Topic 6: Undertreatment Can Persist After Diagnosis
Correct diagnosis does not guarantee adequate longitudinal care. In a US claims study of 10,909 incident patients with HS, most received systemic antibiotics, while biologic prescriptions were recorded for 3.5% of adults and 1.8% of adolescents during the two years after diagnosis. Most diagnoses were made by general practitioners or pediatricians, underscoring the importance of non-dermatology clinicians in recognition and care coordination.7
Those data were collected from 2016 through 2018, when fewer HS-specific advanced therapies were available, so the percentages should not be presented as current prescribing rates. They nevertheless illustrate a recurring care gap: repeated antibiotics and episodic procedures may continue without reassessment of disease control or timely specialist involvement.
North American guidance supports assessing clinical severity and structural disease to inform medical and procedural management. Ongoing reassessment remains important when disease is inadequately controlled.1
| Clinical pearl: After making the diagnosis of HS, the goal becomes disease control. Ask whether the current plan is controlling flares, pain, drainage, functional effects, and progression. |