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Deventer, Netherlands

Schrader A.M.R.,Leiden University | Deckers I.E.,Erasmus Medical Center | Van Der Zee H.H.,Erasmus Medical Center | Boer J.,Deventer Hospital | Prens E.P.,Erasmus Medical Center
Journal of the American Academy of Dermatology

Background Few comprehensive studies exist on the epidemiology of hidradenitis suppurativa, a very distressing skin disease. Objective We sought to identify disease-related factors associated with severity, sex, and family history. Methods Ordinal logistic regression was used in 846 consecutive Dutch patients with hidradenitis suppurativa to calculate odds ratios (ORs) for severity according to Hurley. Sex and family history were compared using Student t test and χ2 test. Results In total, 45.5% of the patients had Hurley I, 41.5% had Hurley II, and 13.0% had Hurley III. Severity was associated with male sex (OR 2.11; P <.001), disease duration (OR 1.03; P <.001), body mass index (OR 1.03; P =.01), smoking pack-years (OR 1.02; P =.001), and axillary (OR 2.24; P <.001), perianal (OR 1.92; P <.001), and mammary lesions (OR 1.48; P =.03). Women had earlier onset, more inguinal and mammary lesions, and more frequent family history for hidradenitis suppurativa. Men more commonly had gluteal, perianal, and atypical lesions, and a history of severe acne. Patients with a family history had earlier onset, longer disease duration, a history of severe acne, more extensive disease, and were more often smokers. Limitations Some parameters were patient-reported. Conclusion The severity risk factors identified in this study could help physicians to select patients who need close monitoring and who would benefit from early, aggressive therapy. © 2014 by the American Academy of Dermatology, Inc. Source

van Leeuwen R.W.F.,Erasmus Medical Center | van Gelder T.,Erasmus Medical Center | Mathijssen R.H.J.,Erasmus Medical Center | Jansman F.G.A.,Deventer Hospital | Jansman F.G.A.,University of Groningen
The Lancet Oncology

In the past decade, many tyrosine-kinase inhibitors have been introduced in oncology and haemato-oncology. Because this new class of drugs is extensively used, serious drug-drug interactions are an increasing risk. In this Review, we give a comprehensive overview of known or suspected drug-drug interactions between tyrosine-kinase inhibitors and other drugs. We discuss all haemato-oncological and oncological tyrosine-kinase inhibitors that had been approved by Aug 1, 2013, by the US Food and Drug Administration or the European Medicines Agency. Various clinically relevant drug interactions with tyrosine-kinase inhibitors have been identified. Most interactions concern altered bioavailability due to altered stomach pH, metabolism by cytochrome P450 isoenzymes, and prolongation of the QTc interval. To guarantee the safe use of tyrosine-kinase inhibitors, a drugs review for each patient is needed. This Review provides specific recommendations to guide haemato-oncologists, oncologists, and clinical pharmacists, through the process of managing drug-drug interactions during treatment with tyrosine-kinase inhibitors in daily clinical practice. © 2014 Elsevier Ltd. Source

Deckers I.E.,Erasmus Medical Center | Van Der Zee H.H.,Erasmus Medical Center | Boer J.,Deventer Hospital | Prens E.P.,Erasmus Medical Center
Journal of the American Academy of Dermatology

Background The reported mean age of onset of hidradenitis suppurativa (HS) is between 20 and 24 years. Prepubertal onset is thought to be rare. Objective We sought to determine the prevalence of early-onset HS and to compare clinical characteristics between early-onset and normal-onset HS in a retrospective study. Methods Data were collected from 855 patients with HS. Early-onset HS was defined as onset before the thirteenth birthday. Clinical characteristics were analyzed in relation to the age of onset. Results In all, 66 patients (7.7%) reported early-onset HS. A family history for HS was significantly higher in early-onset patients (55.6% vs 34.2%; odds ratio 2.1, 95% confidence interval 1.2-3.6, P =.006). They developed inflammatory lesions at more body sites than patients with normal-onset HS (odds ratio 3.0, 95% confidence interval 1.8-4.9, P <.001). Distribution of the Hurley stages of severity showed no differences between the 2 groups (odds ratio 1.1, 95% confidence interval 0.7-1.8, P =.72). Limitations Some data were based on patient-reported information. Conclusion Early-onset HS occurs more frequently than previously believed. Patients with early-onset HS often report a family history for HS and develop lesions at more body sites. © 2014 American Academy of Dermatology, Inc. Source

Van Der Zee H.H.,Erasmus Medical Center | Prens E.P.,Erasmus Medical Center | Boer J.,Deventer Hospital
Journal of the American Academy of Dermatology

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease, often refractory to treatment. Patients with HS and dermatologists are in need of an effective, fast surgical intervention technique. Deroofing is a tissue-saving technique, whereby the "roof" of an abscess, cyst, or sinus tract is electrosurgically removed. The use of a probe is mandatory to explore the full extent of a lesion. Objective: We sought to evaluate the efficacy and patient satisfaction of the deroofing technique for recurrent Hurley I (mild) or II (moderate) graded HS lesions at fixed locations. Methods: An open study consisted of 88 deroofed lesions in 44 consecutive patients with HS, treated by a single clinician with a follow-up time of up to 5 years. Results: Fifteen of 88 (17%) treated lesions showed a recurrence after a median of 4.6 months. In all, 73 treated lesions (83%) did not show a recurrence after a median follow-up of 34 months. The median patient satisfaction with the procedure rated 8 on a scale from 0 to 10. Of the treated patients, 90% would recommend the deroofing technique to other patients with HS. One side effect occurred in the form of postoperative bleeding. Limitations: Some patients were lost to follow-up. Conclusions: The deroofing technique is an effective, simple, minimally invasive, tissue-saving surgical intervention for the treatment of mild to moderate HS lesions at fixed locations and it is suitable as an office procedure. © 2009 by the American Academy of Dermatology, Inc. Source

Boer J.,Deventer Hospital | Nazary M.,University Utrecht
British Journal of Dermatology

Background Hidradenitis suppurativa (HS) is a distressing chronic inflammatory skin disorder which affects predominantly the groins and axillae. In analogy to acne, oral isotretinoin has been considered in the treatment of HS, although there are strong indications that this drug has only a very limited therapeutic effect. During the past 25 years scattered case reports have described promising results of treatment with acitretin. Objectives To evaluate the long-term efficacy of acitretin monotherapy. Methods A retrospective study in 12 patients with severe, recalcitrant HS who were treated with acitretin for 9-12 months at one Dermatology Centre in the Netherlands between 2005 and 2007 and were followed up to 4 years. The patients were men and infertile women. The efficacy of the treatment was rated by the patients on global maximum pain of nodules and abscesses on a visual analogue scale (VAS) as well as by physician global assessment. Results All 12 patients achieved remission and experienced a significant decrease in pain as assessed by VAS. In nine patients long-lasting improvement was observed, with no recurrence of lesions after 6 months (n = 1), 1 year (n = 3), > 2 years (n = 2), > 3 years (n = 2) and > 4 years (n = 1). Conclusions Acitretin appears to be an effective treatment for refractory HS, leading to reduction of pain from painful nodules and reducing the extent of the disease for a prolonged period. Source

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