A new class of drugs, known as JAK inhibitors and biologics, is emerging as a promising treatment for hidradenitis suppurativa (HS), a chronic and often debilitating inflammatory skin condition affecting an estimated one in 100 Britons.
HS causes painful, boil-like lumps to form deep under the skin, typically in areas like the armpits and groin. These lumps can lead to weeping sores and scarring if left untreated. For many patients, existing treatments such as antibiotics, antibacterial washes, and pain relief have proven insufficient in fully managing outbreaks and preventing future occurrences.
Experts suggest that JAK inhibitors, already used for conditions like rheumatoid arthritis and eczema, could be a significant advancement for HS by targeting the root cause: inflammation. These drugs work by blocking inflammatory signals at a cellular level. While they cannot reverse severe skin damage from advanced HS, they show potential in managing early or milder cases.
Dr. Abirami Pararajasingam, a consultant dermatologist and British Skin Foundation spokesperson, noted that the US is more proactive in prescribing these advanced medications due to fewer regulatory restrictions. In contrast, she highlighted that pricing issues in the UK can hinder patient access to these potentially life-changing drugs. "We need to be intervening earlier," Dr. Pararajasingam stated, emphasizing that chronic inflammation associated with HS can also increase the risk of other long-term health issues, including heart disease and stroke.
More than 700,000 people in the UK are now estimated to have HS. The condition arises from an overactive immune system triggering an abnormal inflammatory response when hair follicles become blocked and infected. Symptoms can range from small blackheads and under-the-skin lumps to severe, open wounds that cause extensive scarring. Women are more commonly affected, often experiencing symptoms in their teens.
Diagnosis can be challenging, with HS sometimes taking up to a decade to identify in the UK due to its resemblance to other common ailments and the lack of a definitive lab test. This diagnostic delay means many patients cope with the condition for years without understanding its cause, potentially allowing significant damage to occur. Dr. Beibei Du-Harpur, a clinical lecturer in dermatology at King's College London, pointed out that a lack of awareness among both patients and clinicians contributes to this issue.
While the exact cause of HS remains unclear, genetics are believed to play a role in about one-third of cases. Other contributing factors include being overweight and smoking. Nicotine can cause abnormal skin thickening that blocks hair follicles, while excess body fat releases inflammatory chemicals that can exacerbate HS. Deeper skin folds in individuals who are overweight can also provide an environment for HS eruptions.
Advancements in treatment include biologics, which target specific immune system proteins driving inflammation and tissue damage, thereby reducing flare-ups. Laurelle-Maria Sterling, 32, who has lived with HS since her teens, described how the drug adalimumab, a biologic also used for rheumatoid arthritis and psoriasis, significantly reduced her inflammation. "I still get occasional flare-ups but they no longer become as severe," she said.
In the US, drugs like adalimumab and JAK inhibitors are already being used for milder HS cases. A study published in Nature indicated that the JAK inhibitor povorcitinib reduced inflammatory nodules and abscesses in HS patients by over 50 percent. Dr. Du-Harpur expressed optimism that JAK inhibitor drugs will be made available by the NHS for HS patients within the next one to two years.