Recall how to diagnose hidradenitis suppurativa (HS)

Describe the pathways for development of HS

Discuss novel therapies in development for the treatment of HS

2023 Virtual Grand Rounds Session 6: May 3, 2023 - Navigating the Challenges of Diagnosis and Management of Hidradenitis Suppurativa

Hidradenitis Suppurativa

WEDNESDAY, Feb. 21, 2024 (HealthDay News) -- Treatment of hidradenitis suppurativa (HS) with intravenous ertapenem is associated with improvement in clinical and inflammatory markers, according to a study published online Feb. 19 in JAMA Dermatology.Avigdor Nosrati, M.D., from the Albert Einstein College of Medicine in New York City, and colleagues conducted a retrospective review of the medical records of 98 patients with HS between 2018 and 2022 to examine optimal course duration, efficacy, and patient satisfaction associated with intravenous ertapenem. Treatment was with 1 g of ertapenem, which was self-administered at home for 12 to 16 weeks.The mean treatment duration spanned 13.1 weeks; posttherapy follow-up occurred after 7.8 weeks. The researchers observed significant reductions in the mean HS Physician Global Assessment scores from baseline to posttherapy follow-up and in the numerical rating scale for pain, C-reactive protein, interleukin-6, and leukocytes. Overall, 78.0 percent of the patients participated in the telephone survey at follow-up, with 80.3 percent reporting medium-to-high satisfaction. Most patients (90.8 percent) would recommend ertapenem to other patients."Larger, prospective, randomized clinical trials are needed to further optimize ertapenem dosing and duration, to evaluate the coadministration of other therapies, and to develop strategies for maintaining therapeutic outcomes," the authors write.One author disclosed ties to Verrica Pharmaceuticals.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2815036">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2815041">Editor's Note (subscription or payment may be required)</a>

Significant reductions seen in mean Physician Global Assessment scores and in pain, C-reactive protein, IL-6, leukocytes

Clinical Markers Improve With IV Ertapenem for Hidradenitis Suppurativa

WEDNESDAY, Jan. 17, 2024 (HealthDay News) -- Factors that affect medical decision-making among patients with hidradenitis suppurativa (HS) include suffering threshold, perceptions of treatment risk, treatment fatigue, understanding of the disease, and sources of information, according to a study published online Jan. 10 in JAMA Dermatology.Nicole Salame, M.D., from the Emory University School of Medicine in Atlanta, and colleagues examined factors that affect the medical decision-making process for patients with HS. Open-ended semistructured interviews were conducted with 21 English-speaking adults with HS recruited from two dermatology clinics. On a 0- to 10-point numeric rating scale, participants had an average seven-day pain score of 1 or higher.The researchers found that 96 percent of the participants had Hurley stage II or III disease and 71 percent had a history of adalimumab use. Factors affecting participants' decisions to initiate new treatments for HS included suffering threshold, perceptions of treatment risk, treatment fatigue, disease understanding, and sources of information (dermatologists, the internet, advertisements, and friends and loved ones)."By addressing misconceptions about perceived risks, identifying gaps in disease knowledge, and emphasizing the importance of early treatment to prevent scarring and disease progression, dermatologists may empower patients with HS to make informed and meaningful treatment decisions and to try new therapies," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2813822">Abstract/Full Text (subscription or payment may be required)</a>

Five factors identified, including suffering threshold, perceptions of treatment risk, treatment fatigue

Factors ID'd That Affect Medical Decision-Making in Hidradenitis Suppurativa

WEDNESDAY, Sept. 20, 2023 -- Hidradenitis suppurativa (HS) seems to involve local changes in the skin or its free nerve endings that may lead to peripheral neuropathy, according to a study published online Sept. 13 in JAMA Dermatology.Ali Alsouhibani, P.T., Ph.D., from the Emory University School of Medicine in Atlanta, and colleagues characterized somatosensory profiles in patients with HS at clinically affected and nonaffected sites compared to pain-free reference data in a cross-sectional study. Twenty adults with dermatologist-diagnosed HS and at least one painful HS lesion at the time of testing were included in the study.The researchers found that HS lesions were insensitive to innocuous cold and warmth, noxious heat, and light touch compared with site-specific reference values from healthy, pain-free control participants. Significant hypersensitivity to deep pressure pain and cutaneous pinprick was also seen for HS lesions. The control site also demonstrated hypersensitivity to deep pressure pain. Changes in pain processing that are often seen in neuropathic and nociplastic pain conditions were displayed by a subset of patients with HS, including hypersensitivity to repetitive pinprick, paradoxical thermal sensations, and pain upon light stroking of the skin (26, 15, and 50 percent, respectively)."Additional studies that evaluate the association between quantitative sensory testing findings and other measures of small nerve fiber function across a broader population of patients with HS are needed to further elucidate cutaneous sensory changes that may contribute to pain and itch in HS," the authors write.One author disclosed ties to the pharmaceutical industry.

HS lesions insensitive to innocuous cold and warmth, noxious heat, and light touch compared with healthy pain-free controls

Somatosensory Profiles Characterized in Hidradenitis Suppurativa

WEDNESDAY, Aug. 16, 2023 -- For adults with moderate-to-severe hidradenitis suppurativa (HS), Numerical Rating Scale (NRS) 30, defined as a ≥30 percent and ≥2-point reduction in skin pain, is valid for assessing HS treatment effect with respect to pain, according to a research letter published online Aug. 11 in the Journal of the American Academy of Dermatology.Xiaoling Wei, from Novartis Pharma Shanghai, and colleagues examined data from two phase 3 trials of secukinumab to assess the clinical validity of NRS30. Data were included for adults with moderate-to-severe HS from the SUNSHINE and SUNRISE trials (541 and 543 patients, respectively).The researchers found that the mean NRS pain at baseline was 6.1 ± 1.84 and 6.3 ± 1.78 in SUNSHINE and SUNRISE, respectively. At the second screening visit and baseline, two weeks apart before treatment initiation, strong test-retest reliability was observed for the NRS30 definition (intraclass correlation, 0.81). Construct validity of NRS30 was well supported, with moderate correlation seen with most patient-reported outcomes (PROs); in both trials, the strongest correlations were seen for the Dermatology Life Quality Index (DLQI) and Patient Global Impression of Severity. Achievement of NRS30 at week 16 was associated with moderate-to-large improvements in most clinical and PRO measures; NRS30 nonresponders had small improvements. NRS30 responders at week 16 were more likely to achieve NRS30 response, not experience pain or discomfort, and have improved DLQI scores at 52 weeks."Measuring pain on the NRS scale before and after an intervention is a simple and reliable approach for physicians and patients to assess treatment success in the clinical setting," the authors write.All authors are employees of Novartis, which funded the study.

Achievement of NRS30 at week 16 associated with moderate-to-large improvements in clinical, patient-reported outcome measures

 Is NRS30 Valid for Assessing Treatment Effect for Hidradenitis Suppurativa Pain?

WEDNESDAY, July 26, 2023 &nbsp;-- Common variants located near the SOX9 and KLF5 genes are associated with hidradenitis suppurativa (HS) risk, according to a study published online July 26 in JAMA Dermatology.Quan Sun, from the University of North Carolina at Chapel Hill, and colleagues identified genetic variants associated with HS in a genetic association study involving 753 patients with HS from August 2018 to July 2021. After quality control, a genome-wide association study was performed for 720 patients with controls from the Add Health study, and a meta-analysis was performed with data from two large biobanks: 247 cases from the U.K. Biobank and 673 from FinnGen. Replication testing was performed for variants at three loci in 290 cases from the BioVU biobank.The analysis included 720 patients. The researchers identified and replicated two HS-associated loci in a meta-analysis of the four studies, with lead variants rs10512572 and rs17090189 near the SOX9 and KLF5 genes, respectively. The location of variants at these loci was in enhancer regulatory elements identified in skin tissue."Identifying variant associations near candidate genes with plausible roles in disease biology does not prove a causal effect of these variants or genes on disease risk," the authors write. "Functional studies must assess whether the HS-associated variants and surrounding regulatory elements can alter SOX9 and KLF5 function or expression and, subsequently, affect HS pathology."Several authors disclosed ties to the biopharmaceutical industry.

Two hidradenitis suppurativa-associated loci identified in meta-analysis of four studies, with variants located near SOX9 and KLF5 genes

Variants at Two Loci Associated With Hidradenitis Suppurativa Risk

WEDNESDAY, June 14, 2023 (HealthDay News) -- Pediatric patients with hidradenitis suppurativa (HS) have a higher prevalence of Crohn's disease, according to a research letter published online June 14 in JAMA Dermatology.Nicole Mastacouris, from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, and colleagues compared the prevalence of Crohn disease among pediatric patients with and without HS. The analysis included 2,883 patients with HS (aged 12 to 17 years) and 222,186 control patients.The researchers found that Crohn's disease was prevalent in 0.69 percent of patients with HS and 0.17 percent of control patients (unadjusted prevalence ratio, 4.11). Crohn disease prevalence remained higher in patients with HS in the adjusted analysis (adjusted prevalence ratio, 4.90) versus control patients. Similar results were seen among patients aged 15 to 17 years with HS (adjusted prevalence ratio, 4.84) versus those without."Findings of this study suggest an association between Crohn's disease and HS in pediatric patients," the authors write. "However, the low-absolute prevalence of Crohn's disease in this group is reassuring and should be taken into context when counseling patients."One author disclosed financial ties to pharmaceutical companies, including AbbVie, which supported the study.

Findings seen among pediatric patients aged 12 to 17 years

Crohn's Disease More Common in People With Hidradenitis Suppurativa

WEDNESDAY, May 3, 2023 -- For patients with moderate-to-severe hidradenitis suppurativa (HS), adalimumab combined with surgery yields greater clinical effectiveness and improved quality of life after 12 months compared with adalimumab alone, according to a study published online April 26 in the Journal of the American Academy of Dermatology.Pim Aarts, M.D., from the Erasmus University Medical Center in Rotterdam, Netherlands, and colleagues compared the clinical effectiveness of adalimumab combined with surgery versus adalimumab monotherapy among patients with moderate-to-severe HS in a pragmatic randomized trial. Thirty-one patients were included in each of the arms. The difference in mean International HS Severity Score System (IHS4) reduction after 12 months of treatment was assessed as the primary outcome.After 12 months of treatment, the researchers observed a significantly greater reduction in IHS4 for the surgery group versus the monotherapy group (–19.1 ± 11.3 versus –7.8 ± 11.8). A greater reduction was also seen in the Dermatology Life Quality Index after treatment in the surgery group versus the monotherapy group (–8.2 ± 6.2 versus –4.0 ± 7.7)."The combination of adalimumab with surgery showed significantly greater clinical effectiveness and improvement in quality of life than adalimumab monotherapy, with a higher rate of patient satisfaction," the authors write. "The therapeutic option of adalimumab with surgery should always be proposed to patients with moderate-to-severe hidradenitis suppurativa."

Greater reduction seen in International HS Severity Score System and in Dermatology Life Quality Index in combination group

Adalimumab Plus Surgery Better for Hidradenitis Suppurativa

WEDNESDAY, April 26, 2023 -- The Hidradenitis Suppurativa Investigator Global Assessment (HS-IGA) score has good psychometric properties compared with existing measures, according to a study published online April 26 in JAMA Dermatology.Amit Garg, M.D., from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, and colleagues assessed psychometric properties of the HS-IGA score using a clinical trial dataset. Trial participants with moderate-to-severe HS were randomly assigned to receive bimekizumab, adalimumab, or placebo. The HS-IGA score was measured at prespecified time points up to 12 weeks after randomization.The researchers found that at baseline and week 12, the HS-IGA score showed strong convergent validity with the International Hidradenitis Suppurativa Severity Score System and HS Physician Global Assessment (HS-PhGA) scores. Good test-retest reliability was seen for the HS-IGA score assessed during predosing visits at screening and baseline (intraclass correlation coefficient, 0.92). HS-IGA responders were significantly associated with Hidradenitis Suppurativa Clinical Response (HiSCR-50/75/90) responders at week 12. At week 12, the HS-IGA score was predictive of HiSCR-50/75/90 and of HS-PhGA (areas under the curve, 0.69, 0.73, 0.85, and 0.71, respectively). Low predictive validity with patient-reported outcomes at week 12 was seen for the HS-IGA as a measure of disease activity."The HS-IGA demonstrated good psychometric properties compared with existing measures and may be considered for use as an end point in clinical trials for HS," the authors write. "The HS-IGA represents a valuable clinician-reported outcome to drug development efforts on behalf of patients with HS."Several authors disclosed financial ties to the pharmaceutical industry; one author holds patents, including for the HS-IGA.

Tool has good psychometric properties compared with existing measures

 Validity Demonstrated for Hidradenitis Suppurativa Investigator Global Assessment

Many patients with hidradenitis suppurativa (HS) are dissatisfied with treatment, according to a study published in the December issue of the
 
 British Journal of Dermatology
 
 .




 Bria Midgette, from the Donald &amp; Barbara Zucker School of Medicine at Hofstra Northwell in Hempstead, New York, and colleagues measured associations between treatment satisfaction and clinical and treatment-related characteristics among 1,418 patients with HS recruited from 27 institutions in 14 countries from October 2017 to July 2018. Patients' self-reported overall satisfaction with their current treatments for HS, rated from very dissatisfied to very satisfied on a 5-point scale, was reported.




 The researchers found that 45 percent of patients were either dissatisfied or very dissatisfied with their current medical treatment. In an adjusted analysis, the odds of being satisfied with current treatment were increased for patients primarily treated by a dermatologist for HS versus those not primarily treated by a dermatologist (odds ratio, 1.99). Higher satisfaction was seen in association with treatment with biologics relative to treatment with nonbiologic systemic medications (odds ratio, 2.36). Lower treatment satisfaction was seen in association with smoking (active versus never: odds ratio, 0.78), depression (odds ratio, 0.69), increasing number of comorbidities (odds ratio, 0.88 per comorbidity), and increasing flare frequency.




 "These results may imply low awareness around the role of dermatologists in the care of patients with HS, as well as highlighting the difficulty in accessing dermatologists," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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Odds of being satisfied with treatment increased for patients primarily treated by a dermatologist

Many Hidradenitis Suppurativa Patients Dissatisfied With Treatment

Many patients with hidradenitis suppurativa (HS) with an index emergency department visit for HS return to the emergency department, while few have follow-up dermatology visits, according to a study published online Oct. 26 in
 
 JAMA Dermatology
 
 .




 Cynthia X. Wang, M.D., from the Washington University School of Medicine in St. Louis, and colleagues conducted a retrospective cohort study involving 20,269 patients with HS to examine interventions and patient factors associated with emergency department return following an initial emergency department visit.




 Of the patients, 48.0 percent had incision and drainage performed at the index emergency department visit; 72.6 and 48.9 percent received an oral antibiotic prescription and an opioid medication prescription, respectively. The researchers found that 17.2 percent of patients had at least one return emergency department visit within 30 days for HS or proxy compared with 2.4 percent who had a dermatology visit. Within 180 days, 34.0 percent of patients had a return emergency department visit for HS or proxy, while 6.8 percent had a dermatology visit. The likelihood of returning to the emergency department for treatment was increased for patients with Medicaid and for those with an opioid prescription (odds ratios, 1.48 and 1.48, respectively, within 180 days); in contrast, these patients were less likely to have dermatology follow-up (odds ratios, 0.16 and 0.81, respectively, within 180 days).




 "This study highlights a critical gap in care for patients with HS because a majority of these patients who present to the emergency department do not make it into the ambulatory dermatology setting for follow-up," the authors write.




 Several authors disclosed financial ties to the pharmaceutical industry.




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17.2 percent of patients had at least one return emergency department visit within 30 days, while 2.4 percent had a dermatology visit

Return to ED Common for Hidradenitis Suppurativa Patients

The burden of ambulatory hidradenitis suppurativa (HS) visits is higher during the late spring and summer months (May to August), according to a research letter published online Sept. 12 in
 
 SKIN
 
 .




 Terri Shih, from the David Geffen School of Medicine at the University of California Los Angeles, and colleagues examined the seasonal trends of ambulatory visits for patients with HS using data from the National Ambulatory Medical Care Survey. A total of 2.33 million outpatient visits with a diagnosis of HS were identified between 2008 and 2018.




 The researchers found that about 21, 51, and 28 percent of visits occurred during winter to early spring (January to April), late spring to summer (May to August), and autumn (September to December), respectively. Between these time periods, the number of visits differed significantly. In multivariate analyses, no significant differences were observed in visit number during these months based on gender, race, region, insurance status, or whether the provider was a dermatologist.




 "Our findings can help dermatologists anticipate a higher burden of HS management during late spring and summer months to help ensure continued access to care and address potential season-related HS triggers such as hyperhidrosis early," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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51 percent of ambulatory visits for hidradenitis suppurativa occurred during May to August

Burden of Ambulatory Hidradenitis Suppurativa Visits Up During Summer

The prevalence of depression is increased among pediatric and adult patients with hidradenitis suppurativa (HS), according to a study published in the January issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Shari Wright, from the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, and colleagues compared the prevalence of depression in a cross-sectional analysis of 38,140 adults and 1,162 pediatric HS patients and controls.




 The researchers found that the prevalence of depression was 30.0 and 16.9 percent among adults with HS and controls, respectively, and 11.7 and 4.1 percent, respectively, among children/adolescents with HS and controls. Relative to controls, the odds of having depression were 1.26 (95 percent confidence interval, 1.25 to 1.28; P &lt; 0.001) and 1.42 (95 percent confidence interval, 0.999 to 2.01; P = 0.051) among adults and children/adolescents with HS, respectively, in adjusted analyses.




 "Prevalence of depression among pediatric and adult patients with HS is high," the authors write. "Health care providers should be attentive to signs and symptoms of depression among children, adolescents, and adult patients with HS. Periodic screening for depression may be considered."




 One author disclosed financial ties to the pharmaceutical industry.




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Prevalence of depression increased among adults and children with hidradenitis suppurativa

Depression Up in Pediatric, Adult Hidradenitis Suppurativa Patients

In this episode of Derms and Conditions, host James Q Del Rosso, DO, sits down with Jennifer Hsiao, MD, associate professor of clinical dermatology at Keck Medicine of University of Southern California, to discuss the multifaceted world of hidradenitis suppurativa (HS). From addressing diagnostic obstacles to understanding comorbidities, this episode guides clinicians through the many complexities of HS management.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, sits down with Jennifer Hsiao, MD, associate professor of clinical dermatology at Keck Medicine of University of Southern California, to discuss the multifaceted world of hidradenitis suppurativa (HS). From addressing diagnostic obstacles to understanding comorbidities, this episode guides clinicians through the many complexities of HS management.They begin by exploring the diagnostic hurdles associated with HS, with Dr Hsiao sharing insights to help clinicians navigate through potential misdiagnoses. She emphasizes the importance of recognizing subtle indicators of the disease and thinking outside the box when it comes to the location of lesions, as they may present in atypical areas. She also highlights the significance of recurrent history, which can serve as a diagnostic hallmark.Next, the pair discusses comorbidities associated with HS, with Dr Hsiao detailing the importance of inquiring about patients' primary care arrangements. She notes that while dermatologists may not directly manage these comorbidities, they can play a vital role in identifying and initiating the necessary steps toward management.The discussion then moves to the significant psychological impact of HS, emphasizing the necessity of open dialogue with patients about the psychological toll of HS and the benefits of seeking mental health support. Screening tools like the PHQ-2 can aid in identifying patients at risk and initiating necessary interventions.They next address the limitations of current clinical guidelines for HS and the need for a paradigm shift towards intervening earlier in the disease process to prevent irreversible tissue damage.The discussion concludes with the presentation of a clinical scenario describing a patient transitioning from oral antibiotics to a biologic, with Dr Hsiao outlining her suggested approach for such a patient.Tune in to the episode to learn more about the complexities of HS management and gain valuable insights into navigating the clinical landscape effectively.

Jennifer Hsiao, MD

Derms and Conditions Podcast

Comprehensive Management of Hidradenitis Suppurativa: Expert Insights From Dr Jennifer Hsiao

In Episode 34, host James Q. Del Rosso, DO sits down with Joslyn Sciacca Kirby, MD, MEd, MS, to discuss Hidradenitis Suppurativa and the difficulty that they, along with many Dermatologists, face in treating it.

In Episode 34 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with Joslyn Sciacca Kirby, MD, MEd, MS, who is an Associate Professor of Dermatology at Penn State Health. The two discuss Hidradenitis Suppurativa and the difficulty that they, along with many Dermatologists, face in treating it. They begin by pointing out all of the treatment modalities that have historically been used and how some are still effective, while others should be retired, especially when facing severe or refractory disease. Dr.&nbsp;Kirby&nbsp;then shares some of her preferred topical and systemic therapies and how to select the right drug for the right patient. Finally, she relays that there is hope for the future in treating HS, as she personally participates in clinical trials for new monoclonal antibodies that have shown promising results. You don&rsquo;t want to miss this episode filled with pearls on treating one of the most stubborn dermatologic conditions. FINANCIAL DISCLOSURES JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Joslyn R. Sciacca Kirby, MD, MEd SPEAKER AbbVie GRANTS Incyte CONSULTANT AbbVie, Bayer, ChemoCentryx, InflaRx, Janssen, Moonlake, Novartis, UCB

The Story So Far: How One Thoughtful Dermatologist Is UnFOLDing the Challenges of "HS"

Proactive Strategies: Counseling Patients on HS Flare Management 

In this quick-hitting installment of Topical Conversations, Andrea Murina offers a few tips on some first-visit essentials when counseling your patients on managing their flares associated with hidradenitis suppurativa (HS).&nbsp;The patient education conversationShe encourages dermatologists to initiate conversations about managing HS flares at the patient's first visit and advises educating patients on various ways to handle acute flares.&nbsp;She suggests advising patients to use warm compresses and utilize both topical and oral pain relievers to alleviate symptoms. Furthermore, Dr Murina encourages patients to return to the office if necessary, particularly if they require intralesional Kenalog injections or oral antibiotics.&nbsp;A proactive approach to empower patientsTo empower patients and give them a sense of control over their condition, Dr Murina suggests prescribing oral antibiotics for patients to have on hand in case of a flare-up. By proactively addressing flare management strategies, dermatologists can improve outcomes and enhance overall quality of life for patients with HS.

Patient-Centered Care: Exam Tips for HS

In this installment of Topical Conversations, Andrea T. Murina, MD, associate professor and residency program director at Tulane School of Medicine, offers a few quick-hitting tips on making the patient exam a comfortable and low-stress experience for those with hidradenitis suppurativa.&nbsp;Planning ahead to put the patient at ease&nbsp;Dr Murina emphasizes the significance of ensuring patient comfort throughout the examination process. To achieve this, she suggests several strategies. Firstly, providing patients with a gown and instructing them to undress ahead of time can help them feel more at ease in the exam room. Additionally, offering wound care supplies and any other necessary items in advance can further enhance their comfort and offer a convenient experience by anticipating their needs.&nbsp;Prioritizing patient comfort&nbsp;During the examination itself, Dr Murina stresses the importance of being gentle and careful with patients. She underscores the need for sensitivity to their potential pain and discomfort, encouraging practitioners to ask patients about their pain levels throughout the examination. By prioritizing patient comfort and attentiveness during the assessment of HS, dermatologists can create a supportive and reassuring environment that fosters trust and cooperation.

Treatment of Hidradenitis Suppurativa in 2024

Hidradenitis suppurativa is one of the toughest inflammatory conditions dermatologists treat as it impacts social, psychological, and professional aspects of a patient’s life. Andrea Murina, MD, reviewed oral antibiotics, injectable biologics, and procedures and how to combine them for HS. For long-term maintenance, she recommended spironolactone, metformin, and dapsone. Isotretinoin 20 mg to 60 mg daily is well-suited for patients with evidence of comedones or follicular occlusion phenotypes, while acitretin is good for men and postmenopausal women. Useful additions are zinc 90 mg daily or niacinamide 30 mg daily. Short flares should be managed with oral antibiotics, intralesional steroids, and prednisone if needed. Pain management in HS is another important topic for your patients, and there are a variety of treatment modalities to deploy in treatment. Appropriate wound care, NSAIDs, duloxetine, topical lidocaine, abscess drainage, physical therapy, and even opioids for breakthrough pain may be utilized.&nbsp; Procedural treatments should be considered for both focal and widespread disease in good candidates. Focal disease can be treated with deroofing procedures, Nd:YAG laser, or wide excision, while widespread involvement may benefit from targeting selective areas for excisional surgery in combination with a biologic. Established biologics include adalimumab and secukinumab, which are both FDA approved for HS, and infliximab off-label at 7.5 mg/10 mg per kg every 4 weeks. In 2 RCTs, over 40% of patients on secukinumab achieved at least a 50% reduction in total inflammatory and abscess count by week 16, and over 75% of these patients maintained their response until week 52. However, a few new biologics are on the way including bimekizumab, an IL-17 inhibitor, spesolimab, an IL-36 inhibitor, and various JAK inhibitors. Bimekizumab demonstrated remarkable efficacy with over 50% of patients achieving HiSCR response at week 16 in BE HEARD II at both 2- and 4-week dosing intervals. Draining tunnels improved at week 12 in patients treated with speoslimab, though significant differences were not seen in abscess and inflammatory nodule count. Dr Murina ended her talk with a warning that rising temperatures may increase HS flares.&nbsp;

A Clinician's Guide to Managing Hidradenitis Suppurativa

What's New and Hot in HS

Hidradenitis suppurativa is a life-altering diagnosis that impacts all aspects of a patient’s life from professional to psychosocial. In this presentation delivered by Joslyn Kirby, MD, the acting president of the Hidradenitis Suppurativa Foundation, emerging therapies that may change the landscape of this difficult-to-treat disease were covered along with clinical practice tips to assess treatment response. She recommended seeing patients every 4 to 6 months to assess for migratory lesions, which may indicate the need to switch treatment regimens, or persistent lesions, an indicator that procedures might be the next step. Beyond adalimumab and infliximab, secukinumab, an IL-17A inhibitor, 300 mg weekly for 5 weeks followed by a bimonthly dosing regimen, achieved 50% reduction in inflammatory lesion count by 16 weeks. Bimekizumab, which has high affinity for both IL-17A and IL-17F, also has demonstrated promising results. JAK inhibitors are another encouraging treatment path for this disease, though we still await results of ongoing clinical trials. &nbsp;Besides new biologic medications, other innovations in the field of HS include smartphone photos to harness artificial intelligence to aid in the diagnosis HS. Given the plethora of antimicrobials sometimes erroneously recommended to these patients, this technology could be useful for medical providers. Early prototypes detected moderate to severe HS with 79% sensitivity and 77% specificity. Dr Kirby also detailed up-to-date bench research on the genetics involved in HS, which may provide insight into its complex pathogenesis and potential therapeutic targets. Some things to be on the lookout for are the use of topical ruxolitinib cream and topical aryl hydrocarbon modulators for more mild disease, both of which are currently undergoing trials. &nbsp;

Using Surgical and Medical Techniques to Manage Your Hidradenitis Suppurativa Patients

Hi, I'm Dr. Jennifer Shao, associate clinical professor at the University of Southern California, where I direct a hydrogenitis supertiva clinic. And the topic I covered during this conference was also on HS. As we all know, this is an area with a high emitt need for our patients. So I started by talking about factors to consider when trying to select the best therapeutic options for our patients, including things like what are their comorbidities, what type of HS lesions they have. I also talk about procedural oral therapies for HS, including deroofing that can be done in an outpatient setting under local anesthesia. And then I cover medical management for HS, which ranges from topical therapies to systemic antibiotics, hormonal therapies, metabolic therapies, and, of course, biologic agents, which have really revolutionized the way that we treat HS in the past decade. It's an exciting time for HS. There are multiple agents in the pipeline, and really exciting news is that IL 17 inhibitors Socica, Kinamab and bimakizumab recently achieved their phase three successful results for HS. Hopefully, this means we'll be able to give these medications to our patients really soon. I hope that the future is bright for HS, and there's hope on the horizon and that these patients will suffer less in the future because of our care. Thanks.

Hidradenitis suppurativa (HS) can be very debilitating for patients and difficult for providers to effectively treat. In this session, Jennifer Hsiao, MD discussed both medical and surgical techniques to manage this disease. She began by reviewing the Hurley staging system, common HS comorbidities, and key considerations when deciding how to approach treatment. She reiterates that optimal management of HS involves a multifaceted approach, which includes managing friction/irritation, metabolic dysfunction, hormones, dysbiosis, follicular occlusion, and immune dysregulation.Next, Dr. Hsiao focused on specific treatments for mild HS. She highlighted the importance of lifestyle modifications such as smoking cessation, weight loss, and avoidance of tight-fitting clothes. For topical treatments, she recommended clindamycin 1% gel or lotion and resorcinol 15% ointment. For increased efficacy, she suggested combining these with antiseptic washes such as chlorhexidine or benzoyl peroxide washes. Dr. Hsiao then discussed several systemic medications for mild HS, including oral doxycycline or minocycline 100 mg twice daily for 8-12 weeks, oral dapsone 50 to 100 mg daily, and oral clindamycin 300 mg twice daily with rifampin 300 mg twice daily for 12 weeks.For moderate-to-severe HS, Dr. Hsiao shared that she likes to use biologics, especially adalimumab which is FDA approved for HS, and infliximab and secukinumab which are not yet approved for HS. In the clinical trial for adalimumab, at week 12 up to 58.9% of patients on weekly adalimumab achieved HiSCR, defined as at least a 50% reduction in inflammatory lesion count (abscesses + inflammatory nodules) and no increase in abscesses or draining fistulas when compared with baseline, compared to 27.6% on placebo. Two phase 3 clinical trials for secukinumab are underway, and so far, more patients have achieved HiSCR at week 16 than placebo.Dr. Hsiao concludes the session with procedural management of HS. Her recommendations included intralesional triamcinolone 10 mg/mL – 40 mg/mL, incision and drainage for acute relief of abscesses, botulinum toxin injections, laser therapy, and deroofing or wide local excision. She also teases a few emerging medical therapies for HS, including anti-IL-1, anti-IL-36, and kinase inhibitors.

Can you expand on the off-label use of IL-17, IL-12, and IL-23 inhibitors for HS?

You. So HS is a very hard disease to treat. While we do have an FDA approved biologic for HS, not all patients respond to Humira, the FDA approved biologic for HS. I have used sort of other biologics off label in my practice for HS. Certainly aisle 17 blockage does seem to be promising, and cosentics does have a clinical trial looking at its efficacy in HS, and they are awaiting on FDA approval, which could take some time. So clearly, we do know that IL 17 blockage can play a role in HS. So that's one thing. As far as IL 1223 blockage goes, they did do a sort of open label clinical trial with a eusticinamab for HS, and it did show some trend towards improvement. But then again, it was a small study with just 17 patients, so it's kind of hard to sort of draw inferences on a wider scale. But certainly, if you do have a patient that hasn't responded to an anti tnF, considering biologics that have other mechanisms of action seems worthwhile. Lastly, as far as IL 23 blockage goes, the selkimab is being investigated in a clinical trial with HS patients. So let's see what pans out of that study. But it's too early to tell.

What biologic medication (other than Humira) has worked best in your experience for your moderate to severe HS?

So I was very excited when Humira got approval for moderate to severe HS. But there are some patients who do not respond to humira in my practice. What I switch them to is remicade or infleximab, and that seems to work, at least for the humira failure patients. And the advantage of remicade or infleximab is that it is a weight based dosing. There is sort of like a sliding scale of anything from five milligrams per kg to ten milligrams per kg. So that gives me a lot of leeway for increasing the dose. The second way of sort of increasing the dose of remicade is by increasing the frequency. So it's a loading dose of week zero, two, six and every eight weeks thereafter. But depending on lack of response or the kind of response an HS patient has, I can make the dose more frequent. So certainly in my experience, Humira failures, when I switch them to infleximab or remicade, they do show a positive response on.

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