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    Hidradenitis Suppurativa therapy options progressing

    Early recognition and treatment can prevent disease progression, improve prognosis

     

    Inflammatory process

    The disease is often misdiagnosed as infectious boils, Dr. Hazen says, which unfortunately may delay the implementation of appropriate therapy. The conventional wisdom as of late dictates that inflammation, rather than infection, is one of the central driving factors behind the disease; therefore, targeted therapies that can help control the progressive inflammatory process are key in the improvement of symptoms. Nevertheless, a very thorough medical review of systems must be undertaken in each patient, Dr. Hazen says, in order to rule out and/or elucidate the potential precipitating factors of the disease.

    Understanding the influencing factors for each person with HS is important in selecting therapies. Metabolic syndromes including insulin-resistant diabetes, hyperandrogenism and hyperinflammatory conditions like arthritis, psoriasis or inflammatory bowel disease may be present and influence therapy choices.

    READ: Algorithm provides quicker diagnosis of hidradenitis suppurativa

    “Checking for hormonal abnormalities is one part of evaluating patients with HS. If someone were to be endocrinologically abnormal, that might be one of the places where we could consider treatment,” Dr. Hazen explains. At baseline, Dr. Hazen will regularly check the patient’s androgen status in the preliminary work-up and evaluation.

    Patients with HS may also have other features of the metabolic syndrome including abdominal obesity, hypertension, insulin-resistance/hyperinsulinism, elevated fasting blood glucose, or high serum triglycerides and low high-density cholesterol levels. A complete blood count and liver function evaluation are also usually evaluated at baseline. 

    Therapies focus either on medical or surgical solutions. Therapy for the acute lesion is often directed at immediate relief of pain. Intralesional steroids, other anti-inflammatory therapies, and occasionally incision and drainage may all be helpful. 

    NEXT: Medical management

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