Advances in hidradenitis suppurativa
Transcript: EADV 2024: New research
Georgios Nikolakis
Interview recorded Sep 2024, EADV 2024. All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
There were several points in the congress that, and it's very difficult to focus on one, because they focus on two different types of treatment and of stages of treatment.
The one has to do with patients with an already established disease and all this, including irreversible lesions such as draining tunnels and scarring, where we have seen in the subspecialty meeting new surgical techniques that have been presented and also patients who are a bit earlier, let's say, that we have the possibility to see them at an earlier stage with mostly inflammatory disease, and then the possibilities of treatment are also slightly different.
If I would outline something, I was happy to hear about the possibility of maybe being able to distinguish between HS and possibly acne as a differential diagnosis through a treatment with isotretinoin where acne, is helpful. While for acne, it's helpful while for HS it is not as a, let's say, a potential test, a trial and error in order to outline or find the patients who have facial HS. A second point on which I was also personally involved was the European Hidradenitis Supurativa Foundation. Working currently on a project concerning a step up, some upgrade criteria on the use of biologics on HS, for all biologics, if there are some cases where patients and maybe the healthcare system would benefit if we would hit hard and early, so we're currently, now we have gathered the preliminary data that have been presented in the congress. They're also on the on demand session, and on a subsequent step, we expect a consensus, a Delphi consensus round, where the experts will decide which of these cases indeed should be proposed as checklist for physicians, maybe for an upgrading of these patients early enough so that we can avoid scarring and tunnels. We have currently good treatments also for patients with tunnels.
On the other hand, it is known that the treatment in this case is more difficult or it might take more time. And if we could avoid it also by avoiding having certain phenotypes of the disease with irreversible lesions where surgery cannot be avoided, especially now where the awareness is raised, I think it would be something beneficial. It would be considered a success. And an important point that also maybe need to be mentioned is a case report of a patient who was under anti-TNF treatment and developed a malignant lesion. These lesions can be either HPV induced or HPV might have a role, especially in the anogenital area, or it might not, but I find important also the message that if we have chronic inflammation and we don't see that we have an increase in inflammatory parameters, but at the same time, validated scoring systems of the disease don't change, such as in IHS4, and we see changes such as ulcerations. Then in this case, biopsies need to be taken in order also to exclude a possible malignant transformation.
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