Disease Severity and the Role of Progression in Hidradenitis Suppurativa

EP: 1.Hidradenitis Suppurativa: Practical Tips and Considerations Regarding Diagnosis, Treatment, and Patient Communication

EP: 2.Hidradenitis Suppurativa: Overview, Patient Burden, and Challenges to Diagnosis

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EP: 3.Disease Severity and the Role of Progression in Hidradenitis Suppurativa

EP: 4.Treatment Guidelines and the Role of Biologics in the Treatment of Hidradenitis Suppurativa

EP: 5.Navigating Hidradenitis Suppurativa Chronicles

Hi, and welcome to this Dermatology Times Partner Perspectives video series. I’m Tiffany Mayo, associate professor, vice chair of diversity and inclusion, and director of the clinical research unit at the Heersink School of Medicine department of dermatology at the University of Alabama at Birmingham. In the first video, we discussed the clinical features, patient burden, and challenges of diagnosis of hidradenitis suppurativa, or HS. In this second video, I will discuss the characteristics of disease progression, which can vary considerably among patients and therefore lead to difficulty in assessing severity, or stage of disease.

This episode is sponsored by Novartis, and I have been compensated for my time.

On average, disease onset occurs at approximately 20 years of age. If untreated, HS can progress from localized lesions to diffuse, interconnected abscesses that can ultimately result in keloids, contractures, and immobility.^1,2

The stages of progression are categorized as mild, moderate, and severe.^1,3 The extent of lesions in each area and the degree of duration of pain contribute to definition of disease severity.^1,2

The mild stage can involve isolated, painful, deep-seated nodules that may evolve to single or multiple⁴ abscesses without sinus tracts or scarring. Periods of remission may last several months, and the clinical aspects of the skin may be normal. Misdiagnosis is common at this stage.^1,2

In the moderate stage, patients may experience recurrent abscesses and widely separated lesions that are either restricted to a single region of the body or expanded to multiple areas. At this point, there may be sinus tract formation and scarring.^1,2,5

The severe stage is characterized by diffuse lesions in the affected region, as well as multiple interconnected tracts, abscesses, and scarring. Suppuration is present, and the inflamed nodules may rupture and discharge fluid. Patients experience ongoing pain and discomfort at this stage.^1,5

I’d like to note here that the clinical presentation may not always accurately represent disease severity. Ultrasound and more powerful imaging, such as MRI, can be important in detecting subclinical disease and more accurately determine severity.⁶ Clinicians should also use outcome measures reported by patients, such as pain or quality-of-life scales, and those reported by clinicians, such as the DLQI score or pain visual analog scale. In specific, the Hidradenitis Suppurativa Impact Assessment and Hidradenitis Suppurativa Symptom Assessment are geared toward patients with HS, and results may provide valuable insight for staging.⁵

This brings me to the end of my review on HS disease progression and staging. Next, I will discuss HS treatment guidelines and the role of biologics in HS treatment. Thank you to our viewers for watching.

References

1. Kimball AB, Jemec GBE, eds. Hidradenitis Suppurativa: A Disease Primer. Adis; 2017.

2. Poli F et al. Clinical presentation. In: Jemec GBE et al, eds. Hidradenitis Suppurativa. Springer; 2006:11-24.

3. Jemec GBE. N Engl J Med. 2012;366(2):158-164.

4. Marzano AV et al. Br J Dermatol. 2021;184(1):133-140.

5. Alikhan A et al. J Am Acad Dermatol. 2019;81(1):76-90.

6. Mendes-Bastos P et al. Br J Dermatol. 2023;188(5):591-600.