Topic 5: Avoid the Antibiotic Loop
Antibiotics have an established role in HS management, but repeated or prolonged courses should not become a substitute for reassessing inflammatory control. When lesions recur promptly, treatment is repeatedly restarted, or the clinician already expects an inadequate response, the care plan deserves review.
A 2026 survey of European HS specialists found broad support for earlier biologic initiation in persistent or frequent flares, while also demonstrating that consensus upgrade criteria are still developing. This international expert-opinion evidence is included to illustrate the evolving window-of-opportunity discussion; it is not US treatment guidance and does not supersede FDA labeling or North American recommendations.6
| Clinical pearl for non-dermatologists: Do not equate temporary improvement during antibiotics with adequate longitudinal control. Document flare recurrence, treatment duration, response, adverse effects, and the interval to relapse; this information helps judge whether escalation is appropriate. |