Raising the Bar for HS Outcomes With Barry Resnik, MD

Despite increasing awareness, patients with hidradenitis suppurativa (HS) continue to experience prolonged delays in diagnosis, fragmented care, and years of ineffective or inappropriate treatment. At South Beach Symposium 2026, Barry Resnik, MD,clinical professor at the University of Miami, long-standing executive board member of the HS Foundation, and a clinician deeply immersed in HS care, offered a pragmatic, experience-driven perspective on how clinicians can change that trajectory.¹

A recurring theme was that HS exemplifies an underserved population. Many patients report 7 to 10 years between symptom onset and correct diagnosis, often cycling through repeated short courses of antibiotics, emergency department visits, or being told the disease is infectious or hygiene-related. This prolonged delay not only drives irreversible tissue damage but also exacts a profound psychological toll. By the time patients reach specialized care, they are frequently frustrated, mistrustful, and fatigued by prior medical encounters.

Resnik emphasized the importance of reframing treatment goals early. Rather than incremental escalation after years of progression, he advocated for earlier intervention with effective systemic therapy before extensive tunnel formation and scarring occur. Current disease severity scoring systems, such as the IHS4, allow clinicians to identify moderate disease sooner than traditional staging might suggest. Waiting for extensive sinus tracts or confluent plaques before introducing biologic therapy may represent a missed opportunity to alter disease course.

A major barrier to early biologic use remains patient fear, often fueled by social media and misinformation, regarding immunosuppression and long-term safety. Resnik described a practical communication strategy: emphasizing targeted immunomodulation rather than global immune suppression, setting clear time-limited expectations for response, and framing treatment as a means of restoring normal life rather than imposing a “life sentence.” For example, when initiating TNF-α inhibitors such as adalimumab, he typically reassesses efficacy at approximately 4 months and moves on promptly if meaningful improvement is not achieved.

Functional outcomes, rather than lesion counts alone, were highlighted as critical markers of success. Patients are asked early what activities pain or disease prevents them from doing—raising arms, exercising, hugging family—and progress is measured by restoration of those abilities. The stated goal is for patients to feel “human” every day of the month, not intermittently between flares.

While biologics now form the backbone of moderate to severe HS management, Resnik underscored that effective care is rarely monotherapy. Adjunctive treatments, including anti-inflammatory antibiotics, hormonal modulation with continuous oral contraceptives, spironolactone, and selective use of isotretinoin, remain valuable tools when used with clear intent. Importantly, antibiotics are positioned as anti-inflammatory agents rather than infection-directed therapy.

Procedural interventions also play a key role in comprehensive management. Modern approaches favor minimally invasive techniques such as punch drainage for acute abscesses and de-roofing of sinus tracts to eliminate persistent inflammatory reservoirs. For selected patients with residual scarring and recurrent focal disease, staged CO₂ laser marsupialization was presented as an option capable of durable control, albeit with prolonged healing times.

Looking ahead, the therapeutic landscape for HS is rapidly expanding. Beyond currently approved TNF inhibitors and IL-17 blockers, multiple targeted pathways such as JAK inhibition, CD40 modulation, and nanobody-based IL-17A/F blockade, are under investigation. While many remain early in development, their emergence reflects a broader shift toward mechanism-driven treatment rather than empiricism.

Finally, Resnik stressed that HS care is fundamentally a team effort. Optimal outcomes often require collaboration with surgeons, mental health professionals, and, notably, sexual health and intimacy counselors—recognizing that chronic pain and inflammation profoundly affect relationships and quality of life.

The message was clear: HS is no longer a disease defined solely by frustration and therapeutic nihilism. Earlier recognition, decisive treatment, multidisciplinary care, and evolving targeted therapies offer an opportunity to fundamentally change the lived experience of patients. For clinicians willing to engage, the tools and the responsibility are increasingly within reach.

Reference

1. Resnik B. HS: the future of targeted therapy. Presented at: South Beach Symposium 2026; February 5-7, 2026; Miami Beach, FL.