Vivian Shi, M.D., on the New Renaissance in Hidradenitis Suppurativa Care

Hidradenitis suppurativa (HS) is a painful, chronic skin condition that often leaves patients feeling frustrated, misunderstood and without answers. But according to Vivian Shi, M.D., professor of dermatology at the University of Washington and director of the HS Clinic, the landscape of HS care is changing rapidly.

For years, HS was considered an “orphan disease” with no approved treatments and little attention in the medical community. Many patients endured long delays in diagnosis, cycling through multiple providers and often being misdiagnosed before finding the right care. Shi calls this the “dark ages” of HS. Today, however, she describes the field as entering a “Renaissance era”, fueled by patient advocacy, greater understanding of the disease and new treatment options.

One of the most promising advances is the approval of bimekizumab, the first biologic medication to target both interleukin-17A (IL-17A) and IL-17F. Clinical trial data show that some patients are achieving up to 75% to 100% clearance of their HS symptoms — results that were once unimaginable. Still, important challenges remain. Most available treatments are for moderate to severe HS, leaving those with milder disease underserved. Better definitions of disease severity are also needed to guide treatment escalation, and access barriers — such as insurance approvals — continue to limit patient options.

Shi emphasizes that HS requires a multifaceted approach. No single medication or lifestyle change can cure HS, but a combination of strategies can make a real difference. She points to evidence supporting the Mediterranean diet, reducing dairy or sugary foods, maintaining a healthy weight and prioritizing mental health care as important complements to medical treatment.

Equally critical is collaborative care. Dermatologists, surgeons, mental health providers and other specialists must work together to improve outcomes. And patients themselves, Shi stresses, should be at the center of this process. She encourages people with HS to ask for referrals to dermatology specialists, confirm their providers have experience treating HS and explore resources like the HS Foundation.

“Patients are the experts in their own skin,” Shi says. “We can’t move the field forward without their voices.” With more awareness, advocacy and treatment options, she believes the future for people living with HS is brighter than ever.