To summarize clinically relevant updates on the management of hidradenitis suppurativa (HS) presented at the 2026 AAD Annual Meeting.
Approach:
Redefining Moderate HS Disease: Discussion on evolving definitions of moderate HS, emphasizing the need for broader criteria to identify clinically significant disease and the importance of early intervention, including the presence of 3–4 inflammatory lesions or inadequate symptom control.
Dual Targeted Therapy for Refractory Disease: Exploration of dual targeted therapy (DTT) for severe, treatment-refractory HS, highlighting potential combination strategies across multiple inflammatory pathways and the need for further research on safety and efficacy.
Therapeutic Drug Monitoring: Presentation of data supporting therapeutic drug monitoring (TDM) for adalimumab, indicating that higher trough concentrations correlate with improved clinical responses, although data are limited to adalimumab and infliximab.
Key Findings:
Moderate HS may be redefined to include patients with 3–4 inflammatory lesions or inadequate symptom control.
DTT shows promise for refractory HS but is primarily based on case reports and lacks extensive clinical trial data.
Higher adalimumab trough concentrations are associated with better clinical outcomes in HS.
Interpretation:
The meeting highlighted significant advancements in HS management, particularly in redefining disease severity and exploring combination therapies.
Limitations:
Current evidence for DTT is primarily based on case reports and lacks robust clinical trial data.
TDM data are limited to adalimumab and infliximab, with small sample sizes and investigational thresholds.
Conclusion:
The evolving understanding of HS management emphasizes the need for proactive treatment strategies and further research into combination therapies and therapeutic monitoring.
