Hidradenitis Suppurativa: Severity Scoring and Biologics

Overview / Definition Hidradenitis Suppurativa (HS) is a chronic, debilitating skin disease characterized by recurrent, painful nodules and abscesses in areas such as the axillae, groin, and buttocks. The condition is thought to arise from follicular occlusion leading to inflammation, which can progress to the formation of sinus tracts and scarring. HS significantly impacts patients' quality of life, often leading to psychological distress. Epidemiology HS affects approximately 1-4% of the population, with a higher prevalence in females than males. The onset typically occurs in the late teens to early adulthood, and it is often associated with other comorbidities, including obesity, metabolic syndrome, and Crohn's disease. Commonly affects individuals aged 18-40 years. More prevalent in women, with a female-to-male ratio of approximately 3:1. Associated with other inflammatory conditions. Pathophysiology / Mechanism The exact pathophysiology of HS is not fully understood, but it is believed to involve a combination of genetic predisposition and environmental triggers. Key mechanisms include: Follicular occlusion: Blockage of hair follicles leading to inflammation. Immune dysregulation: Altered immune response, particularly involving TNF-alpha and other pro-inflammatory cytokines. Microbiome alterations: Changes in skin microbiota may contribute to inflammation and disease progression. Clinical Presentation Patients with HS typically present with: Painful lumps or abscesses, often recurrent. Drainage of purulent material. Formation of sinus tracts and scarring over time. Lesions are most commonly found in intertriginous areas, and patients may also experience systemic symptoms such as fever during acute flares. The clinical course is often chronic with periods of exacerbation and remission. Diagnosis / Workup Diagnosis of HS is primarily clinical, based on the characteristic lesions and their distribution. Key diagnostic steps include: History and physical examinatio