Information Pharmacists Can Use to Improve Hidradenitis Suppurativa Awareness and Promote Early Treatment
Early diagnosis and treatment of hidradenitis suppurativa is the only way to stop its progression to a painful and debilitating disease. But first, it must be recognized at an early stage, which is a challenge since initial symptoms often seem like nothing more than a mild case of acne.
Pharmacist outreach to at-risk patients is essential. As you educate patients about this skin condition and raise hidradenitis suppurativa awareness, you give them the chance to see their physician while it’s still in an early stage.
Prevalence of Hidradenitis Suppurativa
The Genetic and Rare Diseases Information Center (GARD) provides information about hidradenitis suppurativa (HS), but the top statement on their web page—and the first thing pharmacists need to know—is this: HS is not a rare disease.1 Acknowledging it’s not rare is vital to ensuring that the condition isn’t overlooked. It’s also important because several reputable sources on the Internet still report it as a rare disease, which means some patients and health care practitioners may approach it with the wrong perspective, resulting in a misdiagnosis and improper treatment.
Prevalence data is still being studied, a task that’s hindered by variable signs and symptoms that make HS easy to confuse with other skin conditions. However, current epidemiology information shows the following:
- Prevalence – 1 to 2 percent of the general population.2
- Age of onset – Any time after puberty, but usually between the ages of 11 to 50 years. The average age of onset is 23 years. HS may occur before the age of 11, but that’s rare—onset before puberty occurs in fewer than 2 percent of patients.
- Sex – Current information says that women are 2 to 5 times more likely than men to develop HS.
- Family history – GARD offers information about HS because of its genetic nature. A family history is reported in about one-third of patients.
HS also has some associations with commorbities. Patients with HS are often smokers, but the condition is also significantly associated with a higher risk of other chronic health conditions such as arthropathies, dyslipidemia, polycystic ovarian syndrome, obesity, hypertension, diabetes, and thyroid disease. Metabolic syndrome and inflammatory bowel disease are two of the most prominent comorbidities:
- Inflammatory bowel disease – A study published in the January 2017 issue of the Journal of Investigative Dermatology reported that patients with HS are 2.6 times more likely to develop Crohn’s disease and have nearly double the risk of ulcerative colitis compared to the general population.3 On the flip side, patients with inflammatory bowel disease are about 9 times more likely to develop HS.4
- Metabolic syndrome – In April 2014, researchers from the Henry Ford Medical Center in Detroit conducted a retrospective chart review covering 18 months of data. They found 366 patients with HS—50.6 percent also had metabolic syndrome, compared with 30 percent in the control group.5
Presentation and Treatment of Hidradenitis Suppurativa
For years, HS was considered a disorder of the apocrine glands, but now the experts know it’s a defect of the follicular epithelium in apocrine gland-bearing skin. As a result, some prefer to call it acne inversa. As the alternative name implies, HS is different from acne because it does not affect sebaceous glands. Initial symptoms are often insidious, mimicking acne or folliculitis, so it’s easy to see how it might be misdiagnosed or patients may choose to self-treat with OTC products.
One of the best ways to identify HS is to ask where the “pimples” are located. Unlike acne, HS typically occurs in the armpit, groin, gluteal area and under the breasts. About half of patients report itching, while most experience pain or tenderness. Presentation follows this course:
- May begin as pimple-like bumps or a single abscess.
- Develops into red, tender bumps or lesions that enlarge, break open and drain foul-smelling pus.
- Leaking bumps or sores heal very slowly, leading to scarring and sinus tracts.
- Chronic relapsing inflammation occurs.
- Progresses to painful, deep-seated abscesses.
- Abscesses recur or persist for years—90 percent of patients have recurrent abscess formation with daily pain.
- Widespread disease with subsequent scarring and contractures restricts movement of legs or arms—about 50 percent develop atypical scarring.
Early diagnosis and treatment are vital to prevent HS from worsening. In later stages, surgery may be needed to treat abscesses, fistulas, scars, and sinus tracts. Treatments may include medical therapy and lifestyle changes.
- Adalimumab – only FDA-approved medication for HS—approved for adults with moderate to severe HS.
- Antibiotics – oral and/or topical
- Metformin – may help HS in patients with diabetes and/or metabolic syndrome
- Hormone therapy – may help reduce pain and fluid drainage in women
- Antiandrogens such as 5-Alpha-reductase inhibitors
- Methotrexate – only for severe cases
- Antibiotic combinations:
Pharmacists should also recommend these lifestyle measures:
- Diligent local hygiene using mild soap with non-irritating ingredients
- Use regular antiperspirants, not extra-strength
- Apply warm compresses – patients can make a cup of tea, then put the hot teabag on the painful area or simply run a clean washcloth under hot water, then keep the compress on for 10 minutes.8
- Wear loose-fitting clothing
- Don’t shave during flare-ups
- Stop smoking cigarettes – should help reduce frequency and severity of HS
- Lose weight if needed
Pharmacist Outreach Can Raise Hidradenitis Suppurativa Awareness
There’s nothing more frustrating for a patient than learning they could have prevented a health problem—if they had only known it existed. Pharmacists need to alert customers as they shop for OTC products to treat early symptoms. You could put up posters mentioning itchy or painful “pimples” in places where they don’t usually appear or offer a handout and an invitation to talk with the pharmacist at the check-out. You can also mention the condition when dispensing medications to patients with common comorbidities. Any effort that leads to proper treatment has the potential to change the outcome and improve long-term quality of life.
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- “Hidradenitis Suppurativa,” January 2017, https://rarediseases.info.nih.gov/diseases/6658/hidradenitis-suppurativa ↩
- “Hidradenitis Suppurativa,” May 2016, http://emedicine.medscape.com/article/1073117-overview ↩
- “Prevalence and Risk of Inflammatory Bowel Disease in Patients with Hidradenitis Suppurativa,” January 2017, https://www.ncbi.nlm.nih.gov/pubmed/28089682 ↩
- “Hidradenitis Suppurativa in Patients with Inflammatory Bowel Disease: A Population-Based Cohort Study in Olmsted County, Minnesota,” January 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4635068/ ↩
- “The Prevalence of Metabolic Syndrome in Patients with Hidradenitis Suppurativa,” April 2014, https://www.ncbi.nlm.nih.gov/pubmed/24433875 ↩
- “Hidradenitis Suppurativa Treated with Tetracycline in Combination with Colchicine: A Prospective Series of 20 Patients,” January 2017, https://www.ncbi.nlm.nih.gov/pubmed/28054351 ↩
- “Combination of Oral Zinc Gluconate and Topical Triclosan: An Anti-Inflammatory Treatment Modality for Initial Hidradenitis Suppurativa,” November 2016, https://www.ncbi.nlm.nih.gov/pubmed/27554338 ↩
- “Hidradenitis Suppurativa: Diagnosis and Treatment,” accessed January 2017, https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa#treatment ↩