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Enhancing Hidradenitis Suppurativa Care: Expert Insights to Your Frequently Asked Questions

Clinical Thought
Clinical Thought
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Released: September 14, 2026

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Hidradenitis suppurativa (HS) remains challenging to recognize and manage amid diagnostic delays and an evolving treatment landscape. Building on questions raised during the webinar, this FAQ-style ClinicalThought addresses practical considerations for biologic treatment sequencing and explores how emerging technologies, including AI, may support HS awareness and more timely care.

Steve Daveluy
Steve Daveluy, MD, FAAD
Venessa Peña-Robichaux
Venessa Peña-Robichaux, MD
Modern hidradenitis suppurativa care FAQ


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In this commentary, Steve Daveluy, MD, FAAD, and Venessa Peña-Robichaux, MD, answer questions posed by healthcare professionals (HCPs) during a live symposium titled “Turning Down the Heat in HS: Translating Emerging Mechanistic Insights and Biologic Innovation Into Meaningful Patient Outcomes.” Learn about specific considerations for sequencing of biologic therapies and how artificial intelligence (AI) is helping close diagnosis gaps in hidradenitis suppurativa (HS) care. 

Many HS experts favor off-label infliximab as a first biologic therapy, but I like to start patients on adalimumab. Which biologic therapy do you prefer to use first in patients with moderate to severe HS?

Steve Daveluy, MD, FAAD:
When it comes to shared decision-making, infliximab is a bit of a pain for patients because we are often administering it every 4-6 weeks. That is a lot of infusions in a year, and a lot of time patients must request time off from work. I have had patients who could not get enough time off for their infliximab treatment. Therefore, I think it is reasonable to start them on adalimumab.

Since bimekizumab and secukinumab are both approved to treat moderate to severe HS, as well, I find that I reach for infliximab a lot less in my practice. The problem is the lack of head-to-head trial data, though some studies have tried to compare the efficacy of these agents in meta-analyses. I am not a strong advocate for infliximab like some HCPs, but I also cannot blame them for reaching for it as a treatment option. We usually have tough HS cases referred to us in dermatology, where a lot of other treatments have failed. So sometimes HCPs can skew toward going hard right away in terms of biologic therapy to help alleviate patients’ symptoms.

I think it is reasonable to at least start with adalimumab, secukinumab, or bimekizumab, while keeping infliximab on the table as a backup. Also, approval-wise, it is likely easier to get patients started on adalimumab, secukinumab, or bimekizumab, considering some health insurance companies will push you toward those agents first because they are the FDA-approved biologic therapies for HS.

Venessa Peña-Robichaux, MD:
I completely agree. I usually start my patients on adalimumab because it is easier to access. Its efficacy has also been shown to have a quick onset for most and is pretty predictable. However, I have patients who I know are going to need infliximab. Regardless, it is easier to get infliximab approved for their HS once adalimumab has failed them for health insurance reasons. That is why I usually start patients with moderate to severe HS on adalimumab.

Do you think AI helps patients come up with an HS diagnosis on their own—to then prompt a discussion about it with their HCP?

Steve Daveluy, MD, FAAD:
Yes, I have had patients ask about HS after using AI. I also have messed around with AI myself. I told it that I kept getting these boils in my armpits and asked, “What is going on?” The response was pretty darn good, which just goes to show that HS is not necessarily hard to diagnose. Rather, the main issue continues to be a lack of awareness and education.

I also have had patients ask about HS because social media diagnosed them. Once I asked a patient, “Am I the first person who said it was HS?” And she responded, “No, social media did. I do not check social media for medical reasons, but it just started showing me pictures of people with scars in their armpits. And I was like, wait, that is what I have.” This happens because social media companies track users across the web and store their personal data, including past web searches, to further target the content they see.

This is 1 good thing with modern-day technology being so invasive—it has helped patients learn that they might have HS. I also think that this could help reduce delays in diagnosis vs educating HCPs themselves. Today’s technology is helping patients. Furthermore, I would say that many patients with HS rely on the internet to figure out what they have before they talk to a specialist about it.

Now that the internet is getting better, social media is getting better, and AI is getting better, patients are getting more correct answers. Some even have to teach their HCP about HS, which is a whole other adventure when you have a chronic, inflammatory disease that is underrecognized and lacks general awareness.

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How often have you had patients start a conversation with you about HS because they heard about it through social media or AI? You can get involved in the conversation by answering the polling question and posting a comment below.

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