GLP-1s and Hidradenitis Suppurativa: The Quiet Shift in Care

For years, the standard hidradenitis suppurativa visit looked like this: review the active nodules, manage the flare with antibiotics or intralesional steroids, talk about smoking if the patient was a smoker, and consider escalation to adalimumab or one of the IL-17 inhibitors if disease severity warranted it. Weight came up only when the patient brought it up. The medication options were clear. The relationship to weight was understood biologically but treated separately by a different specialist, if at all.

Something is changing.

In 2025, JAMA Dermatology published a multicenter analysis of 66 adults with hidradenitis suppurativa who were treated with GLP-1 receptor agonists across the HS-France network and eight French hospitals. Just over half of patients (54 percent) had at least a one-point improvement on the HS-PGA severity scale after a median of about six months, and 67 percent reported a reduction in flare frequency at their last follow-up. Semaglutide was the most commonly prescribed agent. The direction and magnitude of the signal line up with what dermatologists have been seeing in their own clinics.

Patients are improving. Some are tapering biologics they had been on for years. The conversation in dermatology has started to shift.

What the Evidence Actually Says

Let me be careful here. The study is observational, not randomized. There is no placebo arm. Patients who started GLP-1 therapy may have made other lifestyle changes at the same time, and the analysis was not designed to isolate the medication's effect. The data is suggestive, not definitive.

What makes the signal worth taking seriously is the size of the effect, the consistency with the biological case, and the convergence with clinical experience. A response rate north of fifty percent on a validated severity index is not a noise-level finding, even from a multicenter observational study. The mechanistic case for why GLP-1 therapy should help HS has been clear for several years, well before this kind of clinical data appeared.

If you want a more thorough walk-through of the HS plus GLP-1 evidence, our primer on GLP-1 for hidradenitis suppurativa covers it in more depth.

The Mechanism

HS is, at its core, a follicular disease driven by an immune response. The hair follicle becomes occluded, the trapped contents rupture into surrounding tissue, and a neutrophilic inflammatory cascade follows. Over time, that cascade scars, tunnels, and produces the painful sinus tracts that define more advanced disease.

The disease has a tight relationship to body weight. Higher BMI is consistently associated with greater HS severity, more frequent flares, more involved anatomic sites, and slower response to standard therapies. The relationship is not just mechanical, although mechanical friction in skin folds is part of it. The deeper driver is metabolic.

Visceral adipose tissue, the deeper fat around abdominal organs, produces pro-inflammatory cytokines including IL-6 and TNF-alpha. Those are the same cytokines that drive HS at the immune level. The more visceral fat a patient carries, the more inflammatory signal in circulation, and the more fuel for the disease.

GLP-1 receptor agonists work in two directions on this picture. The first is weight reduction itself, which lowers the inflammatory burden by reducing the volume of visceral adipose. The second is direct. GLP-1 receptors are expressed on monocytes, macrophages, T lymphocytes, and dendritic cells. Activating those receptors dampens cytokine release, reduces C-reactive protein, and quiets several of the inflammatory pathways that overlap with HS biology. The medication appears to be doing more than the weight loss alone.

For the full mechanistic story, see our piece on visceral fat, IL-6, and skin inflammation.

What This Does Not Mean

GLP-1 therapy is not a replacement for established HS care. It is an addition.

The patient who needs adalimumab still needs adalimumab. The patient who needs combination antibiotic therapy still needs combination antibiotic therapy. The patient who needs surgical deroofing of a chronic sinus tract still needs surgery. None of that goes away.

What changes is the option to address the metabolic driver of the disease in parallel with the dermatology-specific care. Several of my colleagues are now reporting patients who started on biologics for HS, added a GLP-1 for weight management, and have been able to space out or eventually taper the biologic because the underlying disease activity is so much lower. That is not the typical pattern. It happens often enough that it deserves attention.

I would not promise anyone that outcome. Some HS patients will not respond to GLP-1 therapy. Some will need to stay on biologics for life regardless of weight. Some will not be eligible for GLP-1 therapy at all. But the option is now on the table in a way it was not two years ago, and that matters.

Why a Dermatologist Should Be the One Prescribing It

This is the part most patients have not thought about. GLP-1 therapy for HS is not just a weight management decision. It is a disease management decision that overlaps with active dermatology care.

The prescribing clinician needs to know what biologic you are on, what your recent flare pattern looks like, whether you have ever been on isotretinoin or are still on oral antibiotics, and whether your HS is in a quiet stretch or actively progressing. They need to coordinate with your dermatologist, or be your dermatologist. They need to anticipate the GLP-1 side effects that show up on the skin and scalp, because hair shedding three to six months in is the side effect most patients are caught off-guard by, and a dermatologist is going to handle that conversation differently than a weight-loss-only platform will.

Our companion piece on the GLP-1 side effects most weight-loss programs do not warn you about covers what to expect.

The GLP-1-only telehealth platforms are not designed for this. They are efficient at intake, prescription, and shipping. They are not designed to think about your skin. For an HS patient, that is a real gap.

Where the Conversation Goes Next

The next several years are going to bring better data. Randomized trials of GLP-1 therapy specifically for HS outcomes are being designed. Larger cohort studies are being analyzed. The mechanistic literature is filling in.

In the meantime, the practical posture for HS patients with a weight component to their disease is straightforward. If you are on a biologic and have plateaued, weight may be the variable that has not been addressed. If you are flaring on standard therapy and your BMI is contributing, GLP-1 therapy is a clinically reasonable adjunct worth discussing. If your dermatologist has not raised the topic, that is worth a conversation. Not because they were wrong, but because the data is new enough that the field is still catching up.

The version of HS care worth delivering is one where the metabolic and dermatologic conversations happen in the same intake, with the same clinician, looking at the same chart.

The shift is quiet, but it is real. HS care is becoming metabolic care, in parallel with the immunologic care that has dominated the last decade. Patients deserve the option.

Important Information

Compounded medications are prepared by accredited US compounding pharmacies under a licensed prescriber and are not FDA-approved drug products in the way that brand-name medications such as Wegovy, Ozempic, Mounjaro, and Zepbound are. The FDA-determined drug shortages for semaglutide and tirzepatide resolved in 2025, and 503A pharmacies now compound patient-specific GLP-1s only when a documented clinical reason supports the decision. GLP-1 medications are not FDA-approved as primary therapy for hidradenitis suppurativa. Use in HS patients is as an adjunct for weight management. GLP-1 medications carry possible side effects including nausea, constipation, gallbladder issues, pancreatitis risk, and temporary hair shedding. GLP-1 therapy requires evaluation and prescription by a licensed clinician. This article is educational and is not medical advice.

Sources

• GLP-1 receptor agonists in inflammatory skin disease: a comprehensive review. J Eur Acad Dermatol Venereol. August 2025. doi:10.1111/jdv.20694. The marquee reference for GLP-1 in inflammatory dermatology.
• Gouvrion L, Delage M, Villani AP, et al. Glucagon-Like Peptide-1 Receptor Agonists in Hidradenitis Suppurativa. JAMA Dermatol. 2025;161(10):1084-1086. doi:10.1001/jamadermatol.2025.2723 (multicenter observational study, 66 patients: 54% with a 1-point or greater HS-PGA improvement, 67% with reduced flare frequency).
• GLP-1 receptor agonists in dermatology: a clinical review. J Clin Aesthet Dermatol. 2025. PMC11932103.
• STEP-1: Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183
• SURMOUNT-1: Jastreboff AM, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
• Sartorius K, et al. Suggestions for uniform outcome variables when reporting treatment effects in hidradenitis suppurativa. Br J Dermatol. 2003;149(1):211-213.
• Kromann CB, et al. The influence of body weight on the prevalence and severity of hidradenitis suppurativa. Acta Derm Venereol. 2014;94(5):553-557.
• Sivanand A, et al. Weight loss and hidradenitis suppurativa: a systematic review. J Cutan Med Surg. 2020;24(1):64-72.
• Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab. 2018;27(4):740-756.