Hidradenitis suppurativa (HS) remains one of dermatology’s most difficult diseases to treat for several reasons. Many patients cycle through antibiotics, biologics, and surgery without achieving sustained disease control or remission. Ultimately, trialing several therapies not only makes the care journey complex for physicians, but can take a significant physical and emotional toll on patients who have often been suffering for several decades without relief.
Emerging evidence offers hope to patients with HS and their providers. New studies suggest JAK1 inhibitors may provide a new therapeutic approach that targets multiple inflammatory pathways and could reshape long-term HS management.
Here’s what primary care physicians and dermatologists need to know about this emerging treatment.
The inflammatory skin condition is driven by a complex web of immune system signals, making it challenging to manage. Because HS involves multiple inflammatory pathways, blocking a single pathway may not adequately control disease activity in every patient.
Additionally, the lumps that commonly appear on most HS patients can rupture and burrow deep underneath the skin, creating interconnected channels or tunnels. Medication alone often cannot heal these channels, making surgery necessary for many patients.
Delayed diagnosis is another reason why HS can be difficult to treat. HS lumps can mimic common pimples or boils, leading to misdiagnosis that can take several years to correct. By then, the patient’s disease has advanced and is harder to treat.
Once HS is properly diagnosed, patients and providers often undergo a rigorous trial-and-error process to find the right treatment — whether that’s creams, antibiotics, or biologics. It can be an exhausting care journey for patients, who can continue to experience painful symptoms and emotional distress as they seek out relief.
These factors re-emphasize the need not only for timely diagnosis in the early stages of disease but also for access to more effective treatments without switching through multiple treatment regimens. The current standard of care leaves many patients without durable disease control.
JAK1 (Janus kinase 1) is an enzyme involved in the JAK-STAT signaling pathway, which helps regulate immune and inflammatory responses.
JAK1 inhibitors are immunosuppressive drugs that block the JAK1 enzyme, preventing pro-inflammatory signaling from reaching the cell nucleus, thereby reducing pain, swelling, and tissue damage. Several JAK inhibitors are FDA-approved to treat conditions such as rheumatoid arthritis, atopic dermatitis, ulcerative colitis, and other inflammatory diseases.
The anti-inflammatory drug is among a class of emerging oral medications to treat HS. Early evidence shows that JAK1 inhibitors may reduce HS symptoms such as lumps and abscesses. If approved as an HS treatment, it would be the first oral systemic therapy for the chronic skin condition.
In a phase 2 placebo-controlled clinical trial in the STOP-HS clinical development program, adults with moderate-to-severe hidradenitis suppurativa were randomized to receive 15 mg, 45 mg, or 75 mg of povorcitinib or placebo for 16 weeks. At the study’s conclusion, out of 209 patients, 83.3 percent completed treatment.
At week 16, povorcitinib significantly reduced abscesses and inflammatory nodules compared with placebo. Additionally, povorcitinib-treated patients achieved a complete clinical response at week 16. Researchers concluded that povorcitinib improved clinical outcomes while demonstrating a generally acceptable safety profile across the doses studied.
Phase 3 data from the STOP-HS program demonstrated povorcitinib’s durability and clinical efficacy in patients with moderate-to-severe HS, with up to 71.4 percent of patients achieving HiSCR50 (hidradenitis suppurativa clinical response), followed by up to 57 percent achieving HiSCR75 and up to 29 percent reaching HiSCR100 by week 54 of the clinical trial.
Additionally, the povorcitinib treatment led to consistent reduction across several lesions, with complete resolution achieved in up to 20 percent of participants. There were also clinically significant improvements in quality-of-life measures, including fatigue and skin pain.
JAK1 inhibitors could provide better treatment outcomes for HS patients who haven’t found relief with the current standards of care. But could the immunosuppressive drug be recommended over biologics for moderate-to-severe HS? Could it be a second–line therapy?
As additional clinical trial data becomes available and regulatory decisions are made, treatment guidelines will help clarify where JAK1 inhibitors fit within the HS treatment algorithm.
While JAK1 inhibitors await FDA approval for HS treatment, providers should carefully consider patient selection, safety, and monitoring requirements. Patients with moderate-to-severe HS who have had an inadequate response to conventional therapies may be candidates for these emerging treatments as more data become available. Baseline screening for infections, along with routine lab monitoring, may be recommended depending on the specific agent.
Clinicians should also be aware of the broader safety concerns associated with the JAK inhibitor class, including the potential risk of serious infections and cardiovascular events, while recognizing that safety profiles may differ among individual JAK1 inhibitors.
Additionally, shared decision-making remains a critical component of patient-centered care, especially for those managing multiple comorbidities or those seeking alternatives to existing systemic therapies.
Research consistently shows that HS disproportionately affects Black Americans, particularly Black women. Black patients often experience delayed diagnosis, greater disease severity, and barriers to specialty dermatology care, which can lead to more advanced disease and poorer outcomes.
Expanding therapeutic options — such as JAK1 inhibitors — may help address unmet needs, but equitable access to specialists, newer medications, and clinical trials remain essential.
JAK1 inhibitors are among the most promising therapies in HS. While additional long-term data are still needed, emerging research suggests this immunosuppressive agent could expand treatment options for patients who have historically had limited effective choices. Clinicians should stay up to date on JAK1 inhibitors as regulatory decisions and updated treatment guidelines continue to evolve.
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