Hidradenitis suppurativa: how common is the condition and what is it linked to?

Hidradenitis suppurativa, shortened to HS, is a long-term disease causing painful boils in skin creases such as the armpits and groin. There are no standard tests to confirm the diagnosis and HS is diagnosed by clinicians recognising the condition. I conducted a review of the estimates for how many people have HS and looked for links between HS and other medical conditions. My review did not include every research project on the subject but aimed to include the most important ones. I found that estimates for the percentage of people with HS vary a lot, from only one in 2,000 to one in 25 people. This may be because of the different ways of estimating the figure. Some of the methods miss people who have not yet been diagnosed. For the USA and Europe I found that HS is more common in women in their 30s and 40s, while in South Korea it is commonest in men. There are strong links with smoking and being overweight. People with HS are more likely than those without HS to have risk factors for and die from heart disease and stroke. They are more likely to have depression, and suicide rates are higher in HS. I confirmed that HS is linked with other long-term inflammatory conditions. We still can’t predict who will progress more quickly than others to severe disease. HS generally starts soon after puberty but we don’t know whether it improves after the menopause in women. Linked Article:   Ingram. Br J Dermatol 2020; 183 :990–998 .     

Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study

Background  The co-occurrence of hidradenitis suppurativa (HS) and Crohn disease (CD) published in a few case reports resulted in the wide acceptance of an association between these two diseases. However, the combined prevalence of these diseases is currently unknown; furthermore, it is unknown whether this co-occurrence also applies for ulcerative colitis (UC).
Objectives  To estimate the prevalence of HS in patients with inflammatory bowel disease (IBD) living in the Southwest of the Netherlands.
Methods  During an IBD patient information meeting, randomly, 158 patients with IBD were interviewed about recurrent painful boils in the axillae and/or groin and were shown illustrative clinical pictures of the appearance of HS.
Results  Of the 158 patients interviewed, 102 (65%) had CD and 56 (35%) had UC. Twenty-five people (16%) responded that they had had or still experienced painful boils in the axillae and/or groin, of whom 17 were patients with CD (17%) and eight had UC (14%).
Conclusions  This pilot study shows for the first time that HS occurs in patients with CD or UC. More prospective studies are warranted to establish the association between HS and IBD and its underlying pathogenesis.     

Efficacy and safety of topical agents in the treatment of melasma: What's evidence? A systematic review and meta-analysis

Background

Various topical agents have been used to treat melasma; however, a large-scale evaluation among the currently available treatment is lacking.

Objectives

The aim of this study was to evaluate the efficacy and safety of topical agents for melasma.

Methods

The MEDLINE, Embase, Web of Science, Cochrane, and Alt-Healthwatch databases were searched in November 2021. Original studies that reported pre- and post-treatment Melasma Area Severity Index (MASI)/modified Melasma Area Severity Index (mMASI) scores and/or adverse effects (AEs) were eligible for inclusion. The main outcome was the efficacy analyzed by the changes in the pre- and post-treatment with standardized mean difference (SMD) of MASI/mMASI scores; the AEs were calculated with incidence proportion by the reported percentage of skin irritations.

Results

A total of 45 studies (2359 patients) and 55 studies (4539 patients) met the inclusion criteria for efficacy and AEs, respectively. Hydroquinone (HQ) monotherapy (SMD -1.3, 95% CI [−1.6 to −1.0]), HQ-containing combination therapy (−1.4, [−1.7 to −1.1]), cysteamine (−1.6, [−2.0 to −1.2]), tranexamic acid (−1.5, [−2.0 to −1.1]), azelaic acid (−1.3, [−1.7 to −1.0]), and kojic acid (−0.9, [−1.3 to −0.5]) demonstrated comparable efficacy, while zinc sulfate did not exhibit statistically significant improvement (−1.2, [−2.7 to 0.4]). HQ-containing combination therapy (50.9%) and cysteamine (42.2%) demonstrated the highest incidence of irritation, while azelaic acid (18.7%), kojic acid (5.3%), and tranexamic acid (0.8%) revealed a lower risk.

Conclusions

In this meta-analysis, non-HQ agents except zinc sulfate may be considered as an alternative to HQ-containing agents. However, treatment should be guided by patient's tolerance, availability, and physicians' experience.     

Placebo response in phase 2 and 3 trials of systemic and biological therapies for atopic dermatitis—a systematic review and meta-analysis

A growing number of clinical trials of biological and systemic therapies have been conducted within adult atopic dermatitis (AD). No study has yet examined and meta-analysed the pooled placebo response in AD. We performed a systematic review and meta-analysis to examine the placebo response in clinical trials evaluating the effect of systemic and biological therapies in adult AD and compared it to results from clinical trials in psoriasis. Two screeners independently searched the databases ClinicalTrials.gov, Embase, Pubmed and Web of Science. A total of 2058 articles were identified, of which 78 were full-text reviewed. Overall, 25 trials were included in the qualitative analysis, of which 24 were further included in the quantitative analysis. At 12-week follow-up, EASI50, EASI75 and EASI90 placebo responses were 39.9% [95% confidence interval (CI), 36.7–43.2], 20.9% (95% CI, 18.2–23.8) and 9.0% (95% CI, 6.7–11.6), respectively. At week 12, the pooled proportion of placebo-treated AD patients that obtained EASI50, EASI75 and EASI90 was significantly higher than the pooled proportion of placebo-treated psoriasis patients obtaining PASI50, PASI75 and PASI90 (P < 0.05). Our findings emphasize the fluctuating nature of AD and show that correct and consistent use of topical treatments strongly reduces disease severity.     

Association of acanthosis nigricans with metabolic syndrome – An analytic cross-sectional study

BackgroundGlobally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS.ObjectivesTo determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender.Material and methodsThis was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson’s chi-square test followed by univariate and multivariate analysis.ResultsThe prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN.Study limitationsThe small sample size and single-center data are the limitations of the present study.ConclusionAN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.     

Live interactive teledermatology compared to in-person care – a systematic review

Teledermatology is a rapidly developing field of dermatological care, giving the opportunity to deliver more efficient healthcare to patients in remote areas. Live interactive (LI) teledermatology uses videoconferencing and, hence, allows for direct communication. A current overview on effectiveness, costs, feasibility and accuracy of LI applications compared to standard care is missing. The present systematic review provides this overview on LI teledermatology. Two databases were searched until April 2019, followed by title, abstract and full-text screening. Additionally, reference lists of the detected eligible articles were screened for further eligible studies. Studies comparing LI applications with standard care were included. Data on study design, sample size, country, objectives, main findings and characteristics of LI applications were extracted. Results on time effectiveness, costs, accuracy and feasibility of LI applications were synthesized. Additionally, the quality of included studies was assessed. Twenty-three publications were included in the final analysis: seventeen case–control studies and six randomized controlled trials. Included studies were published between 1997 and 2017. Study quality differed across studies. The studies were carried out in eight different countries. Eleven studies focused on patient consultation, three on patient organization and nine on combined applications of the aforementioned. Nine studies investigated applications facilitating patient–provider interaction. Fourteen studies evaluated applications combining patient–provider and provider–provider interaction, meaning the patient sits next to one provider while using LI applications to interact with another provider. This review reveals that LI applications can be a time effective substitute of or supplement to standard dermatological care. Results demonstrated that LI and standard care are comparable with regard to feasibility and accuracy. No clear tendencies can be reported with regard to costs. However, there is a lack of current comparative studies.     

Hidradenitis suppurativa: a disease of the absent sebaceous gland? Sebaceous gland number and volume are significantly reduced in uninvolved hair follicles from patients with hidradenitis suppurativa

Background The pathogenesis of hidradenitis suppurativa (HS) is not clearly understood. The nomenclature suggests an important role for the apocrine glands but recent evidence implicates the pilosebaceous unit as a more likely candidate to play a central role in the pathogenesis. Objectives Our aim was to estimate the volume of the follicular epithelium, the follicular lumen and the sebaceous glands of patients with HS and healthy controls by means of stereology. Methods Four‐millimetre punch biopsies were taken from 21 patients with HS and nine healthy controls, fixed in formalin, embedded in paraffin and stained with haematoxylin and eosin prior to volume estimation using the Cavalieri principle. Results Sebaceous gland tissue could be visualized in only 10 of 15 suitable hair follicle biopsies from patients with HS but was present in all biopsies from healthy controls (P = 0·05) and the mean sebaceous gland volume per follicle was one‐seventh of that of healthy controls (P = 0·03). There was no significant difference between patients with HS and healthy controls with regard to follicular epithelium and follicle lumen volume. Conclusions Our results suggest that the absence or reduced volume of the sebaceous gland may play a role in the pathogenesis of HS. The presence of fibrosis suggests that sebaceous glands are obliterated early in the pathogenesis of HS.     

Triggering factors in sensitive skin from the worldwide patients’ point of view: a systematic literature review and meta-analysis

Sensitive skin (SS) is a syndrome defined by the occurrence of unpleasant sensations in response to stimuli that normally should not provoke such sensations. In most patients, symptoms occur within 1 h following exposure to trigger factors and may persist for minutes or even hours. Numerous triggering factors (physical, chemical or psychological) are suspected and described in articles. The aim of this article was to perform a systematic literature review to collect data on the triggering factors involved in SS and to then perform a meta-analysis. Thirteen studies were included in the systematic literature review. Subjects were classified into groups, SS or no sensitive skin (NSS), and triggering factors were researched through responses to different questions. SS could be triggered by numerous factors. The most important triggering factor was cosmetics, with an odds ratio (OR) equal to 7.12 [3.98–12.72]. Other triggering factors were physical (variations in temperature, cold, heat, wind, sun, air conditioning, wet air and dry air), chemical (water and pollution) or psychological (emotional) factors. After cosmetics, the most important factors were wet air, OR 3.83 [2.48–5.91]; air conditioning, OR 3.60 [2.11–6.14]; heat, OR 3.5 [2.69–4.63]; and water, OR 3.46 [2.56–4.77].     

Compound glycyrrhizin tablets combined with the 308 nm excimer laser in the treatment of vitiligo: A systematic review and meta-analysis

Background

Although the 308 nm excimer laser is commonly used to cure vitiligo, its clinical efficacy is limited. Experts have found that the efficacy of compound glycyrrhizin tablets combined with the 308 nm excimer laser in the treatment of vitiligo is significantly enhanced, but the specific research methods and clinical data must be clarified.

Objective

To determine the clinical efficacy of compound glycyrrhizin tablets combined with the 308 nm excimer laser in the treatment of vitiligo.

Methods

Until August 2022, studies were searched in PubMed, the Cochrane Library, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, the Chinese Scientific Journal Database, and the Wan Fang Database. We also searched for clinical RCTs involving compound glycyrrhizin tablets combined with the 308 nm excimer laser for the treatment of vitiligo. The meta-analysis was conducted in accordance with the Cochrane Handbook's recommendations. Two reviewers regulated the study selection, data extraction, and assessment of bias risk, and consulted a third reviewer as necessary. For the meta-analysis, Review Manager 5.4 was utilized.

Results

Finally, 9 articles and 1052 patients were included. A systematic review compared the efficacy of compound glycyrrhizin tablets combined with the 308 nm excimer laser to that of the 308 nm excimer laser alone: OR = 3.33, p < 0.00001, 95% confidence interval [2.25, 4.92].

Conclusion

In the treatment of vitiligo, compound glycyrrhizin tablets combined with the 308 nm excimer laser are more effective than the 308 nm excimer laser alone, and there are no serious adverse reactions. It is a safe and efficient way of treatment.     

Nurses’ attitude on pressure injury prevention: A systematic review and meta-analysis based on the pressure ulcer prevention instrument (APuP)

BackgroundPrevention of pressure ulcers (PU) is one of the most important indicators of the quality of patient care that may be influenced by the attitude of nurses. Nurses are responsible for maintaining the integrity of the skin and preventing its complications. The aim of this study was to assess the overall attitude of nurses on PU prevention based on their scores on the Attitude towards Pressure ulcer Prevention instrument (APuP).MethodsIn this systematic review and meta-analysis, databases including Web of Science, Science Direct, PubMed, and Scopus were searched, using the following keywords: Pressure Ulcer, Pressure injury, Bedsore, Pressure Sore, Decubitus Ulcer, Attitude, and their possible combinations. Heterogeneity of studies was assessed with I² index and Cochrane-Q test. Based on heterogeneity between the studies, the data were analyzed using a random effects model. All the analyses were performed using STATA v.16 software.ResultsTwelve studies with a sample size of 7824 people were analyzed. The overall score of attitude towards pressure ulcer prevention was 70.84% (95% CI: 66.34–75.35) and the highest and lowest scores were related to the dimensions of individual priority (78.83%, 95% CI: 74.69–82.97) and competence (70.11%, 95% CI: 67.24–72.94), respectively. The percentage of the total score of attitude towards pressure ulcer prevention in nurses was higher than nursing students (72.15%, 95% CI: 67.10–77.20 vs. 67%, 95% CI: 53.80–80.20). Sensitivity analysis confirmed the stability of the results. Publication bias was significant (p = 0.036).ConclusionThe attitude of nurses and nursing students towards the prevention of pressure ulcers was moderate, and providing the necessary training to these groups was essential.     

Sjögren-Larsson syndrome: a case report and literature review

Sj?gren-Larsson syndrome (SLS) is an autosomal recessive neurocutaneous disorder most commonly seen in the Scandinavian population and characterized by congenital ichthyosis, mental retardation, and spastic diplegia or quadriplegia. We report a case of SLS in an 11-month-old girl of Lebanese and Mexican-Syrian ancestry who presented with ichthyosis, developmental delay, and spasticity. Results of an enzymatic assay and genomic DNA testing in cultured skin fibroblasts confirmed a homozygous C237Y mutation. These findings support the rich diversity of mutations associated with this syndrome.     

Papillon-Lefèvre syndrome: case report and review of the literature

A 15-year-old boy presented with symmetric, well-demarcated, yellowish, keratotic plaques over the skin of his palms and soles extending onto the dorsal surfaces. Well-circumscribed, psoriasiform, erythematous, scaly plaques were also present on the elbows and knees bilaterally along with dystrophy an transverse grooving of the nails. He also had swollen and friable gums since the age of 3 with subsequent loss of most of his permanent dentition. These findings are consistent with Papillon-Lefèvre syndrome. The clinical presentation, differential diagnosis, complications and management of this syndrome are discussed.