AAD and HSF issue first joint guidelines for hidradenitis suppurativa

The American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa Foundation (HSF) have released the first joint clinical guidelines for the management of hidradenitis suppurativa (HS). Published in the Journal of the American Academy of Dermatology, the guidelines provide 37 evidence-based recommendations for adults, adolescents, and children aged nine and older.

For moderate-to-severe cases, the guidelines issue a strong recommendation for biologic therapies, specifically adalimumab, bimekizumab, infliximab, and secukinumab. These treatments have been shown to reduce abscesses and nodules by at least half without the formation of new abscesses or tunnels.

A significant finding in the report is the identification of step therapy as the primary barrier to effective care. The workgroup noted that step therapy—an insurance practice requiring patients to attempt specific insurer-designated treatments before accessing preferred medications—lacks evidence of clinical benefit for HS and is linked to treatment delays and poorer clinical outcomes.

Other conditional recommendations include topical therapies, systemic antibiotics, hormone therapy, and various in-office procedures such as surgical excision and laser hair removal.