Dr. Jenny Hsiao discusses highlights from her lecture "Difficult Cases in HS" on Saturday, November 11, 2023 at the 4th Annual Elevate-Derm PA/NP Conference in Coachella Valley, CA.

In this video

In conversation with dermatology PA Lisa Weiss, Dr. Hsiao addresses the psychosocial weight of hidradenitis suppurativa, noting patients face higher rates of depression, anxiety, stigma, and even increased suicide risk — much of it rooted in pain and the isolation of "never having met anybody else who has HS." She points providers toward HS support groups such as Hope for HS, HS Connect, HS Warriors, and the International Association of the HS Network, many of which patients can join online without having to travel while in pain, and she encourages partnering with primary care and mental health colleagues.

Because HS is a disease that "oftentimes will flare," Dr. Hsiao stresses setting expectations early: framing treatment as decreasing how often patients flare, how many lesions they get, and their pain and drainage, rather than promising total clearance, so provider and patient stay "on the same page." On treatment, she is thrilled that HS finally has a second FDA-approved therapy eight years after the first — an IL-17 agent, a different class from the TNF-alpha adalimumab — and looks ahead to the IL-17A/F inhibitor bimekizumab and JAK inhibitors. Ultimately, she says, she just wants more options so she can match the best medical or surgical treatment to the patient in front of her.

  • HS carries a heavy psychosocial burden — depression, anxiety, stigma, isolation, and increased suicide risk — so connect patients to support groups like Hope for HS, HS Connect, HS Warriors, and the HS Network.
  • Treating the HS itself, and partnering with primary care and mental health colleagues, can meaningfully improve a patient's mental health.
  • Set expectations early: aim to reduce flare frequency, lesion number and size, pain, and drainage rather than promising total clearance.
  • A second FDA-approved HS therapy — an IL-17 agent, distinct from the TNF-alpha adalimumab — has finally arrived eight years after the first.
  • More options are coming, including the IL-17A/F inhibitor bimekizumab and JAK inhibitors; the goal is having enough tools to choose the best fit for each patient.