{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T02:35:33Z","timestamp":1792204533252,"version":"4.4.0"},"reference-count":57,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized primarily by dysregulated innate immunity and abnormal keratinocyte differentiation. Over the past two decades, the treatment paradigm has evolved from antibiotics to targeted biologics, such as anti\u2010TNF\u2010\u03b1 and anti\u2010IL\u201017A\/A\u2010F inhibitors. However, antibiotic therapy remains a prerequisite for biologic initiation despite a lack of comparative studies evaluating their efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to assess current prescription patterns for systemic HS therapies among European HS specialists, evaluate unmet needs in antibiotic and biologic use and explore expert opinions on criteria for biologic upgrade as a first\u2010line therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A structured questionnaire was distributed to 55 HS specialists, the majority of whom were members of the European Hidradenitis Suppurativa Foundation (EHSF), comprising HS experts and future opinion leaders. Responses underwent statistical analysis to assess trends in antibiotic versus biologic prescription, treatment efficacy and potential improvements in therapeutic decision\u2010making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 43 participants (76.6% of invited experts, 80% of invited opinion leaders) responded. While 95% adhered to licensing regulations mandating 10\u201312\u2009weeks of antibiotics before biologics, 81% acknowledged prescribing antibiotics despite anticipating inadequate responses. More than half reported patient\u2010reported flares during antibiotic treatment. The majority (77%) supported earlier biologic initiation in cases of persistent flares, and 79% favoured short\u2010term biologic therapy over antibiotics for early\u2010stage HS. Participants identified specific phenotypic attributes such as rapidly progressing disease, extensive involvement and comorbidities as factors warranting earlier biologic intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Current treatment practice may delay optimal intervention, potentially leading to missed therapeutic windows. A significant proportion of respondents expressed a preference for earlier biologic intervention, especially in cases of severe disease or frequent flares. The findings underscore the need for a consensus statement defining upgrade criteria for biologics as a first\u2010line therapy, potentially improving patient outcomes and reducing healthcare burdens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jdv.70118","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:22:46Z","timestamp":1763036566000},"page":"658-669","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Towards the development of upgrade criteria for the treatment of hidradenitis suppurativa with biologics"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0920-9092","authenticated-orcid":false,"given":"Georgios","family":"Nikolakis","sequence":"first","affiliation":[{"name":"Departments of Dermatology, Venereology, Allergology and Immunology, St\u00e4dtisches Klinikum Dessau Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg  Dessau Germany"},{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7049-0170","authenticated-orcid":false,"given":"Erkan","family":"Alpsoy","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"Department of Dermatology and Venereology Akdeniz University  Antalya T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Arenbergerova","sequence":"additional","affiliation":[{"name":"Department of Dermatovenerology, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk G.","family":"Bechara","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"International Centre for Hidradenitis Suppurativa\/Acne Inversa (ICH), Department of Dermatology, Venereology and Allergology Ruhr\u2010University Bochum  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farida","family":"Benhadou","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"Department of Dermatology H\u00f4pitaux Universitaires de Bruxelles (HUB), Universit\u00e9 libre de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Cabete","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"Department of Dermatology and Venereology Hospital de Santo Ant\u00f3nio dos Capuchos \u2013 ULS de S\u00e3o Jos\u00e9  Lisbon Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0456-9582","authenticated-orcid":false,"given":"Raffaele Dante Caposiena","family":"Caro","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"Dermatology Clinic Maggiore Hospital, University of Trieste  Trieste Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Damiani","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"Department of Biomedical, Surgical and Dental Sciences University of Milan  Milan Italy"},{"name":"Italian Center of Precision Medicine and Chronic Inflammation University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maia","family":"Delage Toriel","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  Dessau Germany"},{"name":"L'Or\u00e9al et Institut Pasteur  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronique","family":"Del Marmol","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V.  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