Key Takeaway
Based on in-depth interviews with U.S. HS specialists and quantitative survey data from high-prescribing dermatologists with large HS practices, REACH's MarketVue® analysis identifies three treatment-related unmet needs that shape opportunities for product differentiation and will determine when and how emerging therapies will be incorporated into the HS treatment algorithm.
Three Unmet Needs in Hidradenitis Suppurativa
1. More Efficacious Therapies for Moderate-to-Severe Disease
Unlike psoriasis or atopic dermatitis, HS has only a handful of approved therapies, most delivering modest efficacy and leaving many patients without meaningful disease control. This is particularly relevant for the approximately 75% of patients with moderate-to-severe disease. The standard practice of patients needing to cycle through multiple biologics in search of partial disease control underscores the unmet need for more efficacious therapies. Biologic selection is entirely empiric as there is no way for physicians to predict which biologic will work, so between 30% and 40% of biologic-treated patients try two or more agents before achieving relief. Each failed therapy introduces a three- to six-month delay in disease control, prolonging active inflammation and increasing the risk of cumulative scarring and tunnel formation that no subsequent therapy can reverse.
"I'm trying to think of another disease where we get enthusiastic about half of people getting half better. In psoriasis, I have 20 drugs to fall back on, and 90% of patients do great. In HS, we have three drugs, none of them work very well, they take an incredibly long time, and when they do work - is that really enough to make a significant impact on quality of life? Not a ton."- HS specialist KOL, March 2026
2. Faster-Acting Therapies
Biologics in HS generally take six to nine months to reach full effect, leaving a prolonged period during which patients continue to experience pain, drainage, tissue damage, and poor quality of life while waiting to learn whether a therapy will provide some relief. This waiting period complicates the decision for both patients and their doctors on switching therapies, as it can be hard to determine the difference between a therapy that is not going to work and one that has not had enough time to.
"I do try to clarify with my patients on [how long it might take to determine that a biologic is not working] because sometimes what their expectations are that the medication will do is just like not in alignment with reality. So usually three months is the rough kind of threshold for giving things an adequate trial. And I think it depends on how disabling the disease is to the patient. Some people don't have like three months to wait for even a little bit of improvement."- HS specialist KOL, March 2026
3. Effective Oral Options for Moderate to Severe HS
Every approved HS biologic requires subcutaneous injection, leaving needle-phobic patients or those without reliable cold-chain access poorly served. Drug developers have taken note and oral therapies are heavily represented among the two dozen therapies in industry-sponsored clinical development. But specialists are unambiguous that oral formulation alone is not enough: a therapy that falls short of current biologics on efficacy will not displace them for patients who are already sick enough to warrant them.
"If it's oral and works as well as what I'm already injecting, everybody switches. Everyone would rather take a pill. The question is whether you can actually get there on efficacy - that's the whole game."- HS specialist KOL, March 2026
The Bottom Line
Therapeutic progress in HS continues to lag behind other inflammatory skin diseases, with approved biologics delivering modest efficacy, slow onset, and a subcutaneous-only route of administration that leaves meaningful patient populations underserved. The next breakthrough will not be defined by simply adding another biologic to the formulary but will require moving the needle on at least one of these dimensions in a clinically meaningful way. Emerging oral therapies, particularly kinase inhibitors, represent the most watched class in the pipeline, but specialists are clear: route of administration is only a win if efficacy keeps pace. The clinical intelligence needed to define exactly what that means - what physicians actually require across efficacy, onset, and formulation - is what the full MarketVue® Hidradenitis Suppurativa report is built to provide.
About MarketVue®
MarketVue® is an opportunity assessment report that delivers KOL-informed strategic intelligence for life sciences teams operating in rare and niche disease markets. Each report integrates primary KOL research, market intelligence, and strategic analysis to answer the questions that matter most to development, commercial, and investment teams: where is and what is the size of the opportunity, what does it take to win, and how is the market about to change.