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LetterLetters

Family physicians’ role in hidradenitis suppurativa management

Valerio De Vita
Canadian Family Physician May 2017, 63 (5) 352-353;
Valerio De Vita
Naples, Italy
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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 burden4–7: 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.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. 1.↵
    1. Lee EY,
    2. Alhusayen R,
    3. Lansang P,
    4. Shear N,
    5. Yeung J
    . What is hidradenitis suppurativa? Can Fam Physician 2017;63:114-20. (Eng), e86–93 (Fr).
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Saunte DM,
    2. Boer J,
    3. Stratigos A,
    4. Szepietowski JC,
    5. Hamzavi I,
    6. Kim KH,
    7. et al
    . Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol 2015;173(6):1546-9. Epub 2015 Nov 3.
    OpenUrl
  3. 3.↵
    1. Bettoli V,
    2. Pasquinucci S,
    3. Caracciolo S,
    4. Piccolo D,
    5. Cazzaniga S,
    6. Fantini F,
    7. et al
    . The hidradenitis suppurativa patient journey in Italy: current status, unmet needs and opportunities. J Eur Acad Dermatol Venereol 2016;30(11):1965-70. Epub 2016 May 2.
    OpenUrl
  4. 4.↵
    1. Shlyankevich J,
    2. Chen AJ,
    3. Kim GE,
    4. Kimball AB
    . Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis. J Am Acad Dermatol 2014;71(6):1144-50. Epub 2014 Oct 14.
    OpenUrlCrossRefPubMed
  5. 5.
    1. Menter A
    . Recognizing and managing comorbidities and complications in hidradenitis suppurativa. Semin Cutan Med Surg 2014;33(3 Suppl):S54-6.
    OpenUrl
  6. 6.
    1. Kohorst JJ,
    2. Kimball AB,
    3. Davis MD
    . Systemic associations of hidradenitis suppurativa. J Am Acad Dermatol 2015;73(5 Suppl 1):S27-35.
    OpenUrl
  7. 7.↵
    1. Miller IM,
    2. McAndrew RJ,
    3. Hamzavi I
    . Prevalence, risk factors, and comorbidities of hidradenitis suppurativa. Dermatol Clin 2016;34(1):7-16.
    OpenUrl
  8. 8.↵
    1. Lima AL,
    2. Karl I,
    3. Giner T,
    4. Poppe H,
    5. Schmidt M,
    6. Presser D,
    7. et al
    . Keratinocytes and neutrophils are important sources of proinflammatory molecules in hidradenitis suppurativa. Br J Dermatol 2016;174(3):514-21. Epub 2015 Dec 12.
    OpenUrl
  9. 9.↵
    1. Revuz JE,
    2. Canoui-Poitrine F,
    3. Wolkenstein P,
    4. Viallette C,
    5. Gabison G,
    6. Pouget F,
    7. et al
    . Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol 2008;59(4):596-601.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. Sartorius K,
    2. Emtestam L,
    3. Jemec GB,
    4. Lapins J
    . Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol 2009;161(4):831-9. Epub 2009 Apr 29.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Alavi A,
    2. Anooshirvani N,
    3. Kim WB,
    4. Coutts P,
    5. Sibbald RG
    . Quality-of-life impairment in patients with hidradenitis suppurativa: a Canadian study. Am J Clin Dermatol 2015;16(1):61-5.
    OpenUrl
  12. 12.
    1. Janse IC,
    2. Deckers IE,
    3. van der Maten AD,
    4. Evers AW,
    5. Boer J,
    6. van der Zee HH,
    7. et al
    . Sexual health and quality of life are impaired in hidradenitis suppurativa: a multicentre cross-sectional study. Br J Dermatol 2016 Aug 18. Epub ahead of print.
  13. 13.↵
    1. Kouris A,
    2. Platsidaki E,
    3. Christodoulou C,
    4. Efstathiou V,
    5. Dessinioti C,
    6. Tzanetakou V,
    7. et al
    . Quality of life and psychosocial implications in patients with hidradenitis suppurativa. Dermatology 2017 Jan 5. Epub ahead of print.
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Canadian Family Physician: 63 (5)
Canadian Family Physician
Vol. 63, Issue 5
1 May 2017
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