Improving Diagnosis and Treatment for Hidradenitis Suppurativa | AAD 2025

Hidradenitis suppurativa (HS), a painful and long-term skin condition that causes skin abscesses and scarring, remains a challenge as it’s often diagnosed late and difficult to manage effectively.

At the 2025 American Academy of Dermatology (AAD) meeting, Steven Daveluy, M.D., associate professor and program director of dermatology at Wayne State University, discussed ongoing barriers to early diagnosis and the latest advancements in treatment.

Many HS patients face years of misdiagnosis or delayed diagnosis because they initially seek care from primary care doctors, emergency physicians or OB-GYNs rather than dermatologists, Daveluy said.

Since these providers may not recognize the condition right away, patients often experience prolonged symptoms before receiving proper treatment.

Daveluy touched on the need to educate both healthcare professionals and the public about HS.

“We really need to increase our efforts of educating our colleagues, raising awareness. And I also think raising public awareness is going to be helpful,” Daveluy said.

“Many dermatologists can tell you that when a patient comes in with a skin disease and they say, ‘I looked it up online and I think I have this,’ it's usually wrong. If they think they have eczema, it's usually psoriasis. But when they look up HS and say, ‘I think I have HS, it's almost always right.’ So it's not a tough diagnosis to make. It's just that awareness needs to increase.”

With approved medications now existing, as well as the marketing for these drugs, he added that dermatologists are seeing some increase in awareness, but there is still much more work to do.

Beyond diagnosis, new insights into HS treatment were a key focus at the AAD meeting. For example, Daveluy discussed the importance of combining medical and surgical therapies.

While medications help reduce inflammation, certain procedures can effectively treat persistent lesions and draining tunnels.

For example, deroofing involves removing the top layer of skin and underlying tissue from an affected area, while punch deroofing targets the overlying skin of an abscess or sinus tract.

Another approach, cryoinsufflation, uses liquid nitrogen to freeze and destroy the lining of sinus tracts, helping to manage the condition more effectively.

He also noted that treatment effectiveness should not be judged solely by occasional flare-ups. Instead, patients should track long-term progress, such as fewer flare-ups and longer periods between episodes.

With more treatment options on the rise and growing recognition of HS, earlier diagnosis and better management strategies could soon become the norm.