Hidradenitis Suppurativa: An Interdisciplinary Problem in Dermatology, Gynecology, and Surgery-Pathogenesis, Comorbidities, and Current Treatments

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.

The Impact of Diet on Hidradenitis Suppurativa Severity: A Cross-Sectional Case-Control Study

Background and Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease primarily affecting hair follicles, characterized by painful nodules, abscesses, and sinus tract formation. Recent evidence suggests that weight management and nutritional factors may influence HS symptoms. This cross-sectional case-control study aimed to assess the impact of body composition and nutritional factors on HS severity. Materials and Methods: We included 50 patients with HS and 50 matched controls comparable in body mass index (BMI), sex, and age. The data collected included 3-day food records, a food frequency questionnaire, 24 h physical activity records, Mediterranean Diet Adherence Screener (MEDAS) scores, body composition, and anthropometric measurements. The macronutrient and micronutrient intake, as well as dietary glycemic index (GI), were analyzed. HS severity was assessed using the Hurley staging system and the International Hidradenitis Suppurativa Severity Score System (IHS4). Results: HS patients exhibited significantly lower adherence to the Mediterranean diet and a higher dietary GI compared to controls. Their micronutrient intake was also reduced, while the consumption of junk food, dairy products, and nightshade vegetables was more frequent. The MEDAS scores and physical activity levels were negatively correlated with the IHS4 scores, while higher anthropometric measurements, dietary energy, protein, total fat, and GI showed positive correlations. The Hurley stage was negatively correlated with the MEDAS scores and positively correlated with the GI and visceral fat. In multiple regression analysis, the MEDAS score emerged as the primary variable associated with disease severity. Conclusions: These findings suggest that an increased adherence to the Mediterranean diet, intake of food with a lower GI, and maintaining an ideal body weight may positively affect HS management. Long-term studies are warranted to corroborate our findings.

Uncommon Drug-Induced Hidradenitis Suppurativa: A Case Report of A Patient on Lithium Therapy

Hidradenitis suppurativa (HS) is not fully understood and is regarded as a multifactorial condition diagnosed based on clinical evaluation. Smoking, obesity, and hormonal imbalances may be the underlying associations of HS. The incidence of HS is greater in patients with diabetes. Psychiatric illnesses and their medications have been linked to new-onset and worsening of HS. This case report discusses a 35-year-old Hispanic male, a non-smoker with a past medical history of schizophrenia and bipolar disorder, who was diagnosed with axillary HS after initiating lithium therapy. He experienced worsening HS and reached Hurley stage III, for which surgical excision was offered as the definitive treatment. Here, we present a case report of HS after the initiation of lithium therapy, focusing on the underlying pathological process of this skin condition. Despite limited data on this topic, clinical features, management of the condition, and possible disease development prevention methods will be emphasized.

Harnessing artificial intelligence for advancing early diagnosis in hidradenitis suppurativa

This perspective delves into the integration of artificial intelligence (AI) to enhance early diagnosis in hidradenitis suppurativa (HS). Despite significantly impacting Quality of Life, HS presents diagnostic challenges leading to treatment delays. We present a viewpoint on AI-powered clinical decision support system designed for HS, emphasizing the transformative potential of AI in dermatology. HS diagnosis, primarily reliant on clinical evaluation and visual inspection, often results in late-stage identification with substantial tissue damage. The incorporation of AI, utilizing machine learning and deep learning algorithms, addresses this challenge by excelling in image analysis. AI adeptly recognizes subtle patterns in skin lesions, providing objective and standardized analyses to mitigate subjectivity in traditional diagnostic approaches. The AI integration encompasses diverse datasets, including clinical records, images, biochemical and immunological data and OMICs data. AI algorithms enable nuanced comprehension, allowing for precise and customized diagnoses. We underscore AI's potential for continuous learning and adaptation, refining recommendations based on evolving data. Challenges in AI integration, such as data privacy, algorithm bias, and interpretability, are addressed, emphasizing the ethical considerations of responsible AI deployment, including transparency, human oversight, and striking a balance between automation and human intervention. From the dermatologists' standpoint, we illustrate how AI enhances diagnostic accuracy, treatment planning, and long-term follow-up in HS management. Dermatologists leverage AI to analyze clinical records, dermatological images, and various data types, facilitating a proactive and personalized approach. AI's dynamic nature supports continuous learning, refining diagnostic and treatment strategies, ultimately reshaping standards of care in dermatology.