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Portugal&#44; entre 2016 e 2019&#46; Foram recuperadas informa&#231;&#245;es epidemiol&#243;gicas&#44; cl&#237;nicas e terap&#234;uticas&#46; A atividade da HS e a resposta ao adalimumabe foram monitoradas no momento inicial e nas semanas 16 &#40;S16&#41;&#44; 24 &#40;S24&#41; e 52 &#40;S52&#41;&#46; Exame cl&#237;nico inicial e um m&#237;nimo de 16 semanas de seguimento foram necess&#225;rios para a inclus&#227;o no estudo&#46; Pacientes que necessitaram de aumento das doses de adalimumabe e casos de HS paradoxal foram exclu&#237;dos&#46; Os pacientes podiam receber tratamentos adjuvantes quando considerados adequados&#46; Utilizaram&#8208;se instrumentos de avalia&#231;&#227;o de gravidade&#44; especificamente <span class="elsevierStyleItalic">Hurley Staging System</span>&#44; <span class="elsevierStyleItalic">International Hidradenitis Suppurativa Severity Score System</span> &#40;iHS4&#41;&#44; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span> &#40;DLQI&#41; e escala visual anal&#243;gica para dor &#40;EVA dor&#41;&#46; A resposta ao tratamento foi avaliada utilizando a escala <span class="elsevierStyleItalic">Hidradenitis Suppurativa Clinical Response</span> &#40;HISCR&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Para a an&#225;lise estat&#237;stica&#44; utilizou&#8208;se o software IBM SPSS Vers&#227;o 24&#46; O teste <span class="elsevierStyleItalic">t</span> de amostras independentes foi usado para testar as diferen&#231;as entre vari&#225;veis cont&#237;nuas e categ&#243;ricas com n&#237;vel de signific&#226;ncia de 0&#44;05&#46; O teste exato de Fischer foi usado para avaliar diferen&#231;as entre duas vari&#225;veis categ&#243;ricas&#44; com n&#237;vel de signific&#226;ncia de 0&#44;05&#44; bicaudal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Dos 198 pacientes com HS&#44; 51 iniciaram tratamento com agente biol&#243;gico e&#44; desses&#44; 36 estavam em uso de adalimumabe e atendiam aos crit&#233;rios do estudo&#46; A compara&#231;&#227;o entre esses 36 pacientes tratados com adalimumabe e os 147 pacientes sem tratamento biol&#243;gico pode ser observada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; 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Digno de nota&#44; o tempo desde o in&#237;cio da HS at&#233; o diagn&#243;stico foi similar em pacientes que atingiram &#40;6&#44;7 anos <span class="elsevierStyleItalic">vs</span>&#46; 11&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;282&#41;&#46; Na S24&#44; houve redu&#231;&#227;o do iHS4 &#40;m&#233;dia iHS4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Na S52&#44; a m&#233;dia do iHS4 foi de 4&#44;7 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e HISCR ainda foi alcan&#231;ado em 76&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#47;30&#41; dos pacientes&#46; Entre o momento inicial e a S52&#44; a DLQI e a EVA da dor passaram de um valor m&#233;dio de 15&#44;4 para 10&#44;5 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de 4&#44;4 para 1&#44;8 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; respectivamente&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nas primeiras 16 semanas&#44; para controlar com sucesso a atividade inflamat&#243;ria da HS&#44; foram empregados tratamentos adjuvantes&#44; transit&#243;rios&#44; em 72&#37; dos casos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#46; Durante o per&#237;odo restante&#44; terap&#234;utica adjuvante foi necess&#225;ria em 20 pacientes para controlar os epis&#243;dios de crise&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Avaliando as diferen&#231;as entre os pacientes estadiados como Hurley II e III &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; 82&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; dos pacientes do sexo masculino foram classificados como Hurley III&#44; enquanto 48&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; do sexo feminino apresentaram essa gravidade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46; No momento inicial&#44; os pacientes Hurley II tendiam a apresentar m&#233;dia da gravidade da doen&#231;a menor &#40;m&#233;dia iHS4&#58; 13&#44;7 <span class="elsevierStyleItalic">vs</span>&#46; 18&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;085&#41; com n&#250;mero significantemente menor de f&#237;stulas de drenagem &#40;2&#44;0 <span class="elsevierStyleItalic">vs</span>&#46; 3&#44;9&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Embora ambos os grupos tenham demonstrado melhora da HS com o tratamento&#44; controle significantemente melhor da atividade da doen&#231;a na S52 foi observado em pacientes Hurley II &#40;iHS4&#58; 1&#44;3 <span class="elsevierStyleItalic">vs</span>&#46; 7&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Da mesma maneira&#44; a resposta ao adalimumabe medida pelo HISCR na S16 e S52 foi superior na S16 e similar na S52 em pacientes Hurley II &#40;S16&#58; 93&#37; <span class="elsevierStyleItalic">vs</span>&#46; 61&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#59; S52&#58; 83&#44;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 72&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;669&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Considerando a &#250;ltima avalia&#231;&#227;o cl&#237;nica de todos os pacientes&#44; 78&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41; mostraram redu&#231;&#227;o de pelo menos 50&#37; de seu iHS4 no momento inicial &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No grupo que n&#227;o obteve tal resposta &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#44; metade apresentou mais de cinco f&#237;stulas de drenagem no momento inicial&#44; e dois pacientes trocaram de tratamento biol&#243;gico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ensaios cl&#237;nicos mostraram que o adalimumabe &#233; tratamento eficaz para HS moderada a grave em pacientes com resposta inadequada aos tratamentos convencionais&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> com taxas de HISCR variando de 40&#37; a 60&#37; em monoterapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;6&#44;8&#44;9</span></a> Nossos resultados mostraram superioridade em termos de escore alcan&#231;ado na escala HISCR nas S12&#47;16&#44; S24 e S52 quando comparados aos ensaios cl&#237;nicos PIONEER I e II e ao estudo multic&#234;ntrico de Marzano et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;6&#8211;8</span></a> Os melhores resultados &#40;75&#37; de HISCR na S16&#41; foram associados ao uso de terap&#234;uticas intralesionais e sist&#234;micas adjuvantes&#46; Acredita&#8208;se que isso pode ser uma medida necess&#225;ria na pr&#225;tica di&#225;ria para reduzir ainda mais a inflama&#231;&#227;o e a dor em casos especialmente graves&#44; auxiliando a a&#231;&#227;o do adalimumabe&#46; Al&#233;m disso&#44; como crises ainda podem ser observadas em pacientes recebendo monoterapia com adalimumabe&#44; terapias adjuvantes podem ser necess&#225;rias para otimizar o tratamento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os resultados deste estudo mostraram resposta maior ao adalimumabe em pacientes Hurley II quando comparados aos pacientes Hurley III&#44; especialmente observ&#225;vel na redu&#231;&#227;o m&#233;dia do escore da iHS4&#46; Al&#233;m disso&#44; o atraso no diagn&#243;stico de HS foi maior no grupo Hurley III&#46; Esses achados seguem a tend&#234;ncia na hip&#243;tese da &#8220;janela de oportunidade&#8221;&#44; que postulou rela&#231;&#227;o inversa entre a dura&#231;&#227;o da HS e&#47;ou atraso no diagn&#243;stico e a efic&#225;cia do adalimumabe&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> Foi sugerido que iniciar o adalimumabe precocemente&#44; quando a HS &#233; caracterizada por les&#245;es revers&#237;veis&#44; tem o potencial de evitar a progress&#227;o da doen&#231;a&#44; o desenvolvimento de f&#237;stulas e deformidades permanentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;10</span></a> Os pacientes Hurley III apresentam quadro cl&#237;nico mais grave&#44; o que pode justificar menor efic&#225;cia do adalimumabe&#46; Os achados do presente estudo destacam ainda a import&#226;ncia do diagn&#243;stico precoce para o tratamento eficaz&#44; evitando a evolu&#231;&#227;o natural da HS&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; o adalimumabe &#233; tratamento &#250;til e eficaz para a HS&#44; embora acredite&#8208;se que seu uso em monoterapia possa n&#227;o ser suficiente para o controle ideal em alguns pacientes&#46; O presente estudo apoia a necessidade de um tratamento proativo&#44; ressaltando a import&#226;ncia do encaminhamento precoce&#44; do uso precoce de adalimumabe e do benef&#237;cio de terapias adjuvantes em pacientes em uso de adalimumabe&#46; Ressalta&#8208;se que as evid&#234;ncias da avalia&#231;&#227;o na pr&#225;tica di&#225;ria ainda s&#227;o escassas&#44; e mais estudos devem ser realizados para propiciar a formula&#231;&#227;o de diretrizes terap&#234;uticas baseadas em evid&#234;ncias mais adequadas&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Os autores n&#227;o receberam suporte financeiro para a pesquisa&#44; autoria e&#47;ou publica&#231;&#227;o deste artigo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Jos&#233; Miguel Neves&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">N&#233;lia Cunha&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Andr&#233; Lencastre&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Joana Cabete&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver potencial conflito de interesses em rela&#231;&#227;o &#224; pesquisa&#44; autoria e&#47;ou publica&#231;&#227;o desse artigo&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Neves JM&#44; Cunha N&#44; Lencastre A&#44; Cabete J&#46; Treating hidradenitis suppurativa patients with adalimumab&#58; a real&#8208;life experience of a tertiary care center in Lisboa&#44; Portugal&#46; An Bras Dermatol&#46; 2022&#59;97&#58;816&#8211;9&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Trabalho realizado no Departamento de Dermatologia e Venereologia&#44; Hospital de Santo Ant&#243;nio dos Capuchos&#44; Centro Hospitalar Universit&#225;rio de Lisboa Central&#44; Lisboa&#44; Portugal&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes tratados com adalimumabe &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes n&#227;o tratados com biol&#243;gicos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>147&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Signific&#226;ncia estat&#237;stica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preval&#234;ncia do sexo feminino&#44; n&#160;&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;69&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;68&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;981&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">In&#237;cio da HS &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atraso no diagn&#243;stico &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de comorbidades<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de locais afetados<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Est&#225;gio de Hurley<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Atraso no diagn&#243;stico &#40;anos&#41;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iHS4 inicial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero inicial de f&#237;stulas de drenagem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">S16 iHS4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S24 iHS4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S52 iHS4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S52 n&#250;mero de f&#237;stulas de drenagem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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Carta ‐ Investigação
Tratamento da hidradenite supurativa com adalimumabe – experiência da prática diária em centro terciário de Lisboa, Portugal
José Miguel Neves
Autor para correspondência
josemoneves@gmail.com

Autor para correspondência.
, Nélia Cunha, André Lencastre, Joana Cabete
Departamento de Dermatologia e Venereologia, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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Portugal&#44; entre 2016 e 2019&#46; Foram recuperadas informa&#231;&#245;es epidemiol&#243;gicas&#44; cl&#237;nicas e terap&#234;uticas&#46; A atividade da HS e a resposta ao adalimumabe foram monitoradas no momento inicial e nas semanas 16 &#40;S16&#41;&#44; 24 &#40;S24&#41; e 52 &#40;S52&#41;&#46; Exame cl&#237;nico inicial e um m&#237;nimo de 16 semanas de seguimento foram necess&#225;rios para a inclus&#227;o no estudo&#46; Pacientes que necessitaram de aumento das doses de adalimumabe e casos de HS paradoxal foram exclu&#237;dos&#46; Os pacientes podiam receber tratamentos adjuvantes quando considerados adequados&#46; Utilizaram&#8208;se instrumentos de avalia&#231;&#227;o de gravidade&#44; especificamente <span class="elsevierStyleItalic">Hurley Staging System</span>&#44; <span class="elsevierStyleItalic">International Hidradenitis Suppurativa Severity Score System</span> &#40;iHS4&#41;&#44; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span> &#40;DLQI&#41; e escala visual anal&#243;gica para dor &#40;EVA dor&#41;&#46; A resposta ao tratamento foi avaliada utilizando a escala <span class="elsevierStyleItalic">Hidradenitis Suppurativa Clinical Response</span> &#40;HISCR&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Para a an&#225;lise estat&#237;stica&#44; utilizou&#8208;se o software IBM SPSS Vers&#227;o 24&#46; O teste <span class="elsevierStyleItalic">t</span> de amostras independentes foi usado para testar as diferen&#231;as entre vari&#225;veis cont&#237;nuas e categ&#243;ricas com n&#237;vel de signific&#226;ncia de 0&#44;05&#46; O teste exato de Fischer foi usado para avaliar diferen&#231;as entre duas vari&#225;veis categ&#243;ricas&#44; com n&#237;vel de signific&#226;ncia de 0&#44;05&#44; bicaudal&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Dos 198 pacientes com HS&#44; 51 iniciaram tratamento com agente biol&#243;gico e&#44; desses&#44; 36 estavam em uso de adalimumabe e atendiam aos crit&#233;rios do estudo&#46; A compara&#231;&#227;o entre esses 36 pacientes tratados com adalimumabe e os 147 pacientes sem tratamento biol&#243;gico pode ser observada na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; 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Digno de nota&#44; o tempo desde o in&#237;cio da HS at&#233; o diagn&#243;stico foi similar em pacientes que atingiram &#40;6&#44;7 anos <span class="elsevierStyleItalic">vs</span>&#46; 11&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;282&#41;&#46; Na S24&#44; houve redu&#231;&#227;o do iHS4 &#40;m&#233;dia iHS4<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#44;5&#59; p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Na S52&#44; a m&#233;dia do iHS4 foi de 4&#44;7 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e HISCR ainda foi alcan&#231;ado em 76&#44;7&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#47;30&#41; dos pacientes&#46; Entre o momento inicial e a S52&#44; a DLQI e a EVA da dor passaram de um valor m&#233;dio de 15&#44;4 para 10&#44;5 &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; e de 4&#44;4 para 1&#44;8 &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; respectivamente&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Nas primeiras 16 semanas&#44; para controlar com sucesso a atividade inflamat&#243;ria da HS&#44; foram empregados tratamentos adjuvantes&#44; transit&#243;rios&#44; em 72&#37; dos casos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&#46; Durante o per&#237;odo restante&#44; terap&#234;utica adjuvante foi necess&#225;ria em 20 pacientes para controlar os epis&#243;dios de crise&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Avaliando as diferen&#231;as entre os pacientes estadiados como Hurley II e III &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#44; 82&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>9&#41; dos pacientes do sexo masculino foram classificados como Hurley III&#44; enquanto 48&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41; do sexo feminino apresentaram essa gravidade &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#46; No momento inicial&#44; os pacientes Hurley II tendiam a apresentar m&#233;dia da gravidade da doen&#231;a menor &#40;m&#233;dia iHS4&#58; 13&#44;7 <span class="elsevierStyleItalic">vs</span>&#46; 18&#44;8&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;085&#41; com n&#250;mero significantemente menor de f&#237;stulas de drenagem &#40;2&#44;0 <span class="elsevierStyleItalic">vs</span>&#46; 3&#44;9&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; Embora ambos os grupos tenham demonstrado melhora da HS com o tratamento&#44; controle significantemente melhor da atividade da doen&#231;a na S52 foi observado em pacientes Hurley II &#40;iHS4&#58; 1&#44;3 <span class="elsevierStyleItalic">vs</span>&#46; 7&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; Da mesma maneira&#44; a resposta ao adalimumabe medida pelo HISCR na S16 e S52 foi superior na S16 e similar na S52 em pacientes Hurley II &#40;S16&#58; 93&#37; <span class="elsevierStyleItalic">vs</span>&#46; 61&#44;9&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;051&#59; S52&#58; 83&#44;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 72&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;669&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Considerando a &#250;ltima avalia&#231;&#227;o cl&#237;nica de todos os pacientes&#44; 78&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>28&#41; mostraram redu&#231;&#227;o de pelo menos 50&#37; de seu iHS4 no momento inicial &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; No grupo que n&#227;o obteve tal resposta &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>8&#41;&#44; metade apresentou mais de cinco f&#237;stulas de drenagem no momento inicial&#44; e dois pacientes trocaram de tratamento biol&#243;gico&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ensaios cl&#237;nicos mostraram que o adalimumabe &#233; tratamento eficaz para HS moderada a grave em pacientes com resposta inadequada aos tratamentos convencionais&#44;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6&#8211;8</span></a> com taxas de HISCR variando de 40&#37; a 60&#37; em monoterapia&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;6&#44;8&#44;9</span></a> Nossos resultados mostraram superioridade em termos de escore alcan&#231;ado na escala HISCR nas S12&#47;16&#44; S24 e S52 quando comparados aos ensaios cl&#237;nicos PIONEER I e II e ao estudo multic&#234;ntrico de Marzano et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;6&#8211;8</span></a> Os melhores resultados &#40;75&#37; de HISCR na S16&#41; foram associados ao uso de terap&#234;uticas intralesionais e sist&#234;micas adjuvantes&#46; Acredita&#8208;se que isso pode ser uma medida necess&#225;ria na pr&#225;tica di&#225;ria para reduzir ainda mais a inflama&#231;&#227;o e a dor em casos especialmente graves&#44; auxiliando a a&#231;&#227;o do adalimumabe&#46; Al&#233;m disso&#44; como crises ainda podem ser observadas em pacientes recebendo monoterapia com adalimumabe&#44; terapias adjuvantes podem ser necess&#225;rias para otimizar o tratamento&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Os resultados deste estudo mostraram resposta maior ao adalimumabe em pacientes Hurley II quando comparados aos pacientes Hurley III&#44; especialmente observ&#225;vel na redu&#231;&#227;o m&#233;dia do escore da iHS4&#46; Al&#233;m disso&#44; o atraso no diagn&#243;stico de HS foi maior no grupo Hurley III&#46; Esses achados seguem a tend&#234;ncia na hip&#243;tese da &#8220;janela de oportunidade&#8221;&#44; que postulou rela&#231;&#227;o inversa entre a dura&#231;&#227;o da HS e&#47;ou atraso no diagn&#243;stico e a efic&#225;cia do adalimumabe&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;9&#44;10</span></a> Foi sugerido que iniciar o adalimumabe precocemente&#44; quando a HS &#233; caracterizada por les&#245;es revers&#237;veis&#44; tem o potencial de evitar a progress&#227;o da doen&#231;a&#44; o desenvolvimento de f&#237;stulas e deformidades permanentes&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4&#44;10</span></a> Os pacientes Hurley III apresentam quadro cl&#237;nico mais grave&#44; o que pode justificar menor efic&#225;cia do adalimumabe&#46; Os achados do presente estudo destacam ainda a import&#226;ncia do diagn&#243;stico precoce para o tratamento eficaz&#44; evitando a evolu&#231;&#227;o natural da HS&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; o adalimumabe &#233; tratamento &#250;til e eficaz para a HS&#44; embora acredite&#8208;se que seu uso em monoterapia possa n&#227;o ser suficiente para o controle ideal em alguns pacientes&#46; O presente estudo apoia a necessidade de um tratamento proativo&#44; ressaltando a import&#226;ncia do encaminhamento precoce&#44; do uso precoce de adalimumabe e do benef&#237;cio de terapias adjuvantes em pacientes em uso de adalimumabe&#46; Ressalta&#8208;se que as evid&#234;ncias da avalia&#231;&#227;o na pr&#225;tica di&#225;ria ainda s&#227;o escassas&#44; e mais estudos devem ser realizados para propiciar a formula&#231;&#227;o de diretrizes terap&#234;uticas baseadas em evid&#234;ncias mais adequadas&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0060" class="elsevierStylePara elsevierViewall">Os autores n&#227;o receberam suporte financeiro para a pesquisa&#44; autoria e&#47;ou publica&#231;&#227;o deste artigo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0065" class="elsevierStylePara elsevierViewall">Jos&#233; Miguel Neves&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">N&#233;lia Cunha&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Andr&#233; Lencastre&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Joana Cabete&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; revis&#227;o cr&#237;tica da literatura&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; an&#225;lise estat&#237;stica&#59; concep&#231;&#227;o e planejamento do estudo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0085" class="elsevierStylePara elsevierViewall">Os autores declaram n&#227;o haver potencial conflito de interesses em rela&#231;&#227;o &#224; pesquisa&#44; autoria e&#47;ou publica&#231;&#227;o desse artigo&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Como citar este artigo&#58; Neves JM&#44; Cunha N&#44; Lencastre A&#44; Cabete J&#46; Treating hidradenitis suppurativa patients with adalimumab&#58; a real&#8208;life experience of a tertiary care center in Lisboa&#44; Portugal&#46; An Bras Dermatol&#46; 2022&#59;97&#58;816&#8211;9&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Trabalho realizado no Departamento de Dermatologia e Venereologia&#44; Hospital de Santo Ant&#243;nio dos Capuchos&#44; Centro Hospitalar Universit&#225;rio de Lisboa Central&#44; Lisboa&#44; Portugal&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes tratados com adalimumabe &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes n&#227;o tratados com biol&#243;gicos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>147&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Signific&#226;ncia estat&#237;stica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preval&#234;ncia do sexo feminino&#44; n&#160;&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25 &#40;69&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;68&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;981&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">In&#237;cio da HS &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Atraso no diagn&#243;stico &#40;anos&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de comorbidades<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero de locais afetados<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Est&#225;gio de Hurley<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Atraso no diagn&#243;stico &#40;anos&#41;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iHS4 inicial &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#250;mero inicial de f&#237;stulas de drenagem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">S16 iHS4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;038&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S24 iHS4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S52 iHS4 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; <a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S52 n&#250;mero de f&#237;stulas de drenagem &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S16 HISCR &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">61&#44;9&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;051&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">S52 HISCR &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">72&#44;2&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;669&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">S52 somente Adalimumabe &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">27&#44;8&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>5&#41;&nbsp;\t\t\t\t\t\t\n
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                    0 => array:1 [
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                          "autores" => array:6 [
                            0 => "C&#46;C&#46; Zouboulis"
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                            3 => "W&#46; Gulliver"
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                      ]
                    ]
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                      "Revista" => array:5 [
                        "tituloSerie" => "J Eur Acad Dermatology Venereol&#46;"
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                        "volumen" => "33"
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                      "titulo" => "Targeted treatments for hidradenitis suppurativa&#58; a review of the current literature and ongoing clinical trials"
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                          "autores" => array:4 [
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                            3 => "V&#46;Y&#46; Shi"
                          ]
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                      ]
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                    0 => array:2 [
                      "doi" => "10.1080/09546634.2017.1395806"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Dermatolog Treat&#46;"
                        "fecha" => "2018"
                        "volumen" => "29"
                        "paginaInicial" => "441"
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                        "link" => array:1 [
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                            0 => "D&#46;M&#46;L&#46; Saunte"
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                        "link" => array:1 [
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To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.