Advances in the treatment of pediatric hidradenitis suppurativa: emerging therapies and future directions

PURPOSE OF REVIEW: Hidradenitis suppurativa is a chronic inflammatory skin disease causing recurrent abscesses, tunnels, and scarring. Despite significant disease burden in children and adolescents, treatment data for this population remains limited. This review summarizes the most recent developments in pediatric hidradenitis suppurativa management. RECENT FINDINGS: The 2025 North American clinical practice guidelines for the medical management of hidradenitis suppurativa in special populations included key consensus-based treatment recommendations for pediatric hidradenitis suppurativa. Although antibiotics remain the mainstay of treatment for acute flares, adult data support the use of intravenous ertapenem as a rescue therapy for severe, recalcitrant hidradenitis suppurativa. Hormonal therapies, including spironolactone and combined oral contraceptives, should be considered in postmenarchal women. Metabolic therapies, particularly metformin and GLP-1 receptor agonists, are newer adjunctive options for patients with comorbid obesity and insulin resistance. Secukinumab was recently approved for moderate-to-severe hidradenitis suppurativa in adolescents at least 12 years, and clinical trials for multiple other biologic therapies for pediatric hidradenitis suppurativa are underway. SUMMARY: Patients with pediatric hidradenitis suppurativa require individualized management approaches that consider their unique comorbidities and stages of development. Clinicians should integrate the 2025 North American guidelines into clinical practice, recognize, and co-manage comorbidities when appropriate, and counsel patients on approved and emerging biologic options.