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

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease with a high burden of metabolic comorbidities, including obesity, metabolic syndrome, type 2 diabetes mellitus, and polycystic ovary syndrome. GLP-1 receptor agonists (GLP-1 RAs) — established for diabetes, obesity, and cardiovascular risk reduction — have recently emerged as candidate agents for HS. A 2024 systematic review and two pivotal 2025 real-world studies now provide preliminary evidence that GLP-1 RAs improve HS disease activity through weight loss and direct anti-inflammatory mechanisms. We argue that this evidence is sufficient to justify a paradigm shift: GLP-1 RAs should be integral components of multidisciplinary HS management in patients with concurrent cardiometabolic disease. We propose a practical patient selection framework and monitoring protocol, and call for dedicated randomised controlled trials.