Olivier Join-Lambert1, Hélène Coignard-Biehler2, Jean-Philippe Jais3, Maïa Delage4, Hélène Guet-Revillet5, Sylvain Poirée6, Sabine Duchatelet7, Vincent Jullien8, Alain Hovnanian7, Olivier Lortholary2, Xavier Nassif5, Aude Nassif9. 1. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Inserm U1151, eq. 11, Paris, France olivier.join-lambert@inserm.fr. 2. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. 3. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Service d'Informatique Médicale et de Biostatistiques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Inserm U1138, eq. 22, Paris, France. 4. Centre d'Infectiologie Necker-Pasteur, Paris, France Service de Dermatologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France Institut Pasteur, Centre Médical, Paris, France. 5. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Inserm U1151, eq. 11, Paris, France. 6. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Service de Radiologie Adulte, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France. 7. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Inserm U1163, Laboratory of Genetic Skin Diseases: From Disease Mechanism to Therapies, Imagine Institute, Paris, France. 8. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Inserm U663, Paris, France. 9. Université Paris Descartes, Sorbonne Paris Cité, Paris, France Centre d'Infectiologie Necker-Pasteur, Paris, France Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France Institut Pasteur, Centre Médical, Paris, France.
Abstract
OBJECTIVES: Hidradenitis suppurativa (HS) is an inflammatory skin disease typically localized in the axillae and inguinal and perineal areas. In the absence of standardized medical treatment, severe HS patients present chronic suppurative lesions with polymicrobial anaerobic abscesses. Wide surgery is the cornerstone treatment of severe HS, but surgical indications are limited by the extent of lesions. Intravenous broad-spectrum antibiotics may help control HS, but their efficacy is not documented. This study was designed to assess the efficacy of a 6 week course of ertapenem (1 g daily) and of antibiotic consolidation treatments for 6 months (M6) in severe HS. PATIENTS AND METHODS: Thirty consecutive patients with severe HS were retrospectively included in this study. The clinical severity of HS was assessed using the Sartorius score, which takes into account the number and severity of lesions. RESULTS: The median (IQR) Sartorius score dropped from 49.5 (28-62) at baseline to 19.0 (12-28) after ertapenem (P < 10(-4)). Five patients were lost to follow-up thereafter. At M6 the Sartorius score further decreased for the 16 patients who received continuous consolidation treatments, since 59% of HS areas reached clinical remission at M6 (i.e. absence of any inflammatory symptoms, P < 10(-4)). Nine patients interrupted or received intermittent consolidation treatments due to poor observance or irregular follow-up. Their Sartorius score stopped improving or returned to baseline. No major adverse event occurred. CONCLUSIONS: Ertapenem can dramatically improve severe HS. Consolidation treatments are needed to further improve HS and are mandatory to prevent relapses. Combined with surgery, optimized antibiotic treatments may be promising in severe HS.
OBJECTIVES:Hidradenitis suppurativa (HS) is an inflammatory skin disease typically localized in the axillae and inguinal and perineal areas. In the absence of standardized medical treatment, severe HS patients present chronic suppurative lesions with polymicrobial anaerobic abscesses. Wide surgery is the cornerstone treatment of severe HS, but surgical indications are limited by the extent of lesions. Intravenous broad-spectrum antibiotics may help control HS, but their efficacy is not documented. This study was designed to assess the efficacy of a 6 week course of ertapenem (1 g daily) and of antibiotic consolidation treatments for 6 months (M6) in severe HS. PATIENTS AND METHODS: Thirty consecutive patients with severe HS were retrospectively included in this study. The clinical severity of HS was assessed using the Sartorius score, which takes into account the number and severity of lesions. RESULTS: The median (IQR) Sartorius score dropped from 49.5 (28-62) at baseline to 19.0 (12-28) after ertapenem (P < 10(-4)). Five patients were lost to follow-up thereafter. At M6 the Sartorius score further decreased for the 16 patients who received continuous consolidation treatments, since 59% of HS areas reached clinical remission at M6 (i.e. absence of any inflammatory symptoms, P < 10(-4)). Nine patients interrupted or received intermittent consolidation treatments due to poor observance or irregular follow-up. Their Sartorius score stopped improving or returned to baseline. No major adverse event occurred. CONCLUSIONS:Ertapenem can dramatically improve severe HS. Consolidation treatments are needed to further improve HS and are mandatory to prevent relapses. Combined with surgery, optimized antibiotic treatments may be promising in severe HS.
Authors: Eran Shavit; Afsaneh Alavi; Falk G Bechara; Richard G Bennett; Marc Bourcier; Ricardo Cibotti; Steven Daveluy; John W Frew; Amit Garg; Iltefat Hamzavi; Lauren K Hoffman; Jenny Hsaio; Joslyn Sciacca Kirby; Hadar Lev-Tov; Erin Martinez; Robert Micheletti; Haley B Naik; Aude Nassif; Cynthia Nicholson; Angie Parks-Miller; Zarine Patel; Vincent Piguet; Mayur Ramesh; Barry Resnik; Christopher Sayed; Gregory Schultz; Aamir Siddiqui; Jerry Tan; Ximena Wortsman; Michelle A Lowes Journal: Exp Dermatol Date: 2019-01 Impact factor: 3.960
Authors: Ali Alikhan; Christopher Sayed; Afsaneh Alavi; Raed Alhusayen; Alain Brassard; Craig Burkhart; Karen Crowell; Daniel B Eisen; Alice B Gottlieb; Iltefat Hamzavi; Paul G Hazen; Tara Jaleel; Alexa B Kimball; Joslyn Kirby; Michelle A Lowes; Robert Micheletti; Angela Miller; Haley B Naik; Dennis Orgill; Yves Poulin Journal: J Am Acad Dermatol Date: 2019-03-11 Impact factor: 15.487