Skin diseases are a common cause of hospitalization and contribute substantially to healthcare utilization, patient morbidity, and healthcare expenditures. Despite evidence supporting specialist involvement, most hospitalized patients with dermatologic conditions are managed without dermatology consultation. This review examines the evolution of inpatient dermatology services and evaluates their impact on diagnostic accuracy, patient outcomes, healthcare utilization, and costs. Across prospective and retrospective studies, dermatology consultation has been associated with diagnostic and therapeutic revisions in many cases. Specialist involvement has been linked to shorter hospital stays, lower readmission rates, improved treatment selection, and high levels of patient and provider satisfaction. These clinical benefits translate into substantial economic value, with analyses demonstrating significant healthcare savings and favorable returns on investment despite relatively low utilization of consultation services. The review also highlights the ongoing contraction of inpatient dermatology services and the resulting gaps in access. Teledermatology has emerged as a promising strategy to extend specialist expertise to underserved hospitals and patient populations, demonstrating high diagnostic concordance with in-person consultation and positive patient acceptance. The literature surrounding cellulitis serves as a particularly compelling example of the value of inpatient dermatology consultation, illustrating how specialist involvement can reduce misdiagnosis, unnecessary hospitalization, antibiotic overuse, and healthcare spending. Collectively, the evidence suggests that inpatient dermatology consultation represents a high-value service that remains underutilized in contemporary hospital practice. Future efforts should focus on developing standardized consultation pathways, expanding teledermatology infrastructure, and aligning reimbursement models with the demonstrated clinical and economic benefits of specialist dermatologic care.
The inpatient dermatology service provides a clinically rich environment for medical education across multiple learner levels, yet systematic guidance on teaching in this setting remains limited. This review summarizes evidence-based best practices for teaching in the inpatient dermatology consult setting. Structured teaching frameworks including the One-Minute Preceptor and SNAPPS have demonstrated effectiveness in clinical education settings and are well suited to the demands of inpatient dermatology teaching. Bedside teaching remains the primary modality for morphologic education and is most effective when combined with active learner involvement and focused debriefing. Case-based learning and chalk talks, integrated with spaced repetition, promote knowledge retention. Effective feedback requires specificity and an educational alliance between supervisor and trainee. The consultative encounter provides an important opportunity for interspecialty education through transparent communication of diagnostic reasoning and point-of-care teaching. Formal resident-as-teacher programming may also increase residents’ knowledge of and confidence in teaching techniques. Effective teaching in the inpatient dermatology setting requires intentional effort from educators at all levels. Evidence-based strategies including structured teaching frameworks, bedside instruction, case-based learning, and formal resident-as-teacher programming can be incorporated into existing clinical workflows without requiring significant additional resources or protected time. Dermatologists who approach both team-based and consultative teaching deliberately are well positioned to improve dermatologic education across specialties and training levels.
This report focuses on oral findings the inpatient dermatologist may encounter when managing patients with a history of solid organ transplantation. While oral ulceration most commonly represents a benign etiology in healthy patients, solid organ transplant recipients (SOTRs) represent a population with increased baseline risk to oral ulceration that not only carry a negative impact on quality of life but also may signify serious underlying etiologies such as disseminated infection or malignancy. A literature review within the last 3 years has increased insight into the etiologies contributing to this condition, as well as the detrimental impact of oral ulceration on quality of life in this patient population. We aim to provide a review of the history, epidemiology, clinical course, diagnostic pearls, and management when encountering oral ulcerations in SOTRs.
Hidradenitis suppurativa (HS) is a heterogeneous, chronic, inflammatory disease with limited treatment options requiring a complex network of interdisciplinary teams. Diagnosis is clinical, relying on the typical morphology, characteristic locations and recurrence of lesions. Initial recognition and longitudinal surveillance of lesions can be exceptionally challenging, and there is not yet a globally accepted nomenclature for the unique morphologies found in HS. Consensus on descriptive terms used for HS would improve diagnostic accuracy, enable reliable comparison of clinical trial data, facilitate clear interdisciplinary communication, enhance our understanding of underlying immunologic mechanisms, and support the development of phenotype classifications to promote individualized treatment plans. Although several glossaries have been proposed to standardize HS nomenclature, none have been universally accepted for widespread use. Phenotypic classifications are currently being developed. However, with attempts to develop these phenotypic classifications, several morphologies have emerged that are not accurately represented by previous definitions. Additionally, distinct molecular and immunologic profiles in patients with certain HS lesions suggest specific pathomechanisms that, with further characterization, may allow clinical examination to guide targeted therapy. In this paper, we address this unmet need and present a review of the morphological features of HS described in the literature. In addition, we propose a convincing definition for previously undefined types of hidradenitis lesions, such as pyoderma gangrenosum-like lesions, eroded nodules (also referred to as pyogenic granuloma-like lesions), cord-like scarring, cribriform scarring, and involuted lesions.
To examine the development, performance, and potential integration of three commercially available gene expression profiling (GEP) assays for primary melanoma into clinical practice through a comparative and evidence-based lens. Recent prospective data has shown the ability for GEP assays to provide additional objective data in stratifying risk of sentinel node positivity for primary melanoma. GEP assays have emerged for patients with melanoma to better define individual metastatic risk based on tumor-intrinsic biology and refine decisions around SLNB, surveillance, and adjuvant therapy. While prospective evidence is currently insufficient to show the associated prognostic value of these tests improves clinical outcomes in all patients with melanoma over clinicopathologic variables alone, these assays may serve as a useful and objective adjunct in clinical decision-making promoting personalized care.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that is characterized by recurrent abscesses, tunnels, and nodules. HS requires complex medical management and a multi-faceted treatment approach, particularly in patients where HS coincides with underlying follicular-occlusive or autoinflammatory syndromes. This review aims to synthesize the current literature regarding the treatment of syndromic HS. Recent reports cover a wide range of treatment modalities for syndromic HS. Treatments most frequently utilized included topical and oral antibiotics, retinoids, biologics, corticosteroids, and surgery. Determining clinical efficacy in treatments was limited due to the rare nature of syndromic HS. This review establishes the first comprehensive overview of efficacious treatments in the clinical management of syndromic HS. Understanding the two pathways of syndromic HS and comparing past treatment results can help clinicians in deciding how to manage the treatment of future HS patients. However, additional research is required to discover more efficacious treatment options.
This review summarizes recent evidence on bacterial and fungal dysbiosis in hidradenitis suppurativa (HS), focusing on how microbiome alterations influence disease pathogenesis and progression. Additionally, the role and effectiveness of antimicrobial treatments in modifying microbial communities and controlling inflammation are evaluated. Emerging studies highlight significant bacterial dysbiosis in HS lesions characterized by decreased commensal species and increased anaerobes. The presence of biofilms in chronic lesions contributes to antibiotic resistance and persistent inflammation. While fungal dysbiosis appears less pronounced, subtle alterations in the mycobiome may influence chronicity or exacerbate disease in susceptible patients. Recent research demonstrates that standard antibiotic regimens remain essential. However, biologics targeting inflammatory cytokines (e.g., TNF-α, IL-17) are increasingly used and may indirectly alter microbial communities. Microbial dysbiosis significantly influences HS pathogenesis by driving chronic inflammation and treatment resistance, especially through biofilm formation. Effective management necessitates combining antimicrobials, biologics, and surgical approaches. Future research should utilize advanced microbiome sequencing to refine targeted treatments and explore microbiome-modulating therapies as adjuncts for sustained clinical remission.
This narrative review explores the current understanding of itch in hidradenitis suppurativa (HS), a common yet underrecognized symptom that contributes significantly to patient burden. Herein, we summarize HS-associated itch pathophysiology, clinical impact, and management. Emerging evidence indicates that itch affects more than half of patients with HS and arises from a complex interplay of immune dysregulation, mast cell activation, neural sensitization, and local irritation. Specific inflammatory markers such as IL-17, IL-31, and CCL-26 potentially play a role in itch pathogenesis. The degree of HS-associated pruritus correlates with disease severity, pain, drainage, and impaired quality of life. Recent studies suggest that topical clindamycin, strontium cream, bimekizumab, brodalumab, apremilast, povorcitinib, remibrutinib, and fostamatinib may improve HS-associated pruritus. Itch significantly contributes to HS disease burden yet often remains underassessed in clinical care. Standardized measurement tools and targeted therapies are needed to improve patient outcomes and guide future research.
This review examines the evolving landscape of clinical trial design in hidradenitis suppurativa (HS), focusing on the challenges posed by high placebo responses and increasingly stringent endpoints. The goal is to identify barriers and propose strategies to improve validity and inclusivity to real-world HS populations. We highlight demographic gaps, underrepresentation of minority and pediatric populations, and the exclusion of patients with comorbidities. High placebo responses, driven by disease variability and subjective endpoints, continue to confound results. Adaptive trial designs, Bayesian-augmented analyses, and more inclusive eligibility criteria are emerging as promising solutions. Longer-term studies reveal that meaningful clinical improvements may require extended treatment durations. Addressing placebo effects, demographic disparities, and endpoint selection is critical for HS research. Strategic trial design, standardized flare management, and innovative statistical methods can enhance reliability and generalizability. These approaches will be essential for future trials to improve outcomes for diverse HS patient populations.
Extracorporeal photopheresis (ECP) is an immunomodulatory treatment in which an apheresis machine isolates mononuclear cells from whole blood that are then treated with psoralen and ultraviolet-A light and reinfused into the patient. ECP has been approved for use in cutaneous T-cell lymphoma (CTCL) for 30 years; it has also been shown to be effective for graft-versus-host disease, solid organ transplant rejection, and various autoimmune diseases. Nonetheless, ECP is relatively underutilized, perhaps due to knowledge gaps and resource limitations. Here, we review ECP indications and techniques, as well as the data supporting its use in clinical settings. Recent clinical studies have emphasized the durability of ECP in CTCL, both as monotherapy and in combination with topical and other systemic CTCL treatment modalities. New insights into the mechanism of action underlying ECP have illuminated its effects on both cellular and humoral immunity. Specific clinical and laboratory findings have been identified as potential predictors of ECP response. ECP is a well-tolerated and effective treatment option for a growing list of indications. In CTCL, ECP can achieve durable responses with longer treatment courses and should be considered as a first-line option for erythrodermic disease and Sézary syndrome.
This review addresses the pathophysiology, clinical manifestations, and management of digital ischemia in autoimmune connective tissue disease (AICTD). Given the substantial morbidity associated with AICTD-related digital ulcers, prompt diagnosis and intervention are critical. Digital ulcerations, which often present in patients with AICTDs, affect nearly half of all systemic sclerosis patients and typically occur in the setting of Raynaud’s phenomenon. While traditional vasodilators such as calcium channel blockers and phosphodiesterase inhibitors constitute first-line therapies, emerging evidence supports the use of adjunctive botulinum toxin injections and intravenous prostacyclins for refractory cases. Inpatient management of digital ischemia requires a multimodal approach, combining behavioral strategies with targeted pharmacotherapies. The recent incorporation of additional vasoactive therapies has augmented the therapeutic landscape. Further research is needed to optimize treatment protocols and establish long-term efficacy.
While flares are a well-recognized feature of hidradenitis suppurativa (HS), defining flares and selecting an appropriate management strategy can be challenging. This narrative review discusses approaches to HS flare identification and management, highlighting both preventive and therapeutic strategies. For decades, topical and systemic antibiotics have been a mainstay of HS flare treatment due to their anti-inflammatory properties and quick onset. According to a 2024 survey of HS experts, trimethoprim-sulfamethoxazole and amoxicillin-clavulanate were the second and third most prescribed antibiotic monotherapy following tetracyclines, respectively. Preliminary evidence suggests that pairing amoxicillin-clavulanate with a prednisone taper may have potential for gaining rapid control of HS flares. Among topical treatments, clascoterone and ruxolitinib emerge as promising non-antimicrobial options for mild to moderate HS. Procedural strategies for flare management include intralesional steroids for acutely inflamed nodules or tunnels and punch incision and drainage for relief of painful abscesses. A survey study of 900 individuals with self-reported HS found that complementary and alternative medicine (CAM) interventions are perceived to be one of the most helpful tools for flare management. Flares have significant implications for the quality of life in patients with HS. In order to synergize anchor therapy of baseline disease with prompt control of flare activity, a multimodal approach of medical, procedural, and CAM interventions combined with trigger avoidance and patient education is critical.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease marked by painful nodules, abscesses, and scarring primarily in intertriginous areas. Although HS affects individuals of all racial and ethnic backgrounds, patients with skin of color (SoC), including Black, Hispanic, and South Asian populations, experience a disproportionate disease burden along with significant disparities in diagnosis, treatment, and outcomes. This review summarizes epidemiological trends, clinical variations, pathophysiologic insights, diagnostic challenges, treatment disparities, and psychosocial impacts of HS in SoC populations. Emerging data reveal that HS patients of SoC have unique clinical features, such as pigmentary changes, keloid formation, and altered erythema presentation, which may complicate recognition in darker skin tones. SoC patients remain underrepresented in clinical trials and are less likely to receive advanced therapies. Emerging evidence suggests that genetic, immunologic, and structural differences may contribute to variations in disease pathophysiology and treatment response. Systemic barriers, including limited access to dermatology, implicit bias, and cultural mistrust, further exacerbate these inequities. Addressing these challenges requires inclusive research, enhanced provider education, and culturally competent care. This review outlines key priorities to advance equity and improve outcomes in HS management for patients with SoC.
This review synthesizes recent evidence on dietary interventions and supplements in the management of hidradenitis suppurativa (HS). Recent findings highlight the potential role of the skin-gut axis and gut microbiome dysbiosis in the pathogenesis of HS. Survey studies indicate that many patients incorporate dietary changes to manage their HS symptoms, with some reporting perceived benefits from Mediterranean, Paleolithic, and ketogenic diets. Elimination of brewer’s yeast shows promising results in survey data, and weak evidence supports zinc and vitamin D supplementation. Increased consumption of dairy and sugar has been associated with worse HS severity and increased HS flares in some cohorts. While dietary modifications and supplements show potential in HS management, current evidence is limited by methodological constraints. Larger, rigorous studies are needed to validate these findings and inform clinical guidelines. Clinicians should cautiously consider dietary approaches alongside conventional therapies in the management of HS.
Currently, there are no standardized, evidence-based guidelines to support clinical decision-making for the inpatient management of hidradenitis suppurativa (HS). This review aims to address this gap by proposing a structured framework to guide the care of hospitalized patients with HS. Although HS pathophysiology is not fully understood, research increasingly supports the hypothesis that HS is an autoinflammatory disorder, rather than primarily a process of follicular occlusion. This evolving understanding has informed the use of targeted immunotherapies and surgical inflammatory debulking. While outpatient treatment options have advanced, data guiding inpatient management remains scarce. This review proposes an evidence-based approach to guide the inpatient dermatologist in optimizing care for hospitalized patients with HS.
Hidradenitis suppurativa (HS) is a chronic dermatologic condition characterized by recurrent painful nodules, abscesses, and draining sinus tracts in the intertriginous areas and can significantly affect patients’ quality of life. On average, patients face a 10-year delay in diagnosis. Despite recent advances in the management of HS, this complex and heterogenous condition presents ongoing challenges for both patients and healthcare providers. Developments in telehealth, artificial intelligence (AI), and HS-specific mobile applications, have emerged as transformative tools in the management of HS with many patients having improved access to care and up to date information. Providers have also benefited from the development of digital tools to improve patient care and research. Herein, we review the current landscape and characterize developments in technology, particularly digital technology such as tele-dermatology and AI, and their effects on HS patient care, patient access, patient experience and HS research.
This review examines recent advances in the understanding of the immunopathogenesis of hidradenitis suppurativa (HS), with a particular emphasis on the emerging roles of B cells, plasma cells, tertiary lymphoid structures (TLSs), and the BAFF-BTK-SYK axis. It also explores the therapeutic implications of these findings and the potential for immune-targeted interventions. Recent studies employing spatial transcriptomics, single-cell RNA sequencing, and proteomics have redefined HS as a disorder of significant humoral immune dysregulation. B cells and plasma cells are predominant in lesional skin, particularly in Hurley stage 3 disease, where they contribute to TLS formation, local autoantibody production, and chronic inflammation. Neutrophils also perpetuate disease through the release of BAFF and NETs, driving plasma cell survival and autoimmunity. Targeted therapies inhibiting BAFF (e.g. ianalumab), BTK (e.g. remibrutinib) and SYK (e.g. fostamatinib) show early promise. The pathogenesis of HS extends beyond innate immune dysregulation to include key components of the adaptive and humoral immune response. B cells, plasma cells, and TLSs play pathogenic roles in a subset of patients, offering new avenues for targeted therapy. Immune endotyping and biomarker stratification may enhance the efficacy of emerging BAFF-, BTK-, and SYK-targeted therapies, ushering a new era of personalised treatment for HS.
This narrative review explores the emerging role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual GLP-1/GIP receptor agonists in the management of hidradenitis suppurativa (HS). Given the strong association between HS, obesity, and metabolic syndrome, these agents may offer therapeutic benefit through their anti-inflammatory and metabolic effects. Recent small observational studies and case reports have documented improvements in quality of life, flare frequency, and disease severity among HS patients treated with GLP-1RAs such as liraglutide, semaglutide, dulaglutide, exenatide, and tirzepatide. Proposed mechanisms include weight loss, systemic anti-inflammatory effects, and improved bioavailability of HS medications. However, the evidence remains primarily anecdotal and heterogeneous. GLP-1RAs may serve as a promising adjunctive therapy for HS, particularly in patients with metabolic comorbidities. Although early observational studies report improvements in HS severity, larger, randomized controlled trials are needed to establish their role in HS disease management.
Serum markers are valuable tools in the inpatient setting, providing objective metrics to support clinical diagnosis, disease monitoring, and therapeutic decisions. In this review, we highlight twelve established serum markers for skin disease management – categorized into infectious, inflammatory, and neoplastic groups – each offering distinct clinical utility and limitations. Infectious markers – including antistreptolysin O (ASO)/anti-DNase B (ADB), β-D-glucan (BDG), galactomannan (GM), non-treponemal tests, treponemal tests, and procalcitonin (PCT) – can be particularly useful in aiding diagnosis of skin-related infections. Inflammatory markers such as ferritin, IL-6, IL-17, IgE, and BP180 autoantibodies offer insights into inflammatory and autoimmune conditions. Neoplastic markers – such as lactate dehydrogenase (LDH) and Anti-Merkel cell polyomavirus (AMERK) antibodies – offer significant prognostic insights. This review covers twelve serum markers of either infectious, inflammatory, or neoplastic utility for skin conditions in the inpatient setting. Ultimately, thoughtful incorporation and cautious interpretation of serum biomarkers can significantly improve diagnostic accuracy, therapeutic decision-making, and patient outcomes in inpatient practice relating to skin conditions and enhance the care of patients with dermatologic disease.
Suboptimal skin image quality can contribute to diagnostic error in asynchronous teledermatology and by AI models. We review the impact of image quality on diagnostic performance in teledermatology and evaluate artificial intelligence (AI)-based dermatologic image quality assessment (DIQA) systems. The goal is to assess the state of DIQA tools and potential for addressing limitations in skin image acquisition. Deep learning approaches, particularly convolutional neural networks (CNNs), have achieved moderate to high accuracy in detecting specific quality issues. Vision transformers (ViTs), though not as well studied, show promise in capturing complex image features due to global attention mechanisms. Hybrid models and transfer learning have been explored to improve model generalizability, but with limited dermatology-specific data. AI-based DIQA tools offer real-time quality assessment, supporting standardized image acquisition and robust AI diagnostics. Future development requires more diverse datasets, prospective validation, and regulatory compliance to enable clinical integration.
