Overview of Hidradenitis Suppurativa (HS): A Multifactorial Disease

Renata Block, MMS, PA-C: Regarding the prevalence of hidradenitis suppurativa [HS], we’re finding that the female-to-male ratio in the United States as well as Europe is pretty high and is 3:1. I found it interesting because South Korea is kind of the outlier; they’re a ratio of 1:2. It’d be interesting to get the data as we become more familiar with this disease about the why in that regard. But with that being said, we have strong associations with obesity and tobacco use that can increase the disease severity, but there are other associations between HS and metabolic syndrome. We must look at 3 prongs of this disease because it is multifactorial, so we’re talking about a combination of genetics. We’re talking about a combination of environments, which can include tobacco use or…disruption of the skin microbiome, and the immunology factors that can play a role in the disease. So we can’t look at just one thing that is causing it, but instead must take a multifactorial approach.

The common symptoms of HS, which I see a lot in the clinic, is infection and scarring. Restricted movement is a big factor, and a lot of this can promote some psychological effects. In the end, the mind is a very powerful aspect of the human body and when you’re having chronic pain, chronic abscess, or chronic drainage, it leads to this hopelessness. As providers, that’s where we come in. We really have to spend time with these patients and listen to their concerns because it’s a lot more than just pain or restricted movement. There’s a lot going on with these patients. It’s, like I said, a multifactorial disease, but it’s also a multifactorial approach. The one thing that I do want to point out is the risk of squamous cell carcinoma, especially in that gluteal cleft area around the anal area, where we do see a lot of HS present itself. Patients may be embarrassed to even show that area, and I’ve experienced it. I’ve been doing this for 20 years. They don’t want to show you that area first thing out of the room when they meet you. It can take a few visits before they feel comfortable in regard to getting fully undressed and sharing that information with you.

Transcript Edited for Clarity