What Is Better Than a Crystal Ball? Dr Vivian Shi Talking About HS

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Vivian Shi, MD, to discuss the changing treatment landscape of hidradenitis suppurativa (HS), emerging therapeutic approaches, and the potential to transform long-term outcomes through earlier intervention.

Reflecting on what she describes as a renaissance in HS care, Dr Shi discusses how the field has progressed from limited treatment options to an expanding therapeutic arsenal. Unlike psoriasis and atopic dermatitis, HS can leave irreversible scarring and structural skin damage even after inflammation is controlled. Dr Shi envisions a future in which earlier, more effective treatment may prevent patients from developing tunnels and other permanent sequelae, fundamentally changing the course of the disease.

A central challenge, however, is recognizing when to intervene. Dr Shi advocates for reconsidering how moderate HS is defined, emphasizing that even a limited number of inflammatory lesions or a single tunnel may warrant escalation of therapy. She and Dr Del Rosso also examine the multiple barriers to timely care, from access to knowledgeable clinicians and specialists to medication approvals and surgical services.

Looking ahead, Dr Shi highlights several promising therapeutic developments, including sonelokimab, an investigational IL-17A/F-targeting nanobody, and povorcitinib, an oral JAK inhibitor. She also discusses the potential of B-cell–targeted approaches and the importance of understanding HS as a heterogeneous disease that may ultimately require more individualized treatment strategies.

Tune in to the episode to hear Dr Shi's perspective on the future of HS management, why redefining moderate disease could help clinicians identify opportunities for earlier intervention, and how an expanding therapeutic toolbox may bring the field closer to preventing irreversible disease progression.