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Dear expert panel

My daughter is 19 and was diagnosed with HS in April this year. She was diagnosed one year after the first lesion appearing. It is currently mild (two lesions, one on the back of her upper leg and one under her buttock). She has had no new lesions appear for a year but the lesion on the back of her leg has flared twice. She is thin (60 kilos and 181 cm tall). There is no history of HS in our family but I have rheumatoid arthritis. She does not smoke and she is now on a ‘clean’ diet (no dairy, no wheat, very few nightshades, very little sugar). In April she was put on Lymecycline 408 mgs daily indefinitely. My questions are:

1. Is it possible that it will not progress given it is mild and was caught early? Do you see cases that are very mild that do not get worse? Everything we see and read online is about cases that are quite bad (even in Hurley Stage 1) and we wondered if very mild cases like hers are simply not reported but might be common?

2. She would like to have laser treatment to remove hair in areas prone to HS. We read that ND-YAG is an OK laser treatment for HS. Where can she get this done? Can she get it done on the NHS? Is there a specialist clinic that provides this type of laser especially for HS?

3. What further preventative lifestyle changes would you recommend?

4. What other treatments would you recommend?

5. Are there any new treatments that might arrest the progression of her disease now while it is very mild?

Thank you very much for answering my questions.

Many thanks for your questions. I will do my best to answer them as fully as possible.

1. There are many people with mild symptoms who are managed by their GPs and will not require referral to a specialist. It is not inevitable for symptoms to progress, in fact severity may even improve with time.
You are correct, there is publication bias when it comes to symptom severity. HS is a difficult condition to manage and the majority of publications focus on treating patients with severe symptoms.

2. Although HS affects hair bearing areas, the cause of lesions is complex and multifactorial. Laser hair removal will not necessarily improve symptoms. It is not a treatment that is generally recommended for HS.

3. Simple interventions that can improve symptoms include: washing with an antiseptic soap (e.g. Dermol 500 lotion or Hibiscrub), wearing loose fitting clothing and stress management.

4. Treatment should be overseen by a doctor with specialist knowledge on HS. This can be a GP with a specialist interest in Dermatology or a Dermatologist. They will discuss the options available and appropriate for your daughter. Options range from antibiotic lotions, special antibiotic regimes, anti-diabetes tablets, hormonal treatments, specialist tablets/injections and surgery.

5. The purpose of treatment is symptom management and stabilisation. The newer therapies tend to be reserved for severe HS and include injections known as biologics.

For more information please consider the following resources:

https://www.bad.org.uk/patient-informat ... uppurativa

https://www.hstrust.org/

Thank you very much for your detailed reply to my questions.

I wondered if you might answer one more question regarding laser treatment. Although laser may not improve HS symptoms my daughter is too scared to shave her under arms or legs, or wax or anything anymore and this makes her feel self conscious and ugly. She also has some hair now on her face which makes her feel worse. What do you recommend for hair removal simply to make her feel better about herself? Can she shave or wax or have laser without it making her HS symptoms worse or causing new lesions where she did not have them before?