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 HS UK and Ireland Network (H-SKIN) seeks to advance evidence-based management and optimize outcomes through collaborative clinical practice. OBJECTIVES: To examine variations in the management of HS and access to treatment between specialist and nonspecialist services. METHODS: An online survey, open from April to August 2025, explored clinical practice in HS management. The survey questionnaire was distributed to clinicians via H-SKIN, the British Association of Dermatologists (BAD) and the British Dermatological Nursing Group (BDNG) networks. RESULTS: In total, 99 questionnaires were completed (38 H-SKIN; 61 BAD/BDNG). Medication use varied, with the largest differences reported in metformin (89% H-SKIN; 62% BAD/BDNG), secukinumab (92% H-SKIN; 52% BAD/BDNG) and spironolactone use (71% H-SKIN; 46% BAD/BDNG). Deroofing and wide local excision were available to 42% and 84% of the H-SKIN group, respectively, compared with 23% and 70% in the BAD/BDNG group. Pain scores were recorded more often in the H-SKIN group than the BAD/BDNG group (61% vs. 29%, respectively). 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 with 8% of the BAD/BDNG group. In the BAD/BDNG group, 79% of respondents had no access to a multidisciplinary team (MDT) to discuss patients with HS. CONCLUSIONS: The results highlight disparities in the UK and Ireland regarding access to HS medical treatments, deroofing and MDT support. Improvements in the standardization of care are needed. The new national HS MDT organized by H-SKIN will help facilitate this by improving access to specialist support.