SDPA Summer | Live Blog | Product Theater: A Milestone in the Treatment to Severe Hidradenitis Suppurativa
Sponsored by AbbVie
During the SDPA’s Annual Summer Dermatology Conference Dr. Craig Teller presented an excellent overview of the presentation and treatment of moderate to severe hidradenitis suppurativa (HS) focusing on a TNF-alpha inhibitor. Hidradentitis suppurativa is a chronic, progressive, debilitating immune mediated condition that has historically been overlooked with the average delay in diagnosis of 7 years. Dr. Teller believes that the main reason for the delay in diagnosis is that providers are not recognizing the condition. Active smokers, women, and African Americans have much higher rates of this condition. HS affects the apocrine glands and is manifested as painful deep seated lesions that commonly presents in the inframammary, axillary and anogenital region.
Dr. Teller described the clinical presentation of hidradenitis suppurativa including the pathognomonic presentation of the double open comedone. Staging of the condition was described with a focus on scarring and sinus tract formation. He implored the audience to diagnose early and “please try not to let patients get to stage 3” due to the tremendous number of co-morbidities associated with disease.
Treatment options for HS were discussed including topical, intralesional, oral therapies as well as surgical options. Humira, or adalimumab, is the only treatment that is FDA approved for hidradenitis suppurativa, receiving approval for HS in 2015.
Dr. Teller described biologics, like adalimubab, as a way to help put the body “back in balance” through its mechanism of action as an immunomodulator. TNF-alpha plays an important role in regulating the cascade of pathogenic events in HS. Furthermore, initial and maintenance dosing of Humira for HS was discussed and compared to dosing for psoriasis. Dr. Teller stated the initial loading dose is higher due to a higher level of inflammation in HS when compared to psoriasis. Finally, the safety profile of Humira in the treatment of HS was discussed with an emphasis on testing for TB prior to initiating treatment.
Byline: Sarah Patton, PA-C, MSHS
Posted: June 1, 2017