Optimising HS management

Optimising HS management

Updates in disease management for hidradenitis suppurativa (HS) direct from key dermatological conferences, including the latest data and insights from HS experts.

Dr Antonio Martorell shares his thoughts on the debate between HiSCR and IHS4 in hidradenitis suppurativa, including limitations to consider. View transcript.

Dr Philippe Guillem 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.