The AAD and HS Foundation just released their first joint clinical guidelines for hidradenitis suppurativa, and they're a major upgrade. Four biologics now carry strong recommendations, and JAK inhibitors get a conditional nod. Pain management and comprehensive care are front and center in the 37 evidence-based recommendations covering patients aged 9 and older.
The American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa (HS) Foundation have released their first-ever joint clinical guidelines for HS — a chronic, painful skin condition affecting up to 1.5% of the global population. Published in the Journal of the American Academy of Dermatology, the guidelines include 37 evidence-based recommendations for managing HS in adults, adolescents, and children aged 9 and older.
The biggest shift from the 2019 guidelines? Four biologics now carry strong recommendations — adalimumab, bimekizumab, secukinumab, and infliximab — compared to just one (adalimumab) previously. JAK inhibitors also make their debut, with topical ruxolitinib and oral upadacitinib receiving conditional recommendations. The guidelines also move away from using Hurley staging to define disease severity, enabling earlier treatment before irreversible tissue damage occurs.
Pain management gets a formal spotlight, with routine pain assessment elevated to a "Good Practice Statement." Supportive options range from warm compresses and NSAIDs to opioids for refractory cases, and SNRIs or gabapentin for chronic pain.
Key Takeaways:
Why it matters: These guidelines give clinicians a clear, modern roadmap for treating a condition that has long lacked standardized care, empowering earlier and more aggressive intervention to prevent permanent scarring and improve patient quality of life.
