Management of hidradenitis suppurativa (HS) remains challenging, particularly for patients with mild-to-moderate disease, where therapeutic options are limited and responses to conventional approaches may be inconsistent. Identifying treatments that reduce inflammatory lesion burden while maintaining a favorable safety profile remains an ongoing clinical priority.

A randomized, double-blind, vehicle-controlled phase 2 study evaluated a topical Janus kinase (JAK) 1/2 inhibitor cream in adults with Hurley stage I–II HS presenting with 3–10 abscesses and inflammatory nodules (ANs) and no draining tunnels. Patients received twice-daily topical therapy or vehicle for 16 weeks, followed by an extension phase in which all participants used the active treatment as needed through week 32.

At week 16, treatment with the topical JAK inhibitor was associated with a greater reduction in AN count compared with vehicle (least squares mean change −3.61 vs −2.42; P = .0215). Reductions in lesion counts were maintained through week 32 during the extension phase. Patients receiving active treatment also experienced fewer disease flares. The therapy was generally well tolerated, and no grade ≥3 treatment-emergent adverse events were reported during the study period.

These findings suggest a potential role for targeted topical immune modulation in earlier-stage HS, particularly in patients without sinus tracts who may benefit from localized anti-inflammatory approaches. Further studies are needed to better understand long-term efficacy and safety.

How do you currently approach treatment escalation for patients with Hurley stage I–II HS who have persistent inflammatory nodules? What role do you foresee for targeted topical immunomodulators in the early management of HS?