Emerging Therapies in Hidradenitis Suppurativa: An Update for Practicing Dermatologists

Hidradenitis suppurativa (HS) is a chronic, treatment-resistant inflammatory skin disease marked by painful nodules, abscesses, and sinus tracts. Recent FDA approvals of IL-17 inhibitors, such as bimekizumab and secukinumab, represent major therapeutic advances. This review highlights emerging therapies and key clinical trials that may further transform HS management. A systematic review was conducted per PRISMA guidelines using ClinicalTrials.gov, PubMed, and Embase. Inclusion criteria consisted of active, recruiting, or pending Phase 2/3 trials and publications within the last five years evaluating investigational HS treatments. Studies involving FDA-approved drugs, procedural interventions, or lacking efficacy data were excluded. Fifty-six studies were included: 22 publications and 38 trial records. Therapeutic targets have broadened to include IL-1, IL-36, JAK1/2, TYK2, and other inflammatory pathways. Spesolimab, an IL-36R inhibitor, recently completed a Phase 2/3 trial and may benefit patients with tunnel-predominant HS. Povorcitinib, a JAK1 inhibitor, showed significant HiSCR improvement in Phase 2 and is now in Phase 3. Sonelokimab, an IL-17A/F inhibitor, and lutikizumab, an IL-1α/β inhibitor, have both advanced to Phase 3 trials with promising early results. These investigational agents demonstrate diverse mechanisms aligned with HS pathophysiology and offer hope for patients unresponsive to existing therapies. Dermatologists should remain informed on trial progress and anticipate data that may inform future clinical decision-making.