Faut-il traiter précocement l'hidradénite suppurée avec des biologiques ou des petites molécules ?

Abstract

The time taken to manage hidradenitis suppurativa (HS) remains long, even though the simultaneous or sequential combination of medical and surgical treatments can improve patient outcomes. The therapeutic arsenal has diversified in recent years, notably with the approval of three biologics (adalimumab, followed by secukinumab and more recently bimekizumab). Numerous molecules are currently in development.

While the prolonged and repeated use of broad-spectrum antibiotics raises concerns, several studies advocate for the benefits of introducing biotherapy earlier in HS, emphasizing the concept of a “window of opportunity”. Would treating patients earlier impact the progression of the disease, particularly by preventing the formation of fistulas that require surgical intervention? Similar to other inflammatory conditions, could a more aggressive approach prevent the development of irreversible lesions?