Creating the virtual HS multispecialty clinic

Hidradenitis suppurativa (HS) patients need multispecialty care. One expert explains how dermatologists can develop virtual multispecialty clinics to better address HS patients’ complex needs, while managing the often debilitating skin condition.

Iltefat H. Hamzavi, M.D., a dermatologist at Hamzavi Dermatology in Fort Gratiot, Mich., and president of the Hidradenitis Suppurativa Foundation, presented on hidradenitis suppurativa care during the March 2017 American Academy of Dermatology (AAD) annual meeting in Orlando, Fla.

There are many physicians, in addition to dermatologists, who need to address the physical manifestations of the disease and should be part of an HS multidisciplinary team. These include: plastic surgeons, reconstructive urologists, gynecologists, infectious disease doctors and colorectal surgeons.

“If you have those five, that’s a building block. You really also have to have two other elements, which is a patient support group, if you’re going to do complex hidradenitis suppurativa, as well as mental health resources,” says Dr. Hamzavi, a senior staff physician at Henry Ford Health System.

HS, he says, is a difficult disease, and people build coping skills to manage it. What that means for dermatologists, who are often at the center of these patients’ care, is lengthy dermatology visits that go beyond addressing acute dermatologic needs. That’s unless dermatologists are prepared to refer HS patients to the appropriate mental health resources. 

“The mental health component is something you should never avoid. But you also have to manage that patient within a reasonable amount of time,” Dr. Hamzavi says. “At the Hidradenitis Suppurative Foundation, we’re affiliated with Hope for HS, which has its own Facebook page, which offers live broadcasts of HS meetings, and a handbook about how to create a support group. Those support groups are virtual, and they really help people ask a lot of questions.”

HS keeps dermatologists busy

Dr. Hamzavi, who runs one of the oldest and largest HS clinics in the U.S., says dermatologists who decide to focus on HS patients will be busy, quickly.

“It’s much more common than we thought it was,” he says.

All stages of the disease considered, HS/Acne Inversa (AI) affects from 1% to 4% of the population, which translates to millions of people living with HS/AI, according to the Foundation’s website.

People with the condition might not seek care because having HS is embarrassing, and many others have been treated to no avail, so they give up, according to Dr. Hamzavi.

By the time they visit a dermatologist well versed in HS treatment, patients might release years’ of mental health turmoil.

“…your visit goes from a two-minute visit to an hour visit. Now the dermatologist is stressed, and the patient is stressed because [he or she has] spoken to someone who is not very good at mental health issues. And you both would have been served well if you had a mental health person,” Dr. Hamzavi says.

Team building

Dermatologists who want to build multispecialty HS teams should call the specialists needed and ask them if they’re interested in the referrals.

“Often they are. But they might have been treating HS inadequately or inappropriately,” he says.

So, the next step is to educate. Among the resources are the available treatment recommendations on the Hidradenitis Suppurativa Foundation website. The Foundation will soon release official HS guidelines, according to Dr. Hamzavi. 

“If you make that phone call to these specialists, and every town has these people, you’ll realize that they’re often struggling with the same patient population,” Dr. Hamzavi says. 

Disclosure: None