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<p>Hidradenitis suppurativa (HS) is a&#xa0;chronic inflammatory skin disease characterized by recurrent abscesses, sinus tracts, and scarring in typical intertriginous areas. Therapeutic management of HS is guided by inflammatory disease activity, assessed using the International Hidradenitis Suppurativa Severity Scoring System (IHS4) score, as well as by clinical phenotypes associated with different progression patterns. In moderate to severe HS, systemic therapies form the cornerstone of treatment. Antibiotics such as doxycycline are primarily used for their immunomodulatory effects but frequently fail to achieve sufficient or sustained disease control. Approved biologic therapies include the tumor necrosis factor‑α inhibitor adalimumab and the interleukin-17&#xa0;inhibitors secukinumab and bimekizumab, which achieve a&#xa0;significant reduction in inflammatory lesions in a&#xa0;relevant proportion of patients. Indirect comparisons suggest higher response rates with bimekizumab, while adalimumab is associated with a&#xa0;favorable safety profile. As emerging therapeutic options, Janus kinase (JAK) inhibitors—particularly the selective JAK&#xa0;1 inhibitors upadacitinib and povorcitinib—have demonstrated clinically meaningful and sustained responses in early studies, including patients with prior biologic treatment failure. Despite these advances, the effectiveness of systemic therapies remains limited in advanced HS, characterized by epithelialized sinus tracts, fibrotic remodeling, and extensive scarring. Surgical interventions therefore play a&#xa0;central role and currently represent the only potentially curative treatment option. Current evidence shows that wide excisions achieve substantially lower recurrence rates compared with purely symptomatic procedures and result in sustained improvements in pain, function, and quality of life. Current guidelines recommend early surgical assessment and the structured integration of surgical procedures into a&#xa0;multimodal treatment strategy, ideally in combination with systemic immunomodulatory therapy, to achieve long-term disease control.</p>

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Neue Wege in der Behandlung der Hidradenitis suppurativa

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月9日

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  • Angelika Le Beau,
  • Magdalena Aichner

摘要

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent abscesses, sinus tracts, and scarring in typical intertriginous areas. Therapeutic management of HS is guided by inflammatory disease activity, assessed using the International Hidradenitis Suppurativa Severity Scoring System (IHS4) score, as well as by clinical phenotypes associated with different progression patterns. In moderate to severe HS, systemic therapies form the cornerstone of treatment. Antibiotics such as doxycycline are primarily used for their immunomodulatory effects but frequently fail to achieve sufficient or sustained disease control. Approved biologic therapies include the tumor necrosis factor‑α inhibitor adalimumab and the interleukin-17 inhibitors secukinumab and bimekizumab, which achieve a significant reduction in inflammatory lesions in a relevant proportion of patients. Indirect comparisons suggest higher response rates with bimekizumab, while adalimumab is associated with a favorable safety profile. As emerging therapeutic options, Janus kinase (JAK) inhibitors—particularly the selective JAK 1 inhibitors upadacitinib and povorcitinib—have demonstrated clinically meaningful and sustained responses in early studies, including patients with prior biologic treatment failure. Despite these advances, the effectiveness of systemic therapies remains limited in advanced HS, characterized by epithelialized sinus tracts, fibrotic remodeling, and extensive scarring. Surgical interventions therefore play a central role and currently represent the only potentially curative treatment option. Current evidence shows that wide excisions achieve substantially lower recurrence rates compared with purely symptomatic procedures and result in sustained improvements in pain, function, and quality of life. Current guidelines recommend early surgical assessment and the structured integration of surgical procedures into a multimodal treatment strategy, ideally in combination with systemic immunomodulatory therapy, to achieve long-term disease control.