An updated safety review of Hidradenitis Suppurativa treatment options

INTRODUCTION: Moderate-to-severe hidradenitis suppurativa (HS) is a chronic inflammatory condition with a significant impact on patients' quality of life. Recent advancements in biologics and small-molecule therapies offer new treatment options by targeting diverse inflammatory pathways. AREAS COVERED: This review evaluates the safety profiles of key biologics and small molecules based on Phase 2 and 3 clinical trials. Infection-related adverse events (AEs) were the most common, particularly with IL-17 inhibitors. Mild gastrointestinal and neurological AEs occurred frequently, while serious AEs were rare, indicating an overall acceptable safety profile. EXPERT OPINION: Emerging therapies such as IL-17 inhibitors (bimekizumab), IL-36 inhibitors (spesolimab), and small molecules like the JAK inhibitor povorcitinib provide promising alternatives for patients unresponsive to conventional treatments. Personalized treatment plans integrating biologics, small molecules, and adjunctive therapies are crucial for optimal outcomes. Challenges remain, including diagnostic delays, economic barriers, and the need for real-world evidence to validate long-term safety and efficacy. Advancing precision medicine, improving early diagnosis, and adopting comprehensive care models will enhance HS management and patients' quality of life.