Building Better HS Treatment Plans Through Case-Based Discussions

Led by Martina Porter, MD, vice chair of research and academics at the department of dermatology at Beth Israel Deaconess Medical Center and assistant professor of dermatology at Harvard Medical School, a recent Dermatology Times Case-Based Roundtable provided clinicians with a platform to discuss complex cases or hidradenitis suppurativa (HS), share insights, and explore evolving therapeutics in a collaborative format.

Case 1: Managing Complex Patients and Timing of Biologics

The first case involved a middle-aged patient with severe HS characterized by extensive tunnels, scarring, and frequent flares that significantly impair quality of life. The patient had a long-standing history of the disease, with prior surgeries and multiple biologic treatments that offered limited relief. Porter emphasized that “the main thing is that this is a disease that doesn’t just need medical treatment. It also means procedural treatment at all different times,” highlighting that management often involves a combination of approaches. She further clarified that decision-making depends not only on clinical criteria but also on patient preferences. This reflection underscores the importance of individual patient factors, such as their motivation, concerns, and lifestyle, when deciding whether and when to escalate to biologic therapy.

Moreover, the discussion reinforced the significance of understanding differences in treatment data—such as efficacy and safety profiles of various biologics—that can guide more individualized decisions. For example, the session discussed how new guidelines from Europe are emphasizing earlier biologic use based on recent evidence, which helps clinicians stay informed about evolving standards of care.

Participants agreed that early biologic therapy, particularly anti-TNF agents, would be the most appropriate approach to control inflammation, prevent further scarring, and improve patient outcomes. There was also consensus on the importance of early intervention to halt disease progression and the potential benefit of combining biologics with procedural interventions for optimal results

Case 2: Understanding Long-Term Efficacy and Response Variability

In the second case, the focus shifted to long-term outcomes and treatment response variability in HS management. This was that of a young patient presenting with mild to moderate HS, primarily affecting isolated areas such as the axillae. The patient was bothered by the lesions but had no significant tunneling or scarring. Attendees witnessed compelling data illustrating the long-term efficacy of biologics. Porter highlighted that “the bigger trials use that quality of life measure called HiSCR,” emphasizing the importance of patient-reported outcomes like pain, intimacy, and daily functioning.

Panelists discussed that initial management should focus on topical therapies, like clindamycin or topical corticosteroids. Procedural options, especially laser de-roofing, were considered valuable adjuncts for localized disease, capable of reducing inflammation and preventing progression. This approach aimed to control symptoms early and minimize the need for systemic therapy.

Case 3: Rapid Disease Progression and Early Intervention

The third case centered on the rapid progression some HS patients can experience, fueling discussions about early intervention. This case involved a young woman with clinically mild HS sparing the underlying structures but reporting considerable distress from the visible lesions and odor. Despite low lesion counts, the patient experienced significant psychosocial disability. The conversation elucidated how quickly inflammation can escalate, leading to tissue destruction and scarring if not promptly managed. Recognizing that most patients with certain phenotypes may deteriorate swiftly reinforced the need for vigilance and proactive management—key lessons for clinicians aiming to prevent irreversible tissue damage.

Panelists highlighted that treatment should be tailored to patient-reported impact rather than solely clinical severity. They suggested that early, aggressive intervention with procedural and laser options could help prevent worsening and scarring, especially given her high psychosocial burden. Counseling about expectations and a personalized treatment plan focusing on quality of life were emphasized

Valuable Peer Insights and Innovative Ideas

Participants shared their experiences with patient-centric tools such as symptom-tracking apps and managing expectations effectively. Porter observed that attendees were very willing to contribute, fostering a collaborative, solution-oriented atmosphere.

The Power of Interactive Discussions

Porter emphasized that “it is nice to meet other clinicians in the area, and I think that this is more interactive than a lecture,” highlighting the advantage of case-based formats for practical learning and peer exchange. Attendees gained insights into adjunctive interventions like laser hair removal and strategies for addressing insurance barriers.

Conclusion

This event demonstrated how discussions centered around real-world cases promote deeper understanding, boost confidence in management decisions, and foster professional connections. Attendees left equipped with nuanced approaches to HS, ready to incorporate new therapies and patient-centered strategies into their practices.