ROSEMONT, Ill. (Oct. 20, 2026) — Over 3 million people have been diagnosed with hidradenitis suppurativa (HS) in the United States and today, the American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa Foundation (HSF) have published the first-ever joint guidelines for the management and care of the painful condition.
HS is a skin condition that causes painful lumps deep in the skin, typically in areas of the body where skin rubs together like armpits, inner thighs, and the groin. Early diagnosis of HS is critical as it is often confused with acne or infection, causing people to go years without an accurate diagnosis. A board-certified dermatologist can both identify HS and screen for the medical and psychiatric conditions that often accompany it, giving patients access to comprehensive, individualized care sooner.
“While hidradenitis suppurativa is a chronic condition, its painful symptoms are highly treatable,” said AAD President and board-certified dermatologist Murad Alam, MD, MSCI, MBA, FAAD. “For millions of people with HS, dermatologists provide more than just a diagnosis. They provide expert, comprehensive care that allows patients to have a better quality of life.”
Compiled by a work group of 13 experts, including 12 board-certified dermatologists, the newly released guidelines, published in the Journal of the American Academy of Dermatology (JAAD), include 37 evidence-based recommendations designed to treat chronic HS disease and acute HS flares.
“These guidelines establish an evidence-based standard of care for HS, giving patients, dermatologists, and payers a shared roadmap for what high-quality HS care looks like,” said board-certified dermatologist Haley B. Naik, MD, FAAD, co-chair of the Hidradenitis Suppurativa Guideline Work Group and president of HSF. “Every person living with HS deserves care that meets this standard.”
The largest barrier to impactful HS care is step therapy, an insurance requirement for patients to try insurer-designated treatments before coverage is approved for the dermatologist-prescribed preferred medication. Evidence does not support the use of step therapy in HS care as it delays access to appropriate treatment.
Strong recommendations of care
Strong recommendations imply that treatment benefits clearly outweigh risks and burdens. These recommendations apply to most patients in most circumstances.
Biologics (adalimumab, bimekizumab, infliximab, and secukinumab), injectable treatments that target the immune system, are strongly recommended for individuals with moderate-to-severe HS. These treatments are shown to reduce the number of abscesses and nodules by at least half, without any new abscess or tunnel development.
Abscesses are painful lumps that grow, join together, and fill with fluid. Tunnels are hollow channels that form under the skin.
Conditional recommendations of care
Conditional recommendations imply that treatment benefits are closely balanced with risks and burdens. These recommendations apply to most patients, but the best course depends on what matters most to each individual, including their tolerance for side effects, treatment goals, and day-to-day circumstances.
Topical therapies (clindamycin, resorcinol, and ruxolitinib) are applied to the skin to reduce abscesses and the severity of symptoms.
Systemic antibiotics (doxycycline, tetracycline, clindamycin in combination with rifampin, and ertapenem) work throughout the body to decrease severity of symptoms and improve quality of life.
Hormone therapy (spironolactone) is taken by mouth to decrease severity.
Systemic therapies (upadacitinib and short-term systemic steroids) are taken by mouth and work throughout the body for individuals with moderate-to-severe HS to reduce disease activity and pain.
Continuing injectable biologics (adalimumab) is recommended for individuals with moderate-to-severe HS undergoing surgery.
In-office procedures can be especially helpful if abscesses and tunnels have formed in the skin, including:
Deroofing, a minor treatment to open and flatten the tunnels under the skin. This treats recurrent or persistently bothersome HS lesions, or bumps, spots, or growths.
Incision and drainage to treat painful abscesses.
Surgical removal of an area of affected skin for abscesses or tunnels that persist or continue to come back.
Laser hair removal for fewer flares.
Botulinum toxin to reduce flares.
Intralesional triamcinolone (a steroid injection) to treat painful, flaring bumps.
Conditional recommendations were made against the use of oral retinoids (acitretin and isotretinoin), certain biologics (etanercept, guselkumab, risankizumab, and vilobelimab), systemic therapies (avacopan, and methotrexate and azathioprine as primary treatments), and radiotherapy for pediatric and adolescent HS patients. In addition, there is insufficient evidence to support oral contraceptive pills or finasteride (hair loss medication) for HS management.
Supportive management
While HS therapies may reduce pain, they don’t always achieve adequate pain relief. Supportive pain management is a conditional recommendation that helps manage sudden pain, consistent pain, and pain that does not improve after treatment and pain relief therapies.
Treatments to manage sudden pain include warm or cool compresses, topical lidocaine (a local anesthetic), acetaminophen (a pain reliever), nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen, steroid injections, incision and drainage, and short-term steroids that work throughout the body. Opioids can be used if the pain doesn’t decrease through other treatments.
Long-lasting pain can be managed with serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, psychotherapy, proper wound care, and nerve pain medications such as gabapentin and pregabalin.
There is insufficient evidence to support weight reduction and GLP-1 usage for HS treatment. There is also insufficient evidence that specific diet plans — intermittent fasting, the Mediterranean diet, the yeast exclusion diet, and the dairy-free diet — help manage HS. However, a heart-healthy diet of fruits and vegetables, whole grains, healthy fats, and lean proteins remains important for reducing heart and diabetes risk for individuals with HS.
Complementary medicine
Lifestyle changes and supplements can also help manage the pain and discomfort from HS. A conditional recommendation was made for quitting tobacco, which can improve an individual’s response to treatments aimed at addressing the disease itself.
Conditional recommendations were made for complementary and alternative medicine, including vitamin D supplements for individuals with deficiencies, and zinc supplements. These supplements, taken under a doctor’s supervision, may reduce lumps and tunnels and relieve pain.
“Untreated HS can have a serious impact on your health and well-being. It can cause scarring, wounds that limit your mobility, and intense pain. It also often happens in combination with other medical and psychiatric conditions, with this increasing its overall toll on patients,” said Dr. Alam. “Whether you’ve been diagnosed with HS or suspect you may have it, please take the time to see a board-certified dermatologist to have it expertly assessed, consider your options, and find the best plan for you.”
To find a board-certified dermatologist in your area, visit aad.org/findaderm.
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Contact
Shelby Homiston, shomiston@aad.org
Nia Carter, ncarter@aad.org
Media Relations, mediarelations@aad.org
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About the AAD
Headquartered in Rosemont, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatologic associations. With a membership of more than 21,500 physicians worldwide, the AAD is committed to advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education and research in dermatology; and supporting and enhancing patient care because skin, hair, and nail conditions can have a serious impact on your health and well-being. For more information, contact the AAD at (888) 462-DERM (3376) or aad.org. Follow @AADskin on Facebook, TikTok, Pinterest, and YouTube, and @AADskin1 on Instagram.
Editor’s note: The AAD does not promote or endorse any products or services. This content is intended as editorial content and should not be embedded with any paid, sponsored, or advertorial content as it could be perceived as an AAD endorsement.
About the Hidradenitis Suppurativa Foundation
Since its founding in 2005, the Hidradenitis Suppurativa Foundation has fostered and encouraged worldwide research by developing and supporting an interdisciplinary family of scientists and physicians devoted to studying Hidradenitis Suppurativa, in order to deliver more effective forms of treatment and preventative measures to those with this common, debilitating, and eminently chronic disease.
HSF is a 501(c)(3) dedicated to improving the lives of people affected by Hidradenitis Suppurativa (HS) through research, education, and advocacy. Explore their resources for patients, clinicians, and investigators at hs-foundation.org, and follow @hsforg on Instagram and YouTube, and @HidradenitisSuppurativaFoundation on Facebook and LinkedIn.
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