Practical Management Approaches for Patients with Hidradenitis Suppurativa

During the SDPA Annual Summer Dermatology Conference in Washington, DC, Ginette Okoye, MD, professor and chair of dermatology at Howard University College of Medicine, presented a session titled ‘Practical Management Approaches for HS’ on strategies for healthcare providers and patients in dealing with hidradenitis suppurativa (HS).

HS, a notoriously challenging and often misunderstood chronic inflammatory skin disease. Okoye’s talk at SDPA, tailored specifically for dermatology physician associates (PAs), provided a practical and comprehensive framework for approaching HS within clinical practice settings. Okoye began by outlining the clinical features and subtypes of HS, highlighting the value of early recognition and classification in order to better personalize care.

“If this is the first time you're hearing about HS, what I want you to leave this lecture with is the idea that HS is not just a skin disease,” Okoye explained during the session. “We know that psoriasis, atopic dermatitis, yes, they are skin diseases, but they represent systemic inflammation, and so does HS. Our patients with HS are at risk for other issues, cardiovascular disease, inflammatory bowel disease, depression, anxiety, and suicide. This is not a disease [in which] we could just hand somebody a prescription for antibiotics and send them on their way. They need systemic, multifaceted, and sometimes multi-specialty care.”

She detailed how HS can present along a spectrum—from isolated nodules to widespread abscesses and scarring—and discussed how different subtypes may influence therapeutic choices. Okoye went through several approaches including the use of lasers.

“If you get rid of the hair follicle in a permanent fashion, you absolutely decrease the number of new HS lesions that a patient will get in the future,” Okoye explained. “So laser hair removal is an excellent option for patients with HS, especially early in disease. And you know, any laser will do technically, but the Nd:YAG laser is the one that's been studied the most and the one that I would strongly recommend, not just because it gets rid of the hair. We know from the literature that this wavelength of light kills some of the bacteria that we know play a role in HS.”

Central to the session was a stepwise treatment approach that included topical agents, systemic antibiotics, hormonal therapies, and biologics like TNF-α inhibitors. Okoye also addressed the more important role of adjunctive strategies, such as weight management, lifestyle modifications, smoking cessation, and control of pain.

“The first thing is to talk to patients about their selection of undergarments,” Okoye said. “The goal is to decrease repetitive friction and repetitive pressure. One way to do that is to rotate their underwear types…The point is, the seam of the underwear should move. It should never be in the same place every day, that seems to make a difference…Another goal of the selection of clothing is to try to decrease the humidity next to the skin. We know that when patients sweat more, or when their clothing stays wet next to the skin, that's also more likely to trigger flares. We really should recommend sweat-wicking materials.”

Okoye’s guidance on disease flare management allowed attendees to have a set of actionable tools to help navigation of unpredictable symptom cycles. Notably, Okoye later highlighted the barriers to care that individuals with HS frequently face,ranging from delayed diagnoses to insurance coverage issues, and she provided attendees of her session with strategies to improve treatment access and adherence.

She also emphasized the power of empathetic communication, asking providers to build trust and to validate the experiences of their patients in a more obvious manner, given that such experiences are often marked by stigma and frustration when shared.

For dermatology PAs, Okoye’s presentation provided both clinical insights and practical approaches to help treat HS more effectively and compassionately. This increased awareness among attendees may ultimately allow for outcome improvements for a patient population that often struggles to find supportive care.

For more from the SDPA Meeting, view our latest conference coverage.