Hidradenitis suppurativa is a chronic, relapsing inflammatory skin disease characterized by painful lesions, nodules, and draining tunnels in areas such as the axilla and groin, presenting significant physical, functional, and psychological burdens. Speaking at the Fall Clinical Dermatology Conference in Las Vegas, specialists outlined advanced strategies for managing treatment expectations, screening for severe systemic comorbidities, and bridging critical gaps in wound care.
In Plain English: The Clinical Takeaway
- Managing Expectations: Setting realistic timelines prevents premature treatment discontinuation. Treatments take 3 to 4 months to reassess, and success looks like fewer, smaller, and faster-resolving lesions rather than instant clearing.
- Comorbidity Screening: Because systemic inflammation spans multiple organ systems, patients require structured screening for conditions like type 2 diabetes, cardiovascular risks, inflammatory bowel disease, and mental health challenges.
- Specialized Wound Care: Dedicated wound management—utilizing super-absorbent, odor-reducing dressings and gentle tapes—prevents further skin trauma and addresses a recognized training gap in dermatology.
Anticipating Patient Trajectories and Mitigating Severe Psychological Distress in Dermatology
Addressing the profound psychological toll of hidradenitis suppurativa requires an anticipatory approach that builds clinical trust. As Afsaneh Hamzavi noted during presentations in Las Vegas, the condition carries one of the highest rates of suicide and depression within dermatology, making proactive rapport-building essential for patient retention and safety.
To combat high discontinuation rates, clinicians must establish clear markers for treatment response early in the care continuum. According to insights reported by Dermatology Times from Vivian Hsiao, therapy aims to reduce active inflammation rather than eradicate symptoms overnight. Hsiao instructs patients to track specific metrics between visits: fewer, smaller lesions that resolve faster, alongside reduced pain and drainage. Without this specific framing, patients frequently abandon effective biological or systemic therapies prematurely, mistaking early flare-ups for treatment failure.
Furthermore, because the therapeutic armamentarium for hidradenitis suppurativa remains limited, avoiding premature cessation preserves long-term options. Hsiao emphasizes a strict reassessment window of 3 to 4 months, allowing adequate time for complex inflammatory cascades to subside before labeling a systemic intervention unsuccessful.
Comorbidity Screening and Multidisciplinary Systemic Management
Managing hidradenitis suppurativa extends far beyond cutaneous lesion control, requiring rigorous screening for systemic immune-mediated and metabolic disorders. Hamzavi detailed a standardized handout designed for primary care physicians, outlining routine evaluations for type 2 diabetes, hyperlipidemia, cardiovascular risk factors, inflammatory bowel disease, arthritic conditions, and behavioral health concerns.
This comprehensive tracking aligns with broader international clinical perspectives. Eva Vilarrasa, Senior Consultant Dermatologist at the Hospital de la Santa Creu i Sant Pau in Barcelona, emphasized that Hurley staging alone is insufficient for tracking disease activity because it measures irreversible damage rather than dynamic inflammation. Vilarrasa highlights that individualizing treatment requires assessing inflammatory burden, tunnel and scar extent, anatomical site, pain, and smoking status, frequently necessitating combination therapies and timely surgical interventions.
| Management Domain | Clinical Objective | Implementation Strategy |
|---|---|---|
| Expectation Setting | Improve adherence and prevent premature discontinuation | Track fewer, smaller lesions over a 3- to 4-month reassessment window |
| Comorbidity Screening | Detect systemic inflammatory and metabolic risks early | Primary care handouts targeting diabetes, lipids, cardiovascular health, and depression |
| Wound Care & Surgery | Manage persistent draining tunnels and protect fragile skin | Super-absorbent dressings, gentle tapes, and targeted procedures like deroofing or laser hair removal |
Therapeutically, managing cutaneous adverse effects and implementing dual therapy for refractory cases form the backbone of modern systemic care. When systemic agents control widespread disease, localized procedures such as laser hair removal, local excision, and deroofing effectively resolve persistent draining tunnels in high-friction zones like the axilla and groin, leaving medical therapy to prevent new lesion formation.
Bridging Training Deficits in Specialized Wound Care
Wound care historically represents a significant gap in standard dermatology residency training, leaving many clinicians underequipped to manage the complex exudate and tissue fragility characteristic of advanced disease. At Henry Ford, dedicated wound care nurses bridge this educational divide by actively instructing patients on optimal material selection.
Patients are guided to choose super-absorbent, odor-reducing dressings paired with specialized tapes engineered to be gentle enough to avoid compounding mechanical skin damage in already compromised tissue. Integrating these specialized nursing protocols into standard outpatient pathways ensures that daily self-care complements advanced medical and surgical interventions.
Long-Term Outlook and Collaborative Care Pathways
The evolution of hidradenitis suppurativa management demands a permanent shift away from repeated, reactive antibiotic courses toward coordinated, longitudinal care models. Modern clinical consensus mandates seamless pathways incorporating systemic pharmacology, specialized surgery, dedicated wound management, pain control, and psychological support to preserve patient dignity and long-term functional status.
References
- Hamzavi I, Hsiao J. Beyond selection of medications: managing patient expectations and comorbidities in hidradenitis suppurativa. Presented at: 2026 Fall Clinical Dermatology Conference; October 8-11, 2026; Las Vegas, NV.
- Vilarrasa E. Rethinking Hidradenitis Suppurativa: An Interview with Eva Vilarrasa. EMJ Dermatology. 2026.
- Dermatology Times. Managing Treatment Expectations in Hidradenitis Suppurativa: What to Tell Patients Before Starting Therapy.
Editor’s note: Afsaneh Hamzavi has served as a consultant, investigator, or board member for multiple pharmaceutical entities, including AbbVie, Pfizer, Incyte, UCB, and Novartis.
