HS is believed to be caused by systemic inflammation, driven by proinflammatory cytokines such as TNF-α (tumor necrosis factor-alpha).2,3
Overexpression of TNF-α plays a key role in fueling HS inflammation.1,4In one study, HS lesions expressed 5 times more TNF-α than normal skin.4
TNF-α=tumor necrosis factor-alpha. Adapted with permission from van der Zee, 2012.6
HS is in the axillae
Adapted with permission from Jemec, 2012.7
As shown in the illustration above, follicular plugging in patients’ sensitive areas can lead to excess keratinocyte production and eventual ductal rupture, stimulating an immune system response. This cycle of TNF-α inflammatory response eventually becomes chronic.6
TNF-α PLAYS A ROLE IN MANY CHRONIC,IMMUNE-MEDIATED CONDITIONS1,4,8
Juvenile idiopathic arthritis
Adult Crohn’s disease
Pediatric Crohn’s disease
FOR A REFERRAL
“I refer my moderate to severe patients to a dermatologist. My relationship as an OB/GYN stays the same, so the dermatologist and I partner in the treatment of HS patients.”
– Insight from an OB/GYN
Dr. Cather discussesHS & THE MODERATE TO SEVERE HS PATIENT
HS & THE MODERATE TO SEVERE HS PATIENT
Dermatologist Dr. Cather discusses the chronic, progressive, inflammatory nature of HS disease, whom it typically affects, and the importance of early diagnosis and treatment. She also shares images of HS.
DR CATHER: Hi, I’m Dr. Jennifer Cather and I’d like to talk to you about hidradenitis suppurativa, or HS. The goal of this video is to help you understand the chronic, progressive, immune-mediated nature of HS; learn more about the people who have it; and highlight the importance of diagnosing and treating it early.
So, what exactly is HS? HS is a chronic, inflammatory skin disease that affects skin containing aprocrine glands. It’s characterized by nodules, abscesses and draining fistulas. HS can have a devastating effect on patients. As it progresses, nodules and abscesses can become more difficult to manage, increasing the impact HS has on a person’s life.
The exact cause of HS is unknown. But what we do know is, elevated levels of cytokines like IL-1ß, IL-10 and TNF-α play a key role in fueling HS inflammation. One study showed that HS lesions expressed five times more TNF-α than normal skin.
In HS patients, hair follicles become plugged and rupture, and an inflammatory response fueled by an overproduction of proinflammatory cytokines follows, causing an inflammatory nodule or abscess to form. Then, these lesions may heal, but the process becomes chronic. This can lead to sinus tracts and scarring. These wounds may become infected, but it’s important to note, HS is not a primary skin infection.
Let’s take a look at who the HS patient is. Approximately 200,000 people in the US suffer from moderate to severe HS, affecting more women than men. The age of onset is typically between a patient’s early 20s to 50s. Studies suggest tobacco use and obesity could potentially exacerbate HS. For women, the most commonly affected areas are under the breasts and in the groin. Men, however, are more commonly affected on the buttocks and in the perianal area.
So, as you can see, HS affects areas that are difficult to examine, and patients can find it embarrassing to show and discuss all aspects of the disease. Because of this, they often minimize the impact their disease has on their lives; it’s hard for them to ask for help. Sometimes it’s necessary for the physician to ask.
As HS progresses it causes the destruction of cutaneous architecture making it more challenging to treat. This could result in a number of debilitating medical and psychosocial sequelae. First, lesions can spontaneously rupture or coalesce to form painful abscesses. These often exude a purulent discharge.
Patients may also experience limited limb mobility or even loss of limb function, caused by excessive scarring and fibrosis produced by the lesions. And, patients may develop draining sinuses that may produce a foul discharge.
Between the drainage, the odor that comes from it, and the scarring, there’s a significant amount of burden for patients that accompanies HS. Especially with the odor. I’ve seen so many patients who always think they smell. Many of them have resorted to taping maxi pads underneath their arms to stop the dripping. I’ve heard patients say they’re embarrassed when friends and coworkers notice the nodules and abscesses in their armpits. I’ve also heard patients sat that even sitting down is uncomfortable when they have numerous lesions around their inner thighs and buttocks.
Hearing from patients what they go through and what they’ve missed out on, is heartbreaking. When physicians understand the impact that moderate to severe HS can have on a patient, they would prioritize this disease. It is crucial to treat patients’ symptoms and manage the underlying inflammation as soon as possible.