Managing Treatment Expectations in Hidradenitis Suppurativa: What to Tell Patients Before Starting Therapy

When initiating medication therapy in hidradenitis suppurativa (HS), it is important to tell patients that initial success means fewer, smaller, shorter flares rather than clear skin, Jennifer Hsiao, MD, said in an interview with Dermatology Times at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada. Setting that expectation at the outset, she said, is what keeps patients on treatment long enough for it to work.

Hsiao, a professor of dermatology at the University of Southern California, where she codirects an HS specialty clinic, drew a contrast with psoriasis and eczema. In those disease states, “oftentimes you start a medication and the skin can just clear as if nothing was ever there before.” HS treatment is not there yet, she explained, and current medications are not expected to “melt tunnels away.”

What Does Treatment Response Look Like in HS?

The goal of therapy, she tells patients, is to reduce active inflammation and the symptoms that come with it. To support her patients, Hsiao provides specific markers for them to track between visits. “The next time you come back, I want you to report on less drainage, less pain. If you get new lesions, hopefully there’s fewer of them. They’re smaller and they go away faster,” she tells patients.

Those markers map to reduced flare frequency, severity, and duration, and they change how patients judge their own progress, Hsiao told Dermatology Times. A patient who knows what to look for can return and report that a few new lesions appeared but were smaller and resolved sooner, and conclude the medication may be working. Without that framing, Hsiao said, the same patient is more likely to wonder, “I don’t think this medication is working at all because why am I still getting new spots?” she said.

“Treatment expectation setting [is] really important for treatment adherence,” she told Dermatology Times.

How Long Should Patients Stay on an HS Therapy Before Reassessing?

Timing is the second expectation Hsiao sets from the start. HS therapies do not work like a 1-week antibiotic course that clears an infection, she said, because there is substantial inflammation to bring under control. She plans to reassess disease severity and treatment effectiveness at 3 to 4 months. Hsiao explains this to patients at the first visit, which helps with their expectations and helps them stay on therapy even if treatment takes longer to work.

The limited number of available HS therapies raises the stakes of stopping early, Hsiao added. She ensures patients are aware of this and understand the idea of not running through the available treatments too quickly.

“You don’t want to miss out on one where maybe they can ultimately achieve a good response, but you just didn’t hang in there long enough,” Hsiao said.