The window of opportunity for early intervention can be critical4,5
Early intervention with systemic treatment can help control inflammatory activity and avoid a destructive disease course.4,6-8 The window of opportunity for intervention with targeted treatment occurs prior to the development of tunnels and fibrotic scarring.4-6
Early treatment*
may improve
outcomes4,5,8
Reversible lesions: inflammatory nodules and abscesses5,9
Delayed treatment*
permanent tissue
destruction3,4
Irreversible lesions: tunnels and scarring3,6
*The images above serve as a depiction of early vs delayed treatment of HS and do not represent actual results.
The current standard of care
Treatment and management of hidradenitis suppurativa requires a multidisciplinary and individualized approach. While there are no curative treatments, pharmacological approaches and other interventions could help.1,10-12
Multidisciplinary care
While dermatology providers have a key role in treating HS, they may need to partner with other providers and specialists to deliver comprehensive care as part of a patient's ongoing treatment10
Current treatments
Today's treatment options encompass several approaches, including lifestyle modifications, topicals, and surgery. Treatments should be individualized according to a patient's needs1,11
Roles within a multidisciplinary care team
A multidisciplinary care team is essential throughout a patient's journey. Management strategies should be coordinated by an HS-treating dermatology provider, but a full team can be comprised of numerous specialties depending on a patient's specific needs.10
See how different specialties can play a role.
Click each to learn more.
Not actual healthcare providers
Additional providers
Additional care may be implemented by other healthcare providers, such as urologists and endocrinologists, among others.10 There are also HS support groups that can help patients and their loved ones navigate the condition. You can find some HS support groups here.
HS is an immune-mediated disease involving both innate and adaptive immune systems3,15,16
Key cytokines involved include IL-17, TNF-α, IL-1β, IL-23, IL-12, and others. Genetic and environmental factors trigger perifollicular inflammation and lymphocyte infiltration.3,16
Figure adapted from Saunte and Jemec 2017; Vossen 2018; Goldburg 2020; Fletcher 2020; and Sabat et al 2020.
Figure adapted from Saunte and Jemec 2017; Vossen 2018; Goldburg 2020; Fletcher 2020; and Sabat et al 2020.
(1) Genetic and environmental factors trigger perifollicular inflammation and lymphocyte infiltration.16-18
(2) Follicular hyperkeratosis results in occlusion, which perpetuates the inflammatory response.3,15-17,19
(3) The dilated follicle ruptures and manifests as an inflammatory lesion.3,16,17
(4) A chronic inflammatory state results in the formation of tunnels and fibrotic scarring.3,15-17,20
IFN-γ, interferon gamma; IL, interleukin; TFG-β, transforming growth factor beta; TNF-α, tumor necrosis factor alpha.
Hidradenitis suppurativa treatment options
HS is a systemic condition requiring prompt action to help limit disease progression.
Mild cases can often be managed by topical treatments and lifestyle adjustments. Moderate or severe cases may require more. Consider treatment strategies based on the individual.3
-
Topical or intralesional therapies
Topical treatment of HS includes skin cleansers, keratolytic agents, and a topical antibiotic.
These options may work for some patients, depending on disease severity.11 -
Hormonal therapy
Androgens are believed to influence HS, as evidenced by the effects of pregnancy and menstrual cycles
for many patients. However, recommendations are based on limited evidence.11 -
Immunomodulators (biologics)
Immunomodulation is rapidly becoming the mainstay of therapy for patients with moderate to
severe HS.11 -
Pain management
Pain is a prominent feature of HS, and if lifestyle changes or certain medications are not
effective, a pain management referral can help. However, pain is not the only symptom related
to HS and patients may need further evaluation from a holistic care team.1 -
Retinoids
Historically, retinoids were frequently used for HS, but results have been limited. Systemic
retinoids should be prescribed by those familiar with side effects and monitoring parameters.11 -
Systemic antibiotics
Systemic antibiotics have been a cornerstone of HS treatment for years. Monotherapy is possible
for mild HS, but in advanced states, antibiotics may not be as effective for some patients.11
-
Deroofing
This is a technique in which abscesses and associated sinuses are probed, and the skin
overlying the sinus or abscess cavity is removed stepwise, with the base left untreated.1 -
Incision and drainage
Incision and drainage have been associated with recurrence rates approaching 100%.
However, these procedures can provide some acute relief when other methods do not.1 -
Wound care
Recommendations for postsurgical and nonsurgical HS wound care are based on limited
evidence, may be costly, and could be complex based on the severity of a patient's condition.1 -
Wide local excision
Wide local excision may result in positive outcomes where the excision was performed,
although excision may typically be limited to a superficial subcutaneous plane.1
-
Hair removal
In HS, changes can occur in areas of the body where skin surfaces touch or rub together,
resulting in follicular plugging and stasis. Hair removal may be appropriate for some patients.13,21 -
Lifestyle modifications
HS is associated with numerous comorbidities. Smoking cessation and weight loss
counseling should be considered, among other lifestyle modifications. Treatment requires
an individualized approach.1
HS treatment approaches are not limited only to those listed.
Supporting patients and their families throughout treatment
A large part of a patient's HS journey is spent at home and immediate family members often serve as caregivers. Helping patients and their families feel supported outside a care facility is an important aspect of disease management.22
Educate about the systemic nature of HS and help patients understand it is not their fault3,23
Build trust with meaningful and empathetic conversations during each appointment10
Consider the impact on caregivers when developing a patient's treatment plan22
Assure patients they are not alone and provide information about HS support groups and other resources10
Help shine a light on HS
by
sharing
on social
media today
Hear from your peers about managing and treating HS
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The healthcare providers featured in these videos were compensated for their time. These videos represent their opinions and do not represent the opinions of Novartis.
Illuminate the facts about hidradenitis suppurativa
The following questions can serve as helpful reminders about HS. Swipe or click on the correct answers.
HS can be effectively cured with current treatment modalities.12
True
SO CLOSE. Keep going
False
CORRECT. Keep it up
Which of the following are HS treatment options?1,11
Topical corticosteroids and angiotensin-converting enzyme inhibitors
SO CLOSE. Keep going
Immunosuppressants and dietary supplements
SO CLOSE. Keep going
Systemic antibiotics, deroofing, and immunomodulator therapy
CORRECT. Keep it up
What percentage of people may exhibit moderate or severe HS when first diagnosed?24
Over 70%
CORRECT. Keep it up
Over 50%
SO CLOSE. Keep going
Less than 10% because HS is rare
SO CLOSE. Keep going
SO CLOSE
You answered out of questions correctly.
Try again or learn more to help bring HS out of the shadows.
What would you like to explore next?
GOOD JOB
You answered out of questions correctly.
What would you like to explore next?
Make a referral and find an HS-treating
dermatology provider using the care locator
See helpful resources for you
and your patients
References: 1. Alikhan A et al. J Am Acad Dermatol. 2019;81(1):76-90. 2. Phan K et al. Ann Transl Med. 2020;8(13):821. 3. Sabat R et al. Nat Rev Dis Primers. 2020;6(1):18. 4. Shih T et al. Am J Clin Dermatol. 2022;23(6):749-753. 5. Martorell A et al. Actas Dermosifiliogr. 2016;107(suppl 2):32-42. 6. Martorell A et al. Dermatol Surg. 2019;45(1):1237-1244. 7. Tricario PM et al. Sci Rep. 2022;12(1):8415. 8. Paek SY et al. J Am Acad Dermatol. 2017;76(4):772-773. 9. Margesson LJ et al. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1013-1027. 10. Collier EK et al. Int J Dermatol. 2020;59(6):744-747. 11. Alikhan A et al. J Am Acad Dermatol. 2019;81(1):91-101. 12. Deckers IE et al. Curr Derm Rep. 2014;3(1):54-60. 13. Kimball AB et al, eds. Hidradenitis Suppurativa: A Disease Primer. Adis; 2017. 14. Kokolakis G et al. Dermatology. 2020;236(5):421-430. 15. Vossen ARJV et al. Front Immunol. 2018;9:2965. 16. Fletcher JM et al. Clin Exper Immunol. 2020;201(2):121-134. 17. Wolk K et al. Br J Dermatol. 2020;183(6):999-1010. 18. Saunte DML et al. JAMA. 2017;318(20):2019-2032. 19. Goldburg SR et al. J Am Acad Dermatol. 2020;82(5):1045-1058. 20. Navrazhina K et al. J Allergy Clin Dermatol. 2021;147(6):2213. 21. Koch D et al. Lasers Med Sci. 2013;30(1):453-467. 22. Basra MK et al. Br J Dermatol. 2007;156(5):929-937. 23. Ather S et al. Int Wound J. 2006;3(3):159-169. 24. Ingram JR et al. J Eur Acad Dermatol Venereol. 2022;36(9):1597-1605.
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