Professor Jacek Szepietowski from Wrocław University of Science and Technology, together with an international research team, has developed a new treatment model for the troublesome skin condition known as hidradenitis suppurativa (HS). Their findings were published in the prestigious journal The Lancet.
Experts believe this could revolutionize the approach to treating patients with this common and highly troublesome condition.
Hidradenitis suppurativa (HS), also known as inverse acne, is a chronic, inflammatory skin disease affecting approximately 1% of the global population. It is characterized by painful, deep-seated lumps, abscesses, and fistulas in areas such as the armpits, groin, genital regions, and under the breasts. Not only does the disease significantly lower the quality of life for those affected, but its associated inflammation also adversely impacts various body organs, leading to serious systemic complications, including inflammatory joint and bowel diseases, mood disorders, depression, and metabolic disturbances like diabetes. Consequently, these factors increase the risk of cardiovascular diseases.
Professor Jacek Szepietowski, a dermatologist-venereologist from the Medical Faculty of Wrocław University of Science and Technology and president of the Polish Dermatological Society, emphasizes that HS affects one in a hundred people, which means up to 350,000 individuals may suffer from it in Poland alone. Despite its prevalence, awareness about HS remains relatively low among both medical professionals and the public.
Source: press release
“HS causes immense psychosocial suffering and leads to significant economic losses due to decreased work activity,” the expert highlighted in a university statement.
Recent years have seen progress in HS pathogenesis research, largely due to earlier work by Professor Szepietowski, resulting in new treatment methods, primarily focused on cytokine neutralization. Cytokines are molecules involved in initiating and sustaining inflammation and even maintaining pathological pain.
The international research team, led by the Polish expert, has now developed a completely new therapeutic model, considering all crucial factors affecting the disease course, including disease phases and coexisting conditions, which the authors were the first to categorize globally. The researchers describe their approach as personalized and interdisciplinary.
As noted in their Lancet publication, hidradenitis suppurativa typically emerges in the second or third decade of life (primarily affecting the 18-35 age group) and predominantly affects women, although in Central Europe the ratio is 1.5:1, and in East Asia, men are equally, if not more, affected. Often, initial symptoms are misdiagnosed as boils, skin infections, or sexually transmitted diseases, leading to an average diagnostic delay of ten years.
This delay in diagnosis means that most patients develop severe skin changes, including fistulas and scars, which can even lead to impaired mobility and reduced work capacity. The numerous comorbidities associated with HS also significantly worsen the quality of life and overall health of the patients.
Professor Szepietowski’s team identified three disease phases: inflammatory, destructive, and burnout.
The scientist explained that the first phase involves painful nodules and abscesses appearing on the body, but the skin is not yet permanently damaged. In the second phase, the development of fistulas and scars leads to permanent skin damage. In the burnout phase, the inflammation subsides, but residual fibrosis and scarring can cause further complications.
The therapeutic approach developed by the researchers includes pharmacotherapy, surgical methods, and lifestyle modifications. Early implementation is crucial for halting disease progression and avoiding severe skin damage.
Until recently, HS treatment primarily involved antibiotics, which did not always yield expected results. Now, patients are offered biological drugs that neutralize key inflammatory cytokines, such as TNF-alpha and IL-17. These include adalimumab (an anti-TNF drug), approved in 2015, which effectively reduces inflammation and fistulas; secukinumab (an anti-IL-17A drug), approved in 2023, which decreases inflammation and prevents new skin lesions; and bimekizumab (an anti-IL-17A and IL-17F drug), approved in 2024, which offers broad anti-inflammatory action.
Other promising therapies under clinical trials include drugs blocking IL-1, IL-36, and JAK kinase inhibitors.
For advanced cases of HS, the researchers also proposed surgical methods ranging from removing individual lesions to extensive procedures to excise fistulas and scars. Combining surgery with biological drugs is key, according to the publication’s authors, as it reduces the risk of relapses and improves the quality of life for patients.
The third step in the model proposed by the team involves lifestyle changes. Weight reduction, quitting smoking, and avoiding mechanical skin irritation can significantly reduce the frequency of exacerbations. Psychological support for patients is also crucial, helping them manage stress and stigmatization often associated with the condition.
“Early diagnosis and treatment with the most effective therapies to control symptoms, stop the progressive destruction of the skin, and minimize the consequences of coexisting diseases are key concepts in the treatment of HS,” summarized Professor Szepietowski.
One of the greatest challenges in caring for patients with HS is the diagnostic delay. Within ten years of the first symptoms, the average patient visits at least three different doctors and often receives incorrect diagnoses. The earlier the diagnosis, the greater the chance of effective treatment and avoiding complications.
“We hope our publication will shorten the time needed to make the correct diagnosis, increase awareness about the systemic nature of the condition and the serious health consequences of HS, and provide the necessary resources for further translational research and interdisciplinary patient care,” emphasized Professor Szepietowski.
The research team also included another Polish scientist, Professor Łukasz Matusiak from Wrocław University of Science and Technology. Other experts represented Charité Medical University in Berlin, Northwell University in New York, Mayo Clinic in Rochester, the Medical Faculty in Santiago de Chile, and Munster in Ireland.
Professors Szepietowski and Matusiak have been conducting research on the pathogenesis and treatment of HS for over 20 years. They are authors of numerous scientific papers on the subject. They were the first in the world to demonstrate elevated levels of TNF-alpha and IL-17 in HS patients, paving the way for the development of effective biological therapies. They have also documented the effectiveness of acitretin in treating the disease, especially its follicular type.
The Polish researchers also actively participate in developing European guidelines for diagnosing and treating hidradenitis suppurativa and lead international courses for physicians.
Source: Polish scientist presents new therapy for burdensome skin disease in The Lancet | Science in Poland
