Turning Action Plans Into Power: Personalizing Care for Patients With Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by recurrent painful nodules, abscesses, sinus tracts, and scarring primarily affecting the axillae, inguinal regions, inframammary folds, and perianal area. The disease is  heterogeneous,and dynamic, with phenotypes that vary in anatomic distribution, lesion morphology, and disease course over time. Individual flares can also manifest differently from patient to patient as new inflammatory nodules, abscesses, or sinus tracts, or worsening drainage or pain in existing areas.¹
 
Early diagnosis and timely initiation of effective therapy are essential to minimizing disease progression, scarring, and psychosocial burden. However, treating HS is complex, requiring a multimodal, individualized plan. Current therapeutic modalities include topical therapies, systemic antibiotics, hormonal therapies, corticosteroids, biologic agents, and surgical or procedural interventions often used in combination to achieve optimal control.

Given the complexity and variability of HS disease activity, a structured treatment action plan can provide a practical framework to personalize care and guide patients through both maintenance therapy and flare management, as well as reduce patient utilization of urgent care centers, emergency departments, and other providers, which can lead to disjointed and expensive care. 

Treatment Action Plans
A treatment action plan provides individualized instructions for patients on how to manage a chronic disease. It outlines medication usage and typically operates on 3 levels: daily management (green zone), early flare management (yellow zone), and severe or refractory flare management (red zone) (Table). This plan should be paired with standing prescriptions that patients can fill as needed. The definition of a flare should be individualized according to each patient’s HS severity and may range from the appearance of a new nodule or abscess to increased drainage, pain, or new sinus tract formation.

Personalized action plans not only significantly improve patient experience but also enable more precise and proactive management by the physician. For patients with HS, these plans help enhance disease understanding and expectations, improve adherence, empower self-management, and reduce anxiety. In a randomized controlled trial, patients with HS who received a written action plan reported greater understanding, confidence, and satisfaction compared with those who received verbal instruction alone.²

For physicians, action plans facilitate clearer communication of HS treatment regimens and allow for efficient monitoring of HS activity based on how frequently the patient needs to escalate treatment. This promotes ongoing, data-driven adjustments and encourages shared decision-making between patient and provider. 

 

Conclusion
Clearly defining each patient’s HS maintenance therapy, flare management, and escalation criteria through a treatment action plan can streamline communication, empower selfmanagement, and improve long-term outcomes in HS. Including reputable HS resources, such as the HS Foundation, Hope for HS, HS Connect, and other patient support groups, within these plans further enhances patient education, engagement, and overall well-being.

Cynthia Chen is a medical student and Dr Rengarajan is an assistant professor in the division of dermatology at Washington University in St. Louis, MO.

Disclosure: The authors report no relevant financial relationships.

References
1. Sabat R, Alavi A, Wolk K, et al. Hidradenitis suppurativa. Lancet. 2025;405(10476):420-438. doi:10.1016/S0140-6736(24)02475-9

2. Thompson AM, Fernandez JM, Shih T, Hamzavi I, Hsiao JL, Shi VY. Improving hidradenitis suppurativa patient education using written action plan: a randomized controlled trial. J Dermatolog Treat. 2022;33(5):2677-2679. 
doi:10.1080/09546634.2021.1970707

3. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part I: diagnosis, evaluation, 
and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76-90. doi:10.1016/j.jaad.2019.02.067

4. Masson R, Park S, Shi VY, Hsiao JL, Aleshin MA. Expert practices in hidradenitis suppurativa flare management: a cross-sectional survey study. Skin Appendage Disord. 2024;10(3):224-228. doi:10.1159/000536094