A New US Hidradenitis Suppurativa Guideline Is Coming: What's Actually Confirmed So Far

You may have seen claims online that a new US hidradenitis suppurativa (HS) guideline has already been “released,” complete with a specific list of which drugs are “strongly” versus “conditionally” recommended. We looked into it directly, and the confirmed picture is more limited — and more useful — than that.

Here is what we could actually verify, what we could not, and why the distinction matters if you’re trying to make sense of your own treatment.

For information only. This article explains the current, verifiable status of an in-development professional guideline. It is not medical advice, and it does not tell you which treatment is right for you.

Key takeaways

• A new joint guideline from the American Academy of DermatologyDermatology: The medical specialty concerned with diagnosing and treating skin conditions. Acne Inversa is often managed by dermatologists, although surgery and other specialties may also be involved.DermatologyThe medical specialty concerned with diagnosing and treating skin conditions. Acne Inversa is often managed by dermatologists, although surgery and other specialties may also be involved.Read more in the glossary (AAD) and the Hidradenitis Suppurativa Foundation is genuinely in development, intended to update the 2019 North American HS guidelines.
• A draft version went out for AAD member public comment in April 2026. A guideline-tracking publication reported that draft contains 37 evidence-based recommendations built on a systematic review and the GRADE framework.
• We could not verify that a final, published version of this guideline exists as of our review date (19 September 2026). Treat any claim that it has already been finalized, or that specific drugs have been assigned specific recommendation grades, with caution unless it links to the actual publication.
• Independent of the guideline’s status, the treatment landscape it will need to describe has already changed substantially since 2019: three biologicsBiologic: A class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.BiologicA class of medications derived from living cells that target specific components of the inflammatory process. For Acne Inversa, biologics such as adalimumab and secukinumab are used when other treatments are insufficient.Read more in the glossary are now FDA-approved for HS instead of one.
• A US guideline, whenever it is finalized, will not itself change drug approval or insurance coverage in Germany or the EU — those run through separate regulatory systems.

What is actually confirmed about the new guideline

The AAD and the Hidradenitis Suppurativa Foundation are working on a joint successor to the 2019 North American HS guidelines, titled (in its draft form) the “Joint American Academy of Dermatology–Hidradenitis Suppurativa Foundation Guidelines of Care for the Management of Hidradenitis Suppurativa.”

According to Guideline Central, a publication that tracks clinical guideline development, a draft of this guideline was opened to AAD member public comment in April 2026, with the comment period reported to have closed on 27 April 2026 (Guideline Central, 2026). That source also reports that the draft contains 37 evidence-based recommendations, developed using a systematic review of the literature and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework — a widely used, structured method for rating evidence quality and recommendation strength as either “strong” or “conditional.”

We were not able to access AAD’s own guideline text directly to confirm those details firsthand — the source above is a secondary report on the draft, not the primary document — so we are presenting them as reported, not as independently verified by us line by line.

What we could not confirm

Two things you may see stated confidently elsewhere are, as far as we can establish, not yet verifiable:

That a final, published version of this guideline exists. A member-comment period on a draft is a step in guideline development, not its conclusion. Panels typically revise a draft based on comments received, complete internal sign-off, and then submit the final version for journal publication — a process that takes additional time. We found no publicly accessible record of a completed, published final guideline as of this review. The Hidradenitis Suppurativa Foundation’s own description of the update has referred to it as expected during 2026, which is consistent with a guideline still moving through development rather than one that has already been finalized.

Which specific drugs will carry which specific recommendation grade. GRADE-based guidelines separate recommendations into “strong” (the panel is confident the benefits clearly outweigh the harms for most patients) and “conditional” (the right choice more often depends on individual circumstances, values or preferences). Until a final guideline text is actually published, we have no reliable way to confirm which named drugs will land in which category, and we are not going to present a specific list as fact when we can’t trace it back to a real, checkable publication. If you see a very specific claim — for example, that a particular biologic is “strongly recommended” while another drug is only “conditionally recommended” — the reasonable response is to ask where that claim is sourced, not to treat it as settled.

Why an update to the 2019 guideline is genuinely overdue

None of the uncertainty above means an update isn’t needed. It clearly is.

The 2019 North American HS guidelines were published in two parts by the United States and Canadian Hidradenitis Suppurativa Foundations: Part I covered diagnosis, evaluation, comorbidityComorbidity: An additional condition existing alongside the primary disease. Acne Inversa is frequently associated with comorbidities including metabolic syndrome, inflammatory bowel disease, spondyloarthritis, and depression.ComorbidityAn additional condition existing alongside the primary disease. Acne Inversa is frequently associated with comorbidities including metabolic syndrome, inflammatory bowel disease, spondyloarthritis, and depression.Read more in the glossary screening, and complementary and procedural management, while Part II covered topical, intralesional and systemic medical treatment (Alikhan et al., 2019, Part I; Part II). At the time those guidelines were written, adalimumabAdalimumab: A biologic drug from the class of TNF-α inhibitors and the first medication officially approved for treating moderate-to-severe Acne Inversa. It is marketed under the brand name Humira® and as biosimilars.AdalimumabA biologic drug from the class of TNF-α inhibitors and the first medication officially approved for treating moderate-to-severe Acne Inversa. It is marketed under the brand name Humira® and as biosimilars.Read more in the glossary — approved by the FDA for moderate-to-severe HS in 2015 — was the only biologic medication with a dedicated HS approval.

That is no longer the case, and this part is independently verifiable, regardless of what any future guideline eventually says:

• Adalimumab remains FDA-approved for HS (since 2015).
• SecukinumabSecukinumab: A biologic drug that inhibits the inflammatory messenger interleukin-17A (IL-17A). Secukinumab was approved as the second biologic for treating Acne Inversa and is available under the brand name Cosentyx®.SecukinumabA biologic drug that inhibits the inflammatory messenger interleukin-17A (IL-17A). Secukinumab was approved as the second biologic for treating Acne Inversa and is available under the brand name Cosentyx®.Read more in the glossary received FDA approval for moderate-to-severe HS in October 2023, the second biologic approved for the condition and the first new one in nearly a decade at the time (Novartis, 2023); its approval was later extended to patients aged 12 and up.
• BimekizumabBimekizumab: A monoclonal antibody blocking both IL-17A and IL-17F. Approved by the FDA on 20 November 2024 as the first IL-17A and IL-17F inhibitor for adults with moderate-to-severe HS; approved by the EMA in April 2024. Brand name: Bimzelx®.BimekizumabA monoclonal antibody blocking both IL-17A and IL-17F. Approved by the FDA on 20 November 2024 as the first IL-17A and IL-17F inhibitor for adults with moderate-to-severe HS; approved by the EMA in April 2024. Brand name: Bimzelx®.Read more in the glossary received FDA approval for moderate-to-severe HS in November 2024, as the first IL-17A/IL-17F dual inhibitor approved for the condition (UCB, 2024).

That is a straightforward, checkable fact: three FDA-approved HS biologics now exist where there was one in 2019. Any credible updated guideline will have to reflect that, whatever its exact final wording turns out to be.

Where infliximab and JAK inhibitors actually stand today

Two other drug names come up often in discussions of “what’s changing” in HS treatment. Here is their actual, current regulatory status — separate from anything a guideline might eventually recommend.

InfliximabInfliximab: A TNF-α-blocking antibody given by intravenous infusion. Used off-label in Acne Inversa, often at higher-than-rheumatology doses, particularly in severe refractory cases or where IBD coexists. Brand name: Remicade® and biosimilars.InfliximabA TNF-α-blocking antibody given by intravenous infusion. Used off-label in Acne Inversa, often at higher-than-rheumatology doses, particularly in severe refractory cases or where IBD coexists. Brand name: Remicade® and biosimilars.Read more in the glossary is a TNF-alpha inhibitor, like adalimumab, and has been used off-label for HS for years based on clinical experience and observational studies. It does not have an FDA-approved indication specifically for HS. A guideline can describe evidence supporting an off-label useOff-Label Use: Prescribing an approved drug for a condition outside its label. Common in Acne Inversa because the approved-drug list is short and patient need is high. Insurance reimbursement for off-label use varies widely by country and payer.Off-Label UsePrescribing an approved drug for a condition outside its label. Common in Acne Inversa because the approved-drug list is short and patient need is high. Insurance reimbursement for off-label use varies widely by country and payer.Read more in the glossary — that happens regularly in medicine — but “the evidence supports considering this drug” is a different statement from “this drug is FDA-approved,” and it is worth keeping the two apart.

UpadacitinibUpadacitinib: An oral JAK1 inhibitor already approved for rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, and Crohn's disease. Studied off-label and in trials for Acne Inversa. Brand name: Rinvoq®.UpadacitinibAn oral JAK1 inhibitor already approved for rheumatoid arthritis, psoriatic arthritis, atopic dermatitis, ulcerative colitis, and Crohn's disease. Studied off-label and in trials for Acne Inversa. Brand name: Rinvoq®.Read more in the glossary (an oral JAK inhibitor, already FDA-approved for conditions including rheumatoid arthritis, psoriatic arthritis and atopic dermatitis) and topical ruxolitinib (a JAK inhibitor approved for other skin conditions) are both being investigated for HS in clinical trials, including studies at the Phase 3 stage for upadacitinib (narrative review of ongoing Phase 3 trials, 2026). Neither currently carries an FDA-approved indication for HS. Trial data being promising is a real and legitimate reason for a guideline panel to discuss a drug — it is not the same thing as approval, and it is not the same thing as a finalized “conditional recommendation” that we can currently point you to in writing.

Recommended, approved, reimbursed: three different questions

This is worth spelling out plainly, because guideline coverage tends to blur it:

1. Does evidence support a treatment? That is what a clinical guideline like this one addresses — whether AAD’s, the European S2k guideline, or any other body’s.
2. Has a regulator approved a specific drug for HS? In the US, that is the FDA. In the EU, it is the European Medicines Agency (EMA) plus national implementation. These are separate legal processes, not something a guideline confers automatically.
3. Will your health system pay for it? In Germany, that runs through the statutory health insurance (GKV) system and depends on the approved indication, your individual situation and your prescribing physician’s justification.

A future AAD/HS Foundation guideline, once actually published, will speak to the first question for a US audience. It will not, by itself, change the second or third question anywhere — including in Germany, where the European S2k guideline and German/EU regulatory and reimbursement frameworks remain the relevant references for your care. See our overview of what the new 2026 European guideline means for patients for what has actually changed on that side.

What to ask your doctor now, without waiting for a final guideline

You do not need to wait for a finalized US guideline to have a productive treatment conversation. Useful questions include:

• “Is my current treatment adequately controlling my HS’s inflammatory activity?”
• “Given my disease pattern, which of the currently approved options — adalimumab, secukinumab or bimekizumab — might be appropriate, and why?”
• “If I’ve already tried an approved biologic without enough benefit, what off-label or trial-based options might be worth discussing, and what would that involve?”
• “How would we judge whether a new treatment is working well enough to continue?”

Our guide to preparing for a shared treatment decision and our 15 questions to ask your dermatologist can help you structure that conversation.

What we will do when the final guideline is actually published

We are treating this as an open item, not a closed one. When a complete, finalized version of the joint AAD/HS Foundation guideline becomes publicly available — in a peer-reviewed journal or through an official AAD channel we can verify directly — we will update this article with the actual recommendations, correctly attributed and correctly graded, and remove the caveats above that no longer apply.

Until then, we would rather tell you clearly what we don’t yet know than hand you a confident-sounding list we can’t stand behind.

The bottom line

A new US hidradenitis suppurativa guideline is genuinely being developed, and a draft went out for AAD member comment in April 2026 with a reported 37 recommendations built on a systematic review and GRADE methodology. We could not verify that a final version has been published, and we are not going to present specific drug-by-drug recommendation grades as settled fact until we can trace them to an actual publication.

What is independently true right now, regardless of the guideline’s publication status: the FDA-approved HS biologic landscape has expanded from one drug in 2019 to three today (adalimumab, secukinumab, bimekizumab), infliximab remains an off-label option, and JAK-pathway drugs like upadacitinib and topical ruxolitinib are in trials rather than approved. That is enough to justify an updated guideline — and enough to have a meaningful treatment conversation with your own clinician today, without needing to wait for one. Which option is suitable, and how much benefit it provides, varies from person to person and can only be decided with your treating clinician.