HS Treatment Selection and Comorbidity Screening: Practical Tips With Jennifer Hsiao, MD

With 3 FDA-approved biologics now available for hidradenitis suppurativa (HS), treatment selection comes down to age, patient preference, comorbidities, and access, Jennifer Hsiao, MD, said in an interview with Dermatology Times at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada. Once a patient is willing to start therapy, she added, speed matters.

Which Factors Guide HS Treatment Selection?

Patients often arrive with firm views about a medication based on what they have heard, and Hsiao, a professor of dermatology at the University of Southern California, where she codirects an HS specialty clinic, takes those views seriously. If options exist and a patient is vehemently opposed to one, “you may not want to push at that visit,” she said. Comorbidities also play a role in treatment selection, she added.

Access is the final factor, and it is where insurance formularies play a role. “If a patient is interested, willing to start a medication, I really want to get a medication into that patient’s hands as soon as possible,” Hsiao told Dermatology Times. Delays can lead patients to decide treatment is more trouble than it is worth, and strong bridge and patient assistance programs can help. The goal, she said, is to identify patients in early moderate disease and start 1 of the 3 therapies to mitigate progression, or at least help them feel better now.

Hsiao noted the options are adalimumab, a tumor necrosis factor α inhibitor; secukinumab, an IL-17A inhibitor; and bimekizumab, an IL-17A and IL-17F inhibitor. Adalimumab and secukinumab are approved for patients 12 years and older, so age factors into the choice.

How to Screen for HS Comorbidities During a Regular Clinic Visit

In screening for comorbidities, Hsiao reminds clinicians, “We don’t need to do everything that first visit.” Cutaneous comorbidities can be covered during the physical examination by looking for acne, checking the scalp for dissecting cellulitis, and checking for pilonidal cysts while examining the groin and buttock areas that HS commonly affects. Reaching out to a primary care provider can help with many of the other comorbidities.

Among inflammatory comorbidities, she recommended focusing on inflammatory bowel disease and spondyloarthritis, as both affect overall health and HS treatment selection, and both can be covered with easy screening questions.

Tobacco smoking is an area where dermatology clinicians can make a difference, but Hsiao raises it at a subsequent visit, after establishing rapport, and approaches it from an overall health perspective.

“You’re not focusing in on smoking because you think that their smoking caused their HS or that they’re in any way to blame for their HS,” she said.

HS Foundation Resources for Clinicians and Residents

Hsiao also highlighted the HS Foundation, which works to advance education, awareness, and research. The Symposium on Hidradenitis Suppurativa Advances, which the foundation copresents, takes place November 6 to 8 in Tucson, Arizona. The foundation’s annual HS Academy aims to equip residents with medical and procedural tools and a deeper understanding of HS, particularly those whose programs lack a dedicated HS clinic.

What Is Next for HS Treatment?

Even with 3 approved biologics, Hsiao said more options are needed. HS is heterogeneous in its pathophysiology, so some patients respond to IL-17 inhibition but not TNF inhibition, or vice versa, and some do not respond adequately to either. JAK inhibitors, which she said are probably furthest along, would add an oral option for patients who are needle averse.

“It’s exciting that we have medications on the horizon,” Hsiao said.