AAD and HSF issued the first joint hidradenitis suppurativa guidelines, outlining 37 recommendations and flagging step therapy as a major barrier.
The American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa Foundation (HSF) have issued the first joint guidelines for the management and care of
More than 3 million people in the United States have been diagnosed with HS, a chronic skin condition that causes painful lumps in areas where skin rubs together, such as the armpits, inner thighs, and groin.¹ The condition is frequently mistaken for acne or infection, often delaying diagnosis by years.
A work group of 13 experts, including 12 board-certified dermatologists, compiled the guidelines, which include 37 evidence-based recommendations covering chronic HS management and acute flares.¹ The guidelines identify step therapy, an insurance practice requiring patients to try insurer-designated treatments before coverage is approved for a dermatologist’s preferred medication, as the largest barrier to effective HS care, noting that evidence does not support its use in this condition.
The guidelines issue a strong recommendation for biologic therapies, including adalimumab, bimekizumab, infliximab, and secukinumab, for patients with moderate-to-severe HS.¹ These treatments were shown to reduce abscesses and nodules by at least half without new abscess or tunnel formation.¹ Conditional recommendations cover topical therapies (clindamycin, resorcinol, ruxolitinib), systemic antibiotics, hormone therapy with spironolactone, and systemic therapies such as upadacitinib.
In-office procedures, including deroofing, incision and drainage, surgical excision, laser hair removal, botulinum toxin, and intralesional triamcinolone, are also conditionally recommended for patients with abscesses or tunnels.¹ The guidelines recommend against oral retinoids, several biologics not supported by HS-specific evidence, and radiotherapy in pediatric and adolescent patients, and note insufficient evidence for oral contraceptives or finasteride.
Because HS therapies do not always resolve pain, the guidelines conditionally recommend supportive pain management tailored to symptom duration.¹ Sudden pain may be managed with compresses, topical lidocaine, acetaminophen, NSAIDs, steroid injections, or incision and drainage, while longer-lasting pain may call for SNRIs, tricyclic antidepressants, psychotherapy, or nerve pain medications such as gabapentin.
The guidelines found insufficient evidence to support weight reduction, GLP-1 medications, or specific diets for HS management, though a heart-healthy diet remains advised given elevated cardiometabolic risk in this population.¹ Conditional recommendations also support smoking cessation and, under physician supervision, vitamin D and zinc supplementation.
The guidelines emphasize that board-certified dermatologists are positioned to both diagnose HS and screen for the medical and psychiatric conditions that frequently accompany it, allowing patients to access comprehensive, individualized care sooner.¹ Untreated HS can lead to scarring, mobility-limiting wounds, and significant pain, and often occurs alongside other health conditions that compound its overall toll.
Editor’s Note: This summary has been edited for grammar and clarity using artificial intelligence tools.
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