Proceedings of the Joint <scp>CHSF</scp>/<scp>HSF</scp>/<scp>EHSF</scp> pre‐<scp>WCD</scp> Hidradenitis Suppurativa Symposium

6 June 2015, Vancouver, Canada The Hidradenitis Suppurativa (HS) symposium took place on 6 June 2015 in Vancouver, Canada, as a joint meeting of the Canadian Hidradenitis Suppurativa Foundation (CHSF), the Hidradenitis Suppurativa Foundation (HSF Inc.) founded in the USA in 2005 and the European Hidradenitis Suppurativa Foundation (EHSF e.V.). This was an official pre-World Congress of Dermatology 2015 scientific event. The purpose of this symposium was to update the speakers themselves and an interested audience on advances in HS, by providing compact discussions of all aspects of the disease presented by world experts (dermatologists and others) in the field of HS. This joint activity was hosted by the CHSF and the HSF Inc. and offered vital proof of the alliance among health care professionals who are targeting improvements in both the understanding of the disorder and the care of patients with HS worldwide. In four sessions, seventeen experienced and emerging experts explored all aspects of HS. The conference was timely, given several recent advances in the development of modalities related to HS management. Over 500 participants from all corners of the globe gathered at the symposium for the presentation and discussion of the latest research in this field. HS is an orphaned disease with a substantial increase in number of patients diagnosed in recent years, due to either raised awareness, an increase in the recognition of the clinical signs, or a true increase based on lifestyle changes. HS is a chronic debilitating skin disease which occurs in young adults and continues throughout life in most of the patients. It presents a higher prevalence in women with a significant effect on work productivity and quality of life, and it is associated with significant comorbidities. Dr Paul Hazen from United States chaired the session on Pathophysiology. The exact prevalence of HS in the population is an estimate at best. The current prevalence has been reported to range from 0.05% to 4% based on the population studied and the methodology used. Currently, three types of studies on the epidemiology of HS are available. These studies include self-reports, studies that utilize databases or registries and group examinations. All these different methodologies must be evaluated to gain insight into the prevalence of the disease. HS is most likely not a rare disease – just orphaned and has recently been acknowledged as a significant health burden 1. While research has allowed for greater insight into the mechanisms behind HS, the exact pathogenesis remains unknown. Prof. Prens’ research has led to significant advances in the knowledge of the immunopathogenesis of HS. The research has determined that the hair follicle is most likely the place in which the HS lesion is initiated. Novel therapeutic options are dependent on research into the inflammatory mechanism involved in HS 2, 3. There are validated tools that can assist in confirming the stage of disease, but the phenotypic classification and the assessment of improvement of HS is still challenging. For example, the Hurley staging system is excellent for determining the surgical approach to HS, but it is not reliable for confirming the inflammatory component of the disease. HS has multiple phenotypes that may include comedonal, hormonally responsive, fistulizing, inflammatory, those with wound healing aberrations as well as some clinically distinct variants like HS fulminans. Auto-inflammatory disorders are characterized by recurrent non-infectious inflammatory episodes in the absence of pathogens, auto-antibodies or antigen-specific T cells. Analysing acne and HS is meaningful as their pathogenic models would provide novel framework for profound understanding of the two chronic skin diseases. Multiple studies have shown the association of HS and comorbid disorders. In a young patient dealing with a recurrent debilitating disease, comorbidity disorders added insult to injury. In addition, they significantly increase the entire costs of his health care. The second session, chaired by Prof. Christos C. Zouboulis was focused on the following. A hospital and population-based cross-sectional study which included 32 HS subjects from the hospital, 430 HS subjects from the general population, and 20780 controls was performed to assess the renal function in HS patients. The study used estimated glomerular filtration rate (eGFR). The higher eGFR in HS hospital patients may indicate a possible association of HS and renal dysfunction. The subject of ‘HS Treatment Uncertainties’ was recently tackled by a HS Priority Setting Partnership of HS patient and clinicians that identified HS uncertainties and prioritized them in a top 10 list 1. The highest ranked uncertainty was ‘What is the most effective and safe group of oral treatments in treating HS?’ The second was ‘What is the best management of an acute flare?’ Pain management was also included after being put forward by patient members of the partnership. The severity risk factors identified in this study may help physicians to select high-risk patients. Ordinal logistic regression was used in 846 consecutive Dutch patients with HS to calculate odds ratios (ORs) for severity according to the Hurley scale. In total, 45.5% of the patients had Hurley I, 41.5% had Hurley II, and 13.0% had Hurley III. Severity was associated with male sex, disease duration, body mass index, smoking pack-years, and axillary, perianal and mammary lesions. The incidence of SCC in HS ranges between 1.7 and 3.2%, with male predominance. The duration of HS ranges from 3 to 50 years. SCC occurring in HS patients is located in the buttock, perineal and perianal areas in most cases. Further studies are needed to clarify the significance of keratin expression as a prognostic factor in this disease. The third session was focused on the Traditional Therapies and was chaired by Prof. Gregor Jemec. Based on the European S1 HS guideline, the choice of treatment depends on disease severity and impact on quality of life. The role of surgery or laser therapy is mainly on localized disease, whereas medical treatment is more appropriate for widely spread lesions. Medical therapy includes antibiotics, acitretin and biologic drugs. Adjuvant measurements, such as pain management, proper wound care and lifestyle changes should be included in the treatment plan 4. The idea that diet plays a role in the progression and prevention of new lesions in HS is still novel, and further extensive work on diet is required. Lesions appear to be induced by hormonally driven activities that cause obstruction of the follicular duct and sebaceous glands, as well as the development of deep dermal sinuses that rupture and cause the commonly seen skin lesions that fail to heal. While a novel approach, it appears that a natural diet, free of dairy and with a low glycaemic load may provide some patients relief from lesion progression, and possibly prevention. Patients with HS suffer from chronic recurrent painful, exudative wounds and need frequent dressing changes. Proper wound care is an essential part of the treatment algorithm and must fit the clinical circumstances of each individual. The choice of dressing depends on the location, the extent, the morphology, amount of exudate, odour, cost and certainly patient preference. Atraumatic adhesives such as silicone diminish trauma and minimize the pain from dressing change. This presentation provided an update on the traditional systemic therapies used in the treatment of HS including antibiotics, anti-androgens, retinoids and immunosuppressants. Systemic antibiotics have the best evidence among oral therapies for treating HS. While traditional systemic therapies may be first line modalities for treating HS, there is no single treatment as golden standard for HS management. Treatment programmes should be individualized according to each patient's severity of disease, prior treatments, comorbid conditions and risk of adverse effects from drug interactions. The final session was chaired by Prof. Gary Sibbald from University of Toronto and focused on the Management of HS. The efficacy of laser therapy in patients with HS is related to two distinct mechanisms. Laser therapy is used to decrease the number of hair follicles, sebaceous glands and reducing bacterial load. Secondly, laser therapy can aim to de-bulk chronic lesions using ablative techniques. The removal of affected tissue and identifying sinus tracts with subsequent destruction by carbon dioxide laser excision has proven efficacious with low rates of complication and recurrence. This presentation focused on four pitfalls that can complicate the dermatosurgeon's work: Infliximab (IFX) and adalimumab (ADA) are two biologics that result in a significant difference in healing of HS lesions based on the reported evidence. IFX versus ADA has also been reported in a small comparative retrospective trial and showed that IFX was superior. In one phase 2 and two phase 3 trials, ADA has met its targets. ADA has the strongest evidence and was shown effective across a variety of clinically relevant subgroups. Weekly dosing was the optimal medium-term dosing strategy in HS during the 36-week observation period. ADA is the first to be approved in the treatment of HS in the EU and the USA and is pending approval in Canada 5, 6. However, it is yet to be decided when biologics should be used in the HS course to prevent mutilation and improve quality of life. In mild HS, the recommended treatment is topical clindamycin 1% lotion 2×/day for 12 weeks [level of evidence (LOE) 2B, strength of recommendation (SOR) B] or tetracycline 500 po 2×/day for 4 months (LOE 2B, SOR B). If case of failure of the topical treatment or if a patient has a PGA score of moderate or severe, the recommended treatment is either tetracycline 500 po 2×/day for 4 months or clindamycin 300 mg po 2×/day plus rifampicin 300 mg po 2×/day × 10 weeks (LOE 3, SOR C). For patients with PGA of moderate-to-severe or very severe HS, treatment with adalimumab is recommended at the following regimen: 160 mg at week 0, 80 mg at week 2 and then 40 mg from week 4 SC 1×/week (LOE 1B, SOR A). If the patients are responding, therapy should be maintained indefinitely. Left to right. Second row: Marc Bourcier (Canada), Raed Alhusyen (Canada), Rodney Sinclair (Australia), Qiang Ju (China), Kim Papp (Canada), Henrique Teixeira (AbbVie global). First row: Melinda Gooderham (Canada), Veronique del Marmol (Belgium), Paul Hazen (United States), R Gary Sibbald (Canada), Christos C. Zouboulis (Germany), William B Danby (United States), Gregor B.E. Jemec (Denmark), Errol Prens (The Netherlands), Afsaneh Alavi (Canada). None.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.