Defining Minimal Disease Activity in Hidradenitis Suppurativa: A New Clinical Target

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin disease lacking a standardized definition of disease control. While minimal disease activity (MDA) serves as a validated treatment target in psoriasis and atopic dermatitis, no equivalent framework exists for HS, limiting the implementation of treat-to-target strategies. OBJECTIVE: To propose and validate clinically relevant MDA criteria for HS, integrating objective measures and patient-reported outcomes in a real-world cohort. METHODS: Prospective, single-center, and observational study including all patients classified as well-controlled between April 2024 and January 2025. Sociodemographic, clinical, and therapeutic data were collected. In a paired analysis, a subgroup with prior moderate/poor control was compared against their pre-control. Factor analysis revealed 2 key dimensions-objective inflammation and patient-perceived symptoms-forming the basis for the proposed MDA definition: LAI ≤0.3, IHS4 ≤7, global/pain/suppuration VAS ≤3, and absence of structural progression. These criteria correctly identified 82% of well-controlled patients. CONCLUSIONS: This study introduces the first operational definition of MDA in HS, empirically derived and clinically feasible. Adoption of this framework could harmonize disease assessment, guide therapeutic targets, and advance precision management in HS.