In recognition of Autoimmune Disease Awareness month, we turn our attention to conditions like Crohn’s disease, rheumatoid arthritis and psoriasis. These autoimmune diseases affect more than 23.5 million Americans.
As a specialty pharmacist in the Accredo Rheumatoid Arthritis and Inflammatory Conditions Therapeutic Resource CenterSM, my colleagues and I have deep clinical expertise of these conditions and even the lesser-known autoimmune diseases.
Understanding the Complexity of Hidradenitis Suppurativa
One example of a rare autoimmune disease is Hidradenitis Suppurativa (HS), a chronic, non-contagious, painful skin disease that causes boils to form in the folds of the skin. Complications from HS include infection, scarring, restricted movement and potentially, squamous cell cancer. In addition to the physical affliction, HS can have a profound impact on quality of life. Patients may become socially isolated due to the appearance and discomfort, and may experience emotional issues secondary to the disease.
The reason people develop HS is unclear, but it is thought that an abnormal response of the immune system plays a role. There are four significant factors that should be considered when determining if boils are due to HS.
- Recurrence of boils in same location
- Characteristic locations (e.g. armpits, under breasts, stomach folds, groin/genital area, buttocks). These areas have a higher density of hair follicles and oil/sweat glands.
- Symmetric presentation (i.e. appearing on both sides of the body)
- Co-morbidities (e.g. metabolic syndrome, obesity, diabetes, inflammatory bowel diseases, nicotine use, severe acne)
Worldwide, millions of people suffer from HS, with varying degrees of severity. It is estimated that up to 200,000 people have moderate to severe HS in the U.S.
Specialty Care for Specialty Conditions
Currently, since there is no true cure for HS, treatment is focused on managing symptoms, preventing new boils from forming and preventing complications. Treatment is also highly individualized, so specialized care is necessary. I counsel patients who may have to try a few different treatments before finding their most effective course of therapy.
- Weight reduction in obese patients
- Laser hair removal
- Smoking cessation
- Anti-inflammatory therapy
Biologics, like Humira® (adalimumab), are generally reserved for severe cases of Hidradenitis Suppurativa, and may be effective in a significant number of these cases. Accredo pharmacists like myself, provide guidance to patients as they learn to administer their injections at home. We also assist in managing potential side effects, including injection site reactions, serious infections, tuberculosis reactivation, and lymphoma. For example, I recently spoke with a patient whose disease was well-controlled with a biologic, but was experiencing sinus congestion and pressure. I counseled the patient and we talked through a plan of action to avert the risk of infection while maintaining appropriate treatment.
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