Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting areas with a high density of apocrine glands and characterized by subcutaneous nodules that may evolve into fistulas with pus secretion. Progressor and aggressive profiles will require the use of immunomodulatory therapies to fight against their disease outcomes. Various options have been proposed to treat HS. Unfortunately, no therapy has been fully successful. Methods: The aim of this review is to investigate all current knowledge on biologic and small molecule options for HS management. A systematic literature research using the words "biologic, " "small molecule, " "therapy, " and "HS" was performed in PubMed/Medline and Scopus/ Embase databases. A search of the clinicaltrials.gov website for interventional recruiting and completed trials including the term "HS" was also performed up to August 2021. Results: At present, tumor necrosis factor TNF alfa blockers are considered the first therapeutic option based on clinical trials results and real-world evidence. However, new therapeutic options based on alternative pathway blockage, including interleukin (IL)-17, Complement and IL-23, seem to offer future alternatives for this condition. Conclusions: Several future studies and clinical trials are necessary to gain new knowledge about HS and to properly treat this complex condition. At present, IL-17 blockers such as secukinumab and bimekizumab represent the most promising alternative therapies for those patients who do not respond to adalimumab.
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