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OBJECTIVES: To describe the ultrasound characteristics of facial and submandibular hidradenitis suppurativa (HS) and detect acne vulgaris (AV) concomitance in these cases. METHODS: We performed a retrospective study of the ultrasound images of patients with facial HS who had been clinically evaluated by dermatologists. The reported ultrasound diagnostic criteria, severity (mSOS-HS), and activity (US-HAS) staging of HS were used to categorize the patients. The finding of fragments of hair tracts within the key lesions (dilated hair follicles, pseudocysts, fluid collections, and tunnels) was considered a pivotal sign to discriminate HS from AV. Demographic and morphological analysis of the images were considered. RESULTS: Thirty-three patients met the criteria (78.8% male/21.2% female). Of these, the mSOS- HS scoring was stage I in 51.5%, stage II in 27.3%, and stage III in 21.2%. Dilation of the hair follicles and the presence of pseudocysts, fluid collections, and tunnels were detected in the HS cases; 63.1% of pseudocysts, 62.4% of tunnels, and 46.2% of fluid collections contained fragments of hair tracts. In all HS cases, there was a key lesion(s) with fragments of hair tracts. Four (12.1%) patients showed concomitant facial HS and acne ultrasound lesions. The acne lesions were pseudocysts without inner hair tract fragments in all cases, and the SOS-Acne scoring was stage II for all of them. CONCLUSION: Facial HS can be detected on ultrasound and shows a morphology similar to that of HS in other corporal regions. In some cases, facial HS could be concomitant with AV. The subclinical ultrasonographic information can support a better management of these cases.

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OBJETIVO: Avaliar a efetividade, segurança, níveis de dor e qualidade de vida associados ao uso de adalimumabe, clindamicina e/ou rifampicina no tratamento da hidradenite supurativa. MÉTODO: Serão incluídos estudos do tipo coorte prospectiva e retrospectiva, ensaios clínicos randomizados e de equivalência, bem como análises econômicas realizadas com adultos diagnosticados com hidradenite supurativa, que tenham utilizado pelo menos uma das seguintes alternativas terapêuticas: adalimumabe, clindamicina ou rifampicina. Os estudos devem abordar um ou mais desfechos, tais como contagem de abscessos e/ou nódulos, presença de nódulos inflamatórios, níveis de dor, qualidade de vida, segurança e custos. As bases de dados consultadas serão: Medical Literature Analysis and Retrieval System Online (MEDLINE, Interface OVID), Excerpta Medica DataBASE (EMBASE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL, interface EBSCO), Psychological Abstracts (PsycINFO, interface EBSCO), Web of Science (WoS) e Source-Neutral Abstract and Citation Database (Scopus). Os processos de triagem, seleção e extração serão conduzidos por pesquisadores independentes e previamente treinados. O risco de viés será avaliado por meio dos instrumentos Risk of Bias 2.0 e ROBINS-I. Os resultados serão combinados em uma síntese qualitativa e quantitativa, com a realização de análises de especificidade e subgrupos.

OBJECTIVE: To evaluate the efficacy, safety, pain, and quality of life associated with the use of adalimumab, clindamycin, and/or rifampicin in the treatment of hidradenitis suppurativa. METHOD: Prospective and retrospective cohort studies randomized clinical trials and equivalence studies, and economic analyses, conducted in adults diagnosed with hidradenitis suppurativa who have used at least one of the following therapeutic alternatives: adalimumab, clindamycin, or rifampicin, will be included. Studies should address one or more outcomes such as abscess and/or nodule counts, presence of inflammatory nodules, pain levels, quality of life, safety, and cost. Databases consulted will include Medical Literature Analysis and Retrieval System Online (MEDLINE, OVID interface), Excerpta Medica DataBASE (EMBASE), Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL, EBSCO interface), Psychological Abstracts (PsycINFO, EBSCO interface), Web of Science (WoS), and Source-Neutral Abstract and Citation Database (Scopus). Screening, selection, and extraction processes will be conducted by independent and previously trained researchers. The risk of bias will be assessed using the Risk of Bias 2.0 and ROBINS-I tools. Results will be summarized in a qualitative and quantitative synthesis, including specificity and subgroup analyses.

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Hidradenitis suppurativa (HS) is a devasting autoimmune cutaneous disease that affects the hair follicles and can clinically present palpable nodules, abscesses, and tunnels (fistulas), usually in the intertriginous regions. It has been widely reported that color Doppler ultrasound can detect subclinical abnormalities and stage the severity of the disease more accurately. Nevertheless, the ultrasound diagnostic criteria were reported with 15 MHz 10 years ago, and now it is possible to detect early anatomical abnormalities in HS using 70 MHz. Thus, an update of the ultrasonographic diagnostic criteria is needed. The most widely used sonographic staging of severity of HS (SOS-HS) includes the number of affected regions, besides counting the number of key lesions like pseudocysts, fluid collections, and tunnels; however, the total number of affected regions may fit better in an activity scoring. Furthermore, a high number of tunnels or communicated tunnels can complicate the management and may indicate an even more urgent treatment, which should be considered in the severity classification. To date, no hidradenitis scoring of activity has been reported in the literature, making it difficult to track the degree of inflammation under treatment objectively. Therefore, two new scorings are proposed. The first is an updated sonographic scoring of severity called modified SOS-HS (mSOS-HS), and the second is an activity ultrasound scoring of HS called US-HSA. Both staging systems can provide better anatomical information for discriminating the categories and, therefore, selecting more appropriate treatments and supporting research and clinical trials by giving more objective anatomical tools in real-world settings.

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INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic skin condition causing considerable distress. It impacts mobility, social interaction, and quality of life. In Brazil, there is a notable gap in epidemiological data and patient experiences regarding HS. METHODS: This study, spanning 2019 to 2022, employed netnography to probe the experiences of Brazilian patients with HS. This approach gleans insights from online interactions, offering a direct view into patients' lives. RESULTS: Notably, the data illuminated the challenges patients face, such as difficulties in obtaining a diagnosis and the complexities involved in managing a chronic, and often debilitating, condition. Furthermore, patients' experiences with various treatments, encompassing antibiotics, biologic agents, lifestyle alterations, surgical procedures, and alternative remedies, were also examined. CONCLUSION: By undertaking a longitudinal analysis of patient interactions, the study aimed to offer a richer understanding of HS, from its diagnosis to its treatment. It underscores the necessity for a more patient-centered approach when managing this condition. We hope that this enhanced understanding can facilitate better care for those affected by HS.

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Dowling Degos disease (DDD) is a rare autosomal dominant genodermatosis characterized by acquired, slowly progressive reticulated pigmented lesions primarily involving flexural skin areas. Mutations in KRT5, POGLUT-1 and POFUT-1 genes have been associated with DDD, and loss-of-function mutations in PSENEN, a subunit of the gamma-secretase complex, were found in patients presenting with DDD or DDD comorbid with hidradenitis suppurativa (HS). A nonsense mutation in NCSTN, another subunit of the gamma-secretase, was already described in a patient suffering from HS and DDD but whether NCSTN could be considered a novel gene for DDD is still debated. Here, we enrolled a four-generation family with HS and DDD. Through Whole Exome Sequencing (WES) we identified a novel nonsense mutation in the NCSTN gene in all the affected family members. To study the impact of this variant, we isolated outer root sheath cells from patients' hair follicles. We showed that this variant leads to a premature stop codon, activates a nonsense-mediated mRNA decay, and causes NCSTN haploinsufficiency in affected individuals. In fact, cells treated with gentamicin, a readthrough agent, had the NCSTN levels corrected. Moreover, we observed that this haploinsufficiency also affects other subunits of the gamma-secretase complex, possibly causing DDD. Our findings clearly support NCSTN as a novel DDD gene and suggest carefully investigating this co-occurrence in HS patients carrying a mutation in the NCSTN gene.

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Introdução: A hidradenite supurativa (HS) é uma doença inflamatória crônica que afeta preferencialmente a pele intertriginosa e está associada a numerosas comorbidades sistêmicas. A área perineal é a segunda área mais comumente afetada depois da axila. A excisão ampla é o tratamento que tem maior probabilidade de atingir melhores resultados com menor risco de recorrência. Com a excisão cirúrgica extensa, o fechamento com retalho oferece maior probabilidade de tratamento definitivo. Alguns retalhos são descritos para reconstruir defeitos da região perineal após câncer, porém poucos deles são estudados no tratamento da HS. Relato de Caso: Mulher de 43 anos, com HS perineal, submetida a ressecção das lesões e reconstrução com retalho fasciocutâneo medial da coxa em V-Y bilateral como tratamento da doença. O retalho permitiu o fechamento completo do períneo total sem complicações graves. Conclusão: Este caso mostra que é útil e prático utilizar o retalho fasciocutâneo medial da coxa em V-Y para reconstrução perineal após ressecções amplas de pele, glândulas apócrinas e folículos pilosos no tratamento da HS, oferecendo boa cobertura de pele, e tecido celular subcutâneo com suprimento vascular confiável, que evita sequelas associadas a sacrifício de músculos e alcança dimensões maiores do que outros retalhos, podendo ser considerado em casos selecionados como uma alternativa no tratamento cirúrgico da HS perineal.

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that preferentially affects the intertriginous skin and is associated with numerous systemic comorbidities. The perineal area is the second most commonly affected area after the armpit. Wide excision is the treatment most likely to achieve better results with a lower risk of recurrence. With extensive surgical excision, flap closure offers a greater likelihood of definitive treatment. Some flaps have been described to reconstruct defects in the perineal region after cancer, but few have been studied in treating HS. Case Report: A 43-year-old woman with perineal HS underwent resection of the lesions and reconstruction with a bilateral V-Y medial thigh fasciocutaneous flap to treat the disease. The flap allowed complete closure of the total perineum without serious complications. Conclusion: This case shows that it is useful and practical to use the V-Y medial thigh fasciocutaneous flap for perineal reconstruction after wide resections of skin, apocrine glands, and hair follicles in the treatment of HS, offering good skin coverage and subcutaneous cellular tissue with supply reliable vascular flap, which avoids sequelae associated with muscle sacrifice and reaches larger dimensions than other flaps, and can be considered in selected cases as an alternative in the surgical treatment of perineal HS.

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INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder with distinct characteristics: chronic nature, morphology, and location. It originates from occluded and ruptured follicles, releasing keratin and bacteria into the nearby dermis. This causes an inflammatory reaction, leading to the formation of abscesses and the destruction of the pilosebaceous junction. CASE PRESENTATION: We present the case 24-year-old female with a severe, stage III case of HS who had a lesion (approx. 10 × 15 cm) on her right axilla spanning 4 years. Despite some response to medical treatment, she experienced recurrent symptoms, due to this, surgical intervention was decided, using a latissimus dorsi thoracodorsal artery perforator (TDAP) flap. The lesion was successfully removed, and the flap was placed, leading to proper postoperative healing, cicatrization, and sensitivity in the patient. DISCUSSION: HS poses a challenge due to its recurring course. Treatment involves pharmacological and surgical approaches, with the former suited for mild to moderate cases and the latter for severe instances. Surgical options, like TDAP flaps, show lower recurrence rates than skin grafts. TDAP flaps also offer advantages such as reduced bulkiness and favorable aesthetic and functional outcomes compared to other latissimus dorsi flaps. CONCLUSION: HS represents an obstacle in terms of systemic effects and aesthetic concerns. Lattisimus dorsi flaps have emerged as an effective treatment method due to the reliable vascular supply and adequate volume to the recipient site as demonstrated by our case, where the patient showed appropriate evolution with no morbidity associated with the procedure as well as adequate aesthetic results.

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Background: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research. Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages. Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education. Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.

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Dermatologic ultrasonography is a new field that has been growing exponentially in the last 10 years. It has multiple applications that can modify patient management, such as the assessment of benign and malignant cutaneous tumors, vascular anomalies, inflammatory dermatologic entities, aesthetic complications, and nail lesions. Compared with other imaging techniques such as computed tomography or magnetic resonance imaging, ultrasonography has the highest axial spatial resolution and has benefited from the development of high- and ultra-high-frequency probes that could even reach 70 MHz. The daily use of ultrasonography in dermatology has been reported to improve the accuracy of diagnoses, the tracking of activity, and the assessment of severity in common dermatologic conditions, which certainly can support better treatment of patients.

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Resumen La hidradenitis supurativa (HS) es una enfermedad dolorosa y crónica, que afecta en especial la unidad folículo-pilosebácea de la piel ubicada en ingle, axilas, región perianal, perineo, genitales y submamaria,regiones anatómicas donde se encuentran glándulas sudoríparas apocrinas. El curso clínico de la HS es heterogéneo pues varía desde formas muy graves con abscesos fluctuantes profundos y drenajes eventuales; concicatricesresiduales graves, hasta otra forma de enfermedad comparativamente leve caracterizada por la aparición de algunos nódulos inflamatorios,pústulas ypápulas,de manera recidivante. Comunicamos el caso de un niño de 12 añosde edad, con diagnóstico de hidradenitis supurativa,quien fue tratado con Adalimumab. Realizamos la revisión del estado de arte de esta patología, describimos sus características clínicas, criterios diagnósticos, diagnósticos diferenciales y los posibles tratamientos. Nuestra presentación, tiene por objeto relatar nuestra experiencia en el seguimiento del caso del paciente, y las vicisitudes diagnósticas al respecto, que variaron desde acné inflamatorio grave hasta finalmente arribar al diagnóstico de certeza de hidradenitis supurativa, basándonos en criterios clínicos y ecográficos.Consideramos de interés haber podido emplear el "agente biológico" inhibidordel factor de necrosis tumoral (FNT) que hemos mencionado, con excelente respuesta.

Abstract Hidradenitis suppurativa (HS) is a painful and chronic disease that particularlyaffects the follicle-pilosebaceous unit of the skin located in the groins, armpits, perianal region, perineum, genitals, and submammary glands, which areanatomical regions whereapocrine sweat glands are found. The clinical course of HS is heterogeneous as it varies from very severe forms with deep fluctuating abscesses and eventual drainage; with severe residual scars, to another form ofacomparatively mild condition characterized by the presence of some recurrent inflammatory nodules, pustules and papules as well. We report the case of a 12-year-old boy, diagnosed with hidradenitis suppurativa, who was treated with Adalimumab. We reviewed the state of the art of this pathology, described its clinical characteristics, diagnostic criteria, differential diagnoses and carried out possible treatments. The purpose of our presentation is to report our experience in monitoring the patient's case, along with the diagnostic vicissitudes in this regard, which ranged from severe inflammatory acne to finally arriving at a certain diagnosis of hidradenitis suppurativa, based on clinical and ultrasound criteria. We consider of interest the possibility of having been able to use the "biological agent" inhibitor of the tumor necrosis factor (TNF) that we have mentioned, with an excellent response.

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BACKGROUND: Pain is not a trivial issue for hidradenitis suppurativa (HS) patients and has been considered a domain in the Core Outcome Set. To date, there is no evidence about pain caused by the ultrasound examinations. OBJECTIVE: The aim of the study was to assess the presence of pain generated by the ultrasound examinations of HS patients. METHODS: A multicentric cross-sectional study for detecting pain during the ultrasound examinations of HS patients using a validated verbal questionnaire immediately after the imaging studies. Statistical analysis included demographic data and possible associations with sex, age, location, clinical (Hurley), and ultrasonographic scoring (SOS-HS). The statistical tests were two proportions Z test, χ2 test, Student's t test, and ANOVA. A p < 0.05 was considered significant. RESULTS: 317 patients met the criteria. 77.3% of them did not present pain. Of cases with pain, 59.8% were mild, 16.7% moderate, and 23.6% severe. No significant association was found with sex, age, staging, location, or the number of affected regions. Although nonsignificant, severe pain cases were more frequent in the clinical Hurley III and ultrasonographic SOS-HS III stages. CONCLUSION: Pain generated by the ultrasound examination of HS patients is infrequent.

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The advances in dermatologic ultrasound have been significantly influenced by the development of high- and ultrahigh-frequency probes, the provision of guidelines for performing the examinations, and a growing number of publications in the field. This review analyzes the most significant contributions that have impacted the daily practice of dermatologists in recent years. This includes the advances in anatomical detection and the patterns of benign and malignant cutaneous tumors, inflammatory dermatologic conditions, vascular anomalies, nail abnormalities, and aesthetic procedures. The knowledge of these advances is a primer for the operators of these examinations.

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Introdução: a hidradenite supurativa é uma doença inflamatória crônica e recidivante. Altas taxas de recorrência podem persistir mesmo após ampla excisão cirúrgica local. Objetivo: avaliar os principais fatores de risco para complicações pós-operatórias da hidradenite supurativa. Metodologia: foram utilizadas referências em artigos científicos nas bases de dados Google, PubMed, LILACS e SciELO nas línguas portuguesa e inglesa, no período de 2000 a 2021. Resultados: os principais fatores que influenciam os resultados pós-operatórios estão relacionados a técnica cirúrgica empregada, gravidade da doença, comorbidades dos pacientes e terapia clínica adjuvante

Introduction: Hidradenitis Suppurativa is a chronic inflamatory and relapsing disease. High levels of recurrence can persist even after wide local excision. Objective: Identify the main risk factors for postoperative complications of Hidradentis Suppurativa. Methods: We included journal articles with data from Google, Pubmed, Lilacs, and Scielo, in Portuguese and English, from 2000 to 2021. Results: The main risk factors that influence postoperative outcomes are related to surgical technique, disease severity, comorbidities, and adjuvant clinical therapy

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Immunobiologicals are a reality in current clinical practice and have increasingly gained space in the inflammatory disease scenario, especially in dermatology, with approved drugs for psoriasis, atopic dermatitis, and hidradenitis suppurativa, in addition to many others undergoing study. It is important for dermatologists to have knowledge of the medications approved in Brazil, for the best management of dermatoses, in addition to the fact that they represent hope for improvement in patients with chronic diseases.

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BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with a significant negative impact on the quality of life of patients. METHODS: We conducted a systematic review to assess current treatment for HS, with a special focus on therapies approved or used in Brazil. We used the PICO framework to improve the research process. The systematic review was reported in line with the PRISMA statement checklist. The search was conducted with clinical questions on two global databases (PubMed (MEDLINE) and Google Scholar) and three databases especially selected to retrieve Brazilian outcomes (BVS, SCIELO and REDALYC). RESULTS: Overall, 4640 articles were screened, 182 articles were analysed and 70 were used in a thematic qualitative analysis. Of these, 12 articles were from Brazil. The evidence-based literature was largely limited to case reports, case series, observational studies and expert opinion. Topical therapy, lifestyle interventions and oral antibiotics appeared as effective measures for mild HS. However, moderate-to-severe HS remains refractory to conventional treatments. CONCLUSION: Some biologic agents, such as adalimumab, infliximab, ustekinumab and secukinumab, have been shown to be effective in the management of moderate-to-severe HS that failed conventional treatment and demonstrated a good tolerability and safety profile.

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Resumen Antecedentes: La hidradenitis supurativa (HS) es una enfermedad inflamatoria crónica de la piel. Se relaciona con diferentes factores que podrían incrementar la severidad, pero algunos son poco conocidos o controvertidos. Dado su alto impacto social, deterioro de la calidad de vida y falta de estudios epidemiológicos en Colombia, decidimos describir las variables relacionadas en pacientes con HS atendidos en un centro dermatológico colombiano. Métodos: Se realizó un estudio descriptivo y retrospectivo en un centro dermatológico de Bogotá. Los datos se obtuvieron de los registros médicos de enero de 2016 a diciembre de 2019. Analizamos edad, sexo, índice de masa corporal (IMC), hipertensión, relación premensual, antecedentes familiares de HS, presencia de acné, severidad y ubicación de las lesiones. Resultados: De 24 pacientes, 18 eran mujeres. La mediana de edad fue de 30 años. La mediana del IMC fue de 22,8 Kg / m². El 25% de los casos eran fumadores, el 12,5% tenía hipertensión arterial, el 25% tenía antecedentes familiares de HS, el 20,8% coexistió con acné. Además, el 38,9% de las mujeres informaron un empeoramiento de la sintomatología de la HS en el período premenstrual. La localización más común fue la axila (58,3%). El estadio I de Hurley fue el más frecuente (41,7%). Conclusiones: Este es el primer estudio epidemiológico en Colombia y uno de los pocos publicados en Latinoamérica. Estamos ante una enfermedad crónica con un diagnóstico frecuentemente retrasado, de difícil tratamiento y que afecta la calidad de vida. Es importante hacer una intervención temprana para mejorar el pronóstico. Finalmente se necesitan más estudios sobre las principales características de la HS.

Abstract Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease. It is related to different factors that could increase the severity, but some are not well known or are controversial. Given its high social impact and quality of life impairment and the lack of epidemiological studies in Colombia, we described disease variables in patients with HS treated at a colombian dermatological center. Methods: A descriptive and retrospective study was carried out in a dermatological center in Bogota. Data were collected from medical records from January 2016 to December 2019. We analyzed age, sex, boy mass index (BMI), hypertension, pre-monthly relationship, family history of HS, acne presence, severity and lesion locations. Results: Of 24 patients, 18 were women. The median age was 30 years . The BMI median was 22,8 Kg/m². The 25% of cases were smoker, 12,5% had arterial hypertension, 25% had family history of HS, 20.8% had coexistence with acne. Also, 38.9% of women reported worsening symptomatology of HS in the premenstrual period. The most common location was the armpit (58.3%). Hurley stage I was the most frequent (41.7%). Conclusions: This is the first epidemiological study in Colombia and one of the few published in Latinamerica. We are facing a chronic disease with a frequently delayed diagnosis, which is difficult to treat and affects quality of life. Is important to do an early intervention to improve the prognosis. Further studies are needed about HS main characteristics.

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Spironolactone is a drug, similar in structure to aldosterone and acts as an aldosterone receptor antagonist with an anti-androgenic effect. This drug has proven to be useful in several dermatological entities, however its use has not been well explored. Its use in diseases such as acne has opened the door to the possibility of new therapies depending on the clinical manifestations of the patients, as well as its possible to use it as a first line treatment. Other diseases associated with the use of spironolactone where its effects have been shown to be useful are hidradenitis suppurativa, hirsutism, and female pattern androgenetic alopecia. In this review, we discuss the use of spironolactone in different skin diseases that are common in our environment, dosage according to different studies, treatment recommendations and adverse effects; all of the above mentioned in order to use this drug in a daily clinical practice.

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Abstract Immunobiologicals are a reality in current clinical practice and have increasingly gained space in the inflammatory disease scenario, especially in dermatology, with approved drugs for psoriasis, atopic dermatitis, and hidradenitis suppurativa, in addition to many others undergoing study. It is important for dermatologists to have knowledge of the medications approved in Brazil, for the best management of dermatoses, in addition to the fact that they represent hope for improvement in patients with chronic diseases.

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Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle characterized by recurrent painful and inflamed lesions, predominantly affecting intertriginous regions. Due to its physical sequelae and impact on quality of life, we should be familiarized with this disease to make an appropriate diagnosis and implement an early treatment. This executive summary of the clinical guideline, elaborated by the hidradenitis suppurativa workgroup of the Chilean Society of Dermatology and Venereology (SOCHIDERM), reviews its definition, epidemiology, pathophysiology, risk factors, comorbidities, psycho-emotional impact, clinical presentation, diagnosis, classifications, ultrasonographic evaluation, and its medical and surgical treatments. Finally, a therapeutic approach algorithm is proposed.

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