It is still a secret disease - clinical images in randomized controlled trials on hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a recalcitrant, chronic, inflammatory skin disease characterized by painful nodules, abscesses, and tunnels, primarily affecting intertriginous areas. Despite its substantial negative impact on patients' quality of life, HS has been historically understudied. Recently, an increasing number of randomized controlled trials (RCTs) have expanded treatment options and informed clinical guidelines. While quantitative data using clinical scoring systems is standard to disseminate RCT results, this study aimed to assess the extent of clinical image dissemination, as this can increase transparency and support layperson communication.

A systematic review was performed on 265 identified articles, of which 37 met the inclusion criteria. Each trial was evaluated for the inclusion of clinical images and the number of patients represented.

Clinical images were included in 15 of 37 trials (40.5%), depicting only 33 of 4,327 randomized patients (0.7%) across 90 photos. Articles published before 2020 more frequently included photos than those published later (p = 0.008). The low inclusion rate of clinical photos in HS RCTs is, however, slightly higher than in comparable psoriasis and atopic dermatitis studies.

Given dermatology's visual nature, the limited use of clinical photos in HS RCTs is notable. Increasing clinical photo dissemination in scientific articles may enhance research transparency, aid young physicians' education, and improve patient communication. However, standardized photo protocols and ethical considerations are essential for implementation.