Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the hair follicles, and has been associated with a multitude of systemic disorders and pathologies. There is increasing evidence to suggest that chronic inflammatory skin disorders may be associated with psychiatric comorbidities, however this relationship has not been well established. We aimed perform a systematic review and meta-analysis to assess the association between HS and psychiatric comorbidities, suicide and substance abuse. Methods: A systematic review and meta-analysis was performed according to PRISMA guidelines. Results: HS cases had a significantly higher odds of having schizophrenia compared to the control group (OR 1.66, 95% CI: 1.53–1.79, P<0.00001). There was also a significant association with bipolar disorders (OR 1.96,95% CI: 1.65–2.33, P<0.00001), depression (OR 1.75, 95% CI: 1.44–2.13, P<0.00001), anxiety (OR 1.71, 95% CI: 1.51–1.92, P<0.00001), and personality disorders (OR 1.50, 95% CI: 1.18–1.92, P=0.001), suicide (OR 2.08, 95% CI: 1.27–3.42, P=0.004), substance-related disorders (OR 2.84, 95% CI: 2.33–3.46, P<0.00001), and alcohol abuse (OR 1.94, 95% CI: 1.43–2.64, P<0.0001). Conclusions: For dermatologists treating patients with HS, screening for these comorbidities, psychiatric referral and adequately managing pain will improve the overall wellbeing of patients.

Background: For severe cases of atopic dermatitis, systemic or potent agents may be required for control of disease. There have been some reports of treatment efficacy of off-label use of mycophenolate mofetil (MMF) in patients with refractory atopic dermatitis or have developed adverse effects to initial systemic agents. Methods: Electronic searches were performed using six databases from their inception to April 2019. Data were extracted and analyzed according to predefined clinical endpoints. Results: From 140 cases, the mean age was 38.21 ± 22.8 years. There were 52.9% males and 47.1% females. The average number of failed agents was 3.5 ± 1.2. 77.6% reported partial or full remission. Relapses occurred in 8.2% of cases. The average time for initial effects was 6.8 ± 7 weeks. There was a significant reduction in pre to post SCORAD scores by 18 points (p = .0002). More males had complications compared to females. Prolonged duration of treatment ≥1 year was associated with herpes infections. Conclusions: In summary, the current evidence to date is low-quality in nature but is promising regarding the efficacy and safety of MMF for adult and pediatric atopic dermatitis. There should be ongoing monitoring for infections that may develop on long term therapy.