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derm.hidradenitis-suppurativa.core.v1PRODUCTION
derm.hidradenitis-suppurativa.core.v1

Hidradenitis suppurativa (acne inversa)

dermatologychronicadultpediatric
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12/12 authored

Canonical 12-phase frame with authored status for this dossier.

Current phase

Frame

Detailed

Frame HS as a CHRONIC recurrent inflammatory follicular-occlusion disease of apocrine-bearing intertriginous skin and a SYSTEMIC inflammatory condition with a major comorbidity burden — NOT a simple recurrent skin infection treatable by drainage alone. Severity is the static Hurley stage + the dynamic IHS4 inflammatory load. The not-to-miss is SCC arising in long-standing perianal/buttock HS.

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chronic systemic HS framing set; acute-flare + SCC + mental-health escape routes noted

Patient inputs (18)

A non-healing, indurated, atypical or rapidly changing lesion in long-standing perianal/buttock HS mandates biopsy for squamous cell carcinoma before any escalation (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Inflammatory nodules / abscesses / draining sinus tracts / bridged scars / double-ended comedones define HS and grade Hurley stage; double comedones + sinus tracts are the HS-vs-furunculosis pivot (European S2k 2024 PMID 39699926)

Recurrence/chronicity in typical sites is the diagnostic third element separating HS from a sporadic S. aureus abscess (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Tobacco is a dominant modifiable driver; cessation is a foundational, every-step intervention and a treatment-response co-determinant (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Obesity/metabolic load aggravates HS and gates metformin/weight optimisation; central modifiable substrate (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Metabolic syndrome / IBD / spondyloarthropathy / PCOS / depression-suicidality co-management; IBD and IL-17 choice interact, PCOS favours hormonal therapy (US/Canadian HS Foundations 2019 Part I PMID 30872156)

HS is post-pubertal; pre-pubertal onset triggers endocrine evaluation; pediatric dosing/agent cut-offs apply (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Apocrine-bearing intertriginous distribution (axillae/groin/inframammary/perianal/genital) is a core diagnostic element and defines the regions for staging/surgery (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Depression and suicidality are over-represented in HS and a screen-positive result routes to mental-health care (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Spreading cellulitis / systemic toxicity superimposed on an HS flare → acute infection route; HS itself is not primarily infective (US/Canadian HS Foundations 2019 Part II PMID 30872149)

Hurley I (nodules/abscesses, no tracts/scarring) / II (recurrent + tracts/scarring, separated) / III (diffuse interconnected tracts) drives the surgical decision for the predominantly non-inflammatory form (US/Canadian HS Foundations 2019 Part I PMID 30872156; European S2k 2024 PMID 39699926)

IHS4 (nodes ×1 + abscesses ×2 + draining tunnels ×4) classifies the inflammatory form mild/moderate/severe and is the dynamic medical step-up/step-down metric (European S2k 2024 PMID 39699926)

Anaemia of chronic inflammation; baseline before biologic/antibiotic courses (US/Canadian HS Foundations 2019 Part II PMID 30872149)

CRP correlates with HS inflammatory burden and supports treatment-response tracking alongside IHS4 (European S2k 2024 PMID 39699926)

Latent-TB + hepatitis screen mandatory before any biologic (TNF/IL-17) initiation; live-vaccine reconciliation (US/Canadian HS Foundations 2019 Part II PMID 30872149)

Baseline + on-treatment hepatic monitoring for rifampicin / tetracyclines and biologic safety (US/Canadian HS Foundations 2019 Part II PMID 30872149)

Tetracyclines / spironolactone / hormonal / rifampicin / isotretinoin contraindicated; certolizumab the preferred biologic; topical/systemic clindamycin retained — gates the whole ladder (European S2k 2024 PMID 39699926)

Renal function + potassium for spironolactone (hyperkalaemia) and CKD-EPI 2021 race-free eGFR for dose adjustment (US/Canadian HS Foundations 2019 Part II PMID 30872149; Inker NEJM 2021)

* = hard-required. Engine cannot meaningfully run until these are filled.

Severity triggers (8)

8 need judgement
  • informationallife_threateningscc_in_chronic_perianal_buttock_hs
    Non-healing, indurated, atypical, fungating or rapidly changing lesion in long-standing (often >10 y) perianal/buttock HS
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereextensive_hurley_iii_with_contractures
    Extensive Hurley III — diffuse interconnected sinus tracts, dermal contractures, severe scarring/disability across one or more regions
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevereacute_severe_abscess_or_secondary_sepsis
    Acutely enlarging exquisitely tender fluctuant abscess with spreading cellulitis and/or systemic toxicity on a background of HS
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseveredepression_suicidality_screen_positive
    Positive depression or suicidality screen in an HS patient (mental-health burden is markedly over-represented in HS)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderaterapidly_progressive_refractory_disease
    Rapidly progressive or systemic-antibiotic-refractory moderate–severe HS (rising IHS4, new tracts, escalating pain/QoL impact)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatesevere_pain_crisis
    Severe uncontrolled HS pain crisis (acute inflamed nodules/abscesses) impairing function despite oral analgesia
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmoderatepregnancy_systemic_gating
    Pregnant/conceiving patient requiring systemic HS therapy
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalmildpre_pubertal_onset_endocrine_eval
    HS-type lesions arising before puberty (HS is characteristically post-pubertal)
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Hidradenitis suppurativa — foundational non-pharm + Hurley/IHS4 severity-driven ladder (US/Canadian HS Foundations 2019 + European S2k 2024)
axis: hs_severity_driven_ladderstep 1 - Step 1 — Mild (Hurley I / low IHS4): topical + foundational non-pharm (every patient, every step, lifelong)
Selected step "Step 1 — Mild (Hurley I / low IHS4): topical + foundational non-pharm (every patient, every step, lifelong)" — Hurley I / IHS4 ≤3 mild inflammatory disease; foundational non-pharm continues at every step and severity
  • smoking_cessation
    first line
    lifestyle_modification
    US/Canadian HS Foundations 2019 Part I (PMID 30872156) + European S2k 2024 (PMID 39699926) — tobacco is a dominant modifiable driver; cessation is foundational at every step and improves treatment response.
  • weight_optimisation_and_metabolic_risk_management
    first line
    lifestyle_modification
    US/Canadian HS Foundations 2019 Part I (PMID 30872156) — obesity/metabolic load aggravates HS; weight reduction (incl. bariatric referral when indicated) reduces severity.
  • friction_reduction_wound_care_and_pain_management
    first line
    supportive_care
    US/Canadian HS Foundations 2019 Part I (PMID 30872156) — loose clothing/friction reduction, absorbent dressings/wound care, and structured pain management are core, every-step supportive measures.
  • clindamycin (topical)
    first line
    topical_antibiotic_anti_inflammatory
    1% solution/gel • topical • BID for ~12 wk (max: per labeling)
    triggers: mild_localised_hurley_I, limited_inflammatory_lesions
    US/Canadian HS Foundations 2019 Part II (PMID 30872149) + European S2k 2024 (PMID 39699926) — topical clindamycin is the first-line topical for mild/localised HS; the only RCT-supported topical antibiotic.
    rxcui 2582
  • chlorhexidine
    first line
    topical_antiseptic
    4% wash • topical • daily antiseptic wash (max: per labeling)
    triggers: mild_hurley_I, adjunct_antiseptic_hygiene
    US/Canadian HS Foundations 2019 Part II (PMID 30872149) — antiseptic washes are a low-risk adjunct reducing bacterial load/flare frequency.
    rxcui 2358
  • benzoyl peroxide
    first line
    topical_antiseptic
    4–10% wash • topical • daily antiseptic wash (max: per labeling)
    triggers: mild_hurley_I, adjunct_antiseptic_hygiene
    US/Canadian HS Foundations 2019 Part II (PMID 30872149) — benzoyl peroxide wash is an alternative antiseptic adjunct for mild HS.
    rxcui 1418
  • resorcinol
    second line
    topical_keratolytic_anti_inflammatory
    15% cream • topical • BID / PRN to active nodules (max: per labeling)
    triggers: recurrent_focal_nodules, self_managed_flare_lesion
    US/Canadian HS Foundations 2019 Part II (PMID 30872149) — topical resorcinol reduces pain/duration of recurrent focal nodules; useful patient-applied flare tool.
    rxcui 35382

outpatient playbook — drug actions (5)

  1. 1. smoking cessation + weight optimisation + friction/wound/pain care (foundation)
    n/a • lifestyle • continuous, lifelong
    trigger: All patients, all severities (US/Canadian HS Foundations 2019 Part I PMID 30872156)
    Foundational modifiable-driver control improves disease and treatment response
  2. 1. topical clindamycin + antiseptic wash (mild Hurley I)
    rxcui 2582
    1% BID • topical • BID ~12 wk
    trigger: Mild localised Hurley I / low IHS4 (US/Canadian HS Foundations 2019 Part II PMID 30872149)
    First-line topical for mild/localised HS
  3. 2. doxycycline or clindamycin+rifampicin course; + spironolactone/metformin if hormonal/metabolic
    rxcui 3640
    100 mg • PO • daily ~12 wk
    trigger: Moderate IHS4 4–10 (European S2k 2024 PMID 39699926)
    Time-limited systemic anti-inflammatory course + comorbidity-targeted hormonal axis
  4. 3. adalimumab / secukinumab / bimekizumab (moderate–severe/refractory)
    rxcui 327361
    40 mg weekly (adalimumab) • SC • weekly
    trigger: Moderate–severe / antibiotic-refractory (PIONEER PMID 27518661; SUNSHINE/SUNRISE PMID 36746171; BE HEARD PMID 38795716)
    EMA/FDA-approved biologics; latent-TB/infection screened
  5. 4. deroofing / wide excision of chronic tract regions + continue biologic
    n/a • surgical • once + healing
    trigger: Hurley II–III irreversible tract burden (US/Canadian HS Foundations 2019 Part I PMID 30872156; PMID 26470621)
    Medical+surgical combination is the holistic standard

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Recurrent painful inflammatory nodules / abscesses in apocrine-bearing intertriginous sites (axillae, groin, inframammary, perianal/genital) (US/Canadian HS Foundations 2019 Part I PMID 30872156); Draining sinus tracts / tunnels + bridged scarring + "tombstone" double comedones — established HS morphology (European S2k 2024 PMID 39699926); Chronicity / recurrence (≥2 episodes in 6 months in typical sites) — the diagnostic third element distinguishing HS from a one-off abscess (US/Canadian HS Foundations 2019 Part I PMID 30872156).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Hidradenitis suppurativa (acne inversa)** (derm.hidradenitis-suppurativa.core.v1).
Phenotype framing: Terminal follicular-occlusion / recurrent-abscess differential with named pivots: HS vs recurrent S. aureus furunculosis (pivot: recurrence in apocrine sites + sinus tracts + double comedones; route derm.skin-abscess.core.v1) vs metastatic/cutaneous Crohn (perianal knife-cut fissures + GI symptoms — GI route) vs acne conglobata / follicular-occlusion tetrad (nodulocystic acne + pilonidal + dissecting cellulitis pivot) vs pilonidal disease (natal-cleft-only pivot) vs LGV/STI abscess (inguinal + sexual exposure + serology pivot) vs epidermoid cyst (solitary + central punctum pivot) vs cutaneous TB / actinomycosis (chronic sinus + organism/culture pivot) vs SCC arising in chronic HS (non-healing indurated long-standing perianal/buttock — biopsy pivot).
Scope: Frame HS as a CHRONIC recurrent inflammatory follicular-occlusion disease of apocrine-bearing intertriginous skin and a SYSTEMIC inflammatory condition with a major comorbidity burden — NOT a simple recurrent skin infection treatable by drainage alone. Severity is the static Hurley stage + the dynamic IHS4 inflammatory load. The not-to-miss is SCC arising in long-standing perianal/buttock HS.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Hidradenitis suppurativa — foundational non-pharm + Hurley/IHS4 severity-driven ladder (US/Canadian HS Foundations 2019 + European S2k 2024)** — step "Step 1 — Mild (Hurley I / low IHS4): topical + foundational non-pharm (every patient, every step, lifelong)".
1. smoking_cessation (lifestyle_modification, first line) — US/Canadian HS Foundations 2019 Part I (PMID 30872156) + European S2k 2024 (PMID 39699926) — tobacco is a dominant modifiable driver; cessation is foundational at every step and improves treatment response.
2. weight_optimisation_and_metabolic_risk_management (lifestyle_modification, first line) — US/Canadian HS Foundations 2019 Part I (PMID 30872156) — obesity/metabolic load aggravates HS; weight reduction (incl. bariatric referral when indicated) reduces severity.
3. friction_reduction_wound_care_and_pain_management (supportive_care, first line) — US/Canadian HS Foundations 2019 Part I (PMID 30872156) — loose clothing/friction reduction, absorbent dressings/wound care, and structured pain management are core, every-step supportive measures.
4. clindamycin (topical) 1% solution/gel topical BID for ~12 wk (topical_antibiotic_anti_inflammatory, first line) — US/Canadian HS Foundations 2019 Part II (PMID 30872149) + European S2k 2024 (PMID 39699926) — topical clindamycin is the first-line topical for mild/localised HS; the only RCT-supported topical antibiotic.
5. chlorhexidine 4% wash topical daily antiseptic wash (topical_antiseptic, first line) — US/Canadian HS Foundations 2019 Part II (PMID 30872149) — antiseptic washes are a low-risk adjunct reducing bacterial load/flare frequency.
6. benzoyl peroxide 4–10% wash topical daily antiseptic wash (topical_antiseptic, first line) — US/Canadian HS Foundations 2019 Part II (PMID 30872149) — benzoyl peroxide wash is an alternative antiseptic adjunct for mild HS.
7. resorcinol 15% cream topical BID / PRN to active nodules (topical_keratolytic_anti_inflammatory, second line) — US/Canadian HS Foundations 2019 Part II (PMID 30872149) — topical resorcinol reduces pain/duration of recurrent focal nodules; useful patient-applied flare tool.

Setting playbook (outpatient) — Confirm clinical HS (triad; exclude furunculosis/Crohn/SCC), screen the full comorbidity cluster, stage by Hurley + IHS4, and escalate the foundational-non-pharm + severity-driven ladder gated on pregnancy/age/comorbidity/latent-TB (US/Canadian HS Foundations 2019 Part I+II PMID 30872156/30872149; European S2k 2024 PMID 39699926)
8. smoking cessation + weight optimisation + friction/wound/pain care (foundation) n/a lifestyle continuous, lifelong — All patients, all severities (US/Canadian HS Foundations 2019 Part I PMID 30872156) (Foundational modifiable-driver control improves disease and treatment response)
9. topical clindamycin + antiseptic wash (mild Hurley I) 1% BID topical BID ~12 wk — Mild localised Hurley I / low IHS4 (US/Canadian HS Foundations 2019 Part II PMID 30872149) (First-line topical for mild/localised HS)
10. doxycycline or clindamycin+rifampicin course; + spironolactone/metformin if hormonal/metabolic 100 mg PO daily ~12 wk — Moderate IHS4 4–10 (European S2k 2024 PMID 39699926) (Time-limited systemic anti-inflammatory course + comorbidity-targeted hormonal axis)
11. adalimumab / secukinumab / bimekizumab (moderate–severe/refractory) 40 mg weekly (adalimumab) SC weekly — Moderate–severe / antibiotic-refractory (PIONEER PMID 27518661; SUNSHINE/SUNRISE PMID 36746171; BE HEARD PMID 38795716) (EMA/FDA-approved biologics; latent-TB/infection screened)
12. deroofing / wide excision of chronic tract regions + continue biologic n/a surgical once + healing — Hurley II–III irreversible tract burden (US/Canadian HS Foundations 2019 Part I PMID 30872156; PMID 26470621) (Medical+surgical combination is the holistic standard)

Non-pharmacologic actions:
- Written flare action plan + self-managed wound care + pain-management plan (US/Canadian HS Foundations 2019 Part I PMID 30872156)
- Smoking-cessation + weight-management programme referral (incl. bariatric where indicated) (US/Canadian HS Foundations 2019 Part I PMID 30872156)
- Mental-health referral on positive depression/suicidality screen
- Surgical (plastic/colorectal) referral for irreversible Hurley II–III tract burden (US/Canadian HS Foundations 2019 Part I PMID 30872156)

AVOID / contraindication checks:
- Rifampicin strong cyp inducer contraceptive failure and drug interaction counsel (US/Canadian HS Foundations 2019 Part II PMID 30872149 — counsel contraceptive failure with hormonal contraception; review all CYP metabolised co medications)
- Tetracyclines and rifampicin and isotretinoin contraindicated in pregnancy (European S2k 2024 PMID 39699926 — avoid in pregnancy/conception)
- Spironolactone and antiandrogen hormonal contraindicated in pregnancy and monitor potassium (US/Canadian HS Foundations 2019 Part II PMID 30872149)
- Biologic latent TB and hepatitis screen before initiation and avoid live vaccines (US/Canadian HS Foundations 2019 Part II PMID 30872149 — TNF/IL 17 infection screening mandatory)
- IL 17 inhibitor caution with concurrent IBD (European S2k 2024 PMID 39699926 — prefer TNF inhibitor when active TNF responsive IBD coexists; IL 17 blockade may worsen IBD)
- Isotretinoin limited HS efficacy not a ladder substitute (US/Canadian HS Foundations 2019 Part II PMID 30872149 — unlike acne vulgaris)
- Incision and drainage alone is not curative high recurrence (US/Canadian HS Foundations 2019 Part I PMID 30872156)
- Pregnancy prefer certolizumab and retain clindamycin options (European S2k 2024 PMID 39699926)

Monitoring

Regimen monitoring:
- IHS4 + Hurley re-stage + pain + DLQI at the agent interval (biologic HiSCR50 judged ~12-16 wk; antibiotic course at 8-12 wk) (European S2k 2024 PMID 39699926)
- biologic: latent-TB/infection vigilance + injection-site + comorbidity reconciliation (US/Canadian HS Foundations 2019 Part II PMID 30872149)
- clindamycin+rifampicin: GI tolerability, LFTs, CYP drug-interaction + contraceptive-failure review, time-limited duration (US/Canadian HS Foundations 2019 Part II PMID 30872149)
- tetracyclines: photosensitivity + GI; spironolactone: potassium + BP (US/Canadian HS Foundations 2019 Part II PMID 30872149)
- antibiotic stewardship anti inflammatory courses are time limited not indefinite (European S2k 2024 PMID 39699926)
- periodic comorbidity surveillance — metabolic syndrome / IBD / spondyloarthropathy / PCOS / depression-suicidality + SCC surveillance of long-standing perianal/buttock sites (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Setting (outpatient) monitoring:
- Reassess IHS4 + Hurley + pain + DLQI at the agent-appropriate interval (European S2k 2024 PMID 39699926)
- Drug-class safety + comorbidity + SCC surveillance on schedule (US/Canadian HS Foundations 2019 Part I+II PMID 30872156/30872149)

Follow-up plan: Chronic-disease maintenance: lifelong smoking-cessation + weight-management reinforcement, friction/wound-care self-management, written flare action plan, biologic maintenance with continued TB/infection vigilance, periodic comorbidity surveillance (metabolic syndrome, IBD, spondyloarthropathy, PCOS, depression/suicidality), antibiotic-stewardship review, and SCC surveillance of long-standing chronic perianal/buttock sites. Multidisciplinary continuity; reconsider surgery for residual tract burden once inflammation controlled.
- Close-out criterion: action plan + lifestyle reinforcement + comorbidity & SCC surveillance + stewardship review documented

Monitoring phase: Disease: IHS4 + Hurley re-stage + pain + DLQI at the agent-appropriate interval (biologic effect judged by ~12–16 wk HiSCR50; antibiotic courses reassessed at 8–12 wk). Drug safety: biologic latent-TB/infection vigilance + injection-site; clindamycin+rifampicin tolerability (GI, hepatic, drug interactions) and duration; tetracycline photosensitivity/GI; spironolactone potassium/BP; antibiotic-stewardship (anti-inflammatory courses are time-limited, not indefinite). Re-screen depression and metabolic comorbidities.

Disposition

Current setting: outpatient — Confirm clinical HS (triad; exclude furunculosis/Crohn/SCC), screen the full comorbidity cluster, stage by Hurley + IHS4, and escalate the foundational-non-pharm + severity-driven ladder gated on pregnancy/age/comorbidity/latent-TB (US/Canadian HS Foundations 2019 Part I+II PMID 30872156/30872149; European S2k 2024 PMID 39699926)

Disposition criteria:
- Continue ladder + foundational non-pharm + multidisciplinary follow-up if responding (European S2k 2024 PMID 39699926)
- Step up the ladder if an adequate course/biologic trial fails (reassess diagnosis, adherence, comorbidity)
- Refer to theatre/inpatient only for extensive Hurley III surgery, severe disabling flare, or secondary sepsis

Escalation triggers (move to higher acuity):
- Acute severe abscess / secondary cellulitis-sepsis → I&D + flare antibiotic + route infection
- Depression/suicidality screen-positive → urgent mental-health routing
- Non-healing indurated long-standing perianal/buttock lesion → biopsy for SCC, oncology route if positive (US/Canadian HS Foundations 2019 Part I PMID 30872156)

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Non-healing, indurated, atypical, fungating or rapidly changing lesion in long-standing (often >10 y) perianal/buttock HS
- [SEVERE] Extensive Hurley III — diffuse interconnected sinus tracts, dermal contractures, severe scarring/disability across one or more regions
- [SEVERE] Acutely enlarging exquisitely tender fluctuant abscess with spreading cellulitis and/or systemic toxicity on a background of HS

Citations

- US/Canadian HS Foundations 2019 North American clinical management guidelines — Part I diagnosis/evaluation/procedural (Alikhan et al, JAAD; PMID 30872156) + Part II topical/intralesional/systemic medical (Alikhan et al, JAAD; PMID 30872149) + European S2k guidelines for HS/acne inversa Part 2: Treatment (Zouboulis et al, JEADV 2024; PMID 39699926 — IHS4-driven medical ladder + Hurley-driven surgery) + pivotal biologic RCTs PIONEER I/II adalimumab (Kimball et al, NEJM 2016; PMID 27518661), SUNSHINE/SUNRISE secukinumab (Kimball et al, Lancet 2023; PMID 36746171), BE HEARD I/II bimekizumab (Kimball et al, Lancet 2024; PMID 38795716) [PMID:30872156](https://pubmed.ncbi.nlm.nih.gov/30872156/)
- Cited evidence (PMID 30872149) [PMID:30872149](https://pubmed.ncbi.nlm.nih.gov/30872149/)
- Cited evidence (PMID 39699926) [PMID:39699926](https://pubmed.ncbi.nlm.nih.gov/39699926/)
- Cited evidence (PMID 27518661) [PMID:27518661](https://pubmed.ncbi.nlm.nih.gov/27518661/)
- Cited evidence (PMID 36746171) [PMID:36746171](https://pubmed.ncbi.nlm.nih.gov/36746171/)

Last reconciled with current guidelines: 2026-05-22.
References
  • US/Canadian HS Foundations 2019 North American clinical management guidelines — Part I diagnosis/evaluation/procedural (Alikhan et al, JAAD; PMID 30872156) + Part II topical/intralesional/systemic medical (Alikhan et al, JAAD; PMID 30872149) + European S2k guidelines for HS/acne inversa Part 2: Treatment (Zouboulis et al, JEADV 2024; PMID 39699926 — IHS4-driven medical ladder + Hurley-driven surgery) + pivotal biologic RCTs PIONEER I/II adalimumab (Kimball et al, NEJM 2016; PMID 27518661), SUNSHINE/SUNRISE secukinumab (Kimball et al, Lancet 2023; PMID 36746171), BE HEARD I/II bimekizumab (Kimball et al, Lancet 2024; PMID 38795716) — PMID:30872156
  • Cited evidence (PMID 30872149) — PMID:30872149
  • Cited evidence (PMID 39699926) — PMID:39699926
  • Cited evidence (PMID 27518661) — PMID:27518661
  • Cited evidence (PMID 36746171) — PMID:36746171