Choosing a first biologic in hidradenitis suppurativa (HS) — a chronic inflammatory disease of apocrine-bearing skin — remains one of the least standardized decisions in dermatology, and Jennifer Hsiao, M.D., addressed it directly at Fall Clinical Derm 2026. Her recommendations, reported by Managed Healthcare Executive, arrive as clinicians weigh a small set of approved agents against patient factors that trial populations rarely capture.

HS biologics are not interchangeable, and the first choice tends to lock in the treatment sequence. That is the practical stake behind Hsiao's guidance: payers frequently require step therapy (a rule that patients must fail one drug before covering another), so an initial selection made without a clear rationale can narrow every subsequent option.

What did Hsiao recommend?

The source report frames her talk as a set of recommendations for selecting a first biologic in HS, delivered at the Fall Clinical Derm 2026 meeting. The session focused on how a clinician should weigh the available agents when a patient with moderate-to-severe disease (Hurley stage II or III, the standard severity grading for HS) needs systemic therapy beyond antibiotics.

What the report does not specify is the full content of her selection criteria. Readers should note that the underlying article, accessed via a syndicated feed, provides the session title and venue but not the enumerated criteria themselves. Derm Field has not independently verified the detailed recommendations, and clinicians seeking the complete framework should consult the meeting proceedings or the original coverage.

Why does first-line selection matter in HS?

HS carries a substantial burden of pain, drainage, and scarring, and biologic therapy has become central for patients who fail conventional management. The decision is consequential because response varies: a patient who loses months to an ineffective first agent faces disease progression that is difficult to reverse.

The managed-care framing matters here. Fall Clinical Derm is a meeting where treatment strategy meets reimbursement reality, and Hsiao's talk sits at that intersection. First-line biologic choice is not only a clinical question but also a prior-authorization question (the insurer approval process required before dispensing a high-cost drug).

What is not said?

The report does not name the specific biologics Hsiao ranked, nor does it give head-to-head trial data, effect sizes, or payer policy details. In a field where indirect comparisons dominate — few randomized trials compare HS biologics directly — any ranking presented at a conference deserves scrutiny against the underlying evidence class.

Derm Field will monitor the published proceedings from Fall Clinical Derm 2026 for the full criteria, including any patient factors — severity, comorbidities, prior antibiotic exposure — that Hsiao identified as decisive. Until those details surface, the headline recommendation stands as a signal that first-line HS biologic selection is being formalized, not as a validated protocol.