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BackgroundHidradenitis suppurativa (HS) is associated with comorbidities that contribute to poor health, impaired life quality, and mortality risk.ObjectiveTo provide evidence-based screening recommendations for comorbidities linked to HS.MethodsSystematic reviews were performed to summarize evidence on the prevalence and incidence of 30 comorbidities in patients with HS relative to the general population. The screening recommendation for each comorbidity was informed by the consistency and quality of existing studies, disease prevalence, and magnitude of association, as well as benefits, harms, and feasibility of screening. The level of evidence and strength of corresponding screening recommendation were graded by using the Strength of Recommendation Taxonomy (SORT) criteria.ResultsScreening is recommended for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking, substance use disorder, polycystic ovary syndrome, obesity, dyslipidemia, diabetes mellitus, metabolic syndrome, hypertension, cardiovascular disease, inflammatory bowel disease, spondyloarthritis, and sexual dysfunction. It is also recommended to screen patients with Down syndrome for HS. The decision to screen for specific comorbidities may vary with patient risk factors. The role of the dermatologist in screening varies according to comorbidity.LimitationsScreening recommendations represent one component of a comprehensive care strategy.ConclusionsDermatologists should support screening efforts to identify comorbid conditions in HS.

Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.

Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are provided.

In November 2017, a formal debate on the role of bacteria in the pathogenesis of hidradenitis suppurativa (HS) was held at the 2nd Symposium on Hidradenitis Suppurativa Advances (SHSA) in Detroit, Michigan. In this report, we present both sides of the argument as debated at the SHSA meeting and then discuss the potential role of bacteria as classic infectious pathogens versus an alternative pathogenic role as activators of dysregulated commensal bacterial-host interactions. Although there was consensus that bacteria play a role in pathogenesis and thus are pathogenic, there was a compelling discussion about whether bacteria in HS incite an infectious disease as we classically understand it or whether bacteria might play a different role in HS pathogenesis.

The 2nd Annual Symposium on Hidradenitis Suppurativa Advances (SHSA) took place on 03-05 November 2017 in Detroit, Michigan, USA. This symposium was a joint meeting of the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA, and the Canadian Hidradenitis Suppurativa Foundation (CHSF). This was the second annual meeting of the SHSA with experts from different disciplines arriving from North America, Europe and Australia, in a joint aim to discuss most recent innovations, practical challenges and potential solutions to issues related in the management and care of Hidradenitis Suppurativa patients. The last session involved clinicians, patients and their families in an effort to educate them more about the disease.

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 (deroofng, 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 faps and 33 by secondary intention healing. Local recurrence occurred in 18% of primary closures and 18% of secondary intention closures (p = 0.98, [chi square] 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. Contexte : L'hidradenite suppuree (HS) est une maladie invalidante chronique du follicule pilo-sebace qui affecte la peau principalement au niveau de l'aisselle, de l'aine, du pli sous-mammaire et du siege. Une intervention chirurgicale pourrait etre une option appropriee dans certains cas, mais il y a un risque de recurrence. Le but de cette etude etait d'evaluer les resultats d'une excision locale large (ELL) jusqu'aux tissus adipeux sous-cutanes sains suivie de cicatrisation secondaire chez des patients atteints d'HS recevant concomitamment des soins chirurgicaux et dermatologiques. Methodes : Nous avons procede a une revue retrospective de 192 consultations consecutives pour HS dans un service de chirurgie generale et nous avons recense les patients traites par ELL. Les cas impliquant des interventions mineures (par incisiondrainage) ont ete exclus. Les donnees demographiques, le site chirurgical, la methode de suture, les complications et les recurrences ont ete enregistres a partir des dossiers des patients. Nous avons aussi procede a une revue de la litterature sur les interventions chirurgicales pour l'HS. Resultats : En tout, 66 patients ont subi 133 interventions d'ELL jusqu'aux tissus adipeux sous-cutanes sains. Tous les patients prenaient concomitamment un traitement medicamenteux sous la supervision d'un dermatologue. Aucun des traitements medicamenteux, y compris les agents biologiques, n'a ete suspendu ou interrompu pour la chirurgie. Cent interventions ont ete refermees principalement par lambeaux de rotation ou d'avancement et 33 par cicatrisation secondaire. Les recurrences locales ont affecte 18 % des fermetures primaires et 18 % des fermetures par cicatrisation secondaire (p = 0,98, test du [chi square], aucune difference entre les groupes). Un patient soumis a la cicatrisation secondaire est retourne aux urgences pour un saignement; 34 % des patients ayant subi une fermeture primaire ont presente un certain degre de dehiscence (23 % majeure, 11 % mineure). Deux patients ayant une atteinte axillaire ont connu des restrictions dans leur capacite de lever les bras et ont du faire de la physiotherapie. Le suivi median a ete de 14,5 (eventail de 1 a 55) mois. Conclusion : La resection jusqu'aux tissus adipeux sous-cutanes sains durant l'ELL permet de maitriser la maladie aussi bien que les resections plus profondes, mais simplife les soins., Hidradenitis suppurativa (HS) is a chronic disease affecting the folliculopilosebaceous unit. (1) The disease was roughly divided into 3 surgical stages by Hurley, but newer staging systems have been described [...]

The article present a case study of a 21-year-old man with several years of recurrent painful cysts and scarring, accompanied by severe pruritus and malodorous purulent discharge in several areas, including the axillae, buttocks, and gluteal cleft. It mentions the diagnosis of hidradenitis suppurativa is clinical with the presence of characteristic morphologies that affect typical areas of the skin. It also mentions a carbuncle is a cluster of abscesses under the surface of the skin.

Competing Interests: Dr Alavi serves as a consultant for Abbvie, Bohhinger Ingelheim (BI), InflaRx, Novartis, UCB biopharmaceutical and an Investigator for BI and Processa. Dr Kirby serves as a speaker for AbbVie, Janssen, and UCB; serves on the Advisory Board for AbbVie, Incyte, Novartis; and serve as a consultant for AbbVie, ChemoCentryx, Incyte, Janssen, Moonlake, Novartis, and UCB

The prevalence of chronic wounds is increasing with the aging population, with 1% to 2% of the worldwide population experiencing leg ulcers and positive patch tests reported in up to 75% of this population. With the introduction of modern dressings and compression therapies, clinicians should be cognizant of the potential risk of contact dermatitis in patients with leg ulcers. Contact dermatitis (both allergic and irritant) to wound products may present as maceration, pain, and overall impaired wound healing. Herein, we review the literature on contact dermatitis to wound-care products., (© 2020 Published by Elsevier Inc. on behalf of Women's Dermatologic Society.)