Optimising HS management

Aikaterini Liakou (University of Nicosia Medical School, Cyprus) shares her opinion on the most important issue addressed at EADV 2024. View transcript. 

Liakou discusses what’s new in the updated European HS guidelines and emphasises the positive impact for patients and physicians. View transcript.

Georgios Nikolakis highlights two poster presentations of interest, one emphasising the need for increased awareness of HS among physicians and the other showing a decrease in diagnostic delay during the COVID-19 pandemic. View transcript.

Among the research presented at this year’s congress on the hidradenitis suppurativa (HS) diagnostic process and the patient experience was a US/European survey of 565 patients with HS and 262 physicians, reported by Elizabeth Nash (Adelphi Real World, Bollington, UK).

This showed that 46% of the patients were initially misdiagnosed, with the most common misdiagnoses being boils (45%) and acne (33%).

The average time from symptom onset to presentation was 1.3 years, with an additional 1.6-year delay to diagnosis, and 40% of patients experienced a subsequent delay in being seen and treated by an HS specialist. Physicians felt that increased awareness and knowledge of HS in both physicians (83%) and patients (40%) was needed to facilitate prompt diagnosis and treatment. Indeed, just 9% of patients had heard of HS prior to their diagnosis.

Aikaterini Liakou discusses pain in people with HS, including the significant impact on mental health and quality of life. View transcript.

Martina Porter (Harvard Medical School, Boston, Massachusetts, USA) shares her thoughts on the possible implications of new treatments for people with HS. View transcript.

Also reported, by Hannah Wainman (Bristol Royal Infirmary, UK), were data from the 100 UK HS patients who participated in the HS Uncovered global survey, revealing the impact of pain associated with HS.

Overall, 43% of participants had needed to stay at home or in bed because of HS pain for most of the week prior to being surveyed, and 63% said HS-related pain impacted their ability to socialise. A majority of respondents (63%) felt that pain relief was the most important aspect of HS treatment.

Optimising HS management

What factors impact hidradenitis suppurativa (HS) management? Catch up on key highlights from EHSF 2024, featuring interviews with experts Dr Antonio Martorell and Dr Philippe Guillem.

Dr Martorell (Hospital de Manises, Valencia, Spain) shares his thoughts on the debate between HiSCR and IHS4 in HS, including limitations to consider. View transcript.

Dr Guillem (Clinique du Val d'Ouest, Ecully, France) highlights data from EHSF 2024 on comorbidities and reveals the key lessons learned from an interactive session involving dermatologists and people with HS. View transcript.

Updates from EHSF 2024

Selected updates on disease management presented at the 2024 European Hidradenitis Suppurativa Foundation conference.

HS flares: Could PROs be the best indictor?

Joslyn Kirby (Penn State University, Hershey, USA) explained that, in current practice, flares in people with HS are predominantly defined according to clinician-reported outcomes.

The performance of patient-reported outcome measures (PROs), including the Hidradenitis Suppurativa Quality of Life (HiSQOL) scale and Numerical Rating Scale (NRS) has not yet been investigated.

This prospective, 12-week cohort study involved 60 patients, with a mean age of 36.4 years, of whom 93% were female. They experienced a total of 208 flares (34% mild, 43% moderate and 23% severe), measured at planned visits every 4 weeks or self-reported for the previous 7 days in weekly online surveys.

In area under the receiver operating characteristic curve analysis, the total scores of PROs were more accurate than those of clinician-reported outcomes (HS Area and Severity Index-Revised and lesion counts) for detecting flare. The same was true for change in score; although the accuracy was lower than for total score, Kirby noted that change in score is less dependent on baseline severity.

The HiSQOL total score performed the best, though similar performance was observed with the NRS

Kirby stressed that, although use of PROs to define flare in HS is novel, it is a successful strategy in conditions such as rheumatoid arthritis and ankylosing spondylitis.

She concluded that “there is a lot of opportunity to look further into how we define flares”.

Factors associated with severe hidradenitis suppurativa

Mathieu Daoud (Université Libre de Bruxelles, Brussels, Belgium) presented a study that aimed to identify factors associated with severe HS, which he noted remain unclear. The team defined severe HS according to Hurley staging (n=647) or the metascore (n=456).

Daoud reported that high BMI was a key factor in the transition from Hurley stage 2 to Hurley stage 3 HS (OR, 1.09; P=0.001).

In addition, blood pressure, male sex, and peri-anal, axillary and gluteal involvement were associated with more severe HS.

Daoud commented: “We asked patients about potential HS triggers, and they selected among several categories.”

He reported that, although there were several associations in the univariate analysis, only “a feeling of aggravation” of HS by nonsteroidal anti-inflammatory drugs was significantly associated with severe HS (defined by metascore) in the multivariable analysis (OR, 8.49 [1.71–41.55]; P=0.008).

High BMI is associated with severe HS, as is aggravation of symptoms by nonsteroidal anti-inflammatory drugs

Daoud concluded by considering opportunities for future research, including investigating genetic and biological factors.

Comorbidities and risk factors associated with HS

Naïla Bouadi (Laval University, Quebec City, Canada) introduced findings from a meta-analysis of 24 studies aiming to assess common comorbidities associated with HS.

The overall prevalence of common risk factors was significantly greater in people with HS when compared with healthy individuals

Smoking was identified as the most reported risk factor (OR, 3.09 [95% CI, 2.52–3.78]; P<0.0001. Depression was highlighted as the psychiatric condition with the highest odd ratio (OR, 2.34 [95% CI, 1.56–3.51]: P<0.0001. Diabetes emerged as a prevalent comorbidity in people with HS (OR, 2.31 [95% CI, 1.63–3.27; P<0.0001).

In addition, spondyloarthritis, polycystic ovarian syndrome, chronic lower respiratory disease, arthritis, and inflammatory bowel disease were prevalent comorbidities associated with HS.

Bouadi closed the presentation by emphasising the importance of identifying patients with comorbidities at the greatest risk of disease progression.