Hidradenitis Suppurativa

Question 1

What is Hidradenitis Suppurativa

Answer 1

Chronic recurring, painful and debilitating inflammatory skin disease

Question 2

Symptoms of HS

Answer 2

Nodules, abscesses, and discharging fistulas, which typically occur in the armpits, groin and buttocks

Question 3

HS prevalence

Answer 3

Approximately 1% of the population in most studied countries and three or four times more common in women than men. Approximately 1/3 of people with HS are genetically predisposed.

Question 4

Causes of HS

Answer 4

The pathophysiology for HS poorly understood; and probably related to cytokinin imbalance.
Several implicated pathways:
1. IL-17
2. Th17
3. IL-23
4. Complement pathway
5. IL-36 mediated neutrophil dysfunction

Question 5

Comorbidities

Answer 5

Obesity, high cholesterol,, high blood pressure, thyroid disease, ovarian disease

Question 6

HS treatment paradigms

Answer 6

1.stage one HS, this is the most difficult to diagnose form . of HS and it’s the most early stages and typically moderate. — don’t typically need suppressive therapies & typical antibiotics is enough
2. Stage two HS moderate disease severity increased number of lesions, follicles and nodules and increased frequency of recurrence — SOC: Humira
3. Stage three of HS most severe form and categorized by scarring — SOC: Humira

Humira: SOC for moderate and severe patients, works for 50% patients —> for the other 50% if females —> combine Humira with Spironolactone and metformin (still very incremental effect maybe ~ 5% but better than nothing); could not give to males given their feminizing effects —> one off label use of IL-17 and IL-23 inhibitors —> most severe patients, surgery to remove scars or active lesions is an option

Humira has very little scarring remodeling benefits

Question 7

HS drug development

Answer 7

Cosentyx / Novartis: positive but not impressive efficacy — some degree of improvement over Humira after patients fail Humira