Interesting Open Access Hidradenitis Suppurativa (HS) Reads – June 2025

Using the search term “hidradenitis suppurativa”, a total of 78 publications appeared in PubMed during June 2025. Of these, approx. 47% (37/78) were open access.

1. Managing HS in Special Populations

🟣 What Is This Paper About?

This review looks at how to treat HS in people who have other serious health conditions. These “special populations” include people who are immunosuppressed, have cancer, inflammatory bowel disease (IBD), heart problems, Down syndrome, or rare syndromes like PASH (pyoderma gangrenosum, acne, and suppurative hidradenitis).

Because these patients have extra health challenges, treating HS can be more complicated and risky. This paper outlines what doctors need to think about when managing HS in these groups.

🔍 Key Populations and What the Study Found

1. People with weakened immune systems (e.g., HIV, transplant recipients):

• Some HS treatments, like TNF blockers, can increase the risk of infections.
• Careful monitoring is needed, but many patients still benefit from these treatments.
• Surgery is an option, but healing may be slower.

2. People with cancer:

• HS may raise the risk of skin cancer, especially in long-standing, untreated areas.
• Treatments like biologics might still be used, but doctors need to balance cancer risks.
• Regular skin checks and lab tests are recommended.

3. People with inflammatory bowel disease (IBD):

• HS is more common in people with Crohn’s disease or ulcerative colitis.
• Some medications help both conditions, but others (like IL-17 inhibitors) might make IBD worse.
• Surgery is often needed for severe or deep lesions, especially around the anus.

4. People with heart or metabolic disease:

• HS increases the risk of heart disease and stroke.
• Regular checks (like blood pressure and cholesterol) are needed.
• Some HS medications may improve or worsen heart risk factors, so choices must be personalized.

5. People with Down syndrome:

• HS occurs more often and starts earlier in people with Down syndrome.
• They often get less treatment than needed, due to concerns about medication safety.
• Evidence suggests biologic treatments are generally safe, and more education is needed for families and healthcare providers.
• Surgery is underused in this group.

6. People with rare syndromes (e.g., PASH):

• These are inflammatory conditions that include hs, acne, and other symptoms.
• Treatment is difficult and often needs a combination of biologic drugs and other medications.
• TNF blockers (like adalimumab or infliximab) are often effective, but not always.

📌Main Message

• HS treatment must be adapted when patients have other serious health issues.
• Biologic drugs (like TNF inhibitors) can still be useful but require close monitoring.
• Surgery remains an important option, even in medically complex patients.
• Care should be personalised and involve a team of specialists (e.g., dermatologists, GPs, gastroenterologists, cardiologists).
• More research is needed to improve care for these underrepresented and often underserved patient groups.

Link: https://link.springer.com/article/10.1007/s13555-025-01457-4

Citation: Mallela T, Passannante L, Patel H, Onyeji L, Sayed C. Management of Hidradenitis Suppurativa in Special Populations: A Narrative Review. Dermatol Ther (Heidelb). 2025 Jun 20. doi: 10.1007/s13555-025-01457-4. Epub ahead of print. PMID: 40542230.

 

2. Management of HS in Primary Care in the UK

🔍What Was the Study About?

This study looked at how healthcare professionals (HCPs) in UK primary care understand and manage HS.

The researchers wanted to find out:

• How confident HCPs are in diagnosing and treating HS
• What knowledge gaps exist
• How care in primary care could be improved

👥 Who Took Part?

• 183 HCPs across the UK completed the survey
• Most were GPs, but also included nurses, pharmacists, and physician associates
• 93% had no specialist dermatology role, and 69% had no formal dermatology training

📊 Key Findings

✅ Confidence in Diagnosing, But Not Managing

• 74% felt confident diagnosing HS
• Only 39% felt confident managing pain, and 45% in managing associated conditions (e.g., diabetes, depression)
• Confidence in starting treatment was higher (67%), but many were unsure about when to refer to dermatology

💊 Treatment & Management Gaps

• Pain management was inconsistent:
  • 63% would use anti-inflammatories
  • Only 24% considered nerve-pain medications
• Only 7% correctly identified a first-time abscess as not diagnostic for HS, showing confusion over early signs

💡 Limited Knowledge of Related Conditions

• Most knew about links with depression (79%) and diabetes (84%)
• Fewer recognized pilonidal sinus (47%) or acne (53%) as common in patients with HS

🩹 Dressing Supplies Were Inadequate

• Many HCPs prescribed too few dressings, especially GPs
• This results in patients with HS buying their own or improvising, which adds financial stress

📉 Why Does This Matter?

• Delayed diagnosis and mismanagement of HS can lead to worsening disease, scarring, and avoidable distress
• Patients often feel dismissed or misunderstood in primary care
• Lack of education on HS leads to missed treatment opportunities, especially early in the disease when treatments like biologics are more effective

🧠 What Needs to Improve?

• Better training on HS for GPs and other primary care professionals
• Clear, practical guidelines tailored to primary care
• Tools to help identify and manage HS early
• Better prescribing practices for dressings and pain relief
• All team members ought to be involved in education and care

📌Main Message

Most HCPs in UK primary care can recognise HS, but many struggle with what to do next. This study highlights the need for improved training, clearer referral pathways, and practical support, which could help catch HS earlier, ease the burden on patients, and reduce long-term health impacts.

Link: https://bjgpopen.org/content/early/2025/06/22/BJGPO.2025.0060

Citation: Wainman HE, Gallard S, Ridd MJ, Ingram JR. Management of hidradenitis suppurativa in UK primary care: cross-sectional survey. BJGP Open. 2025 Jun 23:BJGPO.2025.0060. doi: 10.3399/BJGPO.2025.0060. Epub ahead of print. PMID: 40550630.

 

3. The Microbiome in HS Tunnels

🔍 What Was the Study About?

This review looked at what types of bacteria (the microbiome) live in the tunnels (sinus tracts and fistulas) that form in people with HS. The researchers wanted to understand:

• What bacteria are found in HS tunnels
• How they differ from unaffected skin or other HS lesions
• Whether the bacteria might be causing or worsening the disease

🧪 What Did the Researchers Do?

They analyzed results from 10 studies involving 418 patients with HS, focusing specifically on the microbiome (the collection of bacteria) found inside HS tunnels. They compared these findings to:

• Unaffected skin
• Other HS lesion types (like nodules or abscesses)
• Factors like age, sex, body weight, smoking, and disease severity

🔬 Key Findings

1. Tunnels Have a Unique Bacterial Mix

• Anaerobic bacteria (which grow without oxygen) dominated the tunnels
• Common bacteria included Porphyromonas, Prevotella, Fusobacterium, Parvimonas
• Healthy skin bacteria such as Cutibacterium acnes and Staphylococcus epidermidis were greatly reduced

2. Worse Disease = More Bacteria

• Advanced HS (Hurley stage II or III) had more harmful bacteria
• Mild cases or early lesions had fewer bacterial changes
• Certain bacteria (like Parvimonas) were almost only found in the most severe tunnels

3. Biofilms Were Common

• Biofilms (sticky layers of bacteria) were found in many tunnels
• These can protect bacteria and make treatment harder, possibly explaining why antibiotics sometimes don’t work well

4. No Clear Link to Age or Lifestyle

• Bacteria in tunnels did not vary significantly by age, gender, body mass index, whether people smoked, or location on the body

💡 Why Does This Matter?

• Tunnels in HS are chronic and hard to treat, which may be because they host certain bacteria that are resistant to normal treatments
• Understanding which bacteria are involved might help design better antibiotics, or even new treatments like microbiome therapies or probiotics
• Some bacteria found in HS tunnels are also found in gum disease and gut problems, hinting at shared immune pathways
• The only strong factor linked to more bacteria was disease severity

🧠 What’s Next?

The authors suggest:

• We need more precise studies using modern sequencing tools (not just lab cultures)
• Researchers should compare different lesion types (tunnels vs nodules)
• Future treatment might involve targeting specific bacteria or balancing the skin’s natural microbiome

📌Main Message

Tunnels in HS have a unique mix of bacteria, especially anaerobic ones, which are different from unaffected skin. This may help explain why tunnels keep recurring, why some antibiotics don’t work well, and what new treatments might look like.

Link: https://onlinelibrary.wiley.com/doi/10.1111/ijd.17892?af=R

Citation: Soto-Moreno A, Haselgruber-de Francisco S, León-Pérez J, García-Moronta C, Cuenca Barrales C, Arias-Santiago S, Molina Leyva A. The Microbiome in Hidradenitis Suppurativa Tunnels: A Systematic Review. Int J Dermatol. 2025 Jun 17. doi: 10.1111/ijd.17892. Epub ahead of print. PMID: 40528662.

 

4. Social Media as a Catalyst for HS Education and Early Diagnosis

📱 What is this article about?

This article discusses how social media, especially TikTok, can help people learn about HS and lead to earlier diagnosis and treatment. The authors highlight how online health content is changing the way patients understand their symptoms and interact with healthcare professionals.

📲 How is social media helping?

• TikTok and other platforms allow patients to share their stories, symptoms, and experiences in an easy-to-understand way.
• Videos, like one showing “double-ended blackheads” (pseudocomedones), help people recognize the symptoms and seek medical advice.
• Social media increases awareness, especially among younger people, low-income communities, and those with less access to traditional healthcare.

💬 Why does this matter?

• Traditionally, health education came from doctors only, through brochures or pamphlets.
• Today, platforms like TikTok and Reddit allow real-time, peer-to-peer support.
• People who learn about their symptoms online often visit doctors sooner, communicate their symptoms more clearly, and feel more empowered during appointments.

📈 Key Points:

• Around 80% of adults now use the internet for health information
• TikTok alone had over 1 billion users in 2024, with a huge reach among people under 30
• Online health videos can improve understanding, especially for people with lower health literacy
• Informed patients tend to have better healthcare experiences

📌Main Message

Social media is becoming a powerful tool for health education, especially for conditions like HS. Social media can help people recognize their symptoms, seek help earlier, and feel more confident when speaking with healthcare professionals. However, care must be taken to avoid misinformation.

Link: https://jddonline.com/articles/social-media-as-catalyst-health-education-early-diagnosis-of-hidradenitis-suppurativa-S1545961625P8960X/

Citation: Zadu AK, Adibe I, Welch D, Pastard W, Pritchett EN, Heath CR, Okoye GA, Byrd AS. Social Media as a Catalyst for Health Education and Early Diagnosis of Hidradenitis Suppurativa. J Drugs Dermatol. 2025 Jun 1;24(6):e45. PMID: 40465496.

 

5. Network Meta-Analysis of Monotherapies for HS

🔍 What was this study about?

Researchers wanted to find out which individual treatments (monotherapies) for HS work best. Many different drugs have been tested in clinical trials, but very few have been directly compared to each other. To get around this, the researchers used a method called a network meta-analysis. This lets scientists compare many treatments even if they haven’t been tested directly against each other in the same trial.

💊 What treatments were compared?

They looked at systemic treatments (those that work throughout the body), including:

• Biologics like adalimumab, secukinumab, and bimekizumab
• Small molecule inhibitors like apremilast and povorcitinib
• Other investigational drugs used in trials

📊 What did they measure?

They looked at how well treatments worked after 16 weeks (a commonly used reference point in clinical trials, using:

• HiSCR-50: A 50% improvement in skin symptoms (nodules and abscesses)
• DLQI: A measure of how skin disease affects quality of life
• NRS30: A measure of reduction in skin pain
• Side effects (treatment-emergent adverse events)

🧪 What did they find?

• The three approved treatments (adalimumab, secukinumab, and bimekizumab) worked similarly well overall.
• Bimekizumab showed slightly better results than some non-approved drugs, like IFX-1.
• Apremilast (currently not approved for HS) looked promising in a small study, but isn’t routinely recommended yet.
• In terms of quality of life, bimekizumab outperformed some other treatments, including low-dose adalimumab.
• Most treatments had a similar safety profile, meaning serious side effects were not significantly different.

🧠 Why is this important?

• This study helps doctors, patients, and health services compare current treatment options even when direct head-to-head trials haven’t been done. It highlights which therapies seem to work best and which are safer.
• The researchers also showed the importance of using consistent outcome measures in future trials (like HiSCR, NRS30, DLQI) to make comparing treatments easier and more reliable.

📌Main Message

This study gives the clearest picture yet of how different HS monotherapies compare to each other. Biologics like bimekizumab, adalimumab, and secukinumab show strong effectiveness. The results support more informed treatment decisions and better trial design in future HS research.

Link: https://www.tandfonline.com/doi/epdf/10.1080/09546634.2025.2513054?needAccess=true

Citation: Gupta AK, Bamimore MA, Economopoulos V, Talukder M, Piguet V, Magalhaes R. A network meta-analysis study of monotherapies for hidradenitis suppurativa: analyses of the current evidence base. J Dermatolog Treat. 2025 Dec;36(1):2513054. doi: 10.1080/09546634.2025.2513054. Epub 2025 Jun 4. PMID: 40464762.

 

6. Food Insecurity and HS

 

🥫 What Is the Study About?

This study looked at whether people living with HS are more likely to experience food insecurity, which means not having reliable access to enough affordable, nutritious food.

🔍 Why Does It Matter?

HS is already known to be more common among people with:

• Low income
• Obesity
• Social stress and isolation

Food insecurity is also linked to poor health, including inflammation and chronic conditions. Therefore, the researchers wanted to know if there’s a connection between HS and food insecurity too.

👥 Who Was Studied?

• The study used data from over 57,000 adults in the US who were part of the All of Us Research Program
• Of those, 134 people had HS
• All had answered a short, validated survey on food insecurity

📊 What Did the Study Find?

• 27.6% of people with HS were food insecure
• Only 11% of people without HS were food insecure
• Even after adjusting for income, age, sex, and race/ethnicity, people with HS had 70% higher odds of food insecurity

These findings suggest that HS may play a direct or indirect role in making it harder for people to afford or access enough food, even when money is taken into account.

🧠 Why Might This Be Happening?

The study suggests several possible reasons:

• People with HS may earn less or be unemployed due to pain, stigma, or disability
• HS may increase social isolation or mental health struggles, which are linked to food insecurity
• Inflammation caused by poor diet or stress from food insecurity might worsen HS
• HS may make shopping, cooking, or eating more difficult due to mobility issues

📌Main Message

This is the first large-scale study showing a strong link between HS and food insecurity in the United States. Doctors should consider screening for food insecurity and helping patients with HS access support when needed.

Link: https://karger.com/drm/article/doi/10.1159/000546500/929349/Food-insecurity-in-hidradenitis-suppurativa-a

Citation: Jain S, Gunasti J, Sood A, Dieudonne R, Chopra D, Lev-Tov H, Yeung H, Orenstein LAV. Food insecurity in hidradenitis suppurativa: a cross-sectional analysis from the population-based All of Us Research Program. Dermatology. 2025 Jun 24:1-11. doi: 10.1159/000546500. Epub ahead of print. PMID: 40555198.

 

7. Racial Disparities in HS Management at a Single Institution

🔍 What Was the Study About?

This study looked at how people of different races, especially African American vs. non-African American patients, are treated for HS at one large medical center in the U.S. It aimed to find out whether there are differences or inequalities in how the disease is managed and whether those differences affect outcomes.

👥 Who Was Studied?

• 1,148 patients with HS were included.
• About 66% were African American, and 76% were women.
• All patients were treated by dermatology and/or plastic surgery between 2015–2020.

📊 What Did the Study Find?

🔹 1. African Americans had more extensive disease:

• More likely to have hs in both armpits, breasts, buttocks, abdomen, and thighs.

🔹 2. African Americans were less likely to have surgery:

• More often treated with medication alone (e.g., antibiotics, hormonal treatments).
• Non-African Americans had more surgical procedures, longer hospital stays, and more post-op infections.

🔹 3. Healthcare access & insurance varied:

• African Americans were more likely to have insurance and be on Medicaid.
• Non-African Americans were more likely to be uninsured, visit the emergency room more often, and be hospitalized.

🔹 4. Symptom improvement:

• African Americans reported better symptom improvement, despite receiving less surgery.
• Pain relief and full resolution of symptoms were similar across all groups.

💡 Why Do These Differences Exist?

• The reasons are complex:
  • Mistrust of the medical system (especially around surgery)
  • Cultural differences in healthcare beliefs
  • Location and severity of disease (some areas are harder to operate on)
  • Differences in healthcare access, income, or previous experiences

The authors also noted that non-African Americans had more overall health problems, which may also influence treatment decisions and outcomes.

🩺 What Can Help?

The authors recommend a multidisciplinary care approach, where patients with HS are supported not just by doctors, but also:

• Social workers
• Psychologists
• Nutritionists
• Case managers

This can improve care for all patients and help reduce racial disparities in treatment and outcomes.

📌Main Message

African Americans with HS may be less likely to receive surgical care, despite having more severe disease in sensitive areas.
Their symptom improvement was still high, but differences in treatment, healthcare access, and trust in the system may affect outcomes. More inclusive, team-based care can help address these disparities.

Link: https://journals.lww.com/prsgo/fulltext/2025/06000/racial_disparities_in_hidradenitis_suppurativa.32.aspx

Citation: Singh NP, Burge K, Drummond S, Zaniewski R, MacLeod S, Moradi L, Hattaway R, King TW, Mayo T, de la Torre JI. Racial Disparities in Hidradenitis Suppurativa Management at a Single Institution. Plast Reconstr Surg Glob Open. 2025 Jun 10;13(6):e6803. doi: 10.1097/GOX.0000000000006803. PMID: 40496992.

 

8. Tertiary Lymphoid Structures in HS

🧠 What is this study about?

This article discusses a newly discovered feature of HS called tertiary lymphoid structures (TLSs). These are clusters of immune cells that form in the skin at sites of long-term inflammation, like those seen in HS. The researchers explain how TLSs may be a major reason why HS stays active, keeps coming back, and doesn’t always respond well to treatment.

🔬 What are TLSs?

• TLSs are immune cell hubs that form in non-lymph tissue (like skin) during chronic inflammation.
• In HS, TLSs form near the keratinized tunnels (a key feature of advanced disease).
• They contain T cells, B cells, and antibody-producing cells, similar to what you’d find in lymph nodes.
• These clusters amplify immune responses locally, making inflammation worse.

🧩 What role do fibroblasts play?

• Fibroblasts (support cells in the skin) were previously thought to be passive, but this study shows they actively help build TLSs.
• They produce signaling molecules (like CXCL13 and CCL19) that attract and organize immune cells.
• This makes fibroblasts key players in sustaining chronic inflammation in HS.

🧪 What else did they find?

• Patients with HS had antibodies that target their own skin cells, suggesting an autoimmune component to HS (not just autoinflammatory).
• The same antibody-producing plasma cells were found clustered in lesions, but rarely in the blood, suggesting HS is very localized in its immune response.
• A new “TLS-on-a-chip” model was developed using patient cells to mimic these immune structures in the lab—this could help test treatments in future research.

💊 What does this mean for treatment?

• TNF blockers (like adalimumab) can prevent TLS formation if used early, but don’t break down TLSs once they’re already established.
• New treatments could focus on:
  • Blocking the signals that fibroblasts use (like CXCL13, CCL19)
  • Modifying fibroblast behaviour (with antifibrotic or immune-modulating drugs)
• These findings could also apply to other autoimmune diseases (e.g., Crohn’s, Sjögren’s) that show similar TLS activity.

📌 Main Message

Researchers have found that immune cell clusters called TLSs are a key reason HS becomes severe and long-lasting.

• They help explain why HS keeps recurring.
• They show how the immune system and skin cells feed off each other to keep inflammation going.
• They offer new treatment targets, especially if therapy is started early.

Link: https://linkinghub.elsevier.com/retrieve/pii/S0022202X25001125

Citation: Yu WW, Tong J, Lu CP. Decoding Tertiary Lymphoid Structures in Hidradenitis Suppurativa: New Mechanistic Insights. J Invest Dermatol. 2025 Jun;145(6):1272-1274. doi: 10.1016/j.jid.2025.01.026. Epub 2025 Mar 28. PMID: 40152835.

 

9. Concordance of DLQI and Pain Score in HS Clinical Trials

🧠 What’s this study about?

This research looked at how well two common patient-reported outcomes (PROs), quality of life (DLQI) and pain scores, line up with doctors’ assessments in HS clinical trials.

Doctors often measure how well a treatment works by counting lesions. But how a patient feels, their pain, and how their daily life is affected can give a very different picture.

🔍 What did the researchers do?

They reviewed 164 clinical trials on HS, including 115 that tested treatments. They focused on trials that included:

• DLQI (Dermatology Life Quality Index)
• Pain Numeric Rating Scale (NRS)

These are the most common tools for asking patients how they feel. They checked how often the PROs match the doctors’ assessments (called “concordance”).

📊 What did they find?

• Over 65% of all HS trials now include at least one patient-reported outcome (PRO).
• DLQI and pain scores were used in about 43% of trials each.
• The use of PROs in trials has increased over time, especially after 2020.

Of 11 published placebo-controlled trials that used DLQI and/or pain scores:

• 91% of effective treatments showed agreement between patient and doctor assessments.
• Only 25% of ineffective treatments showed that same agreement.
• In some cases, patients felt better (less pain or better quality of life), even when the main trial goals weren’t fully met.
• In rare cases, the reverse was true: one drug (anakinra) improved lesion counts but didn’t make patients feel better.

✅ Which treatments showed strong concordance?

Treatments where both doctors and patients with HS agreed that the treatment helped include:

• Adalimumab (approved)
• Secukinumab (approved)
• Bimekizumab (approved)
• Infliximab (off-label, but commonly used)
• Povorcitinib (not yet approved)

💡 Why is this important?

• Lesion counts are limited: they give a snapshot, but may miss how flares or pain affect daily life.
• Including quality of life and pain scores gives a more complete picture of how treatments work.
• PROs can also help detect subtle benefits in treatments still under investigation.

📌 Main Message:

PROs like DLQI and pain scores are valuable tools in HS trials. They often match doctor assessments, especially when treatments are working. But they also capture meaningful improvements that lesion counts may miss. Clinical trials are increasingly including PROs, helping to make research more patient-centered and meaningful.

Link: https://journals.lww.com/ijwd/fulltext/2025/06000/concordance_of_dlqi_and_pain_score_in_hidradenitis.5.aspx

Citation: Greene A, Hwang AS, Amjad S, Kechter JA, Mangold AR, Chen SX. Concordance of DLQI and pain score in hidradenitis suppurativa clinical trials: a systematic review. Int J Womens Dermatol. 2025 May 16;11(2):e204. doi: 10.1097/JW9.0000000000000204. PMID: 40384776.