Hidradenitis suppurativa (HS) Learning Zone
Transcript: Multidisciplinary care and clinical barriers
Dr Steve Daveluy and Cindy Stillman
Interview recorded Sep 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.
Yeah, I think HS is definitely a disease that takes more than one provider. At a minimum it's gonna take your primary care provider and your dermatologist. And that's because we know that HS can have comorbidities, other diseases that are more likely in patients with HS. So that's one of the things I always make sure I do is when I see a new patient with HS, I use an electronic health record. So sometimes it's easy 'cause we can sort of have things that go into our note that are like ready to go. And so I have a piece that I put into my note because I know I'm gonna put that into the letter that I send back to someone's primary care provider that talks about some of the other things that can go along with HS, like high blood pressure, diabetes, high cholesterol, cardiovascular risks. And that way they, their provider knows, okay, I need to screen for these things because that's kind of in their wheelhouse.
As the dermatologist, I'm not gonna treat your blood pressure, but I want your primary care doctor to know that you have an increased risk and that they may need to keep a closer eye on it to make sure if you, if it does show up, they catch it early. But then beyond that, there are a lot of other providers in different specialties that can be involved. So we've already mentioned a couple times mental health. That can be huge. And I think opening that door for patients is really important. 'Cause like you said, sometimes you feel alone and you feel like no one really understands and it's already, so there's some stigma around mental health and it's hard to ask for help and hard to bring it up. So I think it's really good for providers to check in and see how patients are doing. Sometimes we share with gastroenterology because it can come with inflammatory bowel disease. Sometimes we're working with surgeons, either general surgeons or plastic surgeons. I do smaller HS surgery right in the clinic in my dermatology office. But for bigger cases I have to work with a local plastic surgeon who I have a good relationship with.
There's no one size fits all treatment for HS. There's not this, you know, some diseases are great. You go, oh, here's the disease, here's the treatment. Works most of the time. Not with HS. It's very individualised. We also don't have treatments, a lot of treatments that are super effective for most patients. Sometimes you get one thing and it works great and they're totally under control and you do a dance of joy. But a lot of times we see treatments that give partial improvement and so we really have to build sort of a regimen of multiple treatments to get it completely under control. And I think that's, that's a challenge, especially because in some of our other inflammatory skin diseases, like say psoriasis, we do have these really highly effective treatments now. So we've sort of gotten used to these treatments where it's like, oh, I'm gonna put you on one medication and you're gonna be 90 to 100% better. And HS is not that way.
A lot of the time, HS is gonna require medical with medications in addition to surgery. And there aren't too many diseases that really follow that pattern for us. We're sort of used to some things, being a surgery is the answer, some things being medical is the answer. But for most of the time with HS, unless we catch it really early, which I hope that's the future as we always catch it and shut it down so early, no one needs surgery. But the reality is now, once it does some of that tissue damage and destruction and builds those tunnels, the medications typically can't get those to stop draining consistently. So then that may need a little surgery. So I think we're, we're getting a lot better and people are really adding surgical treatments. A lot of dermatologists are adding the surgeries to their repertoire of tools because sometimes you hit a wall with the medications where the inflammation is pretty calm, but I still have this spot that bothers me or is painful or gives me trouble and they just need a little surgery.
This content has been developed independently by Medthority who previously received educational funding from Novartis Pharma AG in order to help provide its healthcare professional members with access to the highest quality medical and scientific information, education and associated relevant content.