SOURCE: Hessam S, et al. Correlation of inflammatory serum markers with disease severity in patients with hidradenitis suppurativa (HS). J Am Acad Dermatol 2015;73:998-1005.
Hidradenitis suppurativa sometimes has been called a “heart sink” diagnosis. Patients often suffer chronic bacterial infections in multiple body sites (axillae, chest wall, perineum, glutei) that are unsightly, often painful, and require multiple, often not fully satisfactory treatments. Recently, insights into some of the underlying immunologic pathologies in hidradenitis have prompted utilization of systemic pharmacotherapies usually reserved for patients with rheumatoid arthritis or advanced psoriasis. Though such rheumatologic immunomodulatory agents are expensive, and not without risk, the serious disease burden of hidradenitis, coupled with the generally poor results seen with “traditional” therapies, justifies their consideration.
Probably the two most commonly used scales in the dermatological literature to stratify disease severity in hidradenitis are the Hurley stage scale (stages I, II, and III, with III being most severe) and the modified Hidradenitis Suppurativa Score. Both scores use characteristics noted on physical exam, such as number of lesions, presence of fistulas, presence of sinus tracts, etc. to assess severity.
Hessam et al studied whether systemic markers of inflammation, such as C-reactive protein (CRP) and white blood cell (WBC) count, might correlate with disease severity as assessed through the two severity scales. By evaluating 275 cases of hidradenitis in which CRP and/or WBC had been reported, the investigators determined that there was significant correlation between CRP levels and both clinical scoring systems; WBC correlated only with Hurley stage scores. The authors suggested that measurement of CRP, an inexpensive and readily available test, in hidradenitis patients may enhance assessment of disease severity.
Measurement of C-reactive protein, an inexpensive and readily available test, in hidradenitis patients may enhance assessment of disease severity.
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