Ava MillerOctober is Hidradenitis Suppurativa Awareness Month, and this year it arrives with more reason than ever to pay attention. In March 2026, the U.S. Food and Drug Administration expanded approval of secukinumab (Cosentyx) to patients as young as 12, making it the first biologic treatment specifically cleared for adolescents with moderate to severe HS. Yet a striking disconnect persists: nearly 75% of people living with HS still have no idea FDA-approved medications exist for their condition, according to patient community research from myHSteam.
What Hidradenitis Suppurativa Actually Looks Like
HS is a chronic inflammatory skin disease that most people have never heard of — until they have it. The condition develops when hair follicles at areas of friction become inflamed and rupture, causing painful nodules, abscesses, draining tunnels under the skin, and eventually scarring. Common sites include the armpits, groin, buttocks, and under the breasts.
The FDA estimates HS affects 1% to 4% of the U.S. population — though a large population-based analysis of over 48 million medical records found a diagnosed prevalence of 0.10%, reflecting the substantial under-diagnosis that characterizes this condition. Women account for 73.8% of diagnosed cases. Prevalence is highest among women aged 30 to 39 (172 per 100,000), and significantly elevated among African American (296 per 100,000) and biracial (218 per 100,000) patients.
The disease carries one of the highest quality-of-life burdens of any dermatologic condition. Patients report considerable chronic pain, depression, and social withdrawal — with many avoiding physical activity, intimate relationships, or certain clothing because of active lesions.
The 2026 Treatment Landscape: More Options, Less Awareness
The treatment picture for HS has evolved dramatically over the past decade, but awareness has not kept pace.
Adalimumab (Humira), a TNF-alpha inhibitor, became the first biologic approved for HS back in 2015. It remains a first-line option for adults and adolescents, and clinical trials showed meaningful reductions in lesion counts versus placebo.
Secukinumab (Cosentyx), an IL-17A inhibitor, was approved for adult HS patients in 2023 — and in March 2026, the FDA extended that approval to adolescents aged 12 and older weighing at least 30 kg. This expansion matters because HS often begins in puberty, and for years younger patients had no biologic option at all. In clinical data, over 80% of patients on secukinumab showed no increase in draining tunnels after one year of treatment.
Bimekizumab (Bimzelx), approved in November 2024, works by blocking both IL-17A and IL-17F — a dual inhibition approach that trials showed drove at least 50% symptom reduction in more participants than placebo. Patients receive bi-weekly injections for 16 weeks, then monthly doses.
On the horizon: povorcitinib, an oral JAK inhibitor that showed over-50% reduction in abscesses and nodules in late-stage clinical trials. Unlike existing biologics, which require injections, povorcitinib is a pill — a format that many patients find significantly more manageable. An FDA decision is expected.
Despite this expanding toolkit, fewer than 20% of HS patients report satisfaction with their current treatment, according to patient surveys. The gap between available medicine and actual patient outcomes points to a structural problem: most HS patients are not seeing the right specialist.
Why the Right Specialist Matters More Than Most Realize
HS is famously underdiagnosed. The average patient waits 7 years from first symptom to correct diagnosis, often cycling through primary care providers who treat each lesion as an isolated infection with antibiotics — providing short-term relief while the underlying disease progresses.
A board-certified dermatologist with HS experience doesn't just confirm the diagnosis. They stage the disease using validated tools like the Hurley Staging System (Stages I, II, and III reflect increasing severity and help determine which treatments are appropriate), establish a baseline through careful lesion mapping, and design a step-up treatment plan that typically begins with topical or oral antibiotics before escalating to biologics if needed.
Dermatologists can also coordinate with surgeons for advanced disease — surgical deroofing of tunnels or wide excision for Stage III disease — and connect patients with mental health resources, since the psychological burden of HS is clinically significant. The dermatology specialty has seen major investment in 2026, from biologic pipelines to celebrity-driven conversations about skin health that are helping reduce stigma around visible skin conditions.
Crucially, a specialist can confirm eligibility for biologics. Commercial insurance coverage for Humira, Cosentyx, and Bimzelx exists — but it generally requires documented failure of first-line treatments and specific clinical criteria that need to be established and submitted by a physician.
From Pain to Diagnosis: What Actually Happens in 12 Months
Consider the case of a 34-year-old woman in Austin, Texas — call her Mara — who has been developing recurring, painful lumps in her armpits and groin since her mid-20s. She's seen her primary care doctor four times over the past year, each time receiving a course of antibiotics that temporarily reduces the inflammation. Each flare is progressively larger and takes longer to resolve.
Scenario A — No specialist consultation: Mara continues the antibiotic cycle. At current trajectory, the antibiotics blunt each episode but do not prevent disease progression. By month 12, her dermatology assessment (eventually sought after a particularly severe flare) places her at Hurley Stage II — recurring abscesses with sinus tract formation. The biologics she now needs require prior authorization documentation of a failed conservative treatment period; because her records show only antibiotic prescriptions rather than a documented HS diagnosis, the insurer requests 3 additional months of documented conservative therapy before approving a biologic. Total additional delay: approximately 15 months from today. Estimated additional medical costs: $2,400–$4,800 in antibiotic courses, urgent care visits, and missed workdays.
Scenario B — Dermatologist consultation within 30 days: A single consultation (typically $150–$300 with insurance, or $200–$500 cash pay) establishes the HS diagnosis formally. The dermatologist stages the disease, begins a structured doxycycline course with written documentation, and files the necessary prior authorization. By month 4–5, if conservative treatment proves insufficient, biologic eligibility is established and the authorization pathway is already documented. Many major insurers cover Cosentyx or Bimzelx once the prior auth threshold is met — out-of-pocket costs under most commercial plans range from $0–$150/month with manufacturer copay assistance programs.
The difference in total cost is significant. But the more important variable is disease progression: HS is not static. Scars and tunnels that form while waiting cannot be reversed — only managed.
What to Do If You Recognize These Symptoms
If you or someone you know has recurring painful lumps, abscesses, or skin tunnels in friction-prone areas — armpits, groin, buttocks, under the breasts — that keep coming back in the same locations, the most important step is a formal evaluation by a board-certified dermatologist, not just a primary care visit.
The National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of the National Institutes of Health, provides vetted research resources on HS including current clinical trial opportunities and treatment-focused publications — a reliable starting point before any appointment.
When seeking a specialist, ask specifically whether they have experience treating HS. Not every dermatologist sees it frequently, and the condition benefits from practitioners who regularly assess staging, biologic eligibility, and the skin disease's interaction with comorbidities like metabolic syndrome, inflammatory bowel disease, and depression that appear at elevated rates in HS patients.
ExpertZoom connects patients in the U.S. with board-certified dermatology specialists who can evaluate HS, confirm staging, discuss current treatment options — including the 2026 biologic landscape — and build a personalized treatment plan. Given that a 7-year diagnostic delay is still average for this condition, getting the right consultation sooner rather than later can be the difference between Stage I and Stage III.
This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and treatment of any medical condition.
