Insights into the Window of Opportunity and Outcome Measures in Patients with Moderate to Severe Hidradenitis Suppurativa Treated with Secukinumab: A Real-World Study.

INTRODUCION: The concept of a window of opportunity in hidradenitis suppurativa (HS) management suggests that early initiation of biological therapy leads to better outcomes, though its timing remains uncertain. METHODS: We conducted a retrospective observational multicenter study, including consecutive patients with moderate to severe HS who initiated secukinumab treatment following prior failure with systemic antibiotics or adalimumab. Therapeutic burden was defined as the sum of previous systemic treatment cycles and previous major surgical interventions for HS. Patients were followed up for 24 weeks. Main outcomes were safety and effectiveness, assessed through the proportion of patients achieving HS Clinical Response (HiSCR) and a 55% reduction in International HS Severity Score System (IHS4-55). Additionally, potential predictors of response to secukinumab were studied. Analysis was performed on an intention-to-treat basis. RESULTS: A total of 67 patients (33 men, 34 women) were included, with a mean age of 41.55 (11.94) years and a mean baseline IHS4 of 17.88 (11.13). The mean therapeutic burden was 6.06 (3.49). At week 24, 10.45% (7/67) of patients experienced adverse events, with three leading to treatment discontinuation. At week 24, 41.79% (28/67) of patients achieved HiSCR, and 44.78% (30/67) of patients achieved IHS4-55. HiSCR could not be calculated in 12 patients with a baseline AN count < 3. A lower therapeutic burden was significantly associated with a higher likelihood of achieving HiSCR and IHS4-55 at week 24. CONCLUSIONS: Secukinumab showed safety and efficacy in real-world patients with HS, and the inverse correlation found between therapeutic burden and treatment response supports the concept of a window of opportunity, offering insights into its timing.

Azathioprine in hidradenitis suppurativa with inflammatory phenotype: a case series of 11 patients.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that negatively impacts the quality of life of patients. It presents as deep-seated nodules, abscesses, fistulae, sinus tracts, and scars in the axilla, inguinal area, submammary folds, and perianal area. Recently, two phenotypes have been described: a follicular phenotype and an inflammatory phenotype. Numerous medical treatments are available for hidradenitis suppurativa, with particular importance of antitumor necrosis factor antibodies. Due to the association of HS with other conditions with a pro-inflammatory state, particularly Crohn's disease, it has been suggested that azathioprine may have a role in the treatment of HS. OBJECTIVE: To assess the effectiveness of azathioprine monotherapy in patients with moderate-severe HS. METHODS: We retrospectively studied patients with HS treated with azathioprine in monotherapy. We performed both clinical and ultrasound evaluation at baseline as well as in the follow-up visits. Their baseline score on the iHS4 and DLQI scales and 12-16 weeks after starting the treatment were compared. We also registered the number of patients who achieved HiSCR. RESULTS: Six patients presented significant improvement, reducing their score in iHS4 and DLQI scales and achieving HiSCR. Another patient had clinical improvement, meaning reduction in iHS4 and DLQI, but without achieving HiSCR. Two patients stopped the treatment before week 12 because of adverse events. The remaining two patients presented no improvement. The median (Q3-Q1) baseline iHS4 score was 6 (12-6), and follow-up iHS4 score, 4 (6-2), being these differences statistically significant (P = 0.006). Median (Q3-Q1) baseline DLQI scores and 12-16 weeks after treatment were 17 (23-11) and 14 (18-9) although statistically nonsignificant (P = 0.099). CONCLUSION: We present a case series of 11 patients treated with azathioprine with good clinical and ultrasonographic response. We suggest that azathioprine may benefit a certain patient profile with the inflammatory phenotype.

Short-Term Effectiveness, Safety, and Potential Predictors of Response of Secukinumab in Patients with Severe Hidradenitis Suppurativa Refractory to Biologic Therapy: A Multicenter Observational Retrospective Study.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. Biologic drugs have a key role in the long-term anti-inflammatory treatment of moderate to severe patients due to their immunomodulatory properties. The aim of this study is to evaluate the effectiveness and safety of secukinumab in patients with moderate to severe HS after 16 weeks of treatment, and to explore potential predictors of clinical response to the drug. METHODS: Multicenter observational retrospective study. Patients treated with secukinumab 300 mg every 2 or 4 weeks who had completed at least 16 weeks of follow-up from nine hospitals based in southern Spain (Andalusia) were included in this study. Treatment effectiveness was assessed using the Hidradenitis Suppurativa Clinical Response (HiSCR). Information about adverse events was collected, the therapeutic burden of the patients was calculated as the summation of systemic medical treatments and surgical interventions (excluding incision and drainage) experienced until the start of secukinumab treatment. RESULTS: Forty-seven patients with severe HS were included for analysis. At week 16, 48.9% (23/47) of patients achieved HiSCR. Adverse events were present in 6.4% (3/47) of the patients. The multivariate analysis showed that female sex and, to a lesser extent, lower body mass index (BMI) and a lower therapeutic burden were potentially associated with a higher probability of HiSCR achievement. CONCLUSIONS: Favorable short-term effectiveness and safety of secukinumab in the treatment of severe HS patients were observed. Female sex, lower BMI and a lower therapeutic burden may be associated with a higher probability of achieving HiSCR.

Porfiria cutánea tarda en un paciente con hepatitis C / Porphyria cutanea tarda in a patient with hepatitis C

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Tinea capitis in adults in southern Spain. A 17-year epidemiological study / Tinea capitis en pacientes adultos del sur de España. Un estudio epidemiológico de 17 años

Background. Tinea capitis is an infection of the hair due to keratinophilic fungi, known as dermatophytes. Although the disease is common in children, several studies have also shown that it is far from unusual in adults, especially in post-menopausal women and immunocompromised persons. Aims. To determine the incidence of tinea capitis in adults in our area, as well as the predisposing factors (gender, immunity), and causative species. Materials and methods. A retrospective study was conducted over a period of 17 years, from 1995 to 2011, collecting data on cases of tinea capitis diagnosed in our dermatology department. Information collected for all patients included age, gender, location of the lesions, results of direct examination and culture, immune status, cause of immunosuppression, and the prescribed treatment. Results. Thirty-three cases (11.4%) out of 289 cases of tinea capitis occurred in adults. Most of these adults (72%) were immunocompetent, and the rest were immunocompromised for different reasons. Three of the patients were men and 30 women, with 70% of the latter being post-menopausal. Trichophyton species were isolated in 76% of these adult patients, with Trichophyton violaceum being the most common. Treatment with oral terbinafine was successful in all these cases. Microsporum species were responsible for the other cases, all treated successfully with oral griseofulvin. Conclusions. This series of tinea capitis in adults is one of the largest to date. It shows that tinea capitis is not uncommon among the immunocompetent adult population. In our geographical area, except for prepubescent patients, most cases affecting the adult population were caused by species of the genus Trichophyton. In these cases the treatment of choice was oral terbinafine, which considerably shortened the treatment time, and was associated with fewer side effects than the classical griseofulvin (AU)

Antecedentes. Tinea capitis es una infección del pelo producida por hongos queratinofílicos llamados dermatofitos. Aunque la enfermedad es más común en niños, varios estudios han demostrado que no es infrecuente en adultos, especialmente en mujeres posmenopáusicas y personas inmunodeprimidas. Objetivo. Determinar la incidencia de tinea capitis en adultos de nuestra área, así como los factores predisponentes (inmunidad, género) y agentes causales. Métodos. Llevamos a cabo un estudio retrospectivo de un periodo de 17 años, desde 1995 a 2012, seleccionando casos de tinea capitis diagnosticados en nuestro departamento de Dermatología. Se recogió información clínico-demográfica de los pacientes que incluyó edad, sexo, localización de las lesiones, resultados de examen directo y cultivos, inmunidad, causa de la inmunosupresión y tratamiento. Resultados. De los 289 casos de tinea capitis, 33 (11,4%) eran de pacientes adultos. La mayoría (72%) fueron inmunocompetentes; la inmunodepresión en el resto de los casos era por diferentes causas. Tres de los pacientes eran hombres y 30 mujeres, la mayoría de las cuales eran posmenopáusicas (70%). Las especies de Trichophyton fueron aisladas en el 76% de los casos, con Trichophyton violaceum como el dermatofito más común; el tratamiento con terbinafina oral fue exitoso en todos los casos. Las especies microspóricas fueron responsables de los casos restantes y tuvieron una buena evolución con griseofulvina. Conclusiones. Esta serie de tinea capitis del adulto es una de las más largas hasta la fecha. Se demuestra que tinea capitis no es infrecuente entre la población adulta inmunocompetente. En nuestra área geográfica, salvo en prepúberes, la mayoría de los casos de tinea capitis de adultos son debidos a especies del género Trichophyton. En estos casos el tratamiento de elección fue la terbinafina oral, que acorta considerablemente la duración de tratamiento y se asocia a menos efectos secundarios que la clásica griseofulvina (AU)

Tinea capitis in adults in southern Spain. A 17-year epidemiological study.

BACKGROUND: Tinea capitis is an infection of the hair due to keratinophilic fungi, known as dermatophytes. Although the disease is common in children, several studies have also shown that it is far from unusual in adults, especially in post-menopausal women and immunocompromised persons. AIMS: To determine the incidence of tinea capitis in adults in our area, as well as the predisposing factors (gender, immunity), and causative species. MATERIALS AND METHODS: A retrospective study was conducted over a period of 17 years, from 1995 to 2011, collecting data on cases of tinea capitis diagnosed in our dermatology department. Information collected for all patients included age, gender, location of the lesions, results of direct examination and culture, immune status, cause of immunosuppression, and the prescribed treatment. RESULTS: Thirty-three cases (11.4%) out of 289 cases of tinea capitis occurred in adults. Most of these adults (72%) were immunocompetent, and the rest were immunocompromised for different reasons. Three of the patients were men and 30 women, with 70% of the latter being post-menopausal. Trichophyton species were isolated in 76% of these adult patients, with Trichophyton violaceum being the most common. Treatment with oral terbinafine was successful in all these cases. Microsporum species were responsible for the other cases, all treated successfully with oral griseofulvin. CONCLUSIONS: This series of tinea capitis in adults is one of the largest to date. It shows that tinea capitis is not uncommon among the immunocompetent adult population. In our geographical area, except for prepubescent patients, most cases affecting the adult population were caused by species of the genus Trichophyton. In these cases the treatment of choice was oral terbinafine, which considerably shortened the treatment time, and was associated with fewer side effects than the classical griseofulvin.

Eficacia terapéutica del voriconazol en candidiasis vulvovaginal crónica por Candida glabrata / Efficacy of voriconazole treatment in chronic vulvovaginal candidosis due to Candida glabrata

Antecedentes. La vulvovaginitis candidiásica es una infección frecuente en mujeres jóvenes que se acompaña de alta morbilidad y elevados gastos sanitarios. Objetivos. Las candidiasis vaginales causadas por Candida glabrata constituyen un reto terapéutico dada la resistencia adquirida por muchas cepas de esta especie a los antifúngicos azólicos. Métodos. En este trabajo presentamos 2 casos de candidiasis vaginal complicada por Candida glabrata resistentes a fluconazol y tratadas con voriconazol. Resultados. Las 2 pacientes mejoraron tras la administración de voriconazol, 400mg/12h el primer día y posteriormente 200mg/12h durante 14 días, con desaparición de la sintomatología y la negativización de los cultivos. Conclusiones. En conclusión, los resultados obtenidos nos llevan a sugerir el uso del voriconazol como alternativa terapéutica en este tipo de candidiasis que, aunque no comprometen la vida, llevan asociada una elevada morbilidad(AU)

Background. Vulvovaginal candidosis is a common infection in young women, and it is associated with high morbidity and high health costs. Aims. Vulvovaginal candidosis caused by Candida glabrata is a therapeutic challenge due to the acquired resistance of many strains of this species to azole antifungals. Methods. We present two cases of vaginal candidosis complicated by fluconazole-resistant Candida glabrata, and treated with voriconazole. Results. Both patients improved after administration of voriconazole, 400mg/12h the first day and then 200mg every 12h for 14 days. Their symptoms disappeared and cultures became negative. Conclusions. These results suggest voriconazole can be used as a therapeutic alternative for this type of candidosis which, although not life threatening, is associated with a high morbidity(AU)

[Efficacy of voriconazole treatment in chronic vulvovaginal candidosis due to Candida glabrata]. / Eficacia terapéutica del voriconazol en candidiasis vulvovaginal crónica por Candida glabrata.

BACKGROUND: Vulvovaginal candidosis is a common infection in young women, and it is associated with high morbidity and high health costs. AIMS: Vulvovaginal candidosis caused by Candida glabrata is a therapeutic challenge due to the acquired resistance of many strains of this species to azole antifungals. METHODS: We present two cases of vaginal candidosis complicated by fluconazole-resistant Candida glabrata, and treated with voriconazole. RESULTS: Both patients improved after administration of voriconazole, 400 mg/12 h the first day and then 200 mg every 12 h for 14 days. Their symptoms disappeared and cultures became negative. CONCLUSIONS: These results suggest voriconazole can be used as a therapeutic alternative for this type of candidosis which, although not life threatening, is associated with a high morbidity.

Lesión nodular ulcerada / Ulcerated nodular lesion

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