Don’t Wait for the Tunnels

Early systemic intervention for Hidradenitis Suppurativa (HS) prevents irreversible structural damage, such as tunneling and scarring, which significantly diminishes long-term quality of life. Dr. Chris Sayed emphasizes that waiting for advanced disease stages lowers the potential for achieving high-level clinical responses, such as HiSCR 75 or 90. Rather than relying solely on current lesion counts, clinicians should evaluate disease trajectory and the rate of progression to identify patients who benefit from proactive biologic therapy. While surgical interventions like de-roofing remain necessary for existing tunnels, early medical management stabilizes the condition and limits the need for extensive procedures. This shift toward earlier treatment requires robust shared decision-making, as patients must weigh the commitment of long-term systemic therapy against the physical and psychological burdens of chronic, progressive disease.