Assessing severity, treatment response, and phenotype in HS

Abstract

AbstractHidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent abscesses, nodules, tunnels, and scarring in intertriginous areas. However, disease presentation and phenotype can vary widely, leading to unique challenges in determining disease burden and response to therapy. Over three dozen severity measures have been used at various times to provide static staging and track response to clinical interventions, and there are at least five proposed classification systems for clinical phenotypes, derived by either statistical methods or expert opinion. As yet, no single staging, outcome‐measurement, or phenotyping schema has proven to be far superior to the others in clinical practice, and very few studies have attempted to map proposed phenotypes to either outcome or clinical response to therapy. In this review, we discuss proposed phenotype schemas as well as provider‐scored, patient‐scored, and composite scoring systems that have been proposed for grading HS severity. We include relevant benefits and drawbacks to their routine use, with a focus on the most popular and recently developed systems, in the hope of providing a framework upon which future studies can be built to ensure the best possible care for those suffering from this debilitating disease.