Have you ever wondered what to do during a hidradenitis suppurativa (HS) flare-up? Some people may be curious about whether they can start a new treatment during a flare.

If you’ve looked into starting a biologic, you may be able to start taking it during a flare-up. But there’s more to know about this topic, so read on for a few key facts.

When Can You Start Biologics?

It’s always best to consult with your healthcare provider when starting a new medication or treatment. Biologic treatment typically begins when HS is moderate to severe.

HS stages are calculated in two ways. The initial and still widely used system is the Hurley staging system, which looks at abscesses, scarring, and sinus tracts. The newer staging system is the International HS Severity Score System (IHS4), which uses a formula that takes into account the number of nodules, abscesses, and draining tunnels. Healthcare professionals may use these tools to help them “grade” the severity of your HS.

Before you start a biologic, your medical team has likely already prescribed a variety of other treatments. These include different types of medications, such as antibiotics or anti-inflammatory meds. Topical treatments can be used throughout your HS treatment regimen. Other treatments typically used less often include small surgeries, like incision and drainage or deroofing techniques.

In one study, the average time from first systemic therapy to starting biologics was 15.3 years, but earlier intervention with biologic treatments is becoming more popular.

Is It Safe To Start Biologics During a Flare-Up?

Yes, your doctor may start a biologic during an HS flare if they think it will help ease your symptoms, as long as you don’t have a serious or active infection. Starting a biologic is more about which stage of the disease you have, rather than when your last flare occurred.

Keep in mind that researchers are still performing clinical trials on the most effective treatments and the best time to start them for HS. Your doctor will provide the best guidance on whether it’s a good time to start based on the stage of your HS, your response to previous HS treatments, and your overall health status.

Testing Before Starting a Biologic

Before your medical team starts you on a biologic, they’ll need to do some testing to ensure it’s a good treatment option for you. Biologics target your immune system. While you’re on biologics, you could be at higher risk of getting an infection, so your doctor will want to make sure you’re healthy enough to manage this risk, and that you don’t carry any latent infections such as tuberculosis or hepatitis.

Doctors are also cautious about using biologics in people who are pregnant or trying to get pregnant. It isn’t an absolute no, but it does warrant a discussion with your doctor.

What Happens When You Start a Biologic?

As with any new treatment, your doctors will want you to pay attention to any side effects to make sure you tolerate the treatment well. It’s important to report any signs of infection or irritation at the injection site to your doctor.

Don’t Expect Immediate Results

Biologics don’t work immediately. It can take up to three months to see the effects. So even though you can start a biologic during a flare-up, it won’t necessarily help with the current flare-up itself. In the long term, biologics can help to reduce your future need for other interventions and medications.

Ongoing HS Treatment

Biologics are not a stand-alone treatment. Your medical team will still prescribe other treatments to help manage your HS, especially during flare-ups. For acute pain, you can still use pain medications. Minor surgical techniques targeting HS lesions can also help to relieve acute pain. Adjunct therapies and medical advice, such as pain management techniques, weight loss, and smoking cessation, may also be offered.

Just like other treatments, biologics are only one piece of the puzzle. If you have specific questions about your HS treatment plan, it’s always best to consult your primary doctor or dermatology team.

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On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.

Have you started a biologic during a flare-up? Let others know in the comments below.