Family physicians’ role in hidradenitis suppurativa management

I thank Dr Lee and colleagues for their very interesting review on hidradenitis suppurativa (HS) in the February 2017 issue of Canadian Family Physician.¹ It is hoped that family physicians will be more and more acquainted with HS, as I am convinced that the role of family physicians in HS management could be more substantial than it has been in the past.

There are at least 2 reasons for this. First of all, long delays in diagnosis are common, as HS is frequently misdiagnosed as a simple infection.² If left untreated, the disease causes substantial morbidity. In 40% to 70% of cases, family physicians are the first health care professionals consulted by patients suffering from HS. Even though patients suffering from HS have consultations with 1 or more dermatologists, family physicians are still the primary caregivers for 15% of patients after an HS diagnosis is received.³ Therefore, family physicians might speed up a diagnosis and facilitate patients’ access to HS-dedicated care if they acquire the skills to recognize and manage HS. Furthermore, HS is a systemic disease with a substantial comorbidity burden^4–7: cardiometabolic comorbidities (obesity, dyslipidemia, hypertension, diabetes) are not rare, as they are possibly linked to HS through common genetic and environmental factors and shared inflammatory pathways.⁸ Behavioural factors, such as cigarette smoking and high body mass index,^9,10 influence HS development, and lifestyle modifications are recommended. Hidradenitis suppurativa has a negative effect on patients’ quality of life and psychological support is often needed.^11–13 In light of this evidence, a multidisciplinary approach to HS is required: the traditional “single provider-patient dyad” model, based on the principle that one provider can cover all aspects of HS management, is inefficient. In an alternative model, in which the patients are followed by multiple specialist physicians covering several prespecified areas, family physicians might take on the role of coordinator. In fact, the lack of efficient communication among the different physicians is a frequent limitation of this second model. Moreover, the time constraints of patient visits that are required to meet productivity targets might represent a barrier to efficient care. The undeniable advantage of the relationship between patients and their family physicians lies in the intimacy that characterizes their interactions. Such intimacy is the foundation of personalized goals of care and fulfils the patient’s need for integrated care. Last but not least, it also ensures better communication among physicians and fosters a coherent treatment strategy.

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