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Summary: Background: There is no consensus on core outcome domains for hidradenitis suppurativa (HS). Heterogeneous outcome measure instruments in clinical trials likely leads to outcome‐reporting bias and limits the ability to synthesize evidence. Objectives: To achieve global multistakeholder consensus on a core outcome set (COS) of domains regarding what to measure in clinical trials for HS. Methods: Six stakeholder groups participated in a Delphi process that included five anonymous e‐Delphi rounds and four face‐to‐face consensus meetings to reach consensus on the final COS. The aim was for a 1 : 1 ratio of patients to healthcare professionals (HCPs). Results: A total of 41 patients and 52 HCPs from 19 countries in four continents participated in the consensus process, which yielded a final COS that included five domains: pain, physical signs, HS‐specific quality of life, global assessment and progression of course. A sixth domain, symptoms, was highly supported by patients and not by HCPs but is recommended for the core domain set. Conclusions: Routine adoption of the COS in future HS trials should ensure that core outcomes of importance to both patients and HCPs are collected. [ABSTRACT FROM AUTHOR]

Summary: Case reports and case series remain an important part of journals and are often first to document medical breakthroughs. This article reviews their characteristics, aims and limitations. It provides information on how to increase the validity of the bedside decision‐making process that these studies report, using tools such as validated outcomes and split‐body or n‐of‐1 trials. A section describing tools to improve writing of case reports and case series provides suggestions for detailed reporting and good evaluation of novelty, validity and relevance. It includes general and British Journal of Dermatology‐specific guidance. [ABSTRACT FROM AUTHOR]

Summary: Background: Epidemiology data regarding hidradenitis suppurativa (HS) are conflicting and prevalence estimates vary 80‐fold, from 0·05% in a population‐based study to 4%. Objectives: To assess the hypothesis that previous population‐based studies underestimated true HS prevalence by missing undiagnosed cases. Methods: We performed a population‐based observational and case–control study using the U.K. Clinical Practice Research Datalink (CPRD) linked to hospital episode statistics data. Physician‐diagnosed cases in the CPRD were identified from specific Read codes. Algorithms identified unrecognized ‘proxy’ cases, with at least five Read code records for boils in flexural skin sites. Validation of proxy cases was undertaken with general practitioner (GP) questionnaires to confirm criteria‐diagnosed cases. A case–control study assessed disease associations. Results: On 30 June 2013, 23 353 physician‐diagnosed HS cases were documented in 4 364 308 research‐standard records. In total, 68 890 proxy cases were identified, reduced to 10 146 criteria‐diagnosed cases after validation, extrapolated from 107 completed questionnaires (61% return rate). Overall point prevalence was 0·77% [95% confidence interval (CI) 0·76–0·78%]. An additional 18 417 cases had a history of one to four flexural skin boils. In physician‐diagnosed cases, odds ratios (ORs) for current smoker and obesity (body mass index > 30 kg m‐2) were 3·61 (95% CI 3·44–3·79) and 3·29 (95% CI 3·14–3·45). HS was associated with type 2 diabetes, Crohn disease, hyperlipidaemia, acne and depression, and not associated with ulcerative colitis or polycystic ovary syndrome. Conclusions: Contrary to results of previous population‐based studies, HS is relatively common, with a U.K. prevalence of 0·77%, one‐third being unrecognized, criteria‐diagnosed cases using the most stringent disease definition. If individuals with probable cases are included, HS prevalence rises to 1·19%. [ABSTRACT FROM AUTHOR]

Summary: Background: A core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed‐upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of the literature and a healthcare professional survey, and initial votes had been cast in two e‐Delphi surveys. In this manuscript, we describe two in‐person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items. Objectives: To consider which items from a long list of candidate items to exclude and which to cluster into outcome domains. Methods: The study used an international and multistakeholder approach, involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey. Results: Forty‐one individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS‐specific quality of life, satisfaction, symptoms, pain and global assessments. Conclusions: The HISTORIC consensus meetings I and II will be followed by further e‐Delphi rounds to finalize the core domain set, building on the work of the in‐person consensus meetings. [ABSTRACT FROM AUTHOR]

An editorial is presented, in which the author discusses nurturing Sir William Osler's legacy through supporting dermatology journal clubs. it mentions presentation of a research paper and then an in-depth discussion and critical appraisal of its findings. it also mentions promotion of active discussion around articles published in the periodical.

The article presents information about the Twelfth International Congress of Dermatology. This was the second time that the Congress has been held in the U.S. The opening of the Congress on the morning of September 9, 1962 was impressive. There was a screen of more than 70 national flags at the rear of the platform indicating the extent of the representation at the Congress. Members of the International Committee of Dermatology sat on the platform and proceedings were opened and conducted by Dr. Marion B. Sulzberger, Chairman of the International League of Dermatological Societies, in the meticulous and efficient manner that would be expected of him.

Summary: 化脓性汗腺炎(HS)是一种皮肤症状,会在皮肤褶皱处(腋下、胸下、腹股沟和臀部)引起疼痛的红色肿块。HS可能会被误诊为细菌性脓肿或疮疖,但它并不是由细菌引起的。全球约0.1%到4%的人群受HS困扰。本项研究旨在找出HS临床试验应衡量哪些因素,例如症状(如疼痛、瘙痒)、生理变化(如皮肤发红或肿胀)或对人们生活的影响(如生活质量)。为此,本研究包含了两个组:HS患者和医疗保健服务提供者(医生、制药行业代表和监管代表),并采用在线调查以及面对面谈话的方式来陈述、讨论以及调查,从而收集应包含哪些衡量因素的相关意见。这些代表来自13个国家/地区和四大洲。谈话、讨论和调查的结果表明,至少有70%的HS患者和医疗保健服务提供者建议临床试验包含以下衡量因素:(1)疼痛;(2)因HS导致的生理变化(如发红);(3)特别是因HS而导致的生活质量变化;(4)HS发病期间的变化(如病情发作)(5)全局评级(即考虑所有因素的病情严重程度整体评级)以及(6)其他症状(如疲劳和引流)。这项工作相当重要,因为其中包含了对HS治疗做出贡献的各类人员,包括HS患者、治疗开发或监管人员,以及治疗HS患者的人员。更多的工作还在进行中,这些工作将重点研究HS治疗试验中的衡量因素(以及所用的工具)。 [ABSTRACT FROM AUTHOR]

Summary: Hidradenitis suppurativa (HS) is a skin condition that causes painful swollen red bumps in the folds of the body (underarms, under breasts, groin, and buttocks). It can be mistaken for bacterial abscess or boils, but HS is not caused by bacteria. HS occurs in about 0.1% to 4% of people worldwide. This study aimed to find out what clinical trials for HS should measure, such as symptoms (e.g. pain, itch), physical changes (e.g. skin redness or swelling), or impact on people's lives (e.g. quality of life). To do this, the study included two groups: people with HS and healthcare providers (physicians, pharmaceutical industry representatives, and regulatory representatives) and conducted online surveys and in‐person meetings with presentations and discussions as well as surveys to gather opinions on which measures to include. Thirteen countries and four continents were represented. The result of the meetings, discussions, and surveys showed that at least 70% of the people with HS and healthcare providers recommended that clinical trials include measures of: (1) pain (2) physical changes due to HS (e.g. redness); (3) quality of life changes due to HS specifically; (4) changes in the course of HS (e.g. flare‐ups) (5) global rating (i.e. overall rating, considering everything, of the severity of the condition) and (6) other symptoms (fatigue and drainage). This work is important because it included many different types of people who contribute to HS treatment, including the people who have HS, develop or regulate treatments, and treat people with HS. More work is coming and it will focus on how to measure in trials treating HS (what instruments to use). [ABSTRACT FROM AUTHOR]

Summary: 化脓性汗腺炎是一种影响年轻人的长期皮肤病,会导致皮肤褶皱部位(例如腋窝和腹股沟)多处生疮。疮非常疼痛,且可能会生脓并留下难看的疤痕。HS的普遍性如何仍存有争议,近期一些使用了美国医疗保险数据的报告表明,约有0.1%的人口受到这种疾病的影响,这个数据低于使用自我报告调查问卷(由患者填写)的欧洲研究所得出的数据。这可能是因为保险数据库漏掉了未确诊的病例。我们的研究团队位于英国,旨在使用由英国的全科医师(GP)记录的电子数据来鉴定已知和之前未确诊的HS病例。在鉴别未确诊病例时,我们查找了因至少5处皮肤疮而向医生问诊的患者,并向一些医生发送再次确认的问卷而验证诊断。在GP数据库中的430万名患者中,我们找出了23,000名确诊的HS患者和10,000名未确诊患者,这表示有0.77%的英国人口患有HS。如果包括疑似病例(患者拥有1~4次皮肤疮会诊),这个数字将升至1.19%。将HS患者与未患有HS的类似人群相比较,可以发现,前者的吸烟率和肥胖率(普遍率是后者的三倍),以及2型糖尿病、克罗恩氏病、血脂水平升高、痤疮、高血压和抑郁症的几率都较高。但未发现HS与溃疡性结肠炎或多囊卵巢综合症之间存在关联。结论是,我们发现HS相对较为普遍,比估计数量高出近十倍(使用美国保险数据)。HS患者患上心脏病和中风的风险因素比率较高,因此,检查这些状况非常重要。 [ABSTRACT FROM AUTHOR]

Background: Although hidradenitis suppurativa (HS) is known to affect quality of life, little summative knowledge exists on how HS impacts people living with the condition., Objectives: To synthesize experiences of people with HS within published qualitative research., Methods: Searches on databases MEDLINE, PsycINFO, Embase and CINAHL were conducted on 17 April 2020. Two independent reviewers screened 5512 publications. Study quality was assessed using the National Institute for Health and Care Excellence quality appraisal checklist for qualitative studies. Thematic synthesis generated descriptive and analytic themes., Results: Fourteen studies were included: four studies fulfilled most quality criteria, eight fulfilled some quality criteria, and two fulfilled few quality criteria. There were three final themes. (i) Putting the brakes on life. The physical, psychological and social consequences of HS resulted in people missing out on multiple life events. This could have a cumulative effect that influences the trajectory of someone's life. (ii) A stigmatized identity: concealed and revealed. People try to conceal their HS, visually and verbally, but this results in anticipation and fear of exposure. Social support and psychological acceptance helped people cope. Connecting to others with HS may have a specific role in preserving a positive self-identity. (iii) Falling through the cracks. Delayed diagnosis, misdiagnosis and lack of access to care were reported. People felt unheard and misunderstood by healthcare professionals, and healthcare interactions could enhance feelings of shame., Conclusions: There need to be improvements to clinical care to allow people with HS to live their life more fully., (© 2021 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Palmoplantar pustulosis (PPP) is a rare, debilitating, chronic inflammatory skin disease that affects the hands and feet. Clinical, immunological and genetic findings suggest a pathogenic role for interleukin (IL)-1., Objectives: To determine whether anakinra (an IL-1 receptor antagonist) delivers therapeutic benefit in PPP., Methods: This was a randomized (1 : 1), double-blind, two-staged, adaptive, UK multicentre, placebo-controlled trial [ISCRTN13127147 (registered 1 August 2016); EudraCT number: 2015-003600-23 (registered 1 April 2016)]. Participants had a diagnosis of PPP (> 6 months) requiring systemic therapy. Treatment was 8 weeks of anakinra or placebo via daily, self-administered subcutaneous injections. Primary outcome was the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI) at 8 weeks., Results: A total of 374 patients were screened; 64 were enrolled (31 in the anakinra arm and 33 in the placebo arm) with a mean (SD) baseline PPPASI of 17·8 (10·5) and a PPP investigator's global assessment of severe (50%) or moderate (50%). The baseline adjusted mean difference in PPPASI favoured anakinra but did not demonstrate superiority in the intention-to-treat analysis [-1·65, 95% confidence interval (CI) -4·77 to 1·47; P = 0·30]. Similarly, secondary objective measures, including fresh pustule count (2·94, 95% CI -26·44 to 32·33; favouring anakinra), total pustule count (-30·08, 95% CI -83·20 to 23·05; favouring placebo) and patient-reported outcomes, did not show superiority of anakinra. When modelling the impact of adherence, the PPPASI complier average causal effect for an individual who received ≥ 90% of the total treatment (48% in the anakinra group) was -3·80 (95% CI -10·76 to 3·16; P = 0·285). No serious adverse events occurred., Conclusions: No evidence for the superiority of anakinra was found. IL-1 blockade is not a useful intervention for the treatment of PPP., (© 2021 British Association of Dermatologists.)

Background: Evidence for the effectiveness of vitiligo treatments is limited., Objectives: To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo., Methods: A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015., Results: In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment)., Conclusions: Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants., (© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Economic evidence for vitiligo treatments is absent., Objectives: To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo., Methods: Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015., Results: The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment., Conclusions: Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success., (© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease. The HS core outcome set calls for a patient global assessment (PtGA)., Objectives: To assess the validity, reliability and responsiveness of a candidate single-item PtGA for HS-specific health-related quality of life (HRQoL)., Methods: Cognitive debriefing interviews were conducted with patients with HS in Denmark and the USA. A cross-sectional observational study was done with adults with HS in the USA and Denmark. Candidate PtGA item, demographic items and multiple patient-reported scales - the Hidradenitis Suppurativa Quality of Life (HiSQOL), Dermatology Life Quality Index (DLQI) and numerical rating scale (NRS) for pain - were concurrently administered to evaluate convergent and known-groups validity. Scales with a single-item assessment of change were readministered 24-72 h later, to evaluate reliability and responsiveness., Results: After cognitive debriefing, the candidate PtGA for HS-specific HRQoL was finalized with five response levels. Convergent validity of the PtGA was supported by significant correlations with HiSQOL score [r = 0·79, 95% confidence interval (CI) 0·75-0·82] and DLQI (r = 0·78, 95% CI 0·74-0·82). The PtGA displayed known-groups validity with DLQI score bands based on significance of an anova (P < 0·001). Good test-retest reliability was supported by the intraclass correlation coefficient (0·82, 95% CI 0·78-0·85) for those who reported stable HS. Responsiveness was assessed by differences in PtGA score against a patient-reported assessment of change, which showed significant differences towards improvement., Conclusions: The single-item PtGA exhibits reliability, validity and responsiveness in assessing HS-specific HRQoL in HS, making it a good provisional tool for HS clinical research., (© 2020 British Association of Dermatologists.)