Management Considerations for Patients with Hidradenitis Suppurativa and Lupus Spectrum Disease: A Narrative Review.

Hidradenitis suppurativa (HS) is a chronic inflammatory condition that carries a high burden of comorbidities, including various autoimmune conditions. Emerging population-level data indicate a significant association between HS and lupus spectrum diseases, including systemic lupus erythematosus (SLE), cutaneous lupus erythematosus (CLE), and drug-induced lupus erythematosus (DILE), with studies demonstrating an elevated risk of SLE among patients with HS compared with non-HS controls. Despite shared immunological mechanisms, including overlapping cytokine signaling and pathways such as the Janus kinase/signal transducers and activators of transcription (JAK/STAT) cascade, co-managing HS and lupus presents major clinical challenges. Guidance on how to manage patients with both HS and varying presentations of lupus is limited in the literature. A primary management challenge is the risk of DILE or inducing flares of preexisting SLE. Tumor necrosis factor (TNF)-α inhibitors (e.g., adalimumab, infliximab), which are mainstays of treatment for moderate-to-severe HS, can induce autoantibodies and trigger DILE. Other common medications used for HS, such as minocycline, have also been associated with reports of drug-induced lupus. Managing patients with concurrent HS and lupus should balance adequate HS disease control while avoiding therapies capable of inducing or exacerbating lupus flares. Other treatment options, such as anifrolumab, interleukin (IL)-1 inhibitors, and JAK/tyrosine kinase (TYK)2 inhibitors are currently under investigation, with preliminary data supporting their role in managing both HS and lupus spectrum diseases. Herein, we propose a clinical decision framework to guide safe, individualized therapeutic strategies for clinicians treating this complex patient population.