Why Early Advanced Therapy Matters in Hidradenitis Suppurativa

Starting advanced therapy early in hidradenitis suppurativa (HS) may limit disease progression, tissue destruction, and the morbidity of later surgery, according to Iltefat Hamzavi, MD, senior staff physician in the Department of Dermatology at Henry Ford Health in Detroit, Michigan. In an interview with HCPLive, Hamzavi outlined outcomes clinicians should weigh beyond those captured in pivotal trials.

Hamzavi presented “Why Early Advanced Treatment Is So Important: Looking Beyond the Pivotal Trials and Primary Endpoint” on October 10 at the 2026 Fall Clinical Dermatology Conference in Las Vegas, Nevada.¹ Gary Goldenberg, MD, chaired the session, which also featured Natasha Atanaskova Mesinkovska, MD, PhD, and Alexandra K. Golant, MD.

Hamzavi described how HS progresses from painful nodules to sinus tunnels with chronic drainage and significant tissue destruction. Early treatment aims to halt this progression, prevent scarring and tunnel formation, and reduce days lost to pain and inflammation. He also pointed to the psychosocial toll of missed life events, such as family milestones and job opportunities, as a key outcome to address.

He cited research from Henry Ford and other centers suggesting the inflammatory infiltrate changes once sinus tunnels become inflamed, which can increase the extent and morbidity of surgery. Treating earlier may reduce this surgical burden.

According to Hamzavi, several outcomes important to patients remain underrepresented in clinical trials. Fatigue is a substantial issue for patients with HS. Speed of response also matters greatly to those living with severe pain.

“If you have a hot poker going into your groin, we would like to have that stop as soon as possible. And to go to your dermatologist and say, ‘Well, it is going to take you 3 months.’ That is not good enough,” Hamzavi said.

Hamzavi noted biologics work in about 60% of patients with HS, even in the best circumstances. Open clinical questions include choosing the right advanced therapy at the right time and deciding when to add other treatments.

Editor’s note: This summary has been edited for grammar and clarity using artificial intelligence tools. Hamzavi is a consultant for AbbVie, Pfizer, Incyte, UCB, Boehringer Ingelheim, Sonoma, Merck, Takeda,Teva, Novartis, Jansen, Avita, Galderma, Vimela, and Almirall; an investigator for Pfizer, Incyte, Avita, L'Oréal/La Roche-Posay, ITN, and AbbVie; and a board member and past president of the Hidradenitis Suppurativa and Global Vitiligo foundations.

References

1. Goldenberg G, Mesinkovska NA, Golant AK, Hamzavi I. Why early advanced treatment is so important: looking beyond the pivotal trials and primary endpoint. Presented at: 2026 Fall Clinical Dermatology Conference; October 8-11, 2026; Las Vegas, NV.