The exact cause of HS isn’t known, but an overactive immune system may play a role. HS occurs when hair follicles become blocked with bacteria, which can cause an immune system response that leads to inflammation, swelling, and redness. “It’s a severe and debilitating chronic inflammatory skin disease,” explains Haley Naik, MD, an assistant professor of dermatology and the director of the HS program at the University of California, San Francisco. Previously thought to be a rare disease, HS actually affects about 1 percent of the population. “That’s the same prevalence as psoriasis, but in comparison to psoriasis, HS is understudied, undertreated, and underrecognized,” adds Dr. Naik. “And it’s often misdiagnosed.” In fact, it often takes around 7 years to receive an accurate HS diagnosis. While you may feel embarrassed to talk about these symptoms with your doctor, it’s important to speak up and get proper care. That said, many other types of treatment have been and continue to be used to control skin lesions and reduce the discomfort of HS, including nonsteroidal anti-inflammatory medications (NSAIDs), antibiotics, corticosteroids, retinoids, and surgery to drain or remove abscesses. But biologics work differently: They block the underlying inflammatory process before it even starts. “Over the last 20 to 25 years, biologics have really become one of the best ways to target the immune system to improve disease states and also to minimize complications of oversuppressing your immune system,” says Iltefat Hamzavi, MD, FAAD, president of the Hidradenitis Suppurativa Foundation and a practicing physician at Hamzavi Dermatology Specialists and Henry Ford Hospital in Michigan. While adalimumab is the only biologic approved by the FDA for treating HS, others are also used sometimes to treat the condition. Each type of biologic targets a specific protein that’s thought to play a role in triggering the inflammation that contributes to HS.
Topical or systemic antibiotics, which can help infected lesions. “These are considered to be first-line therapy for HS,” explains Naik.Topical cleansing products, combined with warm baths or compresses and good hygieneNSAIDs, which can help alleviate painHormone therapy, to address the possibility that HS may be caused by a hormonal imbalanceCorticosteroids, which can help reduce inflammation and relieve symptomsRetinoids, or acne medications, to clear up the skin
“Currently, biologics are intended for people who have more moderate to severe HS that has not been responsive to first-line treatment,” explains Naik. If you’re having trouble controlling your HS, talk to your dermatologist. Together, you can come up with the right treatment — or combination of treatments — that can help. “It’s important to have a good relationship with a dermatologist who knows about you and your overall health in order to help you make good decisions about biologic treatment,” says Naik. You’ve learned a lot about biologics for HS. So what’s next? Take some time to absorb all of this info and decide if biologics are something you might want to consider.
