How should I approach the management of a patient with mild hidradenitis suppurativa who is not responding to topical treatments?

Management of mild hidradenitis suppurativa (HS) not responding to topical treatments:

For patients with mild HS who do not respond to topical treatments, the next step is to consider escalation to systemic therapies or referral to a dermatologist for specialist management. This is because topical treatments alone may be insufficient for disease control in cases where symptoms persist or worsen despite initial therapy.

Systemic options may include oral antibiotics or other immunomodulatory treatments tailored to the severity and impact of the disease. Referral to dermatology is recommended to assess the need for second- or third-line treatments such as phototherapy, conventional systemic agents, or targeted immunomodulatory therapies.

Additionally, it is important to provide practical support and advice to improve adherence to treatment and to arrange a review appointment within 4 weeks to evaluate treatment response and tolerability.

Consideration should also be given to managing any associated comorbidities or psychological impact, as HS can significantly affect quality of life.