The advanced stage of hidradenitis suppurativa might lead patients to develop skin cancer.
Dr. José González Chávez, dermatologist; Dr. Alma Cruz, dermatologist; Dr. Samuel Sánchez Rivera, Vice President of the Dermatological Society of Puerto Rico. Photo: Journal of Medicine and Public Health.
Currently, from Medical Sciences Campus Some research projects are being carried out, which among other purposes, seek to raise a robust awareness of the autoimmune condition in Puerto Rico and treatments for these types of patients on the Island.
This was reported at a round table organized by the Journal of Medicine and Public Health, Dr. José González Chávez, a pioneering dermatologist and creator of the first clinics for patients diagnosed in Puerto RicoDr. Alma Cruz, dermatologist and founder of the External Clinical Sciences Program for hidradenitis suppurativa of the Medical Sciences Campus of the University of Puerto Rico and Dr. Samuel Sánchez Rivera, assistant professor at the Medical Sciences Campus and Vice President of the Dermatological Society of Puerto Rico.
Other studies have been more inclined in adolescents who suffer from this disease, since the objective is to investigate the affectation of hidradenitis suppurativa in their sexual life. “We need to make these patients understand that they are not alone, that there are more patients and knowing that you are not alone helps them too.”
In the same way, last 2021 an epidemiological and socioeconomic study of the growing population with this condition was carried out, to have an idea of the reality regarding this pathology in Puerto Rico.
“We don’t need it to be exported data, which is what we are always seeing, but rather real data from the island to be able to fight for more access to treatment, which we don’t have right now,” said Dr. Cruz.
Experts insist on making an early diagnosis of this condition, as stated by Dr. José González Chávez: “Today that 7-year delay should be unacceptable, patients have to be diagnosed earlier, because differential treatment should not fall back to the general practitioner or the pediatrician. It is us dermatologists who must be able, with the therapeutic alternative, to start early treatments that reduce the severity of the diseases and the patients can have a better quality of life”.
Hidradenitis Supurativa
According to the medical literature, hidradenitis suppurativa is defined as a chronic skin condition characterized by the appearance of bumps in the axillary, genital, pubic and gluteal areas.
Dr. González Chávez explains that previously this condition was known as acne reverse: “We are used to seeing that (acne) usually affects the face, but we can retrospectively understand that hidradenitis suppurativa arises because the lesions occur within the hair follicle and not It is not necessarily a disease of the hair, but it is a disease that is associated with a defect in the ducts of the apocrine glands”.
The progression of the disease is due to a genetic disorder, local factors and hormonal factors that contribute to the rupture of the follicle, generating abscesses, infections and fistulas.
Generally, as the specialist has observed, patients consult health professionals when they present clinical symptoms such as lesions, nodules, affected pimples, cystic lesions, open pros on the back and chest. In addition, this condition is related to pilonidal cysts and other pathologies of the scalp,
“There is a genetic factor, a hormonal role and immunological factors that become important in the process when the disease is triggered, and all of them, along with other external factors such as obesity, metabolic deregulation, hormonal factors exacerbate the condition,” stated Dr. Gonzalez.
On the other hand, Dr. Alma Cruz, dermatologist and founder of the External Clinical Sciences Program for hidradenitis suppurativa of the Medical Sciences Campus of the University of Puerto Ricoassured that this condition is more prevalent in women than in men, and that it often appears at puberty.
“It is more frequent in women than in men, 3 to 1, and it is usually diagnosed between 20 and 30 years of age. There is usually a peak in patients of 50 years of age, but it is less. However, studies show that there is a delay From the time the condition starts, to when you can have a diagnosis that actually says hidradenitis suppurativa, it can take 7 to 10 years.”
As mentioned by the expert, this means that the first signs of the disease might be presenting during childhood, but it takes 7 to 10 years to have a diagnosis and be able to start the appropriate treatment of the condition.
“This makes the prognosis of the disease difficult because these patients are being diagnosed late; sometimes this condition is very advanced and then management is more complicated,” the expert emphasized. In addition, he added that “1% of the population must suffer from this condition and the goal is to create awareness regarding what the disease is, not only in the medical class, but in the general population. So that these patients can be diagnosed more early and start aggressive treatment to stop the process of it.
Confusion with other skin diseases delay treatment
One of the characteristics of hidradenitis suppurativa is that it is not a permanent condition, but rather an intermittent condition, that is, it can manifest itself through small abscesses, disappear, and reappear. This reference to the condition is also a causal factor for the delay in diagnosis in patients, who can confuse it with pimples, folliculitis, recurrent abscesses, among others.
“Poor knowledge of the disease delays diagnosis. If we don’t think regarding hidradenitis suppurativa and we don’t have it in our differential diagnosis, when we are examining a patient and looking at the history, we are probably not going to be able to make an early diagnosis” said Dr. Cruz.
“As a skin professional, when you’re starting out, you can miss the diagnosis and the patient begins to move from doctor to doctor, they get desperate and that also contributes to the delay in diagnosis and when we reach the dermatologist, their case is already rather severe,” added Dr. Samuel Sánchez Rivera, assistant professor at the Medical Sciences Campus and Vice President of the Dermatological Society of Puerto Rico.
Stages of hidradenitis suppurativa
This condition consists of three stages and are known as Hurley I, II and III. The first is where small lesions begin to appear that can connect and form tracts. The second is the increase in these lacerations, both in number and location. And, finally, there is the healing stage which, in fact, is the most advanced stage and which is to be avoided, because according to Dr. Sánchez, scars predispose the development of skin cancer.
“The patient can have several lesions in one place, and what bothers them the most is the pain it causes, this being the most common complaint. On some occasions, movement of the arm or the affected area can be made impossible,” explained the specialist.
We must also take into account that the patient’s quality of life is affected, not only by the deterioration of physical health, but also by emotional deterioration; hidradenitis suppurativa interferes with the proper development of daily life, such as work, social life, life with a partner and sexuality.
“The moment you get infected with an abscess you have to go to emergency rooms, you have to wear certain types of clothing, the treatments are expensive and chronic,” said Dr. Cruz.
Treatment
Hidradenitis suppurativa is not curable. Unfortunately, it is a condition that, like non-communicable diseases, is chronic and the goal of treatment is to be able to control it and prevent its progression.
The success of the therapy depends on the patient being diagnosed early, since the more advanced the condition, medical management as the only alternative is not effective. “Many times we are forced to do medical management combined with surgical management, and that leads to greater comorbidity, because surgeries increase the risk of complications,” added the expert.
The three specialists agree that the management of this disease must be multidisciplinary, that is, that the treatment must involve the different specialties. This is how Dr. González explained it:
“There are many factors that are necessary before starting to consume the biological approved by the FDA, such as losing weight, controlling the metabolic syndrome that is common in these patients, consulting with a psychiatrist, psychologist, endocrinologist or sometimes the gynecologist. There are many approaches to the disease that need to be covered.”
See the full interview:
