Treatment Survival in Patients With Hidradenitis Suppurativa

ABSTRACT Background Despite the existence of therapeutic approaches, effective management of hidradenitis suppurativa (HS) remains elusive in many cases. In addition, most of the current studies focus on treatment response in a cross‐sectional analysis of patients, and therefore a proper study analysing different treatment strategies longitudinally in each individual patient is still lacking. Objectives The current study aimed to provide insight into HS patients treated with different treatment strategies and to clarify the reasons for switching or discontinuing each treatment group. Methods The single‐center, retrospective study collected information on patient characteristics and management strategies, focusing on different treatment groups and reasons for discontinuation or switching. Results Ninety‐eight patients were included in the study (53.1% males, median age 38.5 years). During the study period, 98.0% of patients had at least one prescription of topical therapy, particularly non‐antibiotics disinfectants. 92.9% of patients also received a prescription for systemic antibiotics, especially tetracyclines (86.7%). 26.5% were prescribed biologic therapies, mainly TNF‐alpha blockers (25.5%), with a median time to start treatment of 0.9 years. Non‐biologic systemic therapies (relative risk [RR]: 1.54; 95% confidence interval [CI] 1.28–1.85) and systemic antibiotics (RR: 1.97; 95% CI: 1.56–2.48) showed a moderate‐to‐high risk of discontinuation. The most frequent switching patterns were from topicals plus systemic antibiotics to the same combination plus other therapies (11.2%), including surgery and laser, to topical treatment alone (8.5%), or to topicals plus biologics (4.5%). Conclusions Standard care management of HS requires a personalized, multifaceted approach, typically involving a combination of local and systemic treatments, with antibiotics often used first. When antibiotics and other systemic agents are ineffective, biologics may be used alone or with antibiotics; delaying their use can miss the chance to prevent disease progression and the possible ‘window of opportunity’ in the treatment of HS.