Hidradenitis suppurativa (HS) continues to enjoy a tremendous renaissance in research, innovation, and clinical care. Research presented at the recent American Academy of Dermatology meeting confirmed several very important trends. First, the continued refinement of the epidemiology of this disease suggests that it is substantially more common than previously reported, affecting as much as 1% of the population. That said, HS remains a highly hidden disease with a substantial delay in diagnosis for many patients. This delay distressingly results in patients missing the window of opportunity, during which disfiguring scarring can be prevented, and patients appear to be more responsive to treatment.
Fortunately, as we try to reach these patients earlier, there has been a wave of research on both currently available and novel therapies that continue to be improved and include better antibiotic regimens, hormonal approaches, and surgical modalities. The success of biologics and immunomodulatory small molecules confirms the underlying inflammatory nature of the disease, which we also see manifest in high signals of systemic inflammation like sedimentation rates and C-reactive protein levels. The challenge in finding the correct regimens will be getting adequate delivery without substantially disrupting the risk-benefit ratio since the recalcitrance of this disease tends to require high doses of known therapies.
Several recent papers discuss the loss of response over time with Tumour necrosis factor-alpha inhibitors and the presence of antibodies, which may contribute to declining drug levels. This further research may give us some clues on how to maximize therapy or assess for potential responsiveness to therapy over time. Important continued research was also presented on the comorbidities associated with HS, which include cardiovascular disease. , New guidelines have been published with recommendations on screening in the Journal of the American Academy of Dermatology and are worth a review to keep current in this regard. We have also published a visit guide to help clinicians manage all of the potential screenings: they don’t have to all be done at once by the dermatologist. Research is also demonstrating the impact of this disease on patients’ lives: medical resource utilization is high and expensive and is characterized by flares, emergency department episodes, and substantial impact on multiple dimensions of life experience., Other posters presented at the meeting discussed the impact on intimacy, which I expect will be a continued area of research.
Diet and flare triggers continue to be important, and presentations on diet reinforced the potential role of dairy and high glycemic foods. A smoothie, often looked at as a healthy choice, is perhaps a terrible one for HS patients, given that dairy, sugars, and androgenic whey proteins are often included.
In sum, there was much to learn — and as I often say to patients: although we don’t have all the answers for this debilitating disease, this is a great time to be engaging in medical care. There is a lot of progress that has already been made — and a lot more to come.