Hidradenitis suppurativa (HS) is not curable with any currently available treatment. It is a chronic inflammatory skin condition, and no medication, surgery, or lifestyle change can permanently eliminate it. That said, the outlook is more hopeful than many people realize: in a community-based study, nearly 64% of all patients achieved full remission, defined as no active symptoms for six months or longer. The goal of treatment is to reduce flare-ups, prevent the disease from progressing, and get you to a point where HS no longer controls your daily life.
Why HS Can’t Be Cured Yet
HS starts with a problem deep in the hair follicles. The follicles become blocked, swell, and eventually rupture beneath the skin. When that happens, the contents of the follicle spill into surrounding tissue, triggering an aggressive immune response. White blood cells flood the area, forming painful abscesses. Over time, the cycle of blockage, rupture, and inflammation destroys not just the original follicle but neighboring structures as well.
The reason this process keeps repeating comes down to the immune system itself. People with HS have dysregulated immune signaling that promotes chronic inflammation. Their skin tissue produces elevated levels of specific inflammatory proteins, and the severity of the disease correlates with how much of these proteins is present. The underlying genetic and immune factors that drive this cycle persist even when individual flare-ups heal, which is why the condition recurs. Until medicine can correct the root immune dysfunction, a true cure remains out of reach.
What Remission Actually Looks Like
Remission in HS means a sustained period with no active symptoms: no new abscesses, no draining, no pain. A community-based cohort study found that remission rates varied significantly by how severe the disease was at baseline. Among patients with mild disease, 73.7% achieved full remission. For moderate disease, 60.0% did. Even among those with severe disease, 46.7% reached full remission.
These numbers were notably better than what older hospital-based studies suggested, with remission rates 3.8 times higher and progression to severe disease 10.4 times lower. The likely explanation is straightforward: hospital data skews toward the most difficult cases, while community data captures the full range of people living with HS, many of whom respond well to treatment and never need specialized care.
Remission, though, is not a cure. It can last months or years, but the risk of recurrence remains. Many people experience a relapsing-remitting pattern, with stretches of clear skin interrupted by flare-ups that may be triggered by stress, hormonal changes, or friction.
How HS Severity Is Classified
Doctors use a three-stage system to describe how advanced the disease is, and your stage shapes which treatments make sense.
- Stage I: One or more abscesses without any tunnel formation or scarring beneath the skin. This is the mildest form and the most responsive to treatment.
- Stage II: Recurrent abscesses with sinus tracts (tunnels under the skin that connect lesions) and scarring. Lesions may be single or multiple but are separated from each other.
- Stage III: Widespread involvement with multiple interconnected tunnels and abscesses spanning an entire area. This stage involves significant scarring and tissue damage.
HS does not always progress through these stages. Many people remain at Stage I for years or indefinitely, especially with early treatment. Progression to Stage III occurs in a minority of patients.
Medications That Control HS
Treatment typically starts with antibiotics, anti-inflammatory washes, and topical therapies for mild disease. When HS is moderate to severe, biologic therapy becomes the primary option. Adalimumab is currently the only biologic approved by the FDA for HS in both adults and adolescents. It works by blocking a key inflammatory protein that is overproduced in HS lesions, and its levels directly correlate with disease severity. The drug doesn’t work for everyone, but for those who respond, it can significantly reduce the number and severity of flare-ups.
Several newer biologics targeting different parts of the inflammatory pathway are in late-stage clinical trials, and treatment options are expected to expand considerably in the coming years. For now, if adalimumab doesn’t provide adequate relief, dermatologists may use other medications off-label, meaning the drugs are approved for related inflammatory conditions but not specifically for HS.
When Surgery Becomes an Option
Surgery is not a cure for HS either, but it can be the most effective way to deal with specific areas of damage, particularly tunnels and scarring that medications cannot reverse.
Deroofing is a procedure where the “roof” of sinus tracts and abscesses is removed to expose and clean out the tunnels beneath. It works well for localized Stage II and III lesions. In one study of 88 lesions treated with deroofing, 83% showed no recurrence after a median follow-up of 34 months. The overall recurrence rate across studies is about 27%.
Wide excision removes the affected tissue along with a margin of healthy skin surrounding it. This is reserved for severe cases that haven’t responded to other treatments. It has the lowest recurrence rate of any surgical approach: between 5% and 13%, depending on how the wound is closed afterward. Skin grafting after wide excision brings recurrence down to about 6%.
Simple incision and drainage, the kind you might receive in an emergency room, has a 100% recurrence rate and is not considered a real treatment. It relieves pressure temporarily but does nothing to address the underlying tunnels or inflammation. At least 30% of patients who undergo any form of surgery will need a second procedure, so setting realistic expectations matters.
Health Conditions Linked to HS
HS rarely exists in isolation. The same immune dysregulation that drives the skin disease also increases the risk of several other conditions, and managing HS well means being aware of them.
Metabolic syndrome is the most common association, affecting up to 50.6% of HS patients. This cluster of conditions (high blood pressure, elevated blood sugar, excess abdominal fat, abnormal cholesterol) significantly raises cardiovascular risk. HS itself is independently associated with higher rates of heart attack, stroke, and overall mortality. The inflammatory burden of the disease appears to accelerate damage to blood vessels over time.
Crohn’s disease occurs in about 0.8% of HS patients, roughly 2.5 times the rate in the general population. Polycystic ovarian syndrome, spondyloarthritis (a form of inflammatory arthritis affecting the spine), and thyroid disorders also appear at higher rates. Depression and other psychiatric conditions are significantly more common, driven both by the biological effects of chronic inflammation and by the pain, stigma, and social isolation that HS causes.
What You Can Do Right Now
Early treatment is the single most important factor in keeping HS from progressing. People diagnosed and treated at Stage I have the best odds of reaching sustained remission. If you have recurrent painful lumps in your armpits, groin, under the breasts, or in the inner thighs, seeing a dermatologist sooner rather than later makes a meaningful difference in long-term outcomes.
Weight loss, when applicable, reduces friction and inflammation in skin folds and is associated with fewer flare-ups. Smoking cessation also helps: tobacco use is strongly linked to HS severity. Wearing loose clothing, using gentle cleansers, and avoiding shaving in affected areas can reduce mechanical irritation that triggers new lesions. None of these measures cure the disease, but combined with medical treatment, they shift the odds substantially toward longer and more stable periods of remission.