Interview with a Dermatologist
Along with being an Assistant Professor at Queen’s University, Dr. Melinda Gooderham is the Director of The SKiN CENTER FOR DERMATOLOGY. It’s the main dermatological practice in Peterborough, Ontario, a city of roughly 82,000 thousand people an hour and a half drive north east of Toronto. When she’s not teaching or at The Skin Center, she’s often attending conferences and seminars around the world.
My name is Michael D. Wiens, and I’m the story editor for HS Aware. I have a condition called Sapho Syndrome with associated HS disease. Sapho is an auto-inflammatory condition that causes arthritis that can manifest with HS disease. Like most HS patients, a good Dermatologist is essential in my treatment regime and I consider myself extremely fortunate to be a patient of Dr. G’s.
Recently, she agreed to answer a few questions for Hs Aware.
1. What led you into Dermatology?
I was always interested in disorders of the skin, even before I was in medicine. I used to browse through dermatology text books in high school and undergraduate university!
2. Did you learn about HS at all in Med School?
Not that I can recall. There are so many body systems and disorders/diseases covered that I don’t remember covering that topic. I do remember learning about it during Dermatology residency and seeing some very severe cases while training at Sunnybrook.
3. In your opinion what causes HS?
I believe HS is a genetic disorder which is brought out in certain environmental circumstances. The genetic defect involves either part of the hair follicle and/or the immune system that causes a dysfunction of the interaction between these two.
4. How many patients with HS would you say you currently have?
After doing a chart review, I currently have about 50 active patients with HS, but over a 9 year span, I have seen a total of 133 patients with HS.
5. Is that close to the number of patients you would expect to see from a city the size of Peterborough?
Not at all, I think there are more patients with HS who have yet to go to their doctor. I would expect the numbers to be much higher, since I also cover areas outside of Peterborough.
[Editor’s note, She see’s people from all over Peterborough County, which has a population of 135,000 people.]
6. What are the things you look for when making a diagnosis of HS?
I look for recurrence of lesions, with typical features of inflammation/drainage/pain and the location of the lesions (armpits, groin, and buttocks).
7. What sort of treatment options are there, and are they normally effective?
There is not one effective treatment option for HS, which means that we usually use a combination of therapies to try and control HS since there is no cure. I usually find a combination of oral antibiotics (used as an anti-inflammatory) with intralesional steroid injections can control some patients who did not respond to topical antibiotics.
If this combination is not working, sometimes other types of medications including retinoids (Vitamin A derivatives) or anti-androgen medications (for women with HS) can be helpful. For moderate to severe disease, anti-TNF medications (adalimumab or infliximab) can be very effective. We are still working on the best guidelines to know what medication to use for which patients with HS in Canada.
8. What are some of the difficulties that arise when treating HS?
The treatment of HS is a challenge for many reasons. One reason is that not one treatment works for everyone, so there is often a lot of trial and error that goes on trying to find the right treatment for any specific patient. This can be frustrating for patients while they have flare ups on some therapies. Also trying to combine therapy along with lifestyle changes for the patient can sometimes be a challenge to align between the physician and the patient. Like baking a cake, if any of the ingredients are missing, the cake may not turn out the way you hoped. The challenge is trying to get the patient and physician on the same page, where both do their part so you have a greater chance of success.
9. What diet changes / life style changes do you recommend to your patients?
I usually recommend an overall healthy lifestyle which should include increased activity/exercise, a healthy diet and smoking cessation. Although we don’t have studies showing that losing weight and quitting smoking improves HS, we do know that patients suffering from more severe cases of HS are more likely to be overweight and smokers, so we try to keep patients from progressing to that more severe category.
10. How can HS affect the quality of life of its patients?
HS has a profound impact on the quality of life because not only is there skin involvement, but there can be other comorbid conditions which can also impact quality of life (for example, diabetes, arthritis and depression). This is why it is important to make the diagnosis early and work on a treatment plan where both the patient and physician play their part to maximize the chance of success.
One important member of the health care team is the family doctor and family health team (nurse practitioner, dietician). They can also offer support treating the whole patient including the comorbid conditions such as diabetes, arthritis, pain, and depression which have such a significant impact on quality of life.
I’d like to thank Dr. Gooderham for taking the time to answer these questions for HS Aware!