Hidradenitis Suppurativa and IL-17 Inhibitors: A Focus on Trials and Real-Life Data

Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease associated with significant physical and psychosocial burden. Increasing evidence identifies the interleukin (IL)-17 pathway as a central driver of HS pathogenesis. Elevated levels of IL-17 family cytokines, particularly IL-17A and IL-17F, have been consistently demonstrated in lesional skin, where they contribute to keratinocyte activation, neutrophil recruitment, and amplification of proinflammatory cascades. This review provides a comprehensive overview of the pathogenic role of IL-17 in HS and summarizes current evidence on IL-17-targeted therapies from clinical trials and real-world studies. Secukinumab, a selective IL-17A inhibitor, has shown significant efficacy in phase III trials, with clinically meaningful improvements in Hidradenitis Suppurativa Clinical Response (HiSCR), pain, and quality of life, sustained over long-term follow-up. Bimekizumab, a dual inhibitor of IL-17A and IL-17F, has demonstrated robust and consistent efficacy across multiple endpoints, including higher response rates and greater improvements in patient-reported outcomes, supporting the relevance of dual cytokine inhibition. Despite these advances, treatment responses remain heterogeneous, reflecting the multifactorial nature of HS. Further research is needed to identify predictive biomarkers and optimize therapeutic strategies.