Health condition
The HS biologics pathway
Biologic medicines such as adalimumab, secukinumab and bimekizumab are approved in the UK for moderate-to-severe hidradenitis suppurativa that has not responded to antibiotics, and access runs through a hospital dermatologist.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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Biologics are considered when HS remains moderate-to-severe despite a proper trial of oral antibiotic therapy
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Adalimumab, secukinumab and bimekizumab are the main NICE-approved options for HS
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Only a hospital dermatology team can prescribe them, after severity scoring and screening blood tests
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Response is reviewed at a set point - usually 12 to 16 weeks - and treatment continues only if it is working
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
Biologics are injectable medicines that block specific inflammatory signals - TNF-alpha in the case of adalimumab, and IL-17 for secukinumab and bimekizumab. For HS that keeps flaring despite antibiotics, they can markedly reduce the number of painful nodules and abscesses, although they control the disease rather than cure it.
Diagnosis and treatment routes
The pathway starts with a dermatologist confirming disease severity (typically Hurley stage II or III with a documented inadequate response to systemic treatment), followed by screening for tuberculosis, hepatitis and other infections before the first dose. Injections are self-administered at home, with review appointments to score the response; a private dermatologist can complete the assessment and initiate the same NICE-approved medicines. In much of the UK, a routine NHS referral to the relevant specialist clinic can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant dermatologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about The HS biologics pathway.
Quick, plain-English answers to what people ask us most.
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What is The HS biologics pathway?
The HS biologics pathway describes a recognised clinical condition that a doctor can diagnose based on your symptoms, history, and any relevant tests. Its impact varies from person to person, so a proper assessment is the best way to understand your own case. Your GP or a specialist can talk you through what it means in practice.
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What leads to the HS biologics pathway?
The HS biologics pathway can develop for a number of reasons, and the exact cause often depends on individual factors such as underlying health, lifestyle, or in some cases injury. A clinician will usually take a history and may arrange tests to identify what's driving it in your case. Understanding the underlying cause helps guide the most appropriate treatment.
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How would I know if I have the HS biologics pathway?
The presentation of the HS biologics pathway differs between individuals, but it typically involves noticeable changes that prompt people to seek medical advice. Some people have mild symptoms that come and go, while others experience more persistent or severe effects. A clinical assessment is the most reliable way to confirm what's going on.
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Is the HS biologics pathway serious or dangerous?
Severity varies considerably, and while many cases are manageable with appropriate care, some can be more serious and need prompt attention. It's best not to self-diagnose severity, as similar symptoms can have very different underlying causes. A clinician can assess your specific situation and advise on the right next steps.
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Does the HS biologics pathway run in families?
There can be a hereditary element for some people, though many cases occur without any clear family link. If a close relative has been diagnosed with something similar, it's worth mentioning this to your doctor. This can help inform whether any additional monitoring or testing is worthwhile.
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Is there a cure for the HS biologics pathway?
Many cases can be effectively managed or improved with the right treatment, although whether it can be fully "cured" depends on the underlying cause. Early treatment generally gives the best chance of a good outcome. Your clinician can explain what's realistic to aim for in your specific case.
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What treatment options are available for the HS biologics pathway?
Depending on the cause and severity, treatment might involve medication, targeted therapy, monitoring, or in some cases a procedure. Most treatment plans start with the least invasive appropriate option and escalate only if needed. Your care team will personalise this based on your assessment and preferences.
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How long does the HS biologics pathway last?
Duration varies significantly depending on the cause, how promptly it's treated, and individual factors, so it's hard to give a single answer that applies to everyone. Some cases resolve within weeks with treatment, while others need longer-term management. Your clinician can give you a more specific timeframe once they understand your case fully.
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When would I need to see a specialist for the HS biologics pathway?
If first-line treatment isn't giving enough improvement, or if there are features that suggest a more complex underlying problem, a specialist referral is usually the next step. More invasive treatment is typically considered only after simpler options have been tried and haven't worked well enough. A specialist can assess whether this applies to your situation.
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When should I see a doctor about the HS biologics pathway?
It's worth getting checked if things aren't improving, are getting worse, or are causing you ongoing worry or disruption. On the NHS, routine referrals for this kind of assessment can take 20-45+ weeks to come through; going private typically means being seen by a consultant within about 2 weeks.