Andrea Murina, MD, on Optimizing Your Therapy for Patients With Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) carries a huge patient burden of pain and swelling that affect day-to-day life, but clinicians can optimize their therapeutic approach in order to encourage positive patient outcomes.

Andrea Murina, MD, associate professor of dermatology and Program Director at Tulane University School of Medicine in New Orleans, Louisiana, delivered a talk at Winter Clinical Miami, held February 17-20, 2023, in Miami, Florida, that presented a few patient cases with tips on how to best optimize therapy for HS.¹

For early HS, Murina reviewed the options such as topical and oral antibiotics, spironolactone, metformin, and retinoids. She pointed data that show zinc and niacinamide as maintenance without the need for oral antibiotics may be beneficial.

Some procedural interventions for early HS include intralesional triamcinolone, excision, or laser hair removal. Smoking cessation and weigh loss are also commonly recommended for patients with HS.

For late-stage HS, oral immunosuppressants, oral or intravenous antibiotics, excision or deroofing procedures, or laser treatment are recommended.

Clinicians should keep in mind the following combinations for optimal outcomes:

• Single lesions: Deroofing, excision, or intralesional triamcinolone
• Multiple locations: Biologics, Janus kinase inhibitor, or spironolactone
• Menstrual flare: oral contraceptive pills, spironolactone, or finasteride
• Prominent scarring/tunnels: Surgery, deroofing, infliximab
• Uncontrolled pain: Biologics (infliximab), steroids, selective serotonin reuptake inhibitors, or gabapentin
• Follicular occlusion: Retinoids or early intervention with biologics

Murina spoke with Dermatology Times® to offer some more details from her presentation.

This transcript has been edited for clarity and length.

Dermatology Times: Can you first discuss the burden of HS for patients?

Murina: HS causes patients to have abscesses and nodules in their axilla and in their inguinal folds and often in the inframammary area. What that does to patients is it causes a significant amount of pain and swelling in their day-to-day life.

Dermatology Times: Can you provide an overview of the current treatment landscape for HS?

Murina: For early-stage disease, we generally use topical antibiotics like clindamycin. Some patients need oral antibiotics for flares. Then for later stage disease, we may use an FDA-approved medicine called [adalimumab] for the treatment of the abscesses and nodules.

We often start thinking about surgical solutions earlier; there are a couple of different procedures—there's wide excision and there's deroofing procedures that we often integrate into the patient's medical treatment.

One of the other things that's really interesting is that there was a recent study on zinc and niacinamide for the treatment of patients with mild to moderate HS. It actually was a good way to reduce flares in those patients. I've definitely been integrating that more with my patients. The other thing that's interesting for the more severe side is that we really should be pushing a high dose of infliximab or even possibly a high dose of ustekinumab for our most severe HS patients based on recent studies.

Dermatology Times: What agents are in development as far as treatment for HS?

Murina: We have some very promising oral agents and injectable biologics in the pipeline, which will be really exciting for our patients who are struggling with this disease.

Dermatology Times: What do you want your colleagues to know most about treating HS?

Murina: The most compelling reason to treat HS is we have a lot of patients in need of good treatments, and they really need our dermatologic expertise. I think there's a lot of misinformation out there and I think it's our job as board-certified dermatologists to get them on the correct treatment.

Reference:

Murina A. Optimizing your HS therapy. Presented at Winter Clinical Miami 2023; February 17-20, 2023; Miami, FL.