Exploring Diet and New Treatments for Hidradenitis Suppurativa

Following her presentations on hidradenitis suppurativa at the 2024 Elevate-Derm West Conference in Scottsdale, Arizona, Jennifer Hsiao, MD, shared pearls on the topic with Dermatology Times. The presentations, titled, “Diet in HS” and “HS: Unroofing the Possibilities” focused on how to best treat patients with HS, how diet can affect disease, and the latest and greatest in therapeutic options.

TRANSCRIPT
Hsiao: Hi, I'm Jenny Hsiao. I'm an associate professor of dermatology at the University of Southern California, where I direct clinical trials, and I also have an HS clinic. I was really excited to be able to give sessions yesterday on HS and diet and also just an update on HS in general.

Dermatology Times: What topics did you cover during your sessions at Elevate-Derm West 2024?

Hsiao: Some key points from the diet lecture are just to remember at this point the data for diet and HS, it's not super robust, but it does point towards a Mediterranean diet as being helpful for our patients with HS. Thinking about foods like leafy greens, like foods that have a lower glycemic index. Moving away from high carb, high processed foods can be helpful, but just also remembering you're partnering with someone, a patient who has to deal with diet every single day. So not setting impossible goals, I think is really important. I say try to limit consumption of high glycemic index foods, but if it's your birthday and you're going to have some cake, that's okay. I feel like another really important point to emphasize with diet and HS is dietary changes can be helpful, but for many of our patients, they still need more. That's where our therapeutic options come into play. Moving into the second talk that I gave: What are treatment options that we have for HS? Currently, we think aboutthe menu of different things we can choose from. There's topicals, there'sthe hormonal metabolic modulators, there's oral antibiotics, which, again, we're trying to move away from as like a long-term treatment option. Then really what's revolutionized HS in the past decade is the advent of biologics and small molecule inhibitors as long-term therapeutic options for patients with HS. We have 2 that are FDA approved now. We have adalimumab and secukinumab. Knock on wood, hopefully bimekizumabis around the corner, and then I believe after that, we'llprobably see some JAK inhibitors hit the market, and perhaps also a Bruton tyrosine kinase (BTK) inhibitor hit the market. It'll be nice to have some oral options for our patients with HS. But my main points from the HS lecture are remembering to try to diagnose these patients early. Anybody with nodules or abscesses that are in like an intertriginous skin area. It's HS until proven otherwise, remembering that HS can occur outside those classic areas, so neck, trunk, arms, legs, I've seen it. Just because a patient doesn't have it in those classic areas does not necessarily mean it's not HS. Then that combination therapy. Thinking about combining, for example, spironolactone with a biologic. Not just focusing on monotherapy, because for our patients with HS, we're still in that multimodal approach to care, and that's why surgical procedures are still very important for HS. We're not able to, right now, make tunnels disappear for patients with medication, and so being able to help de-roof or excise a tunnel, for example, can make a really big impact on quality of life for these patients.

DT: How do you think precision medicine will change the way we treat patients with HS?

Hsiao: It's a great question. My hope is that we catch these patients earlier, before they have those extensive tunnels and extensive disease burden that we see, and if we're able to do that and maybe start1 of these medications earlier. My hope is that it can help mitigate disease progression, and we're seeing patients unable to catch them at a point where the biologic and small molecule inhibitor likely has the most benefit, and we can stop the train wrecks from coming to our clinic. The patients that I look at and I'mthinking, I just wish I saw you 20 years ago. We could have started something then, and versus right now, there's so much end stagedisease with scarring and tunnels. I know there's going to be large surgeries that are involved, and I don't want patients to have to go through that. So hopefully that'll be the trend. We see them when they're earlier in the disease course, we treat them in a timely fashion, and we can sort of move away from seeing the really severe cases.

DT: What upcoming therapies are you most looking forward to?

Hsiao: I'm just excited about the therapeutic pipeline in HS. I'm excited there's, I think maybe over 40 or 50 active trials right now going on for HS, phase 2 and phase 3. I really want to be able to feel like I have a broad therapeutic armamentarium when I have that patient sitting in front of me and that they're filled with efficacious and safe options that I can talk about. My hope is that also with thepush with new therapies coming into the market that this will also provide the hope that's needed for patients who maybe gave up and thought there was nothing for them, so they haven't interacted with us for a while. I'm hoping we see more patients like return to the healthcare system as well.

[This transcript has been edited for clarity.]