Abstract
Keywords
- •Hidradenitis suppurativa is a progressive inflammatory skin disease that is often underdiagnosed or misdiagnosed because of poor recognition in the medical community.
- •Increased awareness of the clinical presentation, associated comorbidities, and quality of life impact can help address unmet needs for patients.
- •This practical guide provides detailed information that can support timely hidradenitis suppurativa diagnosis and care strategies by primary care providers.
Statement of Literature Search
Introduction to Hidradenitis Suppurativa
- Alikhan A
- Sayed C
- Alavi A
- et al.
Recognizing the Clinical Presentation of Hidradenitis Suppurativa
- Alikhan A
- Sayed C
- Alavi A
- et al.

Common Comorbidities in Hidradenitis Suppurativa
Comorbid Condition | Increased Prevalence or Odds Among Patients with Hidradenitis Suppurativa |
---|---|
Polycystic ovary syndrome |
|
Metabolic syndrome and related conditions |
|
Dyslipidemia |
|
Diabetes mellitus | |
Obesity |
|
Cardiovascular events |
|
Obstetrics risks |
|
Inflammatory bowel disease, including ulcerative colitis and Crohn disease |
|
Arthropathies | |
Psychological distress and related conditions |
|
Sexual dysfunction |
|
Modifiable risk factors | |
Substance use disorders |
|
Tobacco smoking |
|
The Psychological Burden Experienced with Hidradenitis Suppurativa
Current Understanding of the Pathogenesis of Hidradenitis Suppurativa
Therapeutic Options and Disease Management
Available First-Line Treatments That Can Be Administered Prior to Dermatologist Visits | |
---|---|
Topical therapies | Clindamycin 1% solution/gel QD-BID Washes: zinc pyrithione, chlorhexidine, benzoyl peroxide Triamcinolone (intralesional) 40 mg/mL in up to 3 lesions |
Systemic antibiotics | Doxycycline 100 mg BID Rifampin 300 mg BID and clindamycin 300 mg BID Rifampin 300 mg BID plus moxifloxacin 400 mg QD and metronidazole 500 mg TID |
Hormonal therapies | Combination contraceptives Spironolactone 100-150 mg QD (or divided BID) Metformin 500 mg QD to BID Finasteride 1.25-5 mg QD |
Treatment considerations after diagnostic confirmation by a dermatologist | |
Retinoids | Isotretinoin Acitretin Alitretinoin |
Systemic immunomodulatory therapies | Cyclosporine Systemic steroids |
Biologics | TNF-α inhibitors: adalimumab, golimumab, infliximab IL-17 inhibitors: secukinumab IL-1 inhibitors: anakinra, canakinumab IL-12/23 inhibitors: ustekinumab |
Surgical procedures | Incision and drainage Cryosurgery Unroofing/deroofing Lesional or wide excision |
Additional opportunities for PCPs for comprehensive disease management | |
Patient education | Inform patients of the following:
|
Hidradenitis Suppurativa Foundation | Hidradenitis Suppurativa Foundation includes information and resources for both patients and providers about education, management, and events for hidradenitis suppurativa Available online: https://www.hs-foundation.org/ Including a hidradenitis suppurativa clinic finder: https://www.hs-foundation.org/hs-specialty-clinics |
Hidradenitis Suppurativa Source: Hidradenitis Suppurativa Clinical Resource | AbbVie has compiled an online portal that includes support and resources for both patients and providers to increase hidradenitis suppurativa awareness and education, including patient handouts and conversation guides Available online: https://www.hsdiseasesource.com/resources |
Hope for Hidradenitis Suppurativa | Hope for Hidradenitis Suppurativa—a volunteer-based patient and provider nonprofit organization to support and advocate for patients with hidradenitis suppurativa—provides hidradenitis suppurativa resources, such as support group information, patient care information, research, and news Available online: https://hopeforhs.org/ |
Hidradenitis Suppurativa Connect | Hidradenitis Suppurativa Connect provides resources for providers (dermatologists and general clinicians) and patients (adult and pediatric), including mental health support, community connections and events, and clinical trial recruitment information Available online: https://www.hsconnect.org/ |
American Academy of Dermatology (AAD) | The AAD has compiled a collection of hidradenitis suppurativa information to increase education and awareness of this disease for providers and patients, including symptoms, causes, treatments, self-care, mechanisms for coping with depression, and dietary changes that may impact hidradenitis suppurativa Available online: https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview |
- Alikhan A
- Sayed C
- Alavi A
- et al.
Comprehensive Patient Care Strategies
Comorbid Condition | Screening Method |
---|---|
Metabolic syndrome and related conditions (eg, glucose dysregulation, hypertension, dyslipidemia, and obesity) |
|
Obesity |
|
Diabetes mellitus |
|
Polycystic ovary syndrome |
|
Cardiovascular disease and related conditions |
|
Inflammatory bowel disease |
|
Spondyloarthritis |
|
Depression/depressive symptoms |
|
Generalized anxiety disorder |
|
Suicidality/self-harm |
|
Pain |
|
Substance use disorder |
|
- Alikhan A
- Sayed C
- Alavi A
- et al.
Conclusion
Acknowledgments
References
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Footnotes
Funding: Support for third-party writing assistance for this manuscript was provided by Novartis.
Conflicts of Interest: AG has served as an advisor and/or received honoraria from AbbVie, Aclaris Therapeutics, AnaptysBio, Aristea Therapeutics, Boehringer Ingelheim, Bristol Meyers Squibb, Incyte, InflaRx, Insmed, Janssen, Novartis, Pfizer, UCB, and Viela Biosciences; has received research grants from AbbVie, UCB, and National Psoriasis Foundation; and is co-copyright holder of the Hidradenitis Suppurativa Investigator Global Assessment and Hidradenitis Suppurativa Quality of Life instruments. HBN has received consulting fees from 23andMe, AbbVie, Aristea Therapeutics, DAVA Oncology, and Nimbus Therapeutics; advisory fees from Boehringer Ingelheim; investigator fees from Pfizer; grant support from AbbVie; serves as an associate editor for JAMA Dermatology; and is a board member of the US Hidradenitis Suppurativa Foundation. JSK has received speaker and consultant fees from AbbVie; consultant fees from ChemoCentryx, Incyte, Janssen, Novartis, and UCB; and grant support from Incyte.
Authorship: All authors made substantial contributions to the conception and methodology of this literature review; were involved in drafting and critically revising the manuscript; have given necessary attention to ensure the integrity of the work; and have read and approved all versions of this manuscript and its submission.
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