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Background: Pain is not a trivial issue for hidradenitis suppurativa (HS) patients and has been considered a domain in the Core Outcome Set. To date, there is no evidence about pain caused by the ultrasound examinations. Objective: The aim of the study was to assess the presence of pain generated by the ultrasound examinations of HS patients. Methods: A multicentric cross-sectional study for detecting pain during the ultrasound examinations of HS patients using a validated verbal questionnaire immediately after the imaging studies. Statistical analysis included demographic data and possible associations with sex, age, location, clinical (Hurley), and ultrasonographic scoring (SOS-HS). The statistical tests were two proportions Z test, χ2 test, Student’s t test, and ANOVA. A p < 0.05 was considered significant. Results: 317 patients met the criteria. 77.3% of them did not present pain. Of cases with pain, 59.8% were mild, 16.7% moderate, and 23.6% severe. No significant association was found with sex, age, staging, location, or the number of affected regions. Although nonsignificant, severe pain cases were more frequent in the clinical Hurley III and ultrasonographic SOS-HS III stages. Conclusion: Pain generated by the ultrasound examination of HS patients is infrequent.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle which presents with painful nodules, abscesses, and fistulae in apocrine gland-bearing areas of the skin. Approved treatments include antibiotics and biologic drugs such as adalimumab. Despite these treatments, HS management is challenging. Acitretin is an oral retinoid used for its management as 3rd or 4th line therapy. There is little evidence regarding the effectiveness and safety of acitretin treatment for HS, and no reports have previously explored the potential clinical predictors associated with the response to the treatment. Methods: Retrospective cohort study to assess the effectiveness and safety of acitretin treatment in HS patients who failed to respond to topical therapies. Results: Sixty-two patients with moderate to severe HS were included. A significant decrease in the International HS Severity Scoring System (IHS4) score was found over time. Higher basal IHS4 score, family history of HS, follicular phenotype, and history of follicular plugging conditions were potential predictors of response. Most patients did not suffer any adverse events, and no severe side effects were observed. The main cause of discontinuation was lack of efficacy. Conclusion: Acitretin can be considered as a therapeutic option for patients with HS. The presence of follicular phenotype or a history of components of follicular occlusion syndrome is associated with better outcomes.

Background: Chronic spontaneous urticaria (CSU) has been associated with poor quality of life and mood disturbances. However, factor associated to these dimensions have not been properly assessed. Moreover, there is a lack of studies regarding sexual dysfunction (SD) and CSU. Therefore, the aims of this study are to assess quality of life associated factors and to evaluate the prevalence and potential impact of SD in patients with CSU. Method: Cross-sectional study of patients suffering from CSU. Socio-demographic and disease activity variables, quality of life, sleep, SD, anxiety and depression were collected using validated questionnaires. Results: Seventy-five patients were included, with a female to male ratio of 2.40. Female sex, worse disease control, and sexual dysfunction were associated with poor quality-of-life indexes (p

Background: Previously, a new dichotomous outcome was developed, calculated as 55% reduction in the International Hidradenitis Suppurativa 4 score (IHS4-55). It was validated in datasets of adalimumab and placebo treated HS patients. External validation is an important aspect of clinical outcomes. Objectives: We aimed to externally validate the novel dichotomous IHS4-55 in a non-biologic treated dataset of HS patients. Methods: Data from a previously published European-wide prospective clinical study of antibiotic treatment of HS patients was used to assess the association of IHS4-55 achievement with individual reduction in inflammatory nodules, abscesses and draining tunnels. Moreover, the associations between IHS4-55 positivity and achievement of the minimal clinically important differences (MCID) for Dermatology Life Quality Index (DLQI), numerical rating scale (NRS) Pain, and NRS Pruritus were analyzed. Results: Data was obtained from 283 individual patients, of which 36.4% (103/283) were treated with clindamycin and rifampicin and 63.6% (180/283) with tetracyclines for 12 weeks. Achievers of the IHS4-55 demonstrated a significant reduction the counts of inflammatory nodules, abscesses, and draining tunnels (all p

Background/Aims: TNF-α inhibitors represent the most advanced approved therapeutic option for moderate and severe forms of hidradenitis suppurativa (HS). However, in recent years, cases of paradoxical HS secondary to the use of these biological drugs have been described, with very few cases reported in the literature. The aims of this study are (1) to present 2 new cases of paradoxical HS and (2) to perform a systematic review of scientific evidence regarding paradoxical HS with TNF-α inhibitors. Material and Methods: This is a retrospective study in which we searched all the cases of paradoxical HS secondary to the use of TNF-α inhibitors published in the literature and included two additional cases observed in our clinical practice. Results: A total of 34 patients under TNF-α inhibitor treatment were included (adalimumab = 21; infliximab = 9; etanercept = 4). The median delay from exposure to TNF-α inhibitor and the development of paradoxical HS was 12 months (range 1–72). The majority of patients were Hurley stage II (58.8%). Clinical improvement and complete remission were more frequent when the TNF-α inhibitor was stopped or switched to another biological agent with a different therapeutic target rather than maintenance or change to another TNF-α inhibitor. Conclusions: Paradoxical HS is an unusual adverse effect of TNF-α inhibitors. When this adverse effect appears, interruption or substitution of treatment is associated with a better clinical outcome.

Background: Patients with hidradenitis suppurativa (HS) suffer from symptoms such as pruritus and malodour which can significantly impair their quality of life. Objectives: (1) To analyse the impact of pruritus and malodour on the quality of life of patients with HS and (2) to explore the potential association between clinical features and the severity of these symptoms. Patients and Methods: This is a cross-sectional study. The Numeric Rating Scale (NRS) was used to assess pruritus and malodour. Quality of life was assessed by means of the Dermatology Life Quality Index (DLQI). Results: Two hundred and thirty-three patients were included in the study. Both pruritus and malodour positively correlated with worse quality of life (p < 0.05). Pruritus intensity was associated with the number of regions affected by HS, female sex, the intensity of suppuration, and the presence of comorbid Crohn’s disease. Statin use was associated with lower levels of pruritus. Malodour intensity was associated with higher body mass index, disease duration, the number of regions affected, Hurley stage, and intensity of suppuration. Conclusions: The results of our study show that pruritus and malodour are key symptoms in patients with HS which have a great impact on their quality of life. We have identified clinical features potentially associated with the intensity of these symptoms which could be useful to identify higher-risk patients and may influence treatment decisions.