Advancing Hidradenitis Suppurativa Care - Early Diagnosis, Biologic Therapies, and Multidisciplinary Approaches: Part 1

In the recent Dermatology Times Frontline Forum custom video series “Optimizing Hidradenitis Suppurativa Management: From Current Challenges to Emerging Therapies and Future Perspectives,” 5 experts led discussions to delve into the complexities of treating hidradenitis suppurativa (HS) and recent advancements in therapeutic options to manage the burdensome condition. Merrick D. Elias, DO, FAAD; Hadar Lev-Tov, MD, FAAD; Iltefat Hamzavi, MD, FAAD; Jennifer Hsiao, MD, FAAD; and Rani Cooper, MD, FAAD, shared insights on the quality-of-life effects on patients with HS, increased awareness, support systems, biologic advancements, treatment expectations, and more. Each panelist provided perspectives from their respective combined experiences, offering a thorough exploration into improving the lives of patients with HS.

Addressing the Burden of HS

Elias, a board-certified dermatologist at Elias Dermatology in Pembroke Pines, Florida, and Lev-Tov, a board-certified dermatologist and associate professor of clinical dermatology and cutaneous surgery at the University of Miami Miller School of Medicine in Florida, kicked off the panel discussion by reviewing the challenging burden for patients with HS. Lev-Tov described HS as one of the “cruelest” skin diseases due to its early onset and severe impact on patients’ lives. Affecting between 0.1% and 1% of the global population, HS typically manifests during young adulthood, disrupting key milestones such as education, career development, and relationships. The disease’s physical symptoms—painful abscesses, scarring, and sinus tract formation—are compounded by significant mental health comorbidities, including depression, anxiety, and elevated suicide rates.

From a health care perspective, HS demands attention due to its prevalence and complexity. “One of the contributing factors here is the delay to diagnosis,” Lev-Tov said. Patients often face delays of 7 to 10 years before receiving a diagnosis, during which time irreversible tissue damage may occur. Lev-Tov emphasized that early diagnosis within the “window of opportunity” can significantly improve outcomes given the advancements in medical therapies.

Raising Awareness to Reduce Diagnostic Delays

One of the core challenges in HS management and treatment is increasing awareness among health care providers and the broader community, according to the panelists. Misdiagnosis is often common, as nondermatology clinicians may unknowingly mistake HS for abscesses. Elias advocated for collaborative education efforts, such as grand rounds in local surgery departments and lectures at medical societies. These initiatives aim to equip nondermatology clinicians with the knowledge to identify and refer HS cases accurately.

Integrating HS into medical school curricula was proposed as a strategy to familiarize future clinicians with this high-burden disease. Lev-Tov highlighted the importance of interdisciplinary collaboration, noting that HS touches multiple specialties, including endocrinology, gastroenterology, and pain management. Supporting organizations such as the HS Foundation, which advocates for patients and provides educational resources, is crucial in amplifying these efforts.

Discussion continued in part 2.