Biologic therapies and small molecules in the treatment of hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a debilitating chronic skin condition challenging to manage. Treatment options range from topical and systemic medications to various surgical procedures. With the expanding knowledge of cytokine signaling pathways, systemic treatment for HS is entering an exciting phase, offering new opportunities to address imbalanced immune responses. The primary categories of treatment include biologics and small molecules. Currently, the only three approved biologics for HS are the anti-tumor necrosis factor alpha (anti-TNF-α) antibody adalimumab, the anti-interleukin-17A (anti-IL-17A) secukinumab, and the anti-IL-17A or 17F, bimekizumab. Although studies indicate moderate effectiveness of all three drugs, achieving adequate disease control remains challenging for many patients. Research in the field of HS is rapidly evolving, with a wide range of treatments being developed that leverage various mechanisms of action. Drugs targeting the IL-17 and Janus kinase/signal transducer and activator of transcription pathways show promise in ongoing and completed phase 3 studies, offering the potential for more comprehensive treatment responses.