the nape, sometimes spreading to other parts of the scalp, with intense itching. Results: A total of 100 males and 207 women were enlisted in the study and clinically evaluated for features of FK. None of the female participants presented with history and clinical features of FK. Seventy-five percent were between the age of 30 and 60 years. Fifteen male participants had a prior history of FK on the scalp and eight had previous treatment. Examination revealed the presence of FK in four respondents (4%): 3 had only on the scalp and one had on both the scalp and the beard area; and none had keloidal lesions. Conclusion: All respondents with FK presented at the early stage with keratotic/follicular papules. We posit that self-treatment with antibiotics and triple action creams (consisting of potent steroids, antifungal, and antibiotic) sold in the market and over the counter is responsible for the early and mild presentation.
View
... AKN has been observed in patients who have other comorbid infammatory conditions (Table 1). Severe AKN is associated with chronic scalp folliculitis [14] and hidradenitis suppurativa (HS) [15], supporting the role of chronic infammation in the development of keloid-like plaques [14]. Folliculitis decalvans (FD) has been observed alongside AKN with FD lesions occurring proximal to AKN in the occipital scalp, suggesting a pathogenic association between the two conditions [16]. ...
Comorbidities and Treatment Options for Acne Keloidalis Nuchae
Article
Full-text available
Acne keloidalis nuchae (AKN) is a condition that involves chronic inflammation of the hair follicles on the occipital scalp and posterior neck that often progresses to keloid-like plaques. AKN has most commonly been reported to affect postpubertal males of African descent. The cause of AKN has not been definitively described; however, it is likely an inflammatory response to trauma or infection of the scalp. AKN is associated with chronic scalp folliculitis, hidradenitis suppurativa, folliculitis decalvans, acne mechanica, keratosis follicularis spinulosa decalvans, cutis verticis gyrata, metabolic syndrome, acanthosis nigricans, and hypothyroidism. Treatment for AKN begins with topicals, antibiotics, and intralesional steroid injections. Refractory cases are treated with laser and surgery. Isotretinoin, cryotherapy, phototherapy, electrosection, and radiotherapy have also been effective in treating AKN but are less commonly used. In this review, we describe the existing understanding of AKN with a focus on comorbid conditions and available treatment options.
View
... In an Israeli population, a cross-sectional study also showed an association between acne keloidalis nuchae and HS. However, further observational studies are needed to confirm this relationship 114 . ...
Pathophysiology of hidradenitis suppurativa: a systematic review of the literature
Article
Full-text available
  • Nov 2022
Hidradenitis suppurative (HS) is a multifactorial, recurrent, chronic inflammatory disease with a significant impact on patient’s quality of life. The etiopathogenesis of this complex condition is not fully understood. In this systematic review, we aimed to address and clarify the role of genetics, immunity, endocrinology, and skin microbiome together with risk factors in HS etiopathogenesis. A systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was performed using PubMed® and Web of ScienceTM databases on December 3rd, 2021, using patient/population, intervention, comparison and outcomes (PICO) criteria, limited to the last 10 years and English. Reports were analyzed by two independent reviewers. A total of 123 reports were included and divided into five sections: genetics, immunity, endocrinology, microbiome, and risk factors. Regarding genetics, up to 30-40% of patients have a positive family history of HS but only a small subset of these harbor genetic variants in components of the gamma-secretase complex. In fact, in more than 90% of HS patients, the genetic features contributing to disease development remain largely unknown. The immune response is also crucial for HS; it is characterized by antimicrobial peptide and proinflammatory cytokine dysregulation, namely interleukin (IL)—IL-23, IL-12, and Th17 immune response. This immune response in local and, consequently, systemic inflammation is amplified in patients with metabolic syndrome. The relationship between metabolic syndrome and HS is clear, and patients with metabolic syndrome have a higher risk of developing HS. The most recent evidence also associates skin microbiota dysbiosis with HS pathogenesis, contributing to local and systemic inflammation. Besides these intrinsic factors, the role of lifestyle in the development of HS is well accepted. Tobacco smoking and obesity are the main risk factors identified as contributing to HS pathogenesis. Chronic inflammation characterizes HS, a debilitating condition with a complex and multifactorial etiopathogenesis. The current model integrates genetics, immunity, endocrinology, and skin microbiome. Notwithstanding, efforts should be made to improve our comprehension of HS etiopathogenesis, hopefully leading to the development of more effective treatments.
View
... 19 Using a large population-based study, we have previously shown that AKN is associated with hidradenitis suppurativa (HS), another chronic inflammatory disorder that pathologically targets the hair follicle. 20 Although HS has not been shown to be directly associated with gout several attempts have been made to aim Interleukin (IL)-1 as the treatment target for both diseases. 21,22 Interleukin (IL)-1 was found to exert an important pathogenic role in both HS and gout. ...
The burden of gout in acne keloidalis nuchae-Insights from a population-based study
Article
Full-text available
Background: The risk of gout amid patients with acne keloidalis nuchae (AKN) has not been investigated in the past. Objective: To assess the risk of developing gout among patients with AKN relative to control subjects. Methods: A population-based retrospective study followed patients with AKN (n = 2677) and age-, sex-, and ethnicity-matched control subjects (n = 13 190). The incidence of new-onset gout was compared between the two groups. Hazard ratio (HR) for the risk of gout was obtained using a multivariate Cox regression model. Results: The incidence rate of gout was 1.12 (95% CI, 0.68-1.76) and 0.48 (95% CI, 0.34-0.66) per 1000 person-years among patients with AKN and controls, respectively. The crude risk of developing gout was significantly higher in patients with AKN (HR, 2.27; 95% CI, 1.26-4.10; p = 0.007). After controlling for age, sex, and ethnicity, AKN emerged as an independent risk factor of gout (adjusted HR, 2.34; 95% CI, 1.29-4.22; p = 0.005). When adjusting for other confounders such as body mass index, diabetes mellitus, hypertension, and dyslipidemia, the risk of gout in AKN fell out of significance (adjusted HR, 1.39; 95% CI, 0.73-2.65; p = 0.311), CONCLUSION: Patients with AKN experience an increased risk of gout. The risk is not independent and is mainly mediated through the metabolic comorbidities typifying AKN. We recommend screening for gout in patients with suggestive complaints.
View
... HS is known as a neutrophil-mediated auto-inflammatory disease. [1] 11. Acne keloidalis nuchae [5][6][7] A psychological condition related to chronic pain, odor, drainage, deformity of skin in particular areas: 1. Depression 2. Social isolation 3. Sexual dysfunction 4. Decreased work productivity 5. Suicide. ...
Hidradenitis suppurativa; classification, remedies, etiology, and comorbidities; a narrative review
Article
Full-text available
  • Nov 2021
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that is more common in females, especially during puberty and menopause. These inflammatory lesions include painful deep-seated nodules and abscesses, draining sinus tracts, and fibrotic scars. This article is a narrative review to explain whole disease aspects, including complication, causes, epidemiology, history, classification, prognosis, comorbidities, the effect of sex hormone, and potent treatments. Most patients with HS, who are not aware of their primary disease, visit primary care physicians to superinfection lesions instead of specialists. If these physicians suspect HS, their illness will not get misdiagnosed. This brief and comprehensive information in this article may help doctors to decide better about the same situation.
View
Acquired Disorders of Hair
Chapter
  • Mar 2024
This chapter reviews acquired hair disorders, including common scarring and non‐scarring alopecia presentations, conditions characterised by excessive body hair growth and acquired hair shaft disorders. We also describe the biology of normal hair follicles, including structure, hair cycle control and immunity, to better understand the mechanisms underlying these conditions. We present methods for clinical assessment, recommended investigation and management of each disease, and present summaries of frequently used therapeutics and cosmetic options employed when treating these problems.
View
Acquired Non‐Infective Disorders of the Pilosebaceous Unit
Chapter
  • Mar 2024
The presentation, aetiology and management of acquired superficial and deep disorders of the pilosebaceous units are discussed in this chapter. The chapter begins with discussion of external causes and systemic medications, including EGFR inhibitors, as causes of folliculitis. Infantile and adult eosinophilic folliculitis is subsequently explored, followed by actinic folliculitis which rounds up the discussion on the disorders affecting the superficial pilosebaceous unit. Disorders causing inflammation of the pilosebaceous gland below the level of the infundibulum are then discussed. The presentation, aetiology and management of pseudofolliculitis, necrotising lymphocytic folliculitis of the scalp margin, chronic non‐scarring folliculitis of the scalp, and disseminate and recurrent infundibulofolliculitis are covered. Discussion of Fordyce spots and sebaceous hyperplasia concludes the discussion.
View
View
Comorbidities present in hidradenitis suppurativa
Article
  • Mar 2022
Hidradenitis suppurativa (HS) is characterized by a chronic, inflammatory cascade that occurs within the apocrine glands and produces inflammatory papules and nodules, abscesses, and scarred, fistulizing sinus tracts. Despite evidence that patients with HS have a two‐fold greater comorbidity burden in comparison to both psoriasis patients and the unaffected, healthy population; the identification of risk factors and the spectrum of co‐existent medical illnesses have not been fully characterized. Recent data has elucidated increased prevalence of several cutaneous, psychologic, gastrointestinal, musculoskeletal, endocrine, conditions in patients with HS. Treatment modalities can be optimized based on shared cytokine profiles and immune dysregulation. Screening guidelines have been recommended based on prevalence, in order to provide better health outcomes for these patients.
View
Incidence, prevalence, and predictors of inflammatory arthritis in patients with hidradenitis suppurativa: a systematic review and meta‐analysis
Article
  • Aug 2021
  • INT J DERMATOL
An increasing amount of evidence has emerged suggesting that hidradenitis suppurativa (HS) is associated with inflammatory arthritis. This study reviewed the incidence, prevalence, and predictors of inflammatory arthritis in patients with HS. A comprehensive literature search was conducted in CINAHL, Embase, and Medline from inception to February 14, 2020. Articles were included in the review if they provided data on disease epidemiology or predictors of adult or pediatric HS patients with comorbid inflammatory arthritis. There are no validated diagnostic criteria for HS, thus we considered patients as having HS if they had at least one diagnostic code in a hospital or claims database or a diagnosis of HS/inflammatory arthritis in a medical record. The same criteria were used to confirm presence of inflammatory arthritis. We identified an increased incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) in HS patients when compared with estimates in the general population. We identified a relatively high prevalence of RA, spondyloarthritis (SpA), and PsA in HS patients when compared with estimates in the general population. There was evidence to suggest that patients who are younger than 30, male, have severe HS, or are taking infliximab or adalimumab (which may also be confounded by HS disease severity) may be at greater risk for specific subtypes of inflammatory arthritis. However, further data are needed to confirm these associations. The increased incidence and prevalence of inflammatory arthritis within HS patients underscore the need for increased awareness and interdisciplinary partnership within rheumatology and dermatology.
View
Hidradenitis Suppurativa: Clinical Characteristics and Determinants of Treatment Efficacy
Article
Full-text available
Introduction: Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease which cause a significant decline in quality of life. There are numerous treatment options; however real-life data on the efficacy of these treatments is limited. Objective: This study aims to describe the clinical characteristics and treatment outcomes of 139 patients with HS. Methods: We retrospectively evaluated patients diagnosed with HS between 2015-2018 in two centers. Data on demographic and clinical characteristics, Hurley stages, comorbidities were investigated. Treatment response was measured with hidradenitis suppurativa clinical response index (HISCR). Results: The mean body mass index was 27.8±4.88. Acne lesions were the most common comorbidity observed in 23%(32/139). Anti-inflammatory antibiotics were prescribed as first-line drugs and had moderate efficacy in Hurley stage I/II disease. Doxycycline was a front-line option with an acceptable efficacy in this category. Isotretinoin resulted in the lowest HISCR among all treatments. All acitretin treated patients achieved response. Patients treated with tumor necrosis factor alpha (TNF-α) inhibitors had the highest HISCR. Conclusion: HS patients tend to be overweight, inflammatory comorbidities also being strikingly frequent. Acitretin appears to be a valuable alternative in appropriate patients. Physicians may prioritize TNF-α inhibitors when treating patients with resistant Hurley stage II or severe disease. This article is protected by copyright. All rights reserved.
View
Complement activation in hidradenitis suppurativa: A new pathway of pathogenesis?
Article
Full-text available
  • Feb 2018
Objective: Despite the heavy purulence observed in hidradenitis suppurativa (HS), kinetics of complement anaphylatoxins acting to prime chemotaxis of neutrophils has never been studied. Complement activation was explored in HS. Methods: Circulating concentrations of complement factor C5a as well as of membrane attack complex C5b-9 were determined in the plasma of 54 treatment naïve patients and of 14 healthy controls as well as in the pus of seven patients. Results were correlated with Hurley stage and iHS4 score of severity. Peripheral blood mononuclear cells (PBMCs) were isolated form seven Hurley III stage patients and seven healthy volunteers and stimulated in the presence of 25% of plasma for the production of tumor necrosis factor-alpha (TNFα). Results: Circulating C5a and C5b-9 were significantly greater in patient than in control plasma; however concentrations in pus were very low. Circulating C5a levels exceeding 28 ng/ml were associated with specificity greater than 90% with occurrence of HS. Circulating C5a and C5b-9 were greater among the more severe patients. PBMCs of patients produced great TNFα concentrations only when growth medium was enriched with patient plasma; this was reversed with the addition of the C5a blocker IFX-1. Conclusions: Systemic complement activation occurs in HS and may be used as a surrogate biomarker of HS. C5a stimulates over-production of TNFα and may be a future therapeutic target. This article is protected by copyright. All rights reserved.
View
Hidradenitis suppurativa and associated diseases
Article
  • Jun 2018
Hidradenitis suppurativa is a chronic, inflammatory, recurrent, debilitating skin disease characterized by recurrent abscesses, draining sinuses, and scarring, affecting principally areas of body friction. Although the disease pathogenesis is not fully understood, recent advances suggest that hidradenitis suppurativa should be viewed as a systemic inflammatory disease. Moreover, recent studies have defined hidradenitis suppurativa as a systemic disease linked to several comorbidities. Metabolic disorders including obesity and metabolic syndrome are the most common associated conditions observed in patients with hidradenitis suppurativa. Autoimmune diseases, like inflammatory bowel diseases, autoinflammatory diseases, spondyloarthritis, some genetic keratin disorders and also the risk of skin tumor seems to occur more frequently in these patients. This disease can also have severe effects on self-esteem and quality of life and can be associated with psychiatric diseases. The link between hidradenitis suppurativa and systemic associations may be attributed to common genetic or environmental factors or shared inflammatory pathways. Due to these reasons it is mandatory that clinical intervention for hidradenitis suppurativa must include consideration and attention to these comorbidities and complications. In this article we have reviewed current available literature on diseases that can occur together with hidradenitis suppurativa.
View
View
Overall and Subgroup Prevalence of Acne Vulgaris Among Patients with Hidradenitis Suppurativa
Article
  • Oct 2018
  • J AM ACAD DERMATOL
Background: Evidence establishing the link between acne vulgaris (AV) and hidradenitis suppurativa (HS) is limited, and the burden of AV in this group is unknown. Objective: To determine prevalence of AV among adults with HS, and to determine the strength of this association. Methods: Cross-sectional analysis identifying adults with AV among HS and non-HS patients using electronic health records data from a population-based sample of over 55 million patients. Results: Prevalence of AV among adults with HS was 15.2% (7,315 /48,050), compared to 2.9% (497,360 /16,899,470) for adults without HS (p<0.001). Prevalence was greatest among HS patients who were female (5,870/35,790; 16.4%), ages 18-44 years (5,260/28,870; 18.2%), non-white (3,120/17,825); 17.5%), obese (5,430/35,135; 15.5%), and had PCOS (685/2,385; 28.7%). HS patients had 4.51 [95% CI 4.40-4.63] times the odds of having AV compared to non-HS patients, and the higher likelihood of having AV persisted across all HS subgroups. The association between HS and AV was generally stronger for patients who were male, aged ≥ 65 years, non-whites, and obese. Limitations: Influence of disease severity in HS, or in acne, on the strength of the association could not be assessed. Conclusion: Patients with HS may benefit from assessment of acne status and optimization of co-management strategies.
View
Prevalence Estimates for Hidradenitis Suppurativa among Children and Adolescents in the United States: A Gender- and Age-Adjusted Population Analysis
Article
  • Apr 2018
The prevalence of Hidradenitis Suppurativa (HS) in the pediatric population is unknown. We sought to establish standardized overall as well as gender-, age-, and race-specific prevalence estimates of HS among children and adolescents in the United States. We performed a cross-sectional analysis in a heterogeneous sample of 55 million patients across all census regions. We identified 1,240 HS patients in whom the ratio of girls to boys was 3.8:1. Almost all (96.8%) HS patients were ≥10 years of age. Overall HS prevalence was 0.028%, or 28.1 (95% CI 26.5-29.7) per 100,000 children and adolescents. Standardized prevalence was higher in girls [44.6 (95% CI 41.8-47.5) per 100,000], in patients aged 15-17 years [113.7 (95% CI 106.4-121.4) per 100,000], and among African Americans [78.7 (95% CI 71.0-86.9) per 100,000]. Highest prevalence of HS was observed among female adolescents aged 15-17 years who were African Americans [525.1 (95% CI 459.4-597.5) per 100,000] and biracial [253.2 (95% CI 121.4-465.6) per 100,000]. Patients with HS who went undiagnosed were not captured, and as such prevalence estimates may be underestimated. HS appears to be a post-pubertal disease which disproportionately afflicts girls and African Americans in the pediatric population.
View
View
Hidradenitis Suppurativa: Disease Burden and Etiology in Skin of Color
Article
  • Mar 2018
Hidradenitis suppurativa (HS) is a chronic, debilitating skin disease. Although most studies on HS are conducted in largely Caucasian populations, evidence demonstrates a higher prevalence in patients with skin of color, including African and Hispanic populations. These racial subgroups are likely at risk for greater disease burden due to a higher prevalence of components of the metabolic syndrome, comorbid depression, and low socioeconomic status; however, there is a paucity of research in these populations. Additionally, studies examining the genetic and anatomical basis for HS, as well as the response to HS therapies, are lacking for patients with skin of color. Complicating this issue is the limited access to effective medical care, including dermatologists, for African and Hispanic populations as well as other minority groups. In this review, we identify gaps in the knowledge base, highlight the association between HS and patients with skin of color, and provide direction for much needed research into this condition.
View
Hidradenitis Suppurativa: Advances in Diagnosis and Treatment
Article
  • Nov 2017
Importance Hidradenitis suppurativa (HS) is relatively common, with the prevalence of 0.05% to 4.10%, yet many patients receive inadequate treatment. Objective To review the diagnosis, epidemiology, and treatment of HS with an emphasis on advances in the last 5 years. Evidence Review A literature search was conducted using PubMed, MEDLINE (Medical Subject Headings [MeSH]), and EMBASE to include recently published treatment studies (searched from September 1, 2011, to May 1, 2017). Reviews, guidelines, conference abstracts, and studies with less than 10 patients were excluded. Furthermore, internet searches for guidelines on hidradenitis suppurativa using Baidu, Bing, Google, and Qwant browsers were performed. Findings The diagnosis of HS is made by lesion morphology (nodules, abscesses, tunnels, and scars), location (axillae, inframammary folds, groin, perigenital, or perineal), and lesion progression (2 recurrences within 6 months or chronic or persistent lesions for ≥3 months). HS is more common than was previously thought based on epidemiological analysis (0.05%-4.10%). Disability from HS can be significant. Patients with HS may have significant comorbidities (eg, obesity, metabolic syndrome, diabetes, and arthritis) and increased all-cause mortality (incidence rate ratio, 1.35 [95% CI, 1.15-1.59]). Antibiotic treatment with combinations of clindamycin and rifampicin, or ertapenem followed by combination rifampicin, moxifloxacin, and metronidazole for 6 months is effective. Adalimumab is effective in a significant proportion of patients and treatment with IL-1 and IL-12 receptor subunit beta 1 (Rb1) antibodies may also be useful. Tissue-sparing surgical techniques and carbon dioxide laser treatments also are available, but the evidence on clinical outcomes with these approaches is limited. Conclusions and Relevance Hidradenitis suppurativa is more common than previously thought and may be treated by an array of pharmacological and surgical techniques. Hidradenitis suppurativa should be considered in the differential diagnosis of nodular lesions or sinus tracts present in the axillae, groin, perineal, and mammillary fold regions.
View
Hidradenitis suppurativa and the metabolic syndrome
Article
  • Sep 2017
  • CLIN DERMATOL
The association of the metabolic syndrome (MetS) and its components with immune-mediated chronic inflammatory disorders has attracted much interest within the last two decades. In addition to the well-established association of psoriasis with MetS, recent data point to an association between MetS and hidradenitis suppurativa, as well. The association of hidradenitis suppurativa with MetS and its components, such as diabetes, obesity, and dyslipidemia, has been consistently identified in controlled studies. This relationship is not only limited to older individuals but also applicable to younger patients and those with mild disease. This review documents the link between these disorders and discusses its practical implications, mainly highlighting the importance of prevention and routine screening for early diagnosis to prevent cardiovascular-related morbidity.
View