Hidradenitis suppurativa (HS) is a very painful—and lonely—chronic skin condition characterized by recurrent, pus-filled abscesses and nodules where the skin rubs together, such as in the armpits, groin, and buttocks. The pain, odor, and drainage associated with the condition can interfere with a patient’s work or school attendance, and although it’s not contagious, many patients feel isolated from family, friends, or an intimate partner.
This incurable condition has historically been underrecognized and underdiagnosed, so people with HS may go untreated for years.
“Many patients feel shame and anxiety about their condition, but HS is not their fault, and there are things we can do to help,” says Natalie Fragoso, MD, a dermatologist at Dartmouth Health and assistant professor of dermatology at the Geisel School of Medicine at Dartmouth. Fragoso established a clinic to treat people with HS in early 2022; and at the time, it was the only one of its kind in the region. (Since then, another clinic opened in Vermont.)
While oral medications, immunomodulatory injectable medications, and small excisions of the nodules can help, currently there isn’t a treatment that can completely stop flare-ups. Fragoso says, however, that some of her patients don’t want much treatment. “They want moral support, so I try to be there for them and sympathize. I offer a listening ear, and that’s helpful for them,” she says. “I try to be realistic when I’m counseling patients; I tell them we can’t cure it completely, but we are trying to improve their quality of life.”
In addition to her clinical work, Fragoso continues her research to learn more about the condition with the hope of one day being able to provide better treatment for her patients. One of her recent studies focused on the effect of pregnancy on HS disease course.
“Pregnant people are often excluded from clinical trials because we don’t know how the treatment would affect the fetus. So, we looked back as a systematic review to see if there’s any trend in terms of what happens to the disease when a patient is pregnant,” Fragoso says. “We discovered that most patients are stable or have a slightly worse disease course during pregnancy. That’s not great news, but it’s good to be able to counsel them, both the patient and their obstetrician.”
