Biologic use in hidradenitis suppurativa: patient perspectives and barriers

Hidradenitis suppurativa (HS) is an inflammatory dermatosis for which the treatment paradigm is rapidly expanding. We aimed to identify HS patient perspectives and barriers on biologics.

An anonymous survey was distributed between 10/2021 and 1/2022 through HS support groups. Data regarding demographics and perspectives on biologics were collected and analyzed.

Of the 196 respondents, 92% were female (180/196) and 75% were white (147/196). 89.3% had Hurley stage 2/3 HS (102/195). The primary healthcare provider (HCP) for HS in 65% (128/196) of patients was a dermatologist, with 12% (23/196) seen at an HS specialty clinic. Most respondents never tried a biologic medicine (62%, 118/192). The top barriers to biologics were fear of side effects (61%, 109/179), high cost/lack of insurance coverage (46%, 83/179), frequency of weekly injections (32%, 58/179). Respondents reporting their main HCP as a non-dermatologist (4.11 vs 3.0, p < .0001) and not seen at a HS specialty clinic (3.5 vs 2.7, 0.039) were significantly more likely to agree 'I do not know enough about how biologics work to help my HS'.

Our results highlight the importance of specialty care in the education and implementation of biologics. Patients may benefit from comprehensive discussion prior to starting biologics.