Advancing Our Understanding of Hidradenitis Suppurativa: A Comprehensive Guide for Clinicians Designed to Improve Therapeutic Outcomes for Patients-Part 2.

Hidradenitis suppurativa (HS) is a chronic inflammatory cutaneous disorder that often starts in the second or third decade of life, induces both inflammatory and cicatricial cutaneous lesions, and frequently involves intertriginous and anogenital anatomic sites. Abscesses, nodules, and draining tunnels are reversible inflammatory lesions that cycle over time through unpredictable periods of exacerbation; cicatricial lesions are permanent and persist as fibrotic scars and nondraining tunnels, the latter reflecting the shells of prior draining tunnels. HS has a profound adverse impact on overall quality of life with many affected individuals experiencing signs and symptoms that are consistently bothersome physically, psychosocially, and medically, often interfering with several major activities of daily living and enjoyment. The reader is encouraged to review the Part 1 article of this 4-part article series, published in this journal in August 2026, which included an introductory summary of the HS disease state, overview of pathophysiology and etiology, approach to physical examination, suggested fundamental/core laboratory evaluations, and rational assessment of potential comorbidities of HS. This second article of the series covers therapeutic management principles of HS, antibiotic management of HS, adalimumab for HS, and infliximab for HS. Ultimately, the goal of this 4-part article series is to be practical, reasonably comprehensive, and clinically useful as a "guidance tool" to assist clinicians in managing HS. As stated in Part 1, multiple authors have separately contributed individual sections inclusive of supporting references. All authors were primarily responsible for their individual sections but also participated in the review and finalization of the complete series of articles. The order of the authors listed in the article heading reflects the order of appearance of their primary sections in the 4-part article series.