Algorithm provides quicker diagnosis of hidradenitis suppurativa
Panama City, Panama — Hidradenitis suppurativa (HS) is a challenging disease to treat; however, a better understanding of the disease and continued research has led to more clear-cut therapeutic options, according to an expert who spoke at the North American Clinical Dermatologic Society meeting.
Characterized by the development of recurrent chronic painful nodules and abscesses, HS lesions can often progress to dermal contractures, induration and fibrotic scarring, adding to the misery of this unfortunate patient population. Lesions typically occur on apocrine gland bearing skin such as in the axilla, groin, perianal, buttocks and inframammary areas but can also occur in other regions such as the ears and malar face.
While the Sartorius score is a dynamic score more suitable for clinical trials in HS patients much in the same way that the Psoriasis Area Severity Index (PASI) score is used for psoriasis, the Hurley staging system is readily used to help classify the clinical severity of the disease. Approximately 75 percent of affected patients will have stage 1 disease, typically characterized by single or multiple abscesses without sinus tracts or scarring, followed by 24 percent with stage 2 with single or multiple widely separated abscesses as well as scarring and/or tract formation. Fortunately, stage 3 disease is seen in only 1 percent of patients, who typically have diffuse or near diffuse involvement or multiple interconnected sinus tracts and abscesses across an entire affected region.
Recent research has led to the development of a simple diagnostic algorithm with key features focused on location, recurrence and chronicity of the disease, in order to help clinicians arrive at the definitive diagnosis and further, allowing them to implement more targeted therapies in a timely manner (Alikahn A, Lynch PJ, Eisen DB. J Am Acad Dermatol. 2009;60(4):539-561).
“Unfortunately, the diagnosis is not always straightforward given the incidence of staph and MRSA (methicillin-resistant Staphylococcus aureus) infections seen today. However, the diagnostic algorithm put forward by the Alikahn group has significantly helped us in more accurately diagnosing HS,” says Catherine Ramsay, M.D., Permanente Medical Group, Oakland, Calif. “It is important to rule out Crohn’s disease if patients have any GI (gastrointestinal) symptoms and when in doubt, I will often perform a culture to rule out infection and to help confirm the diagnosis.”