An update on the medical treatments of hidradenitis suppurativa.

Hidradenitis suppurativa has emerged from therapeutic obscurity only in the last few years. Initially, the purulent and infectious nature of the lesions naturally lead to first-line treatment with antibiotics, some of which are indeed highly effective, particularly for moderate forms, or when used to overcome a highly inflammatory acute flare. Subsequent advances in physiopathology have emphasised the significant value of immunomodulatory therapies, mainly via the blockade of the TNF-α and IL-17 cytokine pathways. Modulation of these nonspecific immune and inflammatory signalling pathways is thus becoming increasingly important in numerous on-going therapeutic trials: JAK pathway and complement inhibition, IL-1 blockade, and even inhibition of B-lymphocyte activation pathways. In this article we detail the currently available data and drugs, and their indications in relation to disease stage, while being constantly aware that presently optimal results require multidisciplinary collaboration and often the use of combination therapies.