tissue.With persisting discharge and pain noted during his last assessment in October 2019, further surgery is ultimately necessary to attempt to reduce inflammation and tissue injury. DiscussionIn our patient, self-inflicted social isolation, embarrassment, and impaired activities stemming from HS, led to a decrease in his QoL.HS patients often experience stigma, worsened QoL and impaired work productivity greater than other dermatological conditions, including atopic dermatitis and psoriasis [8].In comparison to psoriasis, over a 3-year period a higher proportion of HS patients visited the emergency department [1].Given the high comorbidity rates of HS with various physical and psychological disorders, as well as its overall disease complexity, multidisciplinary treatment should be approached early to ensure long-term relief and the avoidance of unnecessary healthcare resource expenditures [6].Long diagnostic delays may stem in part from avoidance of disclosure to a General Practitioner (GP).Clerc H, et al. [3] found that 42 patients (21.8%) considered their disease shameful, resulting in challenges consulting their GP.Further, Revuz JE, et al. [8] demonstrated that less than 50% of patients consulted for HS in a 1-year period.This may be explained by the fact that lesions often spread to intimate areas and are accompanied by malodourous
Background There is currently at least 1 biologic (adalimumab) approved in North America for treatment of Hidradenitis Suppurativa in the pediatric population. However, no reviews or clinical trials have specifically analyzed the effectiveness and safety data of biologic use in this population. The objective of this systematic review is to identify and summarize the outcomes of biologic therapy in pediatric patients with HS. Methods MEDLINE and EMBASE databases were used to conduct the search on Sept 18, 2020. Results The 15 included studies consisted of 26 patients, with the mean age of 15 ± 2.3 years. Females accounted for 53.8% ( n = 14/26) of cases. The mean duration of HS prior to biologic initiation was 3.5 ± 2.9 years, with the majority having Hurley Stage II. The 26 patients received 34 biologics in total: 85.3% treated with TNF alpha inhibitors (adalimumab n = 17, infliximab n = 10, etanercept n = 1, unspecified n = 1), 5.9% with IL-12/23 inhibitors (ustekinumab n = 2), 5.9% with IL-1 inhibitors (i.e., anakinra n = 2) and 2.9% received IL-23 inhibitors (i.e., guselkumab n = 1) biologics. Of the 26 patients, 23.1% ( n = 6/26) experienced complete resolution (CR), 73.1% ( n = 19/26) experienced partial resolution (PR), and 3.8% ( n = 1/26) had no resolution outcomes reported. The time to resolution of HS lesions after biologic initiation ranged from 10 days to 11.5 months (mean: 5.1 months). No adverse events were reported in the studies. Conclusion Although anti-TNF alpha were the most common biologics used for HS in pediatric cases, large-scale trials specific to pediatric patients with HS are needed to confirm these findings.
ABSTRACT Hypertrophic scars (HTS) are elevated scars which occur due to abnormalities in wound healing after injury and may be associated with pain, pruritus and functional impairment. Despite multiple available treatment options, there is no universal approach to treating HTS. We searched the Web of Science (Core Collection), MEDLINE and EMBASE databases. Title, abstract and full‐text screening, along with data extraction, were performed in duplicate. Risk of bias was assessed using the Cochrane risk‐of‐bias tool. The Vancouver Scar Scale (VSS) scores and mean differences were used for meta‐analysis. We screened 3800 abstracts and included 34 randomised controlled trials evaluating treatments for HTS in adults. Silicone and laser modalities improved VSS scores by 5.06 (95% CI: 6.78, 3.34) and 3.56 (95% CI: 5.58, 1.54), respectively. Intralesional triamcinolone combined with silicone or 5‐fluorouracil was superior to intralesional triamcinolone monotherapy. Limitations of this study include exclusion of studies which did not utilise VSS, and pooling of studies based on common modalities. Further studies are needed to examine the efficacy of existing and emerging treatment modalities for HTS. Our study supports the treatment of HTS in adults with silicone gel or sheets, injected triamcinolone (preferably combined with 5‐fluorouracil or silicone products), pulsed dye laser and fractionated CO 2 laser.
