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Abstract
The painful and often scarring disease hidradenitis suppurtiva is presented comprehensively in this issue of Dermatologic Clinics led by expert Gregor Borut Ernst Jemec. Topics include: Diagnosing hidradentis suppurativa; Prevalence, risk factors and co-morbidities of hidradentis suppurativa; Genetics of hidradentis suppurativa; Histopathology and imaging; Inflammatory mechanisms in hidradentis suppurativa; Microbiology of hidradentis suppurativa; Endocrinological aspects of hidradentis suppurativa; Role of mechanical stress in hidradenitis suppurativa; Randomized controlled trials of hidradentis suppurativa treatment; Antibiotic treatment of hidradentis suppurativa; Other medical treatments of hidradentis suppurativa; Surgical interventions in hidradentis suppurativa; Lasers and IPL in hidradenitis suppurativa; The Handicap of hidradentis suppurativa.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| HidradenitisSuppurativa\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | v | ||
| Letter to the Editor: BRAF Mutations in Erdheim-Chester Disease\r | v | ||
| Preface: The Secret Scourge\r | v | ||
| Diagnosing Hidradenitis Suppurativa\r | v | ||
| Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa\r | v | ||
| The Handicap of Hidradenitis Suppurativa\r | v | ||
| The Genetics of Hidradenitis Suppurativa\r | v | ||
| The Microbiology of Hidradenitis Suppurativa\r | vi | ||
| The Role of Mechanical Stress in Hidradenitis Suppurativa\r | vi | ||
| Endocrinologic Aspects of Hidradenitis Suppurativa\r | vi | ||
| Inflammatory Mechanisms in Hidradenitis Suppurativa\r | vi | ||
| Imaging of Hidradenitis Suppurativa\r | vii | ||
| Randomized Controlled Trials for the Treatment of Hidradenitis Suppurativa\r | vii | ||
| Antibiotic Treatment of Hidradenitis Suppurativa\r | vii | ||
| Medical Treatments of Hidradenitis Suppurativa: More Options, Less Evidence\r | vii | ||
| Surgical Procedures in Hidradenitis Suppurativa\r | viii | ||
| Lasers and Intense Pulsed Light Hidradenitis Suppurativa\r | viii | ||
| DERMATOLOGIC CLINICS\r | ix | ||
| FORTHCOMING ISSUES | ix | ||
| April 2016 | ix | ||
| July 2016 | ix | ||
| October 2016 | ix | ||
| RECENT ISSUES | ix | ||
| October 2015 | ix | ||
| July 2015 | ix | ||
| April 2015 | ix | ||
| BRAF Mutations in Erdheim-Chester Disease | xi | ||
| REFERENCES | xi | ||
| The Secret Scourge | xiii | ||
| Diagnosing Hidradenitis Suppurativa | 1 | ||
| Key points | 1 | ||
| DIAGNOSIS | 1 | ||
| OUTCOMES | 2 | ||
| Prevalence, Risk Factors, and Comorbidities of Hidradenitis Suppurativa | 7 | ||
| Key points | 7 | ||
| PREVALENCE AND INCIDENCE | 7 | ||
| RISK FACTORS AND COMORBIDITIES | 8 | ||
| Age and Sex | 8 | ||
| Obesity | 8 | ||
| Smoking | 8 | ||
| Genetics | 8 | ||
| Other Risk Factors | 9 | ||
| Metabolic Comorbidities | 9 | ||
| Autoimmune Comorbidities | 9 | ||
| Follicular Occlusion Triad, Acne, and Syndromes | 10 | ||
| Rheumatologic Comorbidities | 11 | ||
| Malignancies | 12 | ||
| Other Somatic Complications | 12 | ||
| PSYCHOLOGICAL COMORBIDITIES | 12 | ||
| SUMMARY | 13 | ||
| REFERENCES | 13 | ||
| The Handicap of Hidradenitis Suppurativa | 17 | ||
| Key points | 17 | ||
| INTRODUCTION | 17 | ||
| QUALITY OF LIFE | 17 | ||
| Dermatology-Specific Quality of Life Questionnaires | 17 | ||
| Quality of Life in Patients with Hidradenitis Suppurativa | 18 | ||
| Causes of Low Quality of Life in Hidradenitis Suppurativa | 18 | ||
| Quality of Life in Hidradenitis Suppurativa Versus Other Dermatologic Diseases | 19 | ||
| PSYCHIATRIC COMORBIDITIES | 19 | ||
| Depression | 20 | ||
| Sexual Distress | 20 | ||
| WORK | 20 | ||
| LIFESTYLE CHANGES | 20 | ||
| HEALTH CARE COSTS | 21 | ||
| SUMMARY | 21 | ||
| REFERENCES | 21 | ||
| The Genetics of Hidradenitis Suppurativa | 23 | ||
| Key points | 23 | ||
| INTRODUCTION | 23 | ||
| CONTRIBUTION OF GENETICS TO HIDRADENITIS SUPPURATIVA ETIOLOGY | 23 | ||
| AUTOSOMAL DOMINANT INHERITANCE | 23 | ||
| LINKAGE TO CHROMOSOME 1 | 25 | ||
| DISCOVERY OF γ-SECRETASE MUTATIONS IN HIDRADENITIS SUPPURATIVA | 25 | ||
| γ-SECRETASE STRUCTURE | 25 | ||
| γ-SECRETASE FUNCTION | 26 | ||
| γ-SECRETASE MUTATIONS: TYPES AND GEOGRAPHIC LOCATIONS | 26 | ||
| ARE γ-SECRETASE MUTATIONS NECESSARY AND SUFFICIENT TO CAUSE HIDRADENITIS SUPPURATIVA? | 26 | ||
| GENOTYPE-PHENOTYPE CORRELATIONS | 27 | ||
| FUTURE STUDIES | 27 | ||
| REFERENCES | 27 | ||
| The Microbiology of Hidradenitis Suppurativa | 29 | ||
| Key points | 29 | ||
| INTRODUCTION | 29 | ||
| NORMAL BACTERIAL FLORA OF THE SKIN | 29 | ||
| THE SPECTRUM OF BACTERIA FOUND IN PATIENTS WITH HIDRADENITIS SUPPURATIVA | 30 | ||
| STAPHYLOCOCCUS AUREUS | 31 | ||
| COAGULASE-NEGATIVE STAPHYLOCOCCI | 32 | ||
| BIOFILM | 32 | ||
| METHODS USED FOR BACTERIOLOGIC ANALYSIS | 33 | ||
| SUMMARY | 33 | ||
| REFERENCES | 33 | ||
| The Role of Mechanical Stress in Hidradenitis Suppurativa | 37 | ||
| Key points | 37 | ||
| INTRODUCTION | 37 | ||
| MECHANICAL STRESS OF THE SKIN | 38 | ||
| ETIOPATHOPHYSIOLOGY | 38 | ||
| THE ROLE OF MECHANICAL STRESS IN HIDRADENITIS SUPPURATIVA–ASSOCIATED FOLLICULAR DISEASES | 39 | ||
| THE ROLE OF MECHANICAL STRESS IN LIMB AMPUTEES | 40 | ||
| REFERENCES | 41 | ||
| Endocrinologic Aspects of Hidradenitis Suppurativa | 45 | ||
| Key points | 45 | ||
| INTRODUCTION | 45 | ||
| HIDRADENITIS SUPPURATIVA AND SEX HORMONES | 45 | ||
| HIDRADENITIS SUPPURATIVA AND METABOLIC DISORDERS | 46 | ||
| HIDRADENITIS SUPPURATIVA AND THE HYPOTHALAMUS–PITUITARY AXIS | 46 | ||
| HIDRADENITIS SUPPURATIVA AND THE HORMONAL MICROENVIROMENT | 47 | ||
| SUMMARY | 47 | ||
| REFERENCES | 47 | ||
| Inflammatory Mechanisms in Hidradenitis Suppurativa | 51 | ||
| Key points | 51 | ||
| INTRODUCTION | 51 | ||
| CYTOKINES IN HIDRADENITIS SUPPURATIVA | 52 | ||
| ANTIMICROBIAL PEPTIDES | 53 | ||
| PROPOSED INVOLVED SIGNALING PATHWAYS IN HIDRADENITIS SUPPURATIVA | 53 | ||
| EFFECTS OF SMOKING ON KERATINOCYTES AND SKIN IMMUNITY: FACILITATING SKIN INFLAMMATION? | 54 | ||
| INFLAMMATORY PATHWAYS IN HIDRADENITIS SUPPURATIVA | 54 | ||
| SUMMARY | 55 | ||
| REFERENCES | 57 | ||
| Imaging of Hidradenitis Suppurativa | 59 | ||
| Key points | 59 | ||
| INTRODUCTION | 59 | ||
| ULTRASOUND | 60 | ||
| Ultrasound Criteria for Hidradenitis Suppurativa Diagnosis | 63 | ||
| Ultrasound Staging | 64 | ||
| MRI | 64 | ||
| SUMMARY | 65 | ||
| SUPPLEMENTARY DATA | 67 | ||
| REFERENCES | 67 | ||
| Randomized Controlled Trials for the Treatment of Hidradenitis Suppurativa | 69 | ||
| Key points | 69 | ||
| INTRODUCTION | 69 | ||
| METHODOLOGY | 70 | ||
| RESULTS | 71 | ||
| Biologics | 71 | ||
| Antibiotics | 76 | ||
| Hormones | 77 | ||
| Surgery | 77 | ||
| Laser | 77 | ||
| RANDOMIZED CONTROLLED TRIALS RECENTLY COMPLETED AND ONGOING | 78 | ||
| Biologics | 78 | ||
| Other Treatments | 78 | ||
| SUMMARY AND RECOMMENDATIONS | 78 | ||
| Implications for Daily Clinical Practice | 79 | ||
| Integrating Results of Randomized Controlled Trials in the Current State-of-the-art Treatment of Hidradenitis Suppurativa | 79 | ||
| REFERENCES | 79 | ||
| Antibiotic Treatment of Hidradenitis Suppurativa | 81 | ||
| Key points | 81 | ||
| RATIONALE/BACKGROUND | 81 | ||
| CLINICAL STUDIES: REVIEW | 82 | ||
| Methods | 82 | ||
| Results | 82 | ||
| GENERAL RULES FOR ANTIBIOTIC USE | 83 | ||
| Routes of Administration | 83 | ||
| Side Effects | 86 | ||
| Short-term side effects | 86 | ||
| Common to all antibiotics | 86 | ||
| Specific to 1 class of antibiotics | 86 | ||
| Long-term side effects (risk of resistance) | 87 | ||
| DISCUSSION | 87 | ||
| CONCLUSION | 88 | ||
| REFERENCES | 89 | ||
| Medical Treatments of Hidradenitis Suppurativa | 91 | ||
| Key points | 91 | ||
| INTRODUCTION | 91 | ||
| BIOLOGIC THERAPY | 91 | ||
| STEROIDS, INTRALESIONAL SYSTEMIC | 92 | ||
| SYSTEMIC CORTICOSTEROIDS | 92 | ||
| DAPSONE | 92 | ||
| CYCLOSPORINE | 92 | ||
| HORMONES | 92 | ||
| PAIN CONTROL | 93 | ||
| Opiates | 93 | ||
| DRESSINGS | 93 | ||
| ISOTRETINOIN | 93 | ||
| ACITRETIN | 93 | ||
| ALITRETINOIN | 94 | ||
| RESORCINOL | 94 | ||
| INTRAMUSCULAR GAMMA-GLOBULIN | 94 | ||
| COLCHICINE | 94 | ||
| METFORMIN | 94 | ||
| ZINC GLUCONATE | 94 | ||
| BOTULINUM TOXIN | 94 | ||
| TACROLIMUS | 95 | ||
| FUMARATES | 95 | ||
| FUTURE RESEARCH | 95 | ||
| SUMMARY | 95 | ||
| REFERENCES | 95 | ||
| Surgical Procedures in Hidradenitis Suppurativa | 97 | ||
| Key points | 97 | ||
| INTRODUCTION | 97 | ||
| TREATMENT GOALS AND PLANNED OUTCOMES | 97 | ||
| Relapse Rates | 98 | ||
| Time to Wound Closure | 98 | ||
| Complications | 98 | ||
| Patient-Reported Outcomes | 98 | ||
| PREOPERATIVE PLANNING AND PREPARATION | 98 | ||
| Medication to Calm the Inflammation | 98 | ||
| Imaging | 98 | ||
| PATIENT POSITIONING | 98 | ||
| PROCEDURAL APPROACH | 98 | ||
| Anesthesia | 98 | ||
| Local anesthesia | 98 | ||
| Tumescent local anesthesia | 98 | ||
| General and spinal anesthesia | 99 | ||
| Lesion Removal Techniques | 99 | ||
| Incision and drainage | 99 | ||
| Deroofing | 99 | ||
| Skin-tissue–saving excision with electrosurgical peeling | 99 | ||
| Excision | 100 | ||
| Wound Closure Techniques | 101 | ||
| Primary closure | 101 | ||
| Sutures | 101 | ||
| Split-thickness skin grafts | 101 | ||
| Flaps | 102 | ||
| Healing by secondary intention | 102 | ||
| Combined reconstructions | 103 | ||
| COMPLICATIONS AFTER SURGERY | 103 | ||
| POSTPROCEDURAL CARE | 104 | ||
| REHABILITATION AND RECOVERY | 105 | ||
| OUTCOMES AND CLINICAL RESULTS IN THE LITERATURE | 106 | ||
| Deroofing | 106 | ||
| Skin-tissue–Saving Excision With Electrosurgical Peeling | 106 | ||
| Excision | 106 | ||
| Wound Closure Techniques | 107 | ||
| Other Factors Influencing the Risk of Relapse | 107 | ||
| SUMMARY | 107 | ||
| REFERENCES | 107 | ||
| Lasers and Intense Pulsed Light Hidradenitis Suppurativa | 111 | ||
| Key points | 111 | ||
| INTRODUCTION: NATURE OF THE PROBLEM | 111 | ||
| CARBON DIOXIDE LASER | 111 | ||
| Treatment Goal and Planned Outcome | 111 | ||
| Carbon dioxide laser excision surgery (en bloc) | 111 | ||
| Carbon dioxide laser vaporization surgery (selective focal treatment) | 112 | ||
| Preoperative Planning and Preparation | 112 | ||
| Anesthesia | 113 | ||
| Operative Techniques | 113 | ||
| Vaporization technique | 113 | ||
| Excision technique | 113 | ||
| Postprocedural Care | 113 | ||
| Primary closure | 113 | ||
| Secondary Intention Healing | 113 | ||
| Rehabilitation and Recovery | 113 | ||
| Postprocedural Course | 113 | ||
| Clinical Results in the Literature | 114 | ||
| Summary | 114 | ||
| LASERS AND INTENSE PULSED LIGHT USED FOR HAIR REMOVAL IN THE TREATMENT OF HIDRADENITIS SUPPURATIVA | 114 | ||
| Treatment Goal and Planned Outcome | 114 | ||
| Nd:YAG Laser | 115 | ||
| Long-pulsed 755-nm Alexandrite Laser (Cynosure Elite) | 115 | ||
| Diode Laser (1450 nm) | 115 | ||
| Intense Pulsed Light | 118 | ||
| Outcomes | 118 | ||
| Rehabilitation and recovery | 118 | ||
| Summary | 118 | ||
| OVERALL SUMMARY | 118 | ||
| ACKNOWLEDGMENTS | 118 | ||
| REFERENCES | 118 | ||
| Index | 121 |