Systemic antibiotics continue to play an important role, increasingly as combination or bridging therapies rather than standalone treatments, Shi explained. Severe flares may require intravenous (IV) ertapenem, particularly when rapid control is needed before surgery or while awaiting biologic access. For severe Hurley stage III disease, however, Shi emphasized early use of high-dose IV infliximab, often combined with methotrexate, to improve durability. Despite medical advances, surgery remains essential in severe disease, as medications reduce inflammation but do not eliminate biofilm-filled tunnels that drive recurrence. Overall, the “Hidradenitis Suppuritiva Update 2026” session underscored a new treatment paradigm: HS care in 2026 requires early diagnosis, systemic screening, combination medical therapy, and strategic surgical intervention, all tailored to reduce disease burden and improve long-term patient quality of life.