Evaluation of medical and surgical treatments for hidradenitis suppurativa using real-life data from the Scandinavian registry (HISREG).

BACKGROUND: Hidradenitis suppurativa (HS) substantially affects health-related quality-of-life outcomes. Most treatment options are supported by low quality of evidence without validated outcomes. OBJECTIVE: The aim of this study was to evaluate the efficacy of surgical and medical interventions using physician- and patient-reported outcomes registered in HISREG. METHODS: Data were extracted for all adult patients registered in HISREG between January 2013 and April 2016. Primary endpoints included Dermatology Life Quality Index (DLQI) scores, pain as measured using a numeric rating scale (NRS), Sartorius score and Hurley classification. Minimum clinically important differences (MCIDs) for DLQI and NRS pain were analysed. Secondary endpoints included comparisons among different treatment groups, safety and complications of various treatments. RESULTS: Two hundred and fifty-five patients were included in the study: 31, 188, and 36 patients had Hurley stages I, II and III disease, respectively. Treatment with CO2 lasers was the most common treatment modality. One hundred and forty-nine patients (58.4%) were treated with surgical intervention, 87 (34.1%) received antibiotics and/or anti-inflammatory treatments, and 19 (7.5%) were treated with both surgery and medical intervention. No patients received biologic treatment. In patients with surgical treatments, Sartorius scores were significantly improved compared with baseline (P = 0.001), 83 patients (55%) achieved a DLQI MCID, and 75 patients (49.7%) achieved an NRS pain MCID. In patients with medical treatments, Sartorius scores were not significantly improved compared with baseline (P = 0.582); 25 patients (28%) achieved a DLQI MCID and 28 patients (31%) achieved an NRS pain MCID. In patients treated with surgical and medical combination, 9 (48%) achieved DLQI and NRS pain MCIDs and Sartorius scores were significantly improved. CONCLUSIONS: CO2 laser treatment is more effective than the non-biologic medical treatments in this analysis based on physician- and patient-derived outcomes. The study provides limited evidence for the combination of medical and surgical therapies in patients with HS.

Depression in patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL). It is hypothesized that depression is more common in HS patients than among other dermatological patients. OBJECTIVES: To evaluate the prevalence of depression in patients with HS. METHODS: In total 211 HS patients were included in the study and 233 were dermatological control patients. Their QoL and depression scores were assessed using the Dermatology Life Quality Index (DLQI) and the Major Depression Inventory (MDI) questionnaires. HS severity was recorded with a questionnaire and Hurley stages were extracted from the case records. RESULTS: The DLQI was significantly higher for HS patients than for the control patients, 8.4 ± 7.5 vs. 4.3 ± 5.6 (P < 0.0001) and correlated with Hurley stage severity scores. Mean MDI scores were significantly higher for HS patients, 11.0 vs. 7.2 (P < 0.0001). However, clinically defined depression rates according to the International Classification of Diseases, 10th edition (ICD-10) criteria were not significantly higher in HS patients compared to controls (9% vs. 6%). CONCLUSIONS: HS is a chronic skin disease with major impact on QoL even when compared to other dermatological diseases. MDI scores in HS patients correlate with disease severity. This correlation could indicate that the MDI represents a valid measure of disease related morbidity that may serve as an outcome measure in future studies and a relevant point of intervention for individual patients.

A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES: To test the efficacy of adalimumab in HS. METHODS: This was a prospective, randomized, double-blinded, placebo-controlled, two-centre clinical trial conducted in Denmark. Inclusion criteria were age above 18 years and a clinical diagnosis of moderate to severe HS defined as Hurley stage II or III for at least 6 months. The patients were randomized 1:2 (placebo/active). Actively treated patients received adalimumab 80 mg subcutaneously (s.c.) at baseline followed by 40 mg s.c. every other week for 12 weeks. Placebo-treated patients received identical-looking injections with no active ingredient. The medicine was dispensed in sequentially numbered computer-randomized containers. Participants, care givers and those assessing the outcomes were blinded to group assignment. The primary efficacy endpoints were changes in the HS scores (Sartorius and Hurley scoring systems). Secondary efficacy endpoints included changes in pain (visual analogue scale), days with lesions and Dermatology Life Quality Index, and evaluation of scarring. Recruitment was terminated early due to expiry date of trial medication. RESULTS: Twenty-one patients were included, of whom 15 received adalimumab and six received placebo. All participants were analysed according to the intention to treat principle. A significant reduction was seen in Sartorius score after 6 weeks and an almost significant reduction was seen after 12 weeks of active treatment (-10·7 vs. 7·5, P = 0·024 and -11·3 vs. 5·8, P = 0·07) when compared with the placebo group. CONCLUSIONS: A significant reduction in HS severity was gained after 6 weeks. No long-term curative effect was uniformly seen.

Questionnaire-based diagnosis of hidradenitis suppurativa: specificity, sensitivity and positive predictive value of specific diagnostic questions.

BACKGROUND: Estimates of the prevalence of hidradenitis suppurativa (HS) range from 0.33% to 4%. Further epidemiological data are therefore needed. Because of the hidden nature of the disease, physical screening may be cumbersome and questionnaire-based screening may be more appropriate. OBJECTIVES: To establish the sensitivity (SE), specificity (SP) and positive predictive value (PPV) of simple diagnostic questions used in HS. METHODS: Potential diagnostic questions regarding HS were identified and sent to 85 patients with HS and to an age- and sex-matched control group randomly selected among outpatients not being treated for HS. All respondents were recruited in the Department of Dermatology in Roskilde Hospital. RESULTS: In total, 74 of 85 patients with HS (87%) returned the questionnaire (61 women and 13 men). Of these, 72 reported repeated outbreaks of painful nodules or boils in locations typical for HS compared with 13 patients in the control group. The SE ranged from 0.92 to 0.97, the SP from 0.82 to 0.86 and the PPV from 0.85 to 0.89. Boils appeared significantly more often in patients with HS, who also reported significantly greater suffering from their lesions. CONCLUSIONS: The high diagnostic power suggests that all the questions are potentially useful. The clear symptomatology of HS may be a key factor. It is suggested that further improvement may be achieved by adding definitions of pimples, nodules or boils to future questionnaires. Similarly, adding the possibility to indicate uncommon locations, duration and quality-of-life impairment may benefit the diagnostic power.