Treating the Disease We Have Now and the Damage We Want to Prevent

Amit Garg, MD, and Jennifer Hsiao, MD, take a practical look at how to judge whether HS treatment is working, beyond lesion counts alone. They share the questions they ask in clinic about day-to-day symptoms, flare frequency and severity, pain, quality of life, and signs of progression, and why a therapy generally needs 3 to 4 months before its response can be fairly assessed.

The conversation also covers why earlier control of inflammation matters in a progressive disease, before tunnels and scarring become harder to reverse, and why framing HS as inflammation rather than infection helps patients understand the move beyond repeated antibiotics. With more advanced therapies available and others in development, Garg and Hsiao discuss how prior treatments, efficacy and safety, mechanism of action, route of administration, comorbidities, and patient preference can guide the next decision, and how more options let clinicians move on from a partial response rather than staying with it too long.