Recent advances in hidradenitis suppurativa therapeutics: a focus on existing and future medical therapeutics.

INTRODUCTION: HS is an inflammatory skin condition that causes abscesses, nodules, and tunnels in intertriginous areas. Treatment consists of multimodal therapy such as topical and systemic antibiotics, washes and ointments, hormonal modulation, retinoids, surgery, and recently biologic therapy. The FDA approved three biologics for HS in the last 10 years, although novel options are needed for recalcitrant disease.

AREAS COVERED: A comprehensive search of the National Institutes of Health (NIH) Clinical Trials database was performed in April 2025, with an updated search in October 2025. Trials were limited to hidradenitis suppurativa, phase II or III, and a status of not yet recruiting, recruiting, active, completed, or terminated. Data were supplemented with a PubMed query and an internet search for data and press releases from companies. Results include 52 phase 2 and 16 phase 3 studies.

EXPERT OPINION: Biologics serve as a steppingstone to a new age of therapy for HS. Investigations are needed for recalcitrant disease, to minimize adverse events, and provide personalized treatment. Compounds with promise include JAK inhibitors, while other compounds await results, and others limited by small sample sizes and non-randomized study designs. Future trials should focus on comparative drug designs and ensuring fair access for all, particularly patients with the highest disease burden.