Hidradenitis suppurativa: development of outcome measure instruments.

Abstract

Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle, that usually presents after puberty with painful, deep-seated, inflamed lesions most commonly in the axillae, inguinal and anogenital regions. It has been well established that HS results in a significant decrease in quality of life and that patients with HS suffer from severe physical pain. HS has long been a neglected disease by skin researchers, but in the last 5 years HS research has gained momentum and in recent years, the number of HS-related publications has almost doubled in total. However, there are still important issues to address, most importantly the lack of a uniform, validated and dynamic tool to measure the efficacy of studied treatments. The oldest severity classification was developed by Hurley in 1989. However, it is not suitable for monitoring the efficacy of interventions in clinical trials because it is not quantitative, consisting of only three stages, and is based on static disease characteristics such as scarring and fistulas. In contrast, the Sartorius score, which was later modified, is a more detailed and dynamic severity score. However, it has been argued that it has limited applicability in more severe cases. More recently, a six-stage Physician Global Assessment (PGA) was developed as well as the Hidradenitis Suppurativa Clinical Response (HiSCR). The HiSCR has been defined as at least a 50% reduction in the number of inflammatory nodules and abscesses with no increase in the number of abscesses or draining sinuses, relative to baseline.5 The HiSCR is comparable with a Psoriasis Area and Severity Index 50 improvement in psoriasis. [...]