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Background: Hidradenitis suppurativa, or HS, is a chronic, inflammatory skin condition characterized by abscesses, nodules, and fistulas typically in intertriginous areas of the body. Pediatric providers are key front-line providers for children and adolescents with HS, yet little is known about their diagnostic and management approach. Objective: In this survey study, we elicited the perspectives and experiences of pediatric providers regarding HS care. Methods: An anonymous survey was distributed to pediatric providers through online pediatric organizational listservs. Survey questions addressed providers’ perspectives on HS diagnosis and management. Comparative statistics between survey responses and provider experience were performed using t-tests and a p-value

Introduction: Hidradenitis suppurativa (HS) is associated with comorbidities that are risk factors for severe COVID-19 infection. We evaluated demographics and COVID-19 outcomes in HS patients. Methods: HS patients with COVID-19 (HS+/COVID+) and a randomized age-, race-, and sex-matched control population of patients without HS with COVID-19 (HS−/COVID+) were selected through a retrospective chart review. Data were collected on demographics, medications, comorbidities, vaccination status, and COVID-19 treatment/outcomes. Fisher’s exact test was used to analyze the relationship between risk factors and COVID-19 outcomes. A p value of Results: There were 58 HS+/COVID+ patients, primarily African American (83%, n = 48) and female (88%, n = 51). Compared to HS+/COVID+ patients, HS−/COVID+ patients were significantly more likely to have cardiovascular disease (51% vs. 24%; p = 0.0029) and be pregnant (23% vs. 4%; p = 0.0093). HS+/COVID+ and HS−/COVID+ patients did not vary significantly in vaccination rate at time of COVID-19 diagnosis (6% vs. 5%; p = 0.78). HS−/COVID+ patients were significantly more likely to have COVID-19 complications (35% vs. 7%; p = 0.001) and receive COVID-19 treatment (37% vs. 7%; p = 0.0001) when compared to HS+/COVID+ patients. Conclusion: Our findings support the growing evidence that having HS itself may not be a risk factor for severe COVID-19 outcomes.

Introduction: Although hidradenitis suppurativa (HS) is associated with psychosocial comorbidities such as depression as well as modifiable comorbidities such as obesity, rates of psychosocial screening and lifestyle counseling in the USA have not been characterized. Methods: This cross-sectional study utilized publicly available data from the National Ambulatory Medical Care Survey (NAMCS) between 2008 and 2018 to identify visits with a diagnosis of HS (ICD-9 code 705.83, ICD-10 code L73.2). T tests and multivariate logistic regressions analyzed trends in rates of screening and counseling while controlling for race, sex, and age. Survey weights are applied to each visit to represent a national sample. Results: Depression screening was completed in only 2% of reported visits. No visits reported screening for alcohol misuse, substance abuse, or domestic violence. There were low rates of counseling for weight reduction (7.8%), diet and nutrition (3.3%), exercise (2.4%), smoking (1.0%), and substance abuse (0.7%). Black patients and individuals with public health insurance received less screening and counseling overall. Conclusion: Rates of psychosocial screening and counseling on lifestyle modifications are low in ambulatory clinic visits for HS patients, and there are disparities based on race and insurance status. Implementing strategies to incorporate routine psychosocial screening and lifestyle counseling into visits may improve HS patient outcomes.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatosis associated with significant psychosocial burden. HS patients are more likely to experience mental health comorbidities such as depression and anxiety. They may also experience isolation due to fear of stigmatization as HS lesions are often associated with pain, scarring, and odor. This study investigates the perspectives of HS patients on HS support groups and the usage of this resource among this population. Methods: An anonymous Redcap survey was utilized via online social media HS support groups between 10/2021-1/2022 to collect demographic, usage, and perspective data. Comparative statistics were conducted and p-value of

The Supera (Abbott Vascular, Santa Clara, CA) stent is an interwoven nitinol, shape-memory stent with high strength and flexibility characteristics which are purported to increase resistance to kinking and compression. The purpose of this study was to review single-center outcomes of the use of this stent in the femoropopliteal segment.We performed a single-center, retrospective analysis of patients who underwent Supera stent placement for femoropopliteal occlusive disease from 2016-2019. Data was collected on patient demographics and procedural details. Follow-up imaging data, including duplex imaging and ankle-brachial indices, and clinical data were abstracted from encounter notes.Sixty-two patients with 72 unique Supera stent placements were identified. Mean age was 76 and 69% were male. 56% of patients had severe calcification and 11% had moderate calcification. 48% of lesions were Trans-Atlantic Inter-Society Consensus Document C or D lesions. Primary patency rates at 12, 24, and 36 months were 85%, 82%, and 75%, respectively. Primary patency was not affected significantly by lesion length, degree of calcification, number of outflow vessels, concomitant interventions, or stent size.These results demonstrate sustained primary patency with the Supera stent over a 3-year interval in treatment of patients with femoropopliteal occlusive disease, including in the setting of severely calcified vessels.

Introduction: Patients with hidradenitis suppurativa (HS) report HS flares with increased heat and sweat. However, there is a paucity of literature on whether there is an increased ambulatory visit burden for HS patients during the warmer months. Methods: We used a nationally-representative database of ambulatory visits in the United States, the National Ambulatory Medical Care Survey to examine the seasonal trends of ambulatory visits for patients with HS. Data analyses were performed using SAS Studio 9.04.01 (SAS Institute, Cary, N.C., USA), and variance in the complex survey design is accounted for by utilizing survey weights to create national estimates and confidence intervals. Results: We identified approximately 2.33 million outpatient visits (95% confidence interval 1.95 million-2.71 million) between 2008-2018 with a diagnosis of HS. Approximately 21% of visits occurred during Winter to early Spring (January to April), 51% during late Spring to Summer (May to August), and 28% during Autumn (September to December). The number of visits differed significantly between these three time periods (X2=13.1, p=0.0014). Conclusion: Awareness of the increased burden of HS during summer months may help guide management, including anticipatory counseling on strategic lifestyle modifications and initiation of anti-hyperhidrosis treatments.

Background: Nonmelanoma skin cancer (NMSC), the most prevalent skin cancer, affects over 3 million in the United States annually. Although most patients search for health information on the internet, the readability and quality of NMSC online resources is unknown. Objective: We examine the readability, quality, and comprehensiveness of content in NMSC websites. Methods: Top 50 Google search results for “nonmelanoma skin cancer”, “basal cell skin cancer”, and “squamous cell skin cancer” were evaluated. Advertisements, blogs, scientific articles, and non-comprehensive, professional, and irrelevant sites were excluded. Six readability scales assessed readability. JAMA Benchmark and Discern Instrument assessed quality. Content was evaluated for comprehensiveness. Pearson’s correlation examined the relationship between readability and quality. Results: Seventy-nine websites met inclusion criteria. Average readability level was 11th grade (range 6.8-17.9). No websites met the full criteria of JAMA Benchmark. Only 16.4% had “good”/“excellent” quality per Discern Instrument. Quality and readability scores were not correlated. Most websites discussed risk factors (87.3%), prevention (73.4%), and surgical (87.3%) and nonsurgical (82.3%) treatments. 50.6% included skin cancer images, of which only 17.5% were of skin of color patients. Conclusion: Online NMSC resources need improved readability, quality, and diversity in their representation of skin types.

Introduction: Hidradenitis suppurativa (HS) patients may be at increased risk of COVID-19 infection and complications from their medications and comorbidities. There is a lack of expert consensus on recommendations for the COVID-19 vaccine for HS patients. Herein, we aim to provide expert-driven consensus recommendations regarding COVID-19 vaccinations in HS patients. Methods: A modified Delphi consensus survey developed by a core committee of 7 dermatologist HS experts consisting of 4 demographic questions and 12 practice statements was distributed to the US HS Foundation-sponsored provider listserv. Participants were attending physician HS experts. Survey results were to be reviewed by the core group and revised and resubmitted until consensus (≥70% agreement) was achieved. Results: Among the 33 survey participants, there were 30 (87%) dermatologists, 1 general surgeon, 1 plastic surgeon, and 1 rheumatologist. Consensus for all 12 statements on vaccine counseling and HS treatment counseling was achieved after the first round. Discussion/Conclusion: For now, this consensus can serve as a resource for clinicians discussing COVID-19 vaccination with their HS patients. These recommendations will need to be updated as new evidence on COVID-19 emerges.

Drainage from chronic wounds can significantly negatively impact a patient’s quality of life. Change in severity of wound drainage is an important measure of treatment efficacy for wounds. This study reviews existing tools used to assess wound drainage. Qualitative drainage tools are overall less burdensome, and however, differences in user interpretation may reduce inter-rater reliability. Quantitative drainage tools enable more reliable comparisons of drainage severity and treatment response between patients but sometimes require equipment to administer, increasing responder burden. Gaps in the current wound drainage measurement landscape are highlighted. Many of the existing scales have not been validated in robust studies. There is also a lack of validated global drainage measurement tools for patients with chronic inflammatory skin disorders with drainage, such as hidradenitis suppurativa or pyoderma gangrenosum. Development of a succinct drainage measurement tool for inflammatory skin diseases where drainage is a prominent symptom will improve monitoring of meaningful treatment response.

Lay Summary Active cytomegalovirus (CMV) infection complicates management of inflammatory bowel disease, but the relationship of resolved CMV infection to Crohn’s disease (CD) behavior or localization is unknown. This article reports a striking risk (9-fold) of Crohn’s disease localization to the colon with prior CMV infection. It also reports imputed mucosal cellular composition, HLA class 1, and KIR gene variants that delimit prior observations regarding HLA and KIR associations with Crohn’s disease risk and behavior.

INTRODUCTION Data on pediatric HS presentation and response to treatment are limited. We investigated disease characteristics, prescribed treatments, and treatment responses in a pediatric HS cohort. METHODS Pediatric HS patients were identified through an electronic medical record search using ICD9/10 codes for HS. Inclusion criteria included a diagnosis of HS before 18 years of age. Data on demographics, disease presentation, and treatment was collected. RESULTS 73 patients (59 female, 14 male) were identified. Mean age of symptom onset was 12.6 +/- 2.9 years (range 6-17). Axillary involvement disproportionately affected males (92.9% v 62.7%, p = 0.029), while females had higher groin (59.3% v 28.6%, p = 0.038) involvement. Non-White patients trended toward disproportionately presenting with Hurley-2/3 disease (44.1% v 21.1%, p = 0.093), while females trended toward having a younger age of symptom onset (12.3 v 13.9, p = 0.063), and higher likelihood of HS treatment (93.2% v 78.6%, p = 0.094). The most frequently prescribed treatments were topical clindamycin (61.6%), doxycycline (35.6%), and benzoyl peroxide wash (31.5%). CONCLUSIONS Pediatric HS patients have varied presentations and response to treatment. Further studies are needed to characterize the disease and the most effective treatments.

Childhood sun exposure is associated with development of future skin cancers. Sunscreens are an important tool to prevent harmful ultraviolet rays.The aims of the study are to evaluate sunscreens targeted to children and to analyze cost, marketing claims, ingredients, and allergens to help consumers select products.The top 50 pediatric sunscreens across retailers were analyzed for their cost, marketing claims, ingredients, vehicles, and containers. Ingredients were compared with the American Contact Dermatology Society 2020 Core Allergen List.The mean price was $6.20 per ounce (range, $0.25-$39.98). The mean sun protection factor was 48.5 (range, 30-100; SD, 48.5). There was a mean of 17.5 ingredients and a mean of 1.1 allergens in products. On average, products marketed as "sensitive skin" were not only significantly more expensive ($8.90 vs $3.50 per ounce, P = 0.01) but also were significantly more likely to not contain any allergens (36.0%, n = 18 vs 12%, n = 6; P = 0.05). Products with mineral-only UV blockers were significantly less likely to have any allergen when compared with products that had chemical UV blockers (5.6%, n = 1 vs 94.4%, n = 17; P = 0.02).The current market of pediatric sunscreens varies significantly in price, marketing claims, and active ingredients. Products marked as suitable for sensitive skin had significantly fewer allergens, but a majority of these products still had at least one allergen. Many sunscreens contain contact allergens, which is an important selection consideration.

Alopecia areata (AA) is an autoimmune disorder characterized by well-demarcated patches of hair loss with preservation of the hair follicle (HF). It generally is a nonscarring alopecia that can be extensive and refractory to treatment. We propose modification to an already widely used first-line treatment by diluting intralesional triamcinolone acetonide (ILTA) to 2.5 mg/mL in 1% lidocaine and epinephrine 1:100,000 in place of normal saline (NS). Our 2 cases of severe AA are among many in our practice that responded with seemingly permanent hair regrowth using this novel combination regimen. We hypothesize that local vasoconstriction due to epinephrine potentiates the ILTA and that epinephrine also may play an independent role.

Hidradenitis suppurativa (HS) is a chronic inflammatory often recalcitrant to treatment. There is a lack of an updated systematic data review for infliximab use in HS. We conducted a systematic review and meta-analysis of literature on infliximab in HS. This study was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was pre-registered on PROSPERO (CRD42021283596). In 9/2021, MEDLINE and EMBASE were systematically searched for articles on infliximab in HS. Non-English, duplicate, and studies with5 HS patients were excluded. Study quality was assessed utilizing Cochrane Risk of Bias for prospective trials and Newcastle-Ottawa Scale for cohort studies. Random effects meta-analytical model, Cochran's Q statistic, and I squared index were performed. Nineteen articles (314 patients) met inclusion criteria (six prospective, 13 retrospective studies). All patients with HS severity data available (n = 299) had moderate-to-severe disease. Outcome measures used for meta-analysis of the pooled response rate were largely based on clinician reported outcomes (16 studies). One utilized both clinician and patient assessment. Two utilized patient-reported response alone. The pooled response rate of HS patients to infliximab was 83% (95% CI, 0.71-0.91). The most common adverse events (AEs) included non-serious infections (13.2%) and infusion reaction (2.9%). The rate of serious AEs was 2.9%. Study limitations include the small number of prospective studies and heterogeneity between studies. Overall, infliximab is an effective treatment for moderate-to-severe HS. Efficacy of infliximab in HS should be compared to other biologics in larger, randomized controlled trials.

Hidradenitis suppurativa (HS) is a chronic, progressive inflammatory skin disease that is often recalcitrant to multiple treatments. In determining biologic candidacy for patients with HS, we propose a paradigm shift away from Hurley staging and towards consideration of other variables. Biologics represent a long-term treatment option for HS that may serve as a disease-modifying agent. These medications are typically initiated in patients with moderate to severe disease, which, based on inclusion criteria in clinical trials, is often defined as Hurley stage II or III disease, at which point irreversible tissue damage has already occurred. In real-world clinical settings, these considerations include treatments tried and failed, predicted disease trajectory, disease characteristics beyond lesion type, impact of disease on patients' functional status and quality of life, and patient comorbidities, venturing away from the limitations of Hurley stage designations. Future clinical trials may benefit from inclusion of recalcitrant Hurley stage I patients, which may then re-shape treatment guidelines and insurance coverage and improve patient access to biologic treatments.

Hidradenitis suppurativa (HS) is an inflammatory dermatosis for which the treatment paradigm is rapidly expanding. We aimed to identify HS patient perspectives and barriers on biologics.An anonymous survey was distributed between 10/2021 and 1/2022 through HS support groups. Data regarding demographics and perspectives on biologics were collected and analyzed.Of the 196 respondents, 92% were female (180/196) and 75% were white (147/196). 89.3% had Hurley stage 2/3 HS (102/195). The primary healthcare provider (HCP) for HS in 65% (128/196) of patients was a dermatologist, with 12% (23/196) seen at an HS specialty clinic. Most respondents never tried a biologic medicine (62%, 118/192). The top barriers to biologics were fear of side effects (61%, 109/179), high cost/lack of insurance coverage (46%, 83/179), frequency of weekly injections (32%, 58/179). Respondents reporting their main HCP as a non-dermatologist (4.11 vs 3.0,Our results highlight the importance of specialty care in the education and implementation of biologics. Patients may benefit from comprehensive discussion prior to starting biologics.

The waxing-and-waning nature of hidradenitis suppurativa (HS), complex treatment plans, along with variable responsiveness to therapy, can create management challenges for patients. In this pilot cross-over randomized controlled trial, we aim to evaluate the effectiveness a HS-written action plan (HSWAP) on patient disease understanding and confidence in recognizing flares and adjusting management. Participants were randomized into a pre-crossover control group that received a verbal consultation (VC)-only, and an intervention group which received the VC + HSWAP. The pre-crossover control group then crossed over (post-crossover control) to also receive the VC + HSWAP (ClinicalTrials.gov Identifier: NCT04600375). Patient comprehension of their disease and management steps was high after both a thorough VC and HSWAPs. However, the majority of patients prefer receiving both a VC and a HSWAP. After the addition of the HSWAP, pre-crossover control group patients’ understanding and confidence of their disease and management plan increased across all surveyed questions.

Hidradenitis suppurativa (HS) is a chronic, often debilitating skin condition that disproportionately impacts women in the United States and other Western nations. Dermatologists should consider incorporating palliative care principles into HS management to optimize care. Primary palliative care principles include utilizing evidence-based frameworks in serious illness communication, acknowledging and addressing physical and psychosocial suffering, recognizing and validating the burden of disease in partners, families, and caregivers, and engaging in collaborative care coordination. Certain patients may also benefit from outpatient, or sometimes inpatient, palliative care specialist collaboration, such as those with refractory HS and superimposed challenging psychosocial dynamics and symptom burden. Through integration of these palliative care domains into HS care, dermatologists can optimize their ability to provide comprehensive and compassionate care for patients suffering with this disease.

Hyperhidrosis impairs quality of life (QOL) in hidradenitis suppurativa (HS) patients and may exacerbate HS. However, there is limited literature on whether hyperhidrosis treatments improve HS disease. To systematically review literature on efficacy and tolerability of hyperhidrosis treatments in HS patients. In May 2021, MEDLINE and EMBASE databases were systematically searched by two reviewers per PRISMA guidelines for articles on hyperhidrosis and HS. Sixteen articles met inclusion criteria (2 randomized controlled trials [RCTs], one case-control study, three cross-sectional studies, 10 case-studies/series), encompassing 252 HS patients across studies. They examined botulinum toxin A (BTX-A) (n = 6) and B (BTX-B) (n = 1), suction-curettage (n = 1), diode laser (n = 1), and microwave-based energy device (MED) (n = 3). Overall, BTX treatments improve HS severity, QOL, hyperhidrosis, and were well-tolerated. Suction-curettage did not improve disease. One HS patient tolerated diode laser well, with improvement in sweating and HS. One RCT studying MED was discontinued due to adverse events. Two studies reported MED-induced HS. BTX was overall helpful in HS patients, including in patients without concomitant hyperhidrosis. However, more prospective studies are needed to examine its utility in HS. There is potential harm of MEDs in HS. Most studies examining hyperhidrosis treatments in HS patients are low level of evidence. Larger RCTs should examine the efficacy and tolerability of hyperhidrosis treatments in HS.

Introduction: Pediatric hidradenitis suppurativa (HS) is an understudied condition, and the literature describing the provider landscape for this disease is limited. We aim to characterize healthcare utilization in a cohort of pediatric HS patients at an academic institution. Methods: Patients diagnosed with HS before age 18 were identified via retrospective chart review using ICD-9/10 codes for HS. Data on demographics and HS providers were collected. Results: We found that half of the pediatric HS patients first presented to primary care with their HS symptoms. There was a mean delay in diagnosis of 2 years. Dermatologists and pediatricians were the principal HS care providers, and dermatologists most frequently prescribed treatment or procedures (63%). We also found a low rate of utilization of the HS specialty clinic (11%). Females, patients with more severe disease, and patients with earlier age of onset were more likely to be seen by a dermatologist. Conclusions: Dermatologists play a pivotal role in pediatric HS management as principal care providers for patients. Increasing HS awareness among primary care providers, including pediatricians, is critical for early diagnosis and initiation of treatment.

Ichthyotherapy or fish pedicure is a unique form of biotherapy in which the species Garra rufa or doctor fish is used to exfoliate the skin and potentially aid in healing diseases, such as psoriasis. The practice has gained popularity since its origins in Kangal Fish Spring in Turkey; however, safety concerns, especially among immunocompromised patients, remain. This article reviews the studied dermatological benefits of ichthyotherapy and theorized mechanisms of action. Included are cases examining both infectious and noninfectious complications of this procedure. This review highlights the need to educate susceptible patients about possible adverse effects and the need for more studies assessing this procedure.

Dermatologic procedures are performed under varying degrees of antisepsis, and no clear guidelines exist regarding the role of the aseptic technique in dermatology. This review aims to clarify the terminology surrounding surgical asepsis and examines the importance of various components of the aseptic technique in cutaneous surgery. Included are studies examining optimal glove type, surgical instruments, skin antisepsis, and cost-reducing protocols. Our review highlights that most dermatology procedures are not performed under completely sterile conditions due to the lack of environmental and foot traffic controls in dermatology offices. In addition, for some outpatient procedures, such as for minor excisions and Mohs surgery before reconstruction, elements of the clean technique can be used without increasing infection rates. However, data on the feasibility of a clean protocol for Mohs reconstruction is conflicting. Future prospective, randomized trials analyzing various components of the aseptic technique in dermatology are greatly needed so that guidelines can be established for practicing dermatologists.