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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hidradenitis suppurativa &#40;HS&#41; typically appears between the 2<span class="elsevierStyleSup">nd</span> and 3<span class="elsevierStyleSup">rd</span> decades of life and remains active&#44; on a chronic basis&#44; with some fluctuations&#46; Although there are no prospective studies supporting it&#44; improvement after menopause has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> There is wide variability in estimates of HS prevalence in individuals older than 65 years&#46; A recent study&#44; which sought related diagnoses and contacted patients to confirm the diagnosis&#44; estimates a global prevalence of 0&#46;77&#37; &#40;0&#46;4&#37; in patients older than 65 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> However&#44; studies based on coded diagnoses from large insurance databases suggest a lower frequency of 0&#46;05&#37; in patients older than 65 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The possibility of finding advanced disease in older patients&#44; as expected in a progressive condition&#44; and the difficulty associated with managing certain therapies and surgical procedures in this age group are compelling reasons to increase available evidence&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe cases of HS in patients older than 65 years at the initial visit&#44; seen in a HS monographic consultation from October 2021 through May 2023&#46; All patients signed their informed consent form prior to being included in the HS Registry of our center&#44; which has been approved by the Balearic Islands ethics committee&#46; Relevant comorbidities&#44; time to first visit&#44; clinical characteristics&#44; phenotype according to Martorell et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> lesion count to calculate the International Hidradenitis Suppurativa Severity Score System &#40;IHS4&#41;&#44; quantification of pain&#44; pruritus&#44; and the Dermatology Life Quality Index &#40;DLQI&#41; were recorded&#46; Ultrasound was used to count the lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included a total of 14 patients&#44; which amounts to 4&#46;8&#37; of the all patients included in the HS Registry during this time &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The median follow-up time was 77 days &#40;range&#44; 0-466 days&#41;&#46; Antibiotics were prescribed in 2 patients&#44; metformin in 1&#44; biologics in 2 &#40;adalimumab in one patient and secukinumab in the other&#41;&#44; retinoids in 1 patient&#44; surgery in 3&#44; and photodynamic therapy in 2 patients &#40;external irradiation in one patient and intralesional irradiation in the other&#41;&#46; One patient with an active lung neoplasm benefited from the insertion of a loose seton in a perianal fistula without need for further treatment for symptom control&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">There are few publications on HS in individuals older than 65 years old&#46; In a recent publication&#44; Blum et al&#46; describe a cohort of 26 patients older than 65 years&#44; which amounts to just 2&#46;3&#37; of all patients treated for HS&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Same as in our series&#44; a high prevalence of diseases in the metabolic and cardiovascular sphere&#8212;cancer included&#8212;significantly affect management and morbidity&#46; Compared with the under 65 age group&#44; there is a higher proportion of male patients and a greater presence of obesity and smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> These comorbidities have been described as predictors of disease persistence in retrospective studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> which reinforces the importance of addressing them in consultation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The proportion of patients with Hurley stages 2 and 3 in our series reaches two-thirds&#46; However&#44; only 2 patients &#40;14&#46;2&#37;&#41; had initiated treatment with a biologic drug&#46; This could be due to several factors&#44; such as the higher presence of comorbidities or the relatively low inflammatory burden&#44; as evidenced by the low level of pain and relatively low IHS4 compared with Hurley stage&#46; The presence of more draining fistulas &#40;median 1&#44; range 0 to 6&#41;&#44; and a low count of inflammatory lesions such as nodules and abscesses &#40;median 0&#44; range 0 to 3&#41; should favor the use of lesion-directed treatments such as surgery or photodynamic therapy&#46; The latter&#44; in various modalities&#44; has demonstrated its utility in local HS control&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Another technique directed at the lesion&#44; interesting for its simplicity and effectiveness&#44; is the use of setons&#44; which has been described in HS with good symptom control&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; patients older than 65 years seen for the first time with an HS diagnosis represent a low proportion of the total &#40;2&#46;3&#37; up to 5&#37; overall&#41;&#46; They have a high frequency of Hurley stages 2 and 3&#44; which underscores the need for making all therapeutic options available&#44; although some comorbidities limit access to biologic therapies or extensive surgery&#46; Lesion-directed therapies may be an appropriate and sufficient alternative for symptom control&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">J&#46; Garcias-Ladaria declares having participated as principal investigator in clinical trials for Acelyrin&#44; having received financial support for attending congresses from Alfasigma&#44; Isdin&#44; Cantabria Labs&#44; Janssen&#44; Almirall&#44; Novartis&#44; and UCB&#44; and having received honoraria from Novartis as an advisor and from Novartis and Leo-Pharma as a guest speaker&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ines Gracia-Darder declares having given lectures at events held by UCB&#44; Novartis&#44; Sanofi&#44; Almirall&#44; Janssen&#44; Isdin&#44; Loreal&#44; Pierre Fabre&#44; having participated as a researcher in trials sponsored by Almirall&#44; Leo-Pharma&#44; Acelyrin&#44; and Pierre Fabre&#44; and having received support to attend congresses from Almirall&#44; Janssen&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pierre Fabre&#44; Sanofi&#44; UCB&#44; Amgen&#44; Isdin&#44; Cantabria Labs&#44; Rilastil&#44; and Loreal&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Juan Jer&#243;nimo Gonz&#225;lez Malmierca declared no conflicts of interest whatsoever&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ana Mart&#237;n-Santiago declares having collaborated as a consultant for Abbvie&#44; Amryt&#44; Leo-Pharma&#44; Pfizer&#44; and Sanofi&#44; having given lectures at events held by Abbvie&#44; Amgen&#44; Leo&#44; Leti&#44; Novartis&#44; Pfizer&#44; Sanofi&#44; and having signed research agreements with Almirall&#44; Amgen&#44; Lilly&#44; Leo-Pharma&#44; Novartis&#44; Pierre Fabre&#44; and Sanofi&#44; and having received support to attend congresses from Abbvie&#44; Almirall&#44; Janssen&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pfizer&#44; Pierre Fabre&#44; Sanofi&#44; UCB&#44; and Viatrix&#46;</p></span></span>"
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                  \t\t\t\t">44 &#40;0&#46;3-64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoker or former smoker &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;85&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Active smoker &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Obesity &#40;BMI &#8805; 30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypertension &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dyslipidemia &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ischemic heart disease and&#47;or cerebrovascular disease &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cancer &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Renal failure &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Depression&#47;Anxiety &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cognitive impairment with dependency &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflammatory bowel disease &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflammatory arthropathy &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Disease characteristics at first visit</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Follicular phenotype &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixed phenotype &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflammatory phenotype &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hurley stage 1 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hurley stage 2 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hurley stage 3 &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median count of nodules &#43; abscesses &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median count of draining fistulas &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0-6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median initial IHS4 &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;0-24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median initial DLQI &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0-29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median pain scale score &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0-9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median itching scale score &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical characteristics of treated patients &#62; 65 years &#40;n &#61; 14&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The epidemiology of hidradenitis suppurativa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;R&#46; Ingram"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.19435"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2020"
                        "volumen" => "183"
                        "paginaInicial" => "990"
                        "paginaFinal" => "998"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32880911"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Ingram"
                            1 => "S&#46; Jenkins-Jones"
                            2 => "D&#46;W&#46; Knipe"
                            3 => "C&#46;L&#46;I&#46; Morgan"
                            4 => "R&#46; Cannings-John"
                            5 => "V&#46; Piguet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bjd.16101"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol&#46;"
                        "fecha" => "2018"
                        "volumen" => "178"
                        "paginaInicial" => "917"
                        "paginaFinal" => "924"
                        "link" => array:1 [
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Hidradenitis Suppurativa in Individuals Older than 65Years: A 14-Patient Retrospective Trial
Hidradenitis supurativa en mayores de 65años: estudio retrospectivo de 14 pacientes
J. Garcias-Ladaria
Corresponding author
jgarcila@gmail.com

Corresponding author.
, I. Gracia-Darder, J.J. González Malmierca, A. Martín-Santiago
Servicio de Dermatología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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        "autoresLista" => "J&#46; Garcias-Ladaria, I&#46; Gracia-Darder, J&#46;J&#46; Gonz&#225;lez Malmierca, A&#46; Mart&#237;n-Santiago"
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            "entidad" => "Servicio de Dermatolog&#237;a&#44; Hospital Universitari Son Espases&#44; Palma de Mallorca&#44; Spain"
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      "es" => array:1 [
        "titulo" => "Hidradenitis supurativa en mayores de 65<span class="elsevierStyleHsp" style=""></span>a&#241;os&#58; estudio retrospectivo de 14 pacientes"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hidradenitis suppurativa &#40;HS&#41; typically appears between the 2<span class="elsevierStyleSup">nd</span> and 3<span class="elsevierStyleSup">rd</span> decades of life and remains active&#44; on a chronic basis&#44; with some fluctuations&#46; Although there are no prospective studies supporting it&#44; improvement after menopause has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> There is wide variability in estimates of HS prevalence in individuals older than 65 years&#46; A recent study&#44; which sought related diagnoses and contacted patients to confirm the diagnosis&#44; estimates a global prevalence of 0&#46;77&#37; &#40;0&#46;4&#37; in patients older than 65 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> However&#44; studies based on coded diagnoses from large insurance databases suggest a lower frequency of 0&#46;05&#37; in patients older than 65 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The possibility of finding advanced disease in older patients&#44; as expected in a progressive condition&#44; and the difficulty associated with managing certain therapies and surgical procedures in this age group are compelling reasons to increase available evidence&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We describe cases of HS in patients older than 65 years at the initial visit&#44; seen in a HS monographic consultation from October 2021 through May 2023&#46; All patients signed their informed consent form prior to being included in the HS Registry of our center&#44; which has been approved by the Balearic Islands ethics committee&#46; Relevant comorbidities&#44; time to first visit&#44; clinical characteristics&#44; phenotype according to Martorell et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> lesion count to calculate the International Hidradenitis Suppurativa Severity Score System &#40;IHS4&#41;&#44; quantification of pain&#44; pruritus&#44; and the Dermatology Life Quality Index &#40;DLQI&#41; were recorded&#46; Ultrasound was used to count the lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included a total of 14 patients&#44; which amounts to 4&#46;8&#37; of the all patients included in the HS Registry during this time &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The median follow-up time was 77 days &#40;range&#44; 0-466 days&#41;&#46; Antibiotics were prescribed in 2 patients&#44; metformin in 1&#44; biologics in 2 &#40;adalimumab in one patient and secukinumab in the other&#41;&#44; retinoids in 1 patient&#44; surgery in 3&#44; and photodynamic therapy in 2 patients &#40;external irradiation in one patient and intralesional irradiation in the other&#41;&#46; One patient with an active lung neoplasm benefited from the insertion of a loose seton in a perianal fistula without need for further treatment for symptom control&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">There are few publications on HS in individuals older than 65 years old&#46; In a recent publication&#44; Blum et al&#46; describe a cohort of 26 patients older than 65 years&#44; which amounts to just 2&#46;3&#37; of all patients treated for HS&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Same as in our series&#44; a high prevalence of diseases in the metabolic and cardiovascular sphere&#8212;cancer included&#8212;significantly affect management and morbidity&#46; Compared with the under 65 age group&#44; there is a higher proportion of male patients and a greater presence of obesity and smoking&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> These comorbidities have been described as predictors of disease persistence in retrospective studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">7&#44;8</span></a> which reinforces the importance of addressing them in consultation&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The proportion of patients with Hurley stages 2 and 3 in our series reaches two-thirds&#46; However&#44; only 2 patients &#40;14&#46;2&#37;&#41; had initiated treatment with a biologic drug&#46; This could be due to several factors&#44; such as the higher presence of comorbidities or the relatively low inflammatory burden&#44; as evidenced by the low level of pain and relatively low IHS4 compared with Hurley stage&#46; The presence of more draining fistulas &#40;median 1&#44; range 0 to 6&#41;&#44; and a low count of inflammatory lesions such as nodules and abscesses &#40;median 0&#44; range 0 to 3&#41; should favor the use of lesion-directed treatments such as surgery or photodynamic therapy&#46; The latter&#44; in various modalities&#44; has demonstrated its utility in local HS control&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Another technique directed at the lesion&#44; interesting for its simplicity and effectiveness&#44; is the use of setons&#44; which has been described in HS with good symptom control&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In conclusion&#44; patients older than 65 years seen for the first time with an HS diagnosis represent a low proportion of the total &#40;2&#46;3&#37; up to 5&#37; overall&#41;&#46; They have a high frequency of Hurley stages 2 and 3&#44; which underscores the need for making all therapeutic options available&#44; although some comorbidities limit access to biologic therapies or extensive surgery&#46; Lesion-directed therapies may be an appropriate and sufficient alternative for symptom control&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">J&#46; Garcias-Ladaria declares having participated as principal investigator in clinical trials for Acelyrin&#44; having received financial support for attending congresses from Alfasigma&#44; Isdin&#44; Cantabria Labs&#44; Janssen&#44; Almirall&#44; Novartis&#44; and UCB&#44; and having received honoraria from Novartis as an advisor and from Novartis and Leo-Pharma as a guest speaker&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ines Gracia-Darder declares having given lectures at events held by UCB&#44; Novartis&#44; Sanofi&#44; Almirall&#44; Janssen&#44; Isdin&#44; Loreal&#44; Pierre Fabre&#44; having participated as a researcher in trials sponsored by Almirall&#44; Leo-Pharma&#44; Acelyrin&#44; and Pierre Fabre&#44; and having received support to attend congresses from Almirall&#44; Janssen&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pierre Fabre&#44; Sanofi&#44; UCB&#44; Amgen&#44; Isdin&#44; Cantabria Labs&#44; Rilastil&#44; and Loreal&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Juan Jer&#243;nimo Gonz&#225;lez Malmierca declared no conflicts of interest whatsoever&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ana Mart&#237;n-Santiago declares having collaborated as a consultant for Abbvie&#44; Amryt&#44; Leo-Pharma&#44; Pfizer&#44; and Sanofi&#44; having given lectures at events held by Abbvie&#44; Amgen&#44; Leo&#44; Leti&#44; Novartis&#44; Pfizer&#44; Sanofi&#44; and having signed research agreements with Almirall&#44; Amgen&#44; Lilly&#44; Leo-Pharma&#44; Novartis&#44; Pierre Fabre&#44; and Sanofi&#44; and having received support to attend congresses from Abbvie&#44; Almirall&#44; Janssen&#44; Leo-Pharma&#44; Lilly&#44; Novartis&#44; Pfizer&#44; Pierre Fabre&#44; Sanofi&#44; UCB&#44; and Viatrix&#46;</p></span></span>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Epidemiological characteristics of patients</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male gender &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">44 &#40;0&#46;3-64&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;85&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;57&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;7&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;28&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;14&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0 &#40;0-3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Median count of draining fistulas &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0-6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;0-24&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;0-29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1 &#40;0-10&#41;&nbsp;\t\t\t\t\t\t\n
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                          "etal" => false
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Article information
ISSN: 00017310
Original language: English
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Idiomas
Actas Dermo-Sifiliográficas
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