Combination therapies for hidradenitis suppurativa: Narrative review of current strategies and emerging perspectives
Abstract
Hidradenitis suppurativa (HS) is a chronic, recurrent, and debilitating inflammatory dermatosis affecting approximately 1% of the population, with a female predominance and substantial psychosocial burden. Clinically, it presents with painful nodules, abscesses, and draining tunnels that often progress to fibrosis and long-term disability. Pathogenesis is multifactorial, encompassing follicular occlusion and rupture, dysbiosis, neutrophil-rich inflammation, and cytokine networks driven by tumor necrosis factor-alpha and interleukin-17 (IL-17), and despite advances, major challenges persist, including phenotypic heterogeneity, diagnostic delays, and the limited durability of monotherapies. This narrative review critically synthesizes evidence on combination strategies in HS following a systematic search of PubMed, Embase, and Cochrane (2009–July 2025), including randomized and nonrandomized trials, cohorts, and case series (⩾10 patients) that evaluated multimodal approaches (antibiotics plus biologics, biologics within surgical pathways, small molecules in combination, laser/light-based therapies, and structured wound care). Outcomes of interest included Hidradenitis Suppurativa Clinical Response, International Hidradenitis Suppurativa Severity Score System (IHS4)/IHS4-55, tunnel resolution, patient-reported measures (Dermatology Life Quality Index), flare frequency, and safety; qualitative synthesis was performed according to Scale for the Assessment of Narrative Review…
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