Hidradenitis suppurativa often starts during the teenage years, but treatment options for younger patients have historically lagged years behind those available to adults. The FDA has approved secukinumab (Cosentyx) for moderate to severe HS in patients as young as 12 who weigh at least 30 kg, about 66 pounds. As reported by Dermatology Times, it’s the first IL-17A inhibitor, a drug class that targets a specific inflammatory protein tied closely to active HS, approved for this age group.
An Unusual Path to Approval
Running a placebo-controlled trial in adolescent HS is difficult. The eligible patient pool is small, and withholding treatment from a teenager with a painful, scarring condition raises its own ethical questions. Instead of a pediatric trial, the approval relied on pharmacokinetic modeling: dosing data extrapolated from the adult HS trials that already support secukinumab, combined with pediatric dosing data from three other conditions where the drug is approved in younger patients, including plaque psoriasis and juvenile arthritis. The modeling showed that weight-based dosing in adolescents can reach drug exposure levels similar to what worked in adults with HS, the group the clinical benefit was actually proven in.
A Different Mechanism for a Population That Needs Options
Adalimumab, a TNF-alpha inhibitor, has been available for teens with HS since 2018, so secukinumab isn’t the only biologic option for this age group, but it is the first one that works differently. IL-17A is a protein that shows up in unusually high levels in HS-affected skin, more directly tied to the disease’s inflammation than the pathway TNF inhibitors target. For a teenager who hasn’t responded to a TNF inhibitor, or whose family is weighing long-term treatment, having a second mechanism in the toolkit matters. HS diagnosed at 13 or 14 can mean decades of managing a chronic disease, and more than half of all HS patients develop their first symptoms during adolescence.
What Families Should Know
The approval includes weight-based dosing built specifically for this age group, not a blanket copy of the adult label. Secukinumab has been used in more than 1.8 million patients worldwide since 2015, with over a decade of safety data across several conditions, including younger patients with psoriasis. That track record gives families and dermatologists more to go on than they’d have with a newly developed molecule.
HS diagnosis typically takes close to a decade from first symptoms, and that delay compounds the toll of the disease, physically through scarring and progression, and emotionally through its effect on self-image and social life during formative years. For teenagers navigating that gap, having another biologic option with a different mechanism means more opportunity to find what actually works.
