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- Presentation
Recalcitrant HS: What to Do Next?
Description
The discussion focuses on managing recalcitrant hidradenitis suppurativa (HS), emphasizing strategies and therapies for patients whose conditions are resistant to initial treatments. The speaker highlights a range of treatment options available in their toolkit, including topical treatments like Hiba cleanse and Klenda, as well as new topical medications showing promise in clinical trials. For systemic treatments, the speaker advises on antibiotics, hormonal therapies, and metabolic agents while cautioning against increasing antibiotic resistance. They outline various biologics and small molecule inhibitors used in treatment, noting that combination therapies (including dual biologics) can be beneficial in severe cases. A case study is presented involving a patient with long-standing HS and multiple treatment failures, illustrating the complexity of managing such cases. Following several unsuccessful treatments, the patient finally responds to a combination of upadacitinib and bhima-kaizumab, leading to significant improvement in his quality of life. The speaker reinforces the importance of timely intervention and shared decision-making with patients to optimize care. They conclude with a reminder of the impactful changes that effective management can bring to patients' lives and promote an upcoming HS conference for further engagement in ongoing research.
View moreConclusions
- Effective strategies for managing recalcitrant hidradenitis suppurativa (HS) involve a multimodal approach.
- Topical treatments like ruxolitinib and clascoterone show promise and are currently under investigation.
- Systemic antibiotics can be combined in various ways to enhance efficacy for patients who have failed initial treatments.
- Hormonal and metabolic therapies, such as spironolactone and GLP-1 agonists, should be considered in treatment plans.
- Oral retinoids need careful patient selection due to potential flaring effects.
- Combination therapies, including biologics or small molecular inhibitors with adjunct treatments, can yield better outcomes.
- Early initiation of biologic treatments is crucial for preventing treatment escalation to dual therapies.
- Dual biologic therapy may be beneficial for patients with extensive disease who have failed multiple treatment options, but risks should be considered.
- Patient quality of life significantly improves with effective management of HS, as seen in case studies.
- Shared decision-making is essential in tailoring treatments to individual patient needs.
- Maronese et al. Br J Dermatol. 2023
- Maronese et al. Expert Rev Clin Immunol. 2023
- Feagan et al. Lancet Gastroenterol Hepatol. 2023