Secondary care management of patients with hidradenitis suppurativa in the United Kingdom and Ireland: a survey of current practice

Background

Despite therapeutic advances for hidradenitis suppurativa (HS), specialist multidisciplinary services remain limited. The UK and Ireland HS Network (H-SKIN) seeks to advance evidence-based management and optimise outcomes through collaborative clinical practice.

Objectives

This study examined variations in management and access to treatment between specialist and non-specialist services.

Methods

An online survey open from April to August 2025 explored clinical practice in HS management. It was distributed via H-SKIN, the British Association of Dermatologists (BAD) and the British Dermatology Nursing Group (BDNG) networks.

Results

The survey received 99 responses (38 H-SKIN; 61 BAD/BDNG). Medication use varied, with the biggest differences in metformin (89% H-SKIN; 62% BAD/BDNG), secukinumab (92% H-SKIN; 52% BAD/BDNG) and spironolactone (71% H-SKIN; 46% BAD/BDNG). Deroofing and wide local excision were available to 42% and 84% respectively, of the H-SKIN group compared to 23% and 70% in the BAD/BDNG group.

Pain scores were recorded more often in the H-SKIN group (61% versus 32%). Mental health screening was conducted by 89% of the H-SKIN group and 69% of the BAD/BDNG group. Psychological support was available to 37% of the H-SKIN group compared to 8% of the BAD/BDNG group. In the BAD/BDNG group 79% had no access to a Multidisciplinary Team (MDT) to discuss HS patients.

Conclusion

The results highlight UK disparities in access to HS medical therapies, deroofing and MDT support. Improvements in the standardisation of care are needed. The new National HS MDT run by H-SKIN will help to facilitate this by improving access to specialist support.