Highlights from the 6th EHSF Conference in 2017
13 April 2017
Kelsey van Straalen, MD
Erasmus University Medical Centre
Rotterdam, the Netherlands
Hessel Hindrik van der Zee, MD
Erasmus University Medical Center
Rotterdam, the Netherlands
The 6th European Hidradenitis Suppurativa Foundation (EHSF) Conference was held in Copenhagen from February 8-10, 2017. This yearly conference brings together experts from more than 20 countries to share new results and findings from different aspects of the HS field.
This year’s main topics were: epidemiology and registries; adjuvant therapy; medical treatment; genetics; and immunology. Below we highlight a few of the studies generating interesting new results.
Complement Activation in HS: A Potential Future Target?
To open the conference, Prof. Dr. Giamarellos-Bourboulis presented the first ever study to completely focus on complement activation in HS. 
In this study, circulating concentrations of C3a, C5a, and membrane attack complex C5b-9 were assessed in the plasma of 54 anti-tumour necrosis factor (TNF)–naïve HS patients and 14 healthy controls. The circulating concentration of complement factor C5a was significantly greater in the plasma of HS patients compared with controls. Additionally, plasma levels of C3a exceeding 5,996 ng/mL and levels of C5a exceeding 28 ng/mL were associated with HS. These findings underline the systemic complement activation present in HS, and suggest that this pathway may be a target for future therapy.
Quality of Life in Family Members of Patients With HS
During day 2 of the conference, a study regarding the quality of life of the relatives of HS patients was presented by Dr. Guillem.  The impact of HS on a patient’s quality of life is well-documented; however this study is the first to describe the impact of HS on the quality of life of family members.
Ninety relatives of 84 HS patients were asked to fill out the Family Dermatology Quality of Life Index (FLDQI)—which has scores ranging from 0-30, with a higher score meaning greater quality-of-life impairment—and patients completed the standard DLQI.
The mean global FDLQI score was 9.8±6.4, which is similar to that seen in inflammatory skin diseases (10±6.2).  “Emotional distress” and “time consumed to take care of the patient” scored highest among family members. Interestingly, in patients with a positive family history for HS, family members scored higher on the FDLQI (12.3±0.9 vs 9.1±6.1 for those without family history, P =.046).
This study highlights that HS greatly affects quality of life for both patients and their family. Therefore, exploring quality-of-life impairment in relatives may be an important consideration in future evaluations of interventions aimed at improving quality of life.
IHS4: A New, Simple Scoring System to Evaluate HS Severity
On the last day of the conference, several presentations accentuated the importance of international collaborations. An important example was the study presented by Dr. Tzellos, in which the previously proposed Hidradenitis Suppurativa Severity 4 (HS4) score was validated.  The HS4 is being re-named as the International HS4 (IHS4), to highlight the international collaboration responsible for developing this system.
Data from 236 patients with HS (collected at 11 centres in 6 different countries) were used for validation and adaptation of this score. This new scoring system requires the allocation of 1 point for each nodule, 2 points for each abscess, and 4 points for each fistula. After calculating the total number of points, the disease severity can be classified as mild (≤3 points), moderate (4-10 points), or severe (>10 points).
This novel scoring classification showed a strong correlation with Hurley stage, expert opinion, modified Sartorius score, and the HS-Physician’s Global Assessment (HS-PGA). It is straightforward and easy to use in both research settings and clinical practice, and may facilitate the comparability of future studies and help guide clinical decisions.
In conclusion, the 6th EHSF Conference has shed new light on key aspects of HS and has underscored the importance of international collaborations. Next year’s conference will be held in Rotterdam, the Netherlands, and is sure to bring forth additional new, relevant insights in the field of HS.
|||Giamarellos-Bourboulis E. Complement activation in hidradenitis suppurativa. J Exp Dermatol. 2017;26 Suppl 1:6-7. Abstract O03-2.|
|||Guillem P. Hidradenitis suppurativa profoundly impacts the quality of life of family relatives. J Exp Dermatol. 2017;26 Suppl 1:10-11. Abstract O06-2.|
|||Basra MK, et al. The Family Dermatology Life Quality Index: measuring the secondary impact of skin disease. Br J Dermatol. 2007;156(3):528-538.|
|||Tzellos T. Validation of HS4 scoring system and development and validation of a novel scoring system to assess Hidradenitis suppurativa severity. J Exp Dermatol. 2017;26 Suppl 1:27. Abstract O017-2.|