A new class of drugs, including JAK inhibitors and biologics, are emerging as promising treatments for hidradenitis suppurativa (HS), a chronic inflammatory skin condition affecting an estimated one in every 100 Britons. While existing treatments for HS, such as antibiotics and antibacterial washes, often fall short for severe cases, these newer medications target the underlying inflammation driving the disease.
HS causes painful, boil-like lumps to form deep under the skin, typically in areas like the armpits and groin. These lumps occur when hair follicles become blocked, and in severe cases, can lead to weeping sores that may require surgical removal. The condition can vary significantly in severity, with some experiencing mild lumps and others developing chronic, scarring lesions. It is more common in women, often appearing in the early to late teenage years.
Experts suggest that while these new drugs cannot reverse existing severe skin damage, they could be a significant advancement for individuals with early or milder forms of HS. Dr. Abirami Pararajasingam, a consultant dermatologist and spokesperson for the British Skin Foundation, noted that the United States is generally more proactive in prescribing these medications compared to the UK, where pricing issues can create barriers to patient access.
"In the UK, there are issues with pricing that mean patients can’t access them," Dr. Pararajasingam stated. "Not only is HS painful and, for many, embarrassing, chronic inflammation is also a risk factor for other long-term health issues – from heart disease to stroke. We need to be intervening earlier."
Diagnosing HS can be challenging, often taking up to ten years in the UK because its symptoms can mimic other common ailments and there is no single definitive lab test. This diagnostic delay means many patients cope with the condition for years without understanding its cause. "If HS is diagnosed and treated early, much of the worst damage can be avoided," said Dr. Beibei Du-Harpur, a clinical lecturer in dermatology at King’s College London. "People are just sitting at home coping as that damage is occurring because they don’t understand what’s happening. This lack of awareness is also a huge issue among clinicians."
While the exact cause of HS remains unknown, factors such as genetics, being overweight, and smoking are believed to play a role. Nicotine in tobacco smoke can cause abnormal skin thickening, blocking hair follicles, while excess fat tissue releases pro-inflammatory chemicals that can trigger or worsen HS. Deeper skin folds associated with being overweight can also provide an environment for eruptions. However, some individuals may be predisposed due to their hair follicle and oil gland structure.
Laurelle-Maria Sterling, 32, has lived with HS since her teenage years. After years of antibiotic treatments that did not fully resolve her outbreaks, she began taking adalimumab, a biologic drug also used for conditions like rheumatoid arthritis and psoriasis. "It calmed down the level of inflammation," Sterling reported. "I still get occasional flare-ups but they no longer become as severe."
A study published in Nature highlighted the efficacy of JAK inhibitors, with one such drug, povorcitinib, reducing inflammatory nodules and abscesses in HS patients by over 50 percent. Dr. Du-Harpur anticipates that the NHS may begin rolling out JAK inhibitor drugs for HS patients within the next one to two years. Historically, the political theorist Karl Marx was among the notable figures who suffered from HS.