Jennifer M. Fernandez, RD, is affiliated with the University of Arizona College of Medicine.
The relapsing-remitting nature of hidradenitis suppurativa (HS) can have a significant impact on patients with this condition. A recent study highlighted several physical symptoms of HS flares among patients with different HS severities in order to improve the understanding of this aspect of the disease.1
In the study, the researchers analyzed data from anonymous surveys posted to HS Facebook groups from February to March 2020. A total of 438 adult participants completed the surveys, which asked them to self-report their Hurley stage using text descriptions, select symptoms from a list to characterize their HS flares, and also to select their most defining flare symptom. Hurley stages I, II, and III were reported by 8.2%, 53.4%, and 38.4% of participants, respectively.
The most commonly reported flare symptom was pain (98.9%), followed by drainage (91.8%), itch 81.1%), bleeding (78.8%), increased number of new lesions (66.7%), and other symptoms (7.1%). In addition, 47.7% of participants reported experiencing all five symptoms during flares. Pain was reported as the most defining feature of flares by 78.8% of participants, followed by drainage (12.8%), itch (3.2%), increased lesion count (2.7%), bleeding (0.5%), and other (2.1%).
Dr Shi is associate professor of dermatology and the director of the Hidradenitis Suppurativa Clinic at the University of Arkansas School of Medicine.
In comparisons between Hurley stages, drainage was found to be more common during flares among participants with Hurley stage III and Hurley stage II compared with Hurley stage I (95.8% vs 91.9% vs 72.2%, respectively). Increased new lesions during flares were also significantly more common in Hurley stage III than in Hurley stage II and Hurley stage II than Hurley stage I (77.4% vs 64.1% vs 33.3%). This pattern was also noted for bleeding, which was significantly more common in Hurley stage III compared with Hurley stage II compared with Hurley stage I (86.3% vs 76.5% vs 58.3%).
In an interview with The Dermatologist, lead study author Jennifer M. Fernandez, RD, and corresponding author Vivian Shi, MD, discussed their study and these findings further, as well as their implication for clinical practice. Ms Fernandez is affiliated with the University of Arizona College of Medicine in Tucson, and Dr Shi is an associate professor of dermatology and the director of the Hidradenitis Suppurativa Clinic at the University of Arkansas School of Medicine in Little Rock.
The Dermatologist: This is a very interesting study. What made you decide to conduct it?
Ms Fernandez and Dr Shi: Patients with HS frequently report experiencing flares, but there is limited information available about the symptoms patients experience during flares. Currently, we do not have an optimal assessment tool for HS flares in clinical practice and in clinical trials. In this study, we wanted to understand more about the physical symptoms of HS flares from patients’ perspectives.
We believe the frequency and severity of HS flares are an important indicator of disease control and adequacy of current treatments. Having a clearer definition of HS flares would allow dermatologists to use flare frequency/severity to monitor treatment success in clinical practice and in research trials.
Also, we also hypothesized that flare symptoms could change based on disease severity, and our results confirmed this.
The Dermatologist: Why did you decide to use Facebook groups to recruit patients?
Ms Fernandez and Dr Shi: We recruited participants through HS Facebook groups because this allowed us to reach a large number of participants in a short amount of time. We believe research on HS flares is critical to managing patients with this devastating disease, so we wanted to conduct a pilot survey quickly to direct further research on this topic.
The Dermatologist: What were some of the notable findings from your study?
Ms Fernandez and Dr Shi: First, pain was the most commonly reported flare symptom, and it is experienced by nearly all HS patients during flares. In addition, pain was the most defining flare symptom for nearly 80% of patients.
Drainage was the second most commonly reported flare symptom, experienced by about 90% of patients. Patients also experienced itch, bleeding, and increased number of new lesions, among other symptoms. Half of patients experienced all five symptoms (pain, drainage, itch, bleeding, and increased number of new lesions) during flares.
The Dermatologist: What are the implications of these findings for clinical practice, particularly during the uncertainty of the COVID-19 pandemic?
Ms Fernandez and Dr Shi: Stress can trigger HS flares. We are concerned that the stress many patients are experiencing as a result of the COVID-19 pandemic may be causing more frequent or more severe flares. Additionally, the COVID-19 pandemic has resulted in many lost jobs and issues with the supply chain, and thus, patients may have difficulties obtaining their HS medications, which may affect their flares.
The Dermatologist: What key takeaways would you like to leave with dermatologists regarding flares among patients with HS?
Ms Fernandez and Dr Shi: Dermatologists should ask patients with HS: How often are you experiencing flares? And, what are the symptoms you experience during flares?
Pain is one of the most important symptoms to address as part of a comprehensive HS management plan.
The Dermatologist: What areas of future research are needed to improve the treatment of HS flares?
Ms Fernandez and Dr Shi: HS causes a lot of suffering for patients. Treatments for HS are very limited in their efficacy compared with treatments available for many other medical conditions.
Understanding the physical symptoms of HS flares is another step towards developing a standardized assessment tool for HS exacerbation. Research for HS is rapidly evolving, and we hope that this research leads to improved treatments so that our patients can have a better quality of life.
1. Fernandez JM, Thompson AM, Kirby JS, Hsiao JL, Shi VY. Characterizing physical symptoms of flare in hidradenitis suppurativa: a patient survey. Br J Dermatol. Published online July 23, 2020. doi:10.1111/bjd.19412