Proactive Hidradenitis Suppurativa Management: From Watchful Waiting to Active Intervention

EP: 1.Recognizing Hidradenitis Suppurativa: From First Signs to an Accurate Diagnosis

EP: 2.Hidden in Plain Sight: Strategies to Improve Early Identification of Hidradenitis Suppurativa

EP: 3.The Pharmacist Advantage: Bridging Gaps in Hidradenitis Suppurativa Care

EP: 4.Health Equity in Hidradenitis Suppurativa: Addressing Care Disparities

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EP: 5.Proactive Hidradenitis Suppurativa Management: From Watchful Waiting to Active Intervention

EP: 6.Building Hidradenitis Suppurativa Treatment Plan: Evaluating Standard of Care Pharmacotherapies

Optimizing the clinical management of hidradenitis suppurativa (HS) involves early intervention, patient education, and multidisciplinary coordination. Once HS is diagnosed, treatment decisions should be tailored to the patient’s disease severity, symptom burden, and risk for progression. While milder cases may benefit from noninvasive options like topical treatments, lifestyle adjustments, and flare management plans, true “watchful waiting” is discouraged. Instead, dermatologists—who should ideally lead the care team—are encouraged to take a proactive stance. For instance, even in early-stage disease, providing patients with a clear flare protocol (eg, warm compresses, pre-prescribed short-term antibiotics or anti-inflammatories) can prevent unnecessary suffering and reduce emergency care visits.

As HS progresses to moderate stages—typically indicated by the formation of tunnels or scarring—systemic therapy becomes a crucial part of care. At this point, patients should be educated about the chronic nature of the disease and the likelihood that medications or procedural interventions (such as laser hair removal, botulinum toxin injections, or surgery) will be necessary. It's important to set expectations early and emphasize that a comprehensive treatment plan will likely involve both medical and procedural elements over time. Proactive planning ensures patients aren’t left without treatment options during flares or worsening symptoms, particularly given the often long wait times for specialist appointments.

Effective HS management also depends on pairing the patient with the appropriate provider team and leveraging all available resources. Dermatologists serve as the “quarterback,” coordinating care across specialties such as surgery, wound care, mental health, and pharmacy. Digital tools, patient education handouts, and early use of systemic therapy for moderate disease help close the gap between diagnosis and optimal treatment. This coordinated, anticipatory approach improves outcomes and supports long-term disease control while minimizing the frustration and isolation patients often experience.