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 the intertriginous areas. Treatment consists of multimodal therapy such as topical and systemic antibiotics, topical washes and ointments, hormonal modulation, retinoids, surgery, and recently biologic therapy. The FDA approved 3 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 performed in October 2025. Trials were limited to hidradenitis suppurativa, phase 2 or 3, and a status of not yet recruiting, recruiting, active, completed, or terminated. Data were supplemented with a query of PubMed and an internet search for topline data and press releases from companies. Our results include 52 phase 2 studies 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 effects of adverse events, and provide personalized treatment. Compounds with promising results 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 trial access for all patients, particularly patients with the highest disease burden.