Renata Block, MMS, PA-C

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An expert in dermatology reviews the phase 3 SUNSHINE and SUNRISE trials evaluating the use of secukinumab given in 2-week intervals in patients with HS and shares clinical pearls for managing  the condition.

SUNSHINE and SUNRISE Trials in HS

An expert in dermatology highlights emerging biologic therapy for the management of HS.

Emerging Agents for the Management of HS

HS is a multifactorial disease that includes immunological factors. The fact that we are recognizing biologic therapy as a potential relief for these HS [hidradenitis suppurativa] patients and the first FDA-approved therapy, adalimumab, with the anti-TNF [tumor necrosis factor], is definitely making an impact. But knowing that this is the only thing that’s FDA approved is frustrating because we want to get other things covered. The data and the research is going to allow us to do that. I have experience with that one specifically, but not infliximab. With that being said, I had patients on adalimumab before it was FDA approved, and it was a game changer. It was such an exciting time because there was really nothing else out there, but what I see happening is that patients are doing well, if they’re caught early in the disease. If they are a little bit more advanced in the disease, I’ve had a lot of nonresponders, which, as a practitioner, it is disheartening because you have so much hope for the patient, and the patient has hope as well. I have had a secondary-loss response like that, one patient who was started before it was FDA approved. She did really, really well, and then we kind of peaked, and then it was stagnant. Then we’re starting all over again in regard to what was happening with her HS before she even started treatment. I know that the pipeline is getting robust in regard to the research of other immunological therapies out there. As a practitioner, it’s an exciting time for us that we can offer our patients promising drugs. It’s not going to be a one-size-fits-all treatment, and it never is, but having more options is going to be a game changer for us and the patient.

Renata Block, MMS, PA-C, comments on the use of biologic agents as part of immunomodulatory therapy for HS treatment.

Role of Immunomodulation in HS Treatment

Today’s standard of care of patients is multifactorial. We have to reach out and educate them on the nonpharmacological approach of treating this disease as far as weight loss, smoking cessation, and learning about the gut dysbiosis and the microbiome on the skin to know what’s happening within the body that’s causing this inflammatory response. The other thing is the psychosocial issues. Those are things that definitely have to be approached by the practitioner. In addition, we use topical therapies like intralesional Kenalog, or chronic treatments, of course.

I’m very happy that we have the FDA approval of biological therapies. Systemic oral antibiotics for acute flares work very, very well, but we also approach it hormonally. We approach the disease hormonally, specifically in our female patients, with the spironolactone therapy, or maybe with metformin. Recently I was taught that finasteride might be an option for our male patients. Finally, we have the surgical approach. There are surgical options that patients can learn about, such as the deroofing of these abscesses and surgical excision and allowing that wound to heal on its own. There have been some great data in regard to finding relief for these patients, but again, we need more. We need more guidelines of what actually works the best so that we can follow that pattern to success for our patients.

There are a lot of unmet needs, unfortunately, with HS [hidradenitis suppurativa]. The biggest unmet need is education. I applaud several pharmaceutical companies as well as the HS Foundation for sharing that information not only with our colleagues who are in the health care realm, but also the public at large. That is a movement that we’re seeing in the last 6 months, I’d say. That awareness is going to be out there. We have to keep these patients out of the emergency department and urgent care. That’s a bandage approach. We as practitioners have to educate those providers in regard to those referrals and get them into the dermatology clinic. Sometimes the dermatology clinic is booked out with a dermatologist for 4 or 6 months, but that’s where APPs [advanced practice practitioners] come in. That is where we offer that public service of those patients getting in sooner. Clinics have 911 emergency visits, and I offer that to my patients all the time. Just say, “Hey, call your 911 person. You’re getting in that day to get taken care of and don’t go to the emergency department, don’t go to urgent care.” The other thing is developing novel, validated medications to treat the disease. That goes also with the surgical options out there. We need to have these validated procedures that work and we approach them in a unified manner, knowing that our patient is going to get the results that they need. The support groups are out there. Like I said, they are stepping up in regard to educating the public at large. As practitioners in the dermatology realm, we have a responsibility to do that community outreach. I know I’m going to be doing that in the next 6 months, just hitting up places where I could gather the public and inform them of this disease. Finally, there is a need to design undergarments and clothing and wound-healing products for this disease because that does not exist. In a nutshell, those are the unmet needs. I have to say it’s a long list, but we’re going to get there.

An expert in dermatology reviews the current standard of care for treating patients with mild-to-moderate HS and discusses unmet needs in the clinical management of the condition.

Renata Block, MMS, PA-C

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