Escalation of Therapy in Hidradenitis Suppurativa: Associations Between Disease Burden and Treatment Patterns

Background: Real-world treatment patterns in Hidradenitis Suppurativa (HS) stratified by disease severity remain inadequately characterized. Methods: Using the nationwide TriNetX database, two HS cohorts were defined based on diagnosis frequency: 2-3 vs. ≥4 encounters. Cohorts were propensity matched and treatment utilization compared. Results: Among 60,508 patients (2-3 visits) and 58,114 patients (≥4 visits), those with ≥4 encounters were more likely to be Black or African American (38.3% vs. 32.7%, p<0.01) and less likely to be White (19.2% vs. 45.4%, p<0.01) compared to those with 2-3 visits. Higher disease burden was associated with increased use of antibiotics (85.3% vs. 65.2%), biologics (19.9% vs. 4.2%), systemic therapies, procedures and opioids (all p<0.01). Conclusions: Increased disease intensity correlated with the need for higher-intensity care. This pattern follows current guidelines, which recommend a stepwise progression from antibiotics in mild disease to systemic and invasive therapies in moderate HS. A higher burden of disease is seen among Black or African American patients compared to White patients. Disparities in disease severity emphasize the need for proactive management and equitable access to care.