There is no cure for hidradenitis suppurativa (HS), but the outlook is considerably better than most people expect. A community-based study found that nearly 64% of patients eventually reach full remission, defined as no active symptoms for six months or longer. That number is far higher than older hospital-based estimates suggested, meaning the disease course for many people is more favorable than the medical literature historically reported.
Still, remission is not the same as a cure. HS can return, and managing it well usually means finding the right combination of treatments and lifestyle changes for your specific severity level. Here’s what actually works and what’s on the horizon.
What Remission Looks Like
Remission rates depend heavily on how severe the disease is when it’s first identified. Among patients with mild disease, about 74% reach full remission. For moderate cases, that drops to 60%, and for severe cases, roughly 47% still achieve it. These numbers come from patients tracked in community settings rather than hospital specialty clinics, which tend to see the most difficult cases and therefore paint a grimmer picture.
HS is classified using the Hurley staging system. Stage I means you have abscesses (painful lumps) but no tunnels under the skin and no scarring. Stage II involves recurring abscesses with some tunneling and scarring. Stage III is widespread involvement with interconnected tunnels and abscesses across large areas. Your stage at diagnosis shapes which treatments are recommended and how likely remission becomes.
FDA-Approved Medications
For a long time, HS treatment was limited to antibiotics and surgery. That changed in 2015, when adalimumab became the first FDA-approved biologic for the condition. It works by blocking a specific inflammatory protein, and a long-term study showed 52% of patients maintained a meaningful clinical response at week 168 (just over three years).
Secukinumab was approved in 2023, followed by bimekizumab in 2024. Both target a different inflammatory pathway. Bimekizumab has shown particularly strong numbers: in an open-label extension study, 77% of patients achieved at least a 75% reduction in symptoms by week 96, and 44% reached complete clearance. Across all phase 3 biologic trials, though, roughly half of patients hit the standard clinical response benchmark, and about 20% achieve a deeper response. Biologics help many people significantly, but they don’t work for everyone.
Surgical Options
Surgery targets specific problem areas rather than the underlying disease, making it a localized solution rather than a systemic one. Two main approaches exist: excision (cutting out the affected tissue) and unroofing (opening up tunnels and removing their roofs while preserving surrounding skin).
Unroofing has a lower recurrence rate than excision. About 15% of patients who undergo unroofing see their lesions return, compared to 30% after excision. When measured by individual lesions rather than patients, the gap narrows slightly (20% vs. 26%), but unroofing still comes out ahead. Surgery is most useful for persistent, localized flares that don’t respond well to medication alone, and many patients use it alongside ongoing medical treatment.
Laser Treatment for Early-Stage Disease
Laser therapy, particularly the Nd:YAG laser, works by reducing hair follicles and oil glands in affected areas, which lowers the bacterial load that contributes to flares. It’s considered most useful in Stage I and II disease. A typical course involves four sessions spaced two weeks apart.
Results are moderate. In one study of patients with Stage I and II disease, 7 out of 20 showed good improvement and 1 achieved complete response (more than 65% improvement) after four sessions. Ten had a partial response, and two didn’t respond at all. No patients got worse. It’s a reasonable option for early disease but shouldn’t be expected to clear things entirely on its own.
Hormonal and Supplement Approaches
For women with HS, spironolactone (a hormone-blocking medication typically used for other conditions) has shown real benefits. In a study of patients taking an average of 75 mg daily over about seven months, pain scores, inflammatory lesion counts, and overall disease severity all improved significantly. Interestingly, lower doses appeared to work just as well as higher ones, which matters for tolerability since the medication can cause side effects like dizziness and irregular periods.
Zinc supplementation has also been studied, though the evidence is limited to small pilot data. In one study, 22 patients with mostly mild to moderate HS took 90 mg of zinc gluconate daily (providing about 90 mg total, from six 15 mg capsules). When patients achieved a complete response, the dose was tapered to an average of about 3.5 capsules per day as maintenance. This is a preliminary finding, not a proven treatment, but zinc is inexpensive and low-risk enough that some dermatologists recommend it as an add-on.
What’s in the Pipeline
JAK inhibitors are the most closely watched new class of drugs for HS. One called upadacitinib produced striking results in a real-world study: 100% of patients achieved at least a 50% symptom reduction by week 12, and 95% hit the 75% improvement mark. Those results held through week 24. Formal phase 2 trials are underway but haven’t published full results yet.
Another JAK inhibitor, INCB054707, showed dose-dependent improvement in a phase 2 study. At the highest dose tested, 88% of patients achieved a clinical response at week 8, compared to 57% on placebo. Several other compounds targeting different points in the inflammatory cascade are also being tested in randomized trials with hundreds of patients.
The Realistic Outlook
HS remains a chronic condition without a definitive cure, but “chronic” doesn’t have to mean “always active.” The majority of people with mild or moderate disease can expect periods of remission, and the treatment landscape has expanded dramatically in the last decade. Three biologics are now approved where there were none before 2015. Surgical techniques have improved. New drug classes are showing early results that exceed anything currently available.
The practical goal for most people with HS is sustained disease control: fewer flares, less pain, and minimal scarring. For a meaningful percentage of patients, that control eventually becomes full remission lasting months or years. Working with a dermatologist to match your treatment to your specific Hurley stage, adjusting when something isn’t working, and addressing modifiable risk factors like smoking and weight are the most reliable paths to getting there.