Shi, Vivian Y.

Abstract Background Topical steroid withdrawal syndrome (TSW) is an adverse event following discontinuation of topical corticosteroids (TCS) and is of growing interest among patients and dermatologists. The absence of well-defined diagnostic criteria and limited insights into the pathomechanisms make diagnosis and future research challenging. Objectives To propose preliminary diagnostic criteria for TSW with the erythemato-oedematous subtype applicable for adult and paediatric populations using a Delphi consensus approach informed by a thorough literature review that summarizes the signs, symptoms and histology of TSW. Methods Eleven clinicians experienced in diagnosing and treating suspected TSW in both children and adults participated in a three-round modified Delphi process. Two rounds of surveys were conducted, with items ranked using a 5-point Likert scale. A predefined consensus threshold of ≥ 75% was established for any one feature to be deemed important. The third round involved a live video conference where the panel reached a consensus on essential diagnostic criteria. Results The panel identified 18 critical diagnostic items, encompassing elements from the patient’s clinical history, signs and symptoms. This includes history of escalating TCS requirement, morphology and distribution differing from primary condition, regional or generalized spontaneous neuropathic pain and severe burning sensation of the skin. Conclusions Differentiating TSW from conditions such as severe atopic dermatitis remains challenging. By emphasizing the common signs and symptoms of TSW, we aim to encourage discussions among healthcare professionals and progress towards the development of a reliable diagnostic tool. An author video to accompany this article is available online.

AbstractBackgroundHidradenitis suppurativa (HS) is a chronic inflammatory dermatosis with recurrent painful nodules and abscesses affecting the intertriginous areas. Patients often experience a significant negative impact on quality of life from associated pain, discharge, odor, scarring, and social stigma. Even with complex medical regimens, patients may report inadequate disease control. Lifestyle changes and complementary and alternative medicines (CAM) are used by a majority of HS patients. Conventional medicines and lifestyle and CAM modalities strategically incorporated together can increase treatment satisfaction and success.ObjectiveWe aim to highlight lifestyle and CAM treatment modalities to use alongside conventional treatment plans for HS patients.FindingsLifestyle modifications for HS patients include weight loss, reducing skin friction, smoking cessation, and stress reduction. Dietary modifications for HS patients include limiting foods containing dairy, Brewer's yeast, and simple carbohydrates, appropriate caloric reduction, and consuming foods in the Mediterranean diet. The CAM modalities studied in HS are vitamin D, niacinamide, vitamin B12, zinc, and magnesium. Potential CAM modalities for HS include probiotics, cannabinoids, turmeric, bathing regimens, and acupuncture.ConclusionThis review is a guide for clinicians to provide evidence‐based care for HS patients seeking non‐pharmacologic treatment modalities such as weight loss, clothing choices, dietary changes, and use of supplements and complementary medicine. Lifestyle and CAM modalities may be used in parallel with conventional medicines to synergistically improve patient disease outcomes.

Abstract Hidradenitis suppurativa (HS) is a chronic and often debilitating inflammatory condition characterized by frequent nodules, abscesses, sinus tracts, and scars impacting the intertriginous areas. Many patients with HS often report limited treatment success and symptom coverage with conventional therapies. Recent studies have reported the widespread use of complementary and alternative medicine (CAM) among patients with HS. In this study, our aim was to examine current physician practice patterns, opinions, and comfort with recommending CAM. Our results indicate that provider comfort and opinions on CAM varied based on the provider's experiences, demographics, and the CAM modality itself. Overall, nearly two‐thirds (n = 30, 61.2%) of respondents agreed that CAM and conventional medicine were more effective together than either alone. Meanwhile, 44.9% (n = 22) of respondents routinely recommend CAM while 64.6% (n = 31) of respondents reported that they are routinely asked about CAM. The majority (n = 41, 83.7%) of respondents indicated a lack of scientific evidence in the medical literature as a barrier to recommending CAM along with efficacy concerns (n = 34, 69.4%) and ability to recommend reputable CAM products (n = 32, 65.3%) and practitioners (n = 32, 65.3%). Future investigations are warranted to establish a better understanding of the efficacy and benefit of CAM methods in conjunction with conventional methods.