For the treatment of moderate to severe hidradenitis suppurativa (HS) in patients 12 years of age and older

HOW TO RECOGNIZE HS

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Recognizing
HS
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A Possible
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HomeModerate to Severe Hidradenitis SuppurativaOverviewRecognizing HS

Importance of Timely HS Identification

Hidradenitis suppurativa (HS) 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

HUMIRA is the only FDA approved treatment for hidradenitis suppurativa.

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

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2+ YEARS

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

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7-10 YEARS

is the average delay in diagnosing HS7

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4-5 PHYSICIANS

are typically seen before an HS diagnosis is made6-8

 

Identifying HS Lesions Identifying HS Lesions
Stages of HS Stages of HS

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 21.4,9,10

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.11,12

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

1 

Types of Lesions

Typical signs and symptoms of moderate to severe HS include4,13:

Inflamed, painful lesions and nodules

Inflamed, painful lesions and nodules

Abscesses

Abscesses

Sinus Tracts

Sinus tracts*
(non-draining or draining with malodorous discharge)

Double comedones

Double comedones

Bridged, hypertrophic scarring

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

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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

Stage I of HS

MILD/STAGE I4,9

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

Reprinted with permission from Jemec, 2012.9

Stage II of HS

MODERATE/STAGE II4,9,16

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

Stage III of HS

SEVERE/STAGE III4,9,16

Typically presents as diffuse or near-diffuse involvement with multiple interconnected sinus tracts 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 sinus tracts and scarring, that may leave irreversible, disabling damage.11

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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
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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

INDICATION(S) and IMPORTANT SAFETY INFORMATION FOR HUMIRA (adalimumab)1

INDICATION(S)1

Plaque Psoriasis: HUMIRA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. HUMIRA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.

Psoriatic Arthritis: HUMIRA is indicated, alone or in combination with non-biologic DMARDs, for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis.

Hidradenitis Suppurativa: HUMIRA is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.

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 develops a serious infection or sepsis. 

Reported infections include:

  • Active tuberculosis (TB), including reactivation of latent TB. Patients with TB have frequently presented with disseminated or extrapulmonary disease. Test patients for latent TB before HUMIRA use and during therapy. Initiate treatment for latent TB prior to HUMIRA use.
  • Invasive fungal infections, including histoplasmosis, coccidioidomycosis, candidiasis, aspergillosis, blastomycosis, and pneumocystosis. Patients with histoplasmosis or other invasive fungal infections may present with disseminated, rather than localized, disease. Antigen and antibody testing for histoplasmosis may be negative in some patients with active infection. Consider empiric anti-fungal therapy in patients at risk for invasive fungal infections who develop severe systemic illness.
  • Bacterial, viral, and other infections due to opportunistic pathogens, including Legionella and Listeria.

Carefully consider the risks and benefits of treatment with HUMIRA prior to initiating therapy in patients: 1. with chronic or recurrent infection, 2. who have been exposed to TB, 3. with a history of opportunistic infection, 4. who resided in or traveled in regions where mycoses are endemic, 5. with underlying conditions that may predispose them to infection. Monitor patients closely for the development of signs and symptoms of infection during and after treatment with HUMIRA, including the possible development of TB in patients who tested negative for latent TB infection prior to initiating therapy.

  • Do not start HUMIRA during an active infection, including localized infections.
  • Patients older than 65 years, patients with co-morbid conditions, and/or patients taking concomitant immunosuppressants may be at greater risk of infection.
  • If an infection develops, monitor carefully and initiate appropriate therapy.
  • Drug interactions with biologic products: A higher rate of serious infections has been observed in RA patients treated with rituximab who received subsequent treatment with a TNF blocker. An increased risk of serious infections has been seen with the combination of TNF blockers with anakinra or abatacept, with no demonstrated added benefit in patients with RA. Concomitant administration of HUMIRA with other biologic DMARDs (e.g., anakinra or abatacept) or other TNF blockers is not recommended based on the possible increased risk for infections and other potential pharmacological interactions.

MALIGNANCY

Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients treated with TNF blockers, including HUMIRA. Postmarketing cases of hepatosplenic T-cell lymphoma (HSTCL), a rare type of T-cell lymphoma, have been reported in patients treated with TNF blockers, including HUMIRA. These cases have had a very aggressive disease course and have been fatal. The majority of reported TNF blocker cases have occurred in patients with Crohn’s disease or ulcerative colitis and the majority were in adolescent and young adult males. Almost all of these patients had received treatment with azathioprine or 6-mercaptopurine concomitantly with a TNF blocker at or prior to diagnosis. It is uncertain whether the occurrence of HSTCL is related to use of a TNF blocker or a TNF blocker in combination with these other immunosuppressants.

  • Consider the risks and benefits of HUMIRA treatment prior to initiating or continuing therapy in a patient with known malignancy.
  • In clinical trials, more cases of malignancies were observed among HUMIRA-treated patients compared to control patients.
  • Non-melanoma skin cancer (NMSC) was reported during clinical trials for HUMIRA-treated patients. Examine all patients, particularly those with a history of prolonged immunosuppressant or PUVA therapy, for the presence of NMSC prior to and during treatment with HUMIRA.
  • In HUMIRA clinical trials, there was an approximate 3-fold higher rate of lymphoma than expected in the general U.S. population. Patients with chronic inflammatory diseases, particularly those with highly active disease and/or chronic exposure to immunosuppressant therapies, may be at higher risk of lymphoma than the general population, even in the absence of TNF blockers.
  • Postmarketing cases of acute and chronic leukemia were reported with TNF blocker use. Approximately half of the postmarketing cases of malignancies in children, adolescents, and young adults receiving TNF blockers were lymphomas; other cases included rare malignancies associated with immunosuppression and malignancies not usually observed in children and adolescents.

HYPERSENSITIVITY

  • Anaphylaxis and angioneurotic edema have been reported following HUMIRA administration. If a serious allergic reaction occurs, stop HUMIRA and institute appropriate therapy.

HEPATITIS B VIRUS REACTIVATION

  • Use of TNF blockers, including HUMIRA, may increase the risk of reactivation of hepatitis B virus (HBV) in patients who are chronic carriers. Some cases have been fatal.
  • Evaluate patients at risk for HBV infection for prior evidence of HBV infection before initiating TNF blocker therapy.
  • Exercise caution in patients who are carriers of HBV and monitor them during and after HUMIRA treatment.
  • Discontinue HUMIRA and begin antiviral therapy in patients who develop HBV reactivation. Exercise caution when resuming HUMIRA after HBV treatment.

NEUROLOGIC REACTIONS

  • TNF blockers, including HUMIRA, have been associated with rare cases of new onset or exacerbation of central nervous system and peripheral demyelinating diseases, including multiple sclerosis, optic neuritis, and Guillain-Barré syndrome.
  • Exercise caution when considering HUMIRA for patients with these disorders; discontinuation of HUMIRA should be considered if any of these disorders develop.
  • There is a known association between intermediate uveitis and central demyelinating disorders.

HEMATOLOGIC REACTIONS

  • Rare reports of pancytopenia, including aplastic anemia, have been reported with TNF blockers. Medically significant cytopenia has been infrequently reported with HUMIRA.
  • Consider stopping HUMIRA if significant hematologic abnormalities occur.

CONGESTIVE HEART FAILURE

  • Worsening and new onset congestive heart failure (CHF) has been reported with TNF blockers. Cases of worsening CHF have been observed with HUMIRA; exercise caution and monitor carefully.

AUTOIMMUNITY

  • Treatment with HUMIRA may result in the formation of autoantibodies and, rarely, in development of a lupus-like syndrome. Discontinue treatment if symptoms of a lupus-like syndrome develop.

IMMUNIZATIONS

  • Patients on HUMIRA should not receive live vaccines.
  • Pediatric patients, if possible, should be brought up to date with all immunizations before initiating HUMIRA therapy.
  • Adalimumab is actively transferred across the placenta during the third trimester of pregnancy and may affect immune response in the in utero exposed infant. The safety of administering live or live-attenuated vaccines in infants exposed to HUMIRA in utero is unknown. Risks and benefits should be considered prior to vaccinating (live or live-attenuated) exposed infants.

ADVERSE REACTIONS

  • The most common adverse reactions in HUMIRA clinical trials (>10%) were: infections (e.g., upper respiratory, sinusitis), injection site reactions, headache, and rash.

INDICATIONS1

  • Rheumatoid Arthritis: HUMIRA is indicated, alone or in combination with methotrexate or other non-biologic DMARDs, for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in adult patients with moderately to severely active rheumatoid arthritis.

  • Juvenile Idiopathic Arthritis: HUMIRA is indicated, alone or in combination with methotrexate, for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older.

  • Psoriatic Arthritis: HUMIRA is indicated, alone or in combination with non-biologic DMARDs, for reducing signs and symptoms, inhibiting the progression of structural damage, and improving physical function in adult patients with active psoriatic arthritis.

  • Ankylosing Spondylitis: HUMIRA is indicated for reducing signs and symptoms in adult patients with active ankylosing spondylitis.

  • Crohn’s Disease: HUMIRA is indicated for the treatment of moderately to severely active Crohn’s disease in adults and pediatric patients 6 years of age and older.

  • Ulcerative Colitis: HUMIRA is indicated for the treatment of moderately to severely active ulcerative colitis in adults and pediatric patients 5 years of age and older.

    Limitations of Use:
    The effectiveness of HUMIRA has not been established in patients who have lost response to or were intolerant to TNF blockers.

  • Plaque Psoriasis: HUMIRA is indicated for the treatment of adult patients with moderate to severe chronic plaque psoriasis who are candidates for systemic therapy or phototherapy, and when other systemic therapies are medically less appropriate. HUMIRA should only be administered to patients who will be closely monitored and have regular follow-up visits with a physician.

  • Hidradenitis Suppurativa: HUMIRA is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.

  • Uveitis: HUMIRA is indicated for the treatment of non-infectious intermediate, posterior, and panuveitis in adults and pediatric patients 2 years of age and older.

Please see Full Prescribing Information.

US-HUM-210183

References: 1. HUMIRA Injection [package insert]. North Chicago, IL: AbbVie Inc. 2. Nazary M, van der Zee HH, Prens EP, Folkerts G, Boer J. Pathogenesis and pharmacotherapy of hidradenitis suppurativa. Eur J Pharmacol. 2011;672(1-3):1-8. 3. Kerdel FA, Menter A, Micheletti RG. Introduction. Semin Cutan Med Surg. 2014;33(suppl 3):S47. 4. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60(4):539-561. 5. Woodruff CM, Charlie AM, Leslie KS. Hidradenitis suppurativa: a guide for the practicing physician. Mayo Clin Proc. 2015;90(12):1679-1693. 6. Saunte DM, Boer J, Stratigos A, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015;173(6):1546-1549. 7. Garg A, Neuren E, Cha D, et al. Evaluating patients' unmet needs in hidradenitis suppurativa: results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project. J Am Acad Dermatol. 2020;82(2):366-376. 8. Alavi A, Lynde C, Alhusayen R, et al. Approach to the management of patients with hidradenitis suppurativa: a consensus document. J Cutan Med Surg. 2017;21(6):513-524. 9. Jemec GBE Clinical practice. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158-164. 10. Collier F, Smith RC, Morton CA. Diagnosis and management of hidradenitis suppurativa. BMJ. 2013;346:f2121. 11. Micheletti RG. Natural history, presentation, and diagnosis of hidradenitis suppurativa. Semin Cutan Med Surg. 2014;33(suppl 3):S51-S53. 12. Kimball AB, Jemec GBE, eds. Hidradenitis Suppurativa: A Disease Primer. Switzerland: Springer International Publishing AG; 2017. 13. van der Zee HH, Jemec GBE. New insights into diagnosis of hidradenitis suppurativa: clinical presentations and phenotypes. J Am Acad Dermatol. 2015;73(5)(suppl 1):S23-S26. 14. Vazquez BG, Alikhan A, Weaver AL, Wetter DA, Davis MD. Incidence of hidradenitis suppurativa and associated factors: a population-based study of Olmsted County, Minnesota. J Invest Dermatol. 2013;133(1):97-103. 15. Vinding GR, Miller IM, Zarchi K, Ibler KS, Ellervik C, Jemec GBE. The prevalence of inverse recurrent suppuration: a population-based study of possible hidradenitis suppurativa. Br J Dermatol. 2014;170(4):884-889. 16. Data on file, ABVRRTI68916.