Hidradenitis suppurativa, from basic science to surgery and a new era of tailored targeted therapy: An expert opinion paper.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterised by an aberrant activation of innate immunity and increased production of pro-inflammatory mediators such as interleukin 17 (IL-17). IL-17 has been shown to play a key role in the pathogenesis of HS and evidence highlights the potential of IL-17-targeted therapies. The fully human IgG/κ monoclonal antibody secukinumab, which specifically targets IL-17A and inhibits interaction with its receptor, has recently been approved for the treatment of moderate-to-severe HS. Secukinumab offers patients an efficacious and well-tolerated treatment option in terms of sustained response by rapidly improving signs and symptoms, and preventing disease progression in the absence of loss of response. Being a challenging disease, HS is associated with a delay to diagnosis of 3-10 years and, consequently, late implementation of appropriate treatment, leading to disease progression. Misdiagnosis due to flawed understanding and lack of awareness among medical providers and patients is considered an important factor contributing to the delayed diagnosis. Thus, serious efforts must be made on a large scale to urgently reduce the delay in HS diagnosis and reduce the disease burden in patients, including raising awareness, implementation of education programmes at medical and specialisation schools, as well as continuous education of healthcare providers at different levels for the early detection of HS and initiation of appropriate treatment. Here, we present the main critical unmet needs in the diagnosis and treatment of patients affected by HS, address how disease awareness and comprehensive multidisciplinary management (offering both medical and surgical care) can benefit patients, and suggest therapeutic options, based on clinical characterisation and early identification and intervention (window of opportunity), to be adopted for a timely and better management of disease progression and to fill current gaps.