Hidradenitis Suppurativa: Diagnostic Criteria, Pathophysiology Updates, and Therapeutic Advances
With three FDA-approved treatments now available, clinicians must learn to spot the early signs and understand the evolving science behind hidradenitis suppurativa (HS), a painful and stigmatizing disease. In her presentation at the American Academy of Physician Associates (AAPA) 2025 Conference & Expo meeting, Rosemary Son, PA-C, RDN details the multidisciplinary approach to diagnosis and care to help patients with HS avoid years of physical and emotional trauma.
Additional Resources:
- Kurayev A, Ashkar H, Saraiya A, Gottlieb AB. Hidradenitis Suppurativa: Review of the Pathogenesis and Treatment. J Drugs Dermatol. 2016;15(8):1017-1022.
- Gottlieb A, Natsis NE, Kerdel F, et al. A Phase II Open-Label Study of Bermekimab in Patients with Hidradenitis Suppurativa Shows Resolution of Inflammatory Lesions and Pain. J Invest Dermatol. 2020;140(8):1538-1545.e2. doi:10.1016/j.jid.2019.10.024
Consultant360: Can you describe the key themes of your presentation at the AAPA 2025 Conference & Expo meeting this year?
Rosemary Son, PA-C, RDN: The presentation is aimed at non-dermatology PAs and clinicians. My goal was to help them identify hidradenitis suppurativa (HS) by showing visual comparisons—examples of HS alongside other conditions it can resemble. Dermatology is highly visual, so seeing what HS actually looks like is key. Clinicians should recognize painful boils occurring in classic locations—such as the groin, under the breasts, or abdominal pannus—and if these occur more than twice in six months, HS should be high on the differential.
Consultant360: Why is this topic particularly relevant now?
Rosemary Son: There are now three FDA-approved treatments for HS, which is huge progress. When I started in dermatology in 2014, there were none. The availability of new treatments shows that industry is finally paying attention. Clinicians like Alice B. Gottlieb MD, PhD have led trials that helped spark that attention. HS has long been a neglected disease, often relegated to surgeons who felt powerless because surgery didn’t offer a cure—it just kept recurring. The disease is extremely debilitating, especially when advanced, and we now have options to intervene earlier. My hope is that by educating clinicians on how to recognize HS, they’ll feel confident starting care or making timely referrals.
Consultant360: What are the most important takeaways for clinicians in practice?
Rosemary Son: A simple diagnostic tip: if a patient has a painful boil in one of the characteristic areas more than twice in six months, HS is highly likely. Early recognition and intervention can prevent long-term complications like scarring, tunneling, and fistulization. We still see a lot of severe cases, but ideally, we’d catch it earlier and minimize progression.
Consultant360: Despite three FDA-approved treatments, are there gaps in our knowledge that still remain regarding HS?
Rosemary Son: Absolutely. HS has been poorly understood for years. Many still believe it's a disease of the sweat glands, but we now know it's more likely a follicular occlusion disorder, possibly triggered by an abnormal inflammatory response to skin bacteria. Friction also plays a role, but telling patients to avoid sitting or wearing clothes isn't practical. There’s still much to learn about the pathophysiology.
There are also questions about how newer therapies—like GLP-1 receptor agonists—might affect HS. It's a wide-open field for research. Understanding HS better could also inform our knowledge of other inflammatory disorders. We clearly have more work to do when it comes to the immune system.
Consultant360: Is there anything else you would like our audience to know about your presentation?
Rosemary Son: I made a point to include images of patients with richly pigmented skin because the population I work with is primarily underserved. Statistically, people from disadvantaged backgrounds experience more severe disease and have fewer resources to cope with it. HS is emotionally and socially isolating. I've had patients tell me their families won’t let them sit on furniture because of the drainage. It’s heartbreaking.
This is a multidisciplinary disease—it’s not just dermatology or surgery. There’s a role for pain management, psychiatry, gynecology, urology. We need a team approach. For under-resourced patients, HS can mean the difference between being employable or not. It's devastating, and that’s why I’m passionate about raising awareness.
Reference
Son R. Hidradenitis Suppurativa: A Painful Diagnosis Not to Miss. Presented at the American Academy of Physician Associates (AAPA) 2025. https://aapa2025.eventscribe.net/searchGlobal.asp. Accessed May 9, 2025.