Panelists Share Their Go-To Regimens for Treating HS

In "Panelists Share Their Go-To Regimens for Treating HS," the panel closes the series by sharing the regimens, or as the moderator frames it, the 'favorite cocktails,' they rely on most.

Asked to name their go-to regimens, panelists describe biologic therapy as the non-negotiable foundation, built out with individualized adjuncts. One favors spironolactone or oral contraceptives, metformin for insulin resistance, zinc, low-dose doxycycline, and topical resorcinol applied at the first sign of an emerging lesion to blunt inflammation before it fully develops. Another echoes birth control and spironolactone for hormonal flares, adds GLP-1 therapy when access allows, prioritizes vitamin D supplementation toward a target level, and recommends laser hair removal, noting it benefits some male patients despite more hesitancy toward the procedure in that group. For advanced, treatment-resistant disease, one panelist combines biologic therapy with deroofing procedures and, increasingly, a BTK inhibitor addressing an entirely separate inflammatory mechanism, given how much epigenetic variability exists in which pathway dominates a given patient's disease.

Dr. Payette organizes his approach into five treatment buckets: over-the-counter washes, topical therapy including off-label topical JAK inhibitors still in trials, oral therapy such as doxycycline, spironolactone, or isotretinoin when dissecting cellulitis coexists, biologic therapy as a foundational fourth bucket, and a fifth bucket of off-label options including infliximab infusions dosed alongside methotrexate, clinical trial enrollment, and surgical excision once inflammation is controlled. He notes many patients ultimately need three to five therapies working together, often paired with a GLP-1 agent.

Closing the discussion, panelists return to their central message: treat aggressively and treat early, meeting each patient's individual regimen to their specific presentation and quality of life rather than a rigid protocol. They emphasize screening comorbidities routinely, connecting patients with resources beyond the clinic, and, above all, being willing to act rather than let disease progress unaddressed. Time, as they've repeated throughout, is tissue.

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