Alexa Kimball, MD, on the Future of HS Care

Hidradenitis suppurativa (HS) remains a challenging chronic inflammatory skin disease, despite significant therapeutic progress in recent years. In an interview with Dermatology Times, Alexa Kimball, MD, MPH, president and CEO of Harvard Medical Faculty Physicians and professor of dermatology at Harvard Medical School, outlined the current priorities, unmet needs, and future outlook for HS research and management.

Ongoing Challenges in HS Efficacy

Over the past 10 to 15 years, treatment for HS has advanced considerably, with 3 medications now approved for clinical use. However, Kimball emphasized that many patients continue to require more advanced or aggressive therapy. “The most important imperative for HS at the moment is really about getting our clinical efficacy achievements even higher,” she noted. While current treatments provide relief for many, long-term disease control remains elusive for a significant portion of patients.

Integrating Comorbidities into Research

HS carries a high burden of comorbidities, ranging from cardiometabolic disease to mental health conditions. Kimball highlighted the importance of incorporating these outcomes into research design. “Clearly, the disability and comorbidity burden for people with HS is high, and we need to incorporate that as we think about these patients,” she explained. Large-scale studies are needed to fully evaluate associations with cardiovascular disease, while surrogate markers such as C-reactive protein (CRP) levels are increasingly used to measure systemic inflammation.

She pointed to glucagon-like peptide-1 (GLP-1) receptor agonists as an area of emerging interest. While these therapies have shown promise in obesity, diabetes, and even psoriasis, their role in HS is still under investigation. “So far, it seems like they certainly help patients, but they’re not yet a game changer in terms of their HS,” Kimball said, noting that more definitive data are expected in the coming years.

Addressing the Long-Term Course of HS

Unlike short-term endpoints common in clinical trials, HS is a disease that often spans decades. Most pivotal studies assess efficacy over 12 to 16 weeks, with some extension studies following patients longer. Kimball stressed the need for research to better capture the fluctuating and prolonged nature of the disease.

“In my clinical practice, it usually takes about a year to kind of get them to an optimized therapy, and that still takes some tweaks,” she explained. While many patients ultimately achieve stability, others escalate beyond their current therapy, underscoring the importance of identifying who may require more aggressive early intervention.

The Importance of Early Diagnosis

Diagnosis delays remain a persistent barrier to optimal care. On average, Kimball noted patients may wait 7 to 10 years before receiving an accurate HS diagnosis, though recent data suggest this gap is narrowing. Kimball described a clinical “inflection point,” where patients transition from moderate to severe disease, making early recognition critical for preventing progression and long-term disability.

Encouragingly, awareness among both patients and health care providers has improved. Emergency departments are now more likely to provide follow-up care rather than discharging patients without guidance. Additionally, referring clinicians are increasingly initiating appropriate first-line therapies before patients reach specialty centers. Still, access remains uneven across regions, requiring broader educational and systemic efforts.

Looking Toward Future Success

For long-term HS management, Kimball envisions a future similar to that achieved in psoriasis. “I would love for HS to end up where we are with psoriasis, for example, which is that we can get the vast majority of patients under really superb control in the moderate to severe category with really manageable adverse effect profiles,” she said.

Although she remains cautious about the likelihood of a single “magic bullet,” Kimball expressed optimism that incremental advances will continue to expand therapeutic options. Early treatment, prevention of scarring, and durable disease control remain the ultimate goals. “Mostly we’re headed in the right direction in a pretty expedient kind of way,” she concluded.