At the 2024 Elevate-Derm West Conference in Scottsdale, Arizona, Dr. Jennifer Hsiao, an associate professor of dermatology at the University of Southern California, shared insights on the management of hidradenitis suppurativa (HS). In her presentations, titled “Diet in HS” and “HS: Unroofing the Possibilities,” Dr. Hsiao addressed the role of diet in the disease’s progression and highlighted emerging therapeutic options for treating HS.
Dr. Hsiao, who directs clinical trials and operates an HS clinic at USC, expressed enthusiasm about providing updates on the latest treatment strategies for this chronic skin condition.
Dietary Insights in Managing HS
During her talk on diet, Dr. Hsiao emphasized that while the research on diet’s direct impact on HS is still limited, existing evidence suggests that certain dietary changes could benefit patients. She pointed to the Mediterranean diet, rich in leafy greens and low-glycemic foods, as a potential helpful approach. According to Dr. Hsiao, reducing the intake of processed foods and those with high glycemic indexes may help alleviate symptoms, though she cautioned against setting overly strict dietary goals. She stressed that lifestyle changes should be realistic and flexible, particularly for patients who must manage their diet daily. For example, indulging in a slice of birthday cake now and then is not a major setback, as long as it doesn’t become a habit.
However, Dr. Hsiao acknowledged that diet alone is not enough for many HS patients. For these individuals, medical therapies are often necessary to achieve significant symptom relief.
Therapeutic Advances for HS
In her second presentation, Dr. Hsiao turned to the available treatment options for HS, emphasizing the evolution of care in recent years. While topical treatments, hormonal modulators, and oral antibiotics are still part of the treatment landscape, she highlighted the transformative impact of biologics and small molecule inhibitors. These therapies have revolutionized the long-term management of HS, offering patients more effective options. Currently, two biologics—adalimumab and secukinumab—are FDA-approved for HS. Dr. Hsiao also expressed optimism that additional treatments, including bimekizumab and possibly JAK inhibitors or Bruton’s tyrosine kinase (BTK) inhibitors, may soon be available.
She noted that while biologics offer significant promise, early diagnosis remains crucial. HS should be considered when patients present with nodules or abscesses, especially in intertriginous areas like the armpits or groin. Dr. Hsiao reminded the audience that HS can occur outside of these classic areas, such as the neck, trunk, arms, and legs, and that its diagnosis should not be dismissed based solely on location.
Another key takeaway from Dr. Hsiao’s talk was the importance of multimodal treatment strategies. She recommended combining therapies such as spironolactone with biologics, as monotherapy may not provide sufficient relief for all patients. Surgical options, such as the excision or de-roofing of tunnels, remain an important part of care, as medications alone cannot fully address the physical structures of HS.
Precision Medicine: The Future of HS Treatment
Dr. Hsiao also discussed the potential for precision medicine to change the way HS is treated. She expressed hope that earlier diagnosis and intervention would allow for more effective treatment before patients develop severe disease, characterized by extensive scarring and tunnels. By initiating therapy earlier in the disease course, Dr. Hsiao believes it may be possible to prevent disease progression and avoid the need for major surgeries.
Her goal is to catch HS in its earlier stages, when biologics and small molecule inhibitors can be most effective, thereby preventing the need for extensive and invasive treatments later on.
Looking Ahead: New Therapies on the Horizon
The future of HS treatment looks promising, according to Dr. Hsiao. With more than 40 ongoing clinical trials for HS in Phase 2 and 3, she is optimistic about the expanding therapeutic options for patients. Dr. Hsiao expressed her excitement about having a wider array of safe and effective treatments to offer patients, providing them with hope and encouraging more individuals to seek care.
As new therapies come to market, she anticipates that they will not only improve outcomes for those already diagnosed but also encourage more patients—especially those who may have given up on finding effective treatment—to re-engage with healthcare professionals. The hope is that these advancements will help bring HS patients into care earlier, leading to better overall management and improved quality of life.
Conclusion
The recent presentations at Elevate-Derm West highlighted the growing understanding of both diet and advanced therapies in managing hidradenitis suppurativa. As the field moves toward precision medicine, earlier diagnosis and personalized treatment plans are expected to lead to better outcomes for patients. With ongoing advancements in biologics and other therapies, the future of HS treatment looks brighter than ever.
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