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- Presentation
Recalcitrant HS: What to Do Next?
Description
The lecture discusses treatment strategies for recalcitrant hidradenitis suppurativa (HS) patients, emphasizing the complexity of managing this condition when initial treatments fail. It defines recalcitrance as continued disease progression despite appropriate treatment over a reasonable timeframe and highlights the assessment methods, including pain and quality of life scores. The speaker outlines treatment options for both mild and severe HS, noting that topical therapies like chlorhexidine and clindamycin may be useful for milder cases, while moderate to severe cases may require systemic antibiotics, hormonal therapies, biologics, and small molecule inhibitors. It stresses the importance of combination therapies, such as using antibiotics alongside biologics. The lecture introduces new biologics, including adalimumab and the recently FDA-approved sikukinumab, and discusses dosing strategies for these therapies. It also covers alternative treatments for patients not responding to standard therapies, such as IV erdopenem for severe cases and the potential use of dual biologic therapies. The key takeaway emphasizes the need for personalized treatment approaches, balancing the aggressive nature of HS against treatment risks, while also acknowledging the significant emotional and physical burdens faced by patients.
View moreConclusions
- Recalcitrant hidradenitis suppurativa (HS) is defined as the patient's condition remaining uncontrolled despite appropriate treatment over a reasonable time period.
- Assessment of recalcitrance can include monitoring patient-reported outcomes such as pain and quality of life scores as well as the frequency of bad weeks.
- Topicals and systemic antibiotics are initial treatment options for mild cases, but many patients eventually require more aggressive therapies.
- Combination therapies are often necessary for moderate to severe HS, incorporating antibiotics, hormonal treatments, or biologics.
- Biologics such as adalimumab and secukinumab are FDA approved for HS, with dosage adjustments necessary when efficacy diminishes.
- For severe recalcitrant cases, intravenous antibiotics like ertapenem can provide quick relief while transitioning to long-term therapies.
- Combination of biologics may benefit patients when standard treatments fail, although more evidence is needed to support this approach.
- Patient comfort and the potential for suffering should be key considerations when determining treatment options.
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