Hesitating over hidradenitis suppurativa?
Dermatologists push for earlier diagnosis and treatment in chronic skin disease.
P004 – A New Paradigm in the Management of the Hidradenitis Suppurativa Disease Spectrum
1-3 p.m. | Friday, July 17
Trianon Ballroom
Dermatologists are calling for a major shift in how chronic inflammatory skin diseases — particularly hidradenitis suppurativa (HS) — are diagnosed and managed, emphasizing earlier identification and more proactive treatment strategies to prevent long-term damage.
According to Amit Garg, MD, FAAD, the push comes amid growing concern that patients with HS often face yearslong delays before receiving an accurate diagnosis, allowing the disease to progress to more severe stages where treatment becomes less effective. Dr. Garg, a professor of dermatology at Northwell Health in New York, leads this afternoon’s session, P004 – A New Paradigm in the Management of the Hidradenitis Suppurativa Disease Spectrum.
“On average, it may take 10 years for patients to hear the words and be diagnosed with hidradenitis suppurativa. There may already be significant progression of disease during this time,” Dr. Garg said. “Dermatologists may also be treating patients with the most effective medicines available later in the disease course, because our concept of moderate-to-severe disease for HS may be skewed to the more severe end of the spectrum. And at that stage, there is less we can do to adequately address symptoms and impact, no matter which treatment we try.”
Improving early identification
The good news? Dermatologists may soon have a published framework to guide patients and physicians on recognizing moderate disease in practice, Dr. Garg said.
These tools are designed to:
- Standardize how disease severity in HS is defined in clinical practice
- Initiate the most effective therapies and the most appropriate time in the disease course
Dr. Garg said that timely appreciation of moderate disease status could meaningfully improve outcomes, including modification of disease progression, for HS patients.
Tracking treatment outcomes in real time
Another focus of the evolving approach, he said, is defining how dermatologists can evaluate whether treatments are achieving therapeutic goals. Dr. Garg encourages dermatologists to apply a patient-centered framework that includes the following:
- Asking about improvements in day-to-day symptoms
- Asking about reductions in the frequency, severity, and durations of flares
- Assessing for the development of new, persistent lesions
“A patient-oriented and practice-feasible approach to assessing adequacy of initial treatment can be achieved without exhaustive lesion counts,” Dr. Garg said. “I typically give any treatment about four months to work, after which time a modification or change in the therapeutic strategy is warranted.”
Given the progressive nature of the disease for many patients, he said it is important to make the necessary adjustments to the therapeutic strategy in a timely manner.
Taking a more dynamic treatment approach
Dermatologists are also advocating for a more flexible and proactive management strategy, he said, one that moves away from static treatment plans and toward continuous optimization of care.
According to Dr. Garg, key elements of this approach include:
- Selecting treatment based on disease severity and impact
- Establishing clear timelines to evaluate success
- Adjusting therapy when goals are not met
- Combining medications with office-based procedures when needed
Procedural interventions may be used alongside medical therapies to manage acute flares or resistant lesions, he said, helping patients achieve better overall symptom control.
Looking ahead
Ultimately, as new guidelines and frameworks are finalized and published, Dr. Garg said dermatologists can expect a shift toward:
- Earlier diagnosis
- More timely initiation of disease-modifying therapies
- More structured follow-ups and treatment adjustments
These changes could significantly reduce the long-term burden of a condition that has historically been undertreated, he said.
“My advice is to determine the most appropriate class of treatment based on disease severity and impact and have a specified window of time to evaluate the effectiveness of the treatment strategy,” Dr. Garg said. “When therapy goals are not being met, be deliberate about making the necessary adjustments and incorporate procedures along the way to optimize the management strategy.”
