Patients with hidradenitis suppurativa (HS) may first be seen in a wide range of care settings, including primary care offices, at the pediatrician, in consultation with an obstetrician or gynecologist (OB/GYN), or in the emergency room.1-3
Close collaboration with healthcare professionals specializing in dermatology is preferred given their experience in working with and treating more complex skin diseases. Holistic management of an HS patient may require the intervention of different disciplines and healthcare professionals, ranging from mental health to surgery.1-3
HS Specialist: Dermatologist; NP or PA in Dermatology
- Provide or confirm diagnosis and develop management plan including prescribing appropriate treatments
- Play a central role in the care of the HS patient by:
- Developing relationships with primary care physicians (PCPs), OB/GYNs, pediatricians, and other partners in care to generate awareness about HS and to create an opportunity for swift HS patient referrals into dermatology to help manage disease activity
- Partnering with other specialties to ensure HS patients are getting the additional care or medical support they need to manage comorbidities associated with HS
- Monitoring HS patients over time to assess HS disease activity and effectiveness of their management plan—and modifying the plan as needed
Primary Care Physician/Pediatrician
- Provide initial diagnosis
- Begin initial treatment to alleviate acute symptoms associated with HS
- Partner with an HS specialist in dermatology to develop a treatment and management plan in hopes of preventing disease progression
- Provide ongoing care for the patient, particularly for comorbidities that may be associated with HS
OB/GYN
- Provide initial diagnosis
- Begin initial treatment to alleviate acute symptoms associated with HS
- Partner with an HS specialist in dermatology to develop a treatment and management plan in hopes of preventing disease progression
- Provide ongoing care for the patient, particularly for comorbidities that may be associated with HS
- May be consulted if hormonal treatment approaches are being considered
Wound Care Specialist
- Provide either disease-related or surgery-related wound care for patients with HS usually to protect open wounds, manage inflammation and infection, or to manage sinus tract drainage
- Teach patients proper wound care techniques to help patients care for open and draining wounds at home
- Confirm with the HS patient that they have an active relationship with an HS specialist in dermatology to manage HS disease activity
Psychiatrist/Psychologist
- Provide care for psychosocial symptoms of HS, such as severe depression, anxiety, or feelings of helplessness
- Help HS patients navigate situations with significant impairment in work, social life, or sexual function
- Confirm with the HS patient that they have an active relationship with an HS specialist in dermatology to manage HS disease activity
Other Specialties
- Nurse with specific training for therapeutic patient education tasks
- Emergency medicine: Patients with severe HS symptoms often seek medical attention in hospital emergency departments. Recognition of manifestations of HS for practitioners in the emergency setting and proper referral to appropriate specialists is critical to patient care
- Infectious disease specialist: Patients may be referred to a specialist in infectious diseases during their journey to diagnosis. Although an infectious disease specialist may be able to help address secondary infections related to HS, the patient should be referred to an HS specialist for HS diagnosis and management
REFERENCES
1. Lockwood SJ, Prens LM, Porter ML, Kimball AB. Treatment of hidradenitis suppurativa. In: Kimball AB, Jemec GBE, eds. Hidradenitis Suppurativa: A Disease Primer. Switzerland: Springer International Publishing AG; 2017:39-51. 2. Menter A. Recognizing and managing comorbidities and complications in hidradenitis suppurativa. Semin Cutan Med Surg. 2014;33(suppl 3):S54-S56. 3. Woodruff CM, Charlie AM, Leslie KS. Hidradenitis suppurativa: a guide for the practicing physician. Mayo Clin Proc. 2015;90(12):1679-1693.