GLP-1 Receptor Agonists in Hidradenitis Suppurativa: Time to Treat the Whole Patient

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a disproportionately high burden of metabolic comorbidities, including obesity, metabolic syndrome, type 2 diabetes mellitus (T2DM), dyslipidaemia, and polycystic ovary syndrome. Despite this, clinical management of HS has historically remained siloed within dermatology, with insufficient integration of cardiometabolic risk management.

GLP-1 receptor agonists (GLP-1 RAs) - a drug class now established for T2DM, obesity, and cardiovascular risk reduction - have recently emerged as candidate agents for HS. A systematic review published in 2024 and two pivotal real-world studies published in 2025 provide preliminary evidence that GLP-1 RAs improve HS disease activity through both weight loss and direct anti-inflammatory mechanisms. We argue that this evidence base is already sufficient to justify a paradigm shift: GLP-1 RAs should be considered as adjunctive components of a multidisciplinary treatment strategy for HS patients with concurrent cardiometabolic disease. We propose a practical clinical framework for patient selection and monitoring and call for dedicated randomised controlled trials.

Metabolic comorbidities are mechanistically linked to HS pathogenesis and are inadequately addressed in current clinical practice. GLP-1 RAs offer dual benefit in HS - improving both metabolic outcomes and HS disease activity. Dermatologists should screen every HS patient for cardiometabolic comorbidities and advocate for GLP-1 RA therapy in eligible patients as part of a multidisciplinary approach.