Screening for cardiovascular comorbidity in United States outpatients with psoriasis, hidradenitis, and atopic dermatitis.

Psoriasis, hidradenitis, and atopic dermatitis (AD) are associated with increased cardiometabolic comorbidities. Yet, little is known about screening rates for cardiometabolic comorbidities in patients with these disorders. The objective of this study is to determine rates and predictors of cardiovascular screening among patients with psoriasis, AD, and hidradenitis in the United States. Data from the 2006-2015 National Ambulatory Medical Care Survey were analyzed, including 67,581 pediatric and 322,957 adult outpatient visits. Overall, blood pressure screening was performed less commonly in psoriasis (36.4% [31.0-42.2%]) and AD (41.9% [39.3-44.7%] of visits) compared to other visits (62.5% [61.5-63.6%]) (P < 0.0001). Cholesterol screening was performed more often (adjusted odds ratio [95% confidence interval]) in psoriasis (1.82 [1.20-2.76], P = 0.005) but less often in hidradenitis (0.03 [0.00-0.23], P = 0.001) and AD (0.72 [0.55-0.94], P = 0.02). Obesity screening increased from 2006-2007 to 2014-2015 in AD (31.1% [25.8-36.4%]-44.5% [37.0-81.5%], P = 0.01), psoriasis (19.0% [9.4-28.6%] to 42.8% [30.5-73.3%], P = 0.01), and hidradenitis (28.6% [1.7-55.6%] to 74.2% [55.3-100.0%], P = 0.001), but screening for blood pressure, cholesterol, or diabetes did not. Screening rates for cardiometabolic comorbidities are suboptimal. Future interventions are needed to improve screening rates for cardiometabolic comorbidities.

[Case Report of Pseudomonas Hot-Foot Syndrome in Uppsala, Sweden]. / Badhusfötter ­ ny diagnos i Sverige.

During February and March 2019, an accumulation of clinically similar erythematous plantar nodules was observed at the University Children's Hospital and several primary care facilities in Uppsala, Sweden. At least 20 children sought medical advice, and all cases presented with a recurrent plantar hidradenitis after within a day after visiting Uppsala's largest waterpark and arena for swimming. The presented symptoms were identical with a condition called pseudomonas hot-foot syndrome described in the literature. An investigation led by the local public health authorities revealed heavy growth of Pseudomonas aeruginosa in water-filled toys in a children's play area and in samples taken from the floor of a pool where the surface was partly damaged. After closing the affected part of the pool and removal of the contaminated toys, no more people sought medical advice. Pseudomonas hot-foot syndrome is believed to be more frequent than diagnosed today, and increased awareness is essential to avoid unwarranted diagnostic tests and treatments, and to identify and eradicate the source of infection.

Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.

Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.

Actualización en hidrosadenitis supurativa en Atención Primaria / Update of hidradenitis suppurativa in Primary Care

La hidrosadenitis supurativa es una enfermedad prevalente caracterizada por una marcada variabilidad clínica y por una intensa repercusión sobre la calidad de vida de los pacientes. Esta actualización recoge los últimos avances sobre la hidrosadenitis supurativa tras llevar a cabo una minuciosa revisión de la literatura científica. Indudablemente el médico de Atención Primaria desempeña un papel fundamental en el diagnóstico precoz y en el tratamiento de la hidrosadenitis supurativa. Con esta actualización pretendemos ofrecer una visión global, actualizada y práctica sobre la enfermedad que permita optimizar el uso de los recursos disponibles en la consulta de Atención Primaria (AU)

Hidradenitis suppurativa is a prevalent disease that is noted for its clinical variability and by its severe impact on quality of life. A meticulous scientific literature review is presented in this article in order to give an update on what is known on this condition. Primary Care physicians obviously play an important role in the early diagnosis and management of hidradenitis suppurativa. This review aims to provide a current and practical overview about this disease in order to optimise the healthcare for these patients by making the best use of available resources (AU)

Majocchi Granuloma of the Breast: A Rare Clinical Entity / Granuloma de Majocchi: Una rara entidad

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Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association.

Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn's disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as "the explosive mixture" at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.

Comentario a: “Hidrosadenitis supurativa: nuevas oportunidades para una enfermedad dermatológica huérfana” / Comment on “Hidradenitis Suppurativa: New Opportunities for an Orphan Skin Disease”

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Manejo práctico de la hidrosadenitis supurativa / Practical management of hidradenitis suppurativa

La hidrosadenitis supurativa (HS) es una enfermedad inflamatoria crónica que suele manifestarse en zonas cutáneas con gran densidad de glándulas apocrinas (axilas, ingles, región perianal, perineal, submamaria, etc.). Suele iniciarse en mujeres durante la pubertad. La etiología de esta enfermedad es desconocida, aunque se considera un defecto primario del folículo piloso. Debemos considerar una serie de factores predisponentes (genéticos y hormonales) y otros desencadenantes controvertidos (obesidad, tabaco, ropa ajustada, etc.) en el diagnóstico de la HS. El diagnóstico es básicamente clínico y es importante tener en cuenta las posibles complicaciones derivadas del padecimiento de esta enfermedad, como la posibilidad de desarrollar lesiones tumorales. El manejo de esta patología comprende diversas pautas: medidas generales (jabones antisépticos, baños templados, etc.), farmacológicas (tópicas, intralesionales y sistémicas), quirúrgicas (cierre directo, cierre por segunda intención, injertos, colgajos, etc.) y otras medidas (láser CO2, radioterapia, etc.). Es importante identificar y tratar cuanto antes esta patología debido a los potenciales problemas físicos y psicológicos en los que puede derivar (AU)

Hidradenitis suppurativa is a chronic inflammatory disease that usually affects areas of the skin with a high density of apocrine glands (axillae, groin, perianal and perineal regions, submammary area, etc). It usually appears in women during puberty. The etiology of the disease is unknown, although it is thought to be a primary defect of the hair follicle. When diagnosing hidradenitis suppurativa, a number of genetic and hormonal predisposing factors should be considered alongside other putative triggers, such as obesity, smoking, and tight clothing. Diagnosis is essentially clinical and it is important to bear in mind the possible complications associated with the disease, such as the development of tumors. Management of the disease includes general measures (antiseptic soaps, warm baths, etc), pharmacological therapy (topical, intralesional, and systemic), surgery (direct closure, second-intention healing, grafts, flaps, etc), and other measures (carbon dioxide laser, radiation therapy, etc). It is important that the disease be diagnosed and treated as soon as possible given the potential physical and psychological problems that it can generate (AU)