Management of severe hidradenitis suppurativa with biologic therapy and wide excision

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular occlusive disease that involves the intertriginous areas. Treatment methods include conventional topical and systemic medication, radiotherapy, biologic agents, and surgical excision. Of late, there has been an increased focus on the use of biologic agents in patients with moderate to severe HS. Here, we present the case of a 46-year-old man with Hurley stage III HS for whom wide excision was ultimately curative, after aggressive medical therapy with the use of infliximab and adalimumab had succeeded in limiting the body surface area affected by the disease. This case demonstrates the effective treatment of severe HS with a combination of biologic therapy and surgery.

Impact of a pharmacy-led smoking cessation clinic in a dermatology centre

INTRODUCTION@#Cigarette smoking is a leading cause of morbidity and mortality, and has a deleterious effect on dermatological conditions, such as skin cancers, hidradenitis suppurativa and psoriasis. The study aimed to evaluate the efficacy of a pharmacist-led smoking cessation clinic in reducing cigarette smoking at a tertiary referral dermatology centre. We described the impact of this clinic to provide guidance on how such a model could be further improved and implemented more widely.@*METHODS@#In this single-centre, retrospective study, 74 currently smoking patients who received counselling at a structured smoking cessation clinic between January 2010 and March 2013 were identified. Information on baseline demographic characteristics and detailed past medical history, including smoking history, was collected. Follow-up was conducted at two weeks and three months.@*RESULTS@#At the first follow-up at two weeks, which was attended by 57 patients, 9 (15.8%) had stopped smoking and 26 (45.6%) showed reduction in the number of cigarette sticks smoked per day, with an average reduction of 4.1 cigarette sticks per day. However, a few patients also reported no change or increased number of cigarette sticks smoked per day following counselling.@*CONCLUSION@#A structured pharmacist-led smoking cessation clinic is effective and can be made a part of the holistic management of dermatological conditions.

Psychological Profile of Patients with Psoriasis

INTRODUCTION@#Psoriasis is a chronic inflammatory disease with a global prevalence of approximately 2% and significant psychiatric comorbidity. There is a great deal of existing literature assessing different aspects of psychology in psoriasis. We aimed to conduct an in-depth review of current evidence linking psoriasis to personality traits and psychiatric comorbidities, as well as factors that put these patients at risk of psychopathology.@*MATERIALS AND METHODS@#A search of the PubMed database identified 1632 articles. We included articles studying psychological comorbidity in patients with psoriasis, looking especially at personality characteristics, and data linking psoriasis with increased risks of psychological distress, depression, anxiety and suicidality. In particular, we also evaluated subgroups in psoriasis found to be at risk.@*RESULTS@#Patients with psoriasis are more likely to be alexithymic, lack body awareness and possess a Type D personality. Alcohol, but not illicit drug use, disorders are also more common in patients with psoriasis. Patient groups who are especially at risk of psychological distress include women, younger patients, patients with a younger age of disease onset, those who self-assess their psoriasis to be severe, and those with lesions on visible or sensitive areas. Adopting motivational interviewing skills and incorporating the use of learning materials during consultations have been found to be useful.@*CONCLUSION@#The knowledge of personality characteristics, "at-risk" groups, and early recognition of psychological distress among patients with psoriasis can help clinicians provide better holistic care and encourage a change in patients' behaviour.

Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities

Hidradenitis suppurativa is a chronic inflammatory skin condition associated with an increased prevalence of individual metabolic conditions such as insulin resistance, obesity, hyperlipidemia, hypertension, and with the metabolic syndrome, as a constellation of these risk factors. This places affected patients at an increased risk of early cardiovascular morbidity and mortality. Moreover, many of the therapeutic options, including the newer biologics, used in the treatment of hidradenitis suppurativa have both beneficial and adverse metabolic effects. Therefore, it is critical for physicians to consider the complex interactions between the disease process and the treatment options in the holistic management of these patients with an intrinsically higher risk of metabolic consequences. Other chronic systemic inflammatory diseases such as psoriasis and rheumatoid arthritis have been studied more extensively with regard to their associations and share an underlying link with the metabolic syndrome; we can draw upon the existing knowledge in our understanding and management of hidradenitis suppurativa.

A retrospective analysis of tuberculosis screening by interferon-gamma release assay at National Skin Centre, Singapore

Objective The T-Spot.TB is an interferon-gamma release assay (IGRA) which is increasingly used in dermatology as a screen for latent TB before initiation of biologics and for confirming diagnosis of tuberculids. This study aims to explore its concordance with tuberculin skin tests (TST) and eventual diagnosis of latent TB. Study design This is a retrospective review of all patients in NSC who had a TB T-spot test done between 2008 and 2010. We looked at the dermatological diagnosis, results of T-Spot.TB and TST, chest radiograph findings, tuberculosis status and treatment of TB. Result 51 TB T spot tests were ordered in National Skin Centre between 1 January 2008 and 9 June 2010. 31 tests were for patients with psoriasis with the intention of initiating biologics; 5 were for patients with suspected tuberculids and tuberculosis verrucosa cutis; 3 were done as part of work-up for possible erythema nodosum; 3 tests were part of screening for latent TB in hospital staff and 9 tests were performed for other reasons. There were a total of 13 patients eventually diagnosed with latent or active TB infection. All of whom had a positive T-Spot.TB result except for 1 patient with an indeterminate result. On the other hand, out of these 13 patients, only 5 showed a positive TST, 2 had negative TST and 4 patients did not have a TST done. There were a total of 14 positive T-Spot.TB results for which 12 eventually received antituberculous therapy. All patients with erythema induratum had a positive test result. Six patients’ T-Spot.TB tests were borderline, indeterminate or could not be interpreted due to insufficient lymphocyte yield. Conclusion Our study shows the utility of T-Spot. TB test in various conditions seen in dermatology clinics in a local setting. We suggest that the T-spot test can supplant the tuberculin skin test in screening latent TB for psoriasis patients for whom biologics are intended and in erythema induratum. The high incidence of borderline and indeterminate results should not be ignored. This should be taken into account when interpreting the IGRA especially if patients are on immunosuppressive therapy.