Q&A: Katrina Lee, MD, Sheds Light on Evolving Approaches to Hidradenitis Suppurativa

At the recent Dermatology Innovation Symposium in Anaheim, California, hidradenitis suppurativa (HS) took center stage in a compelling session led by Katrina Lee, MD, a clinical assistant professor of dermatology at USC Keck School of Medicine. In a conversation with Dermatology Times, Lee discussed the clinical challenges that continue to hinder timely diagnosis and treatment, outlined recent advances in our understanding of HS pathophysiology, and highlighted both established and emerging strategies for comprehensive management. With a focus on early intervention, multimodal therapy, and addressing the psychosocial burden of HS, Lee offered attendees practical insights that can be directly applied in clinical practice.

DT: What are the key clinical challenges you highlighted in your session on HS at the Dermatology Innovation Symposium? What do you hope attendees took away from your talk?

Lee: Hidradenitis suppurativa is frequently misdiagnosed or underdiagnosed, which can lead to significant delays in initiation of appropriate therapy for many. Average diagnostic delay ranges from 7 to 10 years, and even longer for some individuals. These delays increase the risk of disease progression and can result in the development of irreversible scarring and devastating impacts on quality of life. Early recognition and prompt treatment are essential to reducing these risks. I highlighted these challenges and stressed the importance of taking advantage of the “window of opportunity” with early and aggressive intervention to halt the progression of symptoms and tissue destruction.

I always look forward to the opportunity to connect with clinicians who are also committed to advancing care for those living with HS and highlight that as medical providers, we have the opportunity to shift the narrative from delayed diagnosis and treatment to early recognition and comprehensive medical and procedural management. I hope that attendees walked away feeling inspired and equipped with practical tools that can be directly implemented in their practices.

DT: How has our understanding of the pathophysiology of HS evolved in recent years, and how is this influencing treatment strategies?

Lee: Although the pathophysiology of HS is not yet fully understood, there has been significant progress in better understanding factors that contribute to HS disease. Although blockage of the hair follicles and abnormal keratinization is believed to be the primary inciting event, immune dysregulation alongside genetic, hormonal, and lifestyle factors are also thought to be contributors. Thus, a multimodal approach incorporating lifestyle modifications, hormonal modulation, and systemic anti-inflammatory agents is often necessary to control disease activity for many patients. Procedures, including local deroofings and wide excisions, can be utilized in conjunction with medical therapies to target fixed or persistent areas.

DT: What role do early diagnosis and disease staging play in improving long-term outcomes for patients with HS?

Lee: Early recognition and intervention are essential to optimizing long-term outcomes for patients living with HS. Uncontrolled HS can lead to severe pain, frequent urgent care/ED visits, hospital stays, social isolation, missed school or workdays, decreased work productivity, and higher rates of mental health disparities such as depression. HS also has the potential to become more recalcitrant the further it progresses. Early diagnosis and initiation of therapy have the potential to reduce scarring, tunnel formation, psychosocial burden, and enhance overall well-being.

DT: Can you speak to any promising innovations, whether in therapeutics, diagnostics, or multidisciplinary care, that are shaping the future of HS management?

Lee: It’s a very exciting time for the HS community. We now have 3 FDA-approved agents including adalimumab, secukinumab and most recently, bimekizumab which was approved in November of 2024. There are several other biologics, small molecule inhibitors, and topical agents with new mechanisms targeting various pathways that are currently being studied in clinical trials and the therapeutic pipeline for HS is rapidly expanding.

DT: How do you approach the psychosocial burden of HS in your own practice, and what tools or strategies do you recommend to support patients beyond medical treatment?

Lee: It is recommended that all patients with HS are screened for depression. At my institution, we screen all HS patients utilizing the Patient Health Questionnaire-2 (PHQ-2), a brief 2-question screening tool to help identify depression. We studied over 150 patients with HS who had completed the PHQ-2 and found over a quarter of patients screened positive and rates of positivity were similar across all Hurley stages. Actually, over half of the patients who screened positive did not have a pre-existing diagnosis of depression. The PHQ-2 tool has been tremendously helpful in identifying patients who may have undiagnosed depression and who may benefit from further evaluation by a mental health professional. It’s been a great tool to help springboard into a discussion on mental health resources, referrals to a therapist, and encouraging patients to seek further care with their primary care provider or a mental health specialist. Support groups are also an immensely valuable resource for patients and can be recommended by their providers; there are several organizations and online platforms that offer support for patients, including the HS Foundation, Hope for HS, HS Connect, and the Association of Hidradenitis Suppurativa & Inflammatory Diseases.