Search

Summary: 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. Respond to this article Linked Comment: Frew and Navrazhina. Br J Dermatol 2019; 181:1121. [ABSTRACT FROM AUTHOR]

Summary: Background: Monitoring disease activity over time is a prerequisite for clinical practice and research. Valid and reliable outcome measurement instruments (OMIs) and staging systems provide researchers and clinicians with benchmark tools to assess the primary and secondary outcomes of interventional trials and to guide treatment selection properly. Objectives: To investigate inter‐rater reliability and agreement in instruments currently used in hidradenitis suppurativa (HS), with dermatologists experienced in HS as the rater population of interest. Methods: In a prospective completely balanced design, 24 patients with HS underwent a physical examination by 12 raters (288 assessments) using nine instruments. The results were analysed using generalized linear mixed models. Results: For the staging systems, the study found good inter‐rater reliability for Hurley staging in the axillae and gluteal region, moderate inter‐rater reliability for Hurley staging in the groin and for Physician's Global Assessment, and fair inter‐rater reliability for refined Hurley staging and the International HS Severity Scoring System. For all the tested OMIs, the observed intervals for limits of agreement were very wide relative to the ranges of the scales. Conclusions: The very wide intervals for limits of agreement imply that substantial changes are needed in clinical research in order to rule out measurement error. The results illustrate a difficulty, even for experienced HS experts, to agree on the type and number of lesions when evaluating disease severity. The apparent caveats call for global efforts, such as the HIdradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC) to reach consensus on how best to measure physical signs of HS reliably in randomized trials. What's already known about this topic? Without valid and reliable instruments to measure outcomes, researchers and clinicians lack the necessary benchmarks to assess primary and secondary end points of interventional trials properly.Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease.Several outcome measure instruments exist for HS, but their validation is generally incomplete or of relatively low methodological quality. What does this study add? Using a prospective completely balanced design this study examined inter‐rater reliability with HS‐experienced dermatologists as the rater population of interest.The study did not find very good reliability for any included instrument or lesion counts.This study illustrates the difficulty in finding agreement on the type and number of HS lesions, even among experts.The results question whether physical signs are best measured by a traditional physician lesion count instrument. What are the clinical implications of this work? For staging, Hurley staging and physician global visual analogue scale proved to be acceptable instruments in terms of inter‐rater reliability.For the instruments designed to measure changes in health status, our study illustrates how difficult it is, even for experts, to measure the physical signs of HS using a simple rater counting.Consequently, other assessment methods of physicals signs, such as ultrasound evaluation, require consideration. Linked Comment: Oosterhaven. Br J Dermatol 2019; 181:438–439. Plain language summary available online Respond to this article [ABSTRACT FROM AUTHOR]

The article discusses the results of a study aimed at exploring the delay in diagnosis for patients with hidradenitis suppurativa (HS) on an international level. Findings reveal that patients with HS have a longer delay in diagnosis than patients with psoriasis and that the relationship between the clinical severity and duration of delay is impacted by the evolution of the disease.

Summary: 化脓性汗腺炎 (HS) 是一种慢性皮肤病,在皮肤相互接触部位(如腋下和腹股沟)有疼痛性毒疮发作。在全世界,每 1000 人中有约 1 到 40 人受此病影响。当尝试在一项临床试验中测量治疗效果时,会使用所谓的"结局测量量表"。已有一些方法估计存在"多少"疾病。结局测量量表的测量结果应正确且不发生随机变化,显而易见这很重要。之前已证实,HS 试验中使用的结局测量量表缺乏可靠性验证。因此,这项研究旨在明确,在使用 9 种不同的量表时,12 名具有 HS经验的皮肤科医生对 24 名 HS 患者的评分一致性如何。这项研究显示,一种名为 Hurley 分期的量表在评分一致性方面是可接受的量表。但是,Hurley 分期仅适合严重程度分期,以指导各期的最适合治疗。对于指定测量疾病严重程度变化的量表,发现其在评定皮肤科医生之间的一致性低。因此,这些结果引出了以下问题,即基于医生对个体 HS 皮损(受影响斑片)计数的传统量表是否能够最好地测量 HS 身体体征。所以,应当考虑使用如超声等技术的其他 HS 身体体征评估方法。 Linked Article: Thorlacius et al. Br J Dermatol 2019; 181:483–491 [ABSTRACT FROM AUTHOR]

Summary: Hidradenitis suppurativa (HS) is a long‐lasting skin disease with flares of painful boils in areas where skin meets skin, such as the armpits and groins. It affects somewhere between 1 and 40 people out of 1000 worldwide. When trying to measure the effect of a treatment in a clinical trial, so‐called 'outcome measurement instruments' are used. These are ways of estimating 'how much' disease is present. It is obviously important that outcome measurement instruments measure the right thing and do not vary at random. It has previously been shown that outcome measurement instruments used in HS trials lack proof of their reliability. This study therefore aimed to find out how consistently 12 HS‐experienced dermatologists would score 24 patients with HS, using nine different instruments. The study showed that one called Hurley staging was an acceptable instrument in terms of consistency of scores. However, Hurley staging is suited only for severity staging e.g. to guide the most appropriate treatment in each stage. For instruments designed to measure changes in disease severity, low agreement between the rating dermatologists was found. Therefore, the results question whether HS physical signs are best measured by traditional instruments based on a physician counting individual HS lesions (affected patches). As a result, other assessment methods of physical signs in HS, using technology such as ultrasound, should also be considered. Linked Article: Thorlacius et al. Br J Dermatol 2019; 181:483–491 [ABSTRACT FROM AUTHOR]

Purpose. Drug expenditure trends in 2008 and 2009, projected drug expenditures for 2010, and factors likely to influence drug expenditures are discussed. Summary. Various factors are likely to influence drug expenditures in 2010, including drugs in development, the diffusion of new drugs, generic drugs, health care reform, drug safety concerns, and comparative effectiveness research. The increasing availability of important generic drugs continues to moderate growth in drug expenditures. Health care reform initiatives, including the potential for biosimilars legislation, will influence drug expenditures in all settings. From 2007 to 2008, total U.S. drug expenditures increased by 1.8%, with total spending rising from $279.6 billion to $284.7 billion. Growth in drug expenditures in clinics declined to the lowest level in a decade, a 1.0% increase from 2007 to 2008. Hospital drug expenditures increased at a moderate rate of only 2.1% from 2007 to 2008; through the first nine months of 2009, hospital drug expenditures increased by 3.0% compared with the same period in 2008. Conclusion. In 2010, we project a 3-5% increase in drug expenditures in outpatient settings, a 6-8% increase in expenditures for clinic-administered drugs, and a 2-4% increase in hospital drug expenditures. [ABSTRACT FROM AUTHOR]

PURPOSE: Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. SUMMARY: Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. CONCLUSION: In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures. [ABSTRACT FROM AUTHOR]