Reimagining HS Care in 2026: Earlier Diagnosis, Biologic Durability, and Smarter Surgery
At the 2026 Masterclasses in Dermatology Annual Meeting, Jack O’Brien, MD; Alice Bendix Gottlieb, MD, PhD; and Dennis P. Orgill, MD, PhD, delivered a comprehensive roadmap for hidradenitis suppurativa (HS), emphasizing earlier recognition, therapeutic durability, and coordinated multidisciplinary care.
Dr O’Brien started off by describing HS as “a systemic inflammatory disease and is associated with many comorbidities.” It is characterized by inflammatory nodules, abscesses, draining tunnels, and hypertrophic scars affecting the axillae, inframammary folds, inguinal, perianal, and buttock regions. Progressive disease leads to irreversible tissue destruction, yet the average time from symptom onset to diagnosis remains approximately 10 years. Patients typically consult more than 3 specialties and receive multiple misdiagnoses before correct identification.
“Multidisciplinary care is not optional,” the Dr O’Brien stressed, given the systemic nature of HS. Comorbidities include type 2 diabetes, metabolic syndrome (prevalence up to 50%), inflammatory bowel disease, arthritis, polycystic ovarian syndrome, depression, and suicidality. Practical screening, such as spacing labs over multiple visits and combining hemoglobin A1c with biologic labs, can streamline care.
Dr O’Brien concluded with some tips and tricks on how dermatologists can shorten the journey to diagnosis.
Next Dr Gottlieb started with treatment options in HS. Among US Food and Drug Administration-approved therapies, adalimumab demonstrated Hidradenitis Suppurativa Clinical Response (HiSCR) responses of 42% vs 26% (P=0.003) in PIONEER 1 and 59% vs 28% (P<0.001) in PIONEER 2 at week 12.
Secukinumab, an IL-17A inhibitor, demonstrated sustained efficacy through 4 years in the SUNSHINE/SUNRISE core and extension trials. Bimekizumab, targeting IL-17A/F, showed high-level HiSCR responded maintained through week 148 in BE HEARD extension analyses. Infliximab, used off label at an optimal dose of 10 mg/kg every 4 weeks IV, remains an option in refractory disease. A 2025 network meta-analysis of 25 randomized controlled trials found multiple cytokine inhibitors superior to placebo, with the conclusion that “nothing beats adalimumab,” Dr Gottlieb noted.
Dr Gottlieb discussed some of the drugs in development in phase 2 and phase 3 trials, including sonelokimab, brivekimig, remibrutinib, povorcitinib, upadacitinib, and lutikizumab.
Early treatment matters. “We need to treat HS earlier to prevent scarring, chronic draining tunnels, disability, and poor quality of life,” Dr Gottlieb emphasized. Ultrasound can detect subclinical tunnels and abscesses not apparent on exam.
Finally, Dr Orgill discusses the surgical management of HS. Surgical options include unroofing, wide excision, flaps, grafts, and negative pressure wound therapy. He also touched on some of the challenges, including smoking, morbid obesity, diabetes, unrealistic expectations, and acute flares.
“HS is challenging to treat surgically, and most surgeons will do it,” noted Dr Orgill. While surgery carries high complication rates, it can significantly improve function and quality of life when integrated with dermatologic management. “We continue to develop new and better technologies that can reduce the morbidity of the surgery,” concluded Dr Orgill.
Lastly, patient experiences were shared by patients with HS present at the meeting.
For more meeting coverage, visit the Masterclasses in Dermatology newsroom.
Reference
O’Brien J, Gottlieb AB, Orgill DP. Reimagining hidradenitis suppurativa care: early recognition, therapeutic innovation, and multidisciplinary care across the patient journey. Presented at: Masterclasses in Dermatology; February 19–22, 2026; Sarasota, FL.
