Recurrence Rate and Patient Satisfaction of CO2 Laser Evaporation of Lesions in Patients With Hidradenitis Suppurativa

Mikkelsen, Peter Riis; Dufour, Deirde Nathalie; Zarchi, Kian; Jemec, Gregor B. E.

doi:10.1097/dss.0000000000000264

Cited by 74 publications

(56 citation statements)

References 22 publications

(10 reference statements)

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“…Obesity was only associated with delayed wound healing. Previous studies suggested that CO 2 laser is an effective treatment option, and that obesity was associated with higher recurrence rates …”

Section: Discussionmentioning

confidence: 99%

Evaluation of medical and surgical treatments for hidradenitis suppurativa using real‐life data from the Scandinavian registry (HISREG)

Grimstad

Tzellos

Dufour

et al. 2019

Acad Dermatol Venereol

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Background Hidradenitis suppurativa (HS) substantially affects health‐related quality‐of‐life outcomes. Most treatment options are supported by low quality of evidence without validated outcomes. Objective The aim of this study was to evaluate the efficacy of surgical and medical interventions using physician‐ and patient‐reported outcomes registered in HISREG. Methods Data were extracted for all adult patients registered in HISREG between January 2013 and April 2016. Primary endpoints included Dermatology Life Quality Index (DLQI) scores, pain as measured using a numeric rating scale (NRS), Sartorius score and Hurley classification. Minimum clinically important differences (MCIDs) for DLQI and NRS pain were analysed. Secondary endpoints included comparisons among different treatment groups, safety and complications of various treatments. Results Two hundred and fifty‐five patients were included in the study: 31, 188, and 36 patients had Hurley stages I, II and III disease, respectively. Treatment with CO2 lasers was the most common treatment modality. One hundred and forty‐nine patients (58.4%) were treated with surgical intervention, 87 (34.1%) received antibiotics and/or anti‐inflammatory treatments, and 19 (7.5%) were treated with both surgery and medical intervention. No patients received biologic treatment. In patients with surgical treatments, Sartorius scores were significantly improved compared with baseline (P = 0.001), 83 patients (55%) achieved a DLQI MCID, and 75 patients (49.7%) achieved an NRS pain MCID. In patients with medical treatments, Sartorius scores were not significantly improved compared with baseline (P = 0.582); 25 patients (28%) achieved a DLQI MCID and 28 patients (31%) achieved an NRS pain MCID. In patients treated with surgical and medical combination, 9 (48%) achieved DLQI and NRS pain MCIDs and Sartorius scores were significantly improved. Conclusions CO2 laser treatment is more effective than the non‐biologic medical treatments in this analysis based on physician‐ and patient‐derived outcomes. The study provides limited evidence for the combination of medical and surgical therapies in patients with HS.

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Section: Discussionmentioning

confidence: 99%

Evaluation of medical and surgical treatments for hidradenitis suppurativa using real‐life data from the Scandinavian registry (HISREG)

Grimstad

Tzellos

Dufour

et al. 2019

Acad Dermatol Venereol

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“…In contrast to flare, the terms recurrence and relapse were used more frequently in the literature and had a higher proportion of studies with a definition (Table S1; see Supporting Information). [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Again, in contrast to flare, recurrence or relapse were more frequently associated with an increase in HS activity after a surgical intervention. Of the 19 studies that defined either relapse or recurrence, six (32%, six of 19) used the term in association with a medical intervention, while the majority (68%, 13 of 19) used the terms for a surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

A narrative review of the definition of ‘flare’ in hidradenitis suppurativa

et al. 2019

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Summary Background Hidradenitis suppurativa (HS) is a chronic, inflammatory condition that can have periodic worsening or flares. Measurement of flare is important because it can inform treatment efficacy; however, it is unclear how HS flare should be defined. Objectives This study reviewed the literature for definitions of HS flare. Methods The PubMed MEDLINE online database was searched on 10 January 2018 and the search was repeated on 8 December 2018 for new publications. Titles and abstracts were screened for inclusion. Subsequently, full articles were screened for inclusion. Papers were included if the publication was a systematic review, clinical trial, cohort study, case report or series, or cross‐sectional study. Studies were excluded if they were journalistic reviews, did not discuss clinical findings of HS or did not use the words ‘flare’, ‘exacerbation’, ‘relapse’ or ‘recurrence’. Results Two hundred and seventy‐four papers were identified and 154 fulfilled the study criteria. Of these, 27 (17.5%) included the term ‘flare’ and 16 (10.4%) included the term ‘exacerbation’. Two of the 27 papers (7%) defined the term flare and both included patient report of changes in symptoms or signs. One of 16 papers (6%) defined exacerbation, which was taken as one new HS lesion. The terms ‘recurrence’ and ‘relapse’ were more apt to be defined: 13% (13 of 100) and 14% (six of 44), respectively. Conclusions The lack of a specific and measurable definition of HS flare is a barrier to assessment of this important outcome. Once a specific and measurable definition is established, validated and reliable measures of HS flare can be incorporated into future studies. What's already known about this topic? Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin condition. The ability to assess flares is important to people who have HS; however, it is unclear how this is defined. HS flare is one of the core outcomes in the core outcome set for HS clinical trials; however, it is unclear how this should be assessed. What does this study add? This literature review reveals the paucity of measurable definitions associated with the use of the term ‘flare’ in the HS literature. It also highlights the variation and lack of a validated and reliable measure of HS flare.

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“…Obesity has been shown to influence the effect of treatments. In HS disease severity appears to co‐vary with BMI and recurrence rates after CO 2 laser surgery are better in patients with low BMI compared with patients with higher BMI . The weight of patients may also prove to be an important factor when treating patients with HS with tumour necrosis factor (TNF)‐α inhibitors .…”

Section: Discussionmentioning

confidence: 99%

“…In HS disease severity appears to co-vary with BMI and recurrence rates after CO 2 laser surgery are better in patients with low BMI compared with patients with higher BMI. 23 The weight of patients may also prove to be an important factor when treating patients with HS with tumour necrosis factor (TNF)-a inhibitors. 24 When using anti-TNF-a agents in chronic inflammatory skin diseases such as psoriasis, 25 optimal responses are less frequently observed in patients with psoriasis with increasing weight, especially above 100 kg, when using fixed standard doses.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies

et al. 2015

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Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease. The aim of the study was to systematically review the literature and critically answer the question: In patients with HS, do cardiovascular risk factors appear at a significantly higher rate compared with controls? The main search was conducted in Medline, Embase and the Cochrane Central Register. Studies eligible for inclusion were of case-control, cross-sectional and cohort design, and included comparison of any cardiovascular risk factor(s) in patients with HS with those of control groups. An I(2) value > 50% was considered to show substantial heterogeneity. In this case, DerSimonian and Laird random-effect models were considered to compute pooled odds ratios (OR). Otherwise, a fixed-effects model was suitable. Nine studies, with 6174 patients with HS and 24 993 controls, were included. Significant association of HS with obesity [OR 3·45, 95% confidence interval (CI) 2·20-5·38, P < 0·001], central obesity (OR 2·97, 95% CI 1·41-6·25, P = 0·004), active smoking (OR 4·34, 95% CI 2·48-7·60, P < 0·001), history of smoking (OR 6·34, 95% CI 2·41-16·68, P < 0·001), hypertriglyceridemia (OR 1·67, 95% CI 1·14-2·47, P = 0·009), low high-density lipoprotein (HDL) (OR 2·48, 95% CI 1·49-4·16, P < 0·001), diabetes (OR 2·85, 95% CI 1·34-6·08, P = 0·007) and metabolic syndrome (OR 2·22, 95% CI 1·62-3·06, P < 0·001) was detected. Associations were significant both in population and hospital patients with HS, with hospital HS groups having uniformly higher ORs than the population HS groups. Causality could not be assessed. Heterogeneity was substantial in all analyses. This systematic review indicated that cardiovascular risk factors appear at a significantly higher rate in patients with HS compared with controls. The need for screening of patients with HS for modifiable cardiovascular risks is emphasized.

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Recurrence Rate and Patient Satisfaction of CO2 Laser Evaporation of Lesions in Patients With Hidradenitis Suppurativa

Cited by 74 publications

References 22 publications

Evaluation of medical and surgical treatments for hidradenitis suppurativa using real‐life data from the Scandinavian registry (HISREG)

Evaluation of medical and surgical treatments for hidradenitis suppurativa using real‐life data from the Scandinavian registry (HISREG)

A narrative review of the definition of ‘flare’ in hidradenitis suppurativa

Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies

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