Overview of Treatment Options in HS

Managing hidradenitis suppurativa (HS) requires a comprehensive, individualized approach that stratifies patients based on disease severity, progression risk, and quality of life impact. For patients with moderate to severe disease, biologics have become the cornerstone of treatment, with 3 FDA-approved options now available that offer substantial improvements in disease control. Even patients with milder disease but significant quality of life impact may benefit from biologic therapy, challenging traditional severity thresholds established for clinical trial enrollment that insurers have adopted as treatment criteria.

Treatment strategies for milder disease include antibiotic therapy, hormonal treatments, laser hair removal, nutritional counseling, and emerging options like GLP-1 agonists that address both HS symptoms and metabolic comorbidities. Practitioners emphasize the importance of early intervention with these approaches, particularly for patients with family history of HS, to potentially prevent disease progression. However, the lack of standardized protocols and outcome measures for mild disease represents a significant gap in clinical practice, leaving providers to rely on clinical experience and patient-reported improvements.

All patients require comprehensive counseling about potential disease flares and access to rescue treatments, including antibiotics for short-term use and options for urgent steroid injections for acute lesions. The management approach combines what patients are born with (genetic predisposition, immune function, wound healing capacity) and what they’re exposed to (environmental triggers, dietary factors), targeting multiple aspects of disease pathophysiology simultaneously. This holistic strategy recognizes that HS management extends beyond medication to include lifestyle modifications, surgical interventions, and ongoing supportive care tailored to individual patient needs and circumstances.