{ "slug": "why-do-i-get-pimples-on-my-butt", "question": "Why do I get pimples on my butt?", "shortTitle": "Why Buttock Pimples Keep Coming Back", "clinicalQuestion": "In adolescents and adults who develop recurrent pimple-like bumps on the buttocks or gluteal cleft, what proportion are due to folliculitis versus other causes such as acne mechanica, hidradenitis suppurativa, or keratosis pilaris, and how do these conditions differ in clinical course and response to treatment?", "pico": { "population": "Adolescents and adults presenting with recurrent pimples or pimple-like bumps on the buttocks or gluteal/natal cleft", "intervention": "Clinical evaluation identifying folliculitis (hair follicle inflammation or infection) as the underlying cause", "comparator": "Other causes of buttock bumps such as acne mechanica/vulgaris, hidradenitis suppurativa, keratosis pilaris, or molluscum contagiosum", "outcomes": [ "proportion of buttock pimples diagnosed as folliculitis", "distinguishing clinical features (lesion location, tenderness, recurrence pattern)", "resolution rate with topical or oral antimicrobial treatment", "recurrence rate over 6-12 months", "association with friction, sweating, or occlusive clothing" ] }, "category": "anorectal", "relatedConditions": [ "folliculitis", "hidradenitis-suppurativa", "acne-vulgaris", "keratosis-pilaris" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "No study has measured what share of buttock bumps are ordinary folliculitis versus other causes — almost all the research found instead describes hidradenitis suppurativa, a distinct, more severe chronic condition, studied only in people already diagnosed with it.", "detail": "The certainty here is very low. The only study to directly examine non-pilonidal causes of gluteal-area bumps was a single 21-patient case series, which found ordinary folliculitis alongside several unrelated diagnoses. One study of competitive sailors found more buttock folliculitis after weeks of friction from racing gear, and small case reports describe hidradenitis suppurativa flaring at sites of mechanical friction from a hernia belt or a bra strap. In people already diagnosed with hidradenitis suppurativa, obesity has been linked to higher rates of folliculitis in children, and long-standing, severe buttock lesions have in some reported cases been linked to skin cancer and, in one small study, to lower sperm quality — but none of this tells you how common ordinary folliculitis is compared with other causes, and no trial has compared any treatment for common buttock folliculitis against doing nothing.", "studyIds": [ "pmid:40861268", "pmid:26948552", "pmid:30390729", "pmid:28128084", "pmid:35285075", "pmid:34075588", "pmid:37974484" ] }, "strength": { "level": "very-low", "why": "The only direct evidence is 1 small or uncontrolled study.", "override": null }, "direction": { "level": "harm-signal", "why": "11 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 327, "recordsScreened": 200, "included": 120, "rcts": 0, "systematicReviews": 6, "observational": 41, "participants": 119336, "yearFrom": 2012, "yearTo": 2026, "registeredTrialsWithoutResults": 0 }, "excluded": [], "outcomes": [ { "name": "Proportion of buttock pimples due to folliculitis vs other causes (acne mechanica, hidradenitis suppurativa, keratosis pilaris)", "status": "not-studied", "note": "No study surveyed a general group of people with buttock pimples and sorted out how many had each cause. The closest study looked at 21 adolescents already referred to a specialist pilonidal clinic, which is not a general population.", "studyIds": [ "pmid:40861268" ] }, { "name": "Clinical features that tell the causes apart (location, tenderness, recurrence pattern)", "status": "insufficient", "note": "Some studies describe patterns — tunnels and blackhead-like openings point toward hidradenitis suppurativa, fistulas and ulcers point toward bowel-disease-related lesions — but these come from people already diagnosed with a specific severe disease, not people trying to work out what their bumps are.", "studyIds": [ "pmid:39306801", "pmid:33089403", "pmid:40861268" ] }, { "name": "Response of keratosis pilaris (rough small bumps) to topical treatment", "status": "possible-improvement", "note": "A survey of dermatologists found lactic acid and salicylic acid creams were the most commonly used and generally felt to help, though bumps often returned within three months of stopping. A registered trial comparing treatments has not yet reported results.", "studyIds": [ "pmid:37801530", "pmid:41736049" ] }, { "name": "Resolution with topical or oral antimicrobial treatment", "status": "insufficient", "note": "No trial tested antibiotics against a placebo for ordinary buttock folliculitis. The only antibiotic-related findings come from hidradenitis suppurativa cohorts, a different and more severe disease, where antibiotics were described as helpful but not tested in a controlled way.", "studyIds": [ "pmid:39571540", "pmid:35086093" ] }, { "name": "Recurrence rate over 6 to 12 months", "status": "not-studied", "note": "No study followed a general group of people with buttock pimples for 6-12 months to track recurrence. Recurrence figures that do exist come from surgery for severe, longstanding hidradenitis suppurativa, which is not the same as ordinary pimples.", "studyIds": [ "pmid:33051068", "pmid:32109015", "pmid:27340739" ] }, { "name": "Link to friction, sweating, or occlusive clothing", "status": "possible-harm", "note": "Sailors developed more buttock folliculitis after three weeks at sea, a man developed boil-like lesions exactly where a hernia and tight trousers rubbed, and a woman developed boils where her bra strap pressed. These point to friction and moisture as triggers.", "studyIds": [ "pmid:26948552", "pmid:30390729", "pmid:28128084" ] }, { "name": "Link to obesity and other health conditions", "status": "possible-harm", "note": "Children with obesity had folliculitis far more often than normal-weight children, and children with Down syndrome had much higher rates of recurrent folliculitis, most often on the buttocks.", "studyIds": [ "pmid:35285075", "pmid:31384491" ] }, { "name": "Whether persistent bumps could signal a more serious condition needing medical care", "status": "possible-harm", "note": "Case reports and chart reviews describe long-standing, untreated hidradenitis suppurativa in the buttock area turning into skin cancer, and severe buttock/genital disease being linked to lower sperm quality and erectile difficulty in men. These harms were seen in diagnosed, severe, long-term cases, not typical mild pimples.", "studyIds": [ "pmid:34075588", "pmid:28274364", "pmid:28099342", "pmid:27681476", "pmid:24656278", "pmid:37974484" ] } ], "benefits": [ { "text": "For keratosis pilaris specifically, a survey of dermatologists found lactic acid and salicylic acid creams were the most commonly used treatments and were generally considered helpful, though bumps often returned within three months of stopping treatment.", "studyIds": [ "pmid:37801530" ] } ], "limitations": [ { "text": "None of the 120 studies found is a randomised trial, so none can prove what causes buttock pimples or fairly test one treatment against another.", "studyIds": [ "pmid:42591326", "pmid:35285075", "pmid:31384491" ] }, { "text": "Most of the studies found are about hidradenitis suppurativa — a chronic, progressive skin disease affecting an estimated 1-4% of people, with painful nodules that recur, rupture and drain, often in the armpits, groin and buttocks — rather than about simple, occasional pimples in that area.", "studyIds": [ "pmid:25188458", "pmid:24567417", "pmid:34075575" ] }, { "text": "Most participants were already diagnosed with hidradenitis suppurativa at specialist clinics, so these studies cannot say what share of 'buttock pimples' in the general population are folliculitis, keratosis pilaris, or something else.", "studyIds": [ "pmid:30294846", "pmid:30885385", "pmid:41032437" ] }, { "text": "A large share of the evidence is single-patient case reports, which describe one person's experience and cannot show how common any cause, treatment response, or harm actually is.", "studyIds": [ "pmid:42591326", "pmid:41804627", "pmid:41201033", "pmid:40204208" ] } ], "risks": [ { "text": "Long-standing, untreated hidradenitis suppurativa in the buttock area has, in reported cases, progressed to a type of skin cancer (squamous cell carcinoma), sometimes fatal.", "studyIds": [ "pmid:34075588", "pmid:28274364", "pmid:28099342", "pmid:27681476", "pmid:24656278" ], "severity": "serious" }, { "text": "Men with severe hidradenitis suppurativa affecting the buttocks and genitals had worse sperm quality and a high rate of erectile dysfunction in one small study.", "studyIds": [ "pmid:37974484" ], "severity": "serious" }, { "text": "Friction from tight clothing, bra straps, or prolonged sweating (as in sailors on a long voyage) was linked to new or worsening boil-like bumps in case reports.", "studyIds": [ "pmid:26948552", "pmid:30390729", "pmid:28128084" ], "severity": "minor" }, { "text": "Obesity was linked to significantly more folliculitis in children in one study.", "studyIds": [ "pmid:35285075" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "Buttock pimples look like facial acne, so people reach for the same scrubs and spot treatments." }, { "text": "They're hidden by clothing and embarrassing, so people self-treat rather than see a doctor." }, { "text": "Tight jeans, gym gear, and sitting all day feel like an obvious cause, so people assume friction and sweat explain everything." }, { "text": "They're easy to blame on 'bad hygiene,' so people scrub harder, which can make irritation worse." } ], "keyStudies": [ "pmid:40861268", "pmid:35285075", "pmid:31384491", "pmid:26948552", "pmid:30390729", "pmid:28128084", "pmid:34075588", "pmid:37974484" ], "studies": [ { "id": "pmid:42591326", "pmid": "42591326", "doi": "10.3389/fimmu.2026.1852135", "nctId": null, "pmcid": "PMC13461627", "title": "Successful treatment of hidradenitis suppurativa with vunakizumab: a case report and literature review", "firstAuthor": "Zhang", "multipleAuthors": true, "journal": "Front Immunol", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "a 17-year-old boy with 5-year history of recurrent painful nodules and abscesses on the buttocks", "intervention": "vunakizumab, an anti-IL-17A monoclonal antibody", "comparator": "no direct comparator; previously treated with conventional antibiotics", "primaryOutcome": "resolution of nodules, abscesses, and tunnels", "result": "complete resolution of nodules, abscesses, and tunnels and no recurrence or significant adverse events during 10 months of follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether the treatment would work for others.", "directness": "direct", "limitations": "Single case report with no control group, making it impossible to know if improvement was due to the drug.", "followUp": "10 months", "plainFinding": "Skin lesions cleared, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42591326/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, recurrent, and disabling inflammatory skin disorder. To our knowledge, this study reports the first use of vunakizumab, a domestically developed anti-IL-17A monoclonal antibody, for the treatment of HS. We present the case of a 17-year-old boy with a 5-year history of recurrent painful nodules and abscesses on the buttocks who had been repeatedly misdiagnosed with common acute bacterial infections and had responded poorly to conventional antibiotics. After 8 weeks of treatment with vunakizumab, which offered a pharmacoeconomic advantage during the transition period before its inclusion in China's national insurance system, the patient showed marked improvement, with complete resolution of nodules, abscesses, and tunnels and no recurrence or significant adverse events during 10 months of follow-up. This case highlights the potential of vunakizumab in the treatment of HS and supports the pathogenic role of IL-17 in the disease.", "provenance": [ { "field": "population", "quote": "a 17-year-old boy with a 5-year history of recurrent painful nodules and abscesses on the buttocks" }, { "field": "intervention", "quote": "vunakizumab, a domestically developed anti-IL-17A monoclonal antibody" }, { "field": "comparator", "quote": "had responded poorly to conventional antibiotics" }, { "field": "primaryOutcome", "quote": "complete resolution of nodules, abscesses, and tunnels" }, { "field": "result", "quote": "complete resolution of nodules, abscesses, and tunnels and no recurrence or significant adverse events during 10 months of follow-up" }, { "field": "n", "quote": "17-year-old boy" } ] }, { "id": "pmid:41884971", "pmid": "41884971", "doi": "10.1111/iwj.70874", "nctId": null, "pmcid": "PMC13140972", "title": "Two-Stage Surgical Management of Anogenital Hidradenitis Suppurativa in Patients on Biologic Therapy: A Retrospective Case Series", "firstAuthor": "Fuchs", "multipleAuthors": true, "journal": "Int Wound J", "year": 2026, "design": "case-series", "n": 5, "nField": "reported", "population": "men with severe, long-term hidradenitis suppurativa (boil-like skin disease) affecting the perineal, anorectal, genital or gluteal area that hadn't responded to biologic drugs", "intervention": "two-stage surgical removal of the affected skin, wound vacuum therapy, then skin grafting", "comparator": "none reported (single-arm case series, no comparison group)", "primaryOutcome": "wound healing and recurrence of disease after surgery", "result": "all patients healed well with over 90% graft success and no disease came back during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only five patients were studied in a retrospective series with no comparison group, so the results can't be generalized.", "directness": "indirect", "limitations": "Retrospective design, very small sample of five male patients, no control group, single centre.", "followUp": "19.2 months", "plainFinding": "Surgery healed severe gluteal HS.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41884971/", "sourceText": "Hidradenitis suppurativa is a chronic inflammatory skin disorder causing painful nodules, abscesses and scarring, with the anogenital region presenting particular functional and reconstructive challenges. Although biologic therapy is commonly used in moderate to severe disease, its limitations highlight the role of surgery in advanced cases. This single-centre retrospective case series included five male patients with Hurley stage III perineal, anorectal, genital or gluteal disease treated surgically between 2021 and 2023 following failure of biologic therapy. Management consisted of two-stage radical excision, negative-pressure wound therapy and reconstruction with meshed split-thickness skin grafts. All patients achieved more than 90% graft take and complete wound healing. No recurrence occurred during a median follow-up of 19.2 months. One patient developed a keloid scar at the donor site, and one experienced delayed healing. Functional and aesthetic results were satisfactory in all cases. Two-stage surgical excision with split-thickness skin graft reconstruction was associated with sustained wound healing and favourable functional outcomes in selected patients with severe anogenital hidradenitis suppurativa refractory to biologic therapy.", "provenance": [ { "field": "n", "quote": "This single-centre retrospective case series included five male patients" }, { "field": "population", "quote": "five male patients with Hurley stage III perineal, anorectal, genital or gluteal disease treated surgically between 2021 and 2023 following failure of biologic therapy" }, { "field": "intervention", "quote": "two-stage radical excision, negative-pressure wound therapy and reconstruction with meshed split-thickness skin grafts" }, { "field": "comparator", "quote": "This single-centre retrospective case series included five male patients" }, { "field": "primaryOutcome", "quote": "All patients achieved more than 90% graft take and complete wound healing." }, { "field": "result", "quote": "No recurrence occurred during a median follow-up of 19.2 months." }, { "field": "followUp", "quote": "median follow-up of 19.2 months" } ] }, { "id": "pmid:41810251", "pmid": "41810251", "doi": "10.36518/2689-0216.2102", "nctId": null, "pmcid": "PMC12971096", "title": "Presentations of Cutaneous Disease in Various Skin Pigmentations: Keratosis Pilaris", "firstAuthor": "Lim", "multipleAuthors": true, "journal": "HCA Healthc J Med", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with keratosis pilaris across different skin tones", "intervention": "not applicable (descriptive review of skin findings)", "comparator": "", "primaryOutcome": "visual identification of keratosis pilaris across skin pigmentations", "result": "the abstract describes clinical features and mimics of keratosis pilaris, not a treatment outcome", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a descriptive review of skin appearance, not a study testing a treatment or cause, so it cannot show why pimples occur or what works.", "directness": "indirect", "limitations": "abstract does not report a study design with participants, comparison, or measured outcome; it is an educational review of disease appearance.", "followUp": "", "plainFinding": "Describes keratosis pilaris, a bump mimic.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41810251/", "sourceText": "Description Keratosis pilaris (KP) is a common benign disorder involving hyperkeratosis of the skin. It is associated with other common dry skin disorders such as atopic dermatitis and ichthyosis vulgaris. Lesions are clinically characterized as symmetrically distributed, monomorphic, folliculocentric, hyperkeratotic papules with a variable degree of perifollicular erythema. The appearance can be likened to spikey bumps that are commonly located on the arms, legs, and buttocks. Awareness of KP is important as every primary care clinician will see patients with this disorder. Identification can support the diagnosis of other associated skin diseases. Education about KP and its treatment may alleviate psychological distress and reduce symptoms. Common mimicking diagnoses include folliculitis, acne vulgaris, and milia. There are also uncommon atrophic variants of KP that result in scarring and alopecia. The clinical images in this review focus on identifying KP across the spectrum of skin tones.", "provenance": [ { "field": "population", "quote": "The clinical images in this review focus on identifying KP across the spectrum of skin tones." }, { "field": "primaryOutcome", "quote": "The clinical images in this review focus on identifying KP across the spectrum of skin tones." }, { "field": "result", "quote": "Common mimicking diagnoses include folliculitis, acne vulgaris, and milia." }, { "field": "intervention", "quote": "Education about KP and its treatment may alleviate psychological distress and reduce symptoms." } ] }, { "id": "pmid:41804627", "pmid": "41804627", "doi": null, "nctId": null, "pmcid": null, "title": "A Case of Porokeratosis Ptychotropica Treated with Cryotherapy", "firstAuthor": "Flor", "multipleAuthors": true, "journal": "Acta Dermatovenerol Croat", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 76-year-old woman with skin lesions between the buttocks and near the vulva", "intervention": "freezing treatment (cryotherapy) applied to the skin lesions", "comparator": "no comparison treatment; lesions had previously not responded to topical or oral antifungal treatment", "primaryOutcome": "whether the skin lesions cleared up after treatment", "result": "the lesions completely cleared after two rounds of cryotherapy, leaving only mild lighter skin patches and no significant scarring", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this treatment or condition applies to most people with similar skin problems.", "directness": "indirect", "limitations": "Only one patient was studied, there is no comparison group, and the condition described (porokeratosis ptychotropica) is a rare, specific skin disorder rather than common pimples or acne on the buttocks.", "followUp": "", "plainFinding": "Rare skin patches cleared after freezing treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41804627/", "sourceText": "Porokeratosis encompasses a group of dermatoses characterized by marked keratinization of epidermis with distinct histological identification of cornoid lamellae of invaginated epidermis (1). Porokeratosis ptychotropica is a rare variant of porokeratosis, presenting as one or more red or brown plaques in the intergluteal and genital areas (2). Affecting predominantly adult men, it remains as uncommon as it is unexplained, with sporadic appearance and unknown physiopathology (3). Diagnosis is based on histology and therapeutic approaches used include topical corticosteroids, systemic retinoids, imiquimod, 5-fluorouracil, laser therapy and cryotherapy (2,4). However, resistance to treatment and recurrences are very frequent, and treatment results are often poor (4). We report a case of porokeratosis ptychotropica successfully treated with cryotherapy. A 76-year-old female with no prior relevant history was referred due to a one-year-long history of cutaneous lesions in the intergluteal region which had not responded to topical or oral antifungal. On observation, she presented two annular erythematous lesions in the right perivulvar and intergluteal region, with 1 and 2 cm of diameter, respectively (Figures 1 a and b). The lesions presented elevated margins, coarse on palpation, with central superficial scaling, associated with moderate pruritus (Figure 2). No other relevant findings were apparent on examination. An incisional biopsy of the larger lesion was performed. Histological examination showed moderately acanthotic and slightly irregular epidermis which contained a narrow cornoid lamella with a small column of parakeratosis, sitting on an area of hypogranulosis with dyskeratotic keratinocytes (Figure 3). Based on these findings, a diagnosis of porokeratosis ptychotropica was established. Two cycles of cryotherapy were performed (20 seconds per lesion). On follow-up, total resolution of lesions was observed, with residual hypopigmentation without significant scarring being observed. Porokeratosis ptychotropica (also known as verrucous porokeratosis of the gluteal cleft) is a rare, idiopathic disorder first described in 1995 by Lucker et. al., characterized by appearance of porokeratosis lesions in the gluteal or genital regions5. These are typically reddish-brown verrucous papules and plaques, which coalesce, expand centrally and may develop peripheral satellite lesions or porokeratosis in other areas, and which are typically pruriginous (2,6). It has a marked male predominance, corresponding to >90% cases reported in clinical case series, and affects mainly adults (7). Case presentation is typically sporadic, but familial distribution suggesting an autosomal dominant transmission has been described in some cases (7). Lesions typically have a chronic course, persisting for years prior to a diagnosis is established. Clinical differential diagnosis includes psoriasis, which porokeratosis ptychotropica often emulates, acrodermatitis enteropathica, lichen planus verrucosus, and tuberculosis verrucosa cutis. Lesion biopsy is essential to establish a diagnosis, exclude other differentials and rule out malignant transformation, which can occur in up to 7.5% of porokeratotic lesions, most frequently as squamous cell carcinoma7,8. Histological examination reveals a digitate epidermis with parakeratosis columns over keratinocytes, as well as dyskeratotic keratinocytes and hypogranulosis. Multiple concentric cornoid lamellae combined with digitate epidermis is the hallmark of porokeratosis ptychotropica. Therapeutic options are controversial and include topical corticosteroids, topical tacrolimus, PUVA, systemic retinoids, imiquimod, 5-fluorouracil, CO2 or excimer laser therapy, and cryotherapy2,4. Results are generally poor, with frequent persistence of lesions, recurrence after an initially successful treatment is also common (6,7). We report an extremely rare case of porokeratosis ptychotropica affecting a female patient. This case is also unique due to the successful treatment of the lesions with cryotherapy; further case series using this treatment option may validate it as an acceptable standard treatment for small lesions of porokeratosis ptychotropica.", "provenance": [ { "field": "population", "quote": "A 76-year-old female with no prior relevant history was referred due to a one-year-long history of cutaneous lesions in the intergluteal region" }, { "field": "intervention", "quote": "Two cycles of cryotherapy were performed (20 seconds per lesion)." }, { "field": "comparator", "quote": "which had not responded to topical or oral antifungal" }, { "field": "primaryOutcome", "quote": "On follow-up, total resolution of lesions was observed" }, { "field": "result", "quote": "On follow-up, total resolution of lesions was observed, with residual hypopigmentation without significant scarring being observed." }, { "field": "n", "quote": "A 76-year-old female" } ] }, { "id": "pmid:41736049", "pmid": "41736049", "doi": "10.1186/s13063-026-09423-x", "nctId": null, "pmcid": "PMC13037331", "title": "Efficacy and safety of the Exfoliate-Dissolve-Repair skin care approach in the treatment of keratosis pilaris: a randomized controlled clinical trial study protocol", "firstAuthor": "Du", "multipleAuthors": true, "journal": "Trials", "year": 2026, "design": "registered-trial-no-results", "n": 72, "nField": "reported", "population": "Adults aged 18-35 with keratosis pilaris (bumpy skin on arms, thighs, buttocks)", "intervention": "Exfoliate-Dissolve-Repair skin care (body scrub plus moisturizing lotion)", "comparator": "0.1% retinoic acid cream", "primaryOutcome": "Improvement in follicular bumps and skin roughness/keratinization", "result": "This is a trial protocol; no results are reported yet", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is only a study protocol for a planned trial, so no outcome data exist yet to judge effectiveness.", "directness": "direct", "limitations": "Single center study; only a protocol, so no results, effectiveness, or safety data are yet available.", "followUp": "4 weeks", "plainFinding": "No results yet, trial planned", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41736049/", "sourceText": "BACKGROUND: Keratosis pilaris (KP) is a chronic skin disease characterized by keratinized hair follicle papules, typically occurring on the arms, thighs, and buttocks. At present, the external treatment plan for KP is relatively singular. To optimize the existing clinical external drug treatment plan for KP, improve side effects, and enhance patients' quality of life, we propose the Exfoliate-Dissolve-Repair (EDR) comprehensive skin care method. Based on the EDR concept, we have designed a treatment plan that combines body scrub and moisturizing lotion. This research plan aims to evaluate the safety and efficacy of a novel skincare combination therapy for KP through a randomized controlled trial. METHODS: This study is a single center, randomized, controlled clinical trial targeting cases of KP aged 18-35 years. Participants (n = 72) were randomly assigned to a treatment group and a control group. The treatment group received EDR comprehensive skin care intervention, while the control group received 0.1% retinoic acid cream intervention. The trial includes a 4-week treatment period, with indicator testing and data collection conducted at 7, 14, 21, and 28 days after the start of treatment. The main outcome measures include the improvement index of follicular papules and evaluation of skin keratinization degree. Secondary outcome measures include skin moisture content, transdermal moisture loss test, skin elasticity, etc. Use the skin lesion condition, blood pressure, heart rate, heart rhythm, and respiratory rate of the subjects as safety evaluation indicators. Exploratory evaluation of the effectiveness and safety of the EDR comprehensive skin care method for KP. DISCUSSION: This study will be the RCT to directly compare the effects of EDR comprehensive skincare approach and 0.1% retinoic acid cream in KP. Findings from the study will provide evidence to inform the clinical management of KP. TRIAL REGISTRATION: This protocol has been registered prospectively in ISRCTN under the ISRCTN14455606 on April 6, 2025.", "provenance": [ { "field": "population", "quote": "targeting cases of KP aged 18-35 years" }, { "field": "n", "quote": "Participants (n = 72) were randomly assigned" }, { "field": "intervention", "quote": "The treatment group received EDR comprehensive skin care intervention" }, { "field": "comparator", "quote": "the control group received 0.1% retinoic acid cream intervention" }, { "field": "primaryOutcome", "quote": "The main outcome measures include the improvement index of follicular papules and evaluation of skin keratinization degree" }, { "field": "result", "quote": "This protocol has been registered prospectively in ISRCTN under the ISRCTN14455606 on April 6, 2025." }, { "field": "followUp", "quote": "The trial includes a 4-week treatment period" } ] }, { "id": "pmid:41732823", "pmid": "41732823", "doi": "10.1111/jocd.70748", "nctId": null, "pmcid": "PMC12930327", "title": "Fractional Microneedling Radiofrequency for Hidradenitis Suppurativa: A Real-World Retrospective Study Demonstrating Clinical Efficacy and Safety Across Diverse Anatomical Sites", "firstAuthor": "Safir", "multipleAuthors": true, "journal": "J Cosmet Dermatol", "year": 2026, "design": "retrospective", "n": 17, "nField": "reported", "population": "patients with moderate-to-severe hidradenitis suppurativa (a chronic inflammatory skin condition, not simple pimples)", "intervention": "fractional microneedling radiofrequency (Morpheus8) treatment", "comparator": "no comparator group; outcomes measured before and after treatment", "primaryOutcome": "change in hidradenitis suppurativa severity score (IHS4) and proportion achieving ≥55% reduction (IHS4-55)", "result": "94.1% of patients showed clinical improvement and 52.9% achieved a ≥55% reduction in severity score", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, retrospective study with no control group, so it can't reliably show the treatment caused the improvement.", "directness": "indirect", "limitations": "Retrospective design, small sample size, no control group, and it studies a specific severe disease (hidradenitis suppurativa) rather than common buttock pimples.", "followUp": "", "plainFinding": "Improved hidradenitis suppurativa lesions, not ordinary pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41732823/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) remains a therapeutically challenging disease despite expanding research and evolving systemic treatments. Energy-based modalities, such as fractional microneedling radiofrequency (FMR), are being increasingly explored as novel treatment options. AIM: To evaluate the real-world efficacy and safety of Morpheus8-based FMR treatment in patients with HS. MATERIALS AND METHODS: This retrospective analysis included 25 HS patients treated at a tertiary dermatology center. Seventeen patients who completed ≥ 2 FMR sessions were included in the efficacy analysis. Outcomes were assessed by the International Hidradenitis Suppurativa Severity Score System (IHS4) and IHS4-55 (≥ 55% reduction). High-frequency ultrasound (HFUS) was used in selected cases to assess treatment response and inflammatory changes. RESULTS: Sixteen of the 17 patients (94.1%) evaluated for efficacy showed clinical improvement, and nine (52.9%) achieved an IHS4-55 response. The mean IHS4 reduction was 4.6 ± 2.5. The highest response rates were observed in the face, chest, and gluteal regions, while groin and thigh showed the lowest. HFUS confirmed a reduction in inflammation. Treatment was generally well tolerated, with pain cited as the most common reason for discontinuation in 3 of 25 patients (12%). CONCLUSION: FMR appears to be a safe and effective treatment option for patients with moderate-to-severe HS, including those with refractory disease and lesions in anatomically challenging areas. Clinical outcomes in our cohort were comparable to those reported for advanced systemic agents and other technology-based interventions. These findings support FMR's potential role in personalized HS management - either as a standalone intervention or in combination with systemic or procedural treatments.", "provenance": [ { "field": "population", "quote": "This retrospective analysis included 25 HS patients treated at a tertiary dermatology center." }, { "field": "n", "quote": "Seventeen patients who completed ≥ 2 FMR sessions were included in the efficacy analysis." }, { "field": "intervention", "quote": "To evaluate the real-world efficacy and safety of Morpheus8-based FMR treatment in patients with HS." }, { "field": "comparator", "quote": "This retrospective analysis included 25 HS patients treated at a tertiary dermatology center." }, { "field": "primaryOutcome", "quote": "Outcomes were assessed by the International Hidradenitis Suppurativa Severity Score System (IHS4) and IHS4-55 (≥ 55% reduction)." }, { "field": "result", "quote": "Sixteen of the 17 patients (94.1%) evaluated for efficacy showed clinical improvement, and nine (52.9%) achieved an IHS4-55 response." } ] }, { "id": "pmid:41560364", "pmid": "41560364", "doi": "10.1111/exd.70200", "nctId": null, "pmcid": null, "title": "The Roles of Keratinocytes in the Initiation, Progression and Maintenance of Hidradenitis Suppurativa", "firstAuthor": "Lai", "multipleAuthors": true, "journal": "Exp Dermatol", "year": 2026, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (a skin condition causing nodules and abscesses in armpits, groin and buttock areas)", "intervention": "", "comparator": "", "primaryOutcome": "understanding how skin cells (keratinocytes) contribute to disease development", "result": "review concludes keratinocytes contribute to inflammation and disease progression through genetic, metabolic and cytokine abnormalities", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review summarizing existing research rather than a study with its own patient data or statistical testing.", "directness": "indirect", "limitations": "abstract states the exact cause of the disease remains unclear and this is a synthesis of other evidence, not new patient data", "followUp": "", "plainFinding": "Skin cell abnormalities may drive this condition.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41560364/", "sourceText": "Hidradenitis suppurativa (HS) is an autoinflammatory skin disease characterised by deep-seated and painful nodules, abscesses and draining tunnels that extensively penetrate the dermis in the axillae, inguinal and gluteal areas. The exact aetiology remains unclear. However, current evidence suggests that HS originates from an intrinsic defect within the hair follicle, leading to follicular obstruction, cyst development and eventual rupture, which triggers an inflammatory reaction. The initiation, progression and maintenance of the disease may involve functional abnormalities in keratinocytes (KCs), significantly contributing to the production of proinflammatory cytokines within and around the affected tissue and increased infiltration of immune cells. This review synthesises current evidence on KCs in HS, emphasising their genetic background and metabolic dysregulation. It comprehensively evaluates the cytokine milieu influenced by KCs within affected tissues. Notably, it highlights the diverse phenotypes of KCs within draining tunnels, underscoring their heterogeneity and implications for disease progression.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is an autoinflammatory skin disease characterised by deep-seated and painful nodules, abscesses and draining tunnels that extensively penetrate the dermis in the axillae, inguinal and gluteal areas." }, { "field": "primaryOutcome", "quote": "This review synthesises current evidence on KCs in HS, emphasising their genetic background and metabolic dysregulation." }, { "field": "result", "quote": "The initiation, progression and maintenance of the disease may involve functional abnormalities in keratinocytes (KCs), significantly contributing to the production of proinflammatory cytokines within and around the affected tissue and increased infiltration of immune cells." }, { "field": "limitations", "quote": "The exact aetiology remains unclear." } ] }, { "id": "pmid:41400110", "pmid": "41400110", "doi": "10.1111/cup.70042", "nctId": null, "pmcid": "PMC12953008", "title": "Verruciform Xanthoma Within the Cyst Lining of Hidradenitis Suppurativa", "firstAuthor": "Nichols", "multipleAuthors": true, "journal": "J Cutan Pathol", "year": 2026, "design": "case-series", "n": 1, "nField": "reported", "population": "56-year-old man with long-standing severe hidradenitis suppurativa affecting the buttock area", "intervention": "not applicable - this is a pathology case report, not a treatment study", "comparator": "none", "primaryOutcome": "microscopic appearance of tissue removed from a draining sinus tract", "result": "the cyst lining showed an unusual pattern called verruciform xanthoma, not previously described in hidradenitis suppurativa", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report describing a tissue finding, not a treatment or outcome study, so it cannot show what causes or helps buttock pimples.", "directness": "indirect", "limitations": "single case, no treatment tested, does not address typical acne/pimples, focuses on a severe chronic condition (HS) with rare microscopic finding", "followUp": "", "plainFinding": "Describes one rare skin finding, not a cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41400110/", "sourceText": "Verruciform xanthoma (VX) is a rare lesion most often seen in the oral mucosa or anogenital region, most commonly characterized histologically by verrucous epithelial hyperplasia and foamy histiocytes in the papillary dermis. While VX has been reported in association with inflammatory dermatoses such as lichen planus and lichen sclerosus, its occurrence in the context of hidradenitis suppurativa (HS) has not been previously documented. In this case we present a 56-year-old man with long-standing, Hurley Stage 3 HS affecting the gluteal region. Following surgical excision of a draining sinus tract, histopathology revealed a squamous-lined follicular cyst consistent with HS, with approximately 10% of the cyst lining displaying features characteristic of VX, including papillomatous acanthosis, parakeratosis with neutrophils, and underlying foamy macrophages. Retrospective review of prior HS specimens did not show similar changes. This case expands the histologic spectrum of HS and suggests that chronic inflammation may promote secondary verruciform xanthomatous changes within follicular cysts. Although mutations in the cholesterol biosynthesis gene NSDHL have been linked to VX, no lichenoid or syndromic features were observed in our patient, supporting an inflammatory rather than genetic etiology. Recognition of VX-like changes in HS is important to avoid misdiagnosis as squamous cell carcinoma and further elucidates the complex epithelial remodeling in chronic inflammatory dermatoses.", "provenance": [ { "field": "n", "quote": "a 56-year-old man with long-standing, Hurley Stage 3 HS affecting the gluteal region" }, { "field": "population", "quote": "a 56-year-old man with long-standing, Hurley Stage 3 HS affecting the gluteal region" }, { "field": "intervention", "quote": "Following surgical excision of a draining sinus tract, histopathology revealed a squamous-lined follicular cyst consistent with HS" }, { "field": "comparator", "quote": "Retrospective review of prior HS specimens did not show similar changes." }, { "field": "primaryOutcome", "quote": "histopathology revealed a squamous-lined follicular cyst consistent with HS, with approximately 10% of the cyst lining displaying features characteristic of VX" }, { "field": "result", "quote": "approximately 10% of the cyst lining displaying features characteristic of VX, including papillomatous acanthosis, parakeratosis with neutrophils, and underlying foamy macrophages" } ] }, { "id": "pmid:41248121", "pmid": "41248121", "doi": "10.1159/000549610", "nctId": null, "pmcid": null, "title": "Ethnic Differences in Hidradenitis Suppurativa: Comorbidities, Lesion Distribution, and Disease Severity in a Taiwanese Population", "firstAuthor": "Chang", "multipleAuthors": true, "journal": "Dermatology", "year": 2026, "design": "retrospective", "n": 512, "nField": "reported", "population": "Taiwanese patients diagnosed with hidradenitis suppurativa compared to matched people without it", "intervention": "being male or a current smoker", "comparator": "being female or a non-smoker", "primaryOutcome": "whether skin lesions occurred on the buttocks (gluteal area) versus armpits/groin, and disease severity", "result": "Men and smokers were more likely to have buttock lesions, while women and obese patients were more likely to have armpit/groin lesions; male sex, smoking, and armpit involvement predicted more severe disease", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It's a retrospective records review comparing groups, which can show links but not prove what actually causes the lesions.", "directness": "indirect", "limitations": "Retrospective design using clinical records, and it studies a specific chronic inflammatory disease (hidradenitis suppurativa) rather than typical acne-like pimples.", "followUp": "", "plainFinding": "Men, smokers more prone to butt lesions.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41248121/", "sourceText": "INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory debilitating disorder showing ethnic heterogeneity in its clinical presentation and associated comorbidities. However, data on East Asian populations remain scarce. METHODS: We conducted a retrospective analysis of clinical records for patients with HS diagnosed between 2006 and 2022 at two tertiary referral hospitals in Taiwan. Age- and sex-matched reference individuals without HS (3:1 ratio) were randomly selected from dermatology outpatients. Association between comorbidities and HS were analyzed using conditional logistic regression, while logistic regression identified predictors for lesion distribution and disease severity. RESULTS: A total of 512 patients with HS and 1,536 reference individuals were identified. Comorbidities independently associated with HS were obesity, smoking, and diabetes. Men had 4.2 times the odds of developing gluteal lesions but only 0.5 times the odds of axillary or inguinal involvement compared to women. Current smokers had 2.8 times the odds of gluteal involvement but 0.6 times the odds of having axillary lesions. A significant association was observed between obesity and axillary involvement. Advanced disease (Hurley stage II and III) was significantly associated with male sex, smoking, and axillary involvement. CONCLUSION: Our study highlights distinct lesion distribution in East Asian patients with HS. Male sex and active smoking could predict for gluteal involvement, while female sex and obesity for axillary involvement. Independent risk factors for advanced disease were male sex, smoking, and axillary involvement.", "provenance": [ { "field": "n", "quote": "A total of 512 patients with HS and 1,536 reference individuals were identified." }, { "field": "population", "quote": "We conducted a retrospective analysis of clinical records for patients with HS diagnosed between 2006 and 2022 at two tertiary referral hospitals in Taiwan." }, { "field": "intervention", "quote": "Men had 4.2 times the odds of developing gluteal lesions but only 0.5 times the odds of axillary or inguinal involvement compared to women." }, { "field": "comparator", "quote": "Current smokers had 2.8 times the odds of gluteal involvement but 0.6 times the odds of having axillary lesions." }, { "field": "primaryOutcome", "quote": "logistic regression identified predictors for lesion distribution and disease severity" }, { "field": "result", "quote": "Male sex and active smoking could predict for gluteal involvement, while female sex and obesity for axillary involvement." } ] }, { "id": "pmid:41201033", "pmid": "41201033", "doi": "10.17992/lbl.2025.11.864", "nctId": null, "pmcid": null, "title": "[Severe hidradenitis suppurativa treated with acellular fish skin - A case report and discussion of the disorder]", "firstAuthor": "Gunnarsdottir", "multipleAuthors": true, "journal": "Laeknabladid", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with severe hidradenitis suppurativa on both buttocks who had already been treated with biologics", "intervention": "debridement (surgical cleaning) combined with acellular fish skin graft", "comparator": "usual extensive surgery with skin transplantation or flap closure", "primaryOutcome": "symptom resolution after surgery", "result": "symptom-free on the right side 21 months after surgery and minimal symptoms on the left side 7 months after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no control group, so it cannot show whether the treatment truly works better than alternatives.", "directness": "indirect", "limitations": "Only one patient was treated and described, limiting how much the result can be generalized.", "followUp": "21 months after surgery on the right side and 7 months after surgery on the left side", "plainFinding": "Fish-skin graft healed severe hidradenitis suppurativa.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41201033/", "sourceText": "Hidradenitis suppurativa is a chronic, debilitating disease due to recurrent infections, pain and foul smelling drainage. Presently, severe cases are treated with biologics. When surgery is needed it is usually extensive, requiring skin transplantation or flaps for closure. This case report presents a patient with severe disease on both buttocks, already treated with biologics. It was decided to attempt treatment with debridement and acellular fish skin to avoid extensive surgery. The treatment was successful, the patient is symptom-free on the right side 21 months after surgery and has minimal symptoms on the left side 7 months after surgery. He is contentwith the results.", "provenance": [ { "field": "n", "quote": "This case report presents a patient with severe disease on both buttocks" }, { "field": "population", "quote": "a patient with severe disease on both buttocks, already treated with biologics" }, { "field": "intervention", "quote": "treatment with debridement and acellular fish skin" }, { "field": "comparator", "quote": "requiring skin transplantation or flaps for closure" }, { "field": "primaryOutcome", "quote": "symptom-free on the right side 21 months after surgery" }, { "field": "result", "quote": "symptom-free on the right side 21 months after surgery and has minimal symptoms on the left side 7 months after surgery" } ] }, { "id": "pmid:41032437", "pmid": "41032437", "doi": "10.31053/1853.0605.v82.n3.48509", "nctId": null, "pmcid": "PMC12699681", "title": "[Hidradenitis Suppurativa: Most Relevant Epidemiological Characteristics of an Underdiagnosed Disease. A Cross-Sectional Study]", "firstAuthor": "Abeledo", "multipleAuthors": true, "journal": "Rev Fac Cien Med Univ Nac Cordoba", "year": 2025, "design": "retrospective", "n": 205, "nField": "reported", "population": "patients diagnosed with Hidradenitis Suppurativa at a university hospital", "intervention": "none - observational review of diagnosed patients' records, treatments described but not compared", "comparator": "", "primaryOutcome": "how common and where Hidradenitis Suppurativa lesions occur, plus treatment response", "result": "the gluteal (buttock) area was affected in 13.7% of patients, less often than the armpits or groin", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a retrospective, descriptive chart review with no comparison group, so it can describe patterns but not prove what causes or treats the lesions", "directness": "indirect", "limitations": "retrospective design based on medical records, no control group, and it studies people already diagnosed with a specific chronic disease rather than the general population asking about buttock pimples", "followUp": "", "plainFinding": "Butt lesions seen in some HS patients", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41032437/", "sourceText": "INTRODUCTION: Hidradenitis Suppurativa (HS) is a chronic inflammatory disease that primarily affects intertriginous areas of the skin, causing painful lesions and scarring. The pathophysiology remains partially unknown, and the disease is often diagnosed late, which significantly impacts patients' quality of life. OBJECTIVES: The aim of this study was to determine the prevalence of HS in a hospital population, describe its most relevant clinical and ultrasound characteristics, and evaluate the treatments used and their therapeutic responses. METHODOLOGY: A cross-sectional study was conducted based on the medical records of patients diagnosed with HS at the Hospital Universitario Austral between 2000 and 2024. Data on comorbidities, clinical manifestations, ultrasound findings, disease stage according to the modified Hurley scale, treatments, and therapeutic responses were collected. RESULTS: A total of 205 patients were analyzed, with an average diagnosis age of 30 years, and 64.9% were women. The most affected areas were the axillae (74.6%), inguinal region (34.1%), and gluteal region (13.7%). The most common comorbidities were obesity (26.3%) and smoking (19.5%). The majority of patients were in Hurley stage I (14%). CONCLUSION: HS is a chronic disease that significantly affects the quality of life. Early diagnosis is key to effective treatment. This study provides valuable information about the prevalence, clinical and ultrasound characteristics of the disease, which may improve patient management.", "provenance": [ { "field": "population", "quote": "based on the medical records of patients diagnosed with HS at the Hospital Universitario Austral between 2000 and 2024" }, { "field": "n", "quote": "A total of 205 patients were analyzed" }, { "field": "intervention", "quote": "evaluate the treatments used and their therapeutic responses" }, { "field": "primaryOutcome", "quote": "determine the prevalence of HS in a hospital population, describe its most relevant clinical and ultrasound characteristics, and evaluate the treatments used and their therapeutic responses" }, { "field": "result", "quote": "The most affected areas were the axillae (74.6%), inguinal region (34.1%), and gluteal region (13.7%)" } ] }, { "id": "pmid:40861268", "pmid": "40861268", "doi": "10.1177/11795565251366775", "nctId": null, "pmcid": "PMC12374114", "title": "Adolescent Gluteal Cleft Pathologies Not Due to Pilonidal Disease: A Case Series and Diagnostic Algorithm", "firstAuthor": "Emengo", "multipleAuthors": true, "journal": "Clin Med Insights Pediatr", "year": 2025, "design": "case-series", "n": 21, "nField": "reported", "population": "adolescent patients with gluteal cleft problems seen at a pediatric pilonidal clinic", "intervention": "diagnostic work-up for non-pilonidal causes of gluteal cleft symptoms", "comparator": "none (descriptive case series)", "primaryOutcome": "final diagnosis causing gluteal cleft symptoms other than pilonidal disease", "result": "21 patients had non-pilonidal diagnoses including neurological conditions, skin diseases like folliculitis, inflammatory bowel disease, sacral dimples, and a pressure ulcer; researchers built an algorithm to distinguish these from pilonidal disease", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small retrospective case series without a comparison group, so it can describe possible causes but not prove how common any one cause is.", "directness": "indirect", "limitations": "Retrospective review; small number of patients; no comparator group; focused on a specialty pilonidal clinic population, which may not reflect general cases of buttock pimples.", "followUp": "", "plainFinding": "Butt bumps can have many causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40861268/", "sourceText": "BACKGROUND: Problems of the gluteal cleft are often due to pilonidal disease, but at times need to be distinguished from other diseases. We reported a series of adolescent patients with non-pilonidal gluteal cleft pathologies. METHODS: We performed a retrospective review of all patients who presented to our pediatric Pilonidal Clinic from 1/2019 to 12/2023. Patients who received a work-up for diseases separate from pilonidal disease were included in our study. Patient demographics, clinical work-up, and treatment outcomes were recorded. RESULTS: We identified 21 patients who had diagnoses other than pilonidal disease: 4 patients had neurological diseases (schwannoma, central disk protrusion, arachnoid cyst, Tarlov cyst); 7 patients had dermatological diseases (folliculitis, moisture-associated skin damage); 5 patients had inflammatory bowel disease; 4 patients had sacral dimples; and 1 patient had a sacral pressure ulcer. Diagnostic decisions were based on the presence and location of an open wound, history of immobility, presence of gluteal cleft swelling or pit, clinical symptoms of pain or erythema, and other similar lesions on the body. These characteristics were utilized to differentiate the diagnoses and construct a diagnostic algorithm. CONCLUSIONS: We developed a practical diagnostic algorithm for differentiating gluteal cleft pathologies in adolescents, including dermatologic, colorectal, neurologic, and traumatic causes.", "provenance": [ { "field": "n", "quote": "We identified 21 patients who had diagnoses other than pilonidal disease" }, { "field": "population", "quote": "We performed a retrospective review of all patients who presented to our pediatric Pilonidal Clinic from 1/2019 to 12/2023." }, { "field": "intervention", "quote": "Patients who received a work-up for diseases separate from pilonidal disease were included in our study." }, { "field": "comparator", "quote": "We reported a series of adolescent patients with non-pilonidal gluteal cleft pathologies." }, { "field": "primaryOutcome", "quote": "Patient demographics, clinical work-up, and treatment outcomes were recorded." }, { "field": "result", "quote": "4 patients had neurological diseases (schwannoma, central disk protrusion, arachnoid cyst, Tarlov cyst); 7 patients had dermatological diseases (folliculitis, moisture-associated skin damage); 5 patients had inflammatory bowel disease; 4 patients had sacral dimples; and 1 patient had a sacral pressure ulcer." } ] }, { "id": "pmid:40498928", "pmid": "40498928", "doi": "10.1093/ced/llaf256", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa in paediatric patients with Down syndrome: a comparative study of 116 participants", "firstAuthor": "Sin-Soler", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2025, "design": "retrospective", "n": 116, "nField": "reported", "population": "Children under 18 with Down syndrome", "intervention": "Having Down syndrome (studied for hidradenitis suppurativa development)", "comparator": "Children with Down syndrome alone (without HS)", "primaryOutcome": "Presence, characteristics and severity of hidradenitis suppurativa (a skin condition causing boil-like bumps, often in groin and buttocks)", "result": "32 of 116 children with Down syndrome developed hidradenitis suppurativa, most commonly affecting the groin and buttocks, usually mild", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, single-centre retrospective study describing a specific population (children with Down syndrome), which limits how much it can tell us about butt pimples in general.", "directness": "indirect", "limitations": "Retrospective nature, small sample size and data collection from a single centre", "followUp": "", "plainFinding": "Linked to hidradenitis suppurativa, not typical acne", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40498928/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) seems to be more prevalent in patients with Down syndrome (DS), presenting with earlier onset and a higher incidence in girls and in association with an increased body mass index (BMI). OBJECTIVES: To describe the demographics, clinical characteristics and severity of HS in children with DS and make comparisons with children with DS alone. METHODS: We carried out a retrospective observational 5-year study of children (aged < 18 years) with DS at the Niño Jesús University Children's Hospital in Madrid, Spain. RESULTS: HS was diagnosed in 32 of 116 patients with DS. Median (interquartile range) age at onset in these patients was 13 (10-14) years, median BMI was 24.4 (21.0-26.5) kg m-² and 53% (n = 17/32) of the patients were girls. The most common phenotype was follicular HS (n = 15/32; 47%), and the majority (n = 27/32; 84%) had mild disease (Hurley stage I). The groin (n = 24/32; 75%) and buttocks (n = 21/32; 66%) were the most commonly affected areas. Treatment mainly involved topical and oral antibiotics, with 9% (n = 3/32) of the patients undergoing surgery. Significant differences were observed across phenotypes in sex distribution, HS lesion location and surgical rates. Our data indicate a higher BMI and greater association with the follicular occlusion tetrad in patients with DS and HS when compared with patients with DS alone. The limitations of this study include its retrospective nature, small sample size and data collection from a single centre. CONCLUSIONS: HS in children with DS is characterized by an early onset, higher BMI, predominance of the follicular phenotype and mild disease severity.", "provenance": [ { "field": "n", "quote": "HS was diagnosed in 32 of 116 patients with DS." }, { "field": "population", "quote": "children (aged < 18 years) with DS" }, { "field": "intervention", "quote": "Hidradenitis suppurativa (HS) seems to be more prevalent in patients with Down syndrome (DS)" }, { "field": "comparator", "quote": "make comparisons with children with DS alone" }, { "field": "primaryOutcome", "quote": "To describe the demographics, clinical characteristics and severity of HS in children with DS" }, { "field": "result", "quote": "The groin (n = 24/32; 75%) and buttocks (n = 21/32; 66%) were the most commonly affected areas." }, { "field": "limitations", "quote": "The limitations of this study include its retrospective nature, small sample size and data collection from a single centre." } ] }, { "id": "pmid:40414610", "pmid": "40414610", "doi": "10.1016/j.clindermatol.2025.05.009", "nctId": null, "pmcid": null, "title": "The comorbidities of hidradenitis suppurativa", "firstAuthor": "Aşkın", "multipleAuthors": true, "journal": "Clin Dermatol", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (a chronic inflammatory skin disease)", "intervention": "", "comparator": "", "primaryOutcome": "what other health conditions and complications occur alongside hidradenitis suppurativa", "result": "the abstract lists conditions that often occur with hidradenitis suppurativa, including obesity, diabetes, depression, and a rare risk of skin cancer in perianal/gluteal lesions, but does not test or report on acne/pimples on the buttocks specifically", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review listing associated conditions, not a study testing any treatment or cause, and it does not address ordinary buttock pimples at all", "directness": "indirect", "limitations": "abstract does not describe methods, study selection, or evidence quality; it does not address common buttock pimples, only hidradenitis suppurativa, a distinct and more severe condition", "followUp": "", "plainFinding": "Not about ordinary butt pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40414610/", "sourceText": "Hidradenitis suppurativa is a chronic inflammatory disease that dramatically decreases the quality of life of afflicted patients. A number of factors may coexist with hidradenitis suppurativa, including stigmatization, social isolation, tobacco use, alcohol abuse, suicidal ideation, depression, other psychiatric disorders, and medical comorbidities such as obesity, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, coronary artery disease, and polycystic ovarian syndrome. These comorbidities should be kept in mind while planning the treatment. A rare but important long-term complication of hidradenitis suppurativa is squamous cell cancer; men with perianal, gluteal, or perineal lesions are at increased risk, and multiple biopsies should be taken in case of any suspicious lesions.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa is a chronic inflammatory disease that dramatically decreases the quality of life of afflicted patients." }, { "field": "result", "quote": "A number of factors may coexist with hidradenitis suppurativa, including stigmatization, social isolation, tobacco use, alcohol abuse, suicidal ideation, depression, other psychiatric disorders, and medical comorbidities such as obesity, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, coronary artery disease, and polycystic ovarian syndrome." }, { "field": "result", "quote": "A rare but important long-term complication of hidradenitis suppurativa is squamous cell cancer; men with perianal, gluteal, or perineal lesions are at increased risk, and multiple biopsies should be taken in case of any suspicious lesions." }, { "field": "primaryOutcome", "quote": "These comorbidities should be kept in mind while planning the treatment." } ] }, { "id": "pmid:40251895", "pmid": "40251895", "doi": "10.1093/ecco-jcc/jjaf066", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa among patients with new-onset inflammatory bowel disease-results from the IBD Prognosis Study", "firstAuthor": "Nielsen", "multipleAuthors": true, "journal": "J Crohns Colitis", "year": 2025, "design": "prospective-cohort", "n": 527, "nField": "reported", "population": "adults newly diagnosed with inflammatory bowel disease (Crohn's disease or ulcerative colitis)", "intervention": "having hidradenitis suppurativa (a chronic skin condition causing boils, often in the groin and buttocks)", "comparator": "IBD patients without hidradenitis suppurativa", "primaryOutcome": "how common hidradenitis suppurativa is and its clinical features in people with new IBD", "result": "Hidradenitis suppurativa was found in 5.5% of patients with Crohn's disease and 8% with ulcerative colitis, most often affecting the groin and buttocks, and these patients had higher BMI, more other inflammatory conditions, and more severe bowel disease", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "It's a large population-based cohort study, but it only shows an association between skin boils and bowel disease, not what causes either one.", "directness": "indirect", "limitations": "Observational cohort study showing association only; no data on causes of hidradenitis suppurativa in people without IBD.", "followUp": "", "plainFinding": "Butt boils linked to bowel disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40251895/", "sourceText": "BACKGROUND AND AIMS: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC). This study aimed to assess the prevalence and clinical characteristics of HS in a population-based cohort of newly diagnosed IBD patients. METHODS: The Copenhagen IBD Inception Cohort is a population-based inception cohort of newly diagnosed patients with IBD between May 2021 and April 2023. Inflammatory bowel disease-related clinical data and extraintestinal manifestations (EIMs) were collected, with HS identified through validated self-reported questionnaires and dermatological examinations. Statistical comparisons were performed between IBD patients with and without HS. RESULTS: Of 527 patients with new-onset IBD, 38.1%, 58.4%, and 3.4% had CD, UC, or unclassified IBD, respectively. Hidradenitis suppurativa was prevalent in 5.5% (n = 29), 8% (n = 16), and 3.9% (n = 12) of patients with CD and UC, respectively. Patients with concomitant HS were most frequently affected in the groin area and buttocks, had significantly higher body mass index (BMI) (26.4 vs 24.2 kg/m², P = .036), and had higher prevalence of EIMs (79.3% vs 41.2%, P < .001) compared to patients with IBD alone. Among CD patients, those with HS had higher disease activity (Harvey-Bradshaw Index: 9.6 vs 6.8, P = .029) and more frequent perianal disease (31.3% vs 9.7%, P = .023). CONCLUSIONS: Hidradenitis suppurativa is a prevalent comorbidity in newly diagnosed IBD patients. Concomitant HS is associated with increased BMI, a higher burden of EIMs, and greater disease severity. Early dermatological assessment and integrated management strategies are essential to optimize care for these patients.", "provenance": [ { "field": "n", "quote": "Of 527 patients with new-onset IBD" }, { "field": "population", "quote": "a population-based cohort of newly diagnosed IBD patients" }, { "field": "intervention", "quote": "Hidradenitis suppurativa was prevalent in 5.5% (n = 29), 8% (n = 16), and 3.9% (n = 12) of patients with CD and UC" }, { "field": "comparator", "quote": "Statistical comparisons were performed between IBD patients with and without HS" }, { "field": "primaryOutcome", "quote": "This study aimed to assess the prevalence and clinical characteristics of HS in a population-based cohort of newly diagnosed IBD patients" }, { "field": "result", "quote": "Patients with concomitant HS were most frequently affected in the groin area and buttocks, had significantly higher body mass index (BMI) (26.4 vs 24.2 kg/m², P = .036), and had higher prevalence of EIMs (79.3% vs 41.2%, P < .001) compared to patients with IBD alone." } ] }, { "id": "pmid:40204208", "pmid": "40204208", "doi": "10.1016/j.pdpdt.2025.104582", "nctId": null, "pmcid": null, "title": "Porokeratosis ptychotropica and concurrent condyloma acuminata respond well to photodynamic therapy", "firstAuthor": "Peng", "multipleAuthors": true, "journal": "Photodiagnosis Photodyn Ther", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "a 73-year-old man with patchy hyperkeratotic lesions and verrucous growths over his buttocks, perianal area, gluteal cleft, and scrotum", "intervention": "photodynamic therapy using 5-aminolevulinic acid gel and red light sessions", "comparator": "", "primaryOutcome": "clinical and symptom improvement of the skin lesions", "result": "significant clinical and symptom improvement at 2 months, and symptom-free at 6 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report of one patient, so it cannot show whether this treatment works in general.", "directness": "indirect", "limitations": "Single patient case report with no control group, describing a rare condition (porokeratosis ptychotropica with genital warts) rather than common buttock pimples.", "followUp": "6-months follow-up", "plainFinding": "Rare skin condition improved with light therapy", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40204208/", "sourceText": "Porokeratosis ptychotropica (PPt), a rare variant of porokeratosis, occurs predominantly in the gluteal cleft, buttocks, perineum, and genitals. Here we present the case of a 73-year-old man with patchy hyperkeratotic lesions and verrucous growths over his buttocks, perianal area, gluteal cleft, and scrotum, which result in an uncomfortable moist sensation over his anus. Skin biopsies of all lesions revealed a combination of cornoid lamellae, koilocytes, and P16 focal-positive immunohistochemistry, indicating condyloma acuminata overlying the PPt. A standardized and effective treatment regimen for porokeratoses is currently lacking. PDT treats a variety of conditions by inducing oxidative stress and enhancing local immunity, and offers a benefit for perianal lesions due to its preservation of anal sphincter function. Three monthly topical photodynamic therapy (PDT) sessions with 78 mg/g 5-aminolevulinic acid (5-ALA) gel and 635 nm red light (total 78 J/cm2) were performed over the patient's perianal and buttock region, and two monthly PDT sessions were performed over his scrotum. 405 nm blue light was used to visualize 5-ALA bioutilization via protoporphyrin IX fluorescence before each session. At 2-month follow-up, the patient reported significant clinical and symptoms improvement, and remains symptom-free at 6-months follow-up. This represents the first report of concurrent PPt and CA. We hope to demonstrate the versatility of PDT and expand its list of indications, and demonstrate that, while PPt and concurrent CA is challenging to treat, PDT may offer an alternative therapeutic option.", "provenance": [ { "field": "n", "quote": "a 73-year-old man" }, { "field": "population", "quote": "Here we present the case of a 73-year-old man with patchy hyperkeratotic lesions and verrucous growths over his buttocks, perianal area, gluteal cleft, and scrotum" }, { "field": "intervention", "quote": "Three monthly topical photodynamic therapy (PDT) sessions with 78 mg/g 5-aminolevulinic acid (5-ALA) gel and 635 nm red light (total 78 J/cm2) were performed over the patient's perianal and buttock region, and two monthly PDT sessions were performed over his scrotum." }, { "field": "primaryOutcome", "quote": "At 2-month follow-up, the patient reported significant clinical and symptoms improvement" }, { "field": "result", "quote": "At 2-month follow-up, the patient reported significant clinical and symptoms improvement, and remains symptom-free at 6-months follow-up." } ] }, { "id": "pmid:40047818", "pmid": "40047818", "doi": "10.12968/jowc.2023.0200", "nctId": null, "pmcid": null, "title": "Multidisciplinary approach to squamous cell carcinoma originating in hidradenitis suppurativa lesions: a case report", "firstAuthor": "Wang", "multipleAuthors": true, "journal": "J Wound Care", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "30-year-old man with long-term hidradenitis suppurativa and a non-healing wound on his buttock", "intervention": "combined treatment by a team of specialists (chemotherapy, wound care, and surgery to remove the lesions)", "comparator": "no comparison group", "primaryOutcome": "complete healing of the wound and no cancer recurrence", "result": "the wound fully healed after 201 days with no recurrence seen during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show whether this approach works in general.", "directness": "indirect", "limitations": "only one patient was studied, and this involved a rare cancer arising from long-standing hidradenitis suppurativa, not ordinary buttock pimples.", "followUp": "201 days", "plainFinding": "Rare cancerous HS wound healed with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40047818/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin disease, and squamous cell carcinoma (SCC) is a rare complication of longstanding HS. In this case report, we describe the clinical management of a 30-year-old male patient with HS, with an eight-year history of a recurrent abscess and a nonhealing ulcer-like wound on his right buttock. The patient was also diagnosed with SCC originating from HS. A multidisciplinary team was established, comprising an oncologist, a plastic surgeon and two enterostomal therapists, to administer various treatments including chemotherapy, wound care, and surgical removal of lesions. The wound completely healed 201 days later, without any recurrence observed during follow-up.", "provenance": [ { "field": "n", "quote": "a 30-year-old male patient with HS" }, { "field": "population", "quote": "a 30-year-old male patient with HS, with an eight-year history of a recurrent abscess and a nonhealing ulcer-like wound on his right buttock" }, { "field": "intervention", "quote": "administer various treatments including chemotherapy, wound care, and surgical removal of lesions" }, { "field": "comparator", "quote": "A multidisciplinary team was established, comprising an oncologist, a plastic surgeon and two enterostomal therapists" }, { "field": "primaryOutcome", "quote": "The wound completely healed 201 days later, without any recurrence observed during follow-up." }, { "field": "result", "quote": "The wound completely healed 201 days later, without any recurrence observed during follow-up." } ] }, { "id": "pmid:39940809", "pmid": "39940809", "doi": "10.3390/ijms26031039", "nctId": null, "pmcid": "PMC11817842", "title": "Impaired Molecular Mechanisms Contributing to Chronic Pain in Patients with Hidradenitis Suppurativa: Exploring Potential Biomarkers and Therapeutic Targets", "firstAuthor": "Radhakrishna", "multipleAuthors": true, "journal": "Int J Mol Sci", "year": 2025, "design": "case-control", "n": 48, "nField": "reported", "population": "people with hidradenitis suppurativa (a chronic skin condition affecting hairy, sweat-gland-rich areas like armpits, groin, buttocks) compared to healthy people", "intervention": "having hidradenitis suppurativa (not a tested treatment)", "comparator": "healthy people without the condition", "primaryOutcome": "patterns of DNA chemical markers (methylation) on genes linked to pain sensitivity", "result": "found 253 genes with different methylation patterns in HS patients, many linked to pain, inflammation, and other body processes", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, exploratory lab study of blood DNA markers in only 24 patients, not a study of acne or pimple causes or treatments.", "directness": "indirect", "limitations": "Small sample size (24 patients, 24 controls); exploratory molecular/epigenetic study not testing any treatment or directly addressing pimple formation on the buttocks.", "followUp": "", "plainFinding": "Found gene markers tied to chronic pain in HS, not pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39940809/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic skin condition that primarily affects areas with dense hair follicles and apocrine sweat glands, such as the underarms, groin, buttocks, and lower breasts. Intense pain and discomfort in HS have been commonly noted, primarily due to the lesions' effects on nearby tissues. Pain is a factor that can influence DNA methylation patterns, though its exact role in HS is not fully understood. We aim to identify molecular markers of chronic pain in HS patients. We performed DNA methylome of peripheral blood DNA derived from a group of 24 patients with HS and 24 healthy controls, using Illumina methylation array chips. We identified 253 significantly differentially methylated CpG sites across 253 distinct genes regulating pain sensitization in HS, including 224 hypomethylated and 29 hypermethylated sites. Several genes with pleiotropic roles include transporters (ABCC2, SLC39A8, SLC39A9), wound healing (MIR132, FGF2, PDGFC), ion channel regulators (CACNA1C, SCN1A), oxidative stress mediators (SCN8A, DRD2, DNMT1), cytochromes (CYP19A, CYP1A2), cytokines (TGFB1, IL4), telomere regulators (CSNK1D, SMAD3, MTA1), circadian rhythm (IL1R2, ABCG1, RORA), ultradian rhythms (PHACTR1, TSC2, ULK1), hormonal regulation (PPARA, NR3C1, ESR2), and the serotonin system (HTR1D, HTR1E, HTR3C, HTR4, TPH2). They also play roles in glucose metabolism (POMC, IRS1, GNAS) and obesity (DRD2, FAAH, MMP2). Gene ontology and pathway enrichment analysis identified 43 pathways, including calcium signaling, cocaine addiction, and nicotine addiction. This study identified multiple differentially methylated genes involved in chronic pain in HS, which may serve as biomarkers and therapeutic targets. Understanding their epigenetic regulation is crucial for personalized pain management and could enhance the identification of high-risk patients, leading to better preventative therapies and improved maternal and neonatal outcomes.", "provenance": [ { "field": "population", "quote": "24 patients with HS and 24 healthy controls" }, { "field": "intervention", "quote": "Hidradenitis suppurativa (HS) is a chronic skin condition that primarily affects areas with dense hair follicles and apocrine sweat glands, such as the underarms, groin, buttocks, and lower breasts." }, { "field": "comparator", "quote": "24 healthy controls" }, { "field": "primaryOutcome", "quote": "We aim to identify molecular markers of chronic pain in HS patients." }, { "field": "result", "quote": "We identified 253 significantly differentially methylated CpG sites across 253 distinct genes regulating pain sensitization in HS, including 224 hypomethylated and 29 hypermethylated sites." }, { "field": "n", "quote": "a group of 24 patients with HS and 24 healthy controls" } ] }, { "id": "pmid:39777571", "pmid": "39777571", "doi": "10.1007/s00403-024-03622-9", "nctId": null, "pmcid": "PMC11711572", "title": "Management of hidradenitis suppurativa in the inpatient setting: a clinical guide", "firstAuthor": "Maskan Bermudez", "multipleAuthors": true, "journal": "Arch Dermatol Res", "year": 2025, "design": "guideline", "n": null, "nField": "not-reported", "population": "people hospitalized with severe flares of hidradenitis suppurativa, a chronic skin condition affecting armpits, groin, buttocks and thighs", "intervention": "inpatient management including specialist consultations, pain control, rescue therapy, surgical planning, and early biologic drugs", "comparator": "", "primaryOutcome": "improved flare management and clinical outcomes", "result": "the abstract gives management guidance but does not report trial results or outcome data", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is an expert guidance review, not a study testing treatment effects, so it can't show whether a specific treatment works.", "directness": "indirect", "limitations": "it is a narrative clinical guide for inpatient care of severe disease, not a study of causes or typical mild cases of buttock pimples.", "followUp": "", "plainFinding": "Guidance only, no outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39777571/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the axilla, inframammary folds, buttocks, inner thighs, and anogenital regions. Patients with moderate to severe HS often seek care in the emergency department and may require hospitalization; however, the lack of clear admission criteria and management guidelines presents significant challenges. To address these issues, we conducted a clinical review aimed at hospitalists and consulting dermatologists considering hospital admission for patients experiencing severe HS flares. Admission offers a unique opportunity to optimize care through specialized consultations, pain management, rescue therapy, and surgical planning. Furthermore, multimodal treatments, particularly biologics, are needed to achieve clinical remission in severe disease. Streamlining care during hospitalization for the early initiation of these therapies can significantly improve flare management and overall clinical outcomes for HS patients. This review aims to improve care for HS by providing clear and comprehensive guidance on its management in the inpatient setting.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the axilla, inframammary folds, buttocks, inner thighs, and anogenital regions." }, { "field": "intervention", "quote": "multimodal treatments, particularly biologics, are needed to achieve clinical remission in severe disease." }, { "field": "primaryOutcome", "quote": "Streamlining care during hospitalization for the early initiation of these therapies can significantly improve flare management and overall clinical outcomes for HS patients." }, { "field": "result", "quote": "This review aims to improve care for HS by providing clear and comprehensive guidance on its management in the inpatient setting." } ] }, { "id": "pmid:39715604", "pmid": "39715604", "doi": "10.1159/000537920", "nctId": null, "pmcid": "PMC12233976", "title": "Questionnaire-Based Global Prevalence of Hidradenitis Suppurativa: A Systematic Review and Meta-Analysis", "firstAuthor": "Zahid", "multipleAuthors": true, "journal": "Dermatology", "year": 2025, "design": "meta-analysis", "n": 49971, "nField": "reported", "population": "adults surveyed with a validated questionnaire about recurring boils/abscesses in skin folds (armpits, groin, genitals, buttocks)", "intervention": "no treatment tested; this is a prevalence survey of hidradenitis suppurativa symptoms", "comparator": "none - no comparison group, just prevalence estimation across studies", "primaryOutcome": "how common hidradenitis suppurativa (recurrent boils) is worldwide", "result": "pooled prevalence of hidradenitis suppurativa was 2.5% of people surveyed", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "it pools many large surveys but the authors warn of heterogeneity between studies and missing data from some world regions.", "directness": "indirect", "limitations": "heterogeneity and sparse data from the Global South; estimate should be interpreted with caution", "followUp": "", "plainFinding": "About 2.5% have hidradenitis suppurativa.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39715604/", "sourceText": "UNLABELLED:

Background: Hidradenitis suppurativa (HS), a chronic inflammatory skin disease affecting intertriginous areas, presents a recurring and debilitating challenge. Even though recent efforts have been made to estimate the overall HS prevalence, variations in screening modalities and missing data from the Global South warrant further investigation. Understanding the HS prevalence is crucial for treatment approaches and pathogenesis. Thus, we aimed to estimate a global HS prevalence based on studies using homogeneous validated questions. METHODS: This systematic review was prospectively registered on PROSPERO and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches in PubMed, Embase, and CINAHL were performed on August 9, 2023. Original reports assessing the HS prevalence in adults using the following two questions were included: \"Do you have recurrent boils of the skin?\" and \"Have you for the past 6 months had 2 or more boils/abscesses in any of the below locations: in the axilla, in the groin, around your genitals, on the buttocks, several locations i.e., first the buttocks then the axilla, etc.?\" A pooled prevalence with 95% confidence interval (CI) was calculated with a random-effects model. RESULTS: Eight studies qualified for inclusion, of which the prevalence estimate ranged from 0.7% to 6.4%. The meta-analysis encompassing 49,971 participants revealed a global HS prevalence of 2.5% (95% CI, 1.8-3.5%). CONCLUSION: This meta-analysis suggests a global HS prevalence of 2.5% using a validated questionnaire. Due to heterogeneity and sparse data from the Global South, this estimate should be interpreted with caution.

.", "provenance": [ { "field": "n", "quote": "The meta-analysis encompassing 49,971 participants revealed a global HS prevalence of 2.5% (95% CI, 1.8-3.5%)." }, { "field": "population", "quote": "\"Have you for the past 6 months had 2 or more boils/abscesses in any of the below locations: in the axilla, in the groin, around your genitals, on the buttocks, several locations i.e., first the buttocks then the axilla, etc.?\"" }, { "field": "intervention", "quote": "This systematic review was prospectively registered on PROSPERO and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines." }, { "field": "comparator", "quote": "A pooled prevalence with 95% confidence interval (CI) was calculated with a random-effects model." }, { "field": "primaryOutcome", "quote": "Thus, we aimed to estimate a global HS prevalence based on studies using homogeneous validated questions." }, { "field": "result", "quote": "revealed a global HS prevalence of 2.5% (95% CI, 1.8-3.5%)" } ] }, { "id": "pmid:39669567", "pmid": "39669567", "doi": "10.3389/fimmu.2024.1475424", "nctId": null, "pmcid": "PMC11635105", "title": "DNA methylation patterns of circadian and ultradian genes are altered in the peripheral blood of patients with hidradenitis suppurativa", "firstAuthor": "Radhakrishna", "multipleAuthors": true, "journal": "Front Immunol", "year": 2024, "design": "case-control", "n": 48, "nField": "reported", "population": "people with hidradenitis suppurativa (a chronic inflammatory skin condition affecting areas like underarms, groin, and buttocks) compared to healthy people", "intervention": "none (this study did not test a treatment; it measured DNA methylation patterns)", "comparator": "healthy control subjects", "primaryOutcome": "patterns of DNA methylation (chemical marks on genes) in blood, focusing on circadian and ultradian clock genes", "result": "several circadian and ultradian genes showed altered (mostly reduced) methylation in HS patients, linked to inflammation and immune pathways", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small observational study of blood samples, not a treatment trial, so it cannot tell us whether anything helps or causes buttock pimples.", "directness": "indirect", "limitations": "Small sample size (24 cases, 24 controls); studies hidradenitis suppurativa specifically, not ordinary acne/pimples; blood methylation rather than skin tissue; no intervention tested.", "followUp": "", "plainFinding": "Immune gene changes found in HS patients", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39669567/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects hair follicles in areas with apocrine sweat glands, such as the underarms, groin, and buttocks. The pathogenesis of HS is not fully understood, but considering the key role played by the biological clock in the control of immune/inflammatory processes the derangement of circadian and ultradian pathways could be hypothesized. METHODS: We analyzed genome-wide DNA methylation patterns in peripheral blood from 24 HS cases and 24 controls using the Infinium HumanMethylation450 BeadChip array (Illumina), followed by bioinformatics and statistical analyses. RESULTS: We found that several circadian and ultradian genes were differentially methylated in HS patients, predominantly exhibiting hypomethylation. These genes were enriched in pathways such as MAPK and WNT cascades, acute phase response, cytokine release, inflammation, innate immune response, xenobiotic detoxification, and oxidative stress response. CONCLUSION: Altered DNA methylation patterns of genes related to circadian and ultradian pathways could contribute to immune system derangement and inflammatory processes chronicization in addition to other comorbidities hallmarking HS onset and progression, at the same time representing possible druggable targets.", "provenance": [ { "field": "population", "quote": "peripheral blood from 24 HS cases and 24 controls" }, { "field": "n", "quote": "peripheral blood from 24 HS cases and 24 controls" }, { "field": "comparator", "quote": "24 HS cases and 24 controls" }, { "field": "primaryOutcome", "quote": "genome-wide DNA methylation patterns" }, { "field": "result", "quote": "several circadian and ultradian genes were differentially methylated in HS patients, predominantly exhibiting hypomethylation" }, { "field": "intervention", "quote": "We analyzed genome-wide DNA methylation patterns in peripheral blood from 24 HS cases and 24 controls" } ] }, { "id": "pmid:39644467", "pmid": "39644467", "doi": "10.5070/D330464106", "nctId": null, "pmcid": null, "title": "Nivolumab-induced hidradenitis suppurativa: a case report", "firstAuthor": "Lamberg", "multipleAuthors": true, "journal": "Dermatol Online J", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "a 44-year-old man with metastatic clear cell renal cell cancer", "intervention": "nivolumab immunotherapy", "comparator": "none", "primaryOutcome": "development of hidradenitis suppurativa (boils/nodules) in skin folds", "result": "he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show how common or likely this cause is for anyone else.", "directness": "indirect", "limitations": "Single case report; no control group; cancer immunotherapy patient, not a general population with buttock pimples.", "followUp": "", "plainFinding": "Cancer drug triggered butt boils.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39644467/", "sourceText": "We present a 44-year-old man with metastatic clear cell renal cell cancer undergoing treatment with nivolumab immunotherapy. Three months post-initiation, he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft. The progressive course, lesion symmetry and location, worsening with nivolumab infusions, and biopsy findings supported the diagnosis. Hidradenitis suppurativa pathogenesis involves immune dysregulation marked by elevated IL17 and neutrophil-dominated inflammation [1]. Immune checkpoint inhibitors, including anti-PD1 agents like nivolumab, are linked to immune-related adverse events related to widespread T cell activation, potentially increasing IL17 signaling associated with HS [2,3]. Clinicians should be aware of, and observant for anti-PD1-induced HS, a rare immune-related adverse event, in patients undergoing immune checkpoint inhibitor therapy.", "provenance": [ { "field": "population", "quote": "a 44-year-old man with metastatic clear cell renal cell cancer undergoing treatment with nivolumab immunotherapy" }, { "field": "intervention", "quote": "nivolumab immunotherapy" }, { "field": "result", "quote": "he developed symmetric recurrent nodules and boils in intertriginous areas, diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft" }, { "field": "primaryOutcome", "quote": "diagnosed as stage II hidradenitis suppurativa of the groin and gluteal cleft" }, { "field": "n", "quote": "a 44-year-old man" }, { "field": "comparator", "quote": "We present a 44-year-old man" } ] }, { "id": "pmid:39571540", "pmid": "39571540", "doi": "10.1159/000542670", "nctId": null, "pmcid": null, "title": "Clinical Features and Natural Course of Hidradenitis Suppurativa in Turkey: A Multicenter Study", "firstAuthor": "Alpsoy", "multipleAuthors": true, "journal": "Dermatology", "year": 2025, "design": "retrospective", "n": 827, "nField": "reported", "population": "patients diagnosed with hidradenitis suppurativa in Turkey", "intervention": "various treatments and factors such as antibiotics, biological therapy, and laser epilation", "comparator": "comparison between male and female patients", "primaryOutcome": "the natural course and severity of hidradenitis suppurativa", "result": "Disease most often started in the armpit, then groin and buttock areas, and was more severe in men; antibiotics improved symptoms while stress worsened them", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, cross-sectional study that relied on patient memory and had no control group, so it can't prove cause and effect.", "directness": "indirect", "limitations": "The chronological order of symptoms was recorded retrospectively, which can introduce recall bias, and there is no comparison group of people without hidradenitis suppurativa.", "followUp": "", "plainFinding": "Butt bumps may be hidradenitis suppurativa.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39571540/", "sourceText": "INTRODUCTION: The natural history, the progression of a disease process in an individual over time, has not yet been fully elucidated in hidradenitis suppurativa (HS). In this large multicenter study, we aimed to investigate the natural history of HS and its gender differences. METHODS: This cross-sectional study included 827 patients. The chronological order of the clinical manifestations for each patient was recorded retrospectively. Sociodemographic characteristics, triggering factors, clinical, treatment, and prognostic features were also evaluated. RESULTS: The mean age of disease onset was significantly younger in women than in men (22.42 ± 9.28 vs. 27.06 ± 20.56, p < 0.001) and those with a family history (p < 0.0001). The mean disease duration was 91.17 ± 83.64 months. The most common symptom was purulent discharge (81%). The mean duration of abscess was shorter in women than in men (3.11 ± 2.65 vs. 3.75 ± 3.75, p = 0.01). The axilla was the most common onset area followed by the inguinal and gluteal regions. The disease ran a more severe course in men. Abscess/inflammatory nodule was defined in the last 6 months in 88.6% of the patients; however, the first 5 years of the disease were the most active disease period in 67.5% of the patients. Multivariate analysis revealed being male, older age, family history, involvement of the axillary, inguinal, and perianal regions independently associated with HS severity. While antibiotic use was the most important factor in improving the disease symptoms, stress was the most common aggravating factor. Biological therapy in men, laser epilation and pregnancy in women were significant alleviating factors, whereas weight gain was a more common aggravating factor for women. CONCLUSION: HS shows a relentlessly progressive course with inflammatory attacks, but the first years of the disease are the most active period. This study confirms that environmental and hormonal factors may play an important role in the disease course, probably with other endogenous or exogenous factors.", "provenance": [ { "field": "n", "quote": "This cross-sectional study included 827 patients." }, { "field": "population", "quote": "This cross-sectional study included 827 patients." }, { "field": "intervention", "quote": "Biological therapy in men, laser epilation and pregnancy in women were significant alleviating factors" }, { "field": "comparator", "quote": "investigate the natural history of HS and its gender differences" }, { "field": "primaryOutcome", "quote": "we aimed to investigate the natural history of HS and its gender differences" }, { "field": "result", "quote": "The axilla was the most common onset area followed by the inguinal and gluteal regions." }, { "field": "result", "quote": "The disease ran a more severe course in men." }, { "field": "limitations", "quote": "The chronological order of the clinical manifestations for each patient was recorded retrospectively." } ] }, { "id": "pmid:39387668", "pmid": "39387668", "doi": "10.2340/actadv.v104.40558", "nctId": null, "pmcid": "PMC11481308", "title": "Malignant Transformation in Porokeratosis Ptychotropica: A Systematic Review", "firstAuthor": "Loh", "multipleAuthors": true, "journal": "Acta Derm Venereol", "year": 2024, "design": "systematic-review", "n": 59, "nField": "reported", "population": "people with a rare skin condition called porokeratosis ptychotropica, median age 49", "intervention": "various treatments tried, including topical lovastatin/cholesterol cream", "comparator": "no direct comparator, review of reported cases", "primaryOutcome": "risk of the condition turning into skin cancer and treatment effectiveness", "result": "about 1.7% of cases turned cancerous, and lovastatin/cholesterol cream looked promising as treatment", "resultDirection": "unclear", "quality": "low", "qualityWhy": "it pools rare case reports on an uncommon condition, which carries a high risk of bias and can't be weighed like a controlled study.", "directness": "indirect", "limitations": "abstract notes significant bias in estimating rare occurrences in rare diseases, and best treatment remains uncertain", "followUp": "", "plainFinding": "Rare skin lesion, not ordinary pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39387668/", "sourceText": "Porokeratosis ptychotropica (PP) is a rare and unusual variant of porokeratosis. There is a dearth of information on the natural history, epidemiology, and optimal treatment options. This study aimed to characterize the worldwide distribution, epidemiology, clinical features, and treatments attempted for all reported cases of porokeratosis ptychotropica. A total of 59 cases of porokeratosis ptychotropica have been reported, with most cases originating from the United States. The median age of patients affected with porokeratosis ptychotropica was 49 years. The most involved body locations are the buttocks and gluteal cleft. The risk of malignant transformation in porokeratosis ptychotropica is approximately 1.7% but there is significant bias in estimating rare occurrences in rare diseases. In conclusion, PP is an important but under-recognized variant of porokeratosis, with a likely low risk of malignant transformation. The best available treatment modality remains uncertain; however, the use of topical lovastatin/cholesterol cream appears promising. Long-term surveillance appears prudent for porokeratosis ptychotropica due to a risk of cancerization.", "provenance": [ { "field": "n", "quote": "A total of 59 cases of porokeratosis ptychotropica have been reported" }, { "field": "population", "quote": "The median age of patients affected with porokeratosis ptychotropica was 49 years." }, { "field": "intervention", "quote": "the use of topical lovastatin/cholesterol cream appears promising" }, { "field": "primaryOutcome", "quote": "The risk of malignant transformation in porokeratosis ptychotropica is approximately 1.7%" }, { "field": "result", "quote": "The risk of malignant transformation in porokeratosis ptychotropica is approximately 1.7% but there is significant bias in estimating rare occurrences in rare diseases." }, { "field": "comparator", "quote": "This study aimed to characterize the worldwide distribution, epidemiology, clinical features, and treatments attempted for all reported cases of porokeratosis ptychotropica." } ] }, { "id": "pmid:39336506", "pmid": "39336506", "doi": "10.3390/medicina60091465", "nctId": null, "pmcid": "PMC11434153", "title": "Hidradenitis Suppurativa in Elderly Patients: Clinical and Therapeutical Outcomes-A Review of the Literature", "firstAuthor": "Martora", "multipleAuthors": true, "journal": "Medicina (Kaunas)", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "elderly patients with hidradenitis suppurativa", "intervention": "treatments for hidradenitis suppurativa including antibiotics and biologic drugs", "comparator": "", "primaryOutcome": "", "result": "the abstract discusses treatment considerations and challenges but does not report a specific outcome result", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative literature review without original data or statistical results, so it cannot show whether treatments work.", "directness": "indirect", "limitations": "No original patient data, no outcome measures, and focuses specifically on elderly patients rather than the general population asking about this condition.", "followUp": "", "plainFinding": "Review of HS treatment in elderly.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39336506/", "sourceText": "The management of hidradenitis suppurativa (HS) in elderly patients presents unique challenges due to its chronic inflammatory nature, heterogeneous clinical presentation and comorbidities. While HS typically affects the anogenital and intertriginous regions, elderly patients may exhibit atypical features such as the involvement of the neck, mammary area and gluteal region. The prevalence of HS in the elderly population is lower and the average age of disease onset is higher than in patients under 65. In contrast, it is unclear whether HS in the elderly has different clinical features. The elderly frequently present multiple comorbidities, including obesity, diabetes, and heart disease, which further complicate management decisions. Therapeutic interventions must consider the frailty and increased risk of multimorbidity and adverse events in elderly patients. While systemic antibiotics remain a mainstay of HS treatment, biologic agents such as TNFα inhibitors and secukinumab offer promising options for refractory cases. However, their safety and efficacy in elderly patients, particularly those with multiple comorbidities, require careful consideration. A comprehensive approach to managing HS in elderly patients involves not only pharmacological interventions but also lifestyle modifications and surgical options where appropriate. Multidisciplinary collaboration between dermatologists, geriatricians and other specialists is essential for tailoring treatment strategies and optimizing long-term outcomes and quality of life in special population.", "provenance": [ { "field": "population", "quote": "The management of hidradenitis suppurativa (HS) in elderly patients presents unique challenges due to its chronic inflammatory nature, heterogeneous clinical presentation and comorbidities." }, { "field": "population", "quote": "elderly patients may exhibit atypical features such as the involvement of the neck, mammary area and gluteal region" }, { "field": "intervention", "quote": "While systemic antibiotics remain a mainstay of HS treatment, biologic agents such as TNFα inhibitors and secukinumab offer promising options for refractory cases." }, { "field": "result", "quote": "their safety and efficacy in elderly patients, particularly those with multiple comorbidities, require careful consideration" } ] }, { "id": "pmid:39306801", "pmid": "39306801", "doi": "10.1111/ijd.17498", "nctId": null, "pmcid": null, "title": "Differentiating clinical characteristics of perianal inflammatory bowel disease from perianal hidradenitis suppurativa", "firstAuthor": "Yamanaka-Takaichi", "multipleAuthors": true, "journal": "Int J Dermatol", "year": 2025, "design": "retrospective", "n": 263, "nField": "reported", "population": "patients with perianal skin problems evaluated at a clinic, some with hidradenitis suppurativa, some with inflammatory bowel disease, some with both", "intervention": "having hidradenitis suppurativa (HS) type perianal lesions", "comparator": "having inflammatory bowel disease (IBD) related perianal fistulas", "primaryOutcome": "identifying which clinical features tell apart HS from IBD-related perianal disease", "result": "HS was linked to tunnels and comedones (whiteheads/blackheads) and lesions near the armpits and groin, while IBD was linked to fistulas, abscesses, ulcers, and lesions on the buttocks and perineum", "resultDirection": "unclear", "quality": "low", "qualityWhy": "it is a retrospective review from patient records at one clinic, which can miss or misclassify details and doesn't test a treatment.", "directness": "indirect", "limitations": "Retrospective chart review from a single academic center, so findings may not generalize and causal relationships can't be confirmed.", "followUp": "", "plainFinding": "Different skin clues separate acne-like bumps from bowel disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39306801/", "sourceText": "BACKGROUND: Perianal draining tunnels in hidradenitis suppurativa (HS) and perianal fistulizing inflammatory bowel disease (IBD) present diagnostic and management dilemmas. METHODS: We conducted a retrospective chart review of patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021. Patients' demographic and clinical data were extracted, and 28 clinical features were collected. After experimenting with several machine learning techniques, random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD. RESULTS: A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS). Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones, while fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD. In addition to having lesions in the perianal area, patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin. Among the statistically significant features, the 15 most important were identified by random forest: fistula, tunnel, digestive symptom, knife-cut ulcer, perineum, body mass index, age, axilla, abscess, tags, smoking, groin, genital cutaneous edema, erythema, and bilateral/unilateral. CONCLUSIONS: The results of this study may help differentiate perianal lesions, especially perineal HS and fistulizing perineal IBD, and provide promise for a better therapeutic outcome.", "provenance": [ { "field": "n", "quote": "A total of 263 patients were included (98 with HS, 100 with IBD, and 65 with both IBD and HS)." }, { "field": "population", "quote": "patients with perianal disease evaluated at Mayo Clinic from January 1, 1998, through July 31, 2021" }, { "field": "intervention", "quote": "Patients with HS had a higher mean body mass index, a higher smoking rate, and more commonly showed cutaneous manifestations of tunnels and comedones" }, { "field": "comparator", "quote": "fistulas, abscesses, induration, anal tags, ulcers, and anal fissures were more common in patients with IBD" }, { "field": "primaryOutcome", "quote": "random forests were used to select the 15 most important clinical features to construct the diagnostic prediction model to distinguish perianal HS from fistulizing perianal IBD" }, { "field": "result", "quote": "patients with IBD often had lesions in the buttocks and perineum, while those with HS had additional lesions in the axillae and groin" } ] }, { "id": "pmid:39032108", "pmid": "39032108", "doi": "10.1111/1346-8138.17375", "nctId": null, "pmcid": null, "title": "Adopting adalimumab combined surgery in the management of moderate to severe hidradenitis suppurativa: Experience from a single medical center in southern Taiwan", "firstAuthor": "Lai", "multipleAuthors": true, "journal": "J Dermatol", "year": 2024, "design": "retrospective", "n": 19, "nField": "reported", "population": "Adults with moderate to severe hidradenitis suppurativa (a chronic inflammatory skin condition often affecting the buttocks and groin)", "intervention": "Adalimumab (a biologic injection) combined with surgical excision", "comparator": "No control group; outcomes compared to expected treatment response", "primaryOutcome": "Clinical improvement after treatment", "result": "68.4% of patients improved, 15.8% stayed stable, 15.8% did not respond as expected, with no severe side effects", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective chart review of a small group with no comparison group, so it can't prove the treatment caused the improvement.", "directness": "indirect", "limitations": "Retrospective nature and lack of a control group", "followUp": "", "plainFinding": "Biologic drug plus surgery improved severe boils.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39032108/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory disorder primarily affecting the intertriginous and anogenital regions. Guidelines recommend various treatments for HS, including biologic agents like adalimumab for moderate to severe cases. Adalimumab is a type of human monoclonal IgG1 antibody designed to target tumor necrosis factor α. Recent studies have shown the effectiveness of adalimumab, either alone or combined with surgery, in managing HS. We retrospectively analyzed the medical chart of HS patients in a southern Taiwan medical center from 2019 to 2022 and investigated clinical features and treatment response. The institutional review board at Chang Gung Medical Foundation granted approval for the study. We primarily focused on moderate to severely affected patients. One hundred and two clinically diagnosed HS patients participated, with a male-to-female ratio of 2:1 and an average age of 31.8 at diagnosis. Among them, 41.2% were in Hurley stage III and 32.4% in stage II. Nineteen patients received excision with pre-surgical adalimumab; their average age at diagnosis was 31.1, with a gender ratio of 5.3:1. Surgery was most common on the buttocks (68%), axillae (21%), and groin (10%). Excision patients were primarily in advanced stages (Hurley III 94.7%, II 5.3%) with high body mass index. Adalimumab and surgery combined yielded a 68.4% improvement rate, while 15.8% remained stable and 15.8% did not respond as expected. In addition, smoking and obesity were prevalent among patients. Adalimumab showed promising results in moderate to severe HS, with significant improvement observed in our cases. The combination of adalimumab and surgery appeared effective in advanced HS patients with larger involved areas and more tunnels. No severe adverse events were reported. However, our study was limited by its retrospective nature and the lack of a control group. Despite these limitations, our study revealed the benefits of integrating adalimumab with suitable surgical procedures in managing patients experiencing moderate to severe HS in real-world scenarios.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic inflammatory disorder primarily affecting the intertriginous and anogenital regions." }, { "field": "n", "quote": "Nineteen patients received excision with pre-surgical adalimumab; their average age at diagnosis was 31.1, with a gender ratio of 5.3:1." }, { "field": "intervention", "quote": "Nineteen patients received excision with pre-surgical adalimumab" }, { "field": "comparator", "quote": "our study was limited by its retrospective nature and the lack of a control group" }, { "field": "primaryOutcome", "quote": "investigated clinical features and treatment response" }, { "field": "result", "quote": "Adalimumab and surgery combined yielded a 68.4% improvement rate, while 15.8% remained stable and 15.8% did not respond as expected." }, { "field": "limitations", "quote": "our study was limited by its retrospective nature and the lack of a control group" } ] }, { "id": "pmid:38946190", "pmid": "38946190", "doi": null, "nctId": null, "pmcid": null, "title": "A Case of Noonan Syndrome and Kyrle's Disease: Coincidence or Causality?", "firstAuthor": "Brusasco", "multipleAuthors": true, "journal": "Acta Dermatovenerol Croat", "year": 2024, "design": "case-series", "n": 1, "nField": "reported", "population": "A 39-year-old woman with Noonan Syndrome who developed itchy bump-like skin lesions", "intervention": "Narrowband UVB phototherapy", "comparator": "No comparison treatment", "primaryOutcome": "Resolution of the itchy perforating skin lesions (Kyrle's disease)", "result": "Complete and long-lasting resolution of symptoms, though with some residual atrophic scarring", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single case report of one rare patient, so it cannot reliably show what causes or treats typical buttock pimples.", "directness": "indirect", "limitations": "Single patient case report; rare condition (Kyrle's disease) linked to Noonan Syndrome, not typical acne or folliculitis; no control group; no clear causal mechanism established.", "followUp": "", "plainFinding": "Rare condition, cleared by light therapy.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38946190/", "sourceText": "A 39-year-old Caucasian woman affected by Noonan Syndrome (NS) mutated in RAF1 was referred to us with itchy lesions on her limbs that had appeared two months earlier. Clinically, there were multiple umbilicated papules with a hyperkeratotic central plug, localized on the upper and lower limbs (Figure 1, a-b). The patient had no personal history of diabetes mellitus and no chronic renal failure, but suffered from hypertrophic cardiomyopathy. Blood tests showed no abnormalities. On histological examination of a skin lesion, an ectatic hair follicle with hyperkeratotic ostium was observed with fragments of hair, inflammatory cells, and epidermal perforation. A final diagnosis of Kyrle's disease (KD) was established. The patient underwent narrowband UVB (NB-UVB) phototherapy with residual atrophic scars (Figure 1, c-d) but with complete and long-lasting resolution of symptoms as well. KD belongs to perforating dermatoses (PD), a heterogeneous group of skin diseases characterized by the transepidermal elimination of dermal components. Despite the classification of PD being debated, four primary forms are traditionally recognized: reactive perforating collagenosis, elastosis perforans serpiginosum, perforating folliculitis, and KD (1). The typical skin manifestation of KD is an eruption of dome-shaped papules and nodules with a whitish central keratotic plug, mainly localized on the extremities and the buttocks. Described by Kyrle in 1916, KD is frequently associated with systemic diseases, especially chronic renal failure and diabetes mellitus. Other associated conditions include chronic hepatic disease, internal malignancies, and congestive heart disease (1). Despite the absence of a consensus, the control of the underlying disease remains the first therapeutic target. Both topical (keratolytics, retinoids, and corticosteroids) and systemic treatments (corticosteroid, retinoids, antibiotics, and phototherapy) have been reported to control skin manifestations (2). In our experience, NB-UVB is an effective option as first-line therapy in case of diffuse lesions, both in KD and in other PDs (3). NS is a relatively common RASopathy, an heterogenous group of genetic disease characterized by a defect of the Ras-mitogen-activated protein kinase (Ras-MAPK) pathway, with an estimated prevalence of 1/1000-2500. PTPN11 is the most frequent mutated gene, accounting for 50% of cases, but more than ten genes were identified as causing NS (4). Classical features include a distinctive facial dysmorphism, short stature, pulmonic stenosis, and other anomalies of different organs. The skin is commonly involved. Keratinization disorders and hair abnormalities such as keratosis pilaris, ulerythema ophryogenes, wavy or curly hair, and scarce scalp hair are often described. Other cutaneous signs include easy bruising, skin hyperlaxity, multiple lentigines, and café-au-lait spots (5). To the best of our knowledge, no cases of KD in patients with NS have been previously reported to date. The exact etiopathogenesis of KD is not clear, but it was hypothesized that systemic diseases, such as diabetes and chronic renal failure, can cause a deposit of substances or dermis alterations, which triggers the inflammatory process with subsequent transepidermal extrusion (1). In our patient, we ruled out all the causes commonly associated with KD. It is however possible that this manifestation could be a direct result of our patient's illness. Our patient suffered from diffuse keratosis pilaris, and one of the possible pathogenetic mechanisms of KD was theorized to be an abnormal epidermal keratinization with a secondary inflammatory dermic response (1). On the other hand, the hyperlaxity and fragility of the skin typical of NS suggest the presence of altered connective tissue, which could trigger an abnormal keratinization and, subsequently, the transepidermal extrusion, as well as perforating elastosis, and is associated with genetic connective tissue diseases (1). Moreover, our patient suffered from a cardiac disease, another condition associated with KD (5). Although these explanations have their appeal, there is currently insufficient evidence of a link between KD and NS, and it will be necessary to collect additional data to confirm this hypothesis.", "provenance": [ { "field": "n", "quote": "A 39-year-old Caucasian woman affected by Noonan Syndrome (NS) mutated in RAF1 was referred to us with itchy lesions on her limbs that had appeared two months earlier." }, { "field": "population", "quote": "A 39-year-old Caucasian woman affected by Noonan Syndrome (NS) mutated in RAF1 was referred to us with itchy lesions on her limbs that had appeared two months earlier." }, { "field": "intervention", "quote": "The patient underwent narrowband UVB (NB-UVB) phototherapy with residual atrophic scars (Figure 1, c-d) but with complete and long-lasting resolution of symptoms as well." }, { "field": "comparator", "quote": "The patient underwent narrowband UVB (NB-UVB) phototherapy with residual atrophic scars (Figure 1, c-d) but with complete and long-lasting resolution of symptoms as well." }, { "field": "primaryOutcome", "quote": "with complete and long-lasting resolution of symptoms as well" }, { "field": "result", "quote": "The patient underwent narrowband UVB (NB-UVB) phototherapy with residual atrophic scars (Figure 1, c-d) but with complete and long-lasting resolution of symptoms as well." } ] }, { "id": "pmid:38796609", "pmid": "38796609", "doi": "10.1007/s00403-024-03000-5", "nctId": null, "pmcid": null, "title": "A review of surgical and reconstructive techniques for hidradenitis suppurativa", "firstAuthor": "Wong", "multipleAuthors": true, "journal": "Arch Dermatol Res", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (chronic inflammatory skin condition affecting armpit, groin, buttock areas)", "intervention": "surgical treatment (excision, laser, deroofing) and reconstructive techniques", "comparator": "medical/non-surgical management", "primaryOutcome": "long-term control and healing of skin lesions", "result": "surgery, especially wide excision, gave the best long-lasting control and healing compared to other treatments, though best reconstruction method is still debated", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative review summarizing existing surgical techniques without new patient data or controlled comparisons.", "directness": "indirect", "limitations": "review does not report original patient numbers or controlled trial data; focuses on surgical technique discussion rather than diagnosing causes of buttock pimples.", "followUp": "", "plainFinding": "Surgery works best for this skin condition.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38796609/", "sourceText": "Hidradenitis suppurativa (HS) is an inflammatory follicular dermatological condition that typically affects the intertriginous and anogenital regions of the apocrine gland-bearing skin. The management of this chronic and recurring disease necessitates a combination of lifestyle changes, medication, and surgical approaches to achieve the best possible outcomes. While medical treatments are recommended for this multimodal disease, surgical therapy, which is the gold standard of treatment for HS, has proven to be the most effective treatment because it provides long-lasting local disease control, reduces the recurrence of lesions, and ensures complete healing of lesions. In the last decade, there has been exponential growth in research into various surgical techniques and reconstructive care, enabling patients to have more surgical options. There is a wide range of surgical management procedures available, such as incision and drainage, deroofing, excisional surgery, carbon dioxide laser therapy, and skin tissue-sparing excision with electrosurgical peeling. Among these surgical procedures, wide surgical excision is the best option since it can eradicate all the affected lesions. Meanwhile, the preferred approach to reconstruction at various anatomical locations remains debatable. Here, we review a variety of surgical treatments and reconstructive techniques for HS, particularly various flap techniques for the axillary, gluteal, and inframammary regions.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is an inflammatory follicular dermatological condition that typically affects the intertriginous and anogenital regions of the apocrine gland-bearing skin." }, { "field": "intervention", "quote": "surgical therapy, which is the gold standard of treatment for HS, has proven to be the most effective treatment" }, { "field": "comparator", "quote": "While medical treatments are recommended for this multimodal disease" }, { "field": "primaryOutcome", "quote": "it provides long-lasting local disease control, reduces the recurrence of lesions, and ensures complete healing of lesions" }, { "field": "result", "quote": "Among these surgical procedures, wide surgical excision is the best option since it can eradicate all the affected lesions." } ] }, { "id": "pmid:38563434", "pmid": "38563434", "doi": "10.1097/DSS.0000000000004185", "nctId": null, "pmcid": null, "title": "Demographic and Clinical Features and Factors Affecting the Quality of Life of Patients With Hidradenitis Suppurativa: A Cross-sectional Study", "firstAuthor": "Erol Mart", "multipleAuthors": true, "journal": "Dermatol Surg", "year": 2024, "design": "retrospective", "n": 176, "nField": "reported", "population": "adults aged 18 to 65 with hidradenitis suppurativa", "intervention": "none - observational study examining demographic and clinical characteristics", "comparator": "none - no treatment comparison, patients compared by disease severity and location", "primaryOutcome": "quality of life as measured by the Dermatology Life Quality Index", "result": "quality of life was worse in patients with more advanced disease stage, lesions in the buttock/leg area, and more affected body areas", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a cross-sectional observational study without a control or follow-up, so it can only show associations, not prove what causes the condition or how to treat it.", "directness": "indirect", "limitations": "abstract does not describe study limitations such as recall bias, generalizability, or confounding", "followUp": "", "plainFinding": "Severe cases hurt quality of life more", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38563434/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with well-known adverse effects on quality of life (QoL). Improving patients' QoL has become an important objective of treatment. OBJECTIVE: The purpose of this study was to evaluate the demographic and clinical characteristics and factors affecting the QoL of patients with HS. MATERIALS AND METHODS: One hundred seventy-six patients with HS aged between 18 and 65 years were included in the study. The patients' demographic and clinical characteristics, treatments, and comorbidities were recorded. The disease stage was determined based on the Hurley staging system. The Dermatology Life Quality Index (DLQI) was used to evaluate QoL. RESULTS: Mean DLQI scores were significantly higher in patients with advanced Hurley stages, lesions in the gluteal region and legs, and with more than 2 affected areas ( p < .001). Correlations between patient-reported treatment outcomes and clinical characteristics of the patients were assessed. Findings of this study indicate the existence of a potential \"window of opportunity\" for laser epilation and wide local surgical excision, similar to anti-tumor necrosis factor therapy. CONCLUSION: Timely and appropriate treatment can only be provided for patients with HS by evaluating objective disease severity measures and subjective patient data in combination.", "provenance": [ { "field": "n", "quote": "One hundred seventy-six patients with HS aged between 18 and 65 years were included in the study." }, { "field": "population", "quote": "One hundred seventy-six patients with HS aged between 18 and 65 years were included in the study." }, { "field": "primaryOutcome", "quote": "The Dermatology Life Quality Index (DLQI) was used to evaluate QoL." }, { "field": "result", "quote": "Mean DLQI scores were significantly higher in patients with advanced Hurley stages, lesions in the gluteal region and legs, and with more than 2 affected areas ( p < .001)." }, { "field": "intervention", "quote": "The patients' demographic and clinical characteristics, treatments, and comorbidities were recorded." }, { "field": "comparator", "quote": "Correlations between patient-reported treatment outcomes and clinical characteristics of the patients were assessed." } ] }, { "id": "pmid:38439730", "pmid": "38439730", "doi": null, "nctId": null, "pmcid": null, "title": "A Case of Noonan Syndrome and Kyrle Disease: Casualty or Causality?", "firstAuthor": "Brusasco", "multipleAuthors": true, "journal": "Acta Dermatovenerol Croat", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "39-year-old woman with Noonan Syndrome who developed itchy skin lesions on her arms and legs", "intervention": "narrowband UVB phototherapy for the skin lesions", "comparator": "", "primaryOutcome": "resolution of the itchy skin lesions", "result": "the lesions completely and lastingly cleared after treatment, though some scarring remained", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this applies to other people or to typical buttock pimples.", "directness": "indirect", "limitations": "Only one patient was described, the condition (Kyrle disease) is rare and linked to other illnesses, and the lesions were on the limbs rather than the buttocks.", "followUp": "", "plainFinding": "Rare condition, not typical acne.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38439730/", "sourceText": "A 39-year-old Caucasian woman affected by Noonan Syndrome (NS) mutated in RAF1 was referred to us with itchy lesions on her limbs that had appeared two months earlier. Clinically, there were multiple umbilicated papules with a hyperkeratotic central plug, localized on the upper and lower limbs (Figure 1, a-b). The patient had no personal history of diabetes mellitus or chronic renal failure, but suffered from hypertrophic cardiomyopathy. Blood tests showed no abnormalities. On histological examination of a skin lesion, an ectatic hair follicle with a hyperkeratotic ostium was observed with fragments of hair, inflammatory cells, and epidermal perforation. A final diagnosis of Kyrle disease (KD) was established. The patient underwent narrowband UVB (NB-UVB) phototherapy with residual atrophic scars (Figure 1, c-d), but with a complete and long-lasting resolution of symptoms. KD belongs to perforating dermatoses (PD), a heterogeneous group of skin diseases characterized by the transepidermal elimination of dermal components. Despite the classification of PD still being under debate, four primary forms are traditionally recognized: reactive perforating collagenosis, elastosis perforans serpiginosum, perforating folliculitis, and KD (1). The typical skin manifestation of KD is an eruption of dome-shaped papules and nodules, with a whitish central keratotic plug, mainly localized on the extremities and the buttocks. Described by Kyrle in 1916, KD is frequently associated with systemic diseases, especially chronic renal failure and diabetes mellitus. Other associated conditions include chronic hepatic disease, internal malignancies, and congestive heart disease (1). Despite the absence of a consensus, the control of the underlying disease remains the first therapeutic target. Both topical (keratolytics, retinoids, and corticosteroids) and systemic treatments (corticosteroids, retinoids, antibiotics, and phototherapy) have been reported to control skin manifestations (2). In our experience, NB-UVB is an effective option as first-line therapy in case of diffuse lesions, both in KD and in other PD (3). NS is a relatively common RASopathy, a heterogenous group of genetic diseases characterized by a defect of the Ras-mitogen-activated protein kinase (Ras-MAPK) pathway, with an estimated prevalence of 1/1000-2500. PTPN11 is the most frequent mutated gene, accounting for 50% of cases, but more than ten genes have been identified as causing NS (4). Classical features include a distinctive facial dysmorphism, short stature, pulmonic stenosis, and other anomalies of different organs. The skin is commonly involved. Keratinization disorders and hair abnormalities such as keratosis pilaris, ulerythema ophryogenes, wavy or curly hair, and scarce scalp hair, are often described. Other cutaneous signs include easy bruising, skin hyperlaxity, multiple lentigines, and café-au-lait spots (5). To the best of our knowledge, no cases of KD in patients with NS have been previously reported to date. The exact etiopathogenesis of KD is not clear, but it has been hypothesized that systemic diseases, such as diabetes and chronic renal failure, can cause a deposit of substances or dermis alterations, which triggers the inflammatory process with subsequent transepidermal extrusion (1). In our patient, we ruled out all the causes commonly associated with KD. It is however possible that this manifestation could be a direct result of the patient's illness. Our patient suffered from diffuse keratosis pilaris, and an abnormal epidermal keratinization with a secondary inflammatory dermic response is among the suggested possible pathogenetic mechanisms of KD (1). On the other hand, the hyperlaxity and fragility of the skin typical of NS suggest the presence of altered connective tissue, which could trigger an abnormal keratinization and, subsequently, the transepidermal extrusion, as well as perforating elastosis, which is associated with genetic connective tissue diseases (1). Moreover, our patient suffered from a cardiac disease, another condition associated with KD (5). Although these explanations have their appeal, there is currently insufficient evidence of a link between KD and NS, and it will be necessary to collect additional data to confirm this hypothesis.", "provenance": [ { "field": "population", "quote": "A 39-year-old Caucasian woman affected by Noonan Syndrome (NS) mutated in RAF1 was referred to us with itchy lesions on her limbs that had appeared two months earlier." }, { "field": "intervention", "quote": "The patient underwent narrowband UVB (NB-UVB) phototherapy" }, { "field": "result", "quote": "with residual atrophic scars (Figure 1, c-d), but with a complete and long-lasting resolution of symptoms." }, { "field": "primaryOutcome", "quote": "complete and long-lasting resolution of symptoms" }, { "field": "n", "quote": "A 39-year-old Caucasian woman" } ] }, { "id": "pmid:38306140", "pmid": "38306140", "doi": "10.36849/JDD.7624", "nctId": null, "pmcid": null, "title": "A New Tool to Improve Communication Between Hidradenitis Suppurativa Patients and Health Care Providers", "firstAuthor": "Zundell", "multipleAuthors": true, "journal": "J Drugs Dermatol", "year": 2024, "design": "case-series", "n": 30, "nField": "reported", "population": "People with hidradenitis suppurativa (HS) seen at a dermatology clinic", "intervention": "A new patient questionnaire ('Shine a Light on HS' as modified by IDEOM) completed before the doctor visit", "comparator": "No comparison group; patients rated the tool after using it", "primaryOutcome": "Patient-rated helpfulness of the questionnaire and overall quality of the clinical visit", "result": "Higher questionnaire helpfulness ratings were linked to better overall clinical experience ratings", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small single-site study of 30 patients with no comparison group, relying on self-reported ratings.", "directness": "indirect", "limitations": "Single site, small sample (n=30), no control group, self-reported outcome scales.", "followUp": "9-month long period", "plainFinding": "Communication tool improved patient-doctor visits.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/38306140/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) patients tend to experience diagnosis delay, misdiagnosis, and embarrassment due to their condition. To address these issues, the International Dermatology Outcome Measure (IDEOM) HS Workgroup collaborated with patients to modify an existing Novartis questionnaire to better suit the needs of HS patients. This quality improvement project aimed to use the resulting Shine a Light on HS as Modified by the IDEOM HS Workgroup Questionnaire to enhance communication between HS patients and providers, improve clinical experience for HS patients, and gather relevant demographic data. METHOD: Patients with HS presenting to Mount Sinai Union Square over a 9-month long period were invited to complete the Shine a Light on HS as Modified by the IDEOM HS Workgroup Questionnaire before seeing their providers. After the visit, patients rated their overall clinical experience and the helpfulness of the survey on a 5-point scale. RESULTS: The analysis cohort (n=30) consisted of a racially and ethnically diverse patient population. On a scale of 0-4, the mean helpfulness rating was 3.1 (SD=1), and the mean clinical experience rating was 3.5 (SD=0.78). There was a positive correlation between survey helpfulness and overall clinical experience and a moderately strong relationship by linear regression analysis (r=0.73, R2=0.53). 80% reported frequent flares, 54% reported >10 years of symptoms, and the most commonly affected areas were the axillae, gluteal cleft, groin, and inguinocrural folds. The mean pain rating was 8 out of 10 (SD=2.55, Var=6.5). The majority of patients reported scars, tunnels, open wounds, ER/Urgent Care visits, inflammatory skin symptoms, and systemic symptoms. 39% had a positive HS family history. Biologics were the least common previous treatment reported (43%). Emotional burden was reported by nearly all patients, and comorbidities included depression, heart disease, arthritis, polycystic ovary syndrome (PCOS), diabetes, and irritable bowel disease (IBD). CONCLUSION: The Shine a Light on HS as Modified by the IDEOM HS Workgroup Questionnaire was successful in improving HS patient-provider conversations, enhancing the overall clinical experience for HS patients, and collecting insightful demographic data. Healthcare providers should consider incorporating the questionnaire as part of their routine care for HS to enhance clinical discussion and improve outcomes for patients. J Drugs Dermatol. 2024;23(2):105-109.   doi:10.36849/JDD.7624.", "provenance": [ { "field": "n", "quote": "The analysis cohort (n=30) consisted of a racially and ethnically diverse patient population." }, { "field": "population", "quote": "Patients with HS presenting to Mount Sinai Union Square over a 9-month long period" }, { "field": "intervention", "quote": "the Shine a Light on HS as Modified by the IDEOM HS Workgroup Questionnaire" }, { "field": "comparator", "quote": "After the visit, patients rated their overall clinical experience and the helpfulness of the survey on a 5-point scale." }, { "field": "primaryOutcome", "quote": "the mean helpfulness rating was 3.1 (SD=1), and the mean clinical experience rating was 3.5 (SD=0.78)" }, { "field": "result", "quote": "There was a positive correlation between survey helpfulness and overall clinical experience and a moderately strong relationship by linear regression analysis (r=0.73, R2=0.53)." } ] }, { "id": "pmid:37974484", "pmid": "37974484", "doi": "10.2340/actadv.v103.11603", "nctId": null, "pmcid": "PMC10666065", "title": "Association between Hidradenitis Suppurativa and Abnormalities in Semen Parameters and Sexual Function: A Pilot Study", "firstAuthor": "Lotan", "multipleAuthors": true, "journal": "Acta Derm Venereol", "year": 2023, "design": "case-control", "n": 72, "nField": "reported", "population": "men with hidradenitis suppurativa (a chronic skin condition), compared to healthy men", "intervention": "having hidradenitis suppurativa, including some with lesions on the buttocks and genitals", "comparator": "healthy men who were spouses of infertile women undergoing IVF", "primaryOutcome": "sperm quality, hormone levels, testicular ultrasound, and erectile function", "result": "men with severe buttock/genital lesions had worse sperm quality than those without such lesions or healthy controls, and 93% reported erectile dysfunction", "resultDirection": "harm", "quality": "low", "qualityWhy": "this was a small pilot study comparing patients to controls who were not perfectly matched, so it cannot prove HS causes these problems.", "directness": "indirect", "limitations": "small pilot study; patients with HS were younger and more often smokers than controls; controls were drawn from an infertility clinic, not the general population", "followUp": "", "plainFinding": "Worse sperm quality, erectile dysfunction.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37974484/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting patients of reproductive age. Although HS shares risk factors with male infertility, only 1 epidemiological study has evaluated this association. To further evaluate this potential association, findings on semen and hormonal analysis, testicular ultrasound, and the International Index of Erectile Function (IIEF-15) were compared between 28 men attending a tertiary HS clinic during the period April 2019 to April 2021, and 44 healthy controls, spouses of infertile women undergoing semen evaluation before in vitro fertilization. Patients with HS were divided based on the absence or presence of gluteal and genital lesions. Patients with HS were younger than controls (median 27 vs 34 years, p < 0.0004) and had a higher proportion of smokers (86% vs 33%, p < 0.0001). Semen parameters in patients with gluteal-genital lesions, specifically those with severe scrotal involvement necessitating surgery, were lower than the WHO reference values and significantly lower than in patients without gluteal-genital lesions and controls. Erectile dysfunction was reported by 93% of patients with HS. These findings suggest that spermatogenesis and sexual function may be impaired in young men with HS. Therefore, multidisciplinary management of HS should include their evaluation to identify patients who might benefit from semen cryopreservation and sexual treatment.", "provenance": [ { "field": "n", "quote": "28 men attending a tertiary HS clinic during the period April 2019 to April 2021, and 44 healthy controls" }, { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting patients of reproductive age" }, { "field": "intervention", "quote": "Patients with HS were divided based on the absence or presence of gluteal and genital lesions" }, { "field": "comparator", "quote": "44 healthy controls, spouses of infertile women undergoing semen evaluation before in vitro fertilization" }, { "field": "primaryOutcome", "quote": "findings on semen and hormonal analysis, testicular ultrasound, and the International Index of Erectile Function (IIEF-15)" }, { "field": "result", "quote": "Semen parameters in patients with gluteal-genital lesions, specifically those with severe scrotal involvement necessitating surgery, were lower than the WHO reference values and significantly lower than in patients without gluteal-genital lesions and controls. Erectile dysfunction was reported by 93% of patients with HS." } ] }, { "id": "pmid:37801530", "pmid": "37801530", "doi": "10.36849/JDD.7534", "nctId": null, "pmcid": null, "title": "Keratosis Pilaris: Treatment Practices of Board-Certified Dermatologists", "firstAuthor": "Greenzaid", "multipleAuthors": true, "journal": "J Drugs Dermatol", "year": 2023, "design": "case-series", "n": null, "nField": "not-reported", "population": "board-certified dermatologists treating keratosis pilaris (bumps often on buttocks)", "intervention": "topical treatments such as lactic acid and salicylic acid, plus laser therapy", "comparator": "different topical and laser treatment options compared to each other", "primaryOutcome": "which treatments dermatologists use most and how well they work", "result": "Lactic acid was the most common first choice, laser therapy was rarely used, and over 60% saw bumps return within three months of stopping salicylic acid or moisturizer treatment", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is just a survey of doctors' opinions and habits, not a controlled study testing whether treatments actually work.", "directness": "indirect", "limitations": "Based on a survey of dermatologists' reported practices and perceptions rather than measured patient outcomes, with no control group.", "followUp": "three months", "plainFinding": "Bumps often return after treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37801530/", "sourceText": "Keratosis pilaris (KP) is a chronic disorder of follicular hyperkeratinization and perifollicular erythema with lesions affecting the extensor surfaces of arms, upper legs, and buttocks. While there is some evidence that laser therapies and topical therapies such as lactic acid reduce the follicular papules of KP, support is limited with respect to which topical treatments dermatologists utilize and their perception of efficacy. A 16-question survey was distributed to a random sampling of the ODAC Conference listserv to determine which topical treatments dermatologists utilize the most, the duration of therapy needed with various treatment modalities, and the effectiveness of topical and laser therapy for treating KP. Our study found topical lactic acid is the most used first-line therapy for KP (43.63% of survey respondents), followed by salicylic acid (20.72%). Laser therapy is only utilized by 8.76% of survey respondents, with a lack of insurance coverage and proper equipment limiting its use. KP is often recalcitrant to treatment, and our study demonstrated that over 60% of respondents found recurrence of KP lesions within three months of stopping salicylic acid treatment and OTC moisturizer treatment. The data herein can be used to better utilize the selection of topical and laser therapies for the treatment of KP. J Drugs Dermatol. 2023;22(10):985-989 doi:10.36849/JDD.7534.", "provenance": [ { "field": "population", "quote": "Keratosis pilaris (KP) is a chronic disorder of follicular hyperkeratinization and perifollicular erythema with lesions affecting the extensor surfaces of arms, upper legs, and buttocks" }, { "field": "intervention", "quote": "topical lactic acid is the most used first-line therapy for KP (43.63% of survey respondents), followed by salicylic acid (20.72%)" }, { "field": "comparator", "quote": "which topical treatments dermatologists utilize the most" }, { "field": "primaryOutcome", "quote": "to determine which topical treatments dermatologists utilize the most, the duration of therapy needed with various treatment modalities, and the effectiveness of topical and laser therapy for treating KP" }, { "field": "result", "quote": "over 60% of respondents found recurrence of KP lesions within three months of stopping salicylic acid treatment and OTC moisturizer treatment" }, { "field": "followUp", "quote": "recurrence of KP lesions within three months of stopping salicylic acid treatment and OTC moisturizer treatment" } ] }, { "id": "pmid:37797882", "pmid": "37797882", "doi": "10.1016/j.ad.2023.09.021", "nctId": null, "pmcid": null, "title": "Gluteal Hidradenitis Suppurativa: Analysis of 83 Patients", "firstAuthor": "Riera-Martí", "multipleAuthors": true, "journal": "Actas Dermosifiliogr", "year": 2024, "design": "retrospective", "n": 83, "nField": "reported", "population": "patients with gluteal hidradenitis suppurativa (boil-like skin disease)", "intervention": "", "comparator": "compared gluteal-phenotype patients to the rest of the hidradenitis suppurativa patient group", "primaryOutcome": "clinical characteristics and subtypes of gluteal hidradenitis suppurativa", "result": "gluteal patients split into two distinct clinical subtypes, with differences in age, sex and lesion type compared to other hidradenitis suppurativa patients", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a small, retrospective study from only two hospitals looking at classification, not treatment effectiveness.", "directness": "indirect", "limitations": "retrospective nature, bicentric design, and small sample size", "followUp": "", "plainFinding": "Describes two subtypes of gluteal boils.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37797882/", "sourceText": "BACKGROUND: In 2013, Canoui-Poitrine et al. identified three hidradenitis suppurativa (HS) phenotypes by a latent class (LC) analysis, based on anatomical sites of involvement. OBJECTIVE: To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile. MATERIAL AND METHODS: We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals. We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661). RESULTS: Compared with global HS series, LC3 patients were more frequently non-obese men, with smoking habit, an associated arthropathy, and a more frequent history of pilonidal sinus. The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions. LIMITATIONS: The study's limitations include its retrospective nature, bicentric design, and small sample size. CONCLUSION: The heterogeneous clinical presentation of HS makes it essential to have a good classification of the patients. Gluteal phenotype could actually be classified into two \"subphenotypes\" with a different clinical profiles and management.", "provenance": [ { "field": "n", "quote": "We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals." }, { "field": "population", "quote": "We designed a bicentric study gathering all LC3 patients (n=83) from two hospitals." }, { "field": "comparator", "quote": "We conducted a two-step cluster analysis among them and also compared their characteristics with the rest of the HS patients (n=661)." }, { "field": "primaryOutcome", "quote": "To improve the classification of the gluteal phenotype (LC3) patients given their diverse lesion types and differences in clinical profile." }, { "field": "result", "quote": "The analysis of LC3 patients yielded two clusters: cluster 1 (38.3%) included elderly female patients, with later diagnosis of the disease and more sinus tracts; cluster 2 (61.7%) encompassed more men with earlier disease onset and more nodules and folliculitis lesions." }, { "field": "limitations", "quote": "The study's limitations include its retrospective nature, bicentric design, and small sample size." } ] }, { "id": "pmid:37715694", "pmid": "37715694", "doi": "10.1093/bjd/ljad345", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa: new insights into disease mechanisms and an evolving treatment landscape", "firstAuthor": "Krueger", "multipleAuthors": true, "journal": "Br J Dermatol", "year": 2024, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (also called acne inversa), a chronic skin condition", "intervention": "various treatments including topical medications, antibiotics, retinoids, hormonal therapy, biologics and surgery", "comparator": "no specific comparator described", "primaryOutcome": "", "result": "review states HS is driven by immune pathways (TNF-alpha and IL-17) and causes chronic bumps and abscesses in areas like the armpits, groin and buttocks", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general review summarizing current understanding and treatments, not a study testing a specific treatment's effect.", "directness": "indirect", "limitations": "abstract does not describe original study methods, population size, or statistical results; it is a review of a specific diagnosed disease rather than general pimples.", "followUp": "", "plainFinding": "Chronic inflammatory skin disease, not simple acne.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37715694/", "sourceText": "Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need. The prevalence of HS reported in most studies is 1-2%, although it is likely to be under-reported and estimates vary globally owing to variance in data collection methods, ethnicity, geographical location and under-diagnosis. HS is characterized by persistent, painful cutaneous nodules, abscesses and draining tunnels commonly affecting the axillary, anogenital, inguinal and perianal/gluteal areas. Over time, chronic uncontrolled inflammation results in irreversible tissue destruction and scarring. Although the pathophysiology of HS has not been fully elucidated, the tumour necrosis factor (TNF)-α and interleukin (IL)-17 pathways have an important role, involving multiple cytokines. Currently, treatment options include topical medications; systemic therapies, including repeated and/or rotational courses of systemic antibiotics, retinoids and hormonal therapies; and various surgical procedures. The anti-TNF-α antibody adalimumab is currently the only biologic approved by both the US Food and Drug Administration and the European Medicines Agency for HS; however, its efficacy varies, with a clinical response reported in approximately 50% of patients in phase III trials. HS is a rapidly evolving field of discovery, with a diverse range of agents with distinct mechanisms of action currently being explored in clinical trials. Several other promising therapeutic targets have recently emerged, and agents targeting the IL-17 and Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathways are the most advanced in ongoing or completed phase III clinical trials. Alongside limited therapeutic options, significant challenges remain in terms of diagnosis and disease management, with a need for better treatment outcomes. Other unmet needs include significant diagnostic delays, thus missing the therapeutic 'window of opportunity'; the lack of standardized outcome measures in clinical trials; and the lack of established, well-defined disease phenotypes and biomarkers.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic disabling and debilitating inflammatory disease with a high unmet medical need." }, { "field": "intervention", "quote": "treatment options include topical medications; systemic therapies, including repeated and/or rotational courses of systemic antibiotics, retinoids and hormonal therapies; and various surgical procedures" }, { "field": "result", "quote": "HS is characterized by persistent, painful cutaneous nodules, abscesses and draining tunnels commonly affecting the axillary, anogenital, inguinal and perianal/gluteal areas" }, { "field": "result", "quote": "the tumour necrosis factor (TNF)-α and interleukin (IL)-17 pathways have an important role, involving multiple cytokines" }, { "field": "comparator", "quote": "The anti-TNF-α antibody adalimumab is currently the only biologic approved by both the US Food and Drug Administration and the European Medicines Agency for HS" } ] }, { "id": "pmid:37686829", "pmid": "37686829", "doi": "10.3390/nu15173797", "nctId": null, "pmcid": "PMC10490062", "title": "Targeting Metabolic Syndrome in Hidradenitis Suppurativa by Phytochemicals as a Potential Complementary Therapeutic Strategy", "firstAuthor": "Witte", "multipleAuthors": true, "journal": "Nutrients", "year": 2023, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic skin disease causing painful lumps in the groin, buttocks, and underarms", "intervention": "plant-derived compounds (phytochemicals) aimed at improving metabolic syndrome", "comparator": "not a controlled comparison; review discusses findings from other studies in healthy people and patients without hidradenitis suppurativa", "primaryOutcome": "whether phytochemicals could help metabolic syndrome in hidradenitis suppurativa patients", "result": "the review describes mechanisms and summarizes existing preclinical and trial data but does not report a direct result for hidradenitis suppurativa patients", "resultDirection": "unclear", "quality": "low", "qualityWhy": "it is a narrative review that mostly discusses mechanisms and evidence from other conditions rather than testing a treatment directly in people with this skin problem", "directness": "indirect", "limitations": "abstract states results on phytochemicals come from preclinical studies and trials in healthy people or patients without hidradenitis suppurativa, not from patients with the condition itself", "followUp": "", "plainFinding": "Possible link to metabolic syndrome, not proven.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37686829/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by the appearance of painful inflamed nodules, abscesses, and pus-draining sinus tracts in the intertriginous skin of the groins, buttocks, and perianal and axillary regions. Despite its high prevalence of ~0.4-1%, therapeutic options for HS are still limited. Over the past 10 years, it has become clear that HS is a systemic disease, associated with various comorbidities, including metabolic syndrome (MetS) and its sequelae. Accordingly, the life expectancy of HS patients is significantly reduced. MetS, in particular, obesity, can support sustained inflammation and thereby exacerbate skin manifestations and the chronification of HS. However, MetS actually lacks necessary attention in HS therapy, underlining the high medical need for novel therapeutic options. This review directs attention towards the relevance of MetS in HS and evaluates the potential of phytomedical drug candidates to alleviate its components. It starts by describing key facts about HS, the specifics of metabolic alterations in HS patients, and mechanisms by which obesity may exacerbate HS skin alterations. Then, the results from the preclinical studies with phytochemicals on MetS parameters are evaluated and the outcomes of respective randomized controlled clinical trials in healthy people and patients without HS are presented.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by the appearance of painful inflamed nodules, abscesses, and pus-draining sinus tracts in the intertriginous skin of the groins, buttocks, and perianal and axillary regions." }, { "field": "intervention", "quote": "evaluates the potential of phytomedical drug candidates to alleviate its components" }, { "field": "comparator", "quote": "the outcomes of respective randomized controlled clinical trials in healthy people and patients without HS are presented" }, { "field": "primaryOutcome", "quote": "evaluates the potential of phytomedical drug candidates to alleviate its components" }, { "field": "result", "quote": "the results from the preclinical studies with phytochemicals on MetS parameters are evaluated and the outcomes of respective randomized controlled clinical trials in healthy people and patients without HS are presented" }, { "field": "limitations", "quote": "the outcomes of respective randomized controlled clinical trials in healthy people and patients without HS are presented" } ] }, { "id": "pmid:37501251", "pmid": "37501251", "doi": "10.26635/6965.6170", "nctId": null, "pmcid": null, "title": "Scaly erythematous eruptions of intertriginous locations", "firstAuthor": "Aung", "multipleAuthors": true, "journal": "N Z Med J", "year": 2023, "design": "case-series", "n": null, "nField": "not-reported", "population": "flaky erythematous eruptions in a female adult", "intervention": "potent topical steroid and avoidance of inciting triggers", "comparator": "", "primaryOutcome": "resolution", "result": "Management with potent topical steroid and avoidance of inciting triggers offered resolution in 4 weeks in this case.", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether the treatment works in general.", "directness": "indirect", "limitations": "single case report with no control group, so findings may not generalize.", "followUp": "4 weeks", "plainFinding": "Steroid cream cleared rash in one case.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37501251/", "sourceText": "Intertriginous or flexural eruptions are common presenting problems in clinical practice, raising several differential diagnoses. A clinico-histopathological correlation is important to establish a correct diagnosis when a clinical diagnosis cannot be ascertained. We here present a case of flaky erythematous eruptions in a female adult, with a final diagnosis of granular parakeratosis, involving nonflexural area mid-back (under bra cover) in addition to flexural zones of the groin, gluteal fold, inframammary fold and axilla. It seems that mechanism of pressure and friction as well as occlusion all play a part. Management with potent topical steroid and avoidance of inciting triggers offered resolution in 4 weeks in this case.", "provenance": [ { "field": "population", "quote": "We here present a case of flaky erythematous eruptions in a female adult" }, { "field": "intervention", "quote": "Management with potent topical steroid and avoidance of inciting triggers" }, { "field": "primaryOutcome", "quote": "offered resolution in 4 weeks in this case" }, { "field": "result", "quote": "Management with potent topical steroid and avoidance of inciting triggers offered resolution in 4 weeks in this case." } ] }, { "id": "pmid:37494055", "pmid": "37494055", "doi": "10.1001/jamadermatol.2023.2227", "nctId": null, "pmcid": "PMC10372757", "title": "NCSTN In-Frame Deletion in Maltese Patients With Hidradenitis Suppurativa", "firstAuthor": "Mintoff", "multipleAuthors": true, "journal": "JAMA Dermatol", "year": 2023, "design": "case-series", "n": 113, "nField": "reported", "population": "Adults with hidradenitis suppurativa (a condition causing lumps and boils in areas like the buttocks, groin, armpits) in Malta", "intervention": "Genetic testing for a specific NCSTN gene deletion", "comparator": "Patients with hidradenitis suppurativa who did not carry the gene variant", "primaryOutcome": "How common the NCSTN gene variant is and whether it links to a distinct disease pattern", "result": "The gene variant was found in about 12% of patients and was linked to earlier onset and an unusual pattern involving the scalp, neck, torso and elbow creases", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a single-center study of one ethnic population looking at genetics, not a treatment trial, so it can't tell us whether any intervention helps.", "directness": "indirect", "limitations": "Conducted in a single ethnic (Maltese) population at one reference center, so findings on this specific gene variant may not generalize, and the study does not address general causes or treatment of buttock pimples.", "followUp": "", "plainFinding": "Rare gene variant linked to unusual HS pattern", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37494055/", "sourceText": "IMPORTANCE: Hidradenitis suppurativa (HS) is a complex trait that has a monogenic etiology in a subset of patients. Variation in genes that encode proteins of the γ secretase complex, particularly NCSTN, account for few patients who exhibit familial forms of HS. Thus far, extensive genotype-phenotype correlations have been lacking. OBJECTIVE: To establish the prevalence of the NCSTN:c.671_682del variant and explore potential genotype-phenotype associations in an ethnically Maltese HS cohort. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study conducted from December 2021 to September 2022 included patients 18 years or older with a diagnosis of HS as defined by recurrent nodules, abscesses, and/or draining tunnels in typical (axilla, breast, groin, buttock, thighs, and inframammary folds) and less typical (scalp, ear pinnae, neck, arms, antecubital fossae) sites who were recruited from the sole national dermatology reference center servicing the Maltese archipelago. Clinical examination and targeted genetic analysis for an NCSTN deletion that was originally identified through whole-exome sequencing in a family with multigenerational disease were performed. EXPOSURE: Recruited patients were phenotyped and genotyped for the NCSTN:c.671_682del variant. MAIN OUTCOME AND MEASURES: To determine the prevalence of the NCSTN:c.671_682del variant and establish possible genotype-phenotype associations in the ethnically Maltese HS cohort. RESULTS: A total of 113 patients with HS (56 women [49.6%]) met the inclusion criteria and were enrolled in this study. The median age of disease onset was 18 years (range, 7-62 years), and the median International Hidradenitis Suppurativa Severity Score System score was 4.39 (range, 1.0-64.0). The NCSTN variant was identified in the heterozygous state in 14 patients (12.4%) from 5 unrelated, nonconsanguineous families of Maltese ethnicity. The variant was not identified in an ethnically matched reference genomic data set of disease-free individuals. Variant carriers manifested HS symptoms earlier and were more likely to exhibit a distinctive HS phenotype, which was characterized by involvement of the scalp, neck, torso, and antecubital fossae. Despite manifesting similar clinical disease severity, variant carriers were more likely to require treatment with adalimumab. CONCLUSIONS AND RELEVANCE: The results of this cross-sectional study suggest that monogenic variation in NCSTN is associated with HS in a subset of patients who have a distinct, atypical phenotype.", "provenance": [ { "field": "n", "quote": "A total of 113 patients with HS (56 women [49.6%]) met the inclusion criteria and were enrolled in this study." }, { "field": "population", "quote": "patients 18 years or older with a diagnosis of HS as defined by recurrent nodules, abscesses, and/or draining tunnels in typical (axilla, breast, groin, buttock, thighs, and inframammary folds) and less typical (scalp, ear pinnae, neck, arms, antecubital fossae) sites" }, { "field": "intervention", "quote": "targeted genetic analysis for an NCSTN deletion" }, { "field": "comparator", "quote": "The variant was not identified in an ethnically matched reference genomic data set of disease-free individuals." }, { "field": "primaryOutcome", "quote": "To determine the prevalence of the NCSTN:c.671_682del variant and establish possible genotype-phenotype associations in the ethnically Maltese HS cohort." }, { "field": "result", "quote": "The NCSTN variant was identified in the heterozygous state in 14 patients (12.4%) from 5 unrelated, nonconsanguineous families of Maltese ethnicity." }, { "field": "result", "quote": "Variant carriers manifested HS symptoms earlier and were more likely to exhibit a distinctive HS phenotype, which was characterized by involvement of the scalp, neck, torso, and antecubital fossae." } ] }, { "id": "pmid:37226509", "pmid": "37226509", "doi": null, "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa. A case report", "firstAuthor": "Fabian", "multipleAuthors": true, "journal": "Ann Ital Chir", "year": 2023, "design": "case-series", "n": 1, "nField": "reported", "population": "a 28-year-old man with advanced, persistent hidradenitis suppurativa", "intervention": "combined conservative and surgical treatment including wide excisions and flap reconstruction surgeries", "comparator": "none", "primaryOutcome": "resolution of the disease/wound closure", "result": "the case was successfully managed with combined surgical and conservative treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether the treatment works in general.", "directness": "indirect", "limitations": "single case report with no comparison group; describes a severe surgical case, not typical mild buttock pimples.", "followUp": "", "plainFinding": "Severe case fixed with surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37226509/", "sourceText": "Hidradenitis suppurativa is a disease with underestimated incidence, consequences and treatment difficulty. Regarded as a minor illness, for the patient it is disabling physically and socially, and for the doctor it is a challenge in choosing the appropriate treatment. We present the case of a 28-year-old man who presented with an advanced and persistent form of hidradenitis treated in a general surgery department. Solving the case combined conservative and surgical treatment (wide excisions, plasties with fasciocutaneous superior gluteal artery perforator flap, thoracodorsal artery perforator flap, free anterolateral thigh flap). This case illustrates the problems raised by a seemingly trivial disease. KEY WORDS: Fasciocutaneous Superior Gluteal Artery Perforator Flap, Follicular Occlusion, Free Anterolateral Thigh Flap, Hidradenitis Suppurativa, Skin Ulcer, Skin Fold, Thoracodorsal Artery Perforator Flap.", "provenance": [ { "field": "n", "quote": "a 28-year-old man" }, { "field": "population", "quote": "a 28-year-old man who presented with an advanced and persistent form of hidradenitis treated in a general surgery department" }, { "field": "intervention", "quote": "Solving the case combined conservative and surgical treatment (wide excisions, plasties with fasciocutaneous superior gluteal artery perforator flap, thoracodorsal artery perforator flap, free anterolateral thigh flap)." }, { "field": "comparator", "quote": "Solving the case combined conservative and surgical treatment" }, { "field": "primaryOutcome", "quote": "Solving the case combined conservative and surgical treatment" }, { "field": "result", "quote": "Solving the case combined conservative and surgical treatment (wide excisions, plasties with fasciocutaneous superior gluteal artery perforator flap, thoracodorsal artery perforator flap, free anterolateral thigh flap)." } ] }, { "id": "pmid:36538899", "pmid": "36538899", "doi": "10.1159/000528752", "nctId": null, "pmcid": null, "title": "Positive Predictive Value of Diagnosis Codes for Hidradenitis Suppurativa and Cutaneous Abscess", "firstAuthor": "Smiley", "multipleAuthors": true, "journal": "Dermatology", "year": 2023, "design": "retrospective", "n": 200, "nField": "reported", "population": "patients with diagnosis codes for hidradenitis suppurativa or cutaneous abscess in the buttock, groin, axilla, or perineum region", "intervention": "a diagnosis-code based algorithm to identify hidradenitis suppurativa or cutaneous abscess cases in a health system database", "comparator": "dermatologist chart review as the gold-standard diagnosis", "primaryOutcome": "accuracy (positive predictive value) of diagnosis codes for correctly identifying hidradenitis suppurativa or cutaneous abscess", "result": "the diagnosis-code algorithm correctly identified hidradenitis suppurativa 88% of the time and cutaneous abscess 75% of the time, compared to doctor chart review", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a small retrospective check of medical record coding accuracy, not a study of causes or treatments, so it offers very little direct evidence for the actual question.", "directness": "indirect", "limitations": "abstract does not describe how records were selected beyond the coding algorithm, nor any info on causes or treatment of buttock pimples.", "followUp": "", "plainFinding": "Did not study causes of buttock pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36538899/", "sourceText": "BACKGROUND: Requisite to the application of clinical databases for observational research in hidradenitis suppurativa (HS) is the identification of an accurate case cohort. There is limited information on the validity of using diagnosis codes to identify HS and cutaneous abscess (CA) case cohorts. OBJECTIVES: The objective of the study was to assess the validity in utilizing diagnosis codes to establish the HS and CA cohorts from an integrated health system clinical database. METHODS: In this retrospective study, we evaluated a case-finding algorithm for HS which included the presence of at least one diagnosis code for HS and no diagnosis codes for CA of the axilla, groin, perineum, or buttock at any time. We evaluated a case-finding algorithm for CA which included the presence of at least one diagnosis code for abscess in the axilla, groin, perineum, or buttock and no codes for HS at any time. Medical records for a random sample of 100 patients meeting algorithm criteria were reviewed and adjudicated by dermatologists for accuracy of diagnosis. The positive predictive values (PPVs) of the ICD code-based case definitions were calculated, using the dermatologist's chart-based adjudication as the reference standard. RESULTS: Among 100 HS patients, median age (interquartile range) in the HS cohort was 33 (24.75, 43.25) years. HS patients were predominantly female (82%) and white (70%). Median age among 100 CA patients was 31.5 (95% CI 6.75, 47.25) years. The majority of CA patients were female (56%) and white (69%). The PPVs of the ICD-based case-finding algorithms for HS and CA were 88% (95% CI 81.6-94.4%) and 75.0% (95% CI 66.5-83.5%), respectively. CONCLUSION: The case-finding algorithms employing at least one diagnosis code for HS and CA of the axilla, groin, perineum, or buttock, with the exclusion of the other's diagnosis codes, has good to strong PPV and may provide balance in achieving accuracy and adequate power for cohorts identified within clinical databases.", "provenance": [ { "field": "n", "quote": "Among 100 HS patients, median age" }, { "field": "n", "quote": "Median age among 100 CA patients" }, { "field": "population", "quote": "identify HS and cutaneous abscess (CA) case cohorts" }, { "field": "intervention", "quote": "a case-finding algorithm for HS which included the presence of at least one diagnosis code for HS and no diagnosis codes for CA of the axilla, groin, perineum, or buttock at any time" }, { "field": "comparator", "quote": "the dermatologist's chart-based adjudication as the reference standard" }, { "field": "primaryOutcome", "quote": "The positive predictive values (PPVs) of the ICD code-based case definitions were calculated" }, { "field": "result", "quote": "The PPVs of the ICD-based case-finding algorithms for HS and CA were 88% (95% CI 81.6-94.4%) and 75.0% (95% CI 66.5-83.5%), respectively." } ] }, { "id": "pmid:36291580", "pmid": "36291580", "doi": "10.3390/biom12101371", "nctId": null, "pmcid": "PMC9599370", "title": "Transcriptome Meta-Analysis Confirms the Hidradenitis Suppurativa Pathogenic Triad: Upregulated Inflammation, Altered Epithelial Organization, and Dysregulated Metabolic Signaling", "firstAuthor": "de Oliveira", "multipleAuthors": true, "journal": "Biomolecules", "year": 2022, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a skin condition causing painful lumps in areas like the armpits, groin, and buttocks", "intervention": "gene-expression (RNA-sequencing) meta-analysis of HS-affected skin", "comparator": "", "primaryOutcome": "patterns of gene activity underlying the disease", "result": "confirmed three combined problems: too much inflammation, disrupted skin-barrier genes, and abnormal metabolism signaling", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a lab-based gene study of a different, more severe condition (hidradenitis suppurativa) rather than ordinary pimples, and it does not report how many patients were studied.", "directness": "indirect", "limitations": "No patient numbers given, no clinical outcomes measured, and findings are specific to hidradenitis suppurativa rather than common acne/pimples.", "followUp": "", "plainFinding": "Inflammation and skin-barrier genes altered in HS", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36291580/", "sourceText": "Hidradenitis suppurativa (HS) is an inflammatory skin condition clinically characterized by recurrent painful deep-seated nodules, abscesses, and sinus tracks in areas bearing apocrine glands, such as axillae, breasts, groins, and buttocks. Despite many recent advances, the pathophysiological landscape of HS still demands further clarification. To elucidate HS pathogenesis, we performed a meta-analysis, set analysis, and a variant calling on selected RNA-Sequencing (RNA-Seq) studies on HS skin. Our findings corroborate the HS triad composed of upregulated inflammation, altered epithelial differentiation, and dysregulated metabolism signaling. Upregulation of specific genes, such as KRT6, KRT16, serpin-family genes, and SPRR3 confirms the early involvement of hair follicles and the impairment of barrier function in HS lesioned skin. In addition, our results suggest that adipokines could be regarded as biomarkers of HS and metabolic-related disorders. Finally, the RNA-Seq variant calling identified several mutations in HS patients, suggesting potential new HS-related genes associated with the sporadic form of this disease. Overall, this study provides insights into the molecular pathways involved in HS and identifies potential HS-related biomarkers.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is an inflammatory skin condition clinically characterized by recurrent painful deep-seated nodules, abscesses, and sinus tracks in areas bearing apocrine glands, such as axillae, breasts, groins, and buttocks." }, { "field": "intervention", "quote": "we performed a meta-analysis, set analysis, and a variant calling on selected RNA-Sequencing (RNA-Seq) studies on HS skin" }, { "field": "primaryOutcome", "quote": "Our findings corroborate the HS triad composed of upregulated inflammation, altered epithelial differentiation, and dysregulated metabolism signaling." }, { "field": "result", "quote": "Our findings corroborate the HS triad composed of upregulated inflammation, altered epithelial differentiation, and dysregulated metabolism signaling." } ] }, { "id": "pmid:36077114", "pmid": "36077114", "doi": "10.3390/ijms23179716", "nctId": null, "pmcid": "PMC9456321", "title": "Immunomodulatory Drugs in the Treatment of Hidradenitis Suppurativa-Possibilities and Limitations", "firstAuthor": "Świerczewska", "multipleAuthors": true, "journal": "Int J Mol Sci", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (acne inversa), a skin condition affecting skin folds including buttock/groin areas", "intervention": "immunomodulatory drugs and biologics (such as adalimumab) targeting the immune pathways of the disease", "comparator": "", "primaryOutcome": "effectiveness of drugs in treating hidradenitis suppurativa", "result": "The abstract does not report specific outcome data; it is a review describing current and emerging drug targets rather than reporting results of a particular treatment trial.", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing drug targets and mechanisms without presenting original trial data or outcomes.", "directness": "indirect", "limitations": "The abstract does not report specific patient numbers, trial results, or direct comparisons; it is a review of molecular mechanisms and treatment possibilities rather than a study of causes of butt pimples.", "followUp": "", "plainFinding": "Reviews drugs for a different skin disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36077114/", "sourceText": "Hidradenitis suppurativa, also known as acne inversa, is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. Treatment is rather difficult and typically requires the use of multiple modalities. Regardless of the presence of several therapeutic options, treatment often turns out to be ineffective or poorly selected concerning the clinical picture of the disease. Thus, the search for new biologics and other target treatments of hidradenitis suppurativa is ongoing. The safety and efficacy of adalimumab, still the only U.S. Food and Drug Administration approved biologic in the hidradenitis suppurativa treatment, paved the way for new drugs to be compared with it. Several more drugs with new immunological targets are currently under investigation for the treatment of acne inversa. The aim of the article was to present the current and future targets of acne inversa treatment, simultaneously providing insights into the molecular pathomechanisms of the disease.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa, also known as acne inversa, is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas." }, { "field": "intervention", "quote": "The safety and efficacy of adalimumab, still the only U.S. Food and Drug Administration approved biologic in the hidradenitis suppurativa treatment, paved the way for new drugs to be compared with it." }, { "field": "primaryOutcome", "quote": "The aim of the article was to present the current and future targets of acne inversa treatment, simultaneously providing insights into the molecular pathomechanisms of the disease." }, { "field": "result", "quote": "Several more drugs with new immunological targets are currently under investigation for the treatment of acne inversa." } ] }, { "id": "pmid:36012322", "pmid": "36012322", "doi": "10.3390/ijms23169057", "nctId": null, "pmcid": "PMC9408811", "title": "Phytotherapeuthics Affecting the IL-1/IL-17/G-CSF Axis: A Complementary Treatment Option for Hidradenitis Suppurativa?", "firstAuthor": "Witte", "multipleAuthors": true, "journal": "Int J Mol Sci", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic skin disease causing painful lesions in armpit, groin, buttock and genital areas", "intervention": "plant-based (phytomedical) drugs targeting certain immune signals", "comparator": "current standard treatments (antibiotics, surgery, TNF-alpha blockers)", "primaryOutcome": "whether plant-based drugs could help treat hidradenitis suppurativa by targeting specific immune pathways", "result": "the review discusses and evaluates immune pathway as a possible target for plant-based treatment, but does not report trial results", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a conceptual review describing a disease pathway and proposing a treatment idea, with no original patient data or trial results.", "directness": "indirect", "limitations": "No original research data, patient numbers, or outcome measurements are reported; this is a theoretical/review discussion, and hidradenitis suppurativa is a distinct, more severe condition than ordinary pimples.", "followUp": "", "plainFinding": "Proposes herbal treatment idea, no results yet", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36012322/", "sourceText": "Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disease characterized by painful skin lesions that occur in the axillary, inguinal, gluteal and perianal areas of the body. These lesions contain recurring deep-seated, inflamed nodules and pus-discharging abscesses and fistulas. Affecting about 1% of the population, this common disease has gained appropriate clinical attention in the last years. Associated with numerous comorbidities including metabolic syndrome, HS is considered a systemic disease that severely impairs the quality of life and shortens life expectancy. Therapeutic options for HS are limited, comprising long-term antibiotic treatment, the surgical removal of affected skin areas, and neutralization of TNF-α, the only approved systemic treatment. Novel treatment options are needed to close the therapeutic gap. HS pathogenesis is increasingly better understood. In fact, neutrophilic granulocytes (neutrophils) seem to be decisive for the development of the purulent destructive skin inflammation in HS. Recent findings suggest a key role of the immune mediators IL-1β, IL-17A and G-CSF in the migration into and activation of neutrophils in the skin. Although phytomedical drugs display potent immunoregulatory properties and have been suggested as complementary therapy in several chronic disorders, their application in HS has not been considered so far. In this review, we describe the IL-1/IL-17/G-CSF axis and evaluate it as potential target for an integrated phytomedical treatment of HS.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disease characterized by painful skin lesions that occur in the axillary, inguinal, gluteal and perianal areas of the body." }, { "field": "intervention", "quote": "phytomedical drugs display potent immunoregulatory properties and have been suggested as complementary therapy in several chronic disorders" }, { "field": "comparator", "quote": "Therapeutic options for HS are limited, comprising long-term antibiotic treatment, the surgical removal of affected skin areas, and neutralization of TNF-α, the only approved systemic treatment." }, { "field": "primaryOutcome", "quote": "we describe the IL-1/IL-17/G-CSF axis and evaluate it as potential target for an integrated phytomedical treatment of HS" }, { "field": "result", "quote": "In this review, we describe the IL-1/IL-17/G-CSF axis and evaluate it as potential target for an integrated phytomedical treatment of HS." } ] }, { "id": "pmid:36000460", "pmid": "36000460", "doi": "10.1177/12034754221116115", "nctId": null, "pmcid": null, "title": "Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update", "firstAuthor": "Johnston", "multipleAuthors": true, "journal": "J Cutan Med Surg", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic inflammatory skin condition affecting armpits, groin, under breasts, and buttock areas", "intervention": "a structured approach to diagnosing and managing the condition, including a medical record template", "comparator": "", "primaryOutcome": "improving diagnosis and quality of care for the condition", "result": "the abstract does not report outcome data, only that the guideline aims to improve diagnosis and management", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is an expert guideline/review, not a study testing a treatment, so it provides no data on whether any intervention works", "directness": "indirect", "limitations": "abstract does not describe any treatment outcomes, patient numbers, or comparative data; it is a practical guideline document", "followUp": "", "plainFinding": "Guideline for diagnosing and managing this skin condition.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36000460/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas. Up to 3.8% of the Canadian population has HS, though due to a lack of awareness of HS, many patients are initially misdiagnosed and do not receive adequate treatment early on in the disease course. Once a diagnosis of HS is made, developing an effective management plan can be a dilemma for many providers. There is significant variability in response to any given therapy within the HS patient population and many HS patients have other medical comorbidities which must be taken into consideration. The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities. A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings. This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin, and gluteal areas." }, { "field": "intervention", "quote": "A sample electronic medical record template for HS management was developed by the Canadian Hidradenitis Suppurativa Foundation Executive Board and is intended for use in clinical settings." }, { "field": "primaryOutcome", "quote": "The aim of this review is to provide a practical approach for all healthcare providers to diagnose and manage HS and its associated comorbidities." }, { "field": "result", "quote": "This will help to increase collaboration between primary healthcare providers, dermatologists, and other medical specialists and ultimately improve the quality of care that HS patients receive." } ] }, { "id": "pmid:35285075", "pmid": "35285075", "doi": "10.1111/pde.14978", "nctId": null, "pmcid": null, "title": "Cutaneous manifestations of obesity in Turkish children: A comparative study", "firstAuthor": "Güven", "multipleAuthors": true, "journal": "Pediatr Dermatol", "year": 2022, "design": "case-control", "n": 168, "nField": "reported", "population": "Turkish children, comparing those with obesity to normal-weight children", "intervention": "having obesity", "comparator": "normal-weight children", "primaryOutcome": "presence of various skin conditions, including folliculitis (a cause of pimple-like bumps)", "result": "Folliculitis was significantly more common in obese children than in normal-weight children (31.7% vs 5.8%)", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a single cross-sectional comparison in children, so it can show an association with obesity but not prove obesity causes the skin bumps, and it does not specifically study buttock pimples in the general population.", "directness": "indirect", "limitations": "Cross-sectional design with no follow-up, no treatment tested, and findings are about multiple skin conditions in obese vs normal-weight children rather than specifically about buttock pimples in a general population.", "followUp": "", "plainFinding": "More skin bumps if obese.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35285075/", "sourceText": "BACKGROUND: Cutaneous changes in obese adults have been investigated in numerous studies, but this issue has not been adequately investigated in children. OBJECTIVES: We aimed to determine the prevalence of skin manifestations in children with obesity by comparing them to normal-weight children. METHODS: A cross-sectional study was conducted between June 2017 and January 2019 in which 82 children with obesity and 86 normal-weight healthy control children were enrolled. Study participants had detailed full-body skin examinations performed by the same dermatologist; mycological and Wood's lamp examinations were performed when necessary. Sociodemographic and anthropometric measurements of the participants were recorded. RESULTS: Striae distensae were the most common skin manifestation in children with obesity; striae were significantly higher in the obese than in the control group (72% vs. 26.7%, p < .001). The anatomical distribution of the striae distensae in the groups differed significantly. Striae distensae were most commonly observed on the buttocks in the control group, while the thighs were the most common site in the obese group. Acanthosis nigricans (63.4% vs. 3.5%, p < .001), acrochordons (17.1% vs. 1.2%, p < .001), keratosis pilaris (32.9% vs. 17.4%, p = .021), intertrigo (11% vs. 0%, p = .001), folliculitis (31.7% vs. 5.8%, p < .001), seborrheic dermatitis (12.2% vs. 3.5%, p = .035) and facial erythema (7.3% vs. 0%, p = .012) were found to be statistically significantly more common in the obese group compared to the control group. CONCLUSIONS: Obesity in children is associated with numerous cutaneous manifestations. Further study is needed to identify whether weight loss can reduce skin manifestations in obese children.", "provenance": [ { "field": "n", "quote": "82 children with obesity and 86 normal-weight healthy control children were enrolled" }, { "field": "population", "quote": "82 children with obesity and 86 normal-weight healthy control children were enrolled" }, { "field": "intervention", "quote": "children with obesity" }, { "field": "comparator", "quote": "normal-weight healthy control children" }, { "field": "primaryOutcome", "quote": "We aimed to determine the prevalence of skin manifestations in children with obesity by comparing them to normal-weight children." }, { "field": "result", "quote": "folliculitis (31.7% vs. 5.8%, p < .001)" } ] }, { "id": "pmid:35189127", "pmid": "35189127", "doi": "10.1016/j.jaci.2022.02.003", "nctId": null, "pmcid": null, "title": "Insights into hidradenitis suppurativa", "firstAuthor": "van Straalen", "multipleAuthors": true, "journal": "J Allergy Clin Immunol", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic skin condition affecting underarms, groin, and buttock areas", "intervention": "", "comparator": "", "primaryOutcome": "", "result": "The abstract describes the biology and risk factors of hidradenitis suppurativa rather than reporting a treatment trial result", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review summarizing disease background, not a study testing any treatment, so it offers no outcome data to weigh", "directness": "indirect", "limitations": "The abstract does not test any intervention or report trial outcomes; it is a descriptive/background review", "followUp": "", "plainFinding": "Explains why these bumps form, no treatment tested", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35189127/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, debilitating, inflammatory skin disorder with a prevalence of around 1% and a profound impact on patients' quality of life. Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty. A complex interplay of genetic predisposition, hormonal factors, obesity, and smoking contributes to development and maintenance of the disease. HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF. Over time, acute lesions transition into chronic disease, with active draining sinus tracts accompanied by extensive fibrosis. HS is associated with other immune-mediated inflammatory diseases, metabolic and cardiovascular disorders, and psychiatric comorbidities. Treatment of HS often requires a combination of antibiotic or immunosuppressing therapies and surgical intervention. Nonetheless, the currently available treatments are not universally effective, and many drugs, which are often repurposed from other inflammatory diseases, are under investigation. Studies into the early stages of HS may yield treatments to prevent disease progression; yet, they are hampered by a lack of appropriate in vitro and animal models.", "provenance": [ { "field": "population", "quote": "Characteristic lesions such as inflammatory nodules, abscesses, and sinus tracts develop in the axillae, inguinal, and gluteal areas, typically during or after puberty." }, { "field": "result", "quote": "HS is considered to arise from an intrinsic defect within the hair follicle, leading to follicular plugging, cyst formation, and subsequent rupture that in turn induce an acute inflammatory response characterized by elevated levels of IL-1β, IL-17, and TNF." } ] }, { "id": "pmid:35128643", "pmid": "35128643", "doi": "10.1111/ijd.16115", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa: a review of current treatment options", "firstAuthor": "Lewandowski", "multipleAuthors": true, "journal": "Int J Dermatol", "year": 2022, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (a chronic skin disease with painful lumps, often in skin folds including the buttock/groin area)", "intervention": "various treatments for hidradenitis suppurativa", "comparator": "different treatment options compared to each other", "primaryOutcome": "effectiveness of treatment / disease management", "result": "no single treatment works well for everyone; best results need a multidisciplinary approach", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a narrative review summarizing treatment options, not a study testing a specific treatment, so it can't show whether any one approach works.", "directness": "indirect", "limitations": "no original data, no quantitative results, and it is about treating an existing diagnosed disease rather than explaining why pimples occur in the first place", "followUp": "", "plainFinding": "No single treatment works well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35128643/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas. The pathogenesis of HS is still not completely understood; currently, it is considered to be an immune-mediated inflammatory illness (IMID). Due to the significant decrease in the patients' quality of life and a delayed beginning of a treatment, the selection of the appropriate therapy is extremely important in these patients. Regardless of the fact that there are multiple treatment options for HS, no uniformly effective therapy has been found. All the guidelines underline the need for a multidisciplinary approach to the disease, which enables providers to create the right management of HS. This article aims to provide updates on the current treatment options of acne inversa to raise awareness and improve the management of the disease.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic, progressive, debilitating, recurrent inflammatory skin disease characterized by the occurrence of very severe, persistent, painful nodules, abscesses, and fistulas, most commonly found in the skin folds of the axilla, groin, gluteal, and perianal areas." }, { "field": "intervention", "quote": "This article aims to provide updates on the current treatment options of acne inversa to raise awareness and improve the management of the disease." }, { "field": "comparator", "quote": "Regardless of the fact that there are multiple treatment options for HS, no uniformly effective therapy has been found." }, { "field": "primaryOutcome", "quote": "the selection of the appropriate therapy is extremely important in these patients" }, { "field": "result", "quote": "Regardless of the fact that there are multiple treatment options for HS, no uniformly effective therapy has been found. All the guidelines underline the need for a multidisciplinary approach to the disease, which enables providers to create the right management of HS." } ] }, { "id": "pmid:35086093", "pmid": "35086093", "doi": "10.1159/000520288", "nctId": null, "pmcid": null, "title": "The Bacteriology of Skin Lesions in Patients with Hidradenitis Suppurativa Is Associated with Previous Antibiotic Treatment in the Community Setting: A Referral Center Experience", "firstAuthor": "Barmatz", "multipleAuthors": true, "journal": "Dermatology", "year": 2022, "design": "retrospective", "n": 97, "nField": "reported", "population": "patients with hidradenitis suppurativa (a chronic skin disease with nodules and abscesses, often in genitalia, buttocks/groin, and underarms)", "intervention": "previous antibiotic treatment in the community before referral", "comparator": "patients not previously treated with antibiotics", "primaryOutcome": "type of bacteria found in skin lesion cultures", "result": "patients previously treated with antibiotics had more gram-negative bacteria and more types of bacteria per lesion than untreated patients", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a retrospective, uncontrolled study of bacterial cultures from one referral clinic, not a trial testing whether any treatment reduces pimples or lesions.", "directness": "indirect", "limitations": "Retrospective, single referral-center cohort; antibiotic use was nonstandardized and not randomized; no comparison to healthy skin or control group without HS.", "followUp": "", "plainFinding": "Prior antibiotics shifted lesion bacteria.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35086093/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory nodules and abscesses. The pathogenic role of bacteria is not fully understood. As the diagnosis is usually delayed, patients are often treated with several lines of antibiotics in a nonstandardized fashion. The aim of the study was to investigate and compare the bacteriology of active HS lesions in patients treated or not treated with antibiotics in the community setting before referral to a dedicated HS clinic. METHODS: Purulent skin lesions of patients with HS referred to the HS Clinic of Rabin Medical Center in 2009-2020 were cultured. Data were collected from the patients' medical files and microbiology reports. The correlation between the location of the skin lesion and the bacteriologic profile was analyzed, and the effects of previous antibiotic treatment on the bacteriologic profile of the lesions and susceptibility patterns of the cultured bacteria were evaluated. RESULTS: Pus (or tissue) from inflammatory lesions of 97 patients with HS was cultured. Mean (SD) patient age was 39.5 (13.0) years, and mean delay in diagnosis was 7.3 (8.3) years. Most patients (57.7%) had dominant involvement of one location, with the most active lesions concentrated in the genitalia, gluteal/perineal area, and axilla. Enterobacterales species were the most frequent isolates detected in all locations except the face and scalp. Seventy-eight patients (80.4%) had been treated in the community setting prior to referral with a median (range) of 2 (1-8) lines of antibiotics. The most commonly prescribed antibiotics were amoxicillin/clavulanate (22.0%), doxycycline/minocycline (16.8%), clindamycin (16.2%; monotherapy 8.1%, clindamycin with rifampicin 8.1%), and cephalexin (13.9%). Compared to the previously untreated patients, cultures of lesions from the previously treated patients yielded a higher percentage of gram-negative Enterobacterales (the most common isolates in this group) (31.3% vs. 10.3%) and a significantly higher median number of isolates per culture (2 vs. 1, p < 0.0001). Gram-positive bacteria, usually considered contaminants (mainly coagulase-negative staphylococci) accounted for 31.0% of the isolates in the previously treated group. Susceptibility testing for the entire cohort revealed 100% bacterial sensitivity to ciprofloxacin. Staphylococcus spp. were 100% sensitive to rifampicin. Both gram-positive and gram-negative bacteria had high sensitivity to trimethoprim and sulfamethoxazole. CONCLUSION: Nonstandardized antibiotic treatment of HS in the community setting can skew the microbiology of skin lesions toward gram-negative bacteria. Therefore, treatment with trimethoprim and sulfamethoxazole or ciprofloxacin, either alone or combined with rifampicin, may be considered.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory nodules and abscesses" }, { "field": "population", "quote": "the most active lesions concentrated in the genitalia, gluteal/perineal area, and axilla" }, { "field": "intervention", "quote": "Seventy-eight patients (80.4%) had been treated in the community setting prior to referral with a median (range) of 2 (1-8) lines of antibiotics" }, { "field": "comparator", "quote": "Compared to the previously untreated patients" }, { "field": "primaryOutcome", "quote": "The correlation between the location of the skin lesion and the bacteriologic profile was analyzed, and the effects of previous antibiotic treatment on the bacteriologic profile of the lesions and susceptibility patterns of the cultured bacteria were evaluated." }, { "field": "result", "quote": "cultures of lesions from the previously treated patients yielded a higher percentage of gram-negative Enterobacterales (the most common isolates in this group) (31.3% vs. 10.3%) and a significantly higher median number of isolates per culture (2 vs. 1, p < 0.0001)" }, { "field": "n", "quote": "Pus (or tissue) from inflammatory lesions of 97 patients with HS was cultured." } ] }, { "id": "pmid:35040156", "pmid": "35040156", "doi": "10.1111/1346-8138.16297", "nctId": null, "pmcid": "PMC9305509", "title": "Real-world safety and effectiveness of adalimumab in patients with hidradenitis suppurativa: 12-week interim analysis of post-marketing surveillance in Japan", "firstAuthor": "Hayashi", "multipleAuthors": true, "journal": "J Dermatol", "year": 2022, "design": "prospective-cohort", "n": 83, "nField": "reported", "population": "Japanese patients with hidradenitis suppurativa, a chronic painful skin disease causing abscesses and nodules, often affecting buttocks and groin", "intervention": "adalimumab (anti-TNF-alpha injection) given under the skin", "comparator": "before-and-after comparison, no control group", "primaryOutcome": "safety of adalimumab in routine clinical practice", "result": "at 12 weeks, 57.4% of patients had a clinical response, with significant reductions in skin pain, quality-of-life impact, and inflammation markers; no serious infections and no new safety concerns", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was an open-label, real-world observational study without a comparison group, so improvement cannot be clearly separated from natural disease fluctuation.", "directness": "indirect", "limitations": "Open-label, observational, post-marketing study with no control group; this is an interim 12-week analysis.", "followUp": "12 weeks", "plainFinding": "Reduced symptoms with adalimumab treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/35040156/", "sourceText": "Hidradenitis suppurativa (HS) is a painful chronic skin disease characterized by abscesses, nodules, and tunnels in the skin. Adalimumab, a monoclonal antibody against tumor necrosis factor-α, is approved for the treatment of HS in Europe, the USA, and Japan. This multicenter, open-label, post-marketing, observational study (ClinicalTrials.gov: NCT03894956) evaluated the safety and effectiveness of adalimumab in routine clinical practice in Japan (March 2019-May 2021). Patients with HS were treated with s.c. doses of adalimumab according to the dosage described in the package insert. The primary end-point was safety (data cut-off, December 2020). Secondary end-points assessed effectiveness, including HS Clinical Response (HiSCR), skin pain, Dermatology Life Quality Index (DLQI), and C-reactive protein (CRP). Here, we report 12-week interim effectiveness results. A total of 84 eligible patients from 65 sites were enrolled; 83 patients were included in this analysis. Mean age was 42.0 years, mean body mass index was 26.9 kg/m2 , 78.3% of patients were male, 61.4% had Hurley stage III disease, 39.8% had a disease duration ≥10 years, and 7.2% had a family history of HS. The most common affected sites were the axilla (60.2%), buttocks (59.0%), and the inguinal and femoral regions (47.0%). Mean abscess and inflammatory nodule count was 13.0 (standard deviation, 12.0). Among patients with a comorbidity (57.8%), the most common were diabetes mellitus, hypertension, and chronic kidney disease. No patient reported a serious infection or any safety event of special interest. One patient died from a serious adverse event of cardiac failure unrelated to adalimumab. At week 12, 57.4% of patients achieved HiSCR, and significant reductions from baseline in skin pain, DLQI (both p < 0.0001), and CRP (p = 0.0029) were observed. These results support the administration of adalimumab as a well-tolerated and effective treatment for Japanese patients with HS in real-world clinical practice.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a painful chronic skin disease characterized by abscesses, nodules, and tunnels in the skin." }, { "field": "population", "quote": "The most common affected sites were the axilla (60.2%), buttocks (59.0%), and the inguinal and femoral regions (47.0%)." }, { "field": "intervention", "quote": "Patients with HS were treated with s.c. doses of adalimumab according to the dosage described in the package insert." }, { "field": "comparator", "quote": "This multicenter, open-label, post-marketing, observational study" }, { "field": "primaryOutcome", "quote": "The primary end-point was safety (data cut-off, December 2020)." }, { "field": "result", "quote": "At week 12, 57.4% of patients achieved HiSCR, and significant reductions from baseline in skin pain, DLQI (both p < 0.0001), and CRP (p = 0.0029) were observed." }, { "field": "n", "quote": "A total of 84 eligible patients from 65 sites were enrolled; 83 patients were included in this analysis." } ] }, { "id": "pmid:34975118", "pmid": "34975118", "doi": "10.4103/cjp.cjp_67_21", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa: Disease pathophysiology and sex hormones", "firstAuthor": "Chu", "multipleAuthors": true, "journal": "Chin J Physiol", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic inflammatory skin disease", "intervention": "review of disease pathophysiology and sex hormone effects (no specific treatment tested)", "comparator": "comparison between men and women with hidradenitis suppurativa", "primaryOutcome": "patterns of disease location and severity by sex and hormonal status", "result": "men were more likely to have buttock lesions while women were more likely to have armpit, groin, and under-breast lesions, and disease severity varied with menstruation, pregnancy, and menopause", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a descriptive review summarizing existing knowledge rather than a study that tested a treatment or measured a specific outcome.", "directness": "indirect", "limitations": "abstract does not describe study methods, sample size, or how sex-difference claims were derived; it is a narrative summary, not original controlled research.", "followUp": "", "plainFinding": "Butt pimples may be hidradenitis suppurativa, more common in men.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34975118/", "sourceText": "Hidradenitis suppurativa is a cutaneous chronic inflammatory disease that is estimated to affect about 1% of the population and caused pain, malodorous discharge, disfigurement, and poor quality of life with psychosocial problems. The typical features are recurrent painful nodules, abscesses, and sinus tracts on the axillae, groins, gluteal areas, and anogenital regions since postpuberty. Smoking and obesity are two major triggering factors of hidradenitis suppurativa. Women are prone to have hidradenitis suppurativa than men in Western countries, but the male-to-female ratio is reversed in oriental countries. The disease severity can be affected by menstruation, pregnancy, and menopause. Furthermore, the phenotypes are different among men and women with hidradenitis suppurativa. Men are prone to have buttock involvement while women are prone to have axillary, groins, and submammary lesions. This review introduces the skin appendages and pathophysiology of hidradenitis suppurativa and then focuses on the sex difference and the effects of sex hormones on hidradenitis suppurativa and current hormone-associated treatments.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa is a cutaneous chronic inflammatory disease that is estimated to affect about 1% of the population" }, { "field": "intervention", "quote": "This review introduces the skin appendages and pathophysiology of hidradenitis suppurativa and then focuses on the sex difference and the effects of sex hormones on hidradenitis suppurativa and current hormone-associated treatments." }, { "field": "comparator", "quote": "Men are prone to have buttock involvement while women are prone to have axillary, groins, and submammary lesions." }, { "field": "primaryOutcome", "quote": "the phenotypes are different among men and women with hidradenitis suppurativa" }, { "field": "result", "quote": "Men are prone to have buttock involvement while women are prone to have axillary, groins, and submammary lesions." }, { "field": "result", "quote": "The disease severity can be affected by menstruation, pregnancy, and menopause." } ] }, { "id": "pmid:34784135", "pmid": "34784135", "doi": "10.36849/jdd.6181", "nctId": null, "pmcid": null, "title": "Optimizing Outcomes With the 1550/1927 nm Dual Wavelength Non-Ablative Fractional Laser: Experienced User Recommendations", "firstAuthor": "Friedman", "multipleAuthors": true, "journal": "J Drugs Dermatol", "year": 2021, "design": "guideline", "n": 8, "nField": "reported", "population": "dermatologists experienced with a specific laser device, not patients with buttock acne", "intervention": "1550 nm/1927 nm dual wavelength non-ablative fractional laser", "comparator": "none reported", "primaryOutcome": "expert recommendations and best practices for using the laser device", "result": "survey of experienced users suggested the laser can treat many skin issues including acne or surgical scarring, and can be used on areas including the buttocks", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a small expert opinion survey about laser technique, not a study testing why pimples occur on the buttocks or how to treat them.", "directness": "indirect", "limitations": "small survey of only 8 dermatologists, opinion-based position paper, not a controlled study, and does not address causes of buttock pimples", "followUp": "", "plainFinding": "Not relevant to buttock pimple causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34784135/", "sourceText": "BACKGROUND: Fractional laser treatment was introduced in 2004 as a non-invasive technique to treat sun-damaged and aging skin. Since then, numerous ablative and non-ablative photothermolysis technologies and devices have been introduced, increasing the options for clinicians and patients but also increasing the complexity regarding which system to use and the techniques to optimize outcomes. No two devices are the same and the user-manuals preset dosimetry does not address many clinical situations, which can create confusion for new and inexperienced users. METHODS: An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device. The survey included 39 questions, addressing experience, best practices and recommendations for use. RESULTS: The survey data suggests that the device can be used to treat patients of all ages and skin types for indications including photoaging and photodamage, periorbital wrinkles, freckles, (ephelides), solar lentigines, poikiloderma, scarring due to acne or surgery. It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks. Unexpected and adverse effects were rarely reported and those that did were mild and transient. CONCLUSIONS: This position paper provides practical real-world guidelines resulting from a small survey of experienced users, for new and early uses of the novel 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser. J Drugs Dermatol. 2021;20(11):1150-1157. doi:10.36849/JDD.6181.", "provenance": [ { "field": "n", "quote": "sent to eight (8) US board certified dermatologists" }, { "field": "population", "quote": "An online survey addressing use of a 1550 nm /1927 nm dual wavelength, non-ablative, fractional laser was sent to eight (8) US board certified dermatologists with extensive experience in the use of the device." }, { "field": "intervention", "quote": "1550 nm /1927 nm dual wavelength, non-ablative, fractional laser" }, { "field": "comparator", "quote": "The survey included 39 questions, addressing experience, best practices and recommendations for use." }, { "field": "primaryOutcome", "quote": "This position paper provides practical real-world guidelines resulting from a small survey of experienced users" }, { "field": "result", "quote": "It can be used on both facial and non-facial areas, including neck, chest, hands, arms, abdomen, legs, and buttocks." } ] }, { "id": "pmid:34477078", "pmid": "34477078", "doi": null, "nctId": null, "pmcid": null, "title": "Two Cases of Hidradenitis Suppurativa Treated with Adalimumab at the Department of Dermatology and Venereology, Clinical Hospital Mostar", "firstAuthor": "Lovrić", "multipleAuthors": true, "journal": "Acta Dermatovenerol Croat", "year": 2021, "design": "case-series", "n": 2, "nField": "reported", "population": "Adults with severe hidradenitis suppurativa (painful boils/nodules in skin fold areas including buttocks)", "intervention": "Adalimumab (biologic injection medication)", "comparator": "No comparator (before-and-after treatment in same patients)", "primaryOutcome": "Improvement in disease severity scores and quality of life", "result": "Both patients improved; one had unchanged Hurley stage but large drop in quality-of-life score, the other improved in both disease stage and quality of life", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only two patients with no comparison group, so results could be due to chance or other factors rather than the drug.", "directness": "indirect", "limitations": "Only 2 patients, no control group, pre-existing conditions (diabetes, TB exposure) may have influenced outcomes.", "followUp": "16 weeks", "plainFinding": "Boils and skin lesions improved with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34477078/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting apocrine gland-rich areas of the body and presenting with painful nodules, abscesses, sinus tracts, and scarring (1). HS is a defect of the follicular epithelium; some have therefore called for the naming the disease acne inversa instead of hidradenitis suppurativa. The term acne inversa links the pathogenesis to acne and reflects the fact that it is an expression of follicular occlusion in localizations inverse to acne vulgaris (2). HS typically occurs after puberty. Studies have shown that the average onset is in the second or third decades of life (3). One of the most frequently cited risk factors for HS is cigarette smoking. Another significant risk factor for HS is obesity. About one-third of patients with HS have reported a family history of the disease (4). A clinically relevant staging and disease severity assessment is essential for the development of evidence-based treatments. There are several scoring systems for the assessment of disease severity of HS, including Hurley staging, HS Physician's Global Assessment (PGA), the modified Sartorius score (MSS), and the HS Severity Index (HSSI). Each of these assessments has both advantages and limitations in daily practice; there is currently no gold standard (5-8). The Hurley staging system is the simplest and most widely used instrument for HS classification in routine clinical practice. It classifies HS into three stages. HS-PGA is relatively easy to apply and is frequently used to measure clinical improvement in clinical trials of medical treatments (5). The system describes six disease stages, increasing in severity on a scale from 1 to 6 (9). MSS is a more detailed and dynamic classification system based on the counting of individual nodules and fistulas within seven anatomical regions. The system, which was developed by Sartorius et al. and later modified, is the first disease-specific instrument for dynamically measuring clinical severity of HS (10). The treatment of HS includes topical clindamycin, triamcinolone acetonide, clobetasol, topical resorcinol, oral antibiotics, hormonal therapy, oral retinoids, and biologic therapies (11). Biologic therapies are increasingly used in patients who fail to sufficiently respond to antibiotic and hormonal treatments. Adalimumab, infliximab, and etanercept have all been tested in the treatment of HS but vary in effectiveness and in how well they have been studied. Subcutaneous weekly adalimumab (160 mg at week 0, 80 mg at week 2, and 40 mg each week thereafter) is the only biologic agent approved by the US Food and Drug Administration (FDA) and the European Medicine Agency (EMA) for the treatment of HS, and it is recommended as first-line therapy for patients with moderate-to-severe disease who are intolerant or unresponsive to oral antibiotics (12). The first male patient aged 59 years was referred to our Department with very long history of HS. The first symptoms had been unrecognized and presented as a pilonidal cyst 25 years ago as well as cysts on the intergluteal region treated with multiple surgical interventions and systemic antibiotics. The first hospitalization at our Department was in 2016. In addition to HS, the patient had diabetes mellitus (DM) type II and hypertension. A physical examination showed multiple abscesses, fistulas, and nodules in the axillary, inguinal, perianal, gluteal, and intergluteal regions; Hurley staging: stage II, PGA staging: IV, DLQI: 24 (Figure 1, Figure 2). Microbiological repeated swabs showed numerous bacteria such as Esch.coli, S.aureus, Serratia.spp, Enterococcus spp, St.epidermidis, and Proteus mirabilis. Laboratory tests which included complete blood cell count, biochemistry, serology for syphilis, HIV, and hepatitis B and C infection together with chest X-rays were all within normal limits. Abdominal ultrasound examination found no abnormalities. Quantiferon test was positive. After the monotherapy with isoniazid, a repeated Quantiferon test two months later was negative. The patient was treated with betadine solution and pus drainage until 2018, when at the Department of Dermatology and Venerology prescribed adalimumab in doses of 80 mg initially, 40 mg ×2 on the first day and the day after that, then 80 mg after fifteen days followed by 40 mg every ten days. After 16 weeks of treatment with adalimumab, Hurley staging was II, PGA IV, DLQI 3. The second male patient aged 28 years was referred to our Department with a shorter history: the first symptoms were presented as pilonidal sinus in 2012, after that in 2015 as inflamed nodules and fistulas in the axillary and inguinal regions. In 2018, physical examination showed the same nodules with a more intense character as well as furuncles on the scalp and skin of the back, with Hurley staging stage II, PGA staging III, DLQI 14 (Figure 3, Figure 4). Until the disease was diagnosed, the patient was treated several times with peroral antibiotics, while laboratory tests which included complete blood cell count, biochemistry, serology for syphilis, HIV, and hepatitis B and C infection together with chest X-rays were all within normal limits with the exception of elevated cholesterol (6.1). Abdominal ultrasound examination found no abnormalities. Quantiferon test was negative. The following therapy was administered during hospitalization: Humira (adalimumab) initial dose 160 mg, a dose of 80 mg after 14 days, and after 7 days 40 mg, in addition to local therapy with 10% resorcinol solution at the location of the skin changes. After 16 weeks of treatment with adalimumab, Hurley staging was II, PGA staging was III, and DLQI index was 3. Hidradenitis suppurativa is a chronic, recurrent inflammatory and debilitating skin disease of the terminal hair follicle that usually presents after puberty with painful, deep seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly the axillary, inguinal, and anogenital region (3). Biological therapies have been increasingly used for patients who failed to sufficiently respond to antibiotics and hormonal treatments. Adalimumab, infliximab, and etanercept have all been tested in the treatment of hidradenitis suppurativa but vary in effectiveness and in how well they have been studied. Subcutaneous weekly adalimumab (160 mg at week, 80 mg at week 2, and 40 mg each week thereafter) is the only biologic agent approved by the US Food and Drug Administration (FDA) and the European Medicine Agency (EMA) for the treatment of HS and is recommended as first-line therapy for patients who moderate-to-severe disease and who are intolerant or unresponsive to oral antibiotics (5,12). Treatment of hidradenitis suppurativa remains a considerable challenge and should be individualized according to the state and extent of the disease. Therapeutic options for hidradenitis suppurativa were long restricted to the use of local disinfectants and systemic antibiotics as well as repeated incisions and drainage, which produce only short-term benefits. Our patients showed regression of lesions after sixteen weeks of biological therapy.", "provenance": [ { "field": "n", "quote": "The first male patient aged 59 years" }, { "field": "population", "quote": "multiple abscesses, fistulas, and nodules in the axillary, inguinal, perianal, gluteal, and intergluteal regions" }, { "field": "intervention", "quote": "prescribed adalimumab in doses of 80 mg initially, 40 mg ×2 on the first day and the day after that, then 80 mg after fifteen days followed by 40 mg every ten days" }, { "field": "comparator", "quote": "Our patients showed regression of lesions after sixteen weeks of biological therapy." }, { "field": "primaryOutcome", "quote": "After 16 weeks of treatment with adalimumab, Hurley staging was II, PGA IV, DLQI 3." }, { "field": "result", "quote": "After 16 weeks of treatment with adalimumab, Hurley staging was II, PGA staging was III, and DLQI index was 3." } ] }, { "id": "pmid:34085331", "pmid": "34085331", "doi": "10.1111/exd.14340", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa in South-East Asia and East Asia", "firstAuthor": "Chandran", "multipleAuthors": true, "journal": "Exp Dermatol", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa in South-East Asia and East Asia", "intervention": "", "comparator": "Western populations with hidradenitis suppurativa", "primaryOutcome": "clinical, environmental, physiological and genetic features of the condition", "result": "Buttock involvement is common in East Asian patients, with male predominance and metabolic comorbidities; family history is less common than in the West", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review describing patterns rather than testing a treatment or reporting a controlled study with numbers.", "directness": "direct", "limitations": "No sample size, methodology, or statistical data given; appears to be a descriptive summary of regional patterns.", "followUp": "", "plainFinding": "Butt pimples common in East Asian HS patients.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34085331/", "sourceText": "Hidradenitis suppurativa (HS) in South-East Asia and East Asia shows distinct clinical, environmental, physiological and likely genetic differences compared with the West. A male predominance is present, which may be due to differences in smoking habits. Involvement of the buttocks is common in East Asian patients, while the axillae are most commonly affected in South-East Asian patients. Metabolic comorbidities are prevalent in South-East Asian and East Asian HS patients. A family history of HS is less common than noted in Western populations. Asian ethnic subgroups deserve further study.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) in South-East Asia and East Asia" }, { "field": "result", "quote": "Involvement of the buttocks is common in East Asian patients, while the axillae are most commonly affected in South-East Asian patients." }, { "field": "result", "quote": "A male predominance is present, which may be due to differences in smoking habits." }, { "field": "result", "quote": "Metabolic comorbidities are prevalent in South-East Asian and East Asian HS patients." }, { "field": "result", "quote": "A family history of HS is less common than noted in Western populations." }, { "field": "primaryOutcome", "quote": "shows distinct clinical, environmental, physiological and likely genetic differences compared with the West" }, { "field": "comparator", "quote": "compared with the West" } ] }, { "id": "pmid:34075588", "pmid": "34075588", "doi": "10.1111/ijd.15677", "nctId": null, "pmcid": null, "title": "Squamous cell carcinoma arising within hidradenitis suppurativa: a literature review", "firstAuthor": "Sachdeva", "multipleAuthors": true, "journal": "Int J Dermatol", "year": 2021, "design": "systematic-review", "n": 95, "nField": "reported", "population": "people with longstanding hidradenitis suppurativa lesions", "intervention": "having chronic hidradenitis suppurativa lesions (no treatment studied)", "comparator": "", "primaryOutcome": "development of squamous cell carcinoma (skin cancer) within HS lesions, and related metastasis, recurrence, and death", "result": "Nearly half of the skin cancers occurred in the buttock area, and most patients who developed this cancer had high rates of spread or death", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a review of scattered past case reports without a control group, so it can't reliably show cause and effect.", "directness": "indirect", "limitations": "Based on pooled case reports with incomplete outcome reporting; no control group or statistical pooling across studies.", "followUp": "", "plainFinding": "Rare skin cancer in long-term HS.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34075588/", "sourceText": "Squamous cell carcinoma (SCC) can present as a rare complication of longstanding hidradenitis suppurativa (HS) lesions. Limited data exist on characteristics and outcomes of SCC development within HS lesions. The purpose of this review is to conduct a literature review of previously reported cases of SCC development in pre-existing HS lesions. EMBASE and MEDLINE searches were conducted in OVID on June 25, 2020, to yield 59 studies. Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95). The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122). The mean duration between HS onset and SCC development was 25.5 years. Of the patients that had outcomes reported, 54.0% (n = 34/63) experienced SCC metastasis, 43.1% (n = 28/65) experienced SCC recurrences, and 58.7% (n = 44/75) experienced a mortality outcome. The most common documented reasons for death included metastasis (34.1%, n = 15/44) and sepsis (13.6%, n = 6/44). Patients with longstanding HS lesions can develop SCCs with a high rate of metastasis and mortality. Thus, chronic HS lesions, especially in the gluteal, perianal, genital, and perineal regions, should be monitored regularly for timely SCC diagnosis and management.", "provenance": [ { "field": "population", "quote": "Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95)." }, { "field": "intervention", "quote": "SCC development in pre-existing HS lesions" }, { "field": "primaryOutcome", "quote": "characteristics and outcomes of SCC development within HS lesions" }, { "field": "result", "quote": "The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122)." }, { "field": "result", "quote": "58.7% (n = 44/75) experienced a mortality outcome" }, { "field": "n", "quote": "Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions" } ] }, { "id": "pmid:34075575", "pmid": "34075575", "doi": "10.1111/ijd.15671", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa in East and Southeast Asian populations: a systematic review and meta-analysis", "firstAuthor": "Gotesman", "multipleAuthors": true, "journal": "Int J Dermatol", "year": 2021, "design": "meta-analysis", "n": 30125, "nField": "reported", "population": "People in East and Southeast Asia diagnosed with hidradenitis suppurativa (a chronic skin condition with inflamed bumps)", "intervention": "No treatment studied — this pooled data on where HS lesions occur on the body", "comparator": "No comparator — descriptive analysis of lesion locations across combined studies", "primaryOutcome": "How often HS lesions occur in the armpit and buttock areas, and other patient characteristics", "result": "About half of patients had lesions on the buttocks and about half in the armpits; most patients were male and few had a family history", "resultDirection": "unclear", "quality": "moderate", "qualityWhy": "It pools many small observational studies which can vary a lot in quality, so the numbers are a reasonable estimate but not a strong test of cause or treatment.", "directness": "indirect", "limitations": "The abstract does not report specific limitations beyond being a meta-analysis of observational/case-series data with wide confidence intervals.", "followUp": "", "plainFinding": "Many HS patients get buttock bumps too.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34075575/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that presents with recurrent inflammatory nodules and draining tunnels in the skin. Most HS studies have focused on Western populations, and the understanding of how HS characteristics differ in specific Asian ethnicities is poor. We conducted the first systematic review and meta-analysis to characterize HS patients from East and Southeast Asia. PubMed, Embase, and Ovid MEDLINE databases were searched from inception to June 12, 2020. English-language case-series, cross-sectional, observational, and randomized controlled trial studies investigating HS in East and Southeast Asian populations were screened by titles, abstracts, and articles in duplicate. Of 136 citations, 10 studies were included in the meta-analysis. Data on gender distribution, lesion distribution in the axilla and gluteal regions, and family history were extracted in duplicate. A random effects model was used for the meta-analysis. A total of 30,125 HS patients were included in the analysis. Most patients were male (66%, 95% CI = 60-72%). About half of Asian patients with HS develop lesions in the axilla (52%, 95% CI = 33-72%) and the buttocks (48%, 95% CI = 38-57%). Only a small subset had positive family history of HS (5%, 95% CI = 2-8%). We report an up-to-date characterization of HS in East and Southeast Asian populations and highlight differences in their Western counterparts. These results will hopefully improve understanding for how HS may manifest, lead to more personalized treatments for Asian patients with HS, and usher in a proper patient-centered approach to treating the disease.", "provenance": [ { "field": "n", "quote": "A total of 30,125 HS patients were included in the analysis." }, { "field": "population", "quote": "English-language case-series, cross-sectional, observational, and randomized controlled trial studies investigating HS in East and Southeast Asian populations" }, { "field": "intervention", "quote": "Data on gender distribution, lesion distribution in the axilla and gluteal regions, and family history were extracted in duplicate." }, { "field": "comparator", "quote": "A random effects model was used for the meta-analysis." }, { "field": "primaryOutcome", "quote": "About half of Asian patients with HS develop lesions in the axilla (52%, 95% CI = 33-72%) and the buttocks (48%, 95% CI = 38-57%)." }, { "field": "result", "quote": "About half of Asian patients with HS develop lesions in the axilla (52%, 95% CI = 33-72%) and the buttocks (48%, 95% CI = 38-57%). Only a small subset had positive family history of HS (5%, 95% CI = 2-8%)." } ] }, { "id": "pmid:33992813", "pmid": "33992813", "doi": "10.1016/j.pdpdt.2021.102339", "nctId": null, "pmcid": null, "title": "Intralesional photodynamic therapy in hidradenitis suppurativa: Getting closer to the target", "firstAuthor": "Garcias-Ladaria", "multipleAuthors": true, "journal": "Photodiagnosis Photodyn Ther", "year": 2021, "design": "retrospective", "n": 42, "nField": "reported", "population": "patients with hidradenitis suppurativa (a chronic skin condition causing painful lumps, including in buttock/groin areas)", "intervention": "intralesional photodynamic therapy using a light-activated drug injected into lesions and then lasered", "comparator": "no comparator group; outcomes measured before and after treatment in the same lesions", "primaryOutcome": "whether lesions resolved, improved, or showed no change 3 months after treatment", "result": "about 22% of lesions resolved and 62% improved at 3 months, but gluteal (buttock) location was linked to worse response; burns and abscesses were common side effects", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective, uncontrolled study of a specific severe skin disease, not a general explanation for pimples, so it offers weak and indirect evidence for the question asked.", "directness": "indirect", "limitations": "retrospective design, no control group, and gluteal lesions specifically responded less well to treatment", "followUp": "3 months", "plainFinding": "Treats a specific severe skin disease, not typical pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33992813/", "sourceText": "BACKGROUND: The successful treatment of hidradenitis suppurativa (HS) with intralesional photodynamic therapy (IL-PDT) has been previously reported in some case series published a few years ago. We present additional data and patient outcome for this form of PDT. METHODS: This is an observational retrospective study including all patients diagnosed with HS and treated with IL-PDT in the Hospital Universitari Son Espases from February 2019 to February 2020. Under local or general anesthesia, 5-aminolevulinic acid (5ALA) in gel 2 % or solution 1 % was introduced in the lesion. After two hours, the lesion was intralesionally irradiated (1.4 W, fluence 168 J/cm2) with the tip of a 0.4-mm thick optical fiber connected to a continuous 630-nm diode laser. The main outcome variable was the result (remission, improvement or no change) for each lesion 3 months after the therapy. The result at 6 months and the side effects were secondary outcomes. A multivariate analysis was carried out in order to obtain adjusted odds ratios for no change vs improvement or remission at 3 months for significant variables. RESULTS: A total of 117 lesions (28 nodules and 89 fistulae) were treated in 42 patients. At 3 months, 26 lesions (22.2 %) had resolved, 73 (62.4 %) had improved in size or symptoms, and 18 (15.4 %) experienced no change. The most frequent side effects were skin burns (53 lesions, 45.3 %), and abscess formation (8 lesions, 6.8 %). In the multivariate analysis, significant variables for no benefit were: a higher International Hidradenitis Suppurativa (IHS4) score, active smoking and gluteal and inguinal location. CONCLUSIONS: Although our results did not present the level of remission of the previous studies, IL-PDT was useful in most of our patients. Early interventions in patients with lower inflammatory burden were the most valuable.", "provenance": [ { "field": "population", "quote": "patients diagnosed with HS and treated with IL-PDT" }, { "field": "intervention", "quote": "5-aminolevulinic acid (5ALA) in gel 2 % or solution 1 % was introduced in the lesion. After two hours, the lesion was intralesionally irradiated" }, { "field": "comparator", "quote": "The main outcome variable was the result (remission, improvement or no change) for each lesion 3 months after the therapy." }, { "field": "primaryOutcome", "quote": "The main outcome variable was the result (remission, improvement or no change) for each lesion 3 months after the therapy." }, { "field": "result", "quote": "At 3 months, 26 lesions (22.2 %) had resolved, 73 (62.4 %) had improved in size or symptoms, and 18 (15.4 %) experienced no change." }, { "field": "result", "quote": "significant variables for no benefit were: a higher International Hidradenitis Suppurativa (IHS4) score, active smoking and gluteal and inguinal location" }, { "field": "n", "quote": "A total of 117 lesions (28 nodules and 89 fistulae) were treated in 42 patients." } ] }, { "id": "pmid:33629618", "pmid": "33629618", "doi": "10.1080/14737167.2021.1895753", "nctId": null, "pmcid": null, "title": "Resource utilization, work productivity and costs in patients with hidradenitis suppurativa: a cost-of-illness study", "firstAuthor": "Gáspár", "multipleAuthors": true, "journal": "Expert Rev Pharmacoecon Outcomes Res", "year": 2022, "design": "retrospective", "n": 200, "nField": "reported", "population": "adults with hidradenitis suppurativa in Hungary", "intervention": "no treatment tested - researchers measured healthcare use, costs, and productivity loss", "comparator": "no comparison group - single cohort cross-sectional analysis", "primaryOutcome": "total annual cost of illness (medical, non-medical, and work-related costs)", "result": "average yearly cost per patient was about €6,791, driven mainly by lost work productivity and biologic drug costs", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a cross-sectional cost survey of one disease group, not a trial testing a cause or treatment, so it cannot explain why the condition occurs.", "directness": "indirect", "limitations": "cross-sectional design limited to one country (Hungary), focused on economic burden rather than disease cause or treatment effect", "followUp": "", "plainFinding": "Study measured costs, not causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33629618/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a, chronic skin disease affecting up to 1% of the population in Europe. This study aims to assess the cost-of-illness of HS from a societal perspective in Hungary and to analyze the predictors of costs. METHODS: A multicentre, cross-sectional cost-of-illness study was performed among 200 adult HS patients. We evaluated direct medical (physician consultations, inpatient admissions, medical, and surgeries), direct non-medical (transportation and caregiving), and indirect costs (productivity loss). RESULTS: The mean annual cost-of-illness of HS was €6,791 per patient. The main cost components were productivity loss (53.3%), biological treatment (21.5%), and informal care (9.2%). Patients missed, on average, 26 and 63 days from work annually due to absenteeism and presenteeism, respectively. Male sex, more severe disease, gluteal involvement, and coexisting inflammatory bowel disease were associated with higher direct medical costs, while lower education level and worse quality-of-life outcomes predicted higher indirect costs. CONCLUSION: This is the first study to assess both direct and indirect costs in HS patients. HS imposes a substantial burden on patients and society, predominantly arising from productivity loss and biological therapy. Resource utilization data and cost-of-illness estimates provide valuable inputs into cost-effectiveness analyses of health interventions in HS.", "provenance": [ { "field": "population", "quote": "among 200 adult HS patients" }, { "field": "intervention", "quote": "We evaluated direct medical (physician consultations, inpatient admissions, medical, and surgeries), direct non-medical (transportation and caregiving), and indirect costs (productivity loss)." }, { "field": "comparator", "quote": "A multicentre, cross-sectional cost-of-illness study was performed among 200 adult HS patients." }, { "field": "primaryOutcome", "quote": "The mean annual cost-of-illness of HS was €6,791 per patient." }, { "field": "result", "quote": "The main cost components were productivity loss (53.3%), biological treatment (21.5%), and informal care (9.2%)." }, { "field": "n", "quote": "among 200 adult HS patients" } ] }, { "id": "pmid:33503635", "pmid": "33503635", "doi": "10.1159/000513447", "nctId": null, "pmcid": null, "title": "Baseline Characteristics of a National French E-Cohort of Hidradenitis Suppurativa in ComPaRe and Comparison with Other Large Hidradenitis Suppurativa Cohorts", "firstAuthor": "Condamina", "multipleAuthors": true, "journal": "Dermatology", "year": 2021, "design": "registry", "n": 396, "nField": "reported", "population": "adults with hidradenitis suppurativa enrolled in a French patient e-cohort", "intervention": "treatment history (mainly oral antibiotics, less often biologics)", "comparator": "no comparator group; descriptive cross-sectional data only", "primaryOutcome": "clinical characteristics and treatment history of hidradenitis suppurativa patients", "result": "Most patients had moderate to severe disease, many were smokers or overweight, and antibiotics were the most common treatment while few received biologics; disease severity was linked to obesity and certain body sites including the gluteal fold and groin.", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a self-reported, cross-sectional survey with no control group, so it can describe patterns but not prove any treatment works.", "directness": "indirect", "limitations": "Cross-sectional, patient-reported data from a self-selected web cohort; no comparator group and no outcome testing of treatment effectiveness.", "followUp": "", "plainFinding": "Describes HS patient traits, no treatment tested.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33503635/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition substantially impacting patients' quality of life; the pathogenesis remains unclear, and treatment is complex and not yet standardized. Observational data are increasingly being used to evaluate therapeutics in \"real-life\" interventions, and the development of e-cohorts is offering new tools for epidemiological studies at the population level. OBJECTIVE: The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort and to compare these to other cohorts. METHODS: We performed a cross-sectional study of the baseline data of HS participants in ComPaRe, an e-cohort of patients with chronic diseases. Data were collected using patient-reported questionnaires about clinical-dem-ographic aspects, quality of life, and treatment history. RESULTS: A total of 396 participants (339 females, 57 males) were included (mean age 38 years); 83 (21%) had a family history of HS, 227 (57.3%) were current smokers, and 241 (60.9%) were overweight or obese. Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%). The breast was more frequently affected in women than men (37.5 vs. 5.3%, p < 0.0001), whereas the dorsal region was more frequently affected in men (39.5 vs. 10.9%, p < 0.0001). Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001]). The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics. Most of these results were consistent with previously published cohorts. CONCLUSION: Recruitment of participants by such a web platform can be a faster way to get relevant scientific data for a wide variety of patients that could be used for epidemiological studies and to evaluate therapeutics in \"real-life\" interventions.", "provenance": [ { "field": "n", "quote": "A total of 396 participants (339 females, 57 males) were included" }, { "field": "population", "quote": "HS participants in the Community of Patients for Research (ComPaRe) cohort" }, { "field": "intervention", "quote": "The most frequently prescribed treatments were oral antibiotics (n = 362, 91.4%), especially amoxicillin-clavulanic acid and cyclins. Less than 10% of participants received biologics." }, { "field": "comparator", "quote": "We performed a cross-sectional study of the baseline data of HS participants in ComPaRe" }, { "field": "primaryOutcome", "quote": "The aim of this study was to describe the clinical characteristics and treatment history of HS participants in the Community of Patients for Research (ComPaRe) cohort" }, { "field": "result", "quote": "Most of the participants declared a Hurley stage II (n = 263, 66.4%) or III (n = 76, 20.3%)." }, { "field": "result", "quote": "Increased disease stage was associated with obesity (25.9 vs. 33.8 vs. 51.3%, p = 0.02) and some HS localizations (genital [p < 0.005], pubis [p < 0.007], gluteal fold [p = 0.02], and groin [p < 0.0001])." } ] }, { "id": "pmid:33187546", "pmid": "33187546", "doi": "10.1186/s13052-020-00933-1", "nctId": null, "pmcid": "PMC7663872", "title": "SAPHO syndrome: the supposed trigger by isotretinoin, the efficacy of adalimumab and the specter of depressive disorder: a case report", "firstAuthor": "Luzzati", "multipleAuthors": true, "journal": "Ital J Pediatr", "year": 2020, "design": "case-series", "n": 1, "nField": "reported", "population": "a boy with severe acne and depression who developed joint and bone inflammation after acne treatment", "intervention": "a biologic drug called adalimumab (blocks TNF-alpha)", "comparator": "anti-inflammatory drugs (NSAIDs) used first", "primaryOutcome": "control of the inflammatory disease", "result": "switching to adalimumab achieved good control of the disease", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this applies to other people.", "directness": "indirect", "limitations": "Single case report; no control group; causal role of isotretinoin not established.", "followUp": "", "plainFinding": "Biologic drug controlled rare syndrome.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33187546/", "sourceText": "BACKGROUND: SAPHO (synovitis, acne, pustolosis, hyperostosis and osteitis) syndrome is a rare autoinflammatory chronic disorder, presenting with non-infectious osteitis, sterile joint inflammation and skin manifestations including palmoplantar pustolosis and severe acne. It could be often misdiagnosed for its heterogeneous clinical presentation. Treatment is challenging and, due to the rarity of this syndrome, no randomized controlled clinical trials have been conducted. Empirical treatments, including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antibiotics and bisphosphonates and disease-modifying anti-rheumatic drugs (DMARDs) could be quite effective. Anti-tumor necrosis factor-alpha (anti-TNF-α) agents and interleukin-1 (IL-1) antagonists have shown promising results in refractory patients. Isotretinoin, commonly used for severe acne, has been rarely described as possible trigger of osteo-articular manifestations, in particular sacroiliitis. CASE PRESENTATION: The case of a boy, affected by acne fulminans and depression, who presented with sacroiliitis after a 10-week treatment with isotretinoin is presented. After SAPHO diagnosis, NSAIDs therapy was started but the onset of bilateral gluteal hidradenitis suppurativa required the switch to a TNF-α antagonist (Adalimumab) with the achievement of a good control of the disease. Despite specific therapy with sertraline, the patient continued to complains severe depression. CONCLUSIONS: Our case reports a temporal association between the onset of osteo-articular symptoms and the introduction of isotretinoin, as previously described. However, this timeline is not sufficient to establish a causal role of this drug into the pathogenesis of sacroiliitis. At this regard, further studies are required. The occurrence of hidradenitis suppurativa during SAPHO course supported the introduction of TNF-α blockers with a favourable result, as reported in a few cases in literature. The association between SAPHO syndrome and depressive mood disorders is already reported. Our patient experienced severe depression whose trend seems to be independent from the course of the main disease. Currently, it is not clarified if depression could be considered reactive to the underling disease or if it forms an integral part of the autoinflammatory disorder.", "provenance": [ { "field": "n", "quote": "The case of a boy, affected by acne fulminans and depression" }, { "field": "population", "quote": "The case of a boy, affected by acne fulminans and depression, who presented with sacroiliitis after a 10-week treatment with isotretinoin is presented." }, { "field": "intervention", "quote": "the switch to a TNF-α antagonist (Adalimumab)" }, { "field": "comparator", "quote": "After SAPHO diagnosis, NSAIDs therapy was started" }, { "field": "primaryOutcome", "quote": "with the achievement of a good control of the disease" }, { "field": "result", "quote": "required the switch to a TNF-α antagonist (Adalimumab) with the achievement of a good control of the disease" } ] }, { "id": "pmid:33171462", "pmid": "33171462", "doi": "10.1159/000511045", "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurativa: Proposal of Classification in Two Endotypes with Two-Step Cluster Analysis", "firstAuthor": "González-Manso", "multipleAuthors": true, "journal": "Dermatology", "year": 2021, "design": "retrospective", "n": 103, "nField": "reported", "population": "103 patients diagnosed with hidradenitis suppurativa (a chronic inflammatory skin disease)", "intervention": "statistical cluster analysis grouping patients by clinical features, genetics and blood markers", "comparator": "", "primaryOutcome": "identifying distinct disease subtypes (endotypes) of hidradenitis suppurativa", "result": "patients split into two subtypes: one with early onset, posterior (buttock/back) nodules, higher IL-10, gamma-secretase gene mutations and history of pilonidal sinus; the other with later onset, front-of-body lesions, obesity, and higher inflammatory markers", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a small, cross-sectional analysis of existing patients with no control group or outcome testing, so it mainly describes patterns rather than proving causes.", "directness": "indirect", "limitations": "small sample size, cross-sectional design with no follow-up, and no testing of why lesions occur—only grouping of existing patients by shared traits", "followUp": "", "plainFinding": "One HS subtype mainly affects buttocks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33171462/", "sourceText": "INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent disorder of the pilosebaceous unit. Currently, several attempts have been made to classify this disease according to its pathogenesis and clinical manifestations. We attempted at classifying 103 patients using two-step cluster analysis. METHODS: The final model included body mass index, C-reactive protein (CRP), and serum concentrations of IL-1, IL-6, IL-17, and IL-10 as continuous variables, and sex, later/early onset, anterior/posterior lesion sites, presence/absence of sinus tracts, nodules and abscesses, positive/negative history of pilonidal sinus, and presence/absence of mutations in gamma-secretase subunits (APH1A, APH1B, MEFV, NCSTN, PSEN1, PSEN2, PSENEN, PSTPIP1) as qualitative variables. RESULTS: The resultant model defined two groupings or clusters: cluster 1 (64.9% of patients) characterized by nonobese males, with nodular lesions in posterior sites, early-onset HS, higher IL-10, presence of gamma-secretase mutations, and history of pilonidal sinus; and cluster 2 (35.1% of patients) characterized by obese females or males, with lesions in anterior sites, more presence of sinus tracts and abscesses and less nodules, later-onset HS, and higher concentrations of IL-1, CRP, IL-17, and IL-6. Severity measures (Hurley, HS-PGA, and IHS4) and tobacco use were discarded because the analysis found them to be less relevant for clustering. CONCLUSION: Our resultant model confirms the clinical impression that HS is a disease spectrum with two pathogenic poles defining two clusters or endotypes. The probability of having severe disease was equally distributed in the two clusters. The variable with the highest predictive value for clustering was involvement of typical anterior sites (axillae, submammary) or atypical posterior sites (back, gluteal). Serum concentrations of interleukins, tobacco use, and sex had a lower predictive power for clustering.", "provenance": [ { "field": "population", "quote": "We attempted at classifying 103 patients using two-step cluster analysis." }, { "field": "intervention", "quote": "two-step cluster analysis" }, { "field": "primaryOutcome", "quote": "The resultant model defined two groupings or clusters" }, { "field": "result", "quote": "cluster 1 (64.9% of patients) characterized by nonobese males, with nodular lesions in posterior sites, early-onset HS, higher IL-10, presence of gamma-secretase mutations, and history of pilonidal sinus; and cluster 2 (35.1% of patients) characterized by obese females or males, with lesions in anterior sites, more presence of sinus tracts and abscesses and less nodules, later-onset HS, and higher concentrations of IL-1, CRP, IL-17, and IL-6" }, { "field": "n", "quote": "103 patients using two-step cluster analysis" } ] }, { "id": "pmid:33099547", "pmid": "33099547", "doi": "10.1159/000511077", "nctId": null, "pmcid": null, "title": "Development and Validation of HSCAPS-1: A Clinical Decision Support Tool for Diagnosis of Hidradenitis Suppurativa over Cutaneous Abscess", "firstAuthor": "Garg", "multipleAuthors": true, "journal": "Dermatology", "year": 2021, "design": "retrospective", "n": 9534, "nField": "reported", "population": "patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock", "intervention": "a clinical decision support to predict diagnosis of HS", "comparator": "cutaneous abscess of the axilla, groin, perineum, and buttock", "primaryOutcome": "predicted probability of HS diagnosis", "result": "The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept -0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076])", "resultDirection": "unclear", "quality": "low", "qualityWhy": "it is a retrospective records-based study without independent outside validation, so it mainly shows a diagnostic tool works reasonably well rather than proving why bumps form.", "directness": "indirect", "limitations": "", "followUp": "", "plainFinding": "Tool tells HS from abscess.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33099547/", "sourceText": "BACKGROUND: A clinical decision support tool may improve recognition of hidradenitis suppurativa (HS) and reduce diagnosis delay. OBJECTIVE: To develop and initially validate a clinical decision support to predict diagnosis of HS and distinguish it from cutaneous abscess of the axilla, groin, perineum, and buttock. METHODS: This was a retrospective, cross-sectional analysis between January 2012 and June 2017 (development set) and July 2017 and March 2019 (validation set). We used an electronic records sample of 56 million patients from the Explorys database to identify patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock. The outcome was predicted probability of HS diagnosis. RESULTS: Development set included 7,974 patients with mean age of 41.4 years, who were predominantly female (66%) and white (62%). Validation set included 1,560 patients with similar demographic composition. Factors which were stronger independent predictors of HS included female sex (OR 2.17 [95% CI 1.96-2.40]); African American race (1.28 [95% CI 1.15-1.44]); increasing BMI (OR 1.05 [95% CI 1.05-1.06)]; history of acne (OR 3.46 [95% CI 2.83-4.23]); Down syndrome (OR 5.35 [95% CI 2.03-14.12]); and prescription for at least 7 opioid medications in the past year (OR 1.05 [95% CI 0.83-1.33]). Up to age 45 years, increasing age was a stronger predictor of HS diagnosis. The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept -0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076]). CONCLUSION: This clinical decision support tool shows good performance in predicting diagnosis of HS and distinguishing it from cutaneous abscess that involves the axilla, groin, perineum, and buttock.", "provenance": [ { "field": "population", "quote": "patients with an ambulatory visit associated with either HS or cutaneous of the axilla, groin, perineum, and buttock" }, { "field": "intervention", "quote": "a clinical decision support to predict diagnosis of HS" }, { "field": "comparator", "quote": "cutaneous abscess of the axilla, groin, perineum, and buttock" }, { "field": "primaryOutcome", "quote": "predicted probability of HS diagnosis" }, { "field": "result", "quote": "The simplified model showed good discrimination (c-statistic 0.746 [SE 0.013]) and moderate calibration (calibration intercept -0.260 [SE 0.055]; calibration slope 1.142 [SE 0.076])" }, { "field": "n", "quote": "Development set included 7,974 patients" }, { "field": "n", "quote": "Validation set included 1,560 patients" } ] }, { "id": "pmid:33098826", "pmid": "33098826", "doi": "10.1016/j.jid.2020.08.032", "nctId": null, "pmcid": null, "title": "Characterization of Hidradenitis Suppurativa Phenotypes: A Multidimensional Latent Class Analysis of the National Italian Registry IRHIS", "firstAuthor": "Cazzaniga", "multipleAuthors": true, "journal": "J Invest Dermatol", "year": 2021, "design": "registry", "n": 965, "nField": "reported", "population": "patients with hidradenitis suppurativa (a chronic skin condition) seen at Italian dermatology clinics", "intervention": "none - this was an observational study classifying patients into disease subtypes, not testing a treatment", "comparator": "none - subtypes were compared to each other, not to a treatment or placebo", "primaryOutcome": "identifying distinct subtypes (phenotypes) of hidradenitis suppurativa based on where lesions occur and other traits", "result": "three patient subtypes were found; one subtype, mostly non-obese men, had a high chance of lesions on the buttocks and groin along with acne and pilonidal cysts", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive, cross-sectional analysis of registry patients without a comparison group or outcome testing, so it cannot establish cause of buttock pimples, only describe patterns within an already-diagnosed condition.", "directness": "indirect", "limitations": "cross-sectional design, patients already diagnosed with hidradenitis suppurativa rather than general population with buttock pimples, no testing of treatment or cause-effect", "followUp": "", "plainFinding": "One skin-disease subtype involves buttock bumps, mainly in men.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33098826/", "sourceText": "In spite of the large heterogeneity, limited data exist on hidradenitis suppurativa (HS) phenotypes. To identify the HS phenotypes that best explain the disease heterogeneity, a cross-sectional study using latent class (LC) analysis was conducted on a cohort of patients examined at 17 dermatological centers participating in the Italian Registry of Hidradenitis Suppurativa and being enrolled between January 2015 and January 2020. Overall, 965 patients aged 32.0 ± 12.4 years (mean ± SD) were evaluated. A three-class model in LC analysis best fitted the data. Patients in LC1 (20.1%) were females, mostly obese, with a high probability of axillary‒groin (0.85) and mammary (0.59) lesions and the highest HS severity. Patients in LC2 (29.6%) were nonobese males, with moderate disease severity; with a high probability of gluteal (0.50) and genital (0.17) lesions, besides axillary‒groin involvement; and with acne and pilonidal cysts. Patients in LC3 (50%) were nonobese females with a milder disease mostly limited to axillary (0.52) and groin (0.66) areas. The stratification of patients with HS into a severe axillary‒mammary‒groin phenotype with predominantly anterior body involvement in females, an axillary‒gluteal‒groin phenotype of intermediate severity mainly affecting males in the posterior body areas, and an axillary‒groin phenotype with mildest clinical symptoms and limited skin involvement may help in optimizing HS management.", "provenance": [ { "field": "n", "quote": "Overall, 965 patients aged 32.0 ± 12.4 years (mean ± SD) were evaluated." }, { "field": "population", "quote": "a cohort of patients examined at 17 dermatological centers participating in the Italian Registry of Hidradenitis Suppurativa" }, { "field": "primaryOutcome", "quote": "To identify the HS phenotypes that best explain the disease heterogeneity, a cross-sectional study using latent class (LC) analysis was conducted" }, { "field": "result", "quote": "Patients in LC2 (29.6%) were nonobese males, with moderate disease severity; with a high probability of gluteal (0.50) and genital (0.17) lesions, besides axillary‒groin involvement; and with acne and pilonidal cysts." }, { "field": "intervention", "quote": "a cross-sectional study using latent class (LC) analysis was conducted on a cohort of patients" }, { "field": "comparator", "quote": "A three-class model in LC analysis best fitted the data." } ] }, { "id": "pmid:33089403", "pmid": "33089403", "doi": "10.1007/s00403-020-02149-z", "nctId": null, "pmcid": null, "title": "Sub-classification of Hidradenitis suppurativa: a cross-sectional study", "firstAuthor": "Thorlacius", "multipleAuthors": true, "journal": "Arch Dermatol Res", "year": 2022, "design": "registry", "n": 524, "nField": "reported", "population": "people diagnosed with hidradenitis suppurativa (a skin condition causing recurrent boils/pimples in skin folds)", "intervention": "no treatment tested – patients were surveyed about where their flare-ups occur", "comparator": "none (no comparison group, single group survey)", "primaryOutcome": "pattern of where HS flare-ups occur on the body", "result": "Found two distinct patterns: an 'upper type' affecting armpits and breast area, and a 'lower type' affecting groin, genitals, anus and buttocks", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a one-time self-reported questionnaire with only 62% response rate and no comparison group, so it can describe patterns but not prove causes.", "directness": "indirect", "limitations": "Abstract notes it is a cross-sectional questionnaire-based design with 62% response rate and relies on self-reported flare locations rather than clinical examination or causal testing.", "followUp": "", "plainFinding": "Lower-type HS pattern often involves buttocks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33089403/", "sourceText": "The typical Hidradenitis Suppurativa (HS) patient is a young woman with axillary and groin involvement, but the spectrum of the disease presentation is broad and no internationally acknowledged sub-classification of the disease exists to date. It is however speculated that different, yet unidentified, subtypes may respond differently to different treatments or carry a different prognosis. Classification according to self-reported clinically meaningful outcomes for patients offer practical advantages. Our objective was to build an empirical framework for sub-classification of HS patients based on the frequency of HS flares in various anatomic locations, using a cross-sectional questionnaire-based design. All patients with a clinically confirmed diagnosis of HS registered at our department until March 1, 2017 were invited to participate. The frequency of HS flares in various anatomic locations was used for identification of possible HS subtypes using Principal Component Analysis (PCA) and cluster analysis. A total of 524 (62%) of 845 invited patients answered the questionnaire; 402 (76.7%) were female. From the cluster analysis, we identified two possible subtypes of HS, labeled the \"upper type\" and the \"lower type\". The \"upper type\" was characterized by repeated outbreaks in axillary and mammary regions. Meanwhile, the \"lower type\" was characterized by outbreaks in the inguinal, genital, perianal, and gluteal regions. Our findings support the notion that HS can be sub-classified and imply that the pattern of where lesions are located may be an important element in future HS sub-classification systems.", "provenance": [ { "field": "n", "quote": "A total of 524 (62%) of 845 invited patients answered the questionnaire" }, { "field": "population", "quote": "All patients with a clinically confirmed diagnosis of HS registered at our department until March 1, 2017 were invited to participate." }, { "field": "intervention", "quote": "using a cross-sectional questionnaire-based design" }, { "field": "comparator", "quote": "The frequency of HS flares in various anatomic locations was used for identification of possible HS subtypes using Principal Component Analysis (PCA) and cluster analysis." }, { "field": "primaryOutcome", "quote": "The frequency of HS flares in various anatomic locations was used for identification of possible HS subtypes" }, { "field": "result", "quote": "we identified two possible subtypes of HS, labeled the \"upper type\" and the \"lower type\"" } ] }, { "id": "pmid:33051068", "pmid": "33051068", "doi": "10.1016/j.amjsurg.2020.10.004", "nctId": null, "pmcid": null, "title": "Surgical management of advanced hidradenitis suppurativa via a one-stage procedure: A single-center experience", "firstAuthor": "Ayala", "multipleAuthors": true, "journal": "Am J Surg", "year": 2020, "design": "retrospective", "n": 139, "nField": "reported", "population": "patients with advanced hidradenitis suppurativa needing surgery", "intervention": "single-stage surgery (skin removal with skin grafting or direct closure)", "comparator": "primary closure versus skin grafting after excision", "primaryOutcome": "surgical success (healing without recurrence)", "result": "skin grafting succeeded in 75% of cases versus 60% for primary closure; success was lowest in the gluteal and perineal areas (54% and 50%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this is a retrospective single-center review without a control group, so it can't reliably prove one method is better.", "directness": "indirect", "limitations": "retrospective design, no comparison group, single center, and high complication/readmission rates reported", "followUp": "", "plainFinding": "Skin grafting more successful than stitching", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33051068/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a debilitating skin condition; in severe forms it requires excision and skin grafting for cure. This is commonly performed as a multi-stage procedure; we explored single-stage operation as a more efficient alternative. METHODS: Retrospective review 2007-2018 evaluating outcomes of patients undergoing single-stage surgery. RESULTS: 139 one-stage procedures were performed: 35 excision and primary closure, 104 split-thickness skin grafting (STSG). Success rate was higher for STSG at 75% versus 60% with primary closure. Of failed primary closures, 57% required revision by grafting due to recurrence. Axilla procedures were most successful at 91% compared to 70%, 54%, and 50% for inguinal, gluteal, and perineal areas, respectively. Infection was the most common complication (17%), with 38% requiring readmission. CONCLUSION: Compared to prior literature on multi-stage HS treatment, one-stage operations are a feasible, cost-effective alternative. STSG should remain the procedure of choice, even when primary closure appears feasible.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a debilitating skin condition; in severe forms it requires excision and skin grafting for cure" }, { "field": "intervention", "quote": "139 one-stage procedures were performed: 35 excision and primary closure, 104 split-thickness skin grafting (STSG)" }, { "field": "comparator", "quote": "Success rate was higher for STSG at 75% versus 60% with primary closure" }, { "field": "primaryOutcome", "quote": "Success rate was higher for STSG at 75% versus 60% with primary closure" }, { "field": "result", "quote": "Axilla procedures were most successful at 91% compared to 70%, 54%, and 50% for inguinal, gluteal, and perineal areas, respectively" }, { "field": "n", "quote": "139 one-stage procedures were performed" } ] }, { "id": "pmid:32525586", "pmid": "32525586", "doi": "10.1111/apt.15863", "nctId": null, "pmcid": null, "title": "Increased risk of permanent stoma in Crohn's disease associated with hidradenitis suppurativa: a case-control study", "firstAuthor": "Dumont", "multipleAuthors": true, "journal": "Aliment Pharmacol Ther", "year": 2020, "design": "case-control", "n": 4645, "nField": "reported", "population": "people with Crohn's disease seen at a gastroenterology hospital", "intervention": "having hidradenitis suppurativa (a chronic skin disease) alongside Crohn's disease", "comparator": "Crohn's disease patients without hidradenitis suppurativa", "primaryOutcome": "disease activity and need for a permanent stoma (bowel diversion surgery)", "result": "Crohn's disease patients with hidradenitis suppurativa had more active disease, needed more anti-TNF treatment, and had a much higher rate of ending up with a permanent stoma", "resultDirection": "harm", "quality": "low", "qualityWhy": "this is a retrospective case-control study from one hospital with a small number of cases, so it shows an association but cannot prove cause, and it doesn't address common pimples in general.", "directness": "indirect", "limitations": "retrospective design, single tertiary care center, small number of HS cases (44), matched controls which can introduce selection effects", "followUp": "", "plainFinding": "Worse Crohn's outcomes, not simple pimples", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32525586/", "sourceText": "BACKGROUND: Crohn's disease (CD) and hidradenitis suppurativa (HS), a chronic inflammatory skin disease, induce similar inflammatory lesions of the groin and gluteal area. Both diseases are characterised by an inadequate immune response to commensal bacteria in genetically predisposed subjects and can be associated. AIM: To assess whether HS was associated with clinical and prognostic factors in CD. METHODS: A retrospective case-control study included 4645 patients with CD referred to Saint-Antoine Hospital gastroenterology tertiary care centre between 2003 and 2016. Matching variables were sex, age, age and the presence of perianal lesions at CD diagnosis, follow-up quality. HS was confirmed by dermatological examination; location, phenotype and severity (Hurley staging) were recorded. RESULTS: Hidradenitis suppurativa prevalence was 0.95% (44 cases); 80% of patients displayed Hurley stage II or III disease. CD preceded HS in 70% of cases with a median interval of 9 years (IQR 5.25-12.75). CD with HS was more active (56% vs 40% years with active disease, P < 0.001) and required more anti-TNF agents (39% vs 23% years spent with anti-TNF treatment, P < 0.001) than CD without HS. HS was associated with a higher risk of permanent stoma, 16.8% (IQR 7.5-33.3) vs 2.5% (IQR 0.8-7.4) in the control group (P = 0.002). Multivariate analysis confirmed HS as independent risk factor for permanent stoma (odds ratio 6.19; 95% CI, 2.30-38.33; P < 0.001). CONCLUSIONS: Hidradenitis suppurativa is associated with worse CD prognosis, more active disease and increased risk of permanent stoma, despite a higher use of anti-TNF agents.", "provenance": [ { "field": "n", "quote": "included 4645 patients with CD referred to Saint-Antoine Hospital gastroenterology tertiary care centre between 2003 and 2016" }, { "field": "population", "quote": "4645 patients with CD referred to Saint-Antoine Hospital gastroenterology tertiary care centre" }, { "field": "intervention", "quote": "Hidradenitis suppurativa prevalence was 0.95% (44 cases)" }, { "field": "comparator", "quote": "CD with HS was more active (56% vs 40% years with active disease, P < 0.001)" }, { "field": "primaryOutcome", "quote": "HS was associated with a higher risk of permanent stoma, 16.8% (IQR 7.5-33.3) vs 2.5% (IQR 0.8-7.4) in the control group (P = 0.002)." }, { "field": "result", "quote": "Multivariate analysis confirmed HS as independent risk factor for permanent stoma (odds ratio 6.19; 95% CI, 2.30-38.33; P < 0.001)." } ] }, { "id": "pmid:32508815", "pmid": "32508815", "doi": "10.3389/fimmu.2020.00847", "nctId": null, "pmcid": "PMC7251184", "title": "Hidradenitis Suppurativa as a Potential Subtype of Autoinflammatory Keratinization Disease", "firstAuthor": "Nomura", "multipleAuthors": false, "journal": "Front Immunol", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (boils/cysts in skin areas like armpits, groin, buttocks)", "intervention": "understanding the biological causes of hidradenitis suppurativa", "comparator": "", "primaryOutcome": "proposed mechanism explaining why hidradenitis suppurativa develops", "result": "Suggests the condition arises from abnormal skin cell growth (keratinization) combined with self-driven inflammation, possibly forming a distinct inflammatory skin disease category", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is an opinion-style review summarizing other studies' findings rather than new patient data, so it cannot prove cause or treatment effect.", "directness": "indirect", "limitations": "No new patient data or experiments; synthesizes genetic, mouse, and treatment-response findings from other studies to propose a disease concept.", "followUp": "", "plainFinding": "Boils linked to immune and skin-growth problems, not simple pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32508815/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, clinically characterized by boiled cysts, comedones, abscesses, hypertrophic scars, and/or sinus tracts typically in the apocrine-gland-rich areas such as the axillae, groin, and/or buttocks. Although its precise pathogenic mechanisms remain unknown, I herein emphasize the importance of the following three recent discoveries in the pathogenesis of HS: First, heterozygous loss-of-function mutations in the genes encoding γ-secretase, including NCSTN, PSENEN, and PSEN1, have been identified in some patients with HS. Such genetic alterations result in hyperkeratosis, dysregulated hair follicle differentiation, and cyst formation via aberrant Notch signaling. Furthermore, Psen1-/Psen2-, Psen1-, Ncstn+/-, and Notch1-/Notch2- mice share common phenotypes of human HS, suggesting a role of aberrant keratinization in the development of HS. Second, upregulation of interleukin 1β, interleukin-36, caspase-1, and NLRP3 and dysregulation of the Th17:Treg cell axis have been demonstrated in HS samples, suggesting that autoinflammation is a key event in the pathophysiology of the disease. Notably, HS may be complicated with other autoinflammatory diseases such as inflammatory bowel diseases and pyoderma gangrenosum, again highlighting the importance of autoinflammation in HS. Last, biologics such as adalimumab, infliximab, anakinra, ustekinumab, and secukinumab are reportedly effective for moderate-to-severe HS. These findings collectively suggest that HS is closely linked with aberrant keratinization and autoinflammation, raising the question whether it represents an autoinflammatory keratinization disease, a recently proposed disease entity. In this mini review, I introduce the concept of autoinflammatory keratinization disease and attempt to address this clinically important question.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition, clinically characterized by boiled cysts, comedones, abscesses, hypertrophic scars, and/or sinus tracts typically in the apocrine-gland-rich areas such as the axillae, groin, and/or buttocks." }, { "field": "result", "quote": "These findings collectively suggest that HS is closely linked with aberrant keratinization and autoinflammation, raising the question whether it represents an autoinflammatory keratinization disease, a recently proposed disease entity." }, { "field": "primaryOutcome", "quote": "In this mini review, I introduce the concept of autoinflammatory keratinization disease and attempt to address this clinically important question." }, { "field": "intervention", "quote": "I herein emphasize the importance of the following three recent discoveries in the pathogenesis of HS" } ] }, { "id": "pmid:32408974", "pmid": "32408974", "doi": "10.1016/j.ad.2019.12.001", "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurative: Our Experience with a Surgical Case Management Team", "firstAuthor": "Garbayo-Salmons", "multipleAuthors": true, "journal": "Actas Dermosifiliogr (Engl Ed)", "year": 2020, "design": "case-series", "n": 104, "nField": "reported", "population": "Patients with hidradenitis suppurativa evaluated by a surgical case management team", "intervention": "Surgical treatment (mainly deroofing) often combined with rifampicin and clindamycin", "comparator": "", "primaryOutcome": "Postoperative outcome (satisfactory result, recurrence, wound complications)", "result": "63.4% had satisfactory postoperative outcomes, 20% had lesion recurrence, and 12% had wound dehiscence", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a descriptive study of one surgical team's patients without a comparison group, so it can't show whether treatment caused the improvement.", "directness": "indirect", "limitations": "Descriptive cross-sectional study, single center, no control group, outcomes assessed subjectively as 'satisfactory'.", "followUp": "", "plainFinding": "Surgery mostly helped, but relapse occurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32408974/", "sourceText": "BACKGROUND AND OBJECTIVES: The complexity of hidradenitis suppurativa (HS) treatment calls for a multidisciplinary approach. We therefore created a multidisciplinary team to manage surgical care. This study aimed to describe the clinical characteristics of the patients we evaluated and the outcomes of the surgical techniques used. MATERIAL AND METHODS: Descriptive cross-sectional study of 104 patients evaluated by our surgical case management team between September 2015 and July 2018. RESULTS: Surgery was used to treat 46% of the patients with HS who were evaluated. Most were men (73%) with no family history of HS (63%) and smokers or former smokers (76%). Gluteal HS comprised the largest phenotype group (41%) and the majority of cases were serious (Hurley stage II, 36%; stage III, 46%). The anatomical regions with the largest number of lesions were the axillae (51.9%) and the groin (41.3%). Surgery was most often performed in the axilla (38.3%), followed by the gluteus (23.4%). The most common drug treatment was a combination of rifampicin and clindamycin, Deroofing was the technique used most often (in 48% of the patients who underwent surgery). Postoperative outcomes were assessed as satisfactory overall in 63.4% of the cases. The HS lesion recurred in 20% and 12% developed wound dehiscence. CONCLUSIONS: Our experience leads us to recommend forming multidisciplinary teams to improve communication between specialists, provide tailored treatment for the patient with HS, and improve follow-up.", "provenance": [ { "field": "population", "quote": "Descriptive cross-sectional study of 104 patients evaluated by our surgical case management team between September 2015 and July 2018." }, { "field": "n", "quote": "Descriptive cross-sectional study of 104 patients" }, { "field": "intervention", "quote": "Deroofing was the technique used most often (in 48% of the patients who underwent surgery)." }, { "field": "intervention", "quote": "The most common drug treatment was a combination of rifampicin and clindamycin" }, { "field": "primaryOutcome", "quote": "Postoperative outcomes were assessed as satisfactory overall in 63.4% of the cases." }, { "field": "result", "quote": "The HS lesion recurred in 20% and 12% developed wound dehiscence." } ] }, { "id": "pmid:32368973", "pmid": "32368973", "doi": "10.2174/1389201021666200505100556", "nctId": null, "pmcid": null, "title": "Novel Therapeutic Approaches and Targets for the Treatment of Hidradenitis Suppurativa", "firstAuthor": "Giuffrida", "multipleAuthors": true, "journal": "Curr Pharm Biotechnol", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic inflammatory skin condition often affecting buttocks and other skin folds", "intervention": "newer targeted therapies such as drugs blocking TNF-alpha, IL-1β, IL-23/Th17 pathways, PDE4 inhibitors, and laser treatment", "comparator": "traditional treatments including anti-inflammatories, antibiotics and surgery", "primaryOutcome": "treatment efficacy and safety for hidradenitis suppurativa", "result": "newer targeted drugs and laser treatment showed clinically meaningful efficacy with good short-term safety", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a narrative literature review summarizing other studies, not original controlled data, so it can't prove these treatments work.", "directness": "indirect", "limitations": "no systematic review methodology described, no quantitative data, and it addresses hidradenitis suppurativa rather than common acne-type pimples", "followUp": "", "plainFinding": "New drugs help a different buttock skin disease, not acne.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32368973/", "sourceText": "BACKGROUND: Hidradenitis Suppurativa (HS) is a chronic, recurrent and disabling inflammatory skin condition, clinically characterized by nodules, bullae, abscesses, fistulae, and draining sinus tracts mainly located in axillae, inguinal folds, inframammary region and buttocks, often leading to pain, scarring, disfigurement and decreased quality of life. Due to its complex nature, with still no completely elucidated etiology and pathogenesis, the management of HS can be challenging. In fact, many patients do not respond to the traditionally available systemic treatments, including antiinflammatories, antibiotics and surgery. Research has provided new insights into the mechanisms of HS, mainly investigating the inflammatory cytokine pathways underlying the disease. METHODS: We review the current knowledge on newer therapeutic approaches and targets for the treatment of HS, through a PubMed-based literature search. RESULTS: In this setting, studies on tumor necrosis factor-α, IL-1β, IL-10, and the IL-23/T-helper (Th) 17 and IL12/Th1 axes in immune dysregulation in HS have helped in developing new regimens. Inhibitor of phosphodiesterase 4 and laser treatments have shown clinically meaningful efficacy with good short-term safety and tolerability. CONCLUSION: Target therapy has revolutionized the treatment of moderate to severe HS, based on the inhibition of specific molecular or cellular targets, directly involved in the pathogenesis of the condition.", "provenance": [ { "field": "population", "quote": "Hidradenitis Suppurativa (HS) is a chronic, recurrent and disabling inflammatory skin condition, clinically characterized by nodules, bullae, abscesses, fistulae, and draining sinus tracts mainly located in axillae, inguinal folds, inframammary region and buttocks" }, { "field": "intervention", "quote": "studies on tumor necrosis factor-α, IL-1β, IL-10, and the IL-23/T-helper (Th) 17 and IL12/Th1 axes in immune dysregulation in HS have helped in developing new regimens. Inhibitor of phosphodiesterase 4 and laser treatments" }, { "field": "comparator", "quote": "many patients do not respond to the traditionally available systemic treatments, including antiinflammatories, antibiotics and surgery" }, { "field": "primaryOutcome", "quote": "We review the current knowledge on newer therapeutic approaches and targets for the treatment of HS" }, { "field": "result", "quote": "Inhibitor of phosphodiesterase 4 and laser treatments have shown clinically meaningful efficacy with good short-term safety and tolerability." } ] }, { "id": "pmid:32339539", "pmid": "32339539", "doi": "10.1016/j.jid.2020.02.046", "nctId": null, "pmcid": null, "title": "The Surface Microbiome of Clinically Unaffected Skinfolds in Hidradenitis Suppurativa: A Cross-Sectional Culture-Based and 16S rRNA Gene Amplicon Sequencing Study in 60 Patients", "firstAuthor": "Riverain-Gillet", "multipleAuthors": true, "journal": "J Invest Dermatol", "year": 2020, "design": "case-control", "n": 77, "nField": "reported", "population": "people with hidradenitis suppurativa and healthy people, sampled on non-affected armpits, groin folds, and buttock creases", "intervention": "skin swabs from clinically normal-looking skinfolds in hidradenitis suppurativa patients", "comparator": "skin swabs from the same skinfold areas in healthy people without hidradenitis suppurativa", "primaryOutcome": "types and amounts of bacteria living on the skin (microbiome)", "result": "Even unaffected buttock crease and groin/armpit skin in hidradenitis suppurativa patients had more anaerobic bacteria like Prevotella and less of the normal skin bacteria Staphylococcus epidermidis, with the buttock crease being the most affected site", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It is a small observational study comparing two groups that also differed a lot in smoking rates, so it cannot prove what causes the bacterial differences.", "directness": "indirect", "limitations": "Patients and controls differed strongly in smoking (87% vs 6%), which could affect skin bacteria independent of disease; study is cross-sectional so cause and effect cannot be determined.", "followUp": "", "plainFinding": "Altered skin bacteria near buttocks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32339539/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin associated with specific lesional dysbiotic features. We studied the microbiome of clinically unaffected typical HS sites (armpits, inguinal folds, and gluteal clefts) in 60 patients with HS and 17 healthy controls. A total of 192 samples obtained by swabbing were analyzed by bacterial cultures. Of these, 116 randomly selected samples were studied by 16S rRNA gene amplicon sequencing. Patients and controls showed similar characteristics, except for smoking (87% vs. 6%, respectively). HS skinfolds were characterized by an increased abundance of anaerobes, predominantly Prevotella, but also Actinomyces, Campylobacter ureolyticus, and Mobiluncus, contrasting with a lower abundance of skin commensals such as Staphylococcus epidermidis, a major component of the skin microbiome; Kocuria; and Micrococcus luteus. The following three independent factors were associated with an abundance of high anaerobes by multivariate analysis: samples originating from patients with HS patients (P = 2.1 × 10-4); body mass index (P = 5 × 10-5); and the sampling site, the gluteal cleft being the most anaerobic area, followed by inguinal folds and axilla (P = 3 × 10-6). The microbiome of clinically unaffected HS skinfolds is reminiscent, albeit to a minor extent, of the microbiome of chronic suppurative HS lesions and may fuel inflammation at a preclinical stage of the disease.", "provenance": [ { "field": "population", "quote": "We studied the microbiome of clinically unaffected typical HS sites (armpits, inguinal folds, and gluteal clefts) in 60 patients with HS and 17 healthy controls." }, { "field": "n", "quote": "60 patients with HS and 17 healthy controls" }, { "field": "intervention", "quote": "A total of 192 samples obtained by swabbing were analyzed by bacterial cultures." }, { "field": "comparator", "quote": "60 patients with HS and 17 healthy controls" }, { "field": "primaryOutcome", "quote": "We studied the microbiome of clinically unaffected typical HS sites" }, { "field": "result", "quote": "HS skinfolds were characterized by an increased abundance of anaerobes, predominantly Prevotella, but also Actinomyces, Campylobacter ureolyticus, and Mobiluncus, contrasting with a lower abundance of skin commensals such as Staphylococcus epidermidis, a major component of the skin microbiome; Kocuria; and Micrococcus luteus." }, { "field": "result", "quote": "the gluteal cleft being the most anaerobic area, followed by inguinal folds and axilla (P = 3 × 10-6)" }, { "field": "limitations", "quote": "Patients and controls showed similar characteristics, except for smoking (87% vs. 6%, respectively)." } ] }, { "id": "pmid:32243413", "pmid": "32243413", "doi": "10.1097/MD.0000000000019779", "nctId": null, "pmcid": "PMC7220192", "title": "Reconstruction of bilateral inferomedial gluteal defects after resection of hidradenitis suppurativa with symmetrical keystone flaps designed parallel to relaxed skin-tension lines: A case report", "firstAuthor": "Kim", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2020, "design": "case-series", "n": 1, "nField": "reported", "population": "18-year-old man with chronic inflammatory lesions on both buttocks (hidradenitis suppurativa)", "intervention": "surgical removal of affected skin followed by reconstruction with symmetrical keystone flaps", "comparator": "none", "primaryOutcome": "flap survival and healing without complications after surgery", "result": "both flaps fully survived with no complications and patient was satisfied at 6 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this approach works in general.", "directness": "indirect", "limitations": "Only one patient was studied, so findings may not generalize; this addresses surgical treatment of an existing severe condition rather than why pimples occur on the buttocks.", "followUp": "6 months", "plainFinding": "Successful surgical repair after cyst removal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32243413/", "sourceText": "RATIONALE: Surgical treatment of hidradenitis suppurativa (HS) is challenging. Wide excision of affected lesions followed by skin graft or flap coverage has been recommended to achieve remission and prevent recurrence. Herein, we present our experience of bilateral inferomedial gluteal defects coverage using symmetrical keystone flaps (KFs) designed parallel to relaxed skin-tension lines (RSTLs). PATIENT CONCERNS: An 18-year-old man was admitted for chronic inflammatory lesions in both inferomedial gluteal areas. DIAGNOSES: Physical examination revealed multiple sinuses with broad surrounding scars in both inferomedial gluteal areas, which led to a diagnosis of HS. INTERVENTIONS: We performed wide excision on all affected lesions. The size of the final defects was 6 × 10 cm on the right side, and 5 × 9 cm on the left side. We covered the defects with KFs 9 × 15 cm (right) and 8 × 12 cm (left), which were based on the hotspots of the interior gluteal artery and internal pudendal artery perforators, and parallel to RSTLs. OUTCOMES: The flaps were inset without tension on each side, and the donor sites were closed primarily. All flaps fully survived and there were no postoperative complications. The patient was satisfied with the final outcome after 6 months of follow-up. LESSONS: Successful reconstruction of bilateral inferomedial gluteal defects was achieved after resection of HS using symmetrical KFs designed parallel to RSTLs. The KF technique considering RSTLs could be a good reconstructive option for gluteal HS.", "provenance": [ { "field": "population", "quote": "An 18-year-old man was admitted for chronic inflammatory lesions in both inferomedial gluteal areas." }, { "field": "intervention", "quote": "We performed wide excision on all affected lesions." }, { "field": "intervention", "quote": "We covered the defects with KFs 9 × 15 cm (right) and 8 × 12 cm (left)" }, { "field": "comparator", "quote": "RATIONALE: Surgical treatment of hidradenitis suppurativa (HS) is challenging." }, { "field": "primaryOutcome", "quote": "The flaps were inset without tension on each side, and the donor sites were closed primarily." }, { "field": "result", "quote": "All flaps fully survived and there were no postoperative complications. The patient was satisfied with the final outcome after 6 months of follow-up." }, { "field": "n", "quote": "An 18-year-old man was admitted" } ] }, { "id": "pmid:32109015", "pmid": "32109015", "doi": "10.1503/cjs.003119", "nctId": null, "pmcid": "PMC7828960", "title": "The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa", "firstAuthor": "Shavit", "multipleAuthors": true, "journal": "Can J Surg", "year": 2020, "design": "retrospective", "n": 66, "nField": "reported", "population": "patients with advanced hidradenitis suppurativa needing surgery, including buttock involvement", "intervention": "wide local excision down to healthy fat, closed with skin flaps", "comparator": "wide local excision closed by secondary intention (left open to heal)", "primaryOutcome": "local recurrence of disease after surgery", "result": "recurrence was the same in both closure methods, about 18% in each", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this is a single-center retrospective chart review without randomization, so it can't reliably prove one method is better.", "directness": "indirect", "limitations": "retrospective design, no control group without surgery, variable follow-up time, outcomes extracted from charts", "followUp": "14.5 (range 1–55) months", "plainFinding": "Similar recurrence with either wound closure method.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32109015/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic debilitating folliculopilosebaceous disease that affects the skin most commonly in the axilla, groin, inframammary, genital and buttock areas. Surgical intervention may be an appropriate option in selected cases, but there is a risk of recurrence. The purpose of this study was to assess the results of wide local excision (WLE) to healthy subcutaneous fat with secondary intention healing in patients with HS who were under concurrent surgical and dermatologic care. METHODS: We conducted a retrospective review of 192 consecutive HS consultations to a general surgical service, identifying patients treated with WLE. Cases involving minor procedures (deroofing, incision and drainage) were excluded. Data on patient demographics, surgical site, method of closure, complications and recurrence were extracted from patient charts. We also conducted a literature review of surgical procedures in the management of HS. RESULTS: A total of 66 patients underwent 133 WLE to healthy subcutaneous fat. All patients were under concurrent medical care directed by a dermatologist. No medical therapies, including biological treatments, were interrupted or withheld for surgery. One hundred procedures were closed primarily with rotation or advancement flaps and 33 by secondary intention healing. Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures (p = 0.98, χ2 test, no difference between groups). One patient with secondary intention healing returned to the emergency department for bleeding; 34% of patients with primary closure experienced some dehiscence (23% major, 11% minor separation). Two patients with axillary disease had restrictions in their ability to raise their arm that required physiotherapy. Median follow-up was 14.5 (range 1–55) months. CONCLUSION: Resection to healthy subcutaneous fat during WLE provides disease control comparable to that with deeper resections, simplifying care.", "provenance": [ { "field": "population", "quote": "patients with HS who were under concurrent surgical and dermatologic care" }, { "field": "intervention", "quote": "One hundred procedures were closed primarily with rotation or advancement flaps" }, { "field": "comparator", "quote": "33 by secondary intention healing" }, { "field": "primaryOutcome", "quote": "Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures" }, { "field": "result", "quote": "p = 0.98, χ2 test, no difference between groups" }, { "field": "n", "quote": "A total of 66 patients underwent 133 WLE to healthy subcutaneous fat." }, { "field": "followUp", "quote": "Median follow-up was 14.5 (range 1–55) months." } ] }, { "id": "pmid:32077977", "pmid": "32077977", "doi": "10.1007/s00105-020-04556-9", "nctId": null, "pmcid": null, "title": "[Hidradenitis suppurativa/acne inversa in the genitoanal region]", "firstAuthor": "Hessam", "multipleAuthors": true, "journal": "Hautarzt", "year": 2020, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "People with hidradenitis suppurativa (acne inversa), a chronic inflammatory skin disease, that affects the genital and anal area", "intervention": "Not a treatment study; this review describes disease patterns and complications rather than testing a treatment", "comparator": "No comparator treatment is described; the review compares body site locations (genitoanal vs other areas) rather than treatments", "primaryOutcome": "How often the genital/anal area is affected, and what complications occur there, including effect on quality of life", "result": "Genital/anal area involvement, especially around the buttocks and perineum, was more common in men, while armpit/groin/under-breast involvement was more common in women; this location was linked to worse quality of life and sexual health, and serious complications like fistulas, lymphedema, and skin cancer can occur", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a general descriptive review summarizing prior findings, not a study testing a treatment or directly measuring outcomes itself.", "directness": "indirect", "limitations": "The abstract does not describe its research methods, does not report how many patients were studied, and does not test any treatment — it only summarizes known patterns and complications of a specific skin disease (hidradenitis suppurativa), which is one possible but not confirmed cause of buttock pimples.", "followUp": "", "plainFinding": "Describes a skin disease, not simple pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32077977/", "sourceText": "Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease. Several studies showed that perianal, perineal and gluteal involvement is more common in men. Axillary, submammary and inguinal localizations seem to be more prevalent in women. Involvement of the genitoanal region is associated with a higher reduced quality of live and sexual health compared to other locations. Moreover HS/AI in the genitoanal region can lead to serious complications. The knowledge of perianal fistula formation, pubogenital lymphedema and squamous cell carcinoma, which are three of the most severe complications, is critical for adequate treatment.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory skin disease." }, { "field": "intervention", "quote": "The knowledge of perianal fistula formation, pubogenital lymphedema and squamous cell carcinoma, which are three of the most severe complications, is critical for adequate treatment." }, { "field": "comparator", "quote": "Axillary, submammary and inguinal localizations seem to be more prevalent in women." }, { "field": "primaryOutcome", "quote": "Involvement of the genitoanal region is associated with a higher reduced quality of live and sexual health compared to other locations." }, { "field": "result", "quote": "Several studies showed that perianal, perineal and gluteal involvement is more common in men." } ] }, { "id": "pmid:31935718", "pmid": "31935718", "doi": "10.1159/000504843", "nctId": null, "pmcid": null, "title": "Analysis of Characteristics and Trends in Treatment Response of Hidradenitis Suppurativa Patients: A Southern US Cohort Study", "firstAuthor": "Peterson", "multipleAuthors": true, "journal": "Dermatology", "year": 2020, "design": "retrospective", "n": 149, "nField": "reported", "population": "patients with hidradenitis suppurativa seen at a dermatology clinic in the southern United States", "intervention": "various treatments including oral antibiotics, topical antibiotics, metabolic medications like metformin/zinc, steroid injections, and biologic TNF-α inhibitors", "comparator": "other treatments compared to biologics, and disease located on the buttocks compared to other body sites", "primaryOutcome": "how well patients responded to treatment", "result": "Disease on the buttocks had a significantly higher treatment response rate than disease elsewhere, and biologic therapy showed a near-significant trend toward better response than other treatments", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a single-center retrospective chart review without randomization, so its treatment comparisons are only preliminary.", "directness": "indirect", "limitations": "Retrospective chart review from a single academic center; the biologic response finding did not reach statistical significance (p = 0.0632).", "followUp": "", "plainFinding": "Buttock lesions responded better to treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31935718/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that has a substantial impact on patients' quality of life. As the exact pathogenesis remains unclear, treatment is complex and not yet standardized. OBJECTIVES: The aim of this study was to describe patient characteristics and to broadly examine trends in treatment response of various therapeutic strategies in patients with HS in a single academic referral center in the southern USA. METHODS: A retrospective chart review was conducted of a cohort of HS patients seen in a faculty general dermatology practice with academic affiliation to Baylor University Medical Center in Dallas, TX, between February 2015 and February 2018. Patient demographics, clinical features, prescribed treatments, and response to treatment were analyzed using the Pearson χ2 test or Fisher exact test, and by the Mann-Whitney U test for categorical and continuous variables, respectively. RESULTS: A total of 149 patients (113 females, 36 males) were included. Hurley stages I, II, and III were diagnosed in 29.6, 36.5, and 33.9% of patients, respectively. 44.2% of patients had a positive family history of HS, 39.5% of patients were current or former smokers, and 52.8% reported alcohol use. 80.9% of patients were overweight or obese (BMI ≥25), compared to 68.5% in Texas in 2016 (p = 0.0012). The most frequently prescribed treatments were oral antibiotic therapy (83.9%), topical antibiotic therapy (74.5%), metabolic medications such as metformin/zinc (67.1%), intralesional Kenalog (63.1%), and biologic therapies (tumor necrosis factor-α inhibitors; TNF-α inhibitors; 49%). In examining the response rate, patients with disease localized to the buttocks had significantly higher response rates (60.4 vs. 25%, p = 0.043) and approached statistical significance in responders versus nonresponders in treatment with biologics (p = 0.0632) when compared against all other treatments. CONCLUSIONS: HS is a complex inflammatory skin condition associated with obesity and smoking. In this cohort, the most frequently prescribed therapies were oral and topical antibiotics. However, the use of biologic agents (TNF-α inhibitors) appears to be associated with the most significant treatment response. KEY POINTS: This is the first study to evaluate trends in treatment response of various therapeutic strategies in HS patients at an academic referral center in Dallas, TX, a unique geographic region of the southern USA. Biologic therapy (TNF-α inhibitor) appears to be associated with the most significant treatment response.", "provenance": [ { "field": "design", "quote": "A retrospective chart review was conducted of a cohort of HS patients" }, { "field": "n", "quote": "A total of 149 patients (113 females, 36 males) were included." }, { "field": "population", "quote": "patients with HS in a single academic referral center in the southern USA" }, { "field": "intervention", "quote": "The most frequently prescribed treatments were oral antibiotic therapy (83.9%), topical antibiotic therapy (74.5%), metabolic medications such as metformin/zinc (67.1%), intralesional Kenalog (63.1%), and biologic therapies (tumor necrosis factor-α inhibitors; TNF-α inhibitors; 49%)." }, { "field": "comparator", "quote": "patients with disease localized to the buttocks had significantly higher response rates (60.4 vs. 25%, p = 0.043) and approached statistical significance in responders versus nonresponders in treatment with biologics (p = 0.0632) when compared against all other treatments" }, { "field": "primaryOutcome", "quote": "to broadly examine trends in treatment response of various therapeutic strategies in patients with HS" }, { "field": "result", "quote": "patients with disease localized to the buttocks had significantly higher response rates (60.4 vs. 25%, p = 0.043) and approached statistical significance in responders versus nonresponders in treatment with biologics (p = 0.0632) when compared against all other treatments" } ] }, { "id": "pmid:31658548", "pmid": "31658548", "doi": "10.3760/cma.j.issn.1009-2587.2019.10.010", "nctId": null, "pmcid": null, "title": "[Clinical therapeutic observation on sequential treatment of chronic wounds with repeated recurrence of hidradenitis suppurativa in buttocks]", "firstAuthor": "Li", "multipleAuthors": true, "journal": "Zhonghua Shao Shang Za Zhi", "year": 2019, "design": "case-series", "n": 15, "nField": "reported", "population": "men with severe recurrent hidradenitis suppurativa (boil-like lumps) on the buttocks after multiple prior surgeries", "intervention": "wide surgical removal of lesions, followed by vacuum wound suction with oxygen-fluid rinsing, then skin grafts or flaps", "comparator": "each patient's own condition before treatment (no separate comparison group)", "primaryOutcome": "wound healing, infection clearance, and recurrence of hidradenitis suppurativa after treatment", "result": "all skin grafts/flaps survived, wounds healed, and no hidradenitis suppurativa recurred at the surgery site during 1 to 5 years of follow-up, though one patient had a separate complication from an anal fistula", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this was a small uncontrolled study of only 15 patients comparing them to themselves before and after treatment, so it cannot rule out other explanations for improvement.", "directness": "indirect", "limitations": "small sample size, no control group, all male patients with a different and more severe condition (hidradenitis suppurativa) than typical acne pimples", "followUp": "1 to 5 years", "plainFinding": "Surgery healed severe buttock boils.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31658548/", "sourceText": "Objective: To observe the clinical effects of sequential treatment with extensive lesion resection, vacuum sealing drainage (VSD) combined with irrigation of oxygen-loaded fluid, and tissue transplantation on hidradenitis suppurativa (HS) in buttocks which recurred after multiple surgeries. Methods: From January 2012 to March 2017, 15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley's stage Ⅲ HS in the buttocks recurred after 2-5 operations who met the inclusion criteria were enrolled in the prospective self pre- and post-control study. After extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid was given, with negative pressure of -16.7 kPa and flow rate of pure oxygen of 1.0 L/min. After 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid, the negative pressure device was removed and autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds. Six patients were performed with split-thickness skin grafting, 4 patients with local flap transplantation, and 5 patients with split-thickness skin grafting together with local flap transplantation. The donor sites of local flaps were sutured directly or transplanted with autologous posterior thigh split-thickness skin grafts, and the donor sites of split-thickness skin grafts with autologous thin split-thickness scalp. The wound tissue or wound granulation tissue was collected before lesion resection and 7 days after treatment with VSD combined with irrigation of oxygen-loaded fluid respectively for bacterial culture and detecting of the content of tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up. Data were processed with paired sample t test. Results: Bacterial culture result of wound tissue before lesion resection was positive in all patients, mainly Staphylococcus, Streptococcus, Proteus mirabilis, and anaerobic bacteria, etc., while that of wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was negative. The content of TNF-α in wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was (10.1±2.9) pg/L, significantly lower than (73.6±5.6) pg/L before lesion resection (t=33.47, P<0.01). The skin grafts and/or flaps of 15 patients survived post operation, and the wounds were healed. The patients were hospitalized for 17-31 days. During follow-up of 1 to 5 years, no recurrence of HS occurred in operative site of buttocks of 15 patients, but 1 patient had ulceration of healed perianal incision caused by high anal fistula and was healed after treatment. Conclusions: Sequential treatment with extensive resection, VSD combined with irrigation of oxygen-loaded fluid, and tissue transplantation can thoroughly remove HS lesions in the buttocks and improve the condition of wound bed for skin acceptance after debridement, which is conducive to the cure of HS in the buttocks which has undergone multiple operations but still recurs after operation.", "provenance": [ { "field": "population", "quote": "15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley's stage Ⅲ HS in the buttocks recurred after 2-5 operations" }, { "field": "intervention", "quote": "extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid" }, { "field": "intervention", "quote": "autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds" }, { "field": "comparator", "quote": "prospective self pre- and post-control study" }, { "field": "primaryOutcome", "quote": "Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up." }, { "field": "result", "quote": "The skin grafts and/or flaps of 15 patients survived post operation, and the wounds were healed." }, { "field": "result", "quote": "During follow-up of 1 to 5 years, no recurrence of HS occurred in operative site of buttocks of 15 patients, but 1 patient had ulceration of healed perianal incision caused by high anal fistula and was healed after treatment." }, { "field": "n", "quote": "15 male patients (aged 26-53 years)" }, { "field": "followUp", "quote": "follow-up of 1 to 5 years" } ] }, { "id": "pmid:31638283", "pmid": "31638283", "doi": "10.1111/1346-8138.15122", "nctId": null, "pmcid": null, "title": "Ustekinumab treatment for hidradenitis suppurativa", "firstAuthor": "Takeda", "multipleAuthors": true, "journal": "J Dermatol", "year": 2019, "design": "case-series", "n": 24, "nField": "reported", "population": "people with hidradenitis suppurativa, a skin disease affecting armpits, groin, buttocks and vulval area", "intervention": "ustekinumab injections", "comparator": "no control group; included patients previously treated with anti-TNF drugs", "primaryOutcome": "improvement or remission of hidradenitis suppurativa symptoms", "result": "most patients began to improve after 3-5 months and some reached complete remission", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small case report plus review of only 24 patients with no control group, so it cannot reliably prove the treatment works.", "directness": "indirect", "limitations": "Based on a single case report combined with a literature review of other reported cases, not a controlled study.", "followUp": "3-5 months", "plainFinding": "Most improved on ustekinumab.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31638283/", "sourceText": "Hidradenitis suppurativa (HS) is a follicular occlusive inflammatory skin disease that occurs in the axilla, groin, buttocks and vulval region. Control of the intractable inflammation is a primary goal of HS treatments. Benefit of anti-tumor necrosis factor (TNF) antibodies against HS have been reported, and adalimumab has been approved for HS in Europe, the USA and Japan. However, the alternative therapies for anti-TNF antibodies have not been established yet. We experienced a case of HS which developed during the infliximab treatment for Crohn's disease (CD) and was well managed by ustekinumab (UST). We reviewed the articles relating to ustekinumab treatments for HS. Twenty-four HS patients, 16 women and eight men, have been treated with ustekinumab. The average age was 35.7 ± 10.8 years (mean ± SD). All were of Hurley stage II or III. Ten (10/24, 41.6%) had received anti-TNF drugs including infliximab, adalimumab and etanercept prior to UST treatment for HS. Although the initial doses varied from 45 mg s.c. to 390 mg i.v., all cases were treated with 45 or 90 mg s.c. every 8 or 12 weeks at the regular dose, by following the regimen for psoriasis or CD. HS in most of the cases started to improve after 3-5 months of UST initiation, and some achieved complete remission. To our knowledge, our case is the first Asian HS patient improved by UST. Overall, UST is useful for HS and could be an alternative treatment if HS patients do not respond to other medications including anti-TNF drugs.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a follicular occlusive inflammatory skin disease that occurs in the axilla, groin, buttocks and vulval region." }, { "field": "intervention", "quote": "ustekinumab treatments for HS" }, { "field": "comparator", "quote": "Ten (10/24, 41.6%) had received anti-TNF drugs including infliximab, adalimumab and etanercept prior to UST treatment for HS." }, { "field": "primaryOutcome", "quote": "Control of the intractable inflammation is a primary goal of HS treatments." }, { "field": "result", "quote": "HS in most of the cases started to improve after 3-5 months of UST initiation, and some achieved complete remission." }, { "field": "n", "quote": "Twenty-four HS patients, 16 women and eight men, have been treated with ustekinumab." } ] }, { "id": "pmid:31596759", "pmid": "31596759", "doi": "10.1097/DCR.0000000000001497", "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurativa", "firstAuthor": "Kawak", "multipleAuthors": false, "journal": "Dis Colon Rectum", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "an obese diabetic man with a 20-year history of perianal, inguinal, and gluteal hidradenitis suppurativa", "intervention": "surgical removal of sinus tracts and diseased skin (unroofing and excision)", "comparator": "previous treatments with doxycycline and infliximab", "primaryOutcome": "", "result": "", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether the treatment generally works.", "directness": "indirect", "limitations": "Only one patient described; no follow-up results or outcome data given in the abstract.", "followUp": "", "plainFinding": "Case report, no outcome given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31596759/", "sourceText": "A 66-year-old obese (BMI 34) diabetic man, a former smoker who had quit 4 months ago, had a 20-year history of perianal, inguinal, and gluteal hidradenitis suppurativa. He presented to the office with persistent perianal and gluteal inflammation and drainage. He had had various surgical excisions of the affected area over the preceding 10 years. The patient was also following up with dermatology and was previously on doxycycline and infliximab with little improvement in his symptoms. On physical examination of his gluteal and perianal region, he had multiple areas of scarring and draining sinus tracts with significant induration ( and ). The patient underwent extensive unroofing of the sinus tracts and excision of active disease ().(Figure is included in full-text article.)(Figure is included in full-text article.)(Figure is included in full-text article.).", "provenance": [ { "field": "population", "quote": "A 66-year-old obese (BMI 34) diabetic man, a former smoker who had quit 4 months ago, had a 20-year history of perianal, inguinal, and gluteal hidradenitis suppurativa." }, { "field": "intervention", "quote": "The patient underwent extensive unroofing of the sinus tracts and excision of active disease" }, { "field": "comparator", "quote": "previously on doxycycline and infliximab with little improvement in his symptoms" }, { "field": "n", "quote": "A 66-year-old obese (BMI 34) diabetic man" } ] }, { "id": "pmid:31384491", "pmid": "31384491", "doi": "10.5826/dpc.0903a03", "nctId": null, "pmcid": "PMC6659610", "title": "Disseminate Recurrent Folliculitis and Hidradenitis Suppurativa Are Associated Conditions: Results From a Retrospective Study of 131 Patients With Down Syndrome and a Cohort of 12,351 Pediatric Controls", "firstAuthor": "Sechi", "multipleAuthors": true, "journal": "Dermatol Pract Concept", "year": 2019, "design": "retrospective", "n": 12482, "nField": "reported", "population": "Children, teens, and young adults with Down syndrome, compared to a large group of pediatric patients without Down syndrome", "intervention": "Having Down syndrome (trisomy 21)", "comparator": "Pediatric patients without Down syndrome", "primaryOutcome": "How common disseminated recurrent folliculitis (DRF) and hidradenitis suppurativa (HS) were in each group, and which body areas were affected", "result": "People with Down syndrome had much higher rates of both skin conditions than controls, and buttocks were the most commonly affected area for the recurrent folliculitis", "resultDirection": "harm", "quality": "low", "qualityWhy": "This was a single-center retrospective study without randomization, so it can show an association but not prove why it happens.", "directness": "indirect", "limitations": "Retrospective design from one center; does not describe the general population asking about buttock pimples, only people with Down syndrome versus pediatric controls.", "followUp": "", "plainFinding": "Down syndrome linked to more butt folliculitis.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/31384491/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disease of the pilosebaceous unit characterized by protean manifestations. Several studies have found an increased incidence and earlier presentation of this disease in patients carrying trisomy 21. Patients with Down syndrome (DS) have a higher risk of developing a wide range of cutaneous manifestations, including HS and chronic folliculitis. Recently, disseminate recurrent folliculitis (DRF) has been reported as an atypical monosymptomatic feature of HS at its onset. OBJECTIVE: To assess the prevalence of HS and DRF by comparing a cohort of patients carrying trisomy 21 vs pediatric controls. METHODS: A retrospective 2-year monocentric clinical study was performed by collecting clinical data of 131 patients with DS, aged 4-36 years, followed at the Dermatology Unit and Down Syndrome Regional Center of Bologna University. Data were matched with those coming from 12,351 pediatric controls. RESULTS: In DS patients, DRF and HS showed a prevalence of, respectively, 6.8% and 24.4%, while 5.3% of patients presented both diseases. In the control group the prevalence for HS+ and DRF+ was 0.5% and 1.2%, respectively, with a 0.14% of overlap cases. The association between HS and DRF proved to be statistically significant in both groups (P < 0.05). In the DS cohort the mean age of symptoms onset was 15.67 (SD: 2.29) years for HS and 13.11 (SD: 4.93) years for DRF. Buttocks were the most frequently affected body area for DRF followed by the inguinocrural area, while in HS buttocks were less frequently involved than groins and upper thighs. CONCLUSIONS: Because of the later onset of HS, patients with DRF at an early age should be monitored for the possible onset of HS in the apocrine-bearing areas.", "provenance": [ { "field": "n", "quote": "131 patients with DS" }, { "field": "n", "quote": "12,351 pediatric controls" }, { "field": "population", "quote": "131 patients with DS, aged 4-36 years, followed at the Dermatology Unit and Down Syndrome Regional Center of Bologna University" }, { "field": "intervention", "quote": "patients carrying trisomy 21" }, { "field": "comparator", "quote": "12,351 pediatric controls" }, { "field": "primaryOutcome", "quote": "To assess the prevalence of HS and DRF by comparing a cohort of patients carrying trisomy 21 vs pediatric controls" }, { "field": "result", "quote": "In DS patients, DRF and HS showed a prevalence of, respectively, 6.8% and 24.4%, while 5.3% of patients presented both diseases. In the control group the prevalence for HS+ and DRF+ was 0.5% and 1.2%, respectively" }, { "field": "result", "quote": "Buttocks were the most frequently affected body area for DRF followed by the inguinocrural area" } ] }, { "id": "pmid:31337387", "pmid": "31337387", "doi": "10.1186/s12895-019-0091-7", "nctId": null, "pmcid": "PMC6651910", "title": "Gluteal hidradenitis suppurativa presenting pemphigus-like findings: case report", "firstAuthor": "Kurihara", "multipleAuthors": true, "journal": "BMC Dermatol", "year": 2019, "design": "case-series", "n": 1, "nField": "reported", "population": "68-year-old man with hidradenitis suppurativa on the buttocks", "intervention": "none (case report describing disease features)", "comparator": "", "primaryOutcome": "presence of pemphigus-like skin findings (acantholysis and desmoglein autoantibodies) alongside hidradenitis suppurativa", "result": "the patient had gluteal hidradenitis suppurativa together with pemphigus-like findings, suggesting a possible link between the two conditions", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show what causes butt pimples in general or how common this is.", "directness": "indirect", "limitations": "only one patient; no comparison group; findings may not generalize to typical cases of buttock acne or folliculitis", "followUp": "", "plainFinding": "Rare case, unusual immune findings.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/31337387/", "sourceText": "BACKGROUND: Hidradenitis suppurativa is one member of the follicular occlusion triad: acne conglobata, hidradenitis suppurativa, and dissecting cellulitis of the scalp. The presence of acantholysis and desmoglein autoantibodies in hidradenitis suppurativa is rare. CASE PRESENTATION: We report a case of 68-year-old male with a diagnosis of gluteal hidradenitis suppurativa co-presenting pemphigus-like findings including acantholysis and positive desmoglein autoantibodies. CONCLUSION: To our knowledge, comorbidity of gluteal hidradenitis suppurativa and pemphigus-like findings has not been reported before. This case implies a relationship between two different conditions; the follicular occlusion triad and pemphigus, highlighting a potential induction of pemphigus-like lesion by chronic inflammatory process.", "provenance": [ { "field": "population", "quote": "We report a case of 68-year-old male with a diagnosis of gluteal hidradenitis suppurativa co-presenting pemphigus-like findings including acantholysis and positive desmoglein autoantibodies." }, { "field": "intervention", "quote": "We report a case of 68-year-old male with a diagnosis of gluteal hidradenitis suppurativa co-presenting pemphigus-like findings including acantholysis and positive desmoglein autoantibodies." }, { "field": "primaryOutcome", "quote": "co-presenting pemphigus-like findings including acantholysis and positive desmoglein autoantibodies" }, { "field": "result", "quote": "comorbidity of gluteal hidradenitis suppurativa and pemphigus-like findings has not been reported before" }, { "field": "n", "quote": "a case of 68-year-old male" } ] }, { "id": "pmid:30919434", "pmid": "30919434", "doi": "10.1111/bjd.17927", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease: an intergluteal localization of hidradenitis suppurativa/acne inversa: a cross-sectional study among 2465 patients", "firstAuthor": "Benhadou", "multipleAuthors": true, "journal": "Br J Dermatol", "year": 2019, "design": "retrospective", "n": 2465, "nField": "reported", "population": "people diagnosed with hidradenitis suppurativa, a chronic skin condition causing inflamed lumps and abscesses", "intervention": "having lesions in the fold between the buttocks (intergluteal fold)", "comparator": "patients without intergluteal fold lesions", "primaryOutcome": "how common pilonidal sinus disease and intergluteal hidradenitis suppurativa were among patients with lesions in that area", "result": "Of patients with available diagnosis, pilonidal sinus disease was found in 78% and intergluteal hidradenitis suppurativa in 22% of those with intergluteal lesions", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a retrospective study without consistent clinical confirmation of diagnoses, so misclassification was possible and it doesn't test a treatment or directly explain acne-like pimples.", "directness": "indirect", "limitations": "Possible misclassification bias since clinical/image-based diagnosis or histopathology of intergluteal lesions was not always available", "followUp": "", "plainFinding": "Butt bumps often linked to pilonidal disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30919434/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses). The association with pilonidal sinus disease (PSD) is frequently reported but not well documented. OBJECTIVES: To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS. METHODS: This was an international multicentre retrospective cross-sectional study based on data collection from a large cohort of patients with HS with and without histopathology. Results From a total of 2465 patients with HS included in the study, 661 (27%) reported lesions in the IGF. These patients were significantly more often smokers and had more severe HS. Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%). IG-HS was associated with the localization of HS in the proximity of the IGF, including the buttocks, genitals and the anus. There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available. CONCLUSIONS: The high prevalence of PSD suggests a strong link between both entities. Therefore, it may be useful to identify common pathophysiological mechanisms and develop common therapeutic strategies. What's already known about this topic? The occurrence of pilonidal sinus disease has not been clearly reported among patients with hidradenitis suppurativa/acne inversa. What does this study add? This is the first study that investigated the prevalence of pilonidal sinus disease among a large cohort of patients and identified the patient characteristics. Risk factors that might help to improve the management of patients were identified.", "provenance": [ { "field": "n", "quote": "From a total of 2465 patients with HS included in the study" }, { "field": "population", "quote": "Hidradenitis suppurativa (HS), also referred to as acne inversa, is a debilitating skin disease characterized by inflammatory nodules, chronic abscesses and tunnels (fistulae and sinuses)" }, { "field": "intervention", "quote": "661 (27%) reported lesions in the IGF" }, { "field": "comparator", "quote": "These patients were significantly more often smokers and had more severe HS" }, { "field": "primaryOutcome", "quote": "To determine the prevalence and characteristics of inflammatory skin lesions located in the intergluteal fold (IGF) of patients with HS" }, { "field": "result", "quote": "Of the 238 patients with an available clinical diagnosis, intergluteal-HS (IG-HS) was diagnosed in 52 patients (22%) and PSD was diagnosed in 186 patients (78%)" }, { "field": "limitations", "quote": "There was a possibility of misclassification bias in this study as a clinical/image-based diagnosis or histopathology of the IGF lesions was not always available" } ] }, { "id": "pmid:30885385", "pmid": "30885385", "doi": "10.1016/j.ad.2019.01.004", "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurativa: Estimated Prevalence, Clinical Features, Concomitant Conditions, and Diagnostic Delay in a University Teaching Hospital in Buenos Aires, Argentina", "firstAuthor": "Zimman", "multipleAuthors": true, "journal": "Actas Dermosifiliogr (Engl Ed)", "year": 2019, "design": "retrospective", "n": 66, "nField": "reported", "population": "patients diagnosed with hidradenitis suppurativa treated at a hospital in Buenos Aires", "intervention": "none; this was an observational study describing disease features rather than testing a treatment", "comparator": "none", "primaryOutcome": "prevalence, clinical features, concomitant conditions, and diagnostic delay in hidradenitis suppurativa", "result": "the condition mainly affected armpits, vulva and groin, was linked to smoking, overweight and obesity, and male sex plus buttock/perianal location were linked to more severe disease, with diagnosis often delayed for years", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small, single-center chart review with no comparison group, so it can describe patterns but not prove what causes the bumps.", "directness": "indirect", "limitations": "Retrospective, single hospital, small confirmed sample (66 of 180 initial cases), and findings may not generalize beyond this population.", "followUp": "", "plainFinding": "Chronic skin condition behind some buttock bumps.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30885385/", "sourceText": "BACKGROUND: Hidradenitis suppurativa is a chronic recurrent systemic inflammatory disease that mainly involves large skin folds. It develops when pilosebaceous units become blocked, leading to the formation of painful nodules, abscesses, fistulas, and scarring. The impact of this disease on quality of life is great. OBJECTIVES: To describe the prevalence and clinical features of hidradenitis suppurativa in patients treated at Hospital Italiano de Buenos Aires and determine the frequency of comorbidities and time to diagnosis in this population. MATERIAL AND METHODS: Retrospective descriptive cross-sectional study. Information was extracted from the computerized clinical records of all patients with a diagnosis of hidradenitis suppurativa managed in Hospital Italiano de Buenos Aires between July 2012 and October 2017. RESULTS: Our initial search of the records yielded 180 cases; the diagnosis was confirmed in 66 cases. Sixty-five percent of the patients were women, and the mean age was 37 years. The prevalence of this diagnosis was 0.02%. The armpits, vulva, and groin were the locations most frequently affected. Smoking, overweight, and obesity were the most commonly recorded concomitant conditions. Male sex and perianal and gluteal locations were associated with severity. Time until diagnosis varied widely, ranging from diagnosis at the first visit in some cases to as long as 142 months and 21 visits. CONCLUSIONS: Our findings are consistent with the literature on hidradenitis suppurativa. This is the first Argentinian study to describe the prevalence of this disease as well as the concomitant conditions found and the rate of diagnostic error.", "provenance": [ { "field": "n", "quote": "the diagnosis was confirmed in 66 cases" }, { "field": "population", "quote": "all patients with a diagnosis of hidradenitis suppurativa managed in Hospital Italiano de Buenos Aires" }, { "field": "intervention", "quote": "Retrospective descriptive cross-sectional study." }, { "field": "comparator", "quote": "Retrospective descriptive cross-sectional study." }, { "field": "primaryOutcome", "quote": "To describe the prevalence and clinical features of hidradenitis suppurativa in patients treated at Hospital Italiano de Buenos Aires and determine the frequency of comorbidities and time to diagnosis in this population." }, { "field": "result", "quote": "The armpits, vulva, and groin were the locations most frequently affected. Smoking, overweight, and obesity were the most commonly recorded concomitant conditions. Male sex and perianal and gluteal locations were associated with severity." } ] }, { "id": "pmid:30656721", "pmid": "30656721", "doi": "10.1111/ced.13906", "nctId": null, "pmcid": "PMC7029778", "title": "Nicastrin haploinsufficiency alters expression of type I interferon-stimulated genes: the relationship to familial hidradenitis suppurativa", "firstAuthor": "Cao", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2019, "design": "lab", "n": null, "nField": "not-reported", "population": "human keratinocyte and embryonic kidney cell lines with reduced NCSTN gene activity", "intervention": "knocking down or deleting the NCSTN gene (linked to familial hidradenitis suppurativa) in cell lines", "comparator": "control cells with normal NCSTN expression", "primaryOutcome": "changes in gene expression and inflammatory signaling pathways in skin cells", "result": "NCSTN-reduced skin cells showed increased activity of inflammation-related genes and altered growth", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a basic lab experiment on cell lines, not on patients, so it cannot show whether any treatment helps or what causes pimples in general.", "directness": "indirect", "limitations": "Study was done only in cell lines, not in patients or tissue samples, and focused on a rare genetic form of hidradenitis suppurativa rather than common buttock pimples.", "followUp": "", "plainFinding": "Gene clue to rare inherited skin condition.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30656721/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS), also called acne inversa, is a chronic skin disease. The symptoms can be severe, and include intensely painful nodules and abscesses in apocrine-gland rich inverse skin, such as the buttocks, under the arms and in the groin. Autosomal dominant forms of HS exist, but are rare. Some of these kindred have heterozygous loss-of-function rare variants in the γ-secretase complex component nicastrin (NCSTN). AIM: To investigate the effect of NCSTN haploinsufficiency on human keratinocytes and assess potential mechanisms for lesion development. METHODS: NCSTN was knocked down using a small hairpin RNA construct in both a keratinocyte cell line (HEK001) and an embryonic kidney cell line (HEK293), and differential gene expression was assessed using RNA microarray. Using the HEK293 line, a heterozygous deletion of NCSTN was created with CRISPR/Cas9 genome editing, and nuclear factor kappa B activity was assessed using a luciferase reporter. RESULTS: Compared with controls, the keratinocyte NCSTN knockdown cell line showed a significantly increased expression of genes related to the type I interferon response pathway. Both HEK001 and HEK293 knockdowns demonstrated evidence of altered growth. There was a small but significant increase in nuclear factor kappa B signalling in response to tumour necrosis factor treatment in HEK293 cells genome-edited for reduced NCSTN. CONCLUSIONS: Our data suggest a role for increased keratinocyte inflammatory responsiveness in familial HS. Confirming this phenotype and characterizing additional effects in different cell types will require study beyond cell lines, such as in primary cells and tissues.", "provenance": [ { "field": "population", "quote": "NCSTN was knocked down using a small hairpin RNA construct in both a keratinocyte cell line (HEK001) and an embryonic kidney cell line (HEK293)" }, { "field": "intervention", "quote": "a heterozygous deletion of NCSTN was created with CRISPR/Cas9 genome editing" }, { "field": "comparator", "quote": "Compared with controls, the keratinocyte NCSTN knockdown cell line showed a significantly increased expression of genes" }, { "field": "primaryOutcome", "quote": "differential gene expression was assessed using RNA microarray" }, { "field": "result", "quote": "the keratinocyte NCSTN knockdown cell line showed a significantly increased expression of genes related to the type I interferon response pathway" }, { "field": "result", "quote": "Both HEK001 and HEK293 knockdowns demonstrated evidence of altered growth." } ] }, { "id": "pmid:30593710", "pmid": "30593710", "doi": "10.1111/ced.13861", "nctId": null, "pmcid": null, "title": "Sex-related differences of clinical features in hidradenitis suppurativa: analysis of an Italian-based cohort", "firstAuthor": "Bianchi", "multipleAuthors": true, "journal": "Clin Exp Dermatol", "year": 2019, "design": "retrospective", "n": 124, "nField": "reported", "population": "Adults diagnosed with hidradenitis suppurativa (a chronic skin condition causing painful lumps) from six Italian dermatology clinics", "intervention": "Being male", "comparator": "Being female", "primaryOutcome": "Where lesions appeared on the body and how severe the disease was", "result": "Men more often had lesions in the buttock area, while women more often had them on the breast; overall severity was similar between sexes", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is an observational study of a specific skin disease (not general acne) looking at sex differences, so it can't tell us why ordinary pimples occur on the buttocks.", "directness": "indirect", "limitations": "Observational design, no control group without the disease, and findings specific to hidradenitis suppurativa rather than common acne.", "followUp": "", "plainFinding": "HS bumps more common on men's buttocks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30593710/", "sourceText": "The clinical characteristics associated with hidradenitis suppurativa (HS) severity are poorly understood. In this study, 124 patients with HS from 6 Italian dermatology centres participated in this study. Disease severity was assessed using the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA) and Hurley score. The impact of clinical characteristics on disease severity was assessed by logistic regression. Clinical characteristics were similar between men (n = 53) and women (n = 71). Disease severity was also similar; 75% of the patients had Hurley stage II or III disease, and > 60% had moderate, severe or very severe HS as judged by HS-PGA. Lesions were more frequent in the gluteal region in men (32.3% in men vs. 8.7% in women, P < 0.001) and more frequent on the breast in women (16.3% in women vs. 4.6% in men, P = 0.02). Obesity was associated with increased disease severity as measured by HS-PGA (OR: 3.28, 95% CI 1.55-6.95, P < 0.01) and Hurley classification (OR: 3.22, 95% CI 1.34-7.31, P < 0.01). Although severity of HS is similar between the sexes, the localization of lesions is different.", "provenance": [ { "field": "population", "quote": "124 patients with HS from 6 Italian dermatology centres participated in this study" }, { "field": "intervention", "quote": "more frequent in the gluteal region in men" }, { "field": "comparator", "quote": "more frequent on the breast in women" }, { "field": "primaryOutcome", "quote": "Disease severity was assessed using the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA) and Hurley score" }, { "field": "result", "quote": "Lesions were more frequent in the gluteal region in men (32.3% in men vs. 8.7% in women, P < 0.001) and more frequent on the breast in women (16.3% in women vs. 4.6% in men, P = 0.02)." }, { "field": "n", "quote": "124 patients with HS" } ] }, { "id": "pmid:30561771", "pmid": "30561771", "doi": "10.1111/1346-8138.14722", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa of the nape: Description of an atypical phenotype related to severe early-onset disease in men", "firstAuthor": "Agut-Busquet", "multipleAuthors": true, "journal": "J Dermatol", "year": 2019, "design": "case-control", "n": 377, "nField": "reported", "population": "patients with hidradenitis suppurativa (HS)", "intervention": "having severe inflammatory lesions on the back of the neck (nape involvement)", "comparator": "HS patients without nape involvement", "primaryOutcome": "disease severity and clinical features linked to nape involvement", "result": "Patients with nape involvement had worse disease, earlier onset, family history, and more often had buttock (gluteal) involvement", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a single-center, cross-sectional study with only 30 patients in the group of interest, so it can show associations but not prove causes.", "directness": "indirect", "limitations": "Single-center study, small subgroup (30 patients) with nape involvement, cross-sectional design so cause-and-effect can't be confirmed.", "followUp": "", "plainFinding": "Severe HS linked to buttock lesions too.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30561771/", "sourceText": "Some patients with hidradenitis suppurativa (HS) develop severe inflammatory lesions of the nape. Through a single-center, cross-sectional study with a total of 377 patients, we sought to compare patients with and without nape involvement, to determine whether disease severity is greater in these patients and to describe their clinical characteristics. Thirty patients (90% male) were identified as having nape involvement. Patients with versus without nape involvement had greater disease severity, earlier disease onset, a family history of HS, lower body mass, and higher Dermatological Life Quality Index and pain scores. Amongst them, involvement of the trunk and gluteal regions predominated. A significant univariate relationship existed between patients with nape involvement and male sex, early disease onset, family history, scalp and gluteal involvement, Canoui-Poitrine phenotypes II and III, and Dowling-Degos disease. A significant multivariate relationship existed with early disease onset, Dowling-Degos disease, and phenotypes II and III.", "provenance": [ { "field": "n", "quote": "a total of 377 patients" }, { "field": "population", "quote": "Some patients with hidradenitis suppurativa (HS) develop severe inflammatory lesions of the nape." }, { "field": "intervention", "quote": "patients with and without nape involvement" }, { "field": "comparator", "quote": "patients with and without nape involvement" }, { "field": "primaryOutcome", "quote": "to compare patients with and without nape involvement, to determine whether disease severity is greater in these patients and to describe their clinical characteristics" }, { "field": "result", "quote": "Patients with versus without nape involvement had greater disease severity, earlier disease onset, a family history of HS, lower body mass, and higher Dermatological Life Quality Index and pain scores. Amongst them, involvement of the trunk and gluteal regions predominated." } ] }, { "id": "pmid:30468376", "pmid": "30468376", "doi": "10.23736/S0392-0488.17.05779-0", "nctId": null, "pmcid": null, "title": "Multidisciplinary approach for hidradenitis suppurativa patients", "firstAuthor": "Veraldi", "multipleAuthors": true, "journal": "G Ital Dermatol Venereol", "year": 2018, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (a chronic skin condition affecting armpits, groin, buttocks and other skin fold areas)", "intervention": "multidisciplinary care involving multiple specialists", "comparator": "dermatologist care alone", "primaryOutcome": "management of the disease and its associated health conditions", "result": "the abstract describes the disease and argues for team-based care but does not report outcome data comparing approaches", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a descriptive discussion piece with no patient data or comparison of outcomes.", "directness": "indirect", "limitations": "no study data, numbers, or outcomes are reported; it is an opinion/overview article", "followUp": "", "plainFinding": "Discusses hidradenitis suppurativa, no outcome data.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30468376/", "sourceText": "Hidradenitis suppurativa or acne inversa is an inflammatory, chronic disease of the hair follicles located in specific areas of the skin surface (axillae, submammary, inguinal and intergluteal folds, pubis, genitalia and buttocks). The diagnosis and the management of this disease are usually made by the dermatologist. However, the frequent association of hidradenitis suppurativa or acne inversa with important systemic comorbidities needs the cooperation with a number of specialists. In particular, the cooperation with rheumatologists, gastroenterologists, endocrinologists, microbiologists/infectivologists, psychologists/psychiatrics and plastic surgeons is often helpful or necessary.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa or acne inversa is an inflammatory, chronic disease of the hair follicles located in specific areas of the skin surface (axillae, submammary, inguinal and intergluteal folds, pubis, genitalia and buttocks)." }, { "field": "intervention", "quote": "the cooperation with rheumatologists, gastroenterologists, endocrinologists, microbiologists/infectivologists, psychologists/psychiatrics and plastic surgeons is often helpful or necessary" }, { "field": "comparator", "quote": "The diagnosis and the management of this disease are usually made by the dermatologist." }, { "field": "primaryOutcome", "quote": "the frequent association of hidradenitis suppurativa or acne inversa with important systemic comorbidities needs the cooperation with a number of specialists" }, { "field": "result", "quote": "the cooperation with rheumatologists, gastroenterologists, endocrinologists, microbiologists/infectivologists, psychologists/psychiatrics and plastic surgeons is often helpful or necessary" } ] }, { "id": "pmid:30390729", "pmid": "30390729", "doi": null, "nctId": null, "pmcid": null, "title": "Mechanical Stress as a Cause of Hidradenitis Suppurativa: A Lesson from a Patient with a Monster Hernia", "firstAuthor": "De Vita", "multipleAuthors": true, "journal": "Acta Dermatovenerol Croat", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "a 54-year-old man with a giant abdominal hernia and no prior history of hidradenitis suppurativa", "intervention": "ongoing mechanical stress (friction and pressure) on the skin from the hernia and tight trousers/belt", "comparator": "none reported", "primaryOutcome": "development of hidradenitis suppurativa-like skin lesions (nodules, cysts, scars)", "result": "The patient developed inflammatory nodules, cysts, and scars specifically in the skin area under constant friction and pressure from the hernia and clothing, supporting mechanical stress as a cause.", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot reliably show cause and effect for the general population.", "directness": "indirect", "limitations": "Single case with no comparison group; conclusions are based on clinical reasoning about one patient's hernia-related skin lesions.", "followUp": "", "plainFinding": "Friction and pressure may cause boils.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30390729/", "sourceText": "We have read with great interest the case report recently published in Acta Dermatovenerologica Croatica by Boer and Mihajlovic (1), which describes a 33-year-old woman with an 18-year history of classic hidradenitis suppurativa (HS) who developed HS-like lesions at the position of the bra strap. We agree with Boer and Mihajlovic: according to our clinical experience, we are convinced that mechanical stress may contribute or, in some cases, result in the development of HS. In this regard, we will describe the case of a patient with a monster hernia who presented HS-like lesions on his abdomen corresponding to the perihernial skin area, suggesting that mechanical stress was an important pathogenic factor for HS development. A 54-year-old man without any previous history of HS developed chronic, recurrent, inflammatory nodules, cysts, and depressed scars at the location of a giant abdominal hernia (Figure 1). The lesions occurred four years ago, six months after the hernia had reached its current size. Cultures from skin swabs showed commensal skin flora and moderate mixed anaerobic bacteria, as would be expected in HS lesions. No lesions occurred in other inverse areas generally affected by HS, such as the axillary and anogenito-crural regions. It is likely that the mechanical stress in the abdominal region was greater than the one occurring at the other folds due to the pressure of the trousers and belt. In fact, there are many kinds of mechanical stress: friction, pressure, pulling, tension, and pinching. Friction can be defined as the resistance to motion in the direction of the common boundary of the two surfaces. The body areas which are at greater risk for such frictional forces are mainly the skin folds, such as axillae, groins, and buttocks. There is a substantial difference between frictional and pressor stress: pressure is defined as the force per unit exerted parallel to the plane of interest. Pressure on the skin can be caused by tight dressings (2). Frictional and pressor forces can act concurrently and synergistically, starting the series of events that lead to clinical onset of HS, as most likely happened in our patient at the abdomen right below the hernia, where the trousers and belt are tightened. It is believed today that the primary event in HS is follicular inflammation: in predisposed subjects, folliculitis can develop into HS. Follicular enlargement has been observed in HS skin. It has been hypothesized that constant mechanical forces, such as pressure and friction, may lead to follicular occlusion, dilatation, microtears, and ruptures with ensuing abscesses (1-6). This case report corroborates observations from the last three decades: HS is a disease of the follicular epithelium rather than the apocrine glands (7,8), and mechanical stress, friction, and pressure may have an important role in its pathogenesis.", "provenance": [ { "field": "n", "quote": "A 54-year-old man without any previous history of HS developed chronic, recurrent, inflammatory nodules, cysts, and depressed scars at the location of a giant abdominal hernia" }, { "field": "population", "quote": "A 54-year-old man without any previous history of HS developed chronic, recurrent, inflammatory nodules, cysts, and depressed scars at the location of a giant abdominal hernia" }, { "field": "intervention", "quote": "the mechanical stress in the abdominal region was greater than the one occurring at the other folds due to the pressure of the trousers and belt" }, { "field": "primaryOutcome", "quote": "developed chronic, recurrent, inflammatory nodules, cysts, and depressed scars at the location of a giant abdominal hernia" }, { "field": "result", "quote": "suggesting that mechanical stress was an important pathogenic factor for HS development" }, { "field": "comparator", "quote": "No lesions occurred in other inverse areas generally affected by HS, such as the axillary and anogenito-crural regions." } ] }, { "id": "pmid:30368496", "pmid": "30368496", "doi": "10.1159/000493342", "nctId": null, "pmcid": null, "title": "Standardized Photographic Documentation of Hidradenitis Suppurativa/Acne Inversa", "firstAuthor": "Zouboulis", "multipleAuthors": true, "journal": "Dermatology", "year": 2019, "design": "lab", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (a skin fold condition), studied via volunteer photography", "intervention": "standardized photography method/protocol for documenting skin lesions", "comparator": "", "primaryOutcome": "creating a reproducible photography protocol for documenting lesions in skin folds including buttocks", "result": "a standardized photography protocol was developed, no treatment or cause was tested", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is not a study of symptoms or causes at all, but a technical photography methods paper, so it cannot answer why someone gets pimples on their buttocks.", "directness": "indirect", "limitations": "abstract does not address causes, treatment or outcomes of buttock lesions, only documents a photography method", "followUp": "", "plainFinding": "Not relevant - photography method only.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30368496/", "sourceText": "BACKGROUND: Despite existing guidelines and methods for standardized clinical photography in dermatology and plastic surgery, human skin exhibits exquisite site-specific morphologies and functions, and each body region can exhibit an individual pathologic phenotype. The aim of this work was to develop a standardized, representative and reproducible documentation of the multilocular hidradenitis suppurativa/acne inversa (HS) lesions, a disease mostly occurring in skin folds. METHOD: Optimal body positions for medical photography of candidate areas for HS involvement were evaluated. Pictures of volunteers were taken, and indicative scientific graphics were designed. RESULTS: Due to the variability of HS lesions and the fact of their localization in skin folds, a standardized, reproducible photographic documentation of HS candidate skin areas (50 cm from the skin surface) is proposed. The photographic series includes: (1) right armpit, (2) left armpit, (3) right groin, (4) left groin, (5) genital area, (6) anal area and anal fold, (7) right buttock, (8) left buttock, (9) chest area, (10) mons pubis, (11) right submammary area (females), (12) left submammary area (females). The protocol is accompanied with indicative scientific graphics for photography-proper positioning of the relevant body parts for documentation of potentially flat skin areas. In addition, former proposals for technical standardization of photography in dermatology, regarding instrumentation, environmental lighting and background colour, have to be respected. CONCLUSION: Standardized photography of candidate skin areas for HS involvement will allow longitudinal intraindividual and interindividual evaluation of the disease course as well as prospective and retrospective comparative studies.", "provenance": [ { "field": "population", "quote": "Pictures of volunteers were taken, and indicative scientific graphics were designed." }, { "field": "intervention", "quote": "a standardized, reproducible photographic documentation of HS candidate skin areas (50 cm from the skin surface) is proposed" }, { "field": "primaryOutcome", "quote": "The aim of this work was to develop a standardized, representative and reproducible documentation of the multilocular hidradenitis suppurativa/acne inversa (HS) lesions" }, { "field": "result", "quote": "Standardized photography of candidate skin areas for HS involvement will allow longitudinal intraindividual and interindividual evaluation of the disease course as well as prospective and retrospective comparative studies." } ] }, { "id": "pmid:30295448", "pmid": "30295448", "doi": "10.23736/S0392-0488.18.06165-5", "nctId": null, "pmcid": null, "title": "Characterization of comorbid conditions burdening hidradenitis suppurativa: a multicentric observational study", "firstAuthor": "Chiricozzi", "multipleAuthors": true, "journal": "G Ital Dermatol Venereol", "year": 2020, "design": "retrospective", "n": 234, "nField": "reported", "population": "patients with hidradenitis suppurativa seen at specialist skin clinics", "intervention": "none (study just looked at related health conditions, not a treatment)", "comparator": "", "primaryOutcome": "which other health conditions occur alongside hidradenitis suppurativa and whether they relate to disease severity", "result": "obesity, polycystic ovary syndrome, high blood pressure, high cholesterol, type 2 diabetes and thyroid problems were the most common conditions found, and obesity was linked to more severe disease and to PCOS", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a chart-review study of one patient group with no comparison group, so it can show links but not prove what causes what.", "directness": "indirect", "limitations": "observational chart review, no control group, and it studies hidradenitis suppurativa rather than ordinary pimples", "followUp": "", "plainFinding": "HS linked to obesity, PCOS, diabetes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30295448/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, disabling, inflammatory skin disorder that primarily affects the hair follicle localized at the apocrine-gland-bearing areas of the body, including axillary, inguinal, buttocks, and anogenital areas, and it may be associated with a wide array of comorbid conditions. This study aimed to described comorbid conditions affecting HS patients and to detect any correlation with disease severity. METHODS: Analyzing clinic database, we included all charts of patients visited at the HS outpatient clinic of three University Dermatologic Departments in order to describe demographic data, anthropometric measures, disease features, personal habits, clinical history, and presence of comorbidities. RESULTS: Two hundred thirty-four patients, mostly females (62%), were enrolled in this study. Based on Hurley staging classification 41% of patients were classified as Hurley Stage I, 43.0% as Hurley II, and 16% Hurley III, with a mean mSartorius Score value of 24.7 (SD: ±19.39) and a mean AISI score value of 12.5 (SD: ±11.93). The most frequently observed comorbidities were: obesity (26.1%), polycystic ovary syndrome (PCOS) (13.8% of the overall study population and 22.3% of females), hypertension (11.9%), dyslipidemia (9.9%), type II diabetes (9.5%), thyroid disorders (9.1%), nervous system disorders (7.1%), acne (6.7%), metabolic syndrome (4.4%), and Crohn's disease (3.6%). Obesity represented a key-comorbid condition increasing the likelihood of having more severe HS and PCOS (odds ratio 3.35 and 3.74, respectively). CONCLUSIONS: HS is associated with a variety of comorbid conditions that should be considered to perform targeted routine screening and to improve HS management.", "provenance": [ { "field": "population", "quote": "patients visited at the HS outpatient clinic of three University Dermatologic Departments" }, { "field": "n", "quote": "Two hundred thirty-four patients, mostly females (62%), were enrolled in this study." }, { "field": "primaryOutcome", "quote": "This study aimed to described comorbid conditions affecting HS patients and to detect any correlation with disease severity." }, { "field": "result", "quote": "The most frequently observed comorbidities were: obesity (26.1%), polycystic ovary syndrome (PCOS) (13.8% of the overall study population and 22.3% of females), hypertension (11.9%), dyslipidemia (9.9%), type II diabetes (9.5%), thyroid disorders (9.1%)" }, { "field": "result", "quote": "Obesity represented a key-comorbid condition increasing the likelihood of having more severe HS and PCOS (odds ratio 3.35 and 3.74, respectively)." }, { "field": "intervention", "quote": "Analyzing clinic database, we included all charts of patients visited at the HS outpatient clinic" } ] }, { "id": "pmid:30294846", "pmid": "30294846", "doi": "10.1111/1346-8138.14656", "nctId": null, "pmcid": null, "title": "Demographic and clinical features of hidradenitis suppurativa in Korea", "firstAuthor": "Yang", "multipleAuthors": true, "journal": "J Dermatol", "year": 2018, "design": "retrospective", "n": 438, "nField": "reported", "population": "people diagnosed with hidradenitis suppurativa in Korea", "intervention": "none (this is an observational chart review, not a treatment study)", "comparator": "comparison between patient subgroups (e.g. male vs female, different body sites) rather than a treatment comparator", "primaryOutcome": "which body areas were affected and what features were linked to more severe disease", "result": "buttocks were the most commonly affected area after axillae and groin, and buttock or perineum involvement was linked to more severe disease", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a single retrospective chart review without a control group, so it describes patterns but cannot prove cause or test a treatment.", "directness": "indirect", "limitations": "Retrospective design based on medical records; only includes patients already diagnosed with hidradenitis suppurativa, so it may not reflect all causes of buttock pimples in the general population.", "followUp": "", "plainFinding": "Buttocks commonly affected by hidradenitis suppurativa.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30294846/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disorder. Although several epidemiological studies have been conducted in Western countries, such data regarding Asian populations are scarce. In this study, we sought to investigate the demographic and clinical features of HS in Korea. A total of 438 patients, diagnosed with HS from May 2007 to April 2017, were enrolled and the electronic medical record of each patient was reviewed. Male patients were predominant with a male : female ratio of 2.5:1. Mean age of disease onset was 23.9 years and most patients had no family history. The most frequently affected area was the buttocks, followed by axillae and groin. Acne and diabetes mellitus were the most prevalent associated diseases and no patients with inflammatory bowel diseases were observed. In the univariable analysis, male patients had severe diseases compared with females with an odds ratio (OR) of 1.790. Two or more affected body regions were associated with HS severity with an OR of 1.693. While involvement of the perineum (OR, 4.067) and buttocks (OR, 1.471) tended to be associated with increased severity of the disease, the inguinal area (OR, 0.620) showed a tendency to be inversely associated with the severity. In multivariable analysis, identified risk factors were the involvement of the perineum (OR, 3.819) and buttocks (OR, 2.288). Smoking status and high body mass index seemed to be associated with more severe diseases. Our results will provide clinical characteristics of HS patients in Asia and help to broaden understanding of HS.", "provenance": [ { "field": "n", "quote": "A total of 438 patients, diagnosed with HS from May 2007 to April 2017, were enrolled" }, { "field": "population", "quote": "we sought to investigate the demographic and clinical features of HS in Korea" }, { "field": "primaryOutcome", "quote": "The most frequently affected area was the buttocks, followed by axillae and groin" }, { "field": "result", "quote": "involvement of the perineum (OR, 4.067) and buttocks (OR, 1.471) tended to be associated with increased severity of the disease" }, { "field": "intervention", "quote": "the electronic medical record of each patient was reviewed" }, { "field": "comparator", "quote": "Male patients had severe diseases compared with females with an odds ratio (OR) of 1.790" } ] }, { "id": "pmid:30105858", "pmid": "30105858", "doi": "10.1111/ijd.14173", "nctId": null, "pmcid": null, "title": "Lymphedema in patients with hidradenitis suppurativa: a systematic review of published literature", "firstAuthor": "Micieli", "multipleAuthors": true, "journal": "Int J Dermatol", "year": 2018, "design": "systematic-review", "n": 27, "nField": "reported", "population": "People with long-standing hidradenitis suppurativa (a chronic boil-like skin condition) who developed lymphedema", "intervention": "Treatment of HS-related lymphedema, most often radical surgical removal of affected tissue plus medical therapy", "comparator": "No comparison group; the review just pooled case reports and case series without controls", "primaryOutcome": "How lymphedema from HS presents and is managed", "result": "Most patients treated with surgical excision plus medical therapy had good outcomes; swelling most often affected the scrotum, penis or vulva, with buttocks affected in only 2 of 27 patients", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "It only pools small case reports and case series with no control group, so it can't reliably show whether treatments work.", "directness": "indirect", "limitations": "Based on only 17 published reports (27 patients total) with no control group, and the abstract notes this complication is rare.", "followUp": "", "plainFinding": "Rare HS swelling, not typical butt pimples", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30105858/", "sourceText": "BACKGROUND: Lymphedema is a debilitating complication of hidradenitis suppurativa (HS) that can be therapeutically challenging. Systematic evaluation of the clinical presentation and management of this condition has yet to be performed. METHODS: OVID MEDLINE and EMBASE databases were searched along with a review of the references of searched articles for all English reports discussing lymphedema secondary to HS. RESULTS: Two case series and 15 case reports met inclusion criteria, representing 27 patients. On average, these patients had a history of HS for 18 years (range 4-30 years). Lymphedema was found in the following areas in order of frequency: scrotum (16 patients, 59%), penis (12 patients, 44%), labia majora (4 patients, 15%), perineum (3 patients, 11%), groin (3 patients, 11%), buttocks (2 patients, 7%), and abdomen (1 patient, 4%). In six patients (22%), lymphedema occurred in two or more of the aforementioned locations. Lymphedema most commonly presented not only as swelling with induration but also as verrucous papules or nodules. The majority of cases (14 patients, 52%) were treated with radical surgical excision combined with medical therapy and obtained favorable outcomes. Surgical defect was most frequently covered with split thickness skin grafts 7 patients, 54%) followed by skin flaps (3 patients, 11%) and healing by secondary intention (3 patients, 11%). CONCLUSIONS: Lymphedema appears to be a relatively rare complication of chronic HS that most commonly affects the anogenital region. Based on the evidence available, dermatologists should pursue a collaborative approach with surgery in the management of this condition at early stages.", "provenance": [ { "field": "n", "quote": "representing 27 patients" }, { "field": "population", "quote": "Lymphedema is a debilitating complication of hidradenitis suppurativa (HS) that can be therapeutically challenging." }, { "field": "intervention", "quote": "The majority of cases (14 patients, 52%) were treated with radical surgical excision combined with medical therapy and obtained favorable outcomes." }, { "field": "comparator", "quote": "Two case series and 15 case reports met inclusion criteria, representing 27 patients." }, { "field": "primaryOutcome", "quote": "Systematic evaluation of the clinical presentation and management of this condition has yet to be performed." }, { "field": "result", "quote": "The majority of cases (14 patients, 52%) were treated with radical surgical excision combined with medical therapy and obtained favorable outcomes." }, { "field": "result", "quote": "buttocks (2 patients, 7%)" } ] }, { "id": "pmid:29284150", "pmid": "29284150", "doi": "10.1016/j.ijsu.2017.12.018", "nctId": null, "pmcid": null, "title": "Men, main victims of hidradenitis suppurativa (A prospective cohort study)", "firstAuthor": "Maghsoudi", "multipleAuthors": true, "journal": "Int J Surg", "year": 2018, "design": "prospective-cohort", "n": 21, "nField": "reported", "population": "patients with moderate to extensive hidradenitis suppurativa, a chronic skin condition with painful lumps and abscesses", "intervention": "wide surgical excision with reconstruction of affected skin areas", "comparator": "conservative (non-surgical) treatment methods", "primaryOutcome": "how well treatment worked, including recurrence of the disease after treatment", "result": "conservative treatment had little or no effect, while wide surgical excision was the only successful treatment", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small surgical case series of only 21 patients without a formal comparison group, so the findings are not strong evidence.", "directness": "indirect", "limitations": "Small number of patients, single hospital, and no randomized comparison group; abstract does not report complication or recurrence rates in detail.", "followUp": "at least 24 months", "plainFinding": "Surgery beat conservative care for severe HS.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29284150/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease presenting as painful subcutaneous nodules, characterized by multiple abscess, inter-networking sinus tracts. We present the option of surgical treatment involving wide surgical excision and methods of reconstruction as well as the rate of recurrence. METHOD: This study reviewed 44 sites in 21 patients with moderate to extensive HS treated surgically in our hospital from 2000 to 2016, with a follow up of at least 24 months. RESULTS: A total number of 44 operative procedures were performed during the study period with 13.6% (6 sites) involving axilla, 38.6% (17 sites) involving the gluteal area, 29.5% (13 sites) involving the perineal and perianal area and 11.4% (5 sites) involving the inguinal region, 4.5% (2 sites) involving the scrotal area, and 1.3% (one case) retrorectal abscess. CONCLUSION: Conservative treatment methods have little or no effects especially on gluteal, perineal/perianal and axillary hidradenitis suppurativa. The morbidity associated with the established disease is significant, and the only successful treatment is wide surgical excision.", "provenance": [ { "field": "n", "quote": "44 sites in 21 patients" }, { "field": "population", "quote": "moderate to extensive HS treated surgically" }, { "field": "intervention", "quote": "wide surgical excision and methods of reconstruction" }, { "field": "comparator", "quote": "Conservative treatment methods have little or no effects" }, { "field": "primaryOutcome", "quote": "the rate of recurrence" }, { "field": "result", "quote": "Conservative treatment methods have little or no effects especially on gluteal, perineal/perianal and axillary hidradenitis suppurativa. The morbidity associated with the established disease is significant, and the only successful treatment is wide surgical excision." }, { "field": "followUp", "quote": "follow up of at least 24 months" } ] }, { "id": "pmid:29166335", "pmid": "29166335", "doi": "10.1097/RLU.0000000000001911", "nctId": null, "pmcid": null, "title": "Multiple Hypermetabolic Subcutaneous Lesions From Hidradenitis Suppurativa Mimicking Metastases on 18F-FDG PET/CT", "firstAuthor": "Asamoah", "multipleAuthors": true, "journal": "Clin Nucl Med", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "a 64-year-old man with vocal cord cancer being scanned for staging, who also had hidradenitis suppurativa", "intervention": "none - this was an imaging case report, not a treatment study", "comparator": "", "primaryOutcome": "whether skin lesions from hidradenitis suppurativa could be mistaken for cancer spread on PET/CT scan", "result": "the hidradenitis suppurativa lesions (including in the buttocks) lit up on the scan and could be mistaken for cancer metastases", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report describing an imaging finding, not a treatment or causal study, so it carries very little weight for explaining why pimples occur.", "directness": "indirect", "limitations": "only one patient; describes an imaging pitfall rather than investigating causes or treatment of buttock lesions; not generalizable.", "followUp": "", "plainFinding": "Describes a skin disease, not pimple causes.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29166335/", "sourceText": "Hidradenitis suppurativa is an inflammatory disease associated with subcutaneous nodules/abscesses that occur commonly in the axillary, inguinal, and perineal regions. We describe a case of a 64-year-old man presenting for F-FDG PET/CT for staging of a left vocal cord squamous cell carcinoma. The scan showed uptake in the left vocal cord malignancy and multiple hypermetabolic subcutaneous foci in the right axilla, right buttocks, and scalp in known locations of skin lesions related to hidradenitis suppurativa. This case illustrates an unusual inflammatory cause of F-FDG incidental uptake that should not be mistaken for metastases.", "provenance": [ { "field": "population", "quote": "We describe a case of a 64-year-old man presenting for F-FDG PET/CT for staging of a left vocal cord squamous cell carcinoma." }, { "field": "n", "quote": "We describe a case of a 64-year-old man" }, { "field": "intervention", "quote": "F-FDG PET/CT" }, { "field": "primaryOutcome", "quote": "This case illustrates an unusual inflammatory cause of F-FDG incidental uptake that should not be mistaken for metastases." }, { "field": "result", "quote": "The scan showed uptake in the left vocal cord malignancy and multiple hypermetabolic subcutaneous foci in the right axilla, right buttocks, and scalp in known locations of skin lesions related to hidradenitis suppurativa." } ] }, { "id": "pmid:28859733", "pmid": "28859733", "doi": null, "nctId": null, "pmcid": null, "title": "Hidradenitis Suppurativa and Concomitant Down Syndrome: Literature Review of Other Associated Mucocutaneous Manifestations in Adults", "firstAuthor": "Sehgal", "multipleAuthors": true, "journal": "Skinmed", "year": 2017, "design": "case-series", "n": null, "nField": "not-reported", "population": "adults with Down syndrome", "intervention": "none (observational description)", "comparator": "none", "primaryOutcome": "presence and features of hidradenitis suppurativa and other skin conditions", "result": "describes hidradenitis suppurativa lesions on inner thighs, groin, and buttocks along with other associated skin conditions in Down syndrome patients", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a case report and literature review describing disease features, not testing a treatment, so it can't show what works or why pimples occur in general.", "directness": "indirect", "limitations": "Case report/review of a rare condition in people with Down syndrome, not a study of typical buttock acne in the general population.", "followUp": "", "plainFinding": "Describes rare skin disease, not typical acne.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28859733/", "sourceText": "This contribution describes hidradenitis suppurativa (HS) occurring in Down disease that presented with morphology conforming to an overlap of stages 1 and 2 of the Hurley staging system, namely the formation of solitary or multiple isolated abscesses without scarring or sinus tracts, recurrent abscesses, and single or multiple widely separated lesions with sinus tract formation, occupying apocrine sweat gland-bearing areas: the inner thighs, groin, and buttocks. The lesions were bilateral and symmetrical, of rare occurrence. In addition, the clinical and pathognomonic features of several other concomitant diseases are defined and reviewed; these include elastosis perforans serpiginosa, fissured tongue/macroglossia, syringomas, palmoplantar keratodermas, cheilitis, xerosis, atopic dermatitis, seborrheic dermatitis, vitiligo, cutis marmorata, and alopecia areata.", "provenance": [ { "field": "population", "quote": "hidradenitis suppurativa (HS) occurring in Down disease" }, { "field": "intervention", "quote": "This contribution describes hidradenitis suppurativa (HS) occurring in Down disease that presented with morphology conforming to an overlap of stages 1 and 2 of the Hurley staging system" }, { "field": "comparator", "quote": "the clinical and pathognomonic features of several other concomitant diseases are defined and reviewed" }, { "field": "primaryOutcome", "quote": "the formation of solitary or multiple isolated abscesses without scarring or sinus tracts, recurrent abscesses, and single or multiple widely separated lesions with sinus tract formation, occupying apocrine sweat gland-bearing areas: the inner thighs, groin, and buttocks" }, { "field": "result", "quote": "The lesions were bilateral and symmetrical, of rare occurrence." } ] }, { "id": "pmid:28722455", "pmid": "28722455", "doi": null, "nctId": null, "pmcid": null, "title": "[Hidradenitis suppurativa - symptoms, diagnostics, and therapy]", "firstAuthor": "Arenbergerová", "multipleAuthors": true, "journal": "Cas Lek Cesk", "year": 2017, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a chronic skin condition affecting areas with hair follicles and sweat glands", "intervention": "various treatments including topical antiseptics, antibiotics, TNF-α antagonists, and surgery", "comparator": "", "primaryOutcome": "description of symptoms, diagnosis, and treatment approaches rather than a measured outcome", "result": "the abstract describes the disease process and treatment options without reporting a specific trial result", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general descriptive review of the disease, not a study testing or comparing treatments, so it can't show whether any treatment works.", "directness": "indirect", "limitations": "no data, statistics, or outcome measures are given; it is a descriptive overview rather than original research.", "followUp": "", "plainFinding": "Explains hidradenitis suppurativa as a cause.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28722455/", "sourceText": "Hidradenitis suppurativa is a chronic skin disorder characterized by recurrent inflammatory nodules, fistulas, abscesses, and scarring mainly in the intertriginous areas with terminal hair and apocrine glands. Hidradenitis suppurativa manifests usually after puberty, in the third life decade and persists for many years. The prevalence of the disease is estimated to be 0,5 % in the Czech Republic. Women are most often affected in the axillary and inguinal parts, while men in the perianal and gluteal areas. The exact pathogenesis is still unknown. It is assumed that hyperkeratosis of the hair follicle leads to its occlusion, dilatation and further rupture when keratin and bacteria are spilled into the dermis causing a massive inflammatory reaction. Smoking and obesity belong to the main triggering factors. Without therapy, the disease is chronic and progressive. The standard therapy depends on the extension of the disorder. For not extensive lesions, treatment consists of topical antiseptics, antibiotics or long- term therapy with systemic antibiotics. In more advanced stages, systemic therapy with TNF-α antagonists is needed. Further therapeutic modality is surgical intervention and wide excision of the affected area. Nevertheless, recurrences in the adjacent tissue cannot be avoided.", "provenance": [ { "field": "population", "quote": "Women are most often affected in the axillary and inguinal parts, while men in the perianal and gluteal areas." }, { "field": "intervention", "quote": "treatment consists of topical antiseptics, antibiotics or long- term therapy with systemic antibiotics" }, { "field": "intervention", "quote": "In more advanced stages, systemic therapy with TNF-α antagonists is needed." }, { "field": "intervention", "quote": "Further therapeutic modality is surgical intervention and wide excision of the affected area." }, { "field": "result", "quote": "Nevertheless, recurrences in the adjacent tissue cannot be avoided." }, { "field": "primaryOutcome", "quote": "Hidradenitis suppurativa is a chronic skin disorder characterized by recurrent inflammatory nodules, fistulas, abscesses, and scarring" } ] }, { "id": "pmid:28705285", "pmid": "28705285", "doi": null, "nctId": null, "pmcid": null, "title": "Childhood-Onset Keratosis Lichenoides Chronica Accompanied by Severe Hair Loss", "firstAuthor": "Dogan", "multipleAuthors": true, "journal": "Skinmed", "year": 2017, "design": "case-series", "n": 1, "nField": "reported", "population": "A 37-year-old woman with lifelong skin erythema and hyperpigmented papules, now with hair loss", "intervention": "None (observational case report, skin biopsy performed)", "comparator": "", "primaryOutcome": "Diagnosis of the skin condition causing papules and plaques, including on the buttocks", "result": "Diagnosed as keratosis lichenoides chronica based on skin appearance and biopsy findings", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this explains most people's buttock pimples or how to treat them.", "directness": "indirect", "limitations": "Single case report of a rare chronic skin disease with no treatment or comparison data, not representative of typical buttock pimples (usually acne or folliculitis).", "followUp": "", "plainFinding": "Rare skin disease caused bumps, not typical pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28705285/", "sourceText": "A 37-year-old woman attended the dermatology outpatient clinic because of recent hair loss from the eyebrows and axillae. Her past medical history revealed mild generalized erythema and hyperpigmented papules and plaques since childhood. On dermatologic examination, there were flat-topped, purple to brown hyperkeratotic lichenoid papules and linear plaques on the elbows, trunk, and buttocks, some of which coalesced into hyperpigmented reticular plaques on the axillae, neck, and groin. Mild erythema was noted. There was thinning and loss of hair of the eyebrows; severe loss of hair was noted in the axillae and genital regions (Figure 1). One of the lichenoid papules was biopsied. The specimen showed histopathologic findings of focal parakeratosis, irregular acanthosis, an increased granular layer, and focal vacuolar degeneration of the basal layer. Necrotic keratinocytes were also observed. Hyalinization and abundant melanin in the papillary dermis and marked congestion of blood vessels were noted (Figure 2). Clinicopathologic correlation of the case was consistent with keratosis lichenoides chronica (KLC).", "provenance": [ { "field": "population", "quote": "A 37-year-old woman attended the dermatology outpatient clinic because of recent hair loss from the eyebrows and axillae." }, { "field": "population", "quote": "Her past medical history revealed mild generalized erythema and hyperpigmented papules and plaques since childhood." }, { "field": "intervention", "quote": "One of the lichenoid papules was biopsied." }, { "field": "primaryOutcome", "quote": "flat-topped, purple to brown hyperkeratotic lichenoid papules and linear plaques on the elbows, trunk, and buttocks" }, { "field": "result", "quote": "Clinicopathologic correlation of the case was consistent with keratosis lichenoides chronica (KLC)." }, { "field": "n", "quote": "A 37-year-old woman" } ] }, { "id": "pmid:28654150", "pmid": "28654150", "doi": "10.1111/bjd.15769", "nctId": null, "pmcid": null, "title": "Severe hidradenitis suppurativa responding to treatment with secukinumab: a case report", "firstAuthor": "Thorlacius", "multipleAuthors": true, "journal": "Br J Dermatol", "year": 2018, "design": "case-series", "n": 1, "nField": "reported", "population": "A 47-year-old man with severe hidradenitis suppurativa affecting the neck, armpits, breasts, genital skin and buttocks", "intervention": "Secukinumab (an antibody drug that blocks interleukin-17A)", "comparator": "No comparator; before-and-after treatment in the same patient", "primaryOutcome": "Number of skin lesions and pain scores reported by the patient", "result": "After 12 weeks, lesion count dropped from 23 to 7 and pain scores improved", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report with no comparison group, so it cannot reliably show the drug caused the improvement.", "directness": "indirect", "limitations": "Only one patient was studied, there was no control group, and improvement could be due to other factors or natural fluctuation of the disease.", "followUp": "12 weeks", "plainFinding": "One patient's severe boils improved.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28654150/", "sourceText": "An inappropriate immunological response to an unknown antigen has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Studies have identified elevated levels of several proinflammatory cytokines, including interleukin (IL)-17A and tumour necrosis factor-α, nominating these as possible therapeutic targets.1 Secukinumab is an IL-17A monoclonal antibody, which binds to IL-17A and inhibits the cytokine interaction with the IL-17 receptors, inhibiting the inflammatory cascade. Here we report a case of a 47-year-old man, with Hurley stage III lesions on the neck, axillae, breasts, genital skin and buttocks, who had experienced only temporary benefit from different medical treatments over several years. After 12 weeks of treatment with secukinumab, the number of lesions reported by the patient within the period of the last 4 weeks was reduced from 23 to seven, his pain visual analogue scale (VAS) score was reduced from 5 to 3 and pain/utility/handicap VAS score was reduced from 7 to 4. These results may be taken to imply that IL-17 blockade could provide a possible therapeutic approach in the treatment of HS.", "provenance": [ { "field": "n", "quote": "a case of a 47-year-old man" }, { "field": "population", "quote": "Hurley stage III lesions on the neck, axillae, breasts, genital skin and buttocks" }, { "field": "intervention", "quote": "Secukinumab is an IL-17A monoclonal antibody, which binds to IL-17A and inhibits the cytokine interaction with the IL-17 receptors" }, { "field": "comparator", "quote": "who had experienced only temporary benefit from different medical treatments over several years" }, { "field": "primaryOutcome", "quote": "the number of lesions reported by the patient within the period of the last 4 weeks" }, { "field": "result", "quote": "After 12 weeks of treatment with secukinumab, the number of lesions reported by the patient within the period of the last 4 weeks was reduced from 23 to seven" } ] }, { "id": "pmid:28377030", "pmid": "28377030", "doi": "10.1016/j.jaad.2017.01.055", "nctId": null, "pmcid": null, "title": "The role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III): Retrospective analysis of 74 patients", "firstAuthor": "Posch", "multipleAuthors": true, "journal": "J Am Acad Dermatol", "year": 2017, "design": "retrospective", "n": 74, "nField": "reported", "population": "patients with severe hidradenitis suppurativa (a chronic skin condition), mostly affecting the groin and buttock area", "intervention": "wide local excision surgery to remove affected skin", "comparator": "before versus after surgery in the same patients", "primaryOutcome": "quality of life measured by a skin disease questionnaire", "result": "quality of life scores improved significantly after surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a look-back study with no comparison group, so it can't prove the surgery itself caused the improvement.", "directness": "indirect", "limitations": "The retrospective nature of the study was a limitation.", "followUp": "", "plainFinding": "Surgery improved quality of life in severe HS", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28377030/", "sourceText": "BACKGROUND: Effective medical treatment for patients with severe hidradenitis suppurativa (HS) is limited. OBJECTIVES: We sought to measure the impact of wide local excision on quality of life in HS Hurley grade III patients and to examine the rate of postoperative complications, disease recurrences, and satisfaction with the cosmetic results. METHODS: Seventy-four patients were enrolled. Outcome measures included Dermatology Life Quality Index responses, disease duration, recurrence, previous therapies, postoperative complications, and satisfaction with cosmetic results. RESULTS: Most patients had inguinogenital/gluteal disease (68.9%, P < .001). Involvement of both the axillary and the inguinogenital/gluteal areas were pronounced in male patients (P = .018). None of the patients was treated with tumor necrosis factor-α inhibitors. Most patients (71.6%) had a disease history of >5 years at the time of presentation and multiple unsuccessful attempts with systemic and local therapeutic interventions. Wide local excision improved Dermatology Life Quality Index scores from initially 27.89 to 5.31 after surgery (P < .001), independent of localization (P = .195). Forty-seven percent of patients had postoperative complications, most frequently pain and scarring. The vast majority of patients (70.3%) were satisfied with the cosmetic results. LIMITATIONS: The retrospective nature of the study was a limitation. CONCLUSIONS: Wide local excision significantly improves the quality of life of HS patients. Local recurrence rates are low, and satisfaction with the cosmetic results is high.", "provenance": [ { "field": "n", "quote": "Seventy-four patients were enrolled." }, { "field": "population", "quote": "Most patients had inguinogenital/gluteal disease (68.9%, P < .001)." }, { "field": "intervention", "quote": "the impact of wide local excision on quality of life in HS Hurley grade III patients" }, { "field": "comparator", "quote": "Wide local excision improved Dermatology Life Quality Index scores from initially 27.89 to 5.31 after surgery (P < .001)" }, { "field": "primaryOutcome", "quote": "Outcome measures included Dermatology Life Quality Index responses" }, { "field": "result", "quote": "Wide local excision improved Dermatology Life Quality Index scores from initially 27.89 to 5.31 after surgery (P < .001)" }, { "field": "limitations", "quote": "The retrospective nature of the study was a limitation." } ] }, { "id": "pmid:28274364", "pmid": "28274364", "doi": "10.1016/j.clindermatol.2016.10.019", "nctId": null, "pmcid": null, "title": "Squamous cell carcinoma arising in long-standing hidradenitis suppurativa: An overlooked facet of the immunocompromised district", "firstAuthor": "Fabbrocini", "multipleAuthors": true, "journal": "Clin Dermatol", "year": 2017, "design": "narrative-review", "n": 90, "nField": "reported", "population": "people with long-standing hidradenitis suppurativa (a chronic skin condition causing boils/abscesses, often in buttock and groin areas)", "intervention": "having long-standing hidradenitis suppurativa", "comparator": "", "primaryOutcome": "development of squamous cell carcinoma (a type of skin cancer) at the affected skin sites", "result": "over 90 reported cases of squamous cell carcinoma developing in long-standing hidradenitis suppurativa, mostly on the perineal or buttock areas", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a narrative literature review of collected case reports, not a controlled study, so it cannot show how common this is or prove cause and effect.", "directness": "indirect", "limitations": "The abstract does not describe a systematic search method, control group, or statistical analysis; it is based on compiled case reports and a theoretical concept.", "followUp": "", "plainFinding": "Long-term boils can rarely turn cancerous.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28274364/", "sourceText": "The list of comorbidities and complications associated with hidradenitis suppurativa is extensive. Among the complications of hidradenitis suppurativa, squamous cell carcinoma is considered the most severe. After a meticulous literature research starting from the 1950s, we were able to identify over 90 cases of patients with hidradenitis suppurativa developing squamous cell carcinoma. Most squamous cell carcinomas appear on the perineal or buttock areas. We believe that the development of squamous cell carcinoma in longstanding hidradenitis suppurativa is a typical condition of an immunocompromised district. The \"immunocompromised cutaneous district\" is a novel concept that applies to an area of diseased or injured skin where local immune control has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor confined to the diseased or injured site.", "provenance": [ { "field": "population", "quote": "patients with hidradenitis suppurativa" }, { "field": "intervention", "quote": "longstanding hidradenitis suppurativa" }, { "field": "primaryOutcome", "quote": "squamous cell carcinoma" }, { "field": "result", "quote": "we were able to identify over 90 cases of patients with hidradenitis suppurativa developing squamous cell carcinoma. Most squamous cell carcinomas appear on the perineal or buttock areas." }, { "field": "n", "quote": "over 90 cases" } ] }, { "id": "pmid:28128084", "pmid": "28128084", "doi": null, "nctId": null, "pmcid": null, "title": "Boils at Frictional Locations in a Patient with Hidradenitis Suppurativa", "firstAuthor": "Boer", "multipleAuthors": true, "journal": "Acta Dermatovenerol Croat", "year": 2016, "design": "case-series", "n": 1, "nField": "reported", "population": "33-year-old obese woman with long-standing hidradenitis suppurativa affecting armpits, groin, and buttocks", "intervention": "having hidradenitis suppurativa plus mechanical friction from a bra strap", "comparator": "no comparator, single case observation", "primaryOutcome": "location and development of boil-like inflamed skin lesions", "result": "she developed new boil-like lesions exactly where her bra strap rubbed, suggesting friction can trigger these lesions in people prone to hidradenitis suppurativa", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot reliably show what causes lesions in general.", "directness": "indirect", "limitations": "Single case report; friction as a cause is based on anecdotal evidence and this patient already had a diagnosed chronic condition, obesity, smoking, and family history that could also contribute.", "followUp": "", "plainFinding": "Friction may trigger boil-like skin lesions.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28128084/", "sourceText": "Dear Editor, Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease. The primary clinical presentation are painful inflamed nodules or boils of inverse areas, i.e. the axillary and anogenito-crural regions, but it can also involve the infra- and inter-mammary regions (1,2). The etiology of HS is not clearly defined. Obesity, smoking, and genetic factors are considered important risk factors. In addition, it has also been suggested that friction may contribute to the development of HS, especially in the obese, but this is based on highly anecdotal reports (3-5). We describe a case with classic HS, obesity, and HS-like lesions at the position of the bra strap, suggesting that mechanical stress was an external pathogenic factor for HS development. A 33-year old woman presented with an 18-year history of chronic, recurrent, inflammatory nodules in the axillae, the groin, the pubic region, and to a lesser extent the abdomen and buttocks. She was obese with as result of 33.2 kg/m-2 of 33.2, had a positive family history of two first grade family members with HS, and was a smoker (19 Pack years). There were no other known comorbidities. The inflamed lesions had been treated with several courses of oral antibiotics (minocycline, erythromycin, and combination therapy of clindamycin and rifampicine) and surgical treatments: lancing, deroofing, and excisions (2,6). On examination, there were nodules, folliculitis, cysts, and depressed scars in the axillae and groins, including the inner thighs (Figure 1). On the chest, corresponding to where the lower edge of the patient's bra was usually located, a superficial nodule and follicular papules were observed, exactly coinciding with the red stripe caused by mechanical stress (friction and pressure) of the bra edge. There was no skin fold present on the location of the HS lesions, and there were no lesions observed in the intermammary region or on the side of the breasts in contact with the skin of the thorax (skin to skin contact) (Figure 2). Cultures from skin swabs showed commensal skin flora and moderate mixed anaerobic bacteria, as would be expected in a HS lesion. It is well documented that HS is a disease of the obese. However, the role of friction as an environmental factor is poorly documented. Patients report that environmental factors such as tight-fitting clothing or friction could cause flares in the disease (2). Furthermore, it has been postulated that friction may contribute to the development of HS by stimulating interfollicular hyperplasia (7). HS lesions arranged in a linear pattern suggest an environmental influence and suggests an etiopathogenic role for mechanical stress. Waistline, or as in this case the chest line, distribution indicates that wearing of tight waistbands, wide belts, or bras may induce HS in predisposed individuals. To our knowledge, there is only one case report describing an obese patient with classic HS (typical lesions in predilection areas) who developed HS like lesions on the upper abdomen (waist) at the height of the waistband as well as under the lower abdominal apron (skin on skin contact) (8). Two other reports suggesting a pathogenic role for mechanical stress are flawed, however, as neither of the cases showed signs of concomitant classic HS or had a family history, bringing into question the implied association of HS (9,10). In summary, we presented a case with classic HS locations (typical lesions on typical locations, i.e. the axillae and inguino-crural regions) developing inflammatory lesions on the chest at the location closely corresponding to where the bra strap was exerting mechanical pressure and friction on the skin. The lesions were clinically and microbiologically compatible with ectopic HS lesions. The chest is an atypical HS location free of apocrine sweat glands. It is postulated that these lesions may have been induced by mechanical stress, additionally triggered by the pro-inflammatory state of the obese body. Patients are encouraged to avoid friction from environmental factors such as tight clothing.", "provenance": [ { "field": "n", "quote": "A 33-year old woman presented with an 18-year history" }, { "field": "population", "quote": "A 33-year old woman presented with an 18-year history of chronic, recurrent, inflammatory nodules in the axillae, the groin, the pubic region, and to a lesser extent the abdomen and buttocks." }, { "field": "intervention", "quote": "a superficial nodule and follicular papules were observed, exactly coinciding with the red stripe caused by mechanical stress (friction and pressure) of the bra edge" }, { "field": "comparator", "quote": "There was no skin fold present on the location of the HS lesions, and there were no lesions observed in the intermammary region or on the side of the breasts in contact with the skin of the thorax (skin to skin contact)" }, { "field": "primaryOutcome", "quote": "HS-like lesions at the position of the bra strap, suggesting that mechanical stress was an external pathogenic factor for HS development" }, { "field": "result", "quote": "It is postulated that these lesions may have been induced by mechanical stress, additionally triggered by the pro-inflammatory state of the obese body." } ] }, { "id": "pmid:28099342", "pmid": "28099342", "doi": "10.1097/MD.0000000000005857", "nctId": null, "pmcid": "PMC5279087", "title": "Successful surgical treatment for squamous cell carcinoma arising from hidradenitis suppurativa: A case report and literature review", "firstAuthor": "Huang", "multipleAuthors": true, "journal": "Medicine (Baltimore)", "year": 2017, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with long-term hidradenitis suppurativa who developed skin cancer on the buttock", "intervention": "surgical removal of the cancer followed by skin grafting", "comparator": "no comparison group (single patient case report)", "primaryOutcome": "whether the cancer came back after surgery", "result": "no cancer recurrence one year after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a report of just one patient, so it cannot show how common or typical this problem is.", "directness": "indirect", "limitations": "Single case report with only one year of follow-up, reviewing prior literature rather than new systematic data.", "followUp": "1-year follow-up", "plainFinding": "Surgery cured rare HS-linked skin cancer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28099342/", "sourceText": "RATIONALE: Hidradenitis suppurativa (HS) is a disabling inflammatory disease mainly affecting apocrine glands. Marjolin ulcer (MU) is a term used to describe a rare type of squamous cell carcinoma (SCC) arising within sites of chronic wounds or preexisting scars. Chronic HS may result in a rare type of SCC, MU, which has a poor prognosis due to its high metastatic rate. CONCERNS OF THE PATIENT: Here we reported a 60-year-old male who developed SCC on the right buttock after suffering from HS for 15 years. INTERVENTIONS: Radical resection with clear margin was performed, after which topical negative pressure (TNP) was applied followed by split-thickness skin grafting. OUTCOMES: In a 1-year follow-up, there was no recurrence of malignancy. LESSONS: Cases reported in English literature since 1991 were reviewed to get a general grasp of status quo. The authors conclude that chronic HS lesion especially in the gluteal region should be cautiously observed. Once tumor arisen from HS lesion, immediate radical excision should be performed. With assured clear margin, TNP could be chosen to offer a favorable environment for the survival of skin grafting.", "provenance": [ { "field": "n", "quote": "a 60-year-old male who developed SCC on the right buttock after suffering from HS for 15 years" }, { "field": "population", "quote": "a 60-year-old male who developed SCC on the right buttock after suffering from HS for 15 years" }, { "field": "intervention", "quote": "Radical resection with clear margin was performed, after which topical negative pressure (TNP) was applied followed by split-thickness skin grafting." }, { "field": "comparator", "quote": "Here we reported a 60-year-old male who developed SCC on the right buttock after suffering from HS for 15 years." }, { "field": "primaryOutcome", "quote": "In a 1-year follow-up, there was no recurrence of malignancy." }, { "field": "result", "quote": "In a 1-year follow-up, there was no recurrence of malignancy." }, { "field": "followUp", "quote": "In a 1-year follow-up, there was no recurrence of malignancy." } ] }, { "id": "pmid:28034606", "pmid": "28034606", "doi": "10.1016/j.jdermsci.2016.12.014", "nctId": null, "pmcid": null, "title": "Treatment of hidradenitis suppurativa with intralesional photodynamic therapy with 5-aminolevulinic acid and 630nm laser beam", "firstAuthor": "Suárez Valladares", "multipleAuthors": true, "journal": "J Dermatol Sci", "year": 2017, "design": "case-series", "n": 38, "nField": "reported", "population": "patients with hidradenitis suppurativa (a chronic inflammatory skin condition), treated between 2011 and 2015", "intervention": "intralesional photodynamic therapy using 5-aminolevulinic acid and light treatment", "comparator": "no comparison group; before-and-after results in the same patients", "primaryOutcome": "change in disease severity score and complete response of treated areas", "result": "24.5 point reduction in severity score and complete response in most treated areas, including 88.9% of buttock lesions", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small case series without a comparison group, so it cannot prove the treatment itself caused the improvement.", "directness": "indirect", "limitations": "No control group, and this study is about hidradenitis suppurativa, a specific chronic condition, not general pimples or acne on the buttocks.", "followUp": "", "plainFinding": "Mostly cleared HS lesions with treatment.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28034606/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease with multiple treatment options that have been used with mixed results. OBJECTIVES: To evaluate the effectiveness, safety and tolerability of intralesional photodynamic therapy (I-PDT) in the management of HS. Also, to assess the effect of this technique on the different areas treated. METHODS: Case series of 38 HS patients treated with I-PDT between 2011-2015 following a standardized protocol to assess response at the treated areas RESULTS: 29 patients achieved a complete response, while persistence was noted on 8 cases and only 1 suffered a recurrence. Difference between basal (median 28.5) and final (0) Hidradenitis Severity Score showed a significant reduction of 24.5 points (p<0.001, 95% OR 19.5-31). Basal (median 10) and final (1) Dermatology Life Quality Index scores reached a reduction of 10 points (p<0.001, 95%OR 8-12). Complete response was achieved in 68.2% of armpits, 88.5% of groins, 88.9% of buttocks and 100% of other locations. 18 out of 38 patients needed only a session to achieve a complete response, while maintaining a good tolerability. CONCLUSION: We believe that I-PDT might be an alternative treatment option for localized HS lesions, achieving a high rate of remission with an adequate maintenance of response i and few complications.", "provenance": [ { "field": "n", "quote": "Case series of 38 HS patients treated with I-PDT between 2011-2015" }, { "field": "population", "quote": "Case series of 38 HS patients treated with I-PDT between 2011-2015" }, { "field": "intervention", "quote": "To evaluate the effectiveness, safety and tolerability of intralesional photodynamic therapy (I-PDT) in the management of HS." }, { "field": "comparator", "quote": "Case series of 38 HS patients treated with I-PDT between 2011-2015 following a standardized protocol to assess response at the treated areas" }, { "field": "primaryOutcome", "quote": "To evaluate the effectiveness, safety and tolerability of intralesional photodynamic therapy (I-PDT) in the management of HS." }, { "field": "result", "quote": "Difference between basal (median 28.5) and final (0) Hidradenitis Severity Score showed a significant reduction of 24.5 points (p<0.001, 95% OR 19.5-31)." }, { "field": "result", "quote": "Complete response was achieved in 68.2% of armpits, 88.5% of groins, 88.9% of buttocks and 100% of other locations." } ] }, { "id": "pmid:27900998", "pmid": "27900998", "doi": "10.4103/0366-6999.194648", "nctId": null, "pmcid": "PMC5146792", "title": "Novel Mutations in PSENEN Gene in Two Chinese Acne Inversa Families Manifested as Familial Multiple Comedones and Dowling-Degos Disease", "firstAuthor": "Zhou", "multipleAuthors": true, "journal": "Chin Med J (Engl)", "year": 2016, "design": "case-series", "n": 2, "nField": "reported", "population": "Two Chinese families with acne inversa (hidradenitis suppurativa) showing comedones, scars, and nodules on face, neck, trunk, axilla, buttocks, upper arms, thighs", "intervention": "Genetic mutation analysis of γ-secretase genes (PSENEN, PSEN1, NCSTN)", "comparator": "", "primaryOutcome": "Identification of specific gene mutations causing the disease", "result": "Two novel mutations found in the PSENEN gene", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a tiny genetic case study of two families, not a treatment trial, so it says nothing about what works.", "directness": "indirect", "limitations": "Only two families studied; no treatment tested; genetic finding only.", "followUp": "", "plainFinding": "Found genetic cause, not a treatment answer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27900998/", "sourceText": "BACKGROUND: Acne inversa (AI), also called hidradenitis suppurativa, is a chronic, inflammatory, recurrent skin disease of the hair follicle. Familial AI shows autosomal-dominant inheritance caused by mutations in the γ-secretase genes. This study was aimed to identify the specific mutations in the γ-secretase genes in two Chinese families with AI. METHODS: In this study, two Chinese families with AI were investigated. All the affected individuals in the two families mainly manifested with multiple comedones, pitted scars, and a few inflammatory nodules on their face, neck, trunk, axilla, buttocks, upper arms, and thighs. Reticulate pigmentation in the flexures areas resembled Dowling-Degos disease clinically and pathologically. In addition, one of the affected individuals developed anal canal squamous cell carcinoma. Molecular mutation analysis of γ-secretase genes including PSENEN, PSEN1, and NCSTN was performed by polymerase chain reaction and direct DNA sequencing. RESULTS: Two novel mutations of PSENEN gene were identified, including a heterozygous missense mutation c.194T>G (p.L65R) and a splice site mutation c.167-2A>G. CONCLUSIONS: The identification of the two mutations could expand the spectrum of mutations in the γ-secretase genes underlying AI and provide valuable information for further study of genotype-phenotype correlations.", "provenance": [ { "field": "population", "quote": "All the affected individuals in the two families mainly manifested with multiple comedones, pitted scars, and a few inflammatory nodules on their face, neck, trunk, axilla, buttocks, upper arms, and thighs." }, { "field": "intervention", "quote": "Molecular mutation analysis of γ-secretase genes including PSENEN, PSEN1, and NCSTN was performed by polymerase chain reaction and direct DNA sequencing." }, { "field": "primaryOutcome", "quote": "This study was aimed to identify the specific mutations in the γ-secretase genes in two Chinese families with AI." }, { "field": "result", "quote": "Two novel mutations of PSENEN gene were identified, including a heterozygous missense mutation c.194T>G (p.L65R) and a splice site mutation c.167-2A>G." }, { "field": "n", "quote": "In this study, two Chinese families with AI were investigated." } ] }, { "id": "pmid:27681476", "pmid": "27681476", "doi": "10.1111/iwj.12671", "nctId": null, "pmcid": "PMC7949826", "title": "Squamous cell carcinoma complicating a chronic lesion of hidradenitis suppurativa: a case report and review of the literature", "firstAuthor": "Jourabchi", "multipleAuthors": true, "journal": "Int Wound J", "year": 2017, "design": "case-series", "n": 80, "nField": "reported", "population": "people with hidradenitis suppurativa (a chronic skin condition causing boil-like lumps) that turned into skin cancer", "intervention": "aggressive surgical removal plus possible radiation therapy for the cancer", "comparator": "not stated", "primaryOutcome": "how well treatment controlled the cancer and prevented recurrence or death", "result": "Treatment approach was based on one patient's case plus a review of 80 other reported cases; the abstract recommends aggressive surgery, lymph node checks and possible radiation, but does not report success rates", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single case report combined with a review of past cases, not a controlled study, so it cannot show whether treatments actually work.", "directness": "indirect", "limitations": "Based on one patient and a literature review of case reports, not a controlled study; no statistics on treatment outcomes given.", "followUp": "4 years", "plainFinding": "Rare cancer in chronic skin boils.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27681476/", "sourceText": "Squamous cell carcinoma (SCC) arising from chronic hidradenitis suppurativa (HS) is rare; however, the morbidity associated with this presentation is high and management has not been standardised or optimised. We present a case of HS of the perineum and buttocks complicated by SCC, requiring multiple extensive surgical resections. Adjuvant radiotherapy was withheld initially because of concern for poor healing of the surgical wound but was eventually initiated after a second recurrence was identified. The patient ultimately expired 4 years after the initial diagnosis of SCC. We also review 80 cases of SCC complicating HS found in the English literature. Case reports and mechanistic studies suggest the possibility that human papilloma virus and smoking may be risk factors associated with SCC in HS. Despite the majority of SCC cases being well-differentiated tumours in HS, the highly aggressive nature of SCC in HS and its high likelihood for rapid progression, recurrence, metastasis and high mortality suggests the need to advocate for aggressive treatment. We recommend an aggressive approach to management at the time of SCC diagnosis in HS, which includes appropriate imaging to establish the extent of the tumour, large and deep surgical excision, sentinel lymph node evaluation, consultation with radiation oncology for potential adjuvant radiation therapy and close surveillance.", "provenance": [ { "field": "population", "quote": "a case of HS of the perineum and buttocks complicated by SCC" }, { "field": "n", "quote": "80 cases of SCC complicating HS found in the English literature" }, { "field": "intervention", "quote": "large and deep surgical excision, sentinel lymph node evaluation, consultation with radiation oncology for potential adjuvant radiation therapy and close surveillance" }, { "field": "comparator", "quote": "Adjuvant radiotherapy was withheld initially because of concern for poor healing of the surgical wound but was eventually initiated after a second recurrence was identified" }, { "field": "primaryOutcome", "quote": "management has not been standardised or optimised" }, { "field": "result", "quote": "We recommend an aggressive approach to management at the time of SCC diagnosis in HS" }, { "field": "followUp", "quote": "The patient ultimately expired 4 years after the initial diagnosis of SCC" } ] }, { "id": "pmid:27579746", "pmid": "27579746", "doi": "10.1590/abd1806-4841.20164397", "nctId": null, "pmcid": "PMC4999109", "title": "Porokeratosis ptychotropica: a rare manifestation with typical histological exam", "firstAuthor": "Veasey", "multipleAuthors": true, "journal": "An Bras Dermatol", "year": 2016, "design": "case-series", "n": 1, "nField": "reported", "population": "healthy adult male with long-standing thick scaly patches on the buttocks", "intervention": "none (diagnostic case report)", "comparator": "none", "primaryOutcome": "correct diagnosis of the skin condition via clinical exam, dermoscopy, and biopsy", "result": "the condition was identified as porokeratosis ptychotropica, a rare variant of porokeratosis, confirmed by skin biopsy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether any treatment works or how common this cause is", "directness": "indirect", "limitations": "only one patient described; no treatment tested; diagnosis took 22 years and multiple doctors before confirmation", "followUp": "", "plainFinding": "Rare skin disorder causing buttock patches.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27579746/", "sourceText": "Porokeratosis is a disorder of epidermal keratinization characterized clinically by a distinctive ridge-like border, and histologically by cornoid lamellae. The known clinical variants of porokeratosis are: classic porokeratosis of Mibelli, disseminated superficial (actinic) porokeratosis (DSAP), porokeratosis palmaris et plantaris disseminata, linear porokeratosis and punctate porokeratosis. In 1995, a seventh form was described as porokeratosis ptychotropica: a verrucous form resembling psoriasis involving the gluteal cleft presenting on the histological exam multiple cornoid lamellae. There are very few reports in the literature of this clinical variant. The present study describes the case of a healthy male presenting gluteal hyperkeratotic plaques for 22 years. He had been to several dermatologists, none of them had achieved a definitive diagnosis. We present a typical clinical presentation and its dermoscopy findings, in addition to histological examination that confirmed the diagnosis.", "provenance": [ { "field": "n", "quote": "the case of a healthy male presenting gluteal hyperkeratotic plaques for 22 years" }, { "field": "population", "quote": "a healthy male presenting gluteal hyperkeratotic plaques for 22 years" }, { "field": "intervention", "quote": "We present a typical clinical presentation and its dermoscopy findings, in addition to histological examination that confirmed the diagnosis." }, { "field": "comparator", "quote": "None of them had achieved a definitive diagnosis." }, { "field": "primaryOutcome", "quote": "histological examination that confirmed the diagnosis" }, { "field": "result", "quote": "a verrucous form resembling psoriasis involving the gluteal cleft presenting on the histological exam multiple cornoid lamellae" } ] }, { "id": "pmid:27530224", "pmid": "27530224", "doi": "10.12659/ajcr.898027", "nctId": null, "pmcid": "PMC4989995", "title": "Pyogenic Arthritis, Pyoderma Gangrenosum, Acne, Suppurative Hidradenitis (PA-PASH) Syndrome: An Atypical Presentation of a Rare Syndrome", "firstAuthor": "Ursani", "multipleAuthors": true, "journal": "Am J Case Rep", "year": 2016, "design": "case-series", "n": 1, "nField": "reported", "population": "a 44-year-old man with a rare autoinflammatory syndrome affecting joints, skin, and sweat glands", "intervention": "treatment with prednisone (steroid)", "comparator": "no comparator; single patient before and after treatment", "primaryOutcome": "healing of painful skin ulcers and resolution of chronic diarrhea", "result": "ulcers healed within 4 weeks and diarrhea resolved after steroid treatment", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single unusual patient case report, so it cannot show what causes typical buttock pimples or whether treatment works generally.", "directness": "indirect", "limitations": "Single case report of a rare syndrome with ulcers and arthritis, not common acne; no control group; findings may not generalize.", "followUp": "4 weeks", "plainFinding": "Steroids healed ulcers in rare syndrome.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27530224/", "sourceText": "BACKGROUND Pyogenic arthritis, pyoderma gangrenosum (PG), acne, and suppurative hidradenitis (PA-PASH) syndrome has been linked to an auto-inflammatory pathway. We report a case that is an atypical presentation of a rare syndrome, which supports literature suggesting that different phenotypes of PG-related syndromes may be a variation of the same pathogenic spectrum. Interestingly, our patient displayed a positive proteinase-3 antibody (PR-3). The clinical relevance of this is unclear. In recent literature, antineutrophil cytoplasmic autoantibodies (ANCA) positivity has been reported in various inflammatory conditions other than ANCA-associated vasculitis (AAV). CASE REPORT A 44-year-old African American male with history of pyogenic arthritis, acne, suppurative hidradenitis, and chronic diarrhea presented for evaluation of painful ulcers located on the bilateral lower extremities, bilateral proximal interphalangeal joints, buttocks, and scrotum, and chronic diarrhea. Infectious etiologies for the ulcers were ruled out. Biopsy of an ulcer revealed PG. Colonoscopy revealed inflammation and ulceration with biopsy consistent with ulcerative colitis (UC). After treatment with prednisone, the ulcers healed within 4 weeks, and the chronic diarrhea resolved. CONCLUSIONS Our patient displayed a variation of PA-PASH syndrome and UC. Previously reported cases of similar phenotypes of PG-related syndromes have not presented in this fashion. Furthermore, the literature does not report cases of PG-related syndromes with an elevation in PR-3 antibody. Elevation in PR-3 has been reported in various inflammatory disorders aside from AAV. The relevance of this is currently unclear. It may be possible that the milieus of these various auto-inflammatory disorders may share pathogenic commonalities.", "provenance": [ { "field": "population", "quote": "A 44-year-old African American male with history of pyogenic arthritis, acne, suppurative hidradenitis, and chronic diarrhea" }, { "field": "intervention", "quote": "After treatment with prednisone, the ulcers healed within 4 weeks" }, { "field": "comparator", "quote": "CASE REPORT A 44-year-old African American male" }, { "field": "primaryOutcome", "quote": "presented for evaluation of painful ulcers located on the bilateral lower extremities, bilateral proximal interphalangeal joints, buttocks, and scrotum, and chronic diarrhea" }, { "field": "result", "quote": "After treatment with prednisone, the ulcers healed within 4 weeks, and the chronic diarrhea resolved." }, { "field": "n", "quote": "A 44-year-old African American male" } ] }, { "id": "pmid:27340739", "pmid": "27340739", "doi": "10.1097/DSS.0000000000000806", "nctId": null, "pmcid": null, "title": "Surgical Management of Hidradenitis Suppurativa: Outcomes of 590 Consecutive Patients", "firstAuthor": "Kohorst", "multipleAuthors": true, "journal": "Dermatol Surg", "year": 2016, "design": "retrospective", "n": 590, "nField": "reported", "population": "patients with hidradenitis suppurativa, mostly severe (Hurley Stage III) disease, treated surgically", "intervention": "surgical treatment (excision, unroofing, or drainage) of hidradenitis suppurativa lesions", "comparator": "different surgical procedure types compared with each other (excision vs unroofing vs drainage)", "primaryOutcome": "postoperative complications and disease recurrence after surgery", "result": "24.4% had recurrence after surgery, 11.7% needed reoperation, and 2.5% had complications; excision and unroofing were effective with low recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a retrospective review of one group of surgical patients with no comparison to non-surgical treatment, so it can't prove surgery is better than other options.", "directness": "indirect", "limitations": "Retrospective design, no control/comparison group, and focuses on a specific chronic skin disease (hidradenitis suppurativa) rather than typical causes of buttock pimples.", "followUp": "", "plainFinding": "Surgery often cured severe hidradenitis suppurativa.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27340739/", "sourceText": "BACKGROUND: Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE: To evaluate hidradenitis surgical patients. METHODS: Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS: Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9), multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION: Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.", "provenance": [ { "field": "n", "quote": "Retrospective review of outcomes of 590 consecutive surgically treated patients." }, { "field": "population", "quote": "Hurley Stage III disease (476 [80.7%])" }, { "field": "intervention", "quote": "Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%])" }, { "field": "comparator", "quote": "Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9), multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7)." }, { "field": "primaryOutcome", "quote": "Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence" }, { "field": "result", "quote": "Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates." } ] }, { "id": "pmid:26948552", "pmid": "26948552", "doi": "10.1016/j.wem.2015.10.011", "nctId": null, "pmcid": null, "title": "Skin Diseases Affecting High-Level Competition Sailors: Descriptive Study Carried Out During the 2012 AG2R Transatlantic Boat Race", "firstAuthor": "Loddé", "multipleAuthors": true, "journal": "Wilderness Environ Med", "year": 2016, "design": "prospective-cohort", "n": 28, "nField": "reported", "population": "competitive sailors during a long ocean race", "intervention": "no treatment tested; observed skin conditions before and after the race", "comparator": "skin condition at departure versus at arrival after 22-24 days at sea", "primaryOutcome": "skin disorders seen in sailors, including buttock folliculitis", "result": "more buttock folliculitis, fungal infections, and hand hyperkeratosis seen after the race than before", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "small, non-randomized descriptive study with incomplete follow-up (only 18 of 32 completed) and no statistical comparison, so it can't prove why acne-like bumps happen.", "directness": "indirect", "limitations": "Only 56% of sailors completed the arrival questionnaire, there was no control group, and conditions on a transatlantic race (poor hygiene, friction gear, sweat) differ from everyday life.", "followUp": "22 to 24 days later", "plainFinding": "More butt folliculitis after sailing", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26948552/", "sourceText": "OBJECTIVES: The primary objective of this study was to identify skin disorders encountered in a population of sport sailors. Unlike merchant mariners and fishermen, there is sparse literature on this maritime population. Secondary objectives were to uncover on-board conditions that may contribute to dermatological problems in this population. METHODS: We conducted a prospective study during the 2012 AG2R transatlantic race. Sixteen two-man crews participated in this race, all using the same model of sailboat (Bénéteau Figaro 2). Clinical examinations were conducted, photographs taken, and questionnaires containing 34 questions were handed out before departure and on arrival, 22 to 24 days later. RESULTS: Twenty-eight of 32 skippers (88%) participated in departure data collection, and 18 (56%) completed data collection on arrival. The average age of sailors was 34 years (SD = 8). Compared with skin diseases documented on departure, there was an increased amount of folliculitis on the buttocks, fungal infections, and hyperkeratosis of the hands on arrival. Furthermore, several new skin problems were found postrace: skin scaling, skin erosions on the buttocks, dyshidrosis, thermal burns, and sunburns. The use of protective gear and sunscreen was common, but on-board hygiene was poor with infrequent bathing and clothing changes. CONCLUSIONS: Skin conditions are nearly universal in this maritime population. Further assessments are needed to know if long-term use of protective gear; improved hygiene; use of barrier creams; and proper on-board care of fungal infections, wounds, and burns could reduce the number and severity of skin problems encountered in sport sailors.", "provenance": [ { "field": "n", "quote": "Twenty-eight of 32 skippers (88%) participated in departure data collection" }, { "field": "population", "quote": "a population of sport sailors" }, { "field": "intervention", "quote": "Clinical examinations were conducted, photographs taken, and questionnaires containing 34 questions were handed out before departure and on arrival" }, { "field": "comparator", "quote": "before departure and on arrival, 22 to 24 days later" }, { "field": "primaryOutcome", "quote": "The primary objective of this study was to identify skin disorders encountered in a population of sport sailors." }, { "field": "result", "quote": "Compared with skin diseases documented on departure, there was an increased amount of folliculitis on the buttocks, fungal infections, and hyperkeratosis of the hands on arrival." }, { "field": "followUp", "quote": "22 to 24 days later" } ] }, { "id": "pmid:26414817", "pmid": "26414817", "doi": "10.9738/INTSURG-D-14-00237.1", "nctId": null, "pmcid": "PMC4587525", "title": "Clinical Role of Modified Seton Procedure and Coring Out for Treatment of Complex Anal Fistulas Associated With Hidradenitis Suppurativa", "firstAuthor": "Tokunaga", "multipleAuthors": true, "journal": "Int Surg", "year": 2015, "design": "case-series", "n": 10, "nField": "reported", "population": "10 men aged 32 to 54 with complex anal fistulas and hidradenitis suppurativa causing discharge in the buttocks and thigh", "intervention": "modified seton procedure combined with coring out of hidradenitis suppurativa tissue", "comparator": "none; no comparison group", "primaryOutcome": "recurrence of fistula/discharge and healing after surgery", "result": "all 10 patients recovered with no recurrence or complications after surgery", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only 10 patients were treated with no comparison group, so it can't show whether the surgery is better than other options.", "directness": "indirect", "limitations": "Very small case series (n=10) with no control group, describing a specific severe surgical condition rather than typical mild buttock pimples.", "followUp": "6 to 8 months", "plainFinding": "Surgery cured severe hidradenitis fistulas.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26414817/", "sourceText": "A variety of techniques have been described to treat complex anal fistulas. When complex anal fistulas are associated with hidradenitis suppurativa, the treatment has to be appropriately tailored for the severity and distribution of the disease so as to remove the external fistula tract to prevent recurrence while ensuring fecal continence. Between 2007 and 2011, a total of 10 males (ranging in age from 32 to 54 years) complained of recurrent purulent discharge in the buttocks and thigh regions. The discharge had started about 12 to 18 months prior, and had increased progressively resulting in complex anal fistulas and hidradenitis suppurativa in the buttocks. They underwent surgical operation according to a modified seton procedure for complex anal fistulas and coring out for hidradenitis suppurativa. They were discharged from the hospital in 4 to 5 days, while the seton dropped spontaneously about 6 to 8 months after surgery. They have been well without any morbidities or recurrence. The present paper demonstrates that cases of complex anal fistulas associated with hidradenitis suppurativa can be successfully treated with a modified seton procedure and coring out of hidradenitis suppurativa.", "provenance": [ { "field": "population", "quote": "a total of 10 males (ranging in age from 32 to 54 years) complained of recurrent purulent discharge in the buttocks and thigh regions" }, { "field": "intervention", "quote": "underwent surgical operation according to a modified seton procedure for complex anal fistulas and coring out for hidradenitis suppurativa" }, { "field": "comparator", "quote": "A variety of techniques have been described to treat complex anal fistulas." }, { "field": "primaryOutcome", "quote": "to remove the external fistula tract to prevent recurrence while ensuring fecal continence" }, { "field": "result", "quote": "They have been well without any morbidities or recurrence." }, { "field": "n", "quote": "a total of 10 males (ranging in age from 32 to 54 years)" } ] }, { "id": "pmid:26016976", "pmid": "26016976", "doi": null, "nctId": null, "pmcid": null, "title": "A case of perforating folliculitis in association with antisynthetase syndrome", "firstAuthor": "Shaw", "multipleAuthors": true, "journal": "J Biol Regul Homeost Agents", "year": 2015, "design": "case-series", "n": 1, "nField": "reported", "population": "a person with antisynthetase syndrome (a rare autoimmune muscle/lung disease) who developed a skin condition", "intervention": "none - this is a description of a skin condition (perforating folliculitis), not a treatment", "comparator": "none", "primaryOutcome": "description of the skin condition and its association with underlying disease", "result": "the abstract describes a single case where follicular bump-like skin lesions (perforating folliculitis) occurred in a patient who already had antisynthetase syndrome, an autoimmune condition", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a report of just one patient, so it cannot show whether this applies to other people or what causes typical buttock pimples.", "directness": "indirect", "limitations": "single case report; no comparison group; describes a rare skin condition linked to a specific autoimmune disease, not common acne-like buttock pimples", "followUp": "", "plainFinding": "Rare skin condition tied to autoimmune disease.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26016976/", "sourceText": "Perforating folliculitis (PF) describes the process by which altered dermal material is eliminated from the epidermis through a follicular unit resulting in keratotic, follicular papules that favor hair-bearing regions of the forearms, arms, buttocks, and thighs. Diabetes mellitus (DM) and chronic renal failure (CRF) are commonly associated with PF. The more general term, acquired perforating dermatosis, has been applied to PF as well as Kyrle’s disease and the non-inherited form of perforating collagenosis. In this report, we describe an instance of PF that arose in the setting of preexisting antisynthetase syndrome.", "provenance": [ { "field": "n", "quote": "In this report, we describe an instance of PF that arose in the setting of preexisting antisynthetase syndrome." }, { "field": "population", "quote": "preexisting antisynthetase syndrome" }, { "field": "primaryOutcome", "quote": "Perforating folliculitis (PF) describes the process by which altered dermal material is eliminated from the epidermis through a follicular unit resulting in keratotic, follicular papules that favor hair-bearing regions of the forearms, arms, buttocks, and thighs." }, { "field": "result", "quote": "In this report, we describe an instance of PF that arose in the setting of preexisting antisynthetase syndrome." }, { "field": "intervention", "quote": "Perforating folliculitis (PF) describes the process by which altered dermal material is eliminated from the epidermis through a follicular unit" }, { "field": "comparator", "quote": "Diabetes mellitus (DM) and chronic renal failure (CRF) are commonly associated with PF." } ] }, { "id": "pmid:25372256", "pmid": "25372256", "doi": null, "nctId": null, "pmcid": null, "title": "Unilateral generalized keratosis pilaris following pregnancy", "firstAuthor": "Zhu", "multipleAuthors": true, "journal": "Cutis", "year": 2014, "design": "case-series", "n": 1, "nField": "reported", "population": "a 29-year-old woman in the second month of her second pregnancy", "intervention": "none (observational case report)", "comparator": "", "primaryOutcome": "development and extent of keratosis pilaris skin bumps", "result": "she developed widespread keratosis pilaris on one side of her body during early pregnancy", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show what causes or helps most people with this condition.", "directness": "indirect", "limitations": "Single case report; no control group; cause is speculative (genetic and hormonal factors suggested but not proven).", "followUp": "", "plainFinding": "One case, pregnancy-linked skin bumps.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25372256/", "sourceText": "Keratosis pilaris (KP) is a common inherited disorder characterized by small folliculocentric keratotic papules that may have surrounding erythema, which gives the skin a stippled appearance resembling gooseflesh. The extensor surfaces of the upper arms, thighs, and buttocks commonly are affected, but a generalized presentation may occur. We report the case of a 29-year-old woman with unilateral generalized KP in the second month of her second pregnancy. Both a genetic mutation and pregnancy-induced hormonal changes played possible roles in the development and progress of unilateral generalized KP in this patient.", "provenance": [ { "field": "population", "quote": "We report the case of a 29-year-old woman with unilateral generalized KP in the second month of her second pregnancy." }, { "field": "primaryOutcome", "quote": "the development and progress of unilateral generalized KP in this patient" }, { "field": "result", "quote": "We report the case of a 29-year-old woman with unilateral generalized KP in the second month of her second pregnancy." }, { "field": "n", "quote": "a 29-year-old woman" }, { "field": "intervention", "quote": "Both a genetic mutation and pregnancy-induced hormonal changes played possible roles in the development and progress of unilateral generalized KP in this patient." } ] }, { "id": "pmid:25188458", "pmid": "25188458", "doi": "10.12788/j.sder.0092", "nctId": null, "pmcid": null, "title": "Natural history, presentation, and diagnosis of hidradenitis suppurativa", "firstAuthor": "Micheletti", "multipleAuthors": false, "journal": "Semin Cutan Med Surg", "year": 2014, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa (a chronic skin condition affecting areas like armpits, groin, and buttocks)", "intervention": "none (describes natural course and diagnosis)", "comparator": "", "primaryOutcome": "how the condition develops and is diagnosed over time", "result": "Describes how the condition starts with small bumps and worsens over time into painful lumps, draining fluid, and scarring if untreated", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a descriptive review of disease features, not a study testing a treatment or comparing outcomes.", "directness": "direct", "limitations": "No original data, treatment comparison, or outcome measurement reported; purely descriptive of disease course and diagnosis.", "followUp": "", "plainFinding": "Describes how this skin condition progresses untreated.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25188458/", "sourceText": "The diagnosis of hidradenitis suppurativa (HS) is based on a characteristic history and physical exam. The anatomic sites of involvement include the axillae (most common), groin, and buttocks, and the perianal, perineal, and mammary regions. Initially, HS manifests with open comedones (usually with two or more \"heads\") and tender subcutaneous acneiform papules. Without intervention, the natural history of HS is chronic and progressive. More painful subcutaneous nodules form, which rupture and drain a thick, mucopurulent, foul-smelling fluid. Later, sinus tracts form, and, over time, ropelike fibrotic subcutaneous scarring occurs, which can lead to disabling contractures of the affected limbs. Clinically, the severity of disease is classified using the Hurley staging system, which provides guidance for choosing among treatment options.", "provenance": [ { "field": "population", "quote": "The anatomic sites of involvement include the axillae (most common), groin, and buttocks, and the perianal, perineal, and mammary regions." }, { "field": "primaryOutcome", "quote": "the natural history of HS is chronic and progressive" }, { "field": "result", "quote": "More painful subcutaneous nodules form, which rupture and drain a thick, mucopurulent, foul-smelling fluid." }, { "field": "intervention", "quote": "Without intervention, the natural history of HS is chronic and progressive." } ] }, { "id": "pmid:24880664", "pmid": "24880664", "doi": "10.1016/j.jaad.2014.04.001", "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa: a retrospective study of 846 Dutch patients to identify factors associated with disease severity", "firstAuthor": "Schrader", "multipleAuthors": true, "journal": "J Am Acad Dermatol", "year": 2014, "design": "retrospective", "n": 846, "nField": "reported", "population": "Dutch patients with hidradenitis suppurativa, a chronic skin disease", "intervention": "", "comparator": "", "primaryOutcome": "factors linked to how severe the disease is, and differences by sex and family history", "result": "Worse disease was linked to being male, longer disease duration, higher body weight, smoking, and lesions in armpit, perianal, and breast areas; men more often had lesions on the buttocks, perianal area, and a history of severe acne; women had earlier onset and more often had family members with the disease", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a backward-looking study without a comparison treatment, some information was self-reported by patients, and it only shows associations, not causes.", "directness": "indirect", "limitations": "Some parameters were patient-reported.", "followUp": "", "plainFinding": "Buttock pimples linked to hidradenitis, not acne.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24880664/", "sourceText": "BACKGROUND: Few comprehensive studies exist on the epidemiology of hidradenitis suppurativa, a very distressing skin disease. OBJECTIVE: We sought to identify disease-related factors associated with severity, sex, and family history. METHODS: Ordinal logistic regression was used in 846 consecutive Dutch patients with hidradenitis suppurativa to calculate odds ratios (ORs) for severity according to Hurley. Sex and family history were compared using Student t test and χ(2) test. RESULTS: In total, 45.5% of the patients had Hurley I, 41.5% had Hurley II, and 13.0% had Hurley III. Severity was associated with male sex (OR 2.11; P < .001), disease duration (OR 1.03; P < .001), body mass index (OR 1.03; P = .01), smoking pack-years (OR 1.02; P = .001), and axillary (OR 2.24; P < .001), perianal (OR 1.92; P < .001), and mammary lesions (OR 1.48; P = .03). Women had earlier onset, more inguinal and mammary lesions, and more frequent family history for hidradenitis suppurativa. Men more commonly had gluteal, perianal, and atypical lesions, and a history of severe acne. Patients with a family history had earlier onset, longer disease duration, a history of severe acne, more extensive disease, and were more often smokers. LIMITATIONS: Some parameters were patient-reported. CONCLUSION: The severity risk factors identified in this study could help physicians to select patients who need close monitoring and who would benefit from early, aggressive therapy.", "provenance": [ { "field": "n", "quote": "846 consecutive Dutch patients with hidradenitis suppurativa" }, { "field": "population", "quote": "846 consecutive Dutch patients with hidradenitis suppurativa" }, { "field": "primaryOutcome", "quote": "We sought to identify disease-related factors associated with severity, sex, and family history." }, { "field": "result", "quote": "Severity was associated with male sex (OR 2.11; P < .001), disease duration (OR 1.03; P < .001), body mass index (OR 1.03; P = .01), smoking pack-years (OR 1.02; P = .001), and axillary (OR 2.24; P < .001), perianal (OR 1.92; P < .001), and mammary lesions (OR 1.48; P = .03)." }, { "field": "result", "quote": "Men more commonly had gluteal, perianal, and atypical lesions, and a history of severe acne." }, { "field": "result", "quote": "Women had earlier onset, more inguinal and mammary lesions, and more frequent family history for hidradenitis suppurativa." }, { "field": "limitations", "quote": "Some parameters were patient-reported." } ] }, { "id": "pmid:24746309", "pmid": "24746309", "doi": null, "nctId": null, "pmcid": null, "title": "An atlas of the morphological manifestations of hidradenitis suppurativa", "firstAuthor": "Scheinfeld", "multipleAuthors": false, "journal": "Dermatol Online J", "year": 2014, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a skin condition", "intervention": "none - this is a descriptive atlas of skin lesion appearances, not a treatment study", "comparator": "", "primaryOutcome": "the different ways hidradenitis suppurativa can look on the skin, including on the buttocks", "result": "many different lesion types were described, including scarring folliculitis of the buttocks, boils, cysts, and sinus tracts, suggesting HS is a 'reaction pattern' with varied appearances", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is just a descriptive picture atlas of skin findings, not a controlled study comparing treatments or outcomes.", "directness": "indirect", "limitations": "no patient numbers, no comparison group, no quantitative data - purely descriptive atlas of appearances", "followUp": "", "plainFinding": "Describes skin condition causing buttock bumps/scarring", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24746309/", "sourceText": "This article is dermatological atlas of the morphologic presentations of Hidradenitis Suppurativa (HS). It includes: superficial abscesses (boils, furnucles, carbuncles), abscesses that are subcutaneous and suprafascial, pyogenic granulomas, cysts, painful erythematous papules and plaques, folliculitis, open ulcerations, chronic sinuses, fistulas, sinus tracts, scrotal and genital lyphedema, dermal contractures, keloids (some that are still pitted with follicular ostia), scarring, skin tags, fibrosis, anal fissures, fistulas (i.e. circinate, linear, arcuate), scarring folliculitis of the buttocks (from mild to cigarette-like scarring), condyloma like lesions in intertrigous areas, fishmouth scars, acne inversa, honey-comb scarring, cribiform scarring, tombstone comedones, and morphia-like plaques. HS can co-exist with other follicular diseases such as pilonidal cysts, dissecting cellulitis, acne conglobata, pyoderma gangrenosum, and acanthosis nigricans. In sum, the variety of presentations of HS as shown by these images supports the supposition that HS is a reaction pattern.HS is a follicular based diseased and its manifestations involve a multitude of follicular pathologies [1,2]. It is also known as acne inversa (AI) because of one manifestation that involves the formation of open comedones on areas besides the face. It is as yet unclear why HS is so protean in its manifestations. HS severity is assessed using the Hurley Staging System (Table 1). It also remains unclear why hidradentitis may remain limited to Hurley Stage 1, evolve to the more confluent (Hurley Stage 2), or progress even further to the fully confluent (Hurley Stage 3).In addition, HS can be associated with other follicular based diseases such as pilonidal cysts (PCs) of the sacrum and buttocks, dissecting cellulitis (DC), and acne conglobata (AC), which usually involves the face, chest, When HS occurs with PCs, DC, and/or AC it is referred to as the follicular occlusion triad or tetrad [2]. HS can more rarely be associated with pyoderma gagrenosum (PG) or Crohn disease (CD), other inflammatory diseases of the skin that are not follicular. The reason for this is unclear [2]. What AC, DC, HS, CD, and PG share is that they occur in bacterially rich environments. HS probably occurs with acanthosis nigricans because many HS patients are obese [2]. This concurrence seems under reported.", "provenance": [ { "field": "population", "quote": "This article is dermatological atlas of the morphologic presentations of Hidradenitis Suppurativa (HS)." }, { "field": "primaryOutcome", "quote": "In sum, the variety of presentations of HS as shown by these images supports the supposition that HS is a reaction pattern." }, { "field": "result", "quote": "scarring folliculitis of the buttocks (from mild to cigarette-like scarring)" }, { "field": "result", "quote": "In sum, the variety of presentations of HS as shown by these images supports the supposition that HS is a reaction pattern." }, { "field": "intervention", "quote": "This article is dermatological atlas of the morphologic presentations of Hidradenitis Suppurativa (HS)." } ] }, { "id": "pmid:24656278", "pmid": "24656278", "doi": null, "nctId": null, "pmcid": null, "title": "A case of a patient with stage III familial hidradenitis suppurativa treated with 3 courses of infliximab and died of metastatic squamous cell carcinoma", "firstAuthor": "Scheinfeld", "multipleAuthors": false, "journal": "Dermatol Online J", "year": 2014, "design": "case-series", "n": 1, "nField": "reported", "population": "a 47-year-old man with long-standing, familial, severe (stage III) hidradenitis suppurativa affecting the groin, legs, buttocks, and perineal areas", "intervention": "infliximab (3 courses, 500mg) plus surgical debridement", "comparator": "none; no comparison group, this is a single patient's treatment course", "primaryOutcome": "development of skin cancer (squamous cell carcinoma) and survival", "result": "squamous cell carcinoma was found after the third infliximab-and-debridement course, it had already spread (metastasized), and the patient died", "resultDirection": "harm", "quality": "very-low", "qualityWhy": "this is a single patient's case report, so it cannot show whether infliximab caused the harm or how often this happens.", "directness": "indirect", "limitations": "only one patient; no control group; cannot separate effects of long-standing untreated disease, infliximab, or other treatments; author notes the disease had already been present for decades before malignant change.", "followUp": "11 months after the infliximab was started", "plainFinding": "Severe long-term disease turned into fatal skin cancer.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24656278/", "sourceText": "Although rare, severe hidradenitis suppurativa (HS) of the anal, perianal, gluteal, thigh, and groin regions can evolve into squamous cell carcinoma (SCC). This usually does not occur until the HS has been present for more than 20 years. Malignant degeneration of HS in the axilla has not been reported. SCC has developed in dissecting cellulitis, acne conglobata, and pilonidal cysts (other members of the follicular tetrad). Whereas the male to female ratio of HS is 1:3, SCC in HS has a male to female ration of 5:1. The reasons behind malignant degeneration in HS are complex and might differ from the malignant degeneration causing Marjolin ulcers. It likely involves the presence of human papilloma virus (HPV) in affected areas (a rarity in the axilla), and impaired defensins, which combat HPV, in the skin of Hurley Stage III HS. In familial HS, the odds of developing SCC are likely greater because of independent loss-of-function mutations in the γ-secretase multiprotein complex, which regulates the Notch signaling pathway. Compromise of the Notch signaling pathway can undermine immune function and increase the risk of neoplastic development. Coincident SCC with use of tumor necrosis factor α blockers has been reported. I report a patient with long standing Hurley Stage III, familial HS, wwho developed metastatic SCC after 3 courses of infliximab and expired 11 months after the infliximab was started. A 47-year-old male presented with progressive HS since early adulthood. His stage III hidradenitis suppurativa (HS) involved his groin, legs buttocks, and perineal areas. Interestingly, his HS was familial; one daughter also suffered from HS. A pilonidal cyst had been excised in the past. He suffered from hypertension for which he took ramipril, 2.5 mg per day. He did not admit to smoking. He had undergone numerous surgeries and courses of clindamycin with rifampin and clindamycin with minocycline. He used pregablin among other stronger medications for pain control. He had also taken isotretinoin years before without substantial long-term benefit. The various treatments were palliative but the HS always returned. He expressed that the pain from his HS was not bearable. He decided in consultations with his doctors to try infliximab owing to the positive clinical data for its efficacy in HS. He took 3 courses of infliximab 500mg, each of which was followed by surgical debridement of the perineal and anal areas. At the 3rd surgical debridement his physician noted the presence of squamous cell carcinoma (SCC) on July 28, 2008. The infliximab was stopped. However, the patient developed the patient underwent scanning soon after that showed soon after that the SCC had metastasized. He expired in June of 2009.", "provenance": [ { "field": "population", "quote": "A 47-year-old male presented with progressive HS since early adulthood. His stage III hidradenitis suppurativa (HS) involved his groin, legs buttocks, and perineal areas." }, { "field": "intervention", "quote": "He took 3 courses of infliximab 500mg, each of which was followed by surgical debridement of the perineal and anal areas." }, { "field": "comparator", "quote": "I report a patient with long standing Hurley Stage III, familial HS, wwho developed metastatic SCC after 3 courses of infliximab and expired 11 months after the infliximab was started." }, { "field": "primaryOutcome", "quote": "At the 3rd surgical debridement his physician noted the presence of squamous cell carcinoma (SCC) on July 28, 2008." }, { "field": "result", "quote": "However, the patient developed the patient underwent scanning soon after that showed soon after that the SCC had metastasized. He expired in June of 2009." }, { "field": "n", "quote": "A 47-year-old male presented with progressive HS since early adulthood." }, { "field": "followUp", "quote": "expired 11 months after the infliximab was started" } ] }, { "id": "pmid:24567417", "pmid": "24567417", "doi": "10.1136/postgradmedj-2013-131994", "nctId": null, "pmcid": "PMC3963556", "title": "Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease", "firstAuthor": "Dufour", "multipleAuthors": true, "journal": "Postgrad Med J", "year": 2014, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with hidradenitis suppurativa, a skin condition affecting armpits, groin, breasts and buttocks", "intervention": "", "comparator": "", "primaryOutcome": "description of the disease: symptoms, prevalence, risk factors and burden", "result": "the abstract describes what the disease looks like, how common it is, and its risk factors, but does not test any treatment or report a benefit/harm outcome", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a descriptive review summarizing general knowledge about the disease, not a study testing a treatment or measuring an outcome", "directness": "direct", "limitations": "abstract does not report study methodology, sample size, or test any intervention - it is purely descriptive", "followUp": "", "plainFinding": "Chronic skin disease, not acne", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24567417/", "sourceText": "Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty. The primary clinical presentation is painful inflamed nodules or boils in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and buttocks/anus) that progress to abscesses, sinus tracts and scarring. Severity is typically described according to three Hurley categories, with most patients having mild or moderate disease. Estimated prevalence is 1-4% worldwide and HS is three times more common in women than men. Patients' disease burden includes intense pain, work disability and overall poor quality of life. Although the clinical signs of the disease can often be hidden by clothing, active HS is associated with a malodorous discharge that contributes to the disabling social stigma. Risk factors include smoking and obesity. Comorbidities include inflammatory bowel disease and spondyloarthropathies. The presentation of the disease is distinct, yet HS is not well-recognised except in dermatology clinics.", "provenance": [ { "field": "population", "quote": "Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin condition that typically occurs after puberty" }, { "field": "population", "quote": "painful inflamed nodules or boils in the apocrine gland-bearing regions (armpits, genital area, groin, breasts and buttocks/anus)" }, { "field": "primaryOutcome", "quote": "Estimated prevalence is 1-4% worldwide and HS is three times more common in women than men" }, { "field": "result", "quote": "Risk factors include smoking and obesity. Comorbidities include inflammatory bowel disease and spondyloarthropathies." } ] }, { "id": "pmid:24144253", "pmid": "24144253", "doi": "10.2310/7750.2012.11144", "nctId": null, "pmcid": null, "title": "Adalimumab in treatment-resistant hidradenitis suppurativa following recurrence after extensive affected area excision: a review of biologics therapy", "firstAuthor": "Samycia", "multipleAuthors": true, "journal": "J Cutan Med Surg", "year": 2013, "design": "case-series", "n": 1, "nField": "reported", "population": "a man with severe long-term hidradenitis suppurativa in the groin, buttock, and perianal area", "intervention": "adalimumab (a biologic drug)", "comparator": "other treatments tried first: etanercept and infliximab with methotrexate, and surgery", "primaryOutcome": "improvement in hidradenitis suppurativa symptoms", "result": "adalimumab led to marked improvement after other treatments failed", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report plus a non-systematic literature summary, so it cannot reliably show whether the treatment works in general.", "directness": "indirect", "limitations": "Single case report; literature review is low-grade evidence without controlled trials; authors note clinical judgment is needed and adverse effects should be watched for.", "followUp": "", "plainFinding": "Marked improvement with adalimumab in one patient.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24144253/", "sourceText": "BACKGROUND: Hidradenitis suppurativa (HS) is characterized by chronic, suppurative abscesses, sinus tracts, and fistulas affecting the axilla, groin, and perianal region resulting from hyperkeratosis and occlusion of the terminal hair follicle. OBJECTIVE: This report highlights the use of biologic agents for the treatment of recalcitrant HS. METHOD: We report on a 48-year-old male with a 15-year history of refractory perianal-inguinal-buttock HS who, despite receiving numerous surgical drainages and traditional medical treatment for HS, still had severe pain. After trialing etanercept and infliximab with methotrexate, the patient had marked improvement with adalimumab. A literature review of biologics therapy was also performed. RESULTS: After trialing many traditional therapies, we found that adalimumab appears to be the most effective treatment modality for our patient. A literature search revealed 53 articles on biologics therapy in HS. These articles are summarized. DISCUSSION: Biologic agents have been shown to have variable results in the treatment of refractory HS. Enough low-grade evidence has been accumulated to make the use of these agents suitable in HS. Until more clinical trials are performed on this topic, physicians should use clinical judgment when treating HS with biologic agents and be cautious by watching for significant adverse effects.", "provenance": [ { "field": "population", "quote": "a 48-year-old male with a 15-year history of refractory perianal-inguinal-buttock HS" }, { "field": "intervention", "quote": "marked improvement with adalimumab" }, { "field": "comparator", "quote": "After trialing etanercept and infliximab with methotrexate" }, { "field": "primaryOutcome", "quote": "still had severe pain" }, { "field": "result", "quote": "After trialing many traditional therapies, we found that adalimumab appears to be the most effective treatment modality for our patient." }, { "field": "n", "quote": "a 48-year-old male" } ] }, { "id": "pmid:24021361", "pmid": "24021361", "doi": null, "nctId": null, "pmcid": null, "title": "Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients", "firstAuthor": "Scheinfeld", "multipleAuthors": false, "journal": "Dermatol Online J", "year": 2013, "design": "narrative-review", "n": 350, "nField": "reported", "population": "people with hidradenitis suppurativa, a skin condition that can affect the buttocks, armpits, groin and other areas", "intervention": "various medical treatments such as topical and oral antibiotics, hormone blockers, biologics and other drugs, chosen based on disease stage", "comparator": "no formal comparison group; treatments compared based on disease severity and stage", "primaryOutcome": "not clearly stated as a measured outcome; the review describes which treatments are used for different severities of hidradenitis suppurativa", "result": "the article summarizes the author's treatment experience and recommends different drug combinations depending on how mild or severe the disease is, without reporting specific success rates", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is one doctor's personal treatment experience and opinion, not a controlled study comparing outcomes.", "directness": "indirect", "limitations": "no control group, no statistical outcome data, and it covers hidradenitis suppurativa specifically rather than general buttock pimples", "followUp": "", "plainFinding": "Treatment guide for hidradenitis suppurativa, not plain pimples.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24021361/", "sourceText": "Hidradenitis suppurativa (HS), a pathological follicular disease, impacts patients' lives profoundly. HS most commonly involves cutaneous intertriginous areas, such as the axilla, inner thighs, groin and buttocks, and pendulous breasts, but can appear on any follicular skin. Protean, HS manifests with variations of abscesses, folliculitis, pyogenic granulomas, scars (oval honeycombed), comedones, tracts, fistulas, and keloids. The pathophysiology might involve both defects of the innate follicular immunity and overreaction to coagulase negative Staphylococcus. Treatment depends on the morphology, extent, severity, and duration. Topical clindamycin and dapsone are often adequate for treating mild HS. For Stage 1 and 2 HS, first line treatment combines rifampin with either oral clindamycin or minocycline. Other HS treatments include: fluoroquinolones with metronidazole and rifampin, oral dapsone, zinc, acitretin, hormone blockers (oral contraceptive pills, spironolactone, finasteride, and dutasteride), and oral prednisone. For severe HS, cyclosporine, adalimumab, or infliximab (used at double psoriatic doses) and intravenous carbapenems or cephalosporins are often required. Isotretinoin, etanercept, isoniazid, lymecycline, sulfasalazine, methotrexate, metformin, colchicine, clarithromycin, IVIG, and thalidomide are less favored treatments. The role of botulinum toxin is uncertain. The most important life style modification is weight loss. De-roofing fluctuant nodules and injection of intralesional corticosteroids ameliorates the disease and perhaps, if done at regular intervals, improves HS more permanently. Surgical excision and CO2 laser ablation are more definitive treatments. The 1064 nm laser for hair removal aids in the treatment of HS. This article centers on medical therapies and will only passingly mention surgical and laser treatments. This article summarizes my treatment experience with over 350 HS patients.", "provenance": [ { "field": "n", "quote": "This article summarizes my treatment experience with over 350 HS patients." }, { "field": "population", "quote": "HS most commonly involves cutaneous intertriginous areas, such as the axilla, inner thighs, groin and buttocks, and pendulous breasts" }, { "field": "intervention", "quote": "Topical clindamycin and dapsone are often adequate for treating mild HS." }, { "field": "comparator", "quote": "Treatment depends on the morphology, extent, severity, and duration." }, { "field": "primaryOutcome", "quote": "This article summarizes my treatment experience with over 350 HS patients." }, { "field": "result", "quote": "For Stage 1 and 2 HS, first line treatment combines rifampin with either oral clindamycin or minocycline." } ] }, { "id": "pmid:23834292", "pmid": "23834292", "doi": "10.1111/iwj.12116", "nctId": null, "pmcid": "PMC7950485", "title": "Topical negative pressure coupled with split-thickness skin grafting for the treatment of hidradenitis suppurativa: a case report", "firstAuthor": "Jianbing", "multipleAuthors": true, "journal": "Int Wound J", "year": 2015, "design": "case-series", "n": 1, "nField": "reported", "population": "A 66-year-old man with hidradenitis suppurativa (chronic skin disease) on the buttocks, who also had diabetes and prior perianal abscesses", "intervention": "Wound debridement plus topical negative pressure therapy and nutritional support, followed by skin grafting", "comparator": "None (single case, no comparison group)", "primaryOutcome": "Wound healing and recurrence of hidradenitis suppurativa", "result": "The wound healed after skin grafting, and there was no recurrence of hidradenitis suppurativa over 2 years", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a single patient case report, so it cannot show whether this treatment works better than other options or reliably prevents pimples on the buttocks in general.", "directness": "indirect", "limitations": "Single case report with no control group, so findings may not generalize; the man had diabetes and severe prior infection, which may not reflect typical cases of buttock pimples.", "followUp": "2-year follow-up", "plainFinding": "Skin healed, no recurrence after grafting.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23834292/", "sourceText": "Hidradenitis suppurativa is a cutaneous, chronic, recurrent inflammatory disease. Here, we report the case of a 66-year-old man who had hidradenitis suppurativa in the buttocks. He suffered from diabetes mellitus. In the past, he had perianal abscesses. Because of improper treatment of furuncle infections in the buttocks, skin ulcers formed, which worsened and resulted in multiple fistulas. The skin lesion surface was large and the infection was severe. After wound debridement treatment, topical negative pressure and nutritional support were given. After one and a half months, the wound healed with split-thickness skin grafting. In a 2-year follow-up, there was no evidence of hidradenitis suppurativa recurrence.", "provenance": [ { "field": "n", "quote": "a 66-year-old man who had hidradenitis suppurativa in the buttocks" }, { "field": "population", "quote": "a 66-year-old man who had hidradenitis suppurativa in the buttocks. He suffered from diabetes mellitus." }, { "field": "intervention", "quote": "After wound debridement treatment, topical negative pressure and nutritional support were given." }, { "field": "comparator", "quote": "Here, we report the case of a 66-year-old man" }, { "field": "primaryOutcome", "quote": "the wound healed with split-thickness skin grafting" }, { "field": "result", "quote": "In a 2-year follow-up, there was no evidence of hidradenitis suppurativa recurrence." }, { "field": "followUp", "quote": "In a 2-year follow-up" } ] }, { "id": "pmid:23728245", "pmid": "23728245", "doi": "10.1097/SAP.0b013e3182840831", "nctId": null, "pmcid": null, "title": "Surgical treatment of extensive sacrococcygeal hidradenitis suppurativa with triangular closure technique", "firstAuthor": "Mutaf", "multipleAuthors": true, "journal": "Ann Plast Surg", "year": 2014, "design": "case-series", "n": 16, "nField": "reported", "population": "adults with severe hidradenitis suppurativa (boil-like skin disease) in the tailbone/buttock area", "intervention": "triangular skin flap surgery to close large wounds after removing diseased tissue", "comparator": "none - all patients received the same surgical technique", "primaryOutcome": "successful wound closure, complications, and recurrence of disease", "result": "all wounds closed successfully, 2 patients had minor tissue death at flap tip, no infections, no recurrence over follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small case series of only 16 patients with no comparison group, so it cannot prove this surgery works better than other options.", "directness": "indirect", "limitations": "small sample size, no control group, and this studies a surgical treatment for a specific severe skin disease rather than ordinary pimples", "followUp": "36 months (6 months-5 years)", "plainFinding": "Surgery healed severe boils well.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23728245/", "sourceText": "BACKGROUND: Recurrence of the sacrococcygeal hidradenitis suppurativa (HS) can significantly be reduced by invasive local excision of all the abscess, sinuses, and scars which often result in large defects on this region. Although a number of surgical procedures have been described, closure of large sacrococcygeal defects resulting from excision of extensive HS still remains a challenge. PURPOSE: Here, we present the use of triangular closure technique as a new alternative in surgical treatment of extensive HS of sacrococcygeal region. MATERIALS AND METHODS: For more than 4 years, triangular closure technique has been used for skin coverage of the large sacrococcygeal defects resulting from excision of the HS in 16 patients (12 men and 4 women) aged between 18 and 52. The size of the defects range from 10 to 25 cm in the greatest dimension. RESULTS: In all patients, a successful tension-free closure of the defect was obtained. Except for 2 patients who had tip necrosis, all patients healed uneventfully. There was no patient with infection and wound dehiscence. A mean follow-up for 36 months (6 months-5 years) revealed no recurrence and an aesthetically acceptable scar formation in all patients. No patient required additional surgery. CONCLUSIONS: Triangular closure technique enables the surgeon to achieve a tension-free defect closure of remarkably large sacrococcygeal defects resulting from surgical excision of extensive HS. Using 2 well-vascularized fasciocutaneous flaps, it provides a durable coverage and soft tissue padding over sacrococcygeal and gluteal region with good cosmesis. With these advantages, triangular closure technique seems to be a useful, 1-stage, and safe reconstructive alternative for the closure of these challenging defects.", "provenance": [ { "field": "n", "quote": "in 16 patients (12 men and 4 women)" }, { "field": "population", "quote": "extensive HS of sacrococcygeal region" }, { "field": "intervention", "quote": "triangular closure technique has been used for skin coverage of the large sacrococcygeal defects resulting from excision of the HS" }, { "field": "comparator", "quote": "Here, we present the use of triangular closure technique as a new alternative in surgical treatment" }, { "field": "primaryOutcome", "quote": "In all patients, a successful tension-free closure of the defect was obtained." }, { "field": "result", "quote": "Except for 2 patients who had tip necrosis, all patients healed uneventfully. There was no patient with infection and wound dehiscence. A mean follow-up for 36 months (6 months-5 years) revealed no recurrence and an aesthetically acceptable scar formation in all patients." } ] }, { "id": "pmid:23373365", "pmid": "23373365", "doi": "10.2298/aci1202091b", "nctId": null, "pmcid": null, "title": "Surgical treatment of chronic hidradenitis suppurativa in the gluteal and perianal regions", "firstAuthor": "Bilali", "multipleAuthors": true, "journal": "Acta Chir Iugosl", "year": 2012, "design": "case-series", "n": 6, "nField": "reported", "population": "adults with long-term severe hidradenitis suppurativa (boil-like infections) on the buttocks and around the anus", "intervention": "wide surgical removal of the affected skin", "comparator": "non-surgical (conservative) treatment", "primaryOutcome": "successful healing without the condition coming back", "result": "83% of patients healed successfully with no recurrence after surgery, while conservative treatment had little effect", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only 6 patients were reviewed retrospectively with no control group, so the findings can't be generalized.", "directness": "indirect", "limitations": "Very small retrospective case series without a control group or long-term follow-up reporting.", "followUp": "", "plainFinding": "Surgery cured most severe cases.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23373365/", "sourceText": "INTRODUCTION: Verneuil disease, or perianal hidradenitis suppurativa (HS), is a chronic suppurative disease with a tendency to develop sinus formation, fibrosis, and sclerosis, having a great impact on quality of life. HS affect the apocrine sweat glands or sebaceous glands and may arise in each of the regions where the apocrine glands are prominent: the axilla, breast aureole, umbilicus, perineum, groin, and buttocks. We present here moderate and extensive HS cases, with their respective treatment methods and outcomes. METHODS: A retrospective review of 6 patients' medical records from January 2001 to December 2010. RESULTS: The 6 patients underwent treatment for HS in the gluteal and perianal regions with surgical excision. Five of the patients were male (83%). The median age was 42.5 years. We performed a total of 8 operations on these patients. In 3 patients, the wound was left open for secondary healing, and the mean time for complete wound healing was 11.3 weeks (range: 9.5-19 weeks). Delayed skin grafting was used for 2 patients in whom the wounds had been left open after the first operation. In this group, complete wound healing took 2 months in total. One patient underwent primary wound closure using rotation flaps, with a complete healing time of 2 weeks. Successful treatment without recurrence was accomplished in 5 (83.3%) of the patients. CONCLUSION: The conservative treatment methods had little effect, particularly on gluteal and perianal/perineal HS. The only successful treatment was wide surgical excision. Management of the wound after wide excision should be tailored to the individual patient.", "provenance": [ { "field": "n", "quote": "A retrospective review of 6 patients' medical records from January 2001 to December 2010." }, { "field": "population", "quote": "perianal hidradenitis suppurativa (HS), is a chronic suppurative disease" }, { "field": "population", "quote": "treatment for HS in the gluteal and perianal regions" }, { "field": "intervention", "quote": "surgical excision" }, { "field": "comparator", "quote": "The conservative treatment methods had little effect, particularly on gluteal and perianal/perineal HS." }, { "field": "primaryOutcome", "quote": "Successful treatment without recurrence was accomplished in 5 (83.3%) of the patients." }, { "field": "result", "quote": "Successful treatment without recurrence was accomplished in 5 (83.3%) of the patients." }, { "field": "result", "quote": "The only successful treatment was wide surgical excision." } ] } ], "faqs": [ { "q": "Why do I get pimples on my butt?", "a": "These studies describe blocked, irritated hair follicles (folliculitis) as a common pattern, often linked to friction, sweat, and tight clothing, but no study measured how often this is the actual cause versus something else. If bumps are painful, keep returning in the same spots, or form tunnels under the skin, that pattern is linked in these studies to hidradenitis suppurativa, a different condition needing medical care." }, { "q": "Why do I keep getting pimples on my butt?", "a": "No study tracked a general group of people to see how often buttock pimples come back. But friction from tight clothing or sitting, sweating, and obesity were each linked to more frequent outbreaks in small studies, and bumps that keep returning in the same spot can be a sign of hidradenitis suppurativa rather than ordinary pimples." }, { "q": "Why do I have so many pimples on my butt?", "a": "Studies found folliculitis was far more common in children with obesity than in normal-weight children, and heavy sweating or friction (seen in sailors after weeks at sea) was linked to more outbreaks. No study set a number for what counts as 'too many.'" }, { "q": "Can you get a pimple in your butt crack?", "a": "Yes. Studies describe the fold between the buttocks (the gluteal cleft) as a site for folliculitis, hidradenitis suppurativa, and pilonidal disease, a separate condition involving hair and cysts near the tailbone." }, { "q": "Should I stop treating it like facial acne?", "a": "If scrubs or spot treatments aren't helping after a few weeks, stop and see a doctor rather than continuing them. These studies suggest persistent or painful bumps in this area are sometimes a different condition, hidradenitis suppurativa, that doesn't respond to acne treatment and may need antibiotics, biologics, or surgery instead." } ], "searchedAs": [ "why do i get pimples on my butt", "why do i keep getting pimples on my butt", "why do i have so many pimples on my butt", "can you get a pimple in your butt crack" ], "patientTakeaway": "Most mild, non-painful bumps on the buttocks are consistent with simple folliculitis from friction and sweat — looser clothing, showering after sweating, and skipping harsh scrubbing is a reasonable first step. But if the bumps are painful, keep coming back in the same spots, or start draining or forming tunnels, stop self-treating and see a doctor: these studies link that pattern to hidradenitis suppurativa, a condition that needs medical treatment and, left untreated, has in rare cases been linked to serious complications.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Folliculitis\"[Mesh] OR folliculitis[tiab] OR \"Acne Vulgaris\"[Mesh] OR \"Hidradenitis Suppurativa\"[Mesh] OR \"Keratosis\"[Mesh]) AND (buttock*[tiab] OR gluteal[tiab] OR \"natal cleft\"[tiab] OR nates[tiab])" }, "pubmedQueryTranslation": "(\"Folliculitis\"[MeSH Terms] OR \"Folliculitis\"[Title/Abstract] OR \"Acne Vulgaris\"[MeSH Terms] OR \"Hidradenitis Suppurativa\"[MeSH Terms] OR \"Keratosis\"[MeSH Terms]) AND (\"buttock*\"[Title/Abstract] OR \"gluteal\"[Title/Abstract] OR \"natal cleft\"[Title/Abstract] OR \"nates\"[Title/Abstract])", "searchedOn": "2026-10-13", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "Why Do I Get Pimples on My Butt?", "description": "No trial has tested why pimples form on the buttocks. 120 studies show painful, recurring bumps can signal a more serious skin condition." }, "lastChecked": "2026-10-13", "lastChanged": "2026-10-13", "nextCheckDue": "2026-11-13", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-13" }, "status": "published" }