INTRODUCTION:Pain is the most impactful symptom of hidradenitis suppurativa (HS), and understanding its management practices can guide improvements in care. This study aimed to describe HS pain severity and associated factors, evaluate pain management practices, and identify barriers to pain management. METHODS:A cross-sectional survey of self-identified adults with HS was conducted from June 13, 2021 to June 30, 2021. Participants were 18 years or older with a confirmed HS diagnosis by a medical provider or a validated questionnaire. Exposures include demographic, clinical factors. PRIMARY OUTCOMES:quality of life (QoL), assessed using the Skindex Mini (0-18 scale), and pain severity, measured via a numerical rating scale (NRS, 0-10). SECONDARY OUTCOMES:pain treatments used and barriers to care. RESULTS:A total of 890 eligible respondents resided in 5 countries. 96.9% self-identified as female, 74.0% White, 8.3% Black, 2.6% Asian, 5.3% Hispanic, 1.3% American Indian and Native Alaskan, and 7.1% mixed race. Moderate (NRS 4-6) and severe pain (NRS ≥7) were significantly associated with reduced QoL, with Skindex Mini scores that were higher for moderate (14.6; 95% CI: 14.0, 15.2) and severe pain (16.1; 95% CI: 15.4, 16.7) compared to mild pain on average (NRS ≤3, 10.8; 95% CI: 10.3, 11.3). Younger age, Asian race, difficulty accessing care, and severe disease were independently associated with higher pain (p ≤ 0.002 for all). Reported barriers to pain management included providers not asking about pain, poor provider knowledge, and perceived unwillingness to treat pain. A total of 38.4% of participants reported they had never received a prescription for pain medication. Pain prescriptions were most commonly received from primary care physicians (22.5%) or dermatologists (13.3%), with severe pain linked to increased use of opioids, tramadol, and antiepileptics to treat HS pain (p < 0.05 for all). CONCLUSION:Pain in HS is linked to lower QoL and barriers to management, emphasizing the need for evidence-based, patient-centered approaches to enhance pain care and address treatment gaps.

This cross-sectional study of US adults with hidradenitis suppurativa in the Boston metropolitan area uses spatial epidemiological methods to analyze disease distribution by socioenvironmental characteristics.

Background:. The impact of hidradenitis suppurativa (HS) on sexual health, pregnancy, and breastfeeding in female patients is understudied. Objective:. To characterize the impact of HS on sexual health, barriers to breastfeeding, and barriers to accessing care for HS during breastfeeding and pregnancy. Methods:. A cross-sectional survey of self-identified adult women with HS from June 13, 2021 to June 30, 2021 was performed to assess associations between demographic and clinical factors, including age, gender, race, and ethnicity, disease severity (patient global assessment), and difficulty accessing dermatologic care with the outcomes of sexual health-related quality of life, breastfeeding practices, and barriers to care. Results:. Eight hundred eight eligible female respondents resided in 5 countries. Seventy-four point three percent self-identified as White, 8.3% Black, 2.4% Asian, 5.3% Hispanic, 7.1% Mixed race, and 1.4% Native Hawaiian or other Pacific Islander. Moderate to extreme difficulties with sexual activity and desire were associated with more difficulty accessing dermatologic care and higher patient global assessment scores (P < .01 for all). Depression and anxiety were associated with moderate to extreme difficulties with sexual activity (P < .01). Of the participants who were previously pregnant, 15% (n = 79/526) reported that HS interfered with breastfeeding ability. The top barrier to care was believing nothing could be done for HS during pregnancy and breastfeeding. Limitations:. Diagnosis and disease severity were self-reported and could not be verified. Conclusion:. Impaired sexual health was associated with access to care limitations, increased disease activity, and comorbid depression and anxiety. Our findings underscore the need for guidance on safe HS therapies during pregnancy and breastfeeding.

Background:The impact of rater bias in applicant selection for residency interviews using holistic review is poorly understood. Objective:To measure faculty raters' bias toward applicant gender and underrepresented in medicine (URiM) status in their recommendations to offer residency interviews. Methods:In this cross-sectional study, applicant (n=3875) and faculty rater (n=69) data within a single institution's dermatology residency application database from 2014 to 2023 were examined for differences in rater judgments to interview applicants as measured by logits (ie, a standardized unit of scoring difference) using the many-facet Rasch model, a statistical method that accounts for variations among raters, applicants, and scoring for applicant gender (23% women, 14% men, and 63% unknown) and URiM status (26% White, 21% non-White non-URiM, 12% URiM, 41% unknown). Results:Rater bias, as measured in logits using the rater severity measure, was minimal for applicant gender (-0.12, 0.08 logits) and URiM status (-0.07, 0.04 logits). However, raters were more lenient (ie, likely to favor an interview) when the applicant's and rater's gender (-1.74 logits, SE 0.05) or URiM status (-0.46 logits, SE 0.05) were concordant. Conversely, raters were more severe (ie, unlikely to favor an interview) when discordant on gender (1.74 logits, SE 0.05) or URiM status (0.46 logits, SE 0.05). More than 50% of individual raters exhibited substantial gender bias, and approximately 33% for URiM status bias when concordant. Conclusions:Raters were more likely to favor offering interview invitations to applicants with concordant gender or URiM status and less likely to favor interviewing applicants with discordant gender or URiM status.

This cross-sectional analysis assesses sexual and gender minority inclusivity within common patient-reported outcome measures used for hidradenitis suppurativa (HS). We found inconsistent integration of inclusive themes in HS-specific measures as well as other general and mental health outcome measures.

People with hidradenitis suppurativa (HS) face structural, provider-related, and patient-related barriers in accessing health care and treatments for HS. This article highlights how these barriers result in delayed diagnosis, inadequate treatment, and poorer health outcomes for people with HS. It also discusses the disparities faced by minoritized and underserved communities in accessing dermatologic care, as well as the need for more efficacious treatments for HS given the current limited therapeutic options. Efforts are underway to increase HS awareness and education, improve and expand access to treatment, and build trust between people with HS and the health care community.

The integration of large language models (LLMs) into clinical diagnostics has the potential to transform doctor–patient interactions. However, the readiness of these models for real-world clinical application remains inadequately tested. This paper introduces the Conversational Reasoning Assessment Framework for Testing in Medicine (CRAFT-MD) approach for evaluating clinical LLMs. Unlike traditional methods that rely on structured medical examinations, CRAFT-MD focuses on natural dialogues, using simulated artificial intelligence agents to interact with LLMs in a controlled environment. We applied CRAFT-MD to assess the diagnostic capabilities of GPT-4, GPT-3.5, Mistral and LLaMA-2-7b across 12 medical specialties. Our experiments revealed critical insights into the limitations of current LLMs in terms of clinical conversational reasoning, history-taking and diagnostic accuracy. These limitations also persisted when analyzing multimodal conversational and visual assessment capabilities of GPT-4V. We propose a comprehensive set of recommendations for future evaluations of clinical LLMs based on our empirical findings. These recommendations emphasize realistic doctor–patient conversations, comprehensive history-taking, open-ended questioning and using a combination of automated and expert evaluations. The introduction of CRAFT-MD marks an advancement in testing of clinical LLMs, aiming to ensure that these models augment medical practice effectively and ethically. By simulating realistic doctor–patient conversations, a framework can be applied to large language models to investigate shortcomings and bias in patient interactions, providing insight before actual clinical deployment.

Artificial intelligence (AI)-based large language models (LLMs) have been shown to have promising performance in medical applications, including on specialty board examination questions and complex clinical cases ( Beam et al., 2023 Beam K. Sharma P. Kumar B. Wang C. Brodsky D. Martin C.R. et al. Performance of a Large Language Model on Practice Questions for the Neonatal Board Examination. JAMA Pediatr. 2023; 177: 977-979 Crossref Scopus (4) Google Scholar ; Eriksen et al., 2023 Eriksen A.V. Moller S. Ryg J. Use of GPT-4 to Diagnose Complex Clinical Cases. NEJM AI. 2023; 1 Crossref Google Scholar ). Previous reports evaluated the performance of LLMs on dermatology practice board examinations questions ( Passby et al., 2023 Passby L. Jenko N. Wernham A. Performance of ChatGPT on dermatology Specialty Certificate Examination multiple choice questions [e-pub ahead of print]. Clin Exp Dermatol. 2023; https://doi.org/10.1093/ced/llad197 Crossref Google Scholar ; Joly-Chevrier et al., 2023 Joly-Chevrier M. Nguyen A.X. Lesko-Krleza M. Lefrançois P. Performance of ChatGPT on a Practice Dermatology Board Certification Examination. J Cutan Med Surg. 2023; 27: 407-409 Crossref Scopus (2) Google Scholar ; Mirza et al., 2024 Mirza F.N. Lim R.K. Yumeen S. Wahood S. Zaidat B. Shah A. et al. Performance of Three Large Language Models on Dermatology Board Examinations. J Invest Dermatol. 2024; 144: 398-400 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ), but the performance of LLMs compared to practicing dermatologists has not been elucidated. In addition, the use of LLMs by dermatologists and patients relies on the quality of the models' prose (free text) responses rather than multiple-choice selections. Clinical reasoning in model prose responses remains poorly understood in the literature. We conducted the first study, to our knowledge, that assesses the specialty knowledge of a commonly used LLM compared to dermatologists and manually evaluates the quality of model prose responses by board-certified dermatologists.

Background Hidradenitis suppurativa (HS), a chronic painful inflammatory skin condition, remains a persistent challenge in dermatology. Its complex pathogenesis has yet to be fully understood, complicating the identification of effective therapeutic strategies. Objective This study aims to investigate the latest insights on antibiotics, hormonal/metabolic interventions, and oral retinoids in the management of HS. Methods A narrative review was conducted to gather data on the efficacy and safety of oral antibiotics, hormonal interventions, and oral retinoids in HS from relevant studies and clinical trials. Results Oral antibiotics, such as tetracyclines and clindamycin-rifampin combination therapy, demonstrated significant improvements in disease severity scores. Hormonal interventions, targeting androgen receptors and insulin resistance, showed promising results in symptom management and improving disease severity. Oral retinoids, including isotretinoin and acitretin, displayed variable efficacy, with acitretin demonstrating more pronounced improvements. Limitations The variability in study designs, patient populations, and duration of follow-up across the reviewed literature may affect the generalizability of these findings. Conclusion While antibiotics continue to play a foundational role, hormonal/metabolic therapies and oral retinoids offer additional avenues for alleviating HS symptoms and addressing its intricate pathogenesis. These findings underscore the importance of personalized treatment approaches tailored to individual patient needs.

This review aims to assess the landscape of in-office procedural management of HS. It evaluates the role of simple office procedures, such as steroid injections and incision and drainage (I D), to the more complicated office surgical procedures, including deroofing and excisions with secondary intention healing, and innovative light and laser-based therapies. Punch debridement (mini-deroofing) remains an underutilized in-office procedure for HS. While the neodymium-doped yttrium aluminum garnet (Nd: YAG) laser continues to be preferred for laser hair removal (LHR), recent evidence highlights the effectiveness of Alexandrite lasers. Minimally invasive approaches such as cryoinsufflation and intralesional photodynamic therapy (PDT) may be helpful for patients reluctant to undergo more invasive surgical procedures. In-office procedures are integral to managing HS in conjunction with medical therapies. These procedures enable a personalized approach to addressing the chronic and challenging nature of HS and improving quality of life.

Our study of 410 patients with hidradenitis suppurativa (HS) and 12 805 direct patient messages identified common message topics, including scheduling; medication refills; itch, bleeding and burning symptoms; insurance and cost; pain; and wound care. Compared with the overall cohort of patients with HS, a lower proportion of Black and Hispanic patients utilized patient portal messaging. Our study provides insights into message topics among patients with HS and identifies opportunities for optimizing care via secure messaging.

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We sought to investigate the feasibility of longitudinal monitoring of disease activity from home in people with hidradenitis suppurativa (HS). Over 6 months, our novel digital tool collected 421 photos of HS-affected skin from 27 participants and captured trends in pain and quality of life scores. We found that participants with mild disease were more likely to share their progress than those with more severe disease, which is favourable as it may suggest a role for remote monitoring in tracking disease progression. This pilot provides proof of concept that will support future studies.

The literature on hidradenitis suppurativa in sexual and gender minorities remains sparse. This review article aims to discuss critical factors for providers to consider in lesbian, gay, bisexual, transgender, queer, intersex, and asexual patients with hidradenitis suppurativa, including associated comorbidities, gender-affirming hormonal therapy, squamous cell carcinoma, infections in HIV-positive patients, and creating a welcoming clinic for sexual and gender minority patients.

IMPORTANCE Patient-perceived barriers to hidradenitis suppurativa (HS) care are poorly understood. Understanding health care barriers is a critical first step toward improving care for this population. OBJECTIVE To characterize the health care experiences of people living with HS, including perceived barriers and facilitators to health care access, and to elucidate potential associations among these barriers and facilitators, health care access, and disease activity. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, an inductive thematic analysis was conducted on 45 in-depth, 60- to 90-minute semistructured interviews of 45 people with HS from diverse sociodemographic backgrounds that took place between March and April 2020. Individuals were eligible if they could speak English, were 18 years or older, and were diagnosed with HS. A diagnosis of HS was confirmed through physician diagnosis or through self-reported, affirmative response to the validated screening question, "Do you experience boils in your armpits or groin that recur at least every six months?" MAIN OUTCOMES AND MEASURES Interviewswere audio recorded and transcribed verbatim. A modified grounded theory approach was used to develop the codebook, which investigators used for inductive thematic analysis. RESULTS Among the 45 participants included, the median (IQR) age was 37 (16) years, 33 (73%) were female, and 22 (49%) were White. There were 6 interrelated themes associated with participant-perceived barriers to accessing HS care: (1) bidirectional associations of disease activity and employment, (2) association of employment with health care coverage, (3) association of health care coverage with costs and perceived access to care, (4) association of costs with access to patient-centered care, (5) health care professional attitudes and knowledge influence patient-centered care and perceived access to care and disease activity, and (6) health system characteristics influence patient-centered care and associated costs, perceived access to care, and disease activity. CONCLUSIONS AND RELEVANCE This qualitative study highlights themes that generate a conceptual model for understanding barriers that may act synergistically to limit health care access and influence disease activity. The disease activity of HSmay be reduced when cycle elements are optimized. This study also highlights areas for future investigations and potential systems-level changes to improve access to patient-centered HS care.

iNaturalist is a global online digital platform for documenting and fostering interest in biodiversity, with Research Grade (RG) entries being vetted and scientifically valid observations. Here we present a review of the role of approximately 16,000 Arkansans using the iNaturalist tool for recording 445,000 verifiable observations comprising 10,800 species, with 40 percent RG, and one third of observations still pending confirmation. Overall, plants lead in RG observations followed by invertebrates and birds. Within these groups, reptiles lead in proportion of RG observations, followed by birds and amphibians. Less charismatic or infrequently encountered organisms are less represented. Arkansas ranks about average in per capita number of RG observations relative to other states. We urge further usage of this tool to increase biota awareness and research within the state of Arkansas.

Hidradenitis suppurativa (HS), also known as acne inversa, is a debilitating inflammatory skin disorder that is characterized by nodules that lead to the development of connected tunnels and scars as it progresses from Hurley stages I to III. HS has been associated with several autoimmune diseases, including inflammatory bowel disease and spondyloarthritis. We previously reported dysregulation of humoral immune responses in HS, characterized by elevated serum total IgG, B-cell activation, and antibodies recognizing citrullinated proteins. In this study, we characterized IgG autoreactivity in HS sera and lesional skin compared with those in normal healthy controls using an array-based high-throughput autoantibody screening. The Cy3-labeled anti-human assay showed the presence of autoantibodies against nuclear antigens, cytokines, cytoplasmic proteins, extracellular matrix proteins, neutrophil proteins, and citrullinated antigens. Most of these autoantibodies were significantly elevated in stages II‒III in HS sera and stage III in HS skin lesions compared with those of healthy controls. Furthermore, immune complexes containing both native and citrullinated versions of antigens can activate M1 and M2 macrophages to release proinflammatory cytokines such as TNF-α, IL-8, IL-6, and IL-12. Taken together, the identification of specific IgG autoantibodies that recognize circulating and tissue antigens in HS suggests an autoimmune mechanism and uncovers putative therapeutic targets.