{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:24:40Z","timestamp":1791915880970,"version":"4.3.4"},"reference-count":87,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"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"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with significant diagnostic delays and impact on quality of life. Current guidelines prioritize antibiotics as first\u2010line therapy, but experts increasingly recognize the need for earlier targeted therapy intervention to prevent irreversible scarring and tunnel formation. To establish consensus on clinical scenarios during the 14th European Hidradenitis Suppurativa Foundation Conference in February 2025, 54 HS experts participated in a Delphi consensus, using a Likert scale (\u22125 to +5) to vote on 16 statements concerning first\u2010line therapy criteria with biologics and\/or small molecules for eligible patients. Seventy\u2010eight HS experts were invited, and 54 participated via hybrid onsite and electronic voting. Experts rated 16 pre\u2010defined statements regarding first\u2010line use of biologics and\/or small molecules for HS using a Likert scale (\u22125 to +5). Agreement metrics were stratified as majority agreement (\u226570%, median 3.0\u20133.5), consensus (\u226575%, median 3.5\u20134.5), and strong consensus (\u226590%, median \u22654.5). Statements were subsequently ranked for clinical relevance. Strong consensus was reached for patients contraindicated for antibiotics, rapid disease progressors and those with severe disease. Consensus also supported upgrading patients with moderate disease (IHS4\u2009\u2265\u20094), frequent flares (\u22653 in 12\u2009weeks), multiple affected areas and specific phenotypes including anogenital involvement. Strong consensus emerged for syndromic HS and for patients with inflammatory comorbidities such as inflammatory bowel disease and arthritis. Paediatric patients with a positive family history and moderate disease were also considered candidates for first\u2010line biologics or small molecules. This consensus provides evidence\u2010based criteria for upgrading HS patients to first\u2010line biologic therapy, reflecting expert practices across Europe aimed at preventing irreversible disease progression. The results support a \u2018hit hard and early\u2019 approach to minimize scarring and tunnel formation, although prospective studies are still needed to validate these expert\u2010driven recommendations.<\/jats:p>","DOI":"10.1111\/jdv.70264","type":"journal-article","created":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T02:14:26Z","timestamp":1769307266000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Delphi consensus: First\u2010line use of biologics and small molecules in hidradenitis suppurativa"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0920-9092","authenticated-orcid":false,"given":"Georgios","family":"Nikolakis","sequence":"first","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"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":"ALLOCATE Group, European Reference Network for Rare Skin Diseases (ERN\u2010Skin)  Paris France"},{"name":"Dermatology Department University Hospital of Basel  Basel Switzerland"}],"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 Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Anzengruber","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Department of Dermatology, University Hospital Zurich University of Zurich  Zurich Switzerland"},{"name":"Division of Dermatology, Department of Internal Medicine Cantonal Hospital Graub\u00fcnden  Chur Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4026-8728","authenticated-orcid":false,"given":"Matthias","family":"Augustin","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Falk G.","family":"Bechara","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Department of Dermatology, Venereology and Allergology, International Centre for Hidradenitis Suppurativa\/Acne Inversa (ICH) Ruhr\u2010University Bochum  Bochum Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7117-7489","authenticated-orcid":false,"given":"Pierre\u2010Andr\u00e9","family":"Becherel","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Dermatology and Clinical Immunology Unit Antony Hospital  Antony France"}],"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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2760-4600","authenticated-orcid":false,"given":"Vincenzo","family":"Bettoli","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"O.U. of Dermatology Azienda Ospedaliera \u2013 University of Ferrara  Ferrara Italy"}],"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","family":"Caposiena 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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1001-4604","authenticated-orcid":false,"given":"Antonella","family":"Di Cesare","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Section of Dermatology, Department of Health Sciences University of Florence  Florence 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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8537-1999","authenticated-orcid":false,"given":"Valentina","family":"Dini","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Dermatology Unit Department of Clinical and Experimental Medicine Ospedale Santa Chiara  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4713-3911","authenticated-orcid":false,"given":"Evangelos 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Centre Groningen University of Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Ingram","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Division of Infection and Immunity Cardiff University  Cardiff UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vaiva","family":"Jarien\u00e8","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"ALLOCATE Group, European Reference Network for Rare Skin Diseases (ERN\u2010Skin)  Paris France"},{"name":"Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LSMU) Hospital of Lithuanian University of Health Sciences Kauno Klinikos  Kaunas 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E.","family":"Jemec","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"ALLOCATE Group, European Reference Network for Rare Skin Diseases (ERN\u2010Skin)  Paris France"},{"name":"Department of Dermatology and Allergy Herlev &amp; Gentofte University Hospitals  Gentofte Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8189-7486","authenticated-orcid":false,"given":"Alexander","family":"Katoulis","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School \u201cAttikon\u201d General University Hospital  Athens Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2390-2309","authenticated-orcid":false,"given":"Natalia","family":"Kirsten","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergy, University Hospital LMU Munich  Munich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8042-7885","authenticated-orcid":false,"given":"Georgios","family":"Kokolakis","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Department of Dermatology, Venereology and Allergology Charit\u00e9\u2010Universit\u00e4tsmedizin Berlin  Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr K.","family":"Krajewski","sequence":"additional","affiliation":[{"name":"European Hidradenitis Suppurativa Foundation e.V  Dessau Germany"},{"name":"Division of Dermatology, Venereology and Clinical Immunology, Faculty of Medicine Wroclaw University of Science and Technology  Wroclaw Poland"},{"name":"L\u00fcbeck Institute of Experimental Dermatology University of L\u00fcbeck &amp; 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