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?

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 made6-8

 

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:

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

Tunneling*
(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

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.
Stage I of HS

MILD/STAGE I4,9

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

Reprinted with permission from Jemec, 2012.9

Stage II of HS

MODERATE/STAGE II4,9

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

Stage III of HS

SEVERE/STAGE III4,9

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 of dilation of hair follicles.

Clinical image

3D ultrasound image with hair follicles outlined.

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 of 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 of 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 of a hidradenitis suppurativa underarm case classified as Hurley Stage III.

Clinical image

3D ultrasound image with hypoechoic fluid collection outlined and starred.

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.

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