P6459Comorbidities are common among patients with moderate-to-severehidradenitis suppurativa; depression and morbid obesity are positivelyassociated with disease severity

Jeffrey J. Crowley, MD, Bakersfield Dermatology, Bakersfield, CA, United States;Jan Mekkes, MD, PhD, University of Amsterdam, Amsterdam, Netherlands; MartinM. Okun, MD, PhD, Abbott Laboratories, Abbott Park, IL, United States; YihuaGu, MS, Abbott Laboratories, Abbott Park, IL, United States

Background: Hidradenitis suppurativa (HS) is a chronic, recurrent, painful inflam-matory skin disease that is often underdiagnosed and undertreated. This analysischaracterizes the prevalence of 3 common comorbidities associated with HS amongpatients enrolled in a phase 2 trial of adalimumab for treatment of moderate-to-severe HS and the relationship between the prevalence of these comorbidities anddisease severity.

Methods: This is a post hoc analysis from a 52-week, phase II study (NCT00918255)of adalimumab treatment in patients with moderate-to-severe HS (HS-Physician’sGlobal Assessment [HS-PGA] of at least moderate [3]). For this analysis, patientswere characterized as having hypertension if they were being treated withantihypertensive medication and/or self-reported history of hypertension at base-line; as having depression if their baseline PHQ-9 score was $ 10; as having morbidobesity if their baseline BMI[40 kg/m2; and as having severe HS if their baseline HS-PGA score was[3 and/or Hurley stage was 3. Logistic regression was used in thecomparisons of prevalence among severe versus nonsevere patients and 95% Waldconfidence intervals (CI) of the odds ratios were generated.

Results: Of 154 patients with HS, themajority werewomen (71%), white (71%),\40years of age (64%), smokers (ever; 70%), with no family history of HS (72%). Meanage was 36 years (11.76 SD). The most common comorbidities in this populationaccording to self-reported medical history were hypertension (21%), depression(18%), and obesity (15%). According to medical examination, the prevalence ofhypertension (self-reported or used hypertension medication) was 22%, morbidobesity (BMI[40 kg/m2) 28%, and depression (PHQ-9 $ 10) 42%. Prevalence ofhypertension was similar among patients with severe HS (18%) versus nonsevere HS(24%), odds ratio [95% CI] 0.69 [0.310-1.551]. Prevalence of morbid obesity washigher among patients with severe HS (37%) versus nonsevere HS (22%), odds ratio[95% CI] 2.01 [0.985, 4.114]. Prevalence of depression was higher among patientswith severe HS (52%) versus nonsevere HS (35%), odds ratio [95% CI] 1.94 [1.004,3.764].

Conclusions: Hypertension, depression, and morbid obesity were relatively com-mon comorbidities among patients enrolled in this HS trial. Patients with severe HSwere more likely to have depression and morbid obesity versus patients whose HSwas not severe.

AB46

ponsored by Abbott Laboratories.

100% is s

P6172Comparative evaluation of antidandruff clinical efficacy of a potentiatedzinc pyrithione shampoo and a zinc pyrithione/climbazole combinationformula

James Schwartz, PhD, Procter and Gamble, Cincinnati, OH, United States;Haruko Mizoguchi, PhD, Procter and Gamble, Cincinnati, OH, United States;Robert Bacon, Procter and Gamble, Cincinnati, OH, United States

Background: Dandruff and seborrheic dermatitis (D/SD) are common and trouble-some scalp conditions that affect patient quality of life. To improve this reoccurringcondition and relieve patients of the negative impact of this condition on their lives,identification and use of the most effective products is required.

Aim: To compare 2 different product technology approaches using establishedclinical methods robustly sized to assess their relative therapeutic effectiveness.

Methods: A randomized, double-blind parallel design clinical trial was conductedamong 620 subjects suffering from dandruff. Subjects used assigned test product 3times per week over 4weeks at the clinical site. On-site washing assures complianceand reduces artifacts associated with varying protocol adherence. Measures weremade of scalp condition at weekly intervals, including flaking severity (ASFS) andother fundamental measures of overall scalp health. Statistical analysis was based onANCOVA with significance determined at a 2-sided P\.05.

Results: The potentiated zinc pyrithione (ZPT) shampoo was significantly moreeffective than the ZPT/climbazole shampoo at all weekly time intervals. Themagnitude of difference between the 2 products widened as subjects continued touse the products over time, indicating an increasing benefit for the potentiated ZPTshampoo. ZPT, since it was first introduced in 1961, has become themost commonlyused antidandruff active; however, differences in products formulations can havesubstantial impact on the magnitude of realized benefit despite using the sameingredient. The potentiated ZPT formula is more effective than a standard formulaeven when it is combined with a second antifungal active, climbazole. In vitromicrobiology demonstrates a lack of additivity between ZPT and climbazole, whilesynergistic effect is observed with the potentiated ZPT formula.

Conclusion: A large scale antidandruff clinical evaluation demonstrates the thera-peutic superiority of a potentiated ZPT shampoo formulation over a ZPT/climbazoleproduct. The results were statistically significant and consistent throughout the 4weekly measured times using a highly reliable, appropriately sized clinicalmethodology.

ponsored by Procter and Gamble.

100% is s

J AM ACAD DERMATOL

P6852Comparative study of syphilid and syphilid-like eruption on the palms

Jung-Min Park, MD, Department of Dermatology, School of Medicine, PusanNational University, Busan, South Korea; Byoung-Soo Kim, MD, PhD, Departmentof Dermatology, School of Medicine, Pusan National University, Busan, SouthKorea; Hoon-Soo Kim, MD, Department of Dermatology, School of Medicine,Pusan National University, Busan, South Korea; Hyun-Chang Ko, MD, Departmentof Dermatology, School of Medicine, Pusan National University, Busan, SouthKorea; Margaret Song, MD, Department of Dermatology, School of Medicine,Pusan National University, Busan, South Korea; Moon-Bum Kim, MEd, PhD,Department of Dermatology, School of Medicine, Pusan National University,Busan, South Korea; Seung-Wook Jwa, MD, Department of Dermatology, Schoolof Medicine, Pusan National University, Busan, South Korea

Background: Syphilis, the ‘‘great imitator,’’ presents with quite variable clinicalmanifestations. Accordingly, suspicion of syphilis while examining cutaneousdisease is important in clinical aspect. It is well known that palmoplantar involve-ment and Biette collarette are useful characteristic diagnostic clue for syphilids.

Objective: To determine the clinical characteristics of syphilids that help differen-tiate syphilid-like dermatoses in clinical aspect.

Method: We conducted a retrospective review of patients presented with palmareruption which was diagnosed as secondary syphilis or as other dermatoses. Weinvestigated the duration of disease, symptom, color, type of scale, dermatoscopicfinding, unilaterality, involved area, and range of palmar skin lesion, morphology,and location of extraplamar skin lesion.

Results: Thirty-four patients were included in syphilid group and 39 patients insyphilid-like group, such as eczema, erythema multiforme, and psoriasis, accordingto serologic tests and biopsy. The subjective symptoms, including pruritus andtingling, were more commonly presented in syphilid-like group (76.9%) thansyphilid group (47.1%; P ¼ .008). In syphilid group, Biette collarette was morecommonly observed and sole and genital region were more frequently involved thansyphilid-like group with statistical significance. There was no difference betweensyphilid and syphilid-like group regarding the symmetry of palmoplantar rash andthe presence of lesion in other body parts.

Conclusion: In summary, Biette collarette in palm and involvement of sole andgenital region could be emphasized as the clinical characteristics that helpdifferentiate syphilids from other syphilid-like dermatoses easily.

cial support: None identified.

Commer

P6112Congenital multiple clustered dermatofibroma and multiple eruptivedermatofibromas: Exceedingly rare presentations of a common entity

Teresa Pinto-Almeida, MD, Dermatology Department, Centro Hospitalar do Porto- Hospital de Santo Ant�onio, Porto, Portugal; Manuela Selores, MD, DermatologyDepartment, Centro Hospitalar do Porto - Hospital de Santo Ant�onio, Porto,Portugal; M�onica Caetano, MD, Dermatology Department, Centro Hospitalar doPorto - Hospital de Santo Ant�onio, Porto, Portugal; Ros�ario Alves, MD,Dermatology Department, Centro Hospitalar do Porto - Hospital de SantoAnt�onio, Porto, Portugal

Background: Dermatofibroma is a common benign dermal tumor, often occurring asa single lesion, but with several clinical variants. We report 2 patients withuncommon presentations.

Case 1: A healthy 12-year-old girl presented with an asymptomatic congenital lesionon the thigh. She referred the lesion remained stable until the previous year, whennew papular lesions began to develop. Physical examination revealed multiplereddish-brown firm papules with 4- to 9-mm, that grouped to form a large plaque onthe lateral aspect of the right thigh. Histopathologic examination showed featuresconsistent with dermatofibroma and immunohistochemistry revealed positivity ofvimentin and negativity of a-actin, desmin and CD34. The diagnosis of congenitalmultiple clustered dermatofibroma (MCD) was made. Reassurance and a conserva-tive attitude were adopted and the patient is kept under surveillance.

Case 2: A 42-year-old woman presented with a 5-year history of multiple painfulcutaneous lesions progressively developing over the entire skin. She had Sj€ogrensyndrome diagnosed 6 years before and was on no regular medication. Physicalexamination revealed multiple (20-30) brown firm papules and nodules with 4- to15-mm, with dimpling on the trunk and upper and lower limbs. Histopathologicexamination showed features compatible with dermatofibroma and the diagnosis ofmultiple eruptive dermatofibromas (MED) was made. Surgical excision of the mostpainful lesions was performed and the patient is kept under surveillance.

Discussion: MCD is an exceedingly rare entity characterized by the development ofclustered dermatofibromas in 1 anatomic area, usually on the lower half of the body.They usually develop early in life and tend to progress over the years. According tothe literature, this is the fourth congenital CMD reported so far. The pathogenesis isstill unknown and it seems to be unassociated with an inciting event or immunedysfunction. Histopathology is essential for the diagnosis and a conservative attitudeis advised. MED is a rare entity defined by the occurrence of more than 15dermatofibromas, usually painful. It has been associated with autoimmune diseases,immunosuppressants, HIV, hematologic malignancies, pregnancy, among otherconditions. In our patient, the possible association is with Sj€ogren syndrome, once itpreceded the development of the dermatofibromas. The pathogenesis remainsunknown but an altered immune status is thought to play an important role.

cial support: None identified.

Commer

APRIL 2013