Hidradenitis Suppurativa: Evaluating Patient Dissatisfaction and Treatment Gaps

Hidradenitis suppurativa (HS) continues to challenge both patients and clinicians—not only due to its chronic, inflammatory nature, but also because of the persistent gap between available treatments and patient expectations. Recent findings underscore a troubling disconnect: despite medical advances, fewer than one in five patients report satisfaction with their current care, and a majority remain unaware of FDA-approved therapies designed specifically for HS.

This misalignment is more than a matter of perception. It signals deeper structural shortcomings in how HS is treated and communicated within clinical practice. For dermatologists and primary care providers, understanding the scope of this dissatisfaction is essential to rethinking therapeutic strategies and optimizing outcomes.

In a survey highlighted by Clinical Advisor, only 19% of respondents expressed satisfaction with their HS treatment, while a staggering 74% reported not knowing about FDA-approved options such as adalimumab—the only biologic currently approved for HS. Parallel findings from international patient data reinforce these results, with nearly half citing poor efficacy or adverse side effects as their top concerns.

What’s clear is that many patients remain undertreated—particularly those with moderate-to-severe disease. According to recent estimates, fewer than 40% of eligible patients are receiving biologics, and just 26% are prescribed hormone therapies despite clinical evidence supporting their use. These numbers suggest not only underutilization of available tools but a failure to individualize treatment based on disease severity and comorbid factors such as obesity, metabolic syndrome, and polycystic ovary syndrome.

The clinical consequences are significant. HS is notorious for its impact on quality of life, with patients often navigating recurrent abscesses, scarring, and pain that disrupt daily functioning. Without effective intervention, the disease trajectory can lead to long-term physical and psychological tolls—burdening not only the patient but the healthcare system at large.

So why the persistent disconnect? Experts point to a confluence of issues: diagnostic delays, therapeutic inertia, limited clinician familiarity with newer treatments, and a communication gap that leaves patients feeling sidelined in the decision-making process. In some cases, patients may cycle through ineffective antibiotics or surgical interventions without ever being evaluated for advanced therapies. In others, systemic inflammation and comorbidities may go unaddressed due to siloed care.

This is where a shift toward more patient-centered, evidence-guided treatment frameworks becomes critical. Physicians Weekly and other clinical sources suggest that incorporating shared decision-making models—where patients are engaged in selecting therapies based on both clinical efficacy and personal goals—could go a long way in rebuilding trust and improving adherence.

Equally important is the need for broader awareness of therapeutic options. Educational outreach, not just to patients but across specialties, could help bridge knowledge gaps and streamline referral pathways to dermatology specialists familiar with HS management. The use of biologics, hormonal agents, and adjunctive therapies like pain management and wound care should be calibrated to disease severity and updated regularly as new evidence emerges.

Ultimately, these challenges speak to an evolving landscape in HS care—one where clinical inertia must give way to innovation and responsiveness. By grounding treatment decisions in real-world data and patient experience, clinicians have an opportunity to close the dissatisfaction gap and elevate standards of care.

The message is clear: it’s not just about having treatments that work—it’s about ensuring they reach the right patients, at the right time, in a way that respects their lived experience. As the field moves forward, the focus must remain on turning dissatisfaction into progress through a more inclusive, informed, and adaptable approach to HS management.