Dr. Micheletti discusses clinical pearls from his lecture, Hidradenitis Suppurativa in Focus: Latest Findings, at the 6th Annual Elevate-Derm Fall Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

In conversation with Veronica Richardson, Dr. Micheletti frames HS as a "tremendously impactful disease" that dermatology providers are good at recognizing but often fall short in managing — patients face a seven-to-ten year diagnostic delay and readmission rates rivaling heart failure. His message: embrace the role of an HS provider and "be that solution for that patient who's suffering." He emphasizes the "window of opportunity" — reaching patients early with effective therapy to prevent scarring, tunnel formation, and suffering — and not lingering on doxycycline or spironolactone when an inflammatory phenotype or sinus tracts signal a need to move to a biologic.

He also stresses that the inflammation on the skin reflects systemic inflammation, so these patients carry higher risk of diabetes, metabolic syndrome, cardiovascular disease, inflammatory arthritis, and chronic anemia — and may be seeing no one but their dermatologist. Because HS is a chronic relationship, he notes providers don't have to do everything in the first visit; they can build trust and chip away at comorbidity screening over time. Looking ahead, he points to exciting data on JAK inhibitors, a combined TNF-inhibitor/OX40-ligand agent, and growing interest in combination biologic therapy to hit multiple pathways in severe patients.

  • Embrace the role of HS provider — with more therapeutic options now, treating HS can be "life-changing."
  • Act within the "window of opportunity": diagnose and treat early to prevent scarring and tunnel formation, and don't linger on doxycycline or spironolactone when sinus tracts, scars, or an inflammatory phenotype point to moderate-to-severe disease.
  • Risk factors for progression include HS in two or more areas (three worse than two), smoking, and higher weight — plus the clinical "inflammatory vibe" of heavy drainage, erythema, pain, and swelling.
  • Screen for systemic comorbidities — diabetes, metabolic syndrome, cardiovascular disease, inflammatory arthritis, anemia — check A1C and lipids, and refer to primary care or cardiology; you don't have to address everything in the first visit.
  • Watch the emerging pipeline: JAK inhibitors, a combined TNF-inhibitor/OX40-ligand drug, and combination biologic therapy to target multiple pathways in severe patients.