Case and Research Letters
Systemic steroids in the management of moderate-to-severe hidradenitis suppurativa
Uso de los corticoides sistémicos en el tratamiento de la hidradenitis supurativa moderada-grave
B. Duarte
, N. Cunha, A. Lencastre, J. Cabete
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Servico de Dermatología, Hospital de Santo António dos Capuchos, Centro Hospitalario de Lisboa Central, Lisboa, Portugal
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Se observó un cambio estadísticamente significativo tanto en el IHS4 como en las valoraciones realizadas por los pacientes (prueba de rangos de Wilcoxon, <span class="elsevierStyleItalic">p</span> < 0,05).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "B. Duarte, N. Cunha, A. Lencastre, J. Cabete" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "Duarte" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Cunha" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Lencastre" ] 3 => array:2 [ "nombre" => "J." 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A, Initial situation of the patient before treatment with involvement of 75% of the surface of the lower lip (right lateral and central region). B, Image of patient with methyl aminolevulinate cream applied and gauze on the posterior face of the lower lip. C, Image of the patient after 8 weeks of treatment. Complete resolution of the lesions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Martín-Carrasco, M. Sendín-Martín, J.J. Domínguez-Cruz, J. Bernabeu-Wittel" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Martín-Carrasco" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Sendín-Martín" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Domínguez-Cruz" ] 3 => array:2 [ "nombre" => "J." 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Duarte, N. Cunha, A. Lencastre, J. Cabete" "autores" => array:4 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Duarte" "email" => array:1 [ 0 => "brunoduarte@campus.ul.pt" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Cunha" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Lencastre" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Cabete" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servico de Dermatología, Hospital de Santo António dos Capuchos, Centro Hospitalario de Lisboa Central, Lisboa, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de los corticoides sistémicos en el tratamiento de la hidradenitis supurativa moderada-grave" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 857 "Ancho" => 3417 "Tamanyo" => 125498 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretreatment (i) and posttreatment (f) with adjunct systemic steroids. A statistically significant change was observed in both the IHS4 and the patient-reported outcomes (Wilcoxon signed-rank test, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hidradenitis Suppurativa (HS) is a debilitating chronic inflammatory disease of the apocrine gland-bearing skin, for which effective medical treatment remains elusive. Several immunological derangements are now identified in the disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Adalimumab is so far the sole European Medicines Agency approved drug. It shows encouraging, albeit suboptimal results.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> More immunosuppressants are in the pipeline. Despite this shift towards anti-inflammatory therapies in HS, evidence is scarce regarding the use of systemic steroids (SS), with only a limited number of case reports<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> and series<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> available. We aimed to evaluate SS as adjuncts to other medical therapies in HS.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A retrospective cohort study was conducted. The setting was an Adnexal Skin Diseases Clinic in a tertiary Dermatology department in Lisbon. Data was captured by searching the electronic and written medical records of the clinic. Patients were eligible if they had moderate or severe HS, as defined by the International HS Severity Score (IHS4), treated with SS at least in one occasion. Primary endpoint was a clinical response as defined by the HS Clinical Response Score (HiSCR).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Changes in patient-reported outcomes (Dermatology Life Quality index – DLQI and pain Numeric Rating Scale - NRS) were also evaluated. For statistical analysis, a Wilcoxon signed-rank test at a level of significance of 0.05 was used with STATA/IC 15.1 (STATA Corp., Texas, USA).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Among 121 HS patients followed at the clinic, 20 (16.5%) met eligibility criteria and 16 were analysed (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Four excluded due to poor compliance or lost to follow-up). Most patients were women (9/16), Caucasian (15/16), with a mean age of 45 years (18-67) and a mean duration of disease of 7.5 years (1-31). Most had severe disease (10/16; median IHS4 of 15).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Twenty cycles of adjunct systemic steroids were performed (three patients underwent >1 cycle). Therapy was initiated for disease cooling (11), acute flares (5), symptomatic relief (2) or preoperative cooling (2). The median maximum prednisolone dose was 0.44<span class="elsevierStyleHsp" style=""></span>mg/kg (0.28-1) and the median duration was 30 days (10-90). SS were mostly used in combination with doxycycline (9 cycles) followed by adalimumab (8 cycles). Most cycles (14/20, 70%) met the HiSCR. Those who did not, were performed in patients with higher disease activity (median IHS4 of 33.3 in non-responders vs 10 in responders). Median IHS4 reduced 40% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0012) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A significant improvement was observed in all patient-reported outcomes: median pain NRS and DLQIs reduced, respectively, 74% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0007) and 19% (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003). Three patients had remarkable disease worsening shortly after steroid withdrawal. No treatment discontinuation or remarkable adverse events were noted.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">There’s a paucity of research regarding the use of systemic steroids in HS, albeit they are prescribed in more than 1% of patients’ visits.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> To the best of our knowledge, this is the largest series to date evaluating SS as adjunct therapy in HS. Our results suggest that a short-to-medium term taper can be beneficial to rapidly control the painful hyperinflammatory flares while conventional HS treatments achieve proper disease control. Previously, long-term low-dose SS have showed advantages,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> but the risk of cumulative steroids’ detrimental effects must be considered. Additionally, uncontrolled inflammation is thought to increase the risk of postsurgical complications.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> In this series, 2 patients were treated preoperatively with favourable results and SS may thus be helpful to include in preoperative cooling strategies.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, moderate-to-severe HS patients are likely to benefit from addition of SS to other medical therapies for both disease control and preoperative care. Due to limitations in the present study, regarding its retrospective design and sample size, a placebo-controlled trial is warranted to further clarify the role of SS in the anti-inflammatory strategies of HS.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-12-25" "fechaAceptado" => "2019-01-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Duarte B, Cunha N, Lencastre A, Cabete J. Uso de los corticoides sistémicos en el tratamiento de la hidradenitis supurativa moderada-grave. Actas Dermosifiliogr. 2020;111:879–883.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 857 "Ancho" => 3417 "Tamanyo" => 125498 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pretreatment (i) and posttreatment (f) with adjunct systemic steroids. A statistically significant change was observed in both the IHS4 and the patient-reported outcomes (Wilcoxon signed-rank test, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">*All scores (IHS4, DLQI and NRS) and their respective Δ are represented by median values. All changes were statistically significant (Wilcoxon signed-rank test, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">§</span>Patient II and XV had only draining-fistulae. HiSCR was considered to be met despite absence of changes in IHS4, as treatment with PDN led to a clinically meaningful reduction in suppuration, inflammatory burden and overall disease severity.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">HS – Hidradenitis Suppurativa; PDN – Prednisolone; Preop – Preoperative; Sympt – Symptomatic; ADA – Adalimumab; Doxy – Doxycycline; Clind-Rif – Clindamycin – Rifampicin; IFX – Infliximab.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><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"><elsevierMultimedia ident="202012160745476971"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2469262.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients general data and treatment outcomes with adjunct systemic steroids. All scores present a pretreatment, a posttreatment and a delta value which is represented, respectively, by the letters i (initial), f (final) and Δ (change with treatment).</p>" ] ] 2 => array:5 [ "identificador" => "202012160745476971" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 1548 "Ancho" => 2917 "Tamanyo" => 414199 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hidradenitis suppurativa advances in diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.M.L. Saunte" 1 => "G.B.E. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 2 | 2 | 4 |
| 2024 Octubre | 95 | 56 | 151 |
| 2024 Septiembre | 126 | 34 | 160 |
| 2024 Agosto | 130 | 63 | 193 |
| 2024 Julio | 94 | 41 | 135 |
| 2024 Junio | 119 | 31 | 150 |
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| 2024 Marzo | 82 | 30 | 112 |
| 2024 Febrero | 67 | 39 | 106 |
| 2024 Enero | 85 | 40 | 125 |
| 2023 Diciembre | 59 | 14 | 73 |
| 2023 Noviembre | 100 | 32 | 132 |
| 2023 Octubre | 95 | 41 | 136 |
| 2023 Septiembre | 74 | 32 | 106 |
| 2023 Agosto | 79 | 18 | 97 |
| 2023 Julio | 92 | 35 | 127 |
| 2023 Junio | 93 | 27 | 120 |
| 2023 Mayo | 121 | 25 | 146 |
| 2023 Abril | 105 | 19 | 124 |
| 2023 Marzo | 108 | 31 | 139 |
| 2023 Febrero | 88 | 20 | 108 |
| 2023 Enero | 69 | 31 | 100 |
| 2022 Diciembre | 82 | 34 | 116 |
| 2022 Noviembre | 76 | 38 | 114 |
| 2022 Octubre | 53 | 22 | 75 |
| 2022 Septiembre | 46 | 39 | 85 |
| 2022 Agosto | 25 | 38 | 63 |
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| 2022 Junio | 29 | 30 | 59 |
| 2022 Mayo | 84 | 33 | 117 |
| 2022 Abril | 92 | 36 | 128 |
| 2022 Marzo | 109 | 57 | 166 |
| 2022 Febrero | 112 | 28 | 140 |
| 2022 Enero | 92 | 47 | 139 |
| 2021 Diciembre | 67 | 46 | 113 |
| 2021 Noviembre | 72 | 47 | 119 |
| 2021 Octubre | 117 | 68 | 185 |
| 2021 Septiembre | 101 | 52 | 153 |
| 2021 Agosto | 119 | 50 | 169 |
| 2021 Julio | 118 | 40 | 158 |
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| 2021 Mayo | 103 | 58 | 161 |
| 2021 Abril | 241 | 51 | 292 |
| 2021 Marzo | 130 | 48 | 178 |
| 2021 Febrero | 98 | 35 | 133 |
| 2021 Enero | 74 | 38 | 112 |
| 2020 Diciembre | 52 | 34 | 86 |
| 2020 Noviembre | 17 | 12 | 29 |
| 2020 Octubre | 1 | 0 | 1 |
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