HUMIRA is approved for the treatment of moderate
to severe
hidradenitis suppurativa (HS) in patients
12 years of age and older.

HOW TO RECOGNIZE HS

Not an actual HS patient

Recognizing
HS

A Possible
Cause

The Role
of HUMIRA

Partnering With a
Dermatologist

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treat with
HUMIRA?

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Importance of Timely HS Identification

Hidradenitis suppurativa is a chronic, immune-mediated skin disease that can be progressive and debilitating.^2,3
It occurs in many patients’ most sensitive areas.⁴ Due to the progressive nature of HS, an early, accurate diagnosis is critical before symptoms become more severe.⁵

Prompt identification and diagnosis is one of the most unmet needs in managing HS³

2+ YEARS

is the average delay in seeing
a physician (from symptom
onset to first visit)⁶

7-10 YEARS

is the average delay
in diagnosing HS⁷

4-5 PHYSICIANS

are typically seen before an HS
diagnosis is made^6-8

Identifying HS lesions Identifying HS lesions

Stages of HS Stages of HS

HS ultrasound imaging HS ultrasound imaging

When identifying HS, it is important to know who is typically affected and the challenges that may delay diagnosis. Women are more likely than men to develop HS, with a 3:1 ratio. Symptoms occur in patients' most sensitive areas and can start at any time between puberty and middle age—with the average age of onset around 21.^6-8

There are 2 key reasons timely HS diagnosis can be challenging. First, patients may be embarrassed and wait until symptoms become severe before seeking medical attention. Secondly, early HS lesions may be mistaken for infections, STDs, or other skin conditions.^9,10

Three criteria must be present to consider a diagnosis of HS¹³:

1 Types of Lesions

Typical signs and symptoms of moderate to severe HS include^4,13:

Inflamed, painful lesions and nodules

Abscesses

Tunneling^*
(non-draining or draining with malodorous discharge)

Double comedones

Bridged, hypertrophic scarring

Consider asking your patient: Have you experienced tender, raised bumps or boils?

^*Photo courtesy of Dr. Marc Bourcier.

2 Location of Lesions

HS lesions typically appear in 1 or more of the following anatomical locations: axilla, groin, genitals, buttocks, or under the breasts. However, lesions can occur anywhere on the body.^11,13,14

Graphic of man and woman showing location of lesions on the body

Consider asking your patient:

Have these bumps or boils appeared on your inner thighs or groin, under your arms or breasts, or on your buttocks?

3 Recurrence of Lesions

Patients with HS often present with a history of chronic inflammation and recurrence of lesions in the same or different anatomical locations. Many HS patients will experience 2 or more recurrences over a 6-month period.^13,15

Consider asking your patient:

Have these symptoms reappeared 2 or more times in the past 6 months in the same or different location?

Other Considerations

To help with diagnosing HS, also consider asking your patients¹³:

Have any scars formed where you experienced these bumps?

Do you have a family history of similar symptoms and/or HS?

The severity of HS may be determined by the Hurley staging system, a widely used classification.^4,9

Hurley Stages II and III studied in PIONEER pivotal trials16.

MILD/STAGE I^4,9

Typically presents as abscess formation, single or multiple, without tunneling and scarring

Reprinted with permission from Jemec, 2012.⁹

MODERATE/STAGE II^4,9

Typically presents as recurrent abscesses with tunnel formation and scarring; single or multiple widely separated lesions

SEVERE/STAGE III^4,9

Typically presents as diffuse or near-diffuse involvement with multiple interconnected tunnels and abscesses across entire area

In a US study of 268 patients, 40% had Hurley Stage II or III disease at diagnosis.¹⁴

Photo courtesy of Dr. Marc Bourcier.

The Progressive Nature of HS

As HS goes undiagnosed, the disease can progress to more severe symptoms, such as the development of tunneling and scarring, that may leave irreversible, disabling damage.¹¹

Ultrasound views of sinus tract development by Hurley Stage can reveal deep subdermal damage caused by HS before comparable damage is visible on the surface.¹⁶

MILD/STAGE I

Patient 1: Dilation of hair follicles¹⁶

Enlargement of the base of the hair follicles in the deep portion of the dermis

Clinical image

3D ultrasound image with hair follicles outlined

Ultrasound imagery suggests that inflammation originates in the follicle, which grows distorted preceding perifollicular edema.¹⁶

Patient 2: Sinus tract¹⁶

Affected dermis and subcutaneous tissue

Clinical image

3D ultrasound image with hair follicles outlined of affected dermis and subcutaneous tissue.

3D ultrasound image with sinus tract starred (*) and outlined

One-third of patients classified as Hurley Stage I were shown to have subclinical sinus tracts.¹⁶

MODERATE/STAGE II

Patient 3: Formation of sinus tracts¹⁶

Involvement of multiple hair follicles

Clinical image

3D ultrasound image with hair follicles outlined of the involvement of multiple hair follicles.

3D ultrasound image with sinus tracts outlined

3D ultrasound imagery shows the formation of sinus tracts, which appear to be the result of lateral intrafollicular links and the involvement of the base of the hair follicles.¹⁶

SEVERE/STAGE III

Patient 4: Subcutaneous fluid¹⁶

Hypoechoic fluid collection with echoes (debris) in the subcutaneous tissue and dermis

Clinical image

3D ultrasound image with hypoechoic fluid collection outlined and starred (*) to show echoes in the subcutaneous tissue and dermis, also connected to the base of the hair follicles

With progressing disease, crypt-like structures appear as hair follicles and sinus tracts link to fluid collections, spreading in a linear fashion to the subcutaneous tissue.¹⁶

Often devastating for patients, frustrating for physicians

Partner with a dermatologist experienced in HS to confirm the diagnosis as soon as you suspect HS.

Find a dermatologist

I didn't want to tell my husband
or my doctor. I started hiding.
I just shut down.

– Insight from actual HS patient

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A Possible Cause

IMPORTANT SAFETY INFORMATION¹

SERIOUS INFECTIONS

Patients treated with HUMIRA are at increased risk for developing serious infections that may lead to hospitalization or death. Most patients who developed these infections were taking concomitant immunosuppressants such as methotrexate or corticosteroids. Discontinue HUMIRA if a patient

IMPORTANT SAFETY INFORMATION¹

SERIOUS INFECTIONS

	HUMIRA^a 40 mg EOW (n=151)		Placebo EOW (n=162)
Parameter: median	Baseline	24 Weeks	Baseline	24 Weeks
Tender joint count^b	20.0	5.0	23.0	17.0
Swollen joint count^c	11.0	3.0	11.0	9.0
Physician global assessment^d	55.0	16.0	53.0	49.0
Patient global assessment^d	48.0	20.0	49.5	49.0
Pain^d	54.0	20.0	49.0	49.0
Disability index (HAQ)^e	1.0	0.4	1.0	0.9
CRP (mg/dL)^f	0.8	0.2	0.8	0.7

	HUMIRA 40 mg EOW (n=151)		Placebo EOW (n=162)
Parameter: median	Baseline	24 Weeks	Baseline	24 Weeks
Number of tender joints	20.0	5.0	23.0	17.0
Number of swollen joints	11.0	3.0	11.0	9.0
Physician global assessment	55.0	16.0	53.0	49.0
Patient global assessment	48.0	20.0	49.5	49.0
Pain	54.0	20.0	49.0	49.0
Disability index (HAQ)	1.0	0.4	1.0	0.9
CRP (mg/dL)	0.8	0.2	0.8	0.7

	PIONEER I			PIONEER II
		HUMIRA EW(n=153) ^g	Control^e (n=154)^g	HUMIRA EW (n=163)^g	Control^f (n=163)^g
Gender, n (%)	Female Male	91 (59.5) 62 (40.5)	105 (68.2) 49 (31.8)	108 (66.3) 55 (33.7)	113 (69.3) 50 (30.7)
Race,^h n (%)	White Black Otherⁱ	116 (75.8) 33 (21.6) 4 (2.6)	118 (76.6) 29 (18.8) 7 (4.5)	143 (87.7) 9 (5.5) 11 (6.7)	130 (79.8) 20 (12.3) 13 (8.0)
Age in years: mean (SD)		36.2 (10.8)	37.8 (11.3)	34.9 (10.0)	36.1 (12.2)
Body weight in kg: mean (SD)	Female Male	(n=91)92.3 (23.2) (n=62)104.1 (25.8)	(n=105)97.5 (23.1) (n=49)103.1 (28.8)	(n=108)87.3 (21.8) (n=55)95.9 (20.7)	(n=113)90.9 (23.2) (n=50)106.5 (28.4)
Body mass index in kg/m²: mean (SD)		(n=152)33.0 (7.6)	(n=154)34.5 (7.9)	(n=163)31.3 (7.4)	(n=161)32.9 (7.9)

	PIONEER I			PIONEER II
		HUMIRA EW(n=153) ^g	Control^e (n=154)^g	HUMIRA EW (n=163)^g	Control^f (n=163)^g
Hurley Stage,^j n (%)	II III	80 (52.3) 73 (47.7)	81 (52.6) 73 (47.4)	86 (52.8) 77 (47.2)	89 (54.6) 74 (45.4)
Previous systemic treatment (%)	Any	71 (46.4)	63 (40.1)	82 (50.3)	76 (46.6)
Disease duration in years: median (range)		8.8 (1.1, 40.4)	9.4 (1.0, 43.0)	9.0 (1.0, 43.5)	9.9 (1.2, 68.5)
Family history of HS^k		39 (25.5)	32 (20.8)	39 (24.1)	43 (26.4)
hs-CRP in mg/L: mean (SD)^l		(n=152)20.3 (25)	(n=151)17.4 (20.2)	13.3 (18.0)	18.3 (30.7)

	PIONEER I			PIONEER II
		HUMIRA EW(n=153) ^g	Control^e (n=154)^g	HUMIRA EW (n=163)^g	Control^f (n=163)^g
Abscess and inflammatory nodule (AN) count categories, n (%)	≤5 6-10 ≥11	24 (15.7) 54 (35.3) 75 (49.0)	36 (23.4) 33 (21.4) 85 (55.2)	47 (28.8) 61 (37.4) 55 (33.7)	50 (30.7) 51 (31.3) 62 (38.0)
Abscess and inflammatory nodule (AN) count, mean (SD)		14.3 (11.9)	14.4 (14.8)	10.7 (8.1)	11.9 (11.0)
Abscesses, mean (SD)		2.8 (3.5)	2.7 (3.7)	2.0 (2.6)	2.4 (3.3)
Inflammatory nodules, mean (SD)		11.5 (10.9)	11.6 (13.9)	8.6 (6.9)	9.4 (9.6)
Draining tunnels, mean (SD)		4.6 (5.2)	3.8 (4.4)	3.0 (4.1)	3.7 (5.2)

HOW TO RECOGNIZE HS

Importance of Timely HS Identification

Prompt identification and diagnosis is one of the most unmet needs in managing HS3

2+ YEARS

7-10 YEARS

4-5 PHYSICIANS

1

Types of Lesions

2

Location of Lesions

3

Recurrence of Lesions

MILD/STAGE I4,9

MODERATE/STAGE II4,9

SEVERE/STAGE III4,9

In a US study of 268 patients, 40% had Hurley Stage II or III disease at diagnosis.14

MILD/STAGE I

Patient 1: Dilation of hair follicles16

Patient 2: Sinus tract16

MODERATE/STAGE II

Patient 3: Formation of sinus tracts16

SEVERE/STAGE III

Patient 4: Subcutaneous fluid16

Often devastating for patients, frustrating for physicians

I didn't want to tell my husband or my doctor. I started hiding. I just shut down.

INDICATION1

IMPORTANT SAFETY INFORMATION for HUMIRA (adalimumab)1

INDICATIONS1

References:

PIONEER I and II STUDY DESIGNS1,3,8,13

PIONEER I control=placebo PIONEER II control=placebo +/- antibiotic

PIONEER I control=placebo PIONEER II control=placebo +/- antibiotic

PIONEER I

PIONEER II

PIONEER I

PIONEER II

PIONEER I

PIONEER II

PIONEER I control=placebo PIONEER II control=placebo +/- antibiotic

PIONEER I

PIONEER II

PIONEER I

PIONEER II

PIONEER I

PIONEER II

PIONEER I and II STUDY DESIGNS 1,3,8,13

SELECT BASELINE PATIENT CHARACTERISTICS8

PIONEER I

PIONEER II

SELECT BASELINE DISEASE CHARACTERISTICS8,15

PIONEER I

PIONEER II

SELECT BASELINE LESION TYPE8.15

PIONEER I

PIONEER II

PIONEER I control=placebo PIONEER II control=placebo +/- antibiotic

IMPORTANT SAFETY INFORMATION1

SERIOUS INFECTIONS

INDICATION1

IMPORTANT SAFETY INFORMATION1

SERIOUS INFECTIONS

IMPORTANT SAFETY INFORMATION1

SERIOUS INFECTIONS

INDICATION1

IMPORTANT SAFETY INFORMATION1

SERIOUS INFECTIONS

INDICATION1

IMPORTANT SAFETY INFORMATION for HUMIRA (adalimumab)1

INDICATIONS1

Prompt identification and diagnosis is one of the most unmet needs in managing HS³

MILD/STAGE I^4,9

MODERATE/STAGE II^4,9

SEVERE/STAGE III^4,9

In a US study of 268 patients, 40% had Hurley Stage II or III disease at diagnosis.¹⁴

Patient 1: Dilation of hair follicles¹⁶

Patient 2: Sinus tract¹⁶

Patient 3: Formation of sinus tracts¹⁶

Patient 4: Subcutaneous fluid¹⁶

I didn't want to tell my husband
or my doctor. I started hiding.
I just shut down.

INDICATION¹

IMPORTANT SAFETY INFORMATION for HUMIRA (adalimumab)¹

INDICATIONS¹

PIONEER I and II STUDY DESIGNS^1,3,8,13

PIONEER I and II STUDY DESIGNS^1,3,8,13

SELECT BASELINE PATIENT CHARACTERISTICS⁸

SELECT BASELINE DISEASE CHARACTERISTICS^8,15

SELECT BASELINE LESION TYPE^8.15

IMPORTANT SAFETY INFORMATION¹

INDICATION¹

IMPORTANT SAFETY INFORMATION¹

IMPORTANT SAFETY INFORMATION¹

INDICATION¹

IMPORTANT SAFETY INFORMATION¹

INDICATION¹

IMPORTANT SAFETY INFORMATION for HUMIRA (adalimumab)¹

INDICATIONS¹