Search

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases., info:eu-repo/semantics/published

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition with nodules and fistula formation and scarring. It is a debilitating disease with a severe negative impact on quality of life. There is a need for increased knowledge about the social and lifestyle characteristics of patients with HS in general, and pregnant women in particular. Objectives: The aims of this study were to investigate and describe social characteristics and comorbidity in all HS patients in Sweden as well as to study the prevalence of lifestyle factors associated with negative impact on health and pregnancy in Swedish pregnant women with HS. Methods: A registry-based cross-sectional study was performed by record linkage between Swedish registers covering the entire population. A cohort of 13,538 HS patients diagnosed with HS in specialised care during the years 2001–2014 and a subgroup of 1,368 HS patients who had undergone pregnancy during 2010–2015 were defined and described. Aggregated public data on the entire Swedish population and all pregnancies in 2014 were described for reference. Results: The HS population had an average age of 44 years on December 31, 2014. The prevalence of HS was 0.14%. In comparison to the Swedish reference population the HS patients were more often women, unmarried (36 vs. 44% married), and had lower education (68 vs. 82% with an upper-secondary school degree or higher) and lower income (39 vs. 16% made SEK Conclusions: The results from this comprehensive characterisation of Swedish HS patients may be used to improve preventive measures, information, and care for this vulnerable group.

SUMMARY: BACKGROUND: Validated, reliable, globally-accepted outcome measurement instruments for hidradenitis suppurativa (HS) are needed. Current tools to measure the physical signs domain for HS rely on lesion counts that are time-consuming and unreliable. OBJECTIVES: To assess the reliability and validity of the Hidradenitis Suppurativa Area and Severity Index Revised (HASI-R) tool, a novel method for assessing HS severity, incorporating signs of inflammation, and body surface area (BSA) involved. METHODS: The measurement properties of the HASI-R tool were evaluated. The tool was created by combining the previously published HASI and Severity and Area Score for Hidradenitis (SASH) instruments. Twenty raters evaluated 15 HS patients in a hospital-based ambulatory dermatology clinic. The objectives of the study were to assess inter-rater and intra-rater reliability of the HASI-R and its components, as well as its construct and known groups validity. Existing lesion count-based clinician-reported measures of HS and their components were also assessed. Raters were also asked their preferences regarding the various HS severity assessment tools. RESULTS: The HASI-R had moderate inter-rater reliability (ICC = 0.60). This was better than all other HS physical sign outcome measures evaluated, which had poor inter-rater reliability (ICC < 0.5). HASI-R had the highest intra-rater reliability (ICC = 0.91). The HASI-R had good construct validity and demonstrated known groups validity. The HASI-R was also the most preferred tool by all raters. CONCLUSIONS: Results from the clinometric assessment of the HASI-R are encouraging, and support continued evaluation of this clinician-reported outcome measure.

Background\ud\udA core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed‐upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of the literature and a healthcare professional survey, and initial votes had been cast in two e‐Delphi surveys. In this manuscript, we describe two in‐person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items.\ud\ud\udObjectives\ud\udTo consider which items from a long list of candidate items to exclude and which to cluster into outcome domains.\ud\ud\udMethods\ud\udThe study used an international and multistakeholder approach, involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey.\ud\ud\udResults\ud\udForty‐one individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS‐specific quality of life, satisfaction, symptoms, pain and global assessments.\ud\ud\udConclusions\ud\udThe HISTORIC consensus meetings I and II will be followed by further e‐Delphi rounds to finalize the core domain set, building on the work of the in‐person consensus meetings.

Background: Cure of acute leukemia after transplantation is mediated by the grafted cells. We investigated the graft-versus-leukemia effect (GVL) in patients with cutaneous acute graft-versus-host disease (GVHD) treated with photochemotherapy (psoralen and ultraviolet light type A). Method: Forty-seven patients with acute leukemia were followed 5,000 days after transplantation to assess survival and GVL by multivariate analysis. The primary predictor was time to treatment of cutaneous acute GVHD by photochemotherapy separated into treatment start during the first week of acute GVHD versus after the first week of acute GVHD. Results: Photochemotherapy started after the first week of acute GVHD predicted GVL with a hazard ratio (HR) of 3.94 (95% confidence interval, CI, 1.67-9.33, p = 0.0018) and survival with preserved GVL with an HR of 2.63 (95% CI 1.30-5.32, p = 0.007). The effects on GVL and survival with preserved GVL were present regardless of whether the patients were transplanted in remission or relapse (p < 0.05). Chronic GVHD came earlier in the group that started photochemotherapy after 1 week of acute GHVD, but chronic GVHD did not increase the GVL. Conclusion: The timing of photochemotherapy after cutaneous acute GVHD may direct the GVL and predict long-term leukemia-free survival.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle. Standard practice of managing acute flares with corticosteroid injection lacks scientific evidence.We sought to assess the outcomes of routine treatment using intralesional triamcinolone (triamcinolone acetonide 10 mg/mL) in the management of acute flares in HS.This was a prospective case series evaluating the effect of intralesional corticosteroids for alleviation of acute flares in HS. Physician- and patient-reported outcomes were noted.Significant reductions in physician-assessed erythema (median score from 2-1, P .0001), edema (median score from 2-1, P .0001), suppuration (median score from 2-1, P .0001), and size (median score from 3-1, P .0001) was demonstrated at follow-up. A significant difference in patient-reported pain visual analog scale scores occurred after 1 day (from 5.5-2.3, P .005) and from day 1 to day 2 (from 2.3-1.4, P .002).Small study size, open single-arm design, and short follow-up time are the limitations of this study.Intralesional injection of corticosteroids is perceived as beneficial by physicians and patients in the management of HS flares by reducing pain after 1 day and signs of inflammation approximately 7 days later.

The water content in the epidermis correlates with different pathologic states of the skin; thus its assessment can aid the diagnosis and monitoring of conditions such as inflammation, edema, burns, and skin cancer. A micromachined microwave near-field probe, operating from 90 to 106 GHz, which, in contrast to earlier used microwave probes, has a minimized sensing area of $0.6\,\,\text {mm} \times 0.5$ mm and an optimized sensing depth of 400 $\mu \text{m}$ in tissue, has been developed and technically characterized by the authors earlier. This letter reports on the long-term monitoring of sodium lauryl sulfate (SLS)-induced skin irritations with the micromachined microwave probe. Aqueous solutions with 1%, 2%, 5%, and 10% SLS were applied to the forearm of a volunteer for 24 h and microwave reflection measurements were taken before and during 11 days after the SLS application. For all SLS-treated spots the microwave absorption reached the highest levels of 4 to 7 days after SLS application and afterward converged toward baseline levels again. The observed biphasic progression of the microwave reflection signal agrees well with trends from the literature for capacitance measurements and for epidermal thickness and signal attenuation in optical coherence tomography after SLS exposure. The measurements indicate that the microwave probe is very suitable to determine changes in the water content in the epidermis and can aid in the diagnosis of pathologic conditions including skin cancer.

BACKGROUND: Superficial fungal infections are common. It is important to confirm the clinical diagnosis by mycological laboratory methods before initiating systemic antifungal treatment, especially as antifungal sensitivity and in vitro susceptibility may differ between different genera and species. For many years, the gold standard for diagnosis of superficial fungal infections has been direct fungal detection in the clinical specimen (microscopy) supplemented by culturing. Lately, newer molecular based methods for fungal identification have been developed.OBJECTIVE: This study was initiated to focus on the current usage of mycological diagnostics for superficial fungal infections by dermatologists. It was designed to investigate whether it was necessary to differentiate between initial diagnostic tests and those used at treatment follow-up in specific superficial fungal infections.METHODS: An online questionnaire was distributed among members of the EADV mycology Task Force and other dermatologists with a special interest in mycology and nail disease.RESULTS: The survey was distributed to 62 dermatologists of whom 38 (61%) completed the whole survey, 7 (11%) partially completed and 17 (27%) did not respond. Nearly, all respondents (82-100%) said that ideally they would use the result of direct microscopy (or histology) combined with a genus/species directed treatment of onychomycosis, dermatophytosis, Candida- and Malassezia-related infections. The majority of the dermatologists used a combination of clinical assessment and direct microscopy for treatment assessment and the viability of the fungus was considered more important at this visit than when initiating the treatment. Molecular based methods were not available for all responders.CONCLUSION: The available diagnostic methods are heterogeneous and their usage differs between different practices as well as between countries. The survey confirmed that dermatologists find it important to make a mycological diagnosis, particularly prior to starting oral antifungal treatment in order to confirm the diagnose and target the therapy according to genus and species.

Mastocytosis is a rare and multifaceted disease group characterized by mast cell accumulation in the skin and/or internal organs. In its most common form solitary or widespread, often itchy, red-brown skin lesions appear in childhood or during adulthood (cutaneous mastocytosis). The skin lesions are not always easy to recognize by medical professionals; hence, a correct diagnosis is often delayed. In children, the lesions tend to resolve before puberty, whereas most post-adolescent patients experience a chronic course combined with extra-cutaneous mast cell infiltration (systemic mastocytosis). Therefore, adult patients with cutaneous mastocytosis should be examined for signs of systemic involvement. This article describes the symptoms and signs in cutaneous mastocytosis, and provides guidelines based on international consensus documents. In addition, a newly updated classification of different forms of cutaneous mastocytosis is given.

Although the clinical presentation of Hidradenitis Suppurativa (HS) is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacterial specimens as well as biofilm formation in lesional HS skin. Consistent findings of Gram-positive cocci and -rods including Staphylococus aureus, Coagulase-negative staphylococci (CoNS) and Corynebacterium species (spp) in deep tissue samples have been demonstrated in HS. Although efficacy of antibiotics, i.e., rifampicin, clindamycin or tetracycline may support a microbial role in disease pathogenesis, the most often isolated bacterial specimens are commensal bacteria (CoNS).

Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the 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 axillae, inguinal and anogenital regions. A mean disease incidence of 6.0 per 100,000 person-years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The central pathogenic event in HS is believed to be the occlusion of the upper part of the hair follicle leading to a perifollicular lympho-histiocytic inflammation. A highly significant association between the prevalence of HS and current smoking (Odds ratio 12.55) and overweight (Odds ratio 1.1 for each body mass index unit) has been documented. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by classical surgery or LASER techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus rifampicine, tetracyclines), acitretin and biologics (adalimumab, infliximab). A Hurley severity grade-relevant treatment of HS is recommended by the expert group following a treatment algorithm. Adjuvant measurements, such as pain management, treatment of superinfections, weight loss and tobacco abstinence have to be considered.

Introduction Overweight is a well established risk factor for Hidradenitis Suppurativa (HS). In this cross sectional study, we compare HS patients with a high body mass index (BMI) with HS patients with a low BMI to investigate differences in disease characteristics. Materials and method Patients were recruited from 17 dermatological centers from 4 continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35. Results Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient reported severity, p < 0.001 for all). There was no difference in smoking (p = 0.783) nor in family history (p = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (p < 0.001, for each). For low BMI patients, an increase in BMI significantly increased patient reported severity (p < 0.001). For patients with a high BMI, number of pack years significantly increased patient reported severity (p = 0.001). Cluster analysis of eruption patterns were location specific for low BMI patients but severity specific for high BMI patients. Discussion Patients with a low and high body mass index could represent two clinically different subtypes. We suggest a non-linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change. This article is protected by copyright. All rights reserved.

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.

Hidradenitis suppurativa (acne inverse) (HS) is a chronic skin disease primarily affecting hair follicles. The aetiology of HS is unknown, but infection is believed to play some role. This retrospective study investigated the microbial colonization directly in skin appendices in HS skin samples. Archival samples from 27 patients with HS were screened by immunofluorescence labelling with monoclonal and polyclonal antibodies against Gram-positive bacteria, Propionibacterium acnes and Propionibacterium granulosum. Fluorescence in situ hybridization was used for further species identification of Staphylococcus spp. Overall, 17 patients (63%) were found positive for bacterial colonization. Of these, 15 showed colonization in hair follicles and/or sinus tracts. The most commonly identified bacteria were DAPI labelled coccoids that were seen in 71% of the positive patients in the form of biofilms and microcolonies. P. acnes was found as biofilms in hair follicles of two patients. Staphylococcus aureus and coagulase-negative staphylococci were not detected in any sample. The results of this study indicate a common bacterial presence in HS skin lesions. Bacterial biofilms are not uncommon and their pathogenic role needs further evaluation.

More than 2 million cases of skin cancer are diagnosed annually in the United States, which makes it the most common form of cancer in that country. Early detection of cancer usually results in less extensive treatment and better outcome for the patient. Millimeter wave silicon micromachined waveguide probe is foreseen as an aid for skin diagnosis, which is currently based on visual inspection followed by biopsy, in cases where the macroscopical picture raises suspicion of malignancy.Demonstration of the discrimination potential of tissues of different water content using a novel micromachined silicon waveguide probe. Secondarily, the silicon probe miniaturization till an inspection area of 600 × 200 μm2, representing a drastic reduction by 96.3% of the probing area, in comparison with a conventional WR-10 waveguide. The high planar resolution is required for histology and early-state skin-cancer detection.To evaluate the probe three phantoms with different water contents, i.e. 50%, 75% and 95%, mimicking dielectric properties of human skin were characterized in the frequency range of 95-105 GHz. The complex permittivity values of the skin are obtained from the variation in frequency and amplitude of the reflection coefficient (S11), measured with a Vector Network Analyzer (VNA), by comparison with finite elements simulations of the measurement set-up, using the commercially available software, HFSS. The expected frequency variation is calculated with HFSS and is based on extrapolated complex permittivities, using one relaxation Debye model from permittivity measurements obtained using the Agilent probe.Millimeter wave reflection measurements were performed using the probe in the frequency range of 95-105 GHz with three phantoms materials and air. Intermediate measurement results are in good agreement with HFSS simulations, based on the extrapolated complex permittivity. The resonance frequency lowers, from the idle situation when it is probing air, respectively by 0.7, 1.2 and 4.26 GHz when a phantom material of 50%, 75% and 95% water content is measured.The results of the measurements in our laboratory set-up with three different phantoms indicate that the probe may be able to discriminate between normal and pathological skin tissue, improving the spatial resolution in histology and on skin measurements, due to the highly reduced area of probing.The probe has the potential to discriminate between normal and pathological skin tissue. Further, improved information, compared to the optical histological inspection can be obtained, i.e. the complex permittivity characterization is obtained with a high resolution, due to the highly reduced measurement area of the probe tip.

A micromachined millimeter-wave probe, optimized for early-stage skin tumor diagnosis has been verified using a murine skin cancer model. Malignant melanoma tumors are clearly distinguishable from surrounding healthy tissue, since the difference in S 11 between a malignant melanoma skin tumor and surrounding healthy tissue is 6.7 times larger than typical standard deviations of measurements on the same spot. Furthermore, the probe has an 8 times higher selectivity to a tumor growing in the skin close to the surface as compared to a subcutaneous tumor buried beneath a thick healthy tissue layer. This confirms the optimized sensitivity of the probe to the targeted upper portion of the skin, in which skin tumor growth starts in malignant melanoma patients.

Background/aims: During previous studies on the electrical impedance of the skin, we formulated a set of four physical indices that could be used to distinguish between the cutaneous effects produced by different chemical irritants. We now employ the electrical impedance technique to compare the properties of different anatomical areas of the skin, using the same set of indices. Methods: Investigations were performed on 131 healthy volunteers, who were divided into four groups on the basis of age and sex. Readings of electrical impedance were taken from ten different regions over the body, and transepidermal water loss was measured for comparison. Results: Baseline values of electrical impedance of the skin were shown to vary, depending on the site. Age was also found to exert a major influence, causing an increase in the indices related to magnitude (MIX, RIX, and IMIX) with increasing age, and a decrease in that related to phase (PIX), while sex had only a marginal effect. Conclusions: As with other non-invasive techniques, baseline characteristics differ from place to place over the body surface, and age is another important determining factor.

Onychomycosis is difficult to cure as this requires eradication of the primary infection and protection of new areas of growth from reinfection. A new topical treatment (K101) has been developed. The aim of this study was to assess the efficacy, safety and tolerability of K101 treatment of distal subungual onychomycosis. This was a 24-week (plus 2-week washout), multicentre, randomised, double-blind, placebo-controlled study in 493 patients with distal subungual onychomycosis (K101, n = 346; placebo, n = 147), stratified according to degree of nail involvement. More patients with ≤50% nail involvement achieved the primary endpoint (mycological cure after 26 weeks) in the K101 group (27.2%) than placebo (10.4%; P = 0.0012). Proportions for patients with 51-75% involvement were 19.1% for K101 and 7.0% for placebo (not significant). More patients applying K101 than placebo judged that their condition had improved from week 2 (P = 0.0148) to week 24 (P = 0.0004). No safety issues were identified. K101 provides early visible improvements in nail appearance and a clinically meaningful antifungal activity.

Peripheral nerve fibres are often increased in lesional skin of atopic dermatitis (AD) patients. We attempted to study nerve fibre profiles, using PGP 9.5 as neuronal marker, in early AD lesions in 10 patients, as compared to non-lesional skin in the same patients and skin from healthy controls. The number of PGP 9.5-positive nerve fibre profiles was not different in the biopsies taken from normal-looking AD skin and healthy controls. The total number of PGP 9.5-positive nerve fibre profiles in the whole skin sections was higher in both the epidermis and the dermis in the group of skin biopsies taken from early lesions of AD patients. Further, the number of epidermal PGP 9.5-positive dendritic cells was increased in AD skin. It seems reasonable that PGP 9.5-positive nerve fibres and PGP 9.5-positive dendritic cells have pathological roles in AD. The findings might serve as a basis for further studies in evaluating novel diagnostic and therapeutic approaches.

Alternative treatments for seborrhoeic dermatitis are needed because of the increasing risk of anti-fungal resistance to existing therapies. To investigate the efficacy, safety and tolerability of topical scalp treatment with K301 solution. Two multi-centre, randomised, double-blind studies were conducted. Study I: 4 weeks of once-daily treatment with either one form of K301 (a or b) or placebo, followed by 4 weeks of maintenance treatment three times-per-week. Study II: 4 weeks of K301 (a) or placebo once-daily. Study I: 98 patients enrolled (K301a + b, n = 51; placebo, n = 47) and 83 completed; 201 entered Study II (K301a, n = 136; placebo, n = 65) and 195 completed. Erythema and desquamation sum score at 4 weeks, mean (SD) values were 2.4 (2.0) for K301a + b and 3.2 (2.2) for placebo in Study I (P = 0.025) and 2.5 (1.9) for K301a and 3.2 (1.8) for placebo in Study II (not significant). In both studies, 4-week desquamation scores were significantly improved for K301 vs. placebo (P < 0.05). Both studies showed significant improvements in symptomatic investigator and patient assessments for K301 over placebo after 4 weeks (P < 0.05). Treatment-related adverse events were generally mild and included some smarting or burning upon application. The K301 was well tolerated and associated with clinically meaningful improvements in seborrhoeic dermatitis endpoints.

Summary Background Hidradenitis suppurativa (HS) is a chronic recurrent disease with scars and sinus tract formation that causes substantial impact on quality of life. For evaluation of HS and treatment results, a scoring system for disease severity (Hidradenitis Suppurativa Score, HSS) has been proposed. Objectives To describe the interobserver reliability of the HSS and further to document its correlation with risk factors and other measures of disease severity. Methods Sixty-one consecutive patients with HS, referred to a clinical centre with special interest in the disease, were scored according to the HSS protocol: eight patients by four dermatologists together, 23 patients by all four observers independently and 30 patients by a single observer. Interobserver variability in HSS between the four observers was investigated in the group of 23 patients. Patients’ reports of weight and height, smoking habits etc., were collected, as well as Dermatology Life Quality Index (DLQI) questionnaires. Results The interobserver concordance of HSS was 0·95. Median (interquartile range, IQR) HSS for all patients was 40 (18–73); women 39 (16–68); men 60·5 (30–95). Median (IQR) HSS for nonsmokers was 26 (12–65); former smokers 30 (10–56); smokers 44 (26–108). Median (IQR) HSS for normal weight patients was 12 (10–30); overweight 43 (25–58); obese 51 (24–95). Mean ± SD DLQI for all patients was 11·3 ± 8·6. Conclusions HSS is simple to use and shows low interobserver variability. The score correlates with suggested risk factors, indicating that it reflects a valid estimation of disease severity.

Background: The precise clinical description of skin lesions observed in some patients with hidradenitis suppurativa (HS) can be extremely difficult. Objective: Establishing a validated glossary of terms allowing the best possible description of lesions observed in HS patients. Material and Methods: Five international experts of HS were to assess a series of 25 photos representing typical lesions of this disorder. For each photo, the experts were asked whether naming of the lesions was possible or not and, if yes, by using which noun. Agreement of their responses was calculated using Fleiss's kappa index. Using a Delphi strategy, photos with disagreement were discussed, and photos were reevaluated on the next day. In case of agreement on the impossibility of naming some clinical situations, new terms, to be included into the glossary, were agreed upon. Results: After the first round of photos, agreement between the experts was poor with a kappa index of only 0.33 (95% CI 0.22-0.46). After extensive discussion of cases with disagreement, the kappa index increased on day 2 to 0.75 (95% CI 0.60-0.87), allowing to conclude on good interobserver agreement on terminology. Furthermore, a few clinical situations were identified in which naming with established semantics is so far not possible. For these situations, the terms ‘multicord', ‘multipore', ‘multitunnel' and ‘retraction' were defined. Discussion: This is the first validation of clinical terms used to describe lesions in patients with HS. This should be helpful in better defining the clinical phenotypes observed in this disorder.

Background: Photochemotherapy may be used to treat cutaneous graft-versus-host disease (GvHD). Animal models show that in the days after photochemotherapy and antigen provocation, cells with an antigen-specific suppressive phenotype are elicited in the lymphoid organs. In GvHD, host antigens are present not only in the skin treated by photochemotherapy but also in the visceral tissues. Objective: The aim of this paper was to evaluate the effect on visceral acute GvHD (aGvHD) of photochemotherapy of the skin. Methods: We retrospectively evaluated 33 patients with aGvHD of the skin, the liver, and/or the gastrointestinal tract treated with photochemotherapy for their aGvHD of the skin and did a long-term follow-up of 10 years on survival. Results: The complete response (CR) to photochemotherapy was 39%, the complete and partial response was 64% and the 6-month survival was 64%. Total body irradiation (TBI) before hematopoietic stem cell transplantation predisposed for CR of aGvHD of the liver and the gastrointestinal tract (p = 0.045). In the TBI group, the accumulated dose (numbers of treatments) for CR of visceral aGvHD increased with the body surface area affected by disease, from 8 (min-max: 5-14) for skin disease stage 1 to 10.5 (6-33) for stage 2 and 13 (11-21) for stage 3 (p = 0.04). Skin disease stage 1 showed a trend to be associated with CR in visceral disease at 28, 56, and 100 days (p = 0.07). Overall CR in visceral disease predicted a better 10-year overall survival (p = 0.0036). Finally, after TBI aGvHD of the gastrointestinal tract without anti-thymocyte globulin (ATG), clearance of T cells and dendritic cells responded better than aGvHD of the liver and aGvHD of the gastrointestinal tract with ATG (p = 0.01). Conclusion: Photochemotherapy after ionizing irradiation regulates the cell-mediated immunity in the viscera, and the systemic efficacy increases when the skin itself is less affected by disease. ATG modulates the regulatory effect of the gastrointestinal tract.

treatment. 21 women and three men. who had suffered from HS for a mean of 13 years (range 1-28 years) and experienced more than three recurrences of suppurating lesions during the year prior to entering the study. The mean follow-up time after CO2 laser surgery was 27 months (range 15-47 months), with elinieal follow-up once or twice a week during the wound-healing period, and then at intervals of 1 - 3 months to evaluate recurrences and assess the end result. The patients' healing time was approximately 4 weeks (range 3-5 weeks). During the follow-up period two patients had recurrences in the treated areas. Twenty-two patients had no recurrences in the treated areas, but in four cases de novo suppurating lesions appeared 5-10 cm beyond the initial sites of surgery. Ten patients had exacerbations of HS lesion(s) in a region other than the treated site. Eight patients did not have any recurrences. Post-surgery results were satisfactory both cosmetically and with regard to quality of life. The CO2 laser stripping-secondary intention technique is a rapid, efficient, and economical method for the treatment of HS. It allows simple treatment of early lesions which would otherwise have been treated using less effective local conservative remedies. Hidradenitis suppurativa (HS. syn. acne inversa^ is a cicatrizing and persistent disease of apocrine glandbearing areas in adults. The severity of the condition varies from a few suppurating lesions to widespread and disabling disease. The aetiology is obscure, but suggested contributory factors include a genetic predisposition, comedones occluding the pilosebaceous apparatus, bacterial infection.^ and hormonal ' factors. Many treatments have been tried, including systemic or local antibiotics, hormones such as oestrogen, progesterone, and cyproterone acetate.* corticosteroids. and retinoids.^ In refractory cases surgery is essential. Simple incision of lesions offers only a short period of relief from pain, is associated with a high recurrence rate, and is therefore of little value in the long term.''"'* The surgical methods employed in individual cases depend on several factors. Simple excision with primary closure, marsupialization. or curettage and electrocoagulation of the sinus tracts may be adequate, but in cases involving the entire apocrine gland-bearing area more extensive surgery is often necessary."* Large wounds resulting from major excisions are either covered by fiaps or meshed grafts, or left to heal by secondary intention.'^~^ We describe an elementary technique using a CO2 laser for the therapy of hidradenitis suppurativa, which aims to produce complete ablation of diseased tissue combined with the greatest possible preservation of healthy tissue.

The purpose of the study was to characterize the resistance mechanism of 36 clindamycin (CL) and erythromycin (EM) resistant Propionibacterium acnes strains and 27 tetracycline (TET) resistant P. acnes isolates, collected from nine European countries, both from acne patients and from patients with different infections. PCR and sequencing of the genes encoding domain V of 23S rRNA for CL and EM resistant strains and 16S rRNA for TET resistant strains were performed. Pulsed-field gel electrophoresis was used as a typing method to establish the relationship between resistance genotypes and pulsed-field types. Several unique resistant genotypes were found to be distributed throughout Europe. P. acnes CL and EM resistant strains carrying one of the mutations within the 23S rRNA were predominantly isolated from Swedish acne patients (64%) compared to other infections (43%), OR=2.33 [CI=1.16-4.69]. Of 36 P. acnes isolates tested, none was found to carry the erm(X) resistance gene. Forty-four percent of TET resistant strains were found to carry a G-C transition in the 16S rRNA of the small ribosomal subunit and all these strains were isolated from Swedish acne patients. MIC of TET among all strains carrying this G-C mutation (n=12) was 32 mg/L and the MIC range for the strains where no mutation was detected ranged from 2 to 8 mg/L. The MIC values of TET were unaffected by the presence of reserpine, a well-known inhibitor of efflux pumps. Those TET resistant strains harbouring the mutation at 16S rRNA were clustered in one pulsotype. For TET resistant strains where no mutation was found, greater variability was noticed. No correlation was noticed between different resistance genotypes of CL and EM resistant strains and pulsed-field types.

The objective was to study the prevalence and antibiotic susceptibility patterns of Propionibacterium acnes strains isolated from patients with moderate to severe acne in Stockholm, Sweden and to determine the diversity of pulsed-field gel electrophoresis types among resistant P. acnes strains. One hundred antibiotic-treated patients and 30 non-antibiotic-treated patients with moderate to severe acne participated in the investigation. Facial, neck and trunk skin samples were taken with the agar gel technique. The susceptibility of P. acnes strains to tetracycline, erythromycin, clindamycin and trimethoprim-sulfamethoxazole was determined by the agar dilution method. The genomic profiles of the resistant strains were determined by pulsed-field gel electrophoresis. In the group of patients treated with antibiotics, resistant P. acnes strains were recovered in 37%, while in the non-antibiotic group of patients the incidence of resistant strains was 13%. Thus antibiotic-resistant P. acnes strains were significantly more often isolated from antibiotic-treated patients with moderate to severe acne than from non-antibiotic-treated patients (odds ratio, 3.8; P=0.01). There was a genetic diversity among the P. acnes strains. Forty-four different patterns of SpeI DNA digests were detected and two predominant clones were found. P. acnes strains exhibited different antibiotic susceptibility patterns and identical genotypes or vice versa. A person can be colonized with different strains with varying degrees of antibiotic resistance. The risk of increased resistance of P. acnes must be considered when treating acne patients with antibiotics, and especially long-term therapy should be avoided.

Patients with eczema and other dry skin conditions use moisturizers also when the skin appears healthy. However, moisturizers have been found to change skin barrier function, and it appears that certain combinations of ingredients increase the skin susceptibility to external agents. In the present randomized and single-blind study, the influence of a urea-containing cream on nickel susceptibility in 35 patients with known allergy to nickel was evaluated. Treatment of the volar forearm twice daily for 20 days with the urea cream reduced transepidermal water loss (TEWL). However, the susceptibility to nickel sulfate was not changed by the cream treatment. Clinical scoring of the skin reaction did not show any difference between the untreated and the cream-treated area. Furthermore, the increase in TEWL did not differ between the areas. The absence in correlation between TEWL and skin susceptibility to nickel suggests different penetration pathways through the skin of water and nickel. Measurement of the skin permeability to other substances than water is pertinent to the understanding of the influence of moisturizers on the skin permeability and, ultimately, to their therapeutic efficacy in the prevention of contact eczema due to exposure to harmful exogenous substances.

Background: Identification of subjects at risk for contact dermatitis by screening tests is desirable in order to adjust the preventive measures to individual skin susceptibility. The present study aimed to examine the effects of basic physiological features, such as baseline electrical imped-ance (IMP) and transepidermal water loss (TEWL), on reactivity to sodium lauryl sulphate (SLS). Methods: On the basis of two previous studies, we re-evaluated the experimental irritant skin reactions (50 μL of 2% SLS in large Finn Chambers for 24 h) on the volar forearms of 29 patients with eczema and 19 healthy controls. Results: We found definite differences in the baseline values of IMP, between the patients and the controls. Moreover, patients with eczema showed higher TEWL and lower MIX values on day 3 after exposure to SLS, which may indicate differences in SLS reactivity. After the study, the biophysical parameters of the eczema patients did not return to baseline, which suggests that their skin heals more slowly than that of normal subjects. Conclusions: Our findings indicate that the IMP technique may help to ‘detect’ chemically vulnerable skin. However, more studies are needed to determine the value of the basal electrical impedance parameters in assessing the risk of developing irritant contact dermatitis.

To assess interlaboratory variability in the measurement of skin electrical impedance (IMP), we evaluated irritant reactions to sodium lauryl sulfate (SLS) (2%) and nonanoic acid (NAA) (40%) in 2 laboratories. We studied the patch test responses in 40 healthy male and female volunteers between 20 and 30 years of age (20 in each laboratory) with an instrument for measuring IMP. 2 other bioengineering methods and visual scoring were also used to facilitate further illumination of any findings. A strict protocol including all details of the measurement procedure was carefully implemented in both laboratories. The skin reactions were evaluated at 23 h and at 3, 7 and 14 days after exposure. Our findings show that both irritants caused distinct dynamic responses detectable with the bioengineering techniques. Interestingly, the IMP baseline values varied between the 2 laboratories. Moreover, at early stages in the development of irritation (day 1), the irritants induced changes in IMP indices in the opposite direction, which accords with the concept of various IMP patterns of contact dermatitis caused by different irritants. Although the absolute values of IMP differed in both laboratories, the dynamic response patterns were the same.

Background and Objective: The allergic contact reaction is a model reaction for studying the cell-mediated immune system of the skin. In this study we use a noninvasive method, electrical impedance (IMP), to compare nickel (Ni) allergic contact reactions with an irritant contact reaction induced by sodium lauryl sulfate, which has already been carefully evaluated with this method. For this purpose, we included only Ni- and sodium lauryl sulfate-induced reactions of very similar appearance. Methods: Various concentrations of Ni sulfate in distilled water were applied on the volar aspect of the forearms of 33 adult women who were allergic to Ni. Assessments were made using visual scoring, a new IMP technique, and transepidermal water loss 3 and 7 days later. Results: In the 19 patients who completed the study, 3 of the 4 impedance indices were significantly lower at the sodium lauryl sulfate sites than at the Ni sites on day 3; ie, the mean magnitude (MIX) ( P ≤ .001), imaginary part (IMAX) ( P ≤ .001), and real part (RIX) indices ( P ≤ .01). Unlike the irritant reactions, no significant increases in transepidermal water loss occurred in the allergic contact reactions. This may be because, in reactions of the studied magnitude, an allergic contact reaction does not significantly affect the epidermis because the inflammatory process is located deeper in the dermis than an irritant reaction. Conclusion: This study suggests that IMP, as used herein, is suitable for distinguishing between contact reactions of allergic and irritant nature. Although pathophysiologic events in the tissue studied significantly modify impedance patterns, little is known about how to interpret the structural and chemical changes underlying these patterns. Studies are needed to determine the relation between anatomic or pathophysiologic parameters, and the findings using IMP and other established methods, such as chemical extraction and histopathology. (J Am Acad Dermatol 2003;48:394-400.)

When debilitating, hyperhidrosis can be seen as a disease and not just as a symptom. It is most often a primary condition but can be secondary to other diseases. Aluminum chloride products are the initial treatment modality for palmar hyperhidrosis followed by anticholinergics, iontophoresis and botulinum toxin. The Dermatology Department of the Karolinska University Hospital in Stockholm, Sweden treated 151 patients at 289 visits with botulinum toxin for palmar hyperhidrosis during a two year period (2012-2013). It was found that botulinum toxin had good effect, which lasted between two and five months in 72% of cases. Muscle weakness (pincer grip) was reported at 41% of return visits and was present for less than one to four weeks in 62% of cases. At 56% of return visits, no side effects of botulinum toxin were reported. 90% of patients surveyed thought that botulinum toxin worked well or very well for their condition and 99% valued the treatment they received at the clinic as good to excellent.

This paper presents for the first time measurement data on in-vivo dermatological experiments verifying the performance of a millimeter-wave medical probe designed for skin-cancer diagnosis. The probe consists of a micromachined silicon-core dielectric-rod waveguide, which is metallized and tapered at its tip as a compromise for high field concentration at the probe-to-skin interface, high sensitivity, high resolution, and an interaction volume depth adapted to diagnosing early-stage melanoma. The in-vivo dermatological tests on humans comprise: (1) measurement at different skin sites; (2) measurements of skin burns; (3) scanning the profile of benign skin neoplasma; (4) standardized dermatological tests with skin-irritant in 5 concentrations on 5 test persons, including monitoring of the healing process and reference measurements using a commercial transepidermal water loss instrument. All tests were successfully completed and show that millimeter-wave sensors are well capable of detecting physiologic changes of the skin and experimental skin reactions.

Background and Objective: The tuberculin (PPD) test is a model reaction for the cell-mediated immune system of the skin. The aim of this study is to compare the non-invasive technique based on electrical impedance for investigation of the tuberculin test with an irritant contact reaction induced by sodium lauryl sulphate, which has already been carefully evaluated using this method. Methods: 0.1 ml of PPD (2 TU) was injected intracutaneously into the volar forearms of 20 adult healthy subjects, all known to be tuberculin sensitized. Assessments were performed 3 and 7 days after the injections, using visual scoring, a new electrical impedance technique and transepidermal water loss (TEWL). Results: In the 16 cases that completed the study, compared to relevant controls and reactions induced by sodium lauryl sulphate statistically significant changes in 3 of the 4 impedance indices were found: both the means of index MIX and index IMIX increased (p ≤ 0.01) and the mean of index PIX decreased (p ≤ 0.05). Furthermore, similar impedance response patterns occurred in another cell- mediated immune reaction that we have studied previously – namely, the allergic contact reaction induced by nickel sulphate. Unlike the irritant reactions, no significant increase in TEWL values in tuberculin reactions were found. This can be explained by the fact that the epidermis is little affected, since the inflammatory process in the tuberculin reaction is located more deeply in the dermis than with the irritant reaction. Conclusion: The current study strongly indicates that electrical impedance in the described version, besides contact dermatitis, also seems suitable for studies of the tuberculin reaction. This will add a new indication for the technique, and studies of further clinical applications are in progress.

Pathophysiological events in biological tissue are characterized by a shift in electrical impedance spectra of the tissue under study. In this paper, techniques based on electrical impedance are reviewed with emphasis on their possible role in evaluating the skin reactivity of an individual, including results from impedance measurement studies on patients with allergic contact reactions, wheals, tuberculin tests, and irritant contact reactions and on an appropriate number of controls. The results show that, compared to relevant controls, at different types of experimental cutaneous reactions, both of allergic and irritant type, statistically significant changes of the impedance parameters have been detected. Each reaction type had a specific impedance index pattern. Data up to now indicate that the improved impedance technique offers not only a noninvasive alternative for characterization and perhaps differentiation between the skin responses induced by either an allergen or an irritant, but also a capability to distinguish responses induced by chemically different irritants.

Filaggrin gene (FLG) mutation carriage increases risks of various types of aberrant human reactivity, including that of atopic dermatitis (AD); sometimes also the severity of the actual sensitivity is related. This chapter attempts to summarize the recent literature, although it is sparse, regarding the relation between FLG mutations, AD, and skin cancer. According to the results of large Scandinavian cohort studies, there is an increased risk of nonmelanoma skin cancer in patients with AD, in contrast to no increased risk of malignant melanoma. The epidemiological findings are discussed in relation to recently published interesting experiments using mice models. Actions should be taken to diminish inflammation and the carcinogenic effects of UV light as well as regular use of moisturizers. In the future, studies will continue to describe the molecular mechanisms involved, to provide insights for treatment improvements, and to find ways to reduce the patients’ risk for skin cancer.

Background: Pathophysiologic events in biological tissue are characterized by a shift of the electrical impedance spectra of the tissue under study. Objective: To discuss studies on experimental skin reactions with an improved impedance spectrometer. The instrumentation is related to noninvasive techniques based on other physical principles. Methods: The results from studies on patients with allergic contact reactions (n = 8), prick tests (n = 10), and irritant contact reactions (benzalkonium chloride [n = 14], sodium lauryl sulfate [n = 12], and nonanoic acid [n = 14]), and an appropriate number of controls are reviewed. Results: Results show statistically significant changes of the impedance parameters when compared with relevant controls, at different types of experimental cutaneous reactions, both allergic and irritant type. Each reaction type had a specific impedance index pattern. Conclusions: Current data indicate that the improved impedance technique offers a possible noninvasive alternative for characterization and perhaps differentiation, not only between the skin responses induced by either an allergen or an irritant, but also a capability to distinguish responses induced by chemically different irritants. The assumption that the impedance method is capable to distinguish allergic from irritant contact reactions has not been proven yet in direct comparative studies.

Background/aims: In our previous studies of the electrical impedance of the skin, we formulated a set of physical indices that could be used to distinguish between the cutaneous effects produced by different chemical irritants. We now describe an investigation of allergic contact reactions, using the same set of impedance indices for characterization. Methods: Skin reactions were induced in the forearm of eight female patients who were allergic to nickel by exposure to nickel sulphate in petrolatum at various concentrations. The responses were evaluated by measurements of electrical impedance and transepidermal water loss, as well as by visual scoring and biopsy. Normal skin was used for controls. Results: Different degrees of allergic contact reactions were produced, and the changes in value of the impedance indices were found to follow a particular pattern. This pattern diverged markedly from that obtained in controls, and the differences were statistically significant. Conclusions: Our results suggest that, by the application of a technique based on electrical impedance, it will be possible to characterize allergic skin reactions.

The purpose of this review is to outline the clinical signs of the symptomatic HIV-1 seroconversion, with the emphasis on skin and mucous membranes. Our own experience is discussed in relation to other reports in the literature. Major findings are fever and pharyngitis with several patients also showing nonoozing, superficial ulcers or rather epithelial defects of the oral, genital, or anal mucosa. Uniform skin eruptions usually consist of circumscribed, erythematous, dull to bright red, macular or maculopapular lesions that were oval or rounded in shape ranging from a few millimeters to 1 cm in diameter on the upper thorax, particularly within the collar region and also on the face, forehead, and scalp. Skin lesions are sparse or absent at the periphery of the extremities. In the most typical cases, the exanthema appears following 48–72 h of fever, with a peak during one day, persisting for 5–8 days and a gradual clearing concurrently with the general recovery of the patient. Skin biopsy findings do not ...

Immunoglobulin isotype switching to IgE in patients infected with Schistosoma mansoni and patients with atopic dermatitis was studied. Patients with parasitic infections or allergic diseases have a higher production of IgE. We found a four-fold increased production of I epsilon RNA in both patient groups as compared to control donors. The increased expression of germ-line transcripts correlates with higher serum IgE levels. Nested primer polymerase chain reaction was used to generate S mu/S epsilon fragments from DNA of patient peripheral blood mononuclear cells. Twenty-nine out of fourty sequenced switch fragments had undergone direct joining from S mu to S epsilon whereas seven fragments showed mono sequential switching from S mu via either S mu, S gamma2, S gamma4 or S epsilon to S epsilon and four fragments demonstrated double sequential switch: S mu/S mu/S gamma1/S epsilon, S mu/S gamma2/S epsilon/S epsilon or S mu/S gamma1/ S gamma2/S epsilon. The sequential switching had occurred either via deletions or inversions. Mapping of the breakpoints showed hot spots for recombination within S mu, S gamma1 and S epsilon. To our knowledge, this is the first in vivo study in humans demonstrating that switching to IgE can occur from sequential rearrangements via gamma1, gamma2 or gamma4.

In previous studies of the electrical impedance of the skin, we introduced a set of physical indices which could be used to distinguish between the cutaneous effects produced by different irritants and allergic contact reactions. In this study, wheals were induced in 10 allergic patients by performing prick tests on the forearm with the relevant allergen and histamine, respectively. Normal skin was used for control. The wheals were evaluated by visual scoring, laser Doppler, and electrical impedance. As expected, there was a close agreement between the visual and laser Doppler readings. Compared to the controls, there were significant changes in the electrical impedance of the wheals, especially in the index related to the phase angle. The changes in the indices were found to follow a particular pattern, which diverged from those obtained in contact skin reactions of both allergic and irritant type. Our results indicate that, by the application of the impedance technique, it will be possible to characterize objectively and quantify the wheal reaction. The results also suggest that cutaneous reactions of completely different causes, such as allergic skin reactions of the late and immediate type, and irritant contact reactions, may be distinguished on the basis of their effects on the electrical impedance of the skin.

Many diseases with autoimmune features are associated with alleles of the human leucocyte antigen (HLA). However, few if any malignant disorders have reproducibly been shown to be HLA-associated. In three independent studies, using serological tissue typing techniques, an increase of the HLA class II specificity DR1 has been found in patients with multiple basal cell carcinomas. These observations prompted us to determine the frequencies of DRB1, DQA1, and DQB1 alleles by high-resolution genomic tissue-typing methods, including subdivision of the serological DR1 specificity in the four sequence-defined alleles, DRB1*0101 to DRB1*0104, in 50 unrelated Swedish patients with a history of four or more basal cell carcinomas and 250 healthy controls. The frequency of DR1 was the same in patients and controls (18%). All DR1-positive patients and controls carried the DQA1*0101 and DQB1*0501 alleles. Six of the nine DR1-positive patients and controls carried the DQA1*0101 and DQB1*0501 allels. Six of the nine DR1-positive patients were DRB1*0101-positive, one DRB1*0102 and two carried the DRB1*0103 allele. This distribution of DRB1*01 alleles did not differ from the one found in the controls. We conclude that genetic factors associated with the HLA class II region do not contribute significantly to the aetiology of multiple basal cell carcinomas.

Summary We have explored the use of measurements of electrical impedance to discriminate between the effects of different irritant substances upon the skin, and have studied the relationships between impedance and histopathological change. Three compounds with different chemical profiles were tested on volunteers: sodium lauryl sulphate, benzalkonium chloride and nonanoic acid. The concentrations selected were such that each irritant produced responses of a similar order, as judged by visual scores. The magnitude and phase of electrical impedance were measured and, for comparison, also the transepidermal water loss. Four physically distinct aspects (indices) were devised from the impedance data, and the values obtained were statistically analysed. The three irritants produced different effects, giving distinctive impedance patterns. These were also found to be reflected by three different types of histopathological skin response. Our results suggest that the indices can be used to classify irritant contact reactions, which it is difficult or impossible to achieve by other non-invasive techniques.

Hidradenitis suppurativa (HS; or acne inversa) is a scar -ring and frequently persistent inflammatory disorder of the terminal hair follicles of apocrine gland-bearing skin in adults. Treatments include local or systemic antibiotics, hormones, retinoids and systemic immunosuppressive agents (1), although on evaluation these have been shown to have only limited or temporary effect. In refractory cases, surgery is necessary, and should be radical and performed as early as possible (2, 3). It is essential to establish a registry of HS in order to address the following important issues: to assess the safety and effectiveness of different treatments; to identify which specific patient subgroups have the best risk/benefit ratio for a given treatment; and to create benchmark data for quality assurance of the medical service. This manuscript presents the Scandinavian Registry for HS, HISREG.METHodS