For moderate-to-severe hidradenitis suppurativa, which treatment is recommended?

• A. Lifestyle modification
• B. Topical clindamycin
• C. Oral antibiotics only
• D. TNF inhibitors such as adalimumab

Answer: (D)

Hidradenitis suppurativa at a moderate to severe level is driven by systemic inflammation, so treatment needs to reach beyond the skin surface to calm the inflammatory process. While lifestyle changes and topical therapies can help with milder disease, they are usually not enough when multiple lesions, abscesses, or sinus tracts are present. Targeting the inflammatory pathway with a TNF-α inhibitor addresses the underlying disease activity, and adalimumab is specifically approved for hidradenitis suppurativa, shown to reduce new lesions and improve existing ones. Because it acts systemically, it can provide meaningful control of inflammation across affected areas. Approaches like lifestyle modification or topical antibiotics don’t offer the same level of control for moderate-to-severe disease, and relying on antibiotics alone often fails to achieve lasting improvement.