Episode 133: HS Treatment Pipeline Explosion: What's New & What's Next | The Future of Dermatology Podcast

Summary:

Hidradenitis Suppurativa (HS) is one of dermatology's most complex and underrecognized conditions and the treatment landscape is changing fast. In this episode, Dr. Faranak Kamangar sits down with Dr. Hadar Lev-tov, Associate Professor at the University of Miami, Director of the Wound Healing Fellowship, and Immediate Past President of the Hidradenitis Suppurativa Foundation, for a rapid-fire review of everything happening in the HS world right now.

Dr. Lev-tov covers the currently approved therapies, the exciting drugs moving through Phase 3 trials, and the groundbreaking science linking microplastics to HS inflammation. He also shares his candid take on GLP-1s in HS management and what the future of dermatology looks like when treatments work so well that doctors can finally focus on the whole patient.

Whether you're a resident just learning HS or a seasoned dermatologist trying to keep up with a fire-hose pipeline, this one is for you.

Topics Covered:

- Approved HS biologics: bimekizumab, secukinumab, adalimumab & biosimilars - Off-label use of infliximab (IV and subcutaneous) in severe HS - Phase 3 pipeline: remibrutinib, povorcitinib, sonelokimab (nanobodies) - CAR T-cell therapy and the possibility of curing inflammatory skin disease - Microplastics, nicastrin, and a landmark Nature Communications paper on HS - GLP-1s in HS: what we know, what we don't, and Dr. Levtov's clinical approach - The HS Foundation's research grants, HS Academy, wound care referral tool, and prior authorization templates - The future of dermatology as lifestyle medicine

Resources Mentioned:

- https://www.nature.com/articles/s41467-025-65789-7 - HS Foundation website & prior authorization templates: https://www.hs-foundation.org/ - HS Academy (free weekend for residents): https://www.hs-foundation.org/hs-academy - Integrative Dermatology Symposium: integrativedermatologysymposium.com - LearnSkin: learnskin.com

This podcast is for educational purposes only and is not a substitute for professional medical advice. Always consult your healthcare provider.

Key Takeaways:

1. Validate HS patients the moment they walk in. They've often been dismissed or bounced between providers for years. Simply saying "I understand what you're going through" builds trust immediately and makes the visit more productive.

2. The approved HS treatment arsenal is growing. Bimekizumab and secukinumab (IL-17 inhibitors) are now approved, and adalimumab — including biosimilars — remains a valuable option. Clinical experts are using biosimilars with confidence.

3. Subcutaneous infliximab is an emerging option. Available off-label in the US, new data from French centers shows a protocol: standard IV induction at weeks 0, 2, and 6, then switching to subcutaneous injections every two weeks at week 10 — but only once the patient is in strong remission.

4. Three major drugs are in or completing Phase 3 trials. Remibrutinib (BTK inhibitor, already approved for chronic spontaneous urticaria), povorcitinib (JAK1 inhibitor), and sonelokimab (a nanobody targeting IL-17A and IL-17F) are all reporting promising results and moving toward FDA application.

5. Nanobodies are a technology to watch. Derived from camelid antibody fragments, nanobodies like sonelokimab can be engineered to target multiple pathways simultaneously in a smaller, more modular molecule — expect to see them across dermatology.

6. Half-life extenders could mean one injection per year. Already emerging in psoriasis, these extended-dosing biologics are heading toward HS — a potential game-changer for patient adherence.

7. CAR T-cell therapy may one day cure inflammatory skin disease. Currently being studied in lupus and rheumatoid arthritis, the protocols are becoming more practical, and the technology is edging toward dermatology.

8. Microplastics may potentiate HS inflammation. A Nature Communications paper by Dr. Luis Garza (Hopkins) found that plastic-associated endocrine disruptors block nicastrin in fibroblasts, amplifying HS-related inflammation. This doesn't prove causation, but it reveals a meaningful environmental link — and highlights the underappreciated role of fibroblasts in HS scarring.

9. GLP-1s in HS: promising but not proven as monotherapy. There's no RCT yet. Dr. Levtov's clinical approach: stabilize HS with a biologic first, then consider adding a GLP-1 as part of a comprehensive plan that includes diet and resistance training. He has seen outcomes go both ways.

10. The HS Foundation is an underutilized resource. Their website offers a clinic finder, wound care referral service, prior authorization templates (one-click Word documents), research grants, the HS Academy (free, all-expenses-paid weekend for residents), and career development awards in partnership with the Dermatology Foundation.

Chapters:

0:00 – Introduction & Dr. Lev-tov's Background 0:49 – The #1 Clinical Tip for Seeing HS Patients 1:44 – Approved HS Treatments: IL-17 Inhibitors, Adalimumab & Biosimilars 2:40 – Off-Label Infliximab: IV and the New Subcutaneous Protocol 4:21 – Phase 3 Pipeline: Remibrutinib, Povorcitinib & Sonelokimab (Nanobodies) 6:00 – Half-Life Extenders & One-Injection-Per-Year Future 7:01 – CAR T-Cell Therapy: Could We Cure Inflammatory Skin Disease? 7:36 – Research Funding & HS Foundation Grants 8:43 – HS Foundation Tools: Prior Auth Templates, Clinic Finder & HS Academy 10:15 – Microplastics, Nicastrin & the Nature Communications Paper 13:22 – What This Means for Fibroblasts and HS Scarring 14:20 – Celebrating Dermatology Science & Clinician-Scientists 15:32 – GLP-1s & HS: What's the Evidence? 17:18 – Dr. Lev-tov's Clinical Approach to GLP-1 Requests 19:06 – The Future of Dermatology: Becoming Lifestyle Doctors 21:28 – The Integrative Dermatology Symposium & LearnSkin Certificate Program 22:50 – Closing Remarks