HS Is Not a Cosmetic Condition: Inflammation, Symptoms, and Coverage

"HS Is Not a Cosmetic Condition: Inflammation, Symptoms, and Coverage" puts a long-standing misconception under scrutiny.

Dr. Lev-Tov states that HS is everything except a cosmetic condition. For comparison, Dr. Lev-Tov asks us to consider a truly cosmetic condition: wrinkles. Wrinkles don't hurt, and wrinkles don't drain. He says using the term cosmetic in the same sentence as HS is inappropriate and couldn't be further from the truth, and then breaks the argument down.

In the skin, there are real inflammatory infiltrates that cause tissue damage, including scarring, tunnels, and abscesses. These changes are not associated with normal aging. Serum levels of inflammatory markers also change in people with HS, and there is sometimes a genetic predisposition.

On symptoms, the disease is painful, drains a great deal of exudate, and burns and itches. Flares tied to hormonal changes, as in women around their periods, show that something in the body is driving the skin disease.

Friction matters too. His patients flare after sitting for long periods on flights or in a truck. Systemic associations such as inflammatory bowel disease, inflammatory arthritis, and metabolic syndrome point to a systemic derangement that shows up most severely in the skin.

Function and burden follow. A wrinkle doesn't prevent working, but an HS flare can keep a patient from getting out of bed. The whole village of people needed to care for these patients makes the cosmetic comparison almost absurd.

Treatment can bring patients back into society emotionally, physically, functionally, and in productivity. Dr. Lev-Tov argues that coverage decisions should not treat HS as cosmetic. Clinicians and payers should instead ask how early treatment can prevent additional provider visits, surgery, hospital admissions, and suicide.

In "Improving HS Care: Early Detection, Awareness, and Reasons for Optimism," Dr. Lev-Tov will describe what needs to change in the healthcare system, and why he remains optimistic.