Across 12 cohorts and 4 case reports, GLP-1 receptor agonists (GLP-1RAs) consistently reduced hidradenitis suppurativa (HS) disease activity—measured by Hurley staging, nodule and abscess counts, and flare frequency—while improving DLQI scores, systemic inflammatory markers, and glycemic control. Crucially, improvements in HS severity appeared independent of BMI reduction in several cohorts, implicating direct suppression of the NF-κB signaling pathway and cytokine modulation as mechanistic drivers distinct from weight loss alone. GLP-1RAs also demonstrated cardiovascular benefits and appeared to potentiate biologic therapies in HS patients.
HS is a notoriously difficult-to-treat condition with limited approved systemic therapies—adalimumab and secukinumab being the primary biologics—and its inflammatory pathophysiology overlaps significantly with metabolic syndrome, making GLP-1RAs an intuitively compelling candidate. The NF-κB angle is particularly noteworthy: this pathway sits upstream of TNF-α and IL-1β, two key drivers of HS pathology, suggesting GLP-1RAs could synergize mechanistically with TNF-blocking biologics. That said, this is a narrative review drawing on heterogeneous, largely observational cohorts without randomized controls, meaning causality and effect size remain uncertain. Publication bias toward positive outcomes is also a real concern. Still, the weight-independent anti-inflammatory signal is the most paradigm-shifting element here—if confirmed in RCTs, it repositions GLP-1RAs not merely as metabolic adjuncts but as disease-modifying agents in inflammatory dermatology.