Dermatology Weekly

Hidradenitis suppurativa literature has expanded in the last few years, but there is still a delay in diagnosis for most patients due to a lack of familiarity with the condition. Dr. Vincent DeLeo talks with Dr. Alexandra P. Charrow about treatment recommendations based on disease severity and for patient lifestyle modifications.

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We bring you the latest in dermatology news and research:

1. Certolizumab safety profile varies widely across indications
   Systemic corticosteroid use and body mass index affect the risk of serious adverse events with certolizumab.
2. Naturopaths emphasize role of diet in atopic dermatitis
   Allopathic and naturopathic providers diverge in opinions on the role of diet in cause and treatment of AD.

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Things you will learn in this episode:

• Many patients with hidradenitis suppurativa present to the ED because they have a severe flare. “We find that patients have a very long lag time from when they come in to all these different specialists and to the emergency department and the time in which they’re given a definitive diagnosis,” according to Dr. Charrow.
• Monitor for severe infection. “Hidradenitis is a complicated condition because it is a chronic inflammatory condition, and for that reason, patients will often have labs that mimic an infection,” said Dr. Charrow.
• The Hurley staging system, used in both surgical and clinical settings, can be used for HS and is divided into three disease stages: stage I is isolated nodules or isolated abscesses; stage II is wide areas separated by sinus tracts or scarring; and stage III includes multiple lesions with near-diffuse involvement and formation of sinus tracts and scarring.
• Recommend lifestyle modifications, such as taking medications for smoking cessation that are not nicotine replacements, as these could aggravate disease; avoiding hair removal strategies that cause regrowth and the possibility of developing ingrown hairs; and avoiding progestin-only and first-generation oral contraceptives.
• Use a short course of antibiotics to control flares for Hurley stage I disease. A longer course of an antibiotic, such as tetracycline for 3-6 months, can be used to prevent further flaring.
• Consider a combination of spironolactone and tetracycline for Hurley stage II. Depending on whether these medications work, adalimumab also can be considered for stage II.
• Medications for Hurley stages I and II can be used for stage III, but if these are ineffective, providing care could be “tough” because the clinician might need to negotiate with insurance companies for other medications such as infliximab. “There’s only one medication that has been FDA approved for hidradenitis and that’s Humira, and only 50% of the patients in the pioneer trial demonstrated significant improvement, which means that there’s half of patients who have no FDA-approved treatment for their disease,” Dr. Charrow noted. “We are reaching for things for which there is no FDA approval but for which there is some pretty good evidence.”
• Consult a table of treatment considerations for HS based on severity, which is available online.
• Ensure that patients with HS feel safe and have an emotional outlet during the visit because they can have a high psychiatric and psychological comorbidity profile. “The disease can be exceptionally isolating. Many patients find they can’t work, they can’t live normal lives . . . It’s helpful to be mindful of just how stigmatizing this condition can be,” Dr. Charrow advised.

Hosts: Elizabeth Mechcatie, Terry Rudd

Guests: Alexandra P. Charrow, MD, MBE (Brigham and Women’s Hospital, Boston)

Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie

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