Dr. Hsiao discusses practical off-label strategies for managing recalcitrant hidradenitis suppurativa, emphasizing strategies for patients with persistent disease despite standard therapy. She highlights 3 key recommendations: adopting a multimodal treatment approach by combining core therapies, such as a biologics or small-molecule inhibitors, with adjunctive agents such as topicals or metabolic agents; incorporating therapeutic drug monitoring through assessment of biologic trough levels or anti-drug antibodies to optimize treatment response; and considering dual immunomodulatory therapy in select patients, including combinations of 2 biologics or a biologic with a Janus kinase inhibitor. These strategies illustrate how individualized, treatment-stacking approaches may help improve outcomes in patients with difficult-to-treat hidradenitis suppurativa.
