Natural History and Prognosis

There are limited data concerning the natural history and prognosis of HS. Ideally, a prognostic study should be based on a representative sample of affected individuals followed-up for a sufficiently long period of time. Loss to follow-up should be reduced to a minimum, outcome measures should be clearly defined at the beginning of the study, and adequate analytic methods should employed (e.g., survival analysis). A number of studies evaluating the impact of HS have been based on a retrospective assessment of patients identified from hospital records at a point in time. These studies tend to be biased toward the selection of more severe and chronic cases and may overemphasize the disability connected with HS. To standardize disease assessment over time, a stage classification would be a useful tool. A three-stage classification was proposed several years ago [20] and, more recently, a lesion, area and severity index for HS was developed [21]. The validation of these instruments would involve assessment of their repeatability, sensitivity to change and ability to predict outcome in terms of morbidity and disability over time.

All the available studies indicate that HS is a disease with a remarkable impact on the patient's life. An analysis of American hospitaliza-tion records shows that more patients with HS receive a principal diagnosis - the chief reason for the hospital stay - than those with psoriasis. This indicates that HS has a much higher morbidity than other dermatoses such as psoriasis [22, 23]. In Denmark, the general self-reported level of health is poorer among HS patients. Due to flare-ups, an average 2.7 days of work per year is lost by Danish patients (stages I and II) [14]. The soreness, discharge, and appearance of lesions are described as problems in both work and leisure activities by 51% of all patients. For grades I and II, the main problem was soreness, which can be used to assess the efficacy of treatment [22, 23]. In the context of the TNS Sofres survey, which is deemed to provide a representative sample of patients with HS in France, 47.2% of HS patients reported a medical consultation for their disease in the year preceding the interview, and 47.7% of the patients reported HS to be a relevant problem and a severe distress [8]. In a survey of the Dermatology Life Quality Index (DLQI) in 114 HS patients, the mean DLQI score was 8.9 (SD ±8.3) points. The highest mean score out of the 10 DLQI questions was recorded for question 1, which measures the level of pain, soreness, stinging or itching (mean 1.55 points, median 2 points). Patients experienced a mean of 5.1 lesions per month [24]. In a questionnaire-based survey among HS patients identified from hospital records of three hospitals in Nottinghamshire (UK) 110 HS patients were interviewed. The average reported age of disease onset was 21.8 years. At the time of the survey patients had suffered on average disease duration of 18.8 years. Most patients (98 of 110) still had experienced active disease within the past year. In women the condition had a tendency to ease or subside after the menopause. Forty-four per cent of women felt that their condition was aggravated by menstruation. The average duration of painful boils was 6.9 days. In addition, 62% of patients acknowledged the presence of permanently painful boils that failed to subside. Patients developed a median of two boils per month. Factors that could aggravate the condition were primarily sweating or heat, stress or fatigue and tight clothing or friction. Factors that could improve the condition consisted largely of a variety of medical treatments and a number of lifestyle measures, such as swimming or baths. Twenty-four per cent of patients had failed to find anything at all to help their condition, despite an average disease duration of almost 19 years. HS appears to be one of the most distressing dermatological diseases [25].

A few case reports exist describing rare but serious complications. Complications of longstanding untreated disease include amyloidosis, leading to fistula formation into the urethra, bladder, rectum, or peritoneum, lymphatic obstruction and lymphoedema of the limbs, scro-tal elephantiasis [26]. Chronic HS-associated arthritis, axial spondyloarthropathy, and sterile osteomyelitis-like lesions also occur [27]. Squa-mous cell carcinomas originating from HS lesions may complicate perineal and buttock localizations.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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