Towards a Paradigm Shift in Delivering Hidradenitis Suppurativa Care: a Narrative Review.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by deep-seated nodules, recurrent painful abscesses, and draining tunnels in the intertriginous skin areas that may lead to irreversible tissue damage and scarring. This disfiguring and debilitating disease is also associated with several systemic comorbid disorders, mental health issues, and reduced quality of life. Recent research has significantly advanced our understanding of HS pathogenesis, thereby opening doors to novel treatments. However, challenges persist, such as disease underreporting, diagnostic delays, and a scarcity of evidence-based treatments. Owing to diagnostic delays, the therapeutic "window of opportunity" is often missed, contributing to suboptimal outcomes, with the patient receiving treatment only at advanced stages of the disease. The heterogeneity in outcome measures and the relative lack of well-defined disease phenotypes and biomarkers further complicates the management of the disease. Strategies aimed toward early treatment initiation, identifying patient phenotypes or risk factors for rapid disease progression, and timely intervention with biologic therapy could enhance treatment outcomes. This article presents a review of these critical areas and the potential measures that could improve patient care leading to a better quality of life.