Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of Dermatology at the University of California Davis in Sacramento, spoke on challenges in the management of hidradenitis suppurativa (HS), as well as promising therapies in the pipeline that target specific pathways suggested to play a role in the pathogenesis and pathophysiology of the disease.
Hidradenitis suppurativa (HS) is a difficult disease to manage for dermatologists, but advances continue to be made in clinical research regarding comprehension and treatment of the disease, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of Dermatology at the University of California Davis in Sacramento.
Can you speak on recent advances and unmet needs in HS care management?
HS is definitely a difficult condition to manage. When I kind of think about psoriasis being a little more straightforward than eczema, I think of eczema being more straightforward than HS. So, HS really has this heterogeneous presentation. Sometimes it's just in the groin, sometimes it's in the axilla, sometimes it's both. It can be atypical and just be on the buttocks. We see this range of primary skin lesions. So, papules, pustules, some have nodules; we see prominent scarring.
So, this is really a very heterogeneous disease in presentation. And these are what we need to be taking on in the clinic and also in our clinical studies. We're just teasing out the pathogenesis of this condition. We’re starting to learn those patients who just get it in the axilla vs those that have prominent scarring. And we're starting to learn what that pathophysiology looks like.
There's some exciting advances happening in HS. We had big dramatic improvements in management when TNF [tumor necrosis factor] inhibitors were approved for this condition, but now we're starting to see studies that are quite advanced looking at the possible benefit of [interleukin] IL-17 blockade as a treatment strategy for HS.
There's been studies looking at the IL-1 signaling family and its role into HS’ development of disease around the hair follicle or the follicular unit. So, we're starting to tease out some subtleties that are going to open up the door. I think this will be the next big inflammatory condition that we learn to treat in dermatology. And as we do that, we're going to start taking biopsies of patients at different stages so that we can sort of better phenotype these groups early on, to have understanding about what therapies might be more effective in certain stages of disease. So, this is a really important disease that we tackle.