Publications by authors named "Gregor B E Jemec"

245 Publications

Associations between maternal and environmental exposures on atopic disease in the offspring of mothers with asthma.

Immun Inflamm Dis 2021 Jun 19. Epub 2021 Jun 19.

Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Background And Objective: Available data on the impact of perinatal and environmental factors on atopic diseases in the offspring are sparse and conflicting. We, therefore, investigated the impact of these factors on the risk of atopic diseases in the offspring of women with asthma.

Methods: Pregnant women referred to give birth at Copenhagen University Hospital-Hvidovre, Denmark, have since 2007 been invited to participate in the Management of Asthma during Pregnancy program. Women with diagnosed asthma, currently prescribed asthma medication, first visit to the respiratory out-patient clinic within the first 18 weeks of pregnancy that completed an online questionnaire about atopic diseases in their child were included in the current study.

Results: Five hundred and seventy-one pregnancies were included. Among the off-spring, 113 children (21%) had doctor-diagnosed asthma, 178 (31%) atopic dermatitis (AD), and 55 (32%) both AD and doctor-diagnosed asthma. AD in the offspring was associated with having a dog at home (odds ratio [OR], 2.56; 95% confidence interval [CI], [1.40-4.67], p = .002), whereas having a cat at home was associated with a higher risk of asthma in the offspring (OR, 2.16; 95% CI, [1.14-4.11], p = .02). The associations remained significant after adjusting for maternal age, smoking status, allergy, treatment with inhaled corticosteroids, forced expiratory volume in 1 s less than 80% predicted, uncontrolled asthma, and history of pre-pregnancy asthma exacerbations. No association was found between gestational weight gain (GWG) in first trimester and total GWG and atopic disease in the offspring.

Conclusion: Having pets at home is associated with AD and asthma in the offspring of mothers with asthma.
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http://dx.doi.org/10.1002/iid3.441DOI Listing
June 2021

Anti-COVID-19 measurements for hidradenitis suppurativa patients.

Exp Dermatol 2021 06;30 Suppl 1:18-22

European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.

The reported incidence of COVID-19 among cohorts of patients with inflammatory bowel and skin diseases under treatment with biologicals is low. Treatment may further modify disease severity as some biological modifiers, such as anakinra, are also proposed for the management of COVID-19 patients potentially providing HS patients with an advantage. The above preliminary evidence suggests that hidradenitis suppurativa (HS) does probably not provide an increased susceptibility for COVID-19 and that any susceptibility is unlikely to be modified negatively by treatment with biologicals. On the occasion of its 10th International Conference, experts of the European Hidradenitis Suppurativa Foundation e.V. have prepared a consensus statement regarding anti-COVID-19 measurements for HS patients. Based on the available knowledge, patients with HS may be vaccinated against SARS-CoV2 and patients affected by metabolic syndrome constitute a high-risk group for COVID-19 and should be vaccinated at the earliest convenient point in time. HS patients on treatment with adalimumab can be vaccinated with non-living virus anti-SARS-CoV2 vaccines. A possible suboptimal effect of the vaccine may be suspected but might not be expected universally. The management of the biological treatment in HS patients is at the discretion of the dermatologist / responsible physician.
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http://dx.doi.org/10.1111/exd.14339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207032PMC
June 2021

Target molecules for future hidradenitis suppurativa treatment.

Exp Dermatol 2021 Jun;30 Suppl 1:8-17

European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.

The registration of the tumour necrosis factor-α inhibitor adalimumab in 2015 was a major step forward in the treatment of hidradenitis suppurativa/acne inversa (HS). However, it soon became evident that the effectiveness of adalimumab in daily practice was highly variable. A significant unmet medical need of HS patients remained, and the search for novel therapeutic targets was intensified. During the 10th European Hidradenitis Suppurativa Foundation (EHSF) e.V. Conference, reknown international HS investigators virtually presented and discussed the published data on these potential target molecules for future HS treatment. This article addresses the most promising molecules currently under investigation from a pathophysiological and clinical point of view. With phase III trials ongoing, the anti- interleukin (IL)-17 biologics bimekizumab and secukinumab are in the most advanced stage of clinical development showing promising results. In addition, targeting IL-1α with bermekimab has shown encouraging results in two clinical trials. Directing treatment at neutrophil recruitment and activation by targeting IL-36 with spesolimab fits well in the pathogenic concept of HS and clinical phase II trial results are pending. In contrast to in situ evidence, Complement 5a (C5a) and C5a receptor blockade have only shown greater clinical benefit in patients with severe HS. Inhibition of Janus kinase (JAK) 1 signalling in HS showed clinical efficacy only in the highest dosage, highlighting that careful surveillance of the balance between safety and efficacy of JAK inhibition is warranted. Overall, clinical efficacies of all novel treatments reported so far are modest. To guide drug development, more and better-defined translational data on the pathogenesis of this severe and enigmatic inflammatory skin disease are required.
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http://dx.doi.org/10.1111/exd.14338DOI Listing
June 2021

How to diagnose and measure primary hyperhidrosis: a systematic review of the literature.

Clin Auton Res 2021 Aug 27;31(4):511-528. Epub 2021 Mar 27.

Department of Dermatology, Faculty of Health and Medical Sciences, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.

Purpose: Hyperhidrosis (i.e. excessive sweating) is diagnosed from patient medical history and physical examination. In addition, focal sweat measurements can substantiate the hyperhidrosis diagnosis. Likewise, the impact of living with hyperhidrosis can be assessed with patient-reported outcome measures. However, no consensus exists on how to diagnose hyperhidrosis, how to quantify the disease, or how to measure the impact hyperhidrosis has on patients. Therefore, the objective of this review was to summarize the literature on diagnostic criteria, focal sweat measurement methods, and patient-reported outcome measures of hyperhidrosis.

Methods: A literature search of Cochrane Library, Embase, and PubMed was conducted. Studies that included and aimed at developing or validating hyperhidrosis diagnostic criteria, focal sweat measurement methods, or patient-reported outcome measures for individuals with hyperhidrosis were eligible for inclusion. The methodological quality of diagnostic accuracy studies about focal sweat measurement methods was determined using the Quality Assessment of Diagnostic Accuracy Studies-2.

Results: Overall, 33 studies were included. We identified two sets of hyperhidrosis diagnostic criteria, one scale for assessment of severity of hyperhidrosis sweating, four focal sweat measurement methods, and 15 patient-reported outcome measures.

Conclusion: The algorithm for diagnosing hyperhidrosis and focal sweat measurement methods needs validation in large cohorts. Most patient-reported outcome measures for hyperhidrosis are not adequately validated. A potential solution is to develop a core outcome set that can standardize outcomes reported in clinical trials.
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http://dx.doi.org/10.1007/s10286-021-00794-6DOI Listing
August 2021

Epidemiology of Hyperhidrosis in Danish Blood Donors.

Acta Derm Venereol 2021 Apr 26;101(4):adv00435. Epub 2021 Apr 26.

Department of Dermatology, Zealand University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, DK-4000 Roskilde, Denmark. E-mail:

The risk factors and disease implications of hyper-hidrosis are unknown. The objectives of this retrospective cohort study were to estimate the prevalence of hyperhidrosis and to compare demographic, life-style, and socioeconomic parameters in blood donors with and without self-reported or hospital-diagnosed hyperhidrosis. The study included blood donors from the Danish Blood Donor Study for the period 2010-2019. Registry data were collected from Statistics Denmark. Overall, 2,794 of 30,808 blood donors (9.07%; 95% confidence interval (95% CI) 8.75-9.40) had self- reported hyperhidrosis and 284 of 122,225 (0.23%; 95% CI 0.21-0.26) had hospital-diagnosed hyperhidrosis. Self-reported hyperhidrosis was associated with smoking (odds ratio (OR) 1.17; 95% CI 1.05-1.31), overweight (OR 1.72; 95% CI 1.58-1.87), "unemployed" (OR 1.60; 95% CI 1.24-2.08), "short education" (OR 0.76; 95% CI 0.64-0.90), and lower income (beta-coefficient -26,121; 95% CI -37,931, -14,311). Hospital-diagnosed hyperhidrosis did not differ from controls. Thus, self-reported hyperhidrosis was associated with potential hyperhidrosis risk factors (smoking, overweight) and disease implications (unemployment, low education level and income).
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http://dx.doi.org/10.2340/00015555-3790DOI Listing
April 2021

Global Harmonization of Morphological Definitions in Hidradenitis Suppurativa for a Proposed Glossary.

JAMA Dermatol 2021 Apr;157(4):449-455

Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.

Importance: Standard morphological terminology and definitions are vital for identification of lesion types in the clinical trial setting and communication about the condition. For hidradenitis suppurativa (HS), morphological definitions have been proposed by different groups, representing various regions of the world, but no international consensus has been reached regarding such definitions. A lack of globally harmonized terminology and definitions may contribute to poor-quality data collection in clinical trials as well as poor communication among clinicians, investigators, and patients.

Objective: To establish and validate consensus definitions for typical morphological findings for HS lesions.

Methods: This study was conducted from August 2019 to August 2020. A Delphi study technique was used to assess agreement and then resolve disagreement on HS terminology among international experts. After an initial preparation phase, the process consisted of 3 rounds. In each round, participants reviewed preliminary definitions and rated them as "keep, with no changes," "keep, with changes," or "remove." Eight HS primary lesions, including papule, pustule, nodule, plaque, ulcer, abscess, comedo, and tunnel, were selected because they are most frequently used in HS clinician-reported outcome measures. The initial definitions were based on extant literature, and modifications were made between rounds based on qualitative thematic analysis of open-ended responses or discussion. Consensus was defined as greater than 70% to accept a definition. Consensus stability across rounds was defined as less than 15% change in agreement. Reliability was evaluated using the Gwet agreement coefficient. Validation was based on assessment of face validity and stability across rounds.

Results: A total of 31 experts participated. All 8 HS primary lesion definitions achieved greater than 70% consensus by Delphi round 3. Stability was achieved for papule, pustule, and abscess. The Gwet agreement coefficient increased from 0.49 (95% CI, 0.26-0.71) in round 1 to 0.78 (95% CI, 0.64-0.92) in round 3. Face validity was supported by expert endorsement to keep terms in survey responses. Previously unmeasured variation among clinicians' definition of tunnels was identified, and consensus was achieved.

Conclusions And Relevance: An international group of experts agreed on definitions for morphological features of HS lesions frequently included in HS clinical trials. These international consensus terms and definitions are needed to support consistency of lesion identification and quantification in clinical trials.
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http://dx.doi.org/10.1001/jamadermatol.2020.5467DOI Listing
April 2021

Intralesional Triamcinolone for Hidradenitis Suppurativa-How Much Is Needed?

Dermatol Surg 2021 07;47(7):1013-1014

Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.

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http://dx.doi.org/10.1097/DSS.0000000000002753DOI Listing
July 2021

Photodynamic therapy: A treatment option for terbinafine resistant Trichophyton species.

Photodiagnosis Photodyn Ther 2021 Mar 23;33:102169. Epub 2021 Jan 23.

Department of Dermatology, Zealand University Hospital, Roskilde, Denmark; Department of Clinical Medicine, Falculty of Health Science, University of Copenhagen, Copenhagen, Denmark; Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark. Electronic address:

Background: Terbinafine is a first-line agent against Trichophyton-infections. However, treatment failure and resistance due to squalene epoxidase (SQLE) alterations are increasingly being reported. Photodynamic therapy (PDT) is based on combining a photosensitizer, light and oxygen to create photo-activated reactive oxygen species. It has demonstrated in vitro and in vivo activity against various microorganisms including dermatophytes. We investigated if PDT is equally effective against terbinafine resistant and susceptible strains.

Methods: Minimum inhibitory concentrations (MIC) of methylene blue (MB)-PDT against wildtype and resistant Trichophyton rubrum and Trichophyton interdigitale were determined in duplicate in microtitre plates following EUCAST E.Def 11.0 reference methodology. Included mutants harboured F397L, L393F, L393S, F415S or F397I SQLE-alterations. Illumination with red diode light was performed after <3 min, 30 min and 3 h of incubation, respectively, and plates were cultured at 25 °C for 5 days. Geometric mean MICs and MIC ranges were calculated for each isolate.

Results: MB-PDT led to complete inhibition of all isolates at geometric mean concentrations of 1-16 mg/L. Efficacy was independent of incubation time prior to illumination, terbinafine susceptibility (MICs ≤0.004-4 mg/L) and presence of SQLE mutations. However, the MB-PDT MIC was slightly elevated (MB: 2-8 mg/L and 8-16 mg/L) in isolates from two pigmented cultures of Trichophyton interdigitale (one wildtype and one harbouring L393F) with a darker color when compared to unpigmented cultures (MB: 0.5-4 mg/L).

Conclusion: Terbinafine resistant and susceptible strains are equally susceptible to MB-PDT. Lower efficacy was observed against dark coloured isolates which we speculate may be due to melanisation interfering with photo-activation due to preferential light absorption.
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http://dx.doi.org/10.1016/j.pdpdt.2020.102169DOI Listing
March 2021

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study.

J Am Acad Dermatol 2021 Aug 20;85(2):369-378. Epub 2021 Jan 20.

Erasmus MC, University Medical Center Rotterdam, Department of Dermatology, Rotterdam, the Netherlands. Electronic address:

Background: Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.

Objective: To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin.

Methods: A prospective, international cohort study performed between October 2018 and August 2019.

Results: In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain.

Limitations: Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline.

Conclusion: This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.
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http://dx.doi.org/10.1016/j.jaad.2020.12.089DOI Listing
August 2021

Risk of Hidradenitis Suppurativa Comorbidities Over Time: A Prospective Cohort Study of Danish Blood Donors.

Acta Derm Venereol 2021 Jan 20;101(1):adv00376. Epub 2021 Jan 20.

Department of Dermatology, Zealand University Hospital, DK-4000 Roskilde, Denmark. E-mail:

Hidradenitis suppurativa is a common recurrent inflammatory skin disease. It is associated with multiple comorbidities whose temporal relationships are unknown due to long diagnostic delays. This study of otherwise healthy blood donors with self-reported symptoms of hidradenitis suppurativa investigated the temporal relationships of comorbidities. A prospective survival analysis on a nationwide cohort of blood donors, using registry data on drug prescription, was used to calculate the hazard ratio of time until first prescription of medical treatment for the following hidradenitis suppurativa-related comorbidities: heart disease, diabetes, depression, thyroid disease and pain. Hidradenitis suppurativa status was determined by a validated questionnaire, and the survival analysis was adjusted for age, sex, body mass index, smoking status and having an International Classification of Diseases Version 10 (ICD-10) diagnosis of hidradenitis suppurativa. Of the participants, 1,012 reported hidradenitis suppurativa symptoms, and these symptoms increased the hazard ratio of antidepressants (1.73, 95% confidence interval 1.17-2.56, p ≈ 0.006) and analgesics (hazard ratio 1.24, 95% confidence interval 1.11-1.39, p < 0.001). Pain and depression are the first comorbidities to present in hidradenitis suppurativa pathogenesis.
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http://dx.doi.org/10.2340/00015555-3737DOI Listing
January 2021

Geosocial Dating Applications Mirror the Increase in Sexually Transmitted Diseases.

Acta Derm Venereol 2021 Jan 25;101(1):adv00378. Epub 2021 Jan 25.

Department of Dermato-Venereology, Zealand University Hospital, DK-4000 Roskilde, Denmark.

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http://dx.doi.org/10.2340/00015555-3732DOI Listing
January 2021

Therapeutic Drug Monitoring in Patients with Suboptimal Response to Adalimumab for Hidradenitis Suppurativa: A Retrospective Case Series.

Am J Clin Dermatol 2021 Mar 26;22(2):275-283. Epub 2020 Nov 26.

Faculty of Medicine, University of Toronto, Toronto, Canada.

Background: Adalimumab, a tumor necrosis factor-α inhibitor, is a biologic used for the treatment of moderate-to-severe hidradenitis suppurativa (HS). It is well known that patients may experience loss of efficacy from its use in other conditions, and it is suggested that developing a strategy for therapeutic drug monitoring (TDM) may help secure optimal clinical outcomes.

Objectives: We sought to determine serum adalimumab concentrations and anti-adalimumab antibody (AAA) status in patients with moderate-to-severe HS.

Methods: A retrospective case series of 38 patients with suboptimal response to adalimumab 40 mg weekly was conducted at a community dermatology clinic. Adalimumab serum trough levels, AAA status, and inflammatory biomarkers were collected. Blood was drawn on identification of suboptimal response (after a minimum of 12 weeks) and was collected once prior to receiving the next scheduled dose. Kruskal-Wallis and Chi-squared tests were used for data analysis.

Results: A total of 38 patients had a median adalimumab trough concentration of 8.76 (interquartile range [IQR] 1.3-12.5) µg/mL. The median duration of adalimumab therapy of all patients was 21 (IQR 12-24) months. AAAs were detected in nine patients (24%), and all had subtherapeutic serum concentrations (< 6 µg/mL). Patients who were AAA+ had a significantly lower median adalimumab concentration than those who were AAA- (0.02 µg/mL [range 0.02-0.81] vs. 10.14 [range 0.76-48.00]; p = 0.0006).

Conclusion: Patients with AAAs had significantly lower serum adalimumab levels. The current study suggests that TDM may identify underlying reasons for suboptimal response and detect patients who may benefit from dose optimization strategies.
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http://dx.doi.org/10.1007/s40257-020-00575-3DOI Listing
March 2021

A survey of clinicians regarding preferred severity assessment tools for hidradenitis suppurativa.

Int J Dermatol 2021 Jun 12;60(6):e248-e251. Epub 2020 Nov 12.

Departments of Medicine and Dermatology, University of Minnesota, Minneapolis, MN, USA.

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http://dx.doi.org/10.1111/ijd.15295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106619PMC
June 2021

Mechanical forces and Hidradenitis Suppurativa.

Exp Dermatol 2021 Feb 25;30(2):212-215. Epub 2020 Nov 25.

Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.

The mechanism by which inflammatory skin disease forms localized patterns of lesions is poorly understood. Hidradenitis suppurtiva (HS) is strikingly located to intertriginous areas. These areas are subject to considerable mechanical stress (friction, pressure and shear forces). Koebner phenomenon (KP) describes the appearance of typical skin lesions of a pre-existing dermatosis on previously clear skin following trauma, such as friction, pressure and more often penetrating injury with subsequent scarring. Striae distensae (SD) are a form of dermal scarring and can be considered as a form of inflammation-driven dermal disarray. Ectopic HS lesions may occur as KP due to trauma and locally increased susceptibility consisting of either altered mechanical qualities or inflammation. SD and mechanical stress may thus provide a model for the development of lesions. In the absence of an (animal) model or experiment, two patients are described who show HS (-like) lesions along co-localized with SD. The suggested two-hits model may be necessary for the development of KP in HS, that is that the general susceptibility, conferred by obesity, requires a local susceptibility factor to result in ectopic lesions. Ultimately, if ectopic HS lesions are considered true HS lesions it may be speculated that similar interaction occurs in the naturally stressed skin areas offering a possible explanation of the localized pattern of the disease.
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http://dx.doi.org/10.1111/exd.14234DOI Listing
February 2021

Sub-classification of Hidradenitis suppurativa: a cross-sectional study.

Arch Dermatol Res 2020 Oct 21. Epub 2020 Oct 21.

Department of Dermatology, Roskilde; Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000, Roskilde, Denmark.

The typical Hidradenitis Suppurativa (HS) patient is a young woman with axillary and groin involvement, but the spectrum of the disease presentation is broad and no internationally acknowledged sub-classification of the disease exists to date. It is however speculated that different, yet unidentified, subtypes may respond differently to different treatments or carry a different prognosis. Classification according to self-reported clinically meaningful outcomes for patients offer practical advantages. Our objective was to build an empirical framework for sub-classification of HS patients based on the frequency of HS flares in various anatomic locations, using a cross-sectional questionnaire-based design. All patients with a clinically confirmed diagnosis of HS registered at our department until March 1, 2017 were invited to participate. The frequency of HS flares in various anatomic locations was used for identification of possible HS subtypes using Principal Component Analysis (PCA) and cluster analysis. A total of 524 (62%) of 845 invited patients answered the questionnaire; 402 (76.7%) were female. From the cluster analysis, we identified two possible subtypes of HS, labeled the "upper type" and the "lower type". The "upper type" was characterized by repeated outbreaks in axillary and mammary regions. Meanwhile, the "lower type" was characterized by outbreaks in the inguinal, genital, perianal, and gluteal regions. Our findings support the notion that HS can be sub-classified and imply that the pattern of where lesions are located may be an important element in future HS sub-classification systems.
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http://dx.doi.org/10.1007/s00403-020-02149-zDOI Listing
October 2020

What causes hidradenitis suppurativa ?-15 years after.

Exp Dermatol 2020 12;29(12):1154-1170

European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.

The 14 authors of the first review article on hidradenitis suppurativa (HS) pathogenesis published 2008 in EXPERIMENTAL DERMATOLOGY cumulating from the 1st International Hidradenitis Suppurativa Research Symposium held March 30-April 2, 2006 in Dessau, Germany with 33 participants were prophetic when they wrote "Hopefully, this heralds a welcome new tradition: to get to the molecular heart of HS pathogenesis, which can only be achieved by a renaissance of solid basic HS research, as the key to developing more effective HS therapy." (Kurzen et al. What causes hidradenitis suppurativa? Exp Dermatol 2008;17:455). Fifteen years later, there is no doubt that the desired renaissance of solid basic HS research is progressing with rapid steps and that HS has developed deep roots among inflammatory diseases in Dermatology and beyond, recognized as "the only inflammatory skin disease than can be healed". This anniversary article of 43 research-performing authors from all around the globe in the official journal of the European Hidradenitis Suppurativa Foundation e.V. (EHSF e.V.) and the Hidradenitis Suppurativa Foundation, Inc (HSF USA) summarizes the evidence of the intense HS clinical and experimental research during the last 15 years in all aspects of the disease and provides information of the developments to come in the near future.
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http://dx.doi.org/10.1111/exd.14214DOI Listing
December 2020

Can we clinically identify patients at risk of malignant transformation of skin tumors in Brooke-Spiegler syndrome?

Acta Dermatovenerol Alp Pannonica Adriat 2020 Sep;29(3):133-140

Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.

Brooke-Spiegler syndrome (BSS) is a rare inherited autosomal dominant disease characterized by the development of multiple adnexal cutaneous neoplasms. BSS has been linked to mutations in CYLD gene, which is a tumor suppressor gene located on chromosome 16q12-q13. An increased risk of malignant transformation of adnexal cutaneous tumors in BSS patients has been reported. However, no reported genetic markers identify patients at risk of cutaneous malignancy. This study reviews published cases of BSS to investigate the role of clinical parameters as biomarkers of skin malignancy. A comprehensive review of the clinical aspects of BSS is based on 55 case reports. Our analysis revealed only age as a predictor of malignancy; however, this is also a general risk factor for development of malignancy and therefore of limited value as a screening tool. The study highlights the need for standardized clinical follow-up of patients.
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September 2020

Hidradenitis Suppurativa is Associated with Non-alcoholic Fatty Liver Disease: A Cross-sectional Study.

Acta Derm Venereol 2020 Aug 18;100(15):adv00239. Epub 2020 Aug 18.

Department of Dermatology, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research, ES-03010 Alicante, Spain. E-mail:

Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of end-stage liver disease. The aim of this controlled cross-sectional study was to assess the association between NAFLD and hidradenitis suppurativa. NAFLD was assessed using hepatic ultrasound. A total of 125 patients with hidradenitis suppurativa and 120 patients without hidradenitis suppurativa were recruited, matched for age, sex and body mass index (< 25 or ≥ 25 kg/m2), a risk factor related to NAFLD. Both groups presented similar proportions of overweight or obesity (89.6% vs 90%). Patients with hidradenitis suppurativa presented significantly higher prevalence of NAFLD compared with those with non- hidradenitis suppurativa (57.6% vs 31.7%, p < 0.001). Multivariable analysis confirmed independent association between hidradenitis suppurativa and NAFLD (odds ratio 2.79, 95% confidence interval 1.48-5.25; p = 0.001) besides age, body mass index, hypertension and hypertransaminasaemia. Hidradenitis suppurativa is significantly associated with the development of NALFD regardless of the presence of classic metabolic risk factors.
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http://dx.doi.org/10.2340/00015555-3597DOI Listing
August 2020

Incomplete Schnitzler Syndrome.

Acta Dermatovenerol Croat 2020 Jul;28(1):38-40

Mattias A.S. Henning, MD, Department of Dermatology, Zealand University Hospital, Sygehusvej 5, 4000 Roskilde, Denmark;

Schnitzler syndrome (SS) is a rare autoinflammatory disease that presents with chronic urticaria and monoclonal immunoglobulin (Ig) M or G, accompanied by fever, abnormal bone remodeling, skin biopsy with a neutrophilic dermal infiltrate, leukocytosis, or elevated C-reactive protein. It is usually refractory to antihistamines and immunosuppression. We present a case report of clinical SS without monoclonal Ig with robust response to interleukin-1 inhibitor anakinra. This suggests the possible existence of an incomplete form of SS and underlines the risk of false negative diagnosis in individuals with such "incomplete SS".
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July 2020

Multimodal management of hidradenitis suppurativa.

Authors:
Gregor B E Jemec

Int J Womens Dermatol 2020 Jun 6;6(3):169-170. Epub 2020 Apr 6.

Department of Dermatology, Zealand University Hospital, Roskilde, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.

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http://dx.doi.org/10.1016/j.ijwd.2020.04.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330436PMC
June 2020

Dynamic Optical Coherence Tomography Imaging of Telangiectasia Prior to Intense Pulsed Light Treatment-An Opportunity to Target Treatment?

Lasers Surg Med 2021 02 12;53(2):212-218. Epub 2020 Jun 12.

Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, Roskilde, 4000, Denmark.

Background And Objectives: To investigate whether optical coherence tomography (OCT) could be utilized to characterize blood flow and vessel dimensions of facial telangiectasias before and during consecutive intense pulsed light (IPL) treatment.

Study Design/materials And Methods: Dynamic OCT (D-OCT) was used to image telangiectasia immediately before and after, 1-3 days after, and 1 month after IPL treatment. Measurements included vessel width and depth, blood flow, and attenuation. Vessel dimensions at baseline were verified by a blinded observer. Clinical improvement was detected as good, moderate, or none, and adverse effects were registered at 1-month follow-up.

Results: In total, 14 patients with facial telangiectasia were included. At baseline, vessel width was median 0.25 mm (interquartile range [IQR]: 0.19-0.34 mm) with an intra-class coefficient (ICC) of 0.89 (95% confidence interval [CI]: 0.70; 0.97). Vessel depth was 0.30 mm (IQR: 0.25-0.33 mm; ICC: 0.40 [CI: -0.07; 0.75]). Vessel depth increased significantly from baseline to 1-month follow-up (P = 0.008), whereas no significant changes in vessel width, blood flow, or attenuation were detected. Clinical efficacy seemed related to the relation between vessel dimensions and applied energy settings.

Conclusions: The D-OCT imaging technique demonstrated that facial telangiectasias were found deeper within the skin after one IPL treatment. By characterizing the vessel dimensions and blood flow of telangiectasia, D-OCT may improve efficacy and safety of IPL. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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http://dx.doi.org/10.1002/lsm.23280DOI Listing
February 2021

Proposed Definitions of Typical Lesions in Hidradenitis Suppurativa.

Dermatology 2020 9;236(5):431-438. Epub 2020 Jun 9.

Private practice, Paris, France.

Background: Although not rare, hidradenitis suppurativa (HS) is often under-recognized by physicians. The diagnosis of HS is clinical via the recognition of lesions typical of the disease, but universally accepted definitions of these latter are currently lacking, which means that certain severity scores employed for HS classification/management are used differently by different physicians. Our aim was to develop a set of descriptive definitions and associated images of HS lesions, in order to enable doctors to better recognize and evaluate the disease.

Methods: MEDLINE-available literature and dermatological textbooks on HS morphology were retrieved (January 1996 to February 2016). A preliminary set of definitions of HS typical lesions was created, including 10 terms. Each term was associated with a pathophysiological classification and an image. This preliminary set was shown during the 5th Conference of the European HS Foundation (EHSF). The physicians attending the event were invited to vote on each term and make comments via a voting sheet.

Results: A total of 81 physicians answered the questionnaire. Their agreement/disagreement rates and comments were used to obtain a revised set of definitions and images. Pathophysiological classifications were dropped.

Conclusion: A user-friendly set of definitions/images of HS typical lesions was proposed and will need to be validated by further studies. This set could ultimately serve as a tool to better recognize, score, and assess treatment efficacy.
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http://dx.doi.org/10.1159/000507348DOI Listing
July 2021

Proposed Definitions of Typical Lesions in Hidradenitis Suppurativa.

Dermatology 2020 9;236(5):431-438. Epub 2020 Jun 9.

Private practice, Paris, France.

Background: Although not rare, hidradenitis suppurativa (HS) is often under-recognized by physicians. The diagnosis of HS is clinical via the recognition of lesions typical of the disease, but universally accepted definitions of these latter are currently lacking, which means that certain severity scores employed for HS classification/management are used differently by different physicians. Our aim was to develop a set of descriptive definitions and associated images of HS lesions, in order to enable doctors to better recognize and evaluate the disease.

Methods: MEDLINE-available literature and dermatological textbooks on HS morphology were retrieved (January 1996 to February 2016). A preliminary set of definitions of HS typical lesions was created, including 10 terms. Each term was associated with a pathophysiological classification and an image. This preliminary set was shown during the 5th Conference of the European HS Foundation (EHSF). The physicians attending the event were invited to vote on each term and make comments via a voting sheet.

Results: A total of 81 physicians answered the questionnaire. Their agreement/disagreement rates and comments were used to obtain a revised set of definitions and images. Pathophysiological classifications were dropped.

Conclusion: A user-friendly set of definitions/images of HS typical lesions was proposed and will need to be validated by further studies. This set could ultimately serve as a tool to better recognize, score, and assess treatment efficacy.
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http://dx.doi.org/10.1159/000507348DOI Listing
July 2021

Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice.

Dermatology 2020 14;236(5):393-412. Epub 2020 May 14.

Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.

Background: Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS.

Summary: This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.
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http://dx.doi.org/10.1159/000507323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177083PMC
July 2021

Photodynamic therapy treatment of superficial fungal infections: A systematic review.

Photodiagnosis Photodyn Ther 2020 Sep 25;31:101774. Epub 2020 Apr 25.

Department of Dermatology, Zealand University Hospital, Sygehusvej 5, DK-4000, Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Blegdamsvej 3B, DK-2200, Copenhagen, Denmark; Unit of Mycology, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen, Denmark. Electronic address:

Background: Fungal infections in skin, hair and nails affect up to 25 % of the global population. Conventional antifungal treatment is effective but due to resistance, treatment failure, drug interactions, and treatment related toxicity, there is a need for alternative treatments. Photodynamic therapy (PDT) has shown antimicrobial properties and is used increasingly for fungal infections. This review investigates the reported efficacy and side effects of PDT of superficial mycoses.

Methods: Pubmed and Embase were searched 26-01-2020 for "superficial fungal infections" and "photodynamic therapy" in "Human subjects" using a predefined search string. Criteria for inclusion were: clinical trials and cases involving PDT-treated patients with primary fungal infections in skin, hair and nails. Criteria for exclusion were: languages other than English, animal models, in vitro trials, secondary fungal infections, reviews and guidelines.

Results: 541 records were identified and 34 papers fulfilled the criteria. PDT of onychomycosis (n = 380 patients) found treatment with methylene blue (MB) photosensitizer (PS) more efficacious with complete cure rates of 70 %-80 % than 5-aminolevulinic acid (ALA)-PDT (mycological cure rates of 17 %-57 %) and methyl aminolevulinate (MAL)-PDT (mycological cure rate of 32 %). Other PDT-treated fungal diseases included (n = 55): foot infections (n = 19), tinea cruris (n = 10), scalp infections (n = 2), Malassezia infections (n = 9) and subcutaneous fungal infections (n = 15) achieved promising effect.

Conclusion: PDT-treatment of superficial mycoses can be efficacious as salvage therapy. In the light of increasing resistance and few licensed treatment alternatives, larger randomized controlled trials investigations and optimization of the PDT-treatment protocol are warranted to evaluate PDT's potential as a future antifungal treatment.
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http://dx.doi.org/10.1016/j.pdpdt.2020.101774DOI Listing
September 2020

Exploring the EQ-5D Dimension of Pain/Discomfort in Dermatology Outpatients from a Multicentre Study in 13 European Countries.

Acta Derm Venereol 2020 Apr 21;100(8):adv00120. Epub 2020 Apr 21.

Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS FLMM, Via dei Monti di Creta 104, IT-00167 Rome, Italy.

Pain and discomfort are important symptoms in dermatology. The aim of this cross-sectional, multicentre study was to describe the prevalence of pain/discomfort and its associations in patients with several dermatological conditions across 13 European countries. The outcome was the prevalence of pain/discomfort according to a question of the EQ-5D questionnaire. Data collected from November 2011 to February 2013 were complete for 3,509 consecutive outpatients. Moderate or extreme pain/discomfort was reported by 55.5% of patients and 31.5% of controls with no skin conditions. The highest proportions were reported by patients with hidradenitis suppurativa (92.9%), leg ulcer (81.4%), prurigo (80%) and lichen planus (75.6%). Pain/discomfort was associated with older age, low educational level, clinical severity, flare on scalp or hands, itch, depression, anxiety, low quality of life, and thoughts of suicide. It is important to enquire specifically about pain/discomfort during clinical consultations and to address it when planning a patient's care.
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http://dx.doi.org/10.2340/00015555-3477DOI Listing
April 2020

Body Image Quality of Life in Patients with Hidradenitis Suppurativa Compared with Other Dermatological Disorders.

Acta Derm Venereol 2020 Apr 6;100(8):adv00107. Epub 2020 Apr 6.

Department of Dermatology, Zealand University Hospital, DK-4000 Roskilde, Denmark.

Hidradenitis suppurativa is a chronic skin disease characterized by inflammation and disfiguring scarring in the intertriginous body areas. Hidradenitis suppurativa is associated with overweight and impaired quality of life. This study sought to describe Body Image Quality of Life (BI-QoL) in patients with hidradenitis suppurativa and to compare it with patients with other skin diseases (controls). A total of 285 participants were recruited, 141 with hidradenitis suppurativa and 144 controls, at the Department of Dermatology at Zealand University Hospital, Denmark (during 2017-18). The Danish "Body Image Quality of Life Inventory" questionnaire measured BI-QoL. Patients with hidradenitis suppurativa had significantly lower mean BI-QoL than controls: Hidradenitis suppurativa BI-QoL (standard deviation; SD) -0.87 (0.98) vs. control BI-QoL (SD) 0.01 (1.11), p < 0.001. Predictors of negative BI-QoL were hidradenitis suppurativa, increased body mass index, female sex, symptoms of depression, and body mass index moderated by hidradenitis suppurativa. These data suggest that BI-QoL is impaired in patients with hidradenitis suppurativa compared with patients with other skin diseases after adjusting for confounders.
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http://dx.doi.org/10.2340/00015555-3464DOI Listing
April 2020

Clinical characteristics of pediatric hidradenitis suppurativa: a cross-sectional multicenter study of 140 patients.

Arch Dermatol Res 2020 Dec 12;312(10):715-724. Epub 2020 Mar 12.

Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.
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http://dx.doi.org/10.1007/s00403-020-02053-6DOI Listing
December 2020
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