Optimizing HS Visits: A Dermatologist’s Guide to Compassionate, Effective Care

© 2025 HMP Global. All Rights Reserved.
Any views and opinions expressed are those of the author(s) and/or participants and do not necessarily reflect the views, policy, or position of The Dermatologist or HMP Global, their employees, and affiliates.

Hidradenitis suppurativa (HS) is not only a debilitating disease, but also a historically undertreated one. As both patients and primary care providers become more aware of HS, dermatologists are likely to see more individuals with HS seeking clinical care. While HS can require a multidisciplinary team, it is dermatologists who most often take the primary role in HS care. Advances in medical therapy for HS, including the recent approval of new biologics, as well as procedural training for dermatologists, place us in a position to offer thorough and comprehensive care for patients with HS.

Clinic visits with these patients can be time-consuming and complex, especially initial visits. This is expected given what we know about HS, which can be an all-encompassing disease, with significant impacts on daily life due to pain, drainage, odor, and fatigue. The spectrum of symptoms is unpredictable. Furthermore, patients with HS have often experienced years of delayed diagnosis, misdiagnosis, repeated dismissals from practitioners, blatant blame, and diagnostic misinformation. The combination of these factors underscores the need for holistic care for patients with HS, beginning at the point of initial diagnosis.

Based on the described historical context of HS, it is not surprising that many patients with HS are skeptical of the medical establishment. It is our job as physicians to help rebuild trust and offer compassionate care and hope for our patients with HS. Below are practical tips from a dermatologist’s perspective on how to get the most out of HS visits in a busy clinic. Every dermatologist is fully equipped to provide great HS care!

Practical tips for patients with HS:

1. Remind patients you are on their team. Be frank; you will not accomplish everything in one visit, especially if they have longstanding or severe disease, but over the course of multiple visits, you will be able to address their complex concerns.
2. Consider having a focused HS intake form. If you see numerous patients with HS, an intake form to attain such information as history and previous treatments can improve efficiency.
3. Assess the patient’s main goals. Whether it is minimizing pain, reducing the number of flares and consequent drainage, improving sexual experiences, or just wearing a preferred clothing item, every patient has unique treatment goals. By building rapport starting with the first visit, you can tailor their treatment plan to what matters most to them.
4. Discuss expectations early. All treatments for HS require time to work, and unfortunately the same treatments do not work for everyone. This is not because they do not work, but because everyone’s response is unique, and the pathophysiology of HS is complex and not fully understood. If patients have spent time in online forums, they may already have preconceived notions of certain treatments. Reminding them that you are treating them as individuals can be helpful.
5. Relay that there likely is not a “silver bullet” treatment. Because of the complexity of HS, layering different treatments with different mechanisms and procedures is usually the best option. For example, someone with moderate HS may need a biologic, spironolactone, or metformin to help with the hormonal component and still require deroofing for stubborn draining tunnels. Be prepared to discuss alternative therapies with patients if they desire, such as dietary changes and supplemental nutrition.
6. Understand the answer may be no. Every patient has their own concerns and fears. You can do your best to put the risks into context, but in the end, if a patient declines a particular therapy, they still deserve care and discussion of alternative treatments.
7. Have a plan for flares. Flares can come quickly and outside of business hours. Ask the patient what has worked in the past. Be flexible with quick intralesional triamcinolone visits. Consider having a standing prescription for a course of antibiotics or a few days of prednisone that a patient can fill for flares.
8. Expand your knowledge and skills. Check out an educational video or conference session to learn deroofing. If you can do simple excisions, you can learn how to deroof HS nodules and tunnels. Go to HS talks or review resources on the HS Foundation’s (HSF) website for the latest updates. Take advantage of the prior authorization templates available through HSF.
9. Provide resources to your patients. There are many high-quality online support groups and resources available to help patients connect with others with HS and dive deeper into their condition.
10. Prioritize mental health. Patients with HS are at high risk for depression, anxiety, and suicidal ideation. Ask about mental health concerns and refer when appropriate.

As you implement these tips in your practice, remember to learn from your patients. They are often the best resource for tips on bandaging, over-the-counter products, and sharing their lived experiences. They are true HS experts with 24/7 experience.

At the Medical College of Wisconsin in Milwaukee, WI, Dr Roth is an associate professor in the department of dermatology and Precious Anyanwu is a fourth-year medical student.

Disclosure: Dr Roth has been a consultant or paid advisory board member for Incyte Corporation and an investigator for Lilly and Moonlake Immunotherapeutics.