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    HS treatment requires multipronged approach

    The estimated pervasiveness of hidradenitis suppurativa (HS) in the United States ranges from a low of 0.006% to a high of 4.1% in the general population.

    This compares to a prevalence of 2.2% for psoriasis in the United States.

    Adam Friedman, MDDr. Friedman“This is an extremely common condition, but a condition that is identified late,” says Adam Friedman, M.D., an associate professor of dermatology at George Washington School of Medicine and Health Sciences in Washington, D.C. “The reality, though, is that we do not know the actual prevalence. The range is extraordinary.”

    Dr. Friedman, who gave a presentation on HS at the Orlando Dermatology Aesthetic & Clinical Conference (ODAC) in Miami in January, says patients are affected physically with pain, discomfort, ongoing dysfunction and even permanent scarring.

    But the impact may be even greater from a psychosocial perspective. “There is the potential social ostracism, not to mention the mental impact of having a chronic inflammatory disease” says Dr. Friedman, in a post-presentation interview with Dermatology Times.

    As with psoriasis and eczema, HS is a systemic disease.

    “HS is not infection,” Dr. Friedman notes. “It is a mix of inappropriate immune stimulation.” 

    Likewise, analogous inflammatory cascades, as seen with acne, cause the HS lesions in the groin, under the breasts, in the buttocks and in the armpits.

    Recent studies show that patients with HS are at much higher risk for multiple medical problems, including diabetes and peripheral vascular disease (PVD).

    “This list is similar to what we find with psoriasis,” Dr. Friedman says.

    Factors that worsen HS, and may negate the effects of treatment, are drugs (lithium, androgenic medications), smoking, stress, friction (rubbing, squeezing, pinching) and obesity.

    However, HS is not an easy disease to diagnose.

    “Based on the data, the condition is first identified among patients in their late 20s or early 30s,” Dr. Friedman reports.Skin phototype V female with ulcerated plaques, sinus tracts, and scarring. Photo: Adam Friedman, M.D.

    But HS usually manifests much earlier in life. For instance, in the beginning, it can look like an ingrown hair, a boil, skin acne or infection.

    “Patients usually do not see a dermatologist,” Dr. Friedman says.

    Instead, patients are treated by emergency medicine, where HS is managed like an infection.

    “The infection is cut open, which is the worst thing you can do because that injury will create more inflammation and scarring,” Dr. Friedman explains.

    Short-term medication is also not a solution, as HS is a condition that needs to be monitored long term.

    “By the time these patients visit a dermatologist, a lot of damage has already occurred,” Dr. Friedman says.

    NEXT: Treatment recommendations

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