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Hidradenitis suppurativa (HS)/acne inversa is a debilitating chronic disease that remains poorly understood and difficult to manage. Clinical practice is variable, and there is a need for international, evidence‐based and easily applicable consensus on HS management. We report here the findings of a systematic literature review, which were subsequently used as a basis for the development of international consensus recommendations for the management of patients with HS. A systematic literature review was performed for each of nine clinical questions in HS (defined by an expert steering committee), covering comorbidity assessment, therapy (medical, surgical and combinations) and response to treatment. Included articles underwent data extraction and were graded according to the Oxford Centre for Evidence‐based Medicine criteria. Evidence‐based recommendations were then drafted, refined and voted upon, using a modified Delphi process. Overall, 5310 articles were screened, 171 articles were analysed, and 65 were used to derive recommendations. These articles included six randomized controlled trials plus cohort studies and case series. The highest level of evidence concerned dosing recommendations for topical clindamycin in mild disease (with systemic tetracyclines for more frequent/widespread lesions) and biologic therapy (especially adalimumab) as second‐line agents (following conventional therapy failure). Good‐quality evidence was available for the hidradenitis suppurativa clinical response (HiSCR) as a dichotomous outcome measure in inflammatory areas under treatment. Lower‐level evidence supported recommendations for topical triclosan and oral zinc in mild‐to‐moderate HS, systemic clindamycin and rifampicin in moderate HS and intravenous ertapenem in selected patients with more severe disease. Intralesional or systemic steroids may also be considered. Local surgical excision is suggested for mild‐to‐moderate HS, with wide excision for more extensive disease. Despite a paucity of good‐quality data on management decisions in HS, this systematic review has enabled the development of robust and easily applicable clinical recommendations for international physicians based on graded evidence. [ABSTRACT FROM AUTHOR]

Main objective of this manuscript is to analyse the cleaning efficiency of a regional wastewater treatment plant through monitoring its the change of ecotoxicological properties. The other aim of this research was the comparative analysis of the sensitivity of the protocol using filtered and unfiltered wastewater samples based on correlation with analytical parameters. Whole effluent samples were collected at the municipal wastewater treatment plant of Szombathely and were tested with the Microtox® 100 according to the respective standard protocols (Microtox, ISO 11348-3 protocol). The samples were evaluated parallel with both chemical and analytical (metals, BOD5/COD) analysis methods. The results proved that the plant operates with good cleaning efficiency even under extreme weather conditions. The role of total and dissolved metals in the toxicity of the samples was small. Measurements on the samples using the Microtox luminometer according to conventional methods on the unfiltered and filtered samples correlated strongly with the amount of measured toxic organic compounds (COD / BOD5) and the filtered samples also represented the meteorological conditions well. Measurement on raw samples might overestimate the toxicity in the case of highly turbid samples. However, filtering removed a portion of particle-bound contaminants. [ABSTRACT FROM AUTHOR]

Background Folliculotropic mycosis fungoides (FMF) is an aggressive variant of mycosis fungoides (MF) and generally less responsive to standard skin-directed therapies (SDTs). Recent studies distinguished indolent (early-stage FMF) and more aggressive (advanced-stage FMF) subgroups. The optimal treatment for both subgroups remains to be defined. Objectives To evaluate initial treatment results in patients with early- and advanced-stage FMF. Methods A study was undertaken of 203 patients (84 early-stage, 102 advanced-stage, 17 extracutaneous FMF) included in the Dutch Cutaneous Lymphoma Registry between 1985 and 2014. Type and results of initial treatment were retrieved from the Dutch Registry. Main outcomes were complete remission (CR); sustained complete remission; partial remission (PR), > 50% improvement; and overall response (OR; CR + PR). Results Patients with early-stage FMF were treated with nonaggressive SDTs in 67 of 84 cases resulting, respectively, in CR and OR of 28% and 83% for monotherapy topical steroids, 0% and 83% for ultraviolet B (UVB), and 30% and 88% for psoralen plus ultraviolet A (PUVA). In patients with advanced-stage FMF these SDTs were less effective (combined CR and OR 10% and 52%, respectively). In patients with advanced-stage FMF local radiotherapy (CR 63%; OR 100%), total skin electron beam irradiation (CR 59%; OR 100%) and PUVA combined with local radiotherapy (CR 5%, OR 75%) were most effective. Conclusions The results of the present study demonstrate that not all patients with FMF should be treated aggressively. Patients with early-stage FMF may benefit very well from standard SDTs also used in early-stage classic MF and have an excellent prognosis. [ABSTRACT FROM AUTHOR]

We hypothesized that PD-1 inhibitors would have a limited place in clinical practice, as a large proportion of patients with advanced disease are immunocompromised (e.g. organ transplant patients) and would have a contraindication for PD-1 inhibitors. Dear Editor, Systemic treatment with programmed death receptor 1 (PD-1) inhibitors has been approved for patients with advanced cutaneous squamous cell carcinoma (cSCC) ineligible for curative surgery or radiation. Thirty-six patients (52%) were excluded due to relative contraindications, including one patient with both an absolute and a relative contraindication, leading to 30 (43%) patients fulfilling the study eligibility criteria. [Extracted from the article]