Comorbidities an important consideration in HS treatment

Photo by BRI72783 via Wikimedia Commons

There is greater appreciation of potential comorbidities in patients with hidradenitis suppurativa (HS), both in the adult and pediatric setting, according to a special report in the June 2026 edition of The Chronicle of Skin & Allergy.

Comorbidities are common in patients with HS, and some of the most challenging to manage include inflammatory bowel disease, inflammatory arthritis, polycystic ovary syndrome, metabolic syndrome, depression, anxiety, and chronic pain. “These can have a major impact on quality of life and often influence treatment decisions,” said Dr. Raed Alhusayen, a dermatologist, Associate Professor, University of Toronto, Associate Scientist, Sunnybrook Research Institute in Toronto, and a board member of the Canadian Hidradenitis Suppurativa Foundation.

Some HS treatments may also help manage comorbid conditions, noted Dr. Alhusayen. “For example, anti-TNF therapy may help inflammatory bowel disease [IBD] and inflammatory arthritis while IL-17 inhibitors may help psoriasis and inflammatory arthritis, but require caution in patients with inflammatory bowel disease. Hormonal therapies may also be helpful in selected patients with PCOS.”

Dr. Jessica Asgarpour underlined that treatment choices may be guided by the presence of comorbidities. “The safest drug to use for patients with HS and IBD would be an anti-TNF alpha agent,” said Dr. Asgarpour. “You can treat Crohn’s disease and ulcerative colitis with the TNF-alpha inhibitor and treat the HS as well.” She is a dermatologist at Skin Health & Wellness Centre, Dermphi Centre, Dermphi Shop, and Dermatology Research Institute, in Calgary, a member of the board of the Canadian Hidradenitis Suppurative Foundation (CHSF) and co-chair of the second annual Canadian Hidradenitis Suppurativa Symposium.

Given numerous comorbidities that present concomitantly with HS, multi-disciplinary care may be implemented and involve dermatologists and other healthcare providers such as gastroenterologists, surgeons, endocrinologists, rheumatologists, and primary care providers.

“Other healthcare professionals help us [dermatologists] to appropriately manage patients,” said Dr. Asgarpour, noting non-dermatologists and dermatologists alike attended the second annual Canadian Hidradenitis Suppurativa Symposium, held in May 2026.

Benefits of GLP-1 receptor agonists

Patients with HS may also have conditions such as obesity, metabolic syndrome, and diabetes, and may benefit from exposure to GLP-1 RAs, noted Dr. Alhusayen.

“The broader concept of combining targeted anti-inflammatory therapy with metabolic treatment is very relevant,” said Dr. Alhusayen. “GLP-1 receptor agonists may help selected HS patients through weight loss, improved insulin resistance, and possibly effects on systemic inflammation.”

GLP-1 RA medications address concurrent obesity which can present in patients with HS, thus offering benefit in control of lesions activated by obesity, and can increase the impact of medications targeting HS, explained Dr. Asgarpour.

“We think GLP-1 RAs are effective for two reasons in this population,” said Dr. Asgarpour. “We know that obesity does trigger HS lesions. The other aspect is because the patient is losing weight because of the GLP-1 RA, the biologic medication may become more bioavailable for that patient.”

With files from Correspondent Louise Gagnon

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