Can We Improve Prognosis in Hidradenitis Suppurativa? Identifying Patients in the Window of Opportunity

Severity and Therapeutic Decisions Based on Lesion Location in Patients With Hidradenitis Suppurativa

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic inflammatory disease for which several phenotypic classifications have been proposed in recent years to optimize medical care. The aim of this study was to define a new classification of HS based on the anatomical distribution of lesions, serving as a tool for therapeutic decision-making.

METHODS

This cross-sectional study with consecutive sampling included patients attending their first medical consultation at the Hidradenitis Suppurativa Unit of Virgen de las Nieves University Hospital in Granada, Spain, between January 1, 2017, and March 1, 2024. Patients were classified into four groups based on the anatomical distribution of HS: Upper, Atypical, Lower, and Progressor HS. Sociodemographic variables, personal history, and HS-related variables were collected.

RESULTS

A total of 557 patients were included, with a similar proportion of men and women. Patients with the Upper type exhibited milder forms of HS and underwent surgical treatment more frequently. In contrast, those with the Progressor type presented more severe forms of HS and required more immunomodulatory treatment. Patients in the Atypical and Lower groups showed more heterogeneity in therapeutic approaches, although the presence of lesions in specific locations may help predict the need for early initiation of more aggressive treatments.

CONCLUSIONS

We propose a new HS classification based on the location of lesions. This classification can be used alone or in conjunction with previous ones to identify patients at higher risk of progression and to guide therapeutic decision-making.

[Translated article] Spanish Hidradenitis Suppurativa Registry (REHS) of the Spanish Academy of Dermatology and Venereology: Description and Data From its First Year of Operation

INTRODUCTION

Hidradenitis suppurativa (HS) is a skin disease that significantly impacts patients' quality of life. There are still uncertainties surrounding its epidemiology, natural history, and the safety and effectiveness of existing treatments. The Spanish Academy of Dermatology and Venereology has promoted the creation of a Spanish Registry of patients with HS (REHS). The aim of this article is to present the REHS and provide the initial results obtained.

METHODS

The REHS is a prospective, multicenter, observational study that collects the clinical and epidemiological characteristics of patients with HS, as well as the safety and effectiveness of the medical and surgical treatments received.

RESULTS

Between June 2023 and June 2024, 359 patients were recruited from 23 Spanish centers. The average age of the patients is 37 years, and 53% of them are women. Over 70% of the patients are smokers or former smokers. One third have a family history of HS. The most frequent sites of disease onset are the axillae and groin. Median baseline IHS4 at recruitment was 4 (p25-p75=1-9), HiSQOL was 20 (p25-p75=8-36), and BMI was 27.3 (p25-p75=24-33.2). At least 82% of patients have received antibiotic therapy for their disease, and almost 20% a biologic drug.

CONCLUSIONS

We present data from the first patients enrolled in the REHS, which will allow for the generation of evidence on the natural course of the disease, as well as the effectiveness and safety of treatments in HS.

Inflammatory proteins and hidradenitis suppurativa: Insights from genetic correlation and Mendelian randomization

Previous research has highlighted a significant association between inflammatory proteins and the development and progression of hidradenitis suppurativa (HS). Nevertheless, the potential causative link between these factors remains to be definitively established. To investigate the genetic correlation between inflammatory proteins and HS, linkage disequilibrium score regression (LDSC) was employed. Mendelian randomization (MR) analysis, incorporating inverse variance weighted, MR-Egger, and weighted median methodologies, was utilized to evaluate the possible causal relationship between circulating inflammatory proteins (CIPs) and HS. Additionally, reverse MR analysis was carried out to explore reverse causality. The data set for 91 CIPs was derived from a genome-wide protein quantitative trait loci study, while HS-related data were acquired from the FinnGen study. Moreover, the stability of the causal relationships was assessed via sensitivity analyses, encompassing tests for pleiotropy, heterogeneity, and leave-one-out analysis. The LDSC analysis suggested the existence of genetic correlations between the levels of Fibroblast growth factor 21 (FGF-21), stem cell factor, and HS. The MR analysis identified a suggestive association of T-cell surface glycoprotein CD5 and C-X-C motif chemokine 11 with an elevated risk of HS. Conversely, C-C motif chemokine 4, Protein S100-A12, Interleukin-10 receptor subunit beta, and Programmed cell death 1 ligand 1 were associated with a diminished risk of HS. Moreover, HS was demonstrated to increase the levels of four CIPs: Interleukin-20, Leukemia inhibitory factor (LIF), LIF receptor, and Thymic stromal lymphopoietin. The findings of this investigation offer suggestive evidence for possible genetic correlations and causal links between various genetically predicted inflammatory proteins and HS. There exists a pressing requirement for additional studies to elucidate the fundamental processes driving these associations.

Therapeutic burden in hidradenitis suppurativa: a cross-sectional study of 557 patients

INTRODUCTION

Therapeutic burden (TB) has been identified as a potential predictor of response to biologic therapy in hidradenitis suppurativa (HS). We aim to analyze the determinants of TB in real-world clinical settings among HS patients to explain this concept and its utility as an additional tool for guiding therapeutic decision-making.

METHODS

We conducted a cross-sectional study including all consecutive HS patients attending a specialized HS clinic between 2017 and 2024. The primary variable was TB, defined as the cumulative sum of prior systemic treatment cycles and surgical interventions for HS. We analyzed whether sociodemographic or clinical factors were associated with a higher TB.

RESULTS

We included 557 HS patients. Of these, 50.81% were women, and the mean age was 41.87 (14.19) years. Most patients (62.30%) were referred from general dermatology consultations. The mean disease duration was 17.52 (11.51) years. Regarding disease severity, 46.50% presented with Hurley II, and 42.19% had an IHS-4 score between 4 and 10. Before their baseline visit, 9.70% of patients had received biological therapy, mostly adalimumab (88.89%). The mean TB was 2.42 (2.25) systemic medical and/or surgical interventions. Referral from general dermatology or other hospital departments, older age, longer disease duration, greater HS severity, presence of pilonidal sinus, and prior biological therapy were significantly associated with higher TB.

CONCLUSIONS

Our findings suggest that TB comprehensively captures HS severity and progression factors. This metric could prove valuable in aiding decision-making for HS patients by indicating when a change in therapy might be necessary.

Hidradenitis suppurativa, from basic science to surgery and a new era of tailored targeted therapy: An expert opinion paper

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterised by an aberrant activation of innate immunity and increased production of pro-inflammatory mediators such as interleukin 17 (IL-17). IL-17 has been shown to play a key role in the pathogenesis of HS and evidence highlights the potential of IL-17-targeted therapies. The fully human IgG/κ monoclonal antibody secukinumab, which specifically targets IL-17A and inhibits interaction with its receptor, has recently been approved for the treatment of moderate-to-severe HS. Secukinumab offers patients an efficacious and well-tolerated treatment option in terms of sustained response by rapidly improving signs and symptoms, and preventing disease progression in the absence of loss of response. Being a challenging disease, HS is associated with a delay to diagnosis of 3-10 years and, consequently, late implementation of appropriate treatment, leading to disease progression. Misdiagnosis due to flawed understanding and lack of awareness among medical providers and patients is considered an important factor contributing to the delayed diagnosis. Thus, serious efforts must be made on a large scale to urgently reduce the delay in HS diagnosis and reduce the disease burden in patients, including raising awareness, implementation of education programmes at medical and specialisation schools, as well as continuous education of healthcare providers at different levels for the early detection of HS and initiation of appropriate treatment. Here, we present the main critical unmet needs in the diagnosis and treatment of patients affected by HS, address how disease awareness and comprehensive multidisciplinary management (offering both medical and surgical care) can benefit patients, and suggest therapeutic options, based on clinical characterisation and early identification and intervention (window of opportunity), to be adopted for a timely and better management of disease progression and to fill current gaps.

Spanish Hidradenitis Suppurativa Registry (REHS) of the Spanish Academy of Dermatology and Venereology: description and data from its first year of operation

INTRODUCTION

Hidradenitis suppurativa (HS) is a skin disease that significantly impacts patients' quality of life. There are still uncertainties surrounding its epidemiology, natural history, and the safety and effectiveness of existing treatments. The Spanish Academy of Dermatology and Venereology has promoted the creation of a Spanish Registry of patients with HS (REHS). The aim of this article is to present the REHS and provide the initial results obtained.

METHODS

The REHS is a prospective, multicenter, observational study that collects the clinical and epidemiological characteristics of patients with HS, as well as the safety and effectiveness of the medical and surgical treatments received.

RESULTS

Between June 2023 and June 2024, 359 patients were recruited from 23 Spanish centers. The average age of the patients is 37 years, and 53% of them are women. Over 70% of the patients are smokers or former smokers. One third have a family history of HS. The most frequent sites of disease onset are the axillae and groin. Median baseline IHS4 at recruitment was 4 (p25-p75=1-9), HiSQOL was 20 (p25-p75=8-36), and BMI was 27.3 (p25-p75=24-33.2). At least 82% of patients have received antibiotic therapy for their disease, and almost 20% a biologic drug.

CONCLUSIONS

We present data from the first patients enrolled in the REHS, which will allow for the generation of evidence on the natural course of the disease, as well as the effectiveness and safety of treatments in HS.

Insights into the Window of Opportunity and Outcome Measures in Patients with Moderate to Severe Hidradenitis Suppurativa Treated with Secukinumab: A Real-World Study

INTRODUCION

The concept of a window of opportunity in hidradenitis suppurativa (HS) management suggests that early initiation of biological therapy leads to better outcomes, though its timing remains uncertain.

METHODS

We conducted a retrospective observational multicenter study, including consecutive patients with moderate to severe HS who initiated secukinumab treatment following prior failure with systemic antibiotics or adalimumab. Therapeutic burden was defined as the sum of previous systemic treatment cycles and previous major surgical interventions for HS. Patients were followed up for 24 weeks. Main outcomes were safety and effectiveness, assessed through the proportion of patients achieving HS Clinical Response (HiSCR) and a 55% reduction in International HS Severity Score System (IHS4-55). Additionally, potential predictors of response to secukinumab were studied. Analysis was performed on an intention-to-treat basis.

RESULTS

A total of 67 patients (33 men, 34 women) were included, with a mean age of 41.55 (11.94) years and a mean baseline IHS4 of 17.88 (11.13). The mean therapeutic burden was 6.06 (3.49). At week 24, 10.45% (7/67) of patients experienced adverse events, with three leading to treatment discontinuation. At week 24, 41.79% (28/67) of patients achieved HiSCR, and 44.78% (30/67) of patients achieved IHS4-55. HiSCR could not be calculated in 12 patients with a baseline AN count < 3. A lower therapeutic burden was significantly associated with a higher likelihood of achieving HiSCR and IHS4-55 at week 24.

CONCLUSIONS

Secukinumab showed safety and efficacy in real-world patients with HS, and the inverse correlation found between therapeutic burden and treatment response supports the concept of a window of opportunity, offering insights into its timing.

Resorcinol 10% as a Promising Therapeutic Option for Mild Hidradenitis Suppurativa: A Prospective, Randomized, Open Study

Introduction

Treatment of hidradenitis suppurativa (HS) is challenging, and in Hurley stage I, it is based on topical measures. Our aim was to compare the efficacy and safety of topical resorcinol 10% with topical clindamycin 1% and no therapy, in Hurley stage I HS.

Methods

In this open, prospective, randomized trial, we studied 60 Hurley stage I patients with IHS4 ≤10. Group A was treated with topical resorcinol 10%; group B with clindamycin lotion 1%; and group C received no treatment. Patients were evaluated by total lesion count, the International Hidradenitis Suppurativa Severity Score System (IHS4) and the Dermatology Life Quality Index (DLQI) at baseline, 12 and 24 weeks. Self-reported number of flares and adverse events (AEs) were recorded.

Results

A significant reduction in the mean total lesion count and DLQI scores were observed in group A, compared to group B at week 12 (p = 0.036, p < 0.001, respectively), and in the mean total lesion count, IHS4, and DLQI scores at week 24 (p = 0.034, p = 0.017, p < 0.001, respectively). Resorcinol 10% was well-tolerated with only mild AEs.

Conclusion

Resorcinol 10% may represent a useful alternative for the long-term treatment of mild HS, which is superior to topical clindamycin and has a favorable safety profile.