Groundbreaking: FDA Approved Humira for H.S.

FDA Approves Drug To Treat Skin Disease

The Pharmacy Times (9/11, Ross) reports that the Food and Drug Administration has approved AbbVie’s Humira (adalimumab) “to treat moderate to severe hidradenitis suppurativa (HS), an inflammatory skin disease.” According to the company, the drug is the “first and only FDA-approved therapy to treat HS among adults.”

Our Physician Assistant has penned an article in response to the groundbreaking news of Humira being approved for Hidradentitis Supprativa: Hidradentitis Supprativa( H.S) by Margene Tranter, PA-C

New medical treatment is now available, last week, a new medication has been approved by the FDA for the treatment of Hidradenitis. Humira (adalimumab) a medication used in Dermatology, as well as, other specialties in the past for inflammatory conditions such as Psoriasis, Psoriatic Arthritis, Crohn’s disease, and Ulcerative Colitis, has now been found to help in Hidradenitis Suppurativa.

This drug targets the inflammation pathway that is active in the disease process, like all medications there are risk and benefits.  This medication will require close follow up and laboratory monitoring, you should make an appointment with a medical provider to discuss your H.S. and determine if you are a candidate.

Hidradentitis Supprativa H.S, can be a painful and embarrassing condition. Practicing medicine as a Physician Assistant, I have participated in the care of patients suffering from Hidradentis in the specialties of Women’s Health and Dermatology.  The medical history for my gynecological patients with H.S. would often include “bumps down there”. Patients unsure if they had an infection and even more worried could they be contagious.  

Patients started noticing that the initial “bumps” developed around puberty and continued to progress with each outbreak becoming worse and more uncomfortable. In many cases these patients had suffered in silence, too embarrassed to ask questions or seek treatment.  Hidradentits in young teens is often described as pimple under the arm or in the groin that has not gone away or progressed and scarred and now new ones developing.

As male and female patients transition into adulthood and present in the medical Dermatology office they have had the diagnosis for years, and for some have required surgeries to treat the sequelae of the disease. Treating H.S., and the persistence of disease activity is a frustration for patient and for their medical provider. Having Hidradentis is not only an uncomfortable and often painful condition, it can lead to social avoidance and even depression.

So what’s happening in the skin  and progression of H.S?

Hidradentis has also been referred to as inverse acne, this is because like acne we have a clogging of a hair follicle with dead skin cells, this builds up and can create an overactive inflammatory response. The bacteria will take advantage and feed off the buildup skin cells and infect the clogged follicle.

The combination leads to even more significant inflammation swelling and pus formation causing the process to become cyclical so that you have new lesions developing as old ones resolve and often form scars and in some cases fistulas or tracks under the skin. The difference we see between acne and H.S is the location and involvement of the apocrine gland. Apocrine glands are found in the skin and they make  sweat.

The more you sweat the more active these glands are and these glands are located in higher numbers under the arms, in the groin, buttox area and near the anus.  Often in the early stages it can appear as solitary lesion mistaken as a boil or ingrown hair. Then it progresses to multiple lesions affecting areas such as under the arms, groin, buttox and in female patients sometimes under the breast. The amount and severity of disease can vary for each patient.

Who is at risk?

Often I have heard from patients what did I do to cause this, the truth is we still don’t know what causes hidradenitis. What we do know is that is starts around puberty and thus there is a hormonal component.  Inflammation also plays a role and there is an overactive inflammatory response to the clogged hair follicle.

Women tend to be more effected then men. Being overweight and smoking are risk factors, additonally, if you have a family member who has hidradenitis there is an increased risk of developing the disease as well.   We do know that hygiene does not play a role in disease development, so over cleaning these areas does not seem to affect the disease process.

What else are HS patients at risk for?

Secondary bacterial and fungal infections in H.S patients are not uncommon. Also because of the chronic inflammation and scar formation the risk of developing Squamous Cell Carcinoma, a skin cancer, in active disease areas can occur. Another important risk factor associated with H.S. is Depression. Hidradentitis can be both emotionally and socially difficult and because of this Depression it is not uncommon among patients diagnosed with H.S.

What treatments are available?

Currently, there is no cure for Hidradentitis.  Treating H.S in the past has been similar to acne in that we target the follicle and the bacteria responsible for creating inflammation. This is often done with topical treatments containing both Clindamycin and Benzoyl Peroxide. Other treatments have been directed at the keratinocytes (dead skin cells) that build up in the follicle such as Isotretinoin. Treatments such as Aluminum Chloride solution and Botox have been used to address excessive sweating as well. Surgery has been used for chronic and significant scarring and track formation.

Final note

I have found in treating patients with chronic disease two things have empowered my patients. First knowledge, the American Academy of Dermatology has some helpful and more in depth information about HS.  Second, talking with others who suffer from the disease and understand what it means to live with it on a daily basis. Because of the location of HS it is often a topic some patients don’t want to discuss with friends or family and that leaves no outlet which can be lonely. Below are some sites that may be helpful to you. Most of all, be brave, and have the conversation with your health care provider, you do not have to suffer

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