Before a patient with hidradenitis suppurativa (HS) starts any therapy, the conversation that clinician and patient have about what treatment can realistically deliver may matter as much as the prescription itself. That is the central argument of a new Dermatology Times commentary, "Managing Treatment Expectations in Hidradenitis Suppurativa: What to Tell Patients Before Starting Therapy."

HS is a chronic inflammatory follicular disorder that presents with painful nodules, abscesses, sinus tracts, and scarring, most often in intertriginous areas. Because the disease waxes and wanes over years and rarely resolves permanently, patients frequently arrive at the dermatology office with expectations shaped by acute-care models — a course of treatment, a cure, a clear endpoint. The commentary's premise is that this mismatch between expectation and disease biology drives dissatisfaction, premature discontinuation, and loss to follow-up.

What should patients hear before the first prescription?

The piece frames pre-therapy counseling as a core clinical task rather than a courtesy. Practical points include:

• Explaining the chronic, recurrent nature of HS and the realistic goal of flare reduction rather than cure
• Establishing a timeline for visible response, so patients do not abandon an effective regimen too early
• Aligning the patient's own definition of improvement — pain, drainage, lesion count — with what therapy can plausibly move and how quickly
• Preparing patients for stepwise escalation, since first-line choices often precede more intensive options

Why expectation-setting matters clinically

Nonadherence is a persistent problem across chronic dermatoses, and HS carries particular risk. Pain, odor, and drainage affect quality of life heavily, so patients judge therapies against symptoms they feel daily. When improvement lags behind that felt experience, trust erodes. The commentary positions the initial consultation as the point where the clinician can pre-empt that erosion by defining success in terms the patient accepts.

The condition's visibility and psychological burden also make framing important. Patients who understand that response is gradual and partial are more likely to stay engaged through dose adjustments, regimen changes, and combination approaches.

What this means for practice

For dermatology teams, the takeaway is procedural rather than pharmacologic: build expectation management into the visit structure for every new HS diagnosis. That includes documenting the goals the patient agrees to, revisiting them at follow-up, and adjusting the conversation as therapy escalates.

As biologic and systemic options for HS continue to expand, the practices that pair those therapies with disciplined upfront counseling are best positioned to keep patients on treatment long enough to benefit from it.

Note: Derm Field's summary is based on the published headline and framing of the Dermatology Times piece; readers should consult the full article for the author's specific counseling protocols and drug-specific timelines.