Pediatric HS & Biologics: Hope or Heartbreak? A Scientist’s Perspective on New Data

My name is Jaap, and I am a biomedical scientist that also used to live with severe Hidradenitis Suppurativa, the kind that takes over your life. Today, I am completely asymptomatic because I learned how to heal Hidradenitis Suppurativa from within. More importantly, I’ve had the privilege of helping many other individuals with HS get their lives back, too.

Introduction: The Weight of Treating Our Youngest

There are certain topics in the Hidradenitis Suppurativa (HS) world that hit differently, carrying an extra weight of concern. The idea of children and adolescents facing this relentless disease is certainly one of them. Thinking about young people starting powerful medications like biologics stirs up a complex mix of hope and apprehension. Hope, because we desperately want relief for anyone suffering, especially the young. Apprehension, because we instinctively question the long-term implications of suppressing symptoms so early in life.

Recently, a new case series published by Dr. Gilberto Pires da Rosa and colleagues from Portugal shed some light on the real-world use of biologics in pediatric-onset Hidradenitis Suppurativa [1]. It’s a valuable contribution, adding data to an area where research is still limited. First, a sincere thank you to these researchers for documenting and sharing these cases. Today, we’re going to respectfully dive into their findings, explore what they mean for young patients and their families, and discuss why this research, perhaps unintentionally, makes a powerful case for the natural treatment of hidradenitis suppurativa, focusing on the root cause, especially when we have the chance to intervene early.

What Did the Study Investigate? A Look at Biologics in Young HS Patients

The researchers conducted a retrospective analysis, meaning they looked back at the records of patients diagnosed with HS before the age of 18 at their university hospital. They specifically focused on 12 patients who had started their first biologic medication before reaching adulthood.

These weren’t mild cases. At the time of diagnosis, a significant majority (67%) were already classified as Hurley Stage III, the most severe stage, with another 25% at Stage II. This immediately tells us something crucial: many of these young people were already dealing with advanced disease by their teenage years.

Key Findings: A Snapshot of the Patients and Biologic Outcomes

The study provides valuable real-world data on the characteristics of these young patients and how biologic treatments performed. Here’s a summary of the key points:

• Patient Profile:
  • Age & Diagnosis: Median age at diagnosis was 16, but the median time from symptom onset was 27 months, meaning symptoms often started much earlier.
  • Comorbidities: A striking 83% (10 out of 12) were overweight or obese. Severe acne (42%) and pilonidal sinus (33%) were also common, highlighting the systemic nature of HS even in youth.
  • Affected Locations: The groin (100%) and armpits (83%) were most common, followed by the perineal area (58%).
  • Previous Treatments Failed: All 12 patients had already tried oral antibiotics without success. Many had also tried contraceptive pills (females), oral retinoids, and Dapsone.

• Biologic Treatment Journey:
  • Adalimumab (Humira) First: All 12 patients started with adalimumab, typically around age 16.5 (some as young as 11).
  • Mixed Efficacy: Adalimumab showed primary failure (didn’t work) in 17% and secondary failure (stopped working) in 50% after about 2 years. Only 33% maintained efficacy long-term. Increasing the dose didn’t help those who failed.
  • Other Biologics Used: Ustekinumab, infliximab, and secukinumab were used in smaller numbers, often after adalimumab failed, with varying success. Patients used an average of 2 different biologics.
  • Adjunct Therapies Needed: Despite being on biologics, 83% still required HS-related surgery and 83% needed intermittent oral antibiotics. Corticosteroids (33%) and oral retinoids (25%) were also used concurrently.
  • Overall Control Limited: Only 42% achieved “controlled disease” (severe to mild). 33% had partial control (severe to moderate), and 25% remained uncontrolled despite biologic therapy.

Patient Takeaway from these Findings: This data paints a picture of young people already dealing with severe, widespread HS and related health issues, often after a significant diagnostic delay. The high rate of obesity points towards underlying metabolic dysfunction. While biologics can help, efficacy is far from guaranteed, many experience treatment failure, and the high need for ongoing surgeries and antibiotics underscores that biologics often suppress symptoms rather than resolving the root cause. They are a shield, not a cure.

A Moment of Reflection: Early Symptom Suppression

Seeing this data laid out, young people, already facing severe HS, cycling through powerful immune-suppressing drugs, still needing surgery, it’s impossible not to feel a pain of sadness. It’s fantastic that medicine offers tools that can provide relief, and for some, these biologics are truly life-changing shields. We should absolutely be grateful for that progress.

But here’s where my heart aches, both as a scientist and as someone who found a different path to healing. These are children and teenagers. Their bodies are still developing. We know HS is driven by systemic inflammation, often linked to metabolic issues (that stunning 83% obesity rate!) and lifestyle factors. Is the first-line approach truly to start them on lifelong medication designed to silence the immune system’s alarm bells, without an aggressive, simultaneous focus on putting out the underlying fire?

What happens ten, twenty, or fifty years down the line for an individual who starts suppressing their immune system at age 11 or 13? The study shows a median follow-up of 6 years, but HS is a lifelong condition. We’re potentially committing these young people to decades of medication, with the known risks of side effects, infections, and the possibility of the drug losing effectiveness. I just cant believe how academia and medicine in approaching this……..

It feels like a missed opportunity. Adolescence and young adulthood are critical windows to instill foundational health habits, to address the diet, the stress, the gut health – the very factors that fuel the inflammatory fire. By focusing primarily on the pharmaceutical shield, are we inadvertently neglecting the chance to teach them how to rebuild the castle from within? It’s a profound thought, and one that weighs heavily on me as I see the direction conventional treatment often takes.

The Critical Question: Are We Missing the Forest for the Trees? (The Knowledge Gap)

This brings us to the crucial knowledge gap that plagues so much of conventional HS care. The researchers rightfully point out the significant diagnostic delay (a median of 27 months, with most already at severe stages by diagnosis) and the high prevalence of obesity. They even mention the need for earlier recognition to facilitate timely access to therapies.

But which therapies? The underlying assumption in much of the medical literature, and reflected in this study’s focus, is that therapy primarily means drugs and surgery. While the paper acknowledges obesity, there’s no deep dive into why it’s so prevalent or aggressive strategies to address it as a primary treatment lever.

This is the classic Fire and Smoke Alarm scenario. Conventional medicine excels at developing sophisticated tools (biologics) to cut the wires to the smoke alarm (the painful lesions, the inflammation markers). They provide temporary relief from the noise. But they invest far less energy in finding the source of the fire (the metabolic dysfunction, the dietary triggers, the gut dysbiosis, the chronic stress) and teaching patients how to put it out.

The fact that 83% of these young patients on biologics still needed antibiotics and surgery is not a failure of the biologics themselves; it’s evidence that the underlying fire was still burning strong. The study comparing the biologic group to pediatric patients who didn’t need biologics found the biologic group had significantly higher Hurley scores at diagnosis and more perineal involvement. This suggests the fire was simply burning hotter in these individuals from the start, making the need to address the source even more critical, not less.

A Different Path: Focusing on the Fire, Not Just the Alarm (The HS Armor Philosophy)

This is where the HS Armor philosophy offers a fundamentally different, and I believe more hopeful, path, especially for young people. We reverse the conventional model.

At HS Armor, we see highly effective evidence-based nutrition and lifestyle change, and natural therapies and practices not as optional add-ons, but as the foundation of healing. Pharmaceuticals like biologics are viewed as powerful, temporary shields, sometimes absolutely necessary to control a raging fire and prevent irreversible damage, but they are not the long-term solution.

Our goal is to systematically identify and remove the triggers fueling the inflammatory fire. This involves:

1. Foundational Nutrition: Addressing the metabolic dysfunction highlighted by the study’s obesity findings. Identifying personal trigger foods and nourishing the body to calm inflammation.
2. Strategic Lifestyle Changes: Implementing science-backed strategies for stress management, sleep optimization, and appropriate movement.
3. Natural Therapies & Skincare: Using targeted natural compounds and skincare to support immune balance and skin healing.
4. Accountability & Support: Providing the guidance and community needed to make lasting changes.
5. Targeted Medical Testing: Using specific tests to uncover hidden hurdles like gut imbalances or nutrient deficiencies.

The aim is to build such a strong foundation of health that the fire goes out, making the smoke alarms unnecessary. We strive to create an internal environment where the immune system is calm and balanced, reducing or potentially eliminating the need for lifelong reliance on immune-suppressing shields. For a child or adolescent, catching the disease early and focusing on these foundational principles offers the incredible potential to change the entire trajectory of their life with HS.

Key Takeaways

• Biologics in Pediatric HS: This study confirms biologics are used in severe pediatric-onset HS, but failure rates are significant.
• Adjunct Therapies Common: Most young patients on biologics still required additional treatments like surgery and antibiotics, indicating symptom suppression, not root cause resolution.
• Severe Disease & Delay: Many children already have severe HS by diagnosis, often after a significant delay.
• Metabolic Link is Clear: High rates of overweight/obesity underscore the critical link between HS and metabolic health, demanding a lifestyle-focused approach.
• The Foundational Path: True, lasting remission, especially when starting young, requires addressing the root causes of inflammation through nutrition, lifestyle, and natural therapies.

Conclusion: Choosing the Path Forward for Our Youngest Warriors

This research from Dr. Rosa and colleagues provides valuable insights into the current landscape of biologic use for pediatric-onset HS. It confirms that these drugs can offer help but are far from a perfect solution, with significant failure rates and a continued need for other interventions.

More profoundly, the study’s data, the high severity at diagnosis, the long delays, the stark prevalence of obesity, screams for a shift in approach. It highlights the tragic missed opportunity of those early years. Instead of waiting for the disease to become severe and then deploying powerful immune suppressants, what if we aggressively focused on identifying and extinguishing the inflammatory fire from the moment the first smoke alarm sounds?

Can you cure HS? We know that achieving deep, sustainable remission is absolutely possible. For children and adolescents, the potential to establish lifelong health habits that address the root cause of HS is immense. It’s not about rejecting medicine; it’s about putting it in its proper context. Biologics can be a crucial shield, but the true path to a life free from the grip of HS lies in rebuilding the foundation from within. Let’s give our youngest generation the knowledge, tools, and support to put out the fire, and prevent the damage from happening in the first place.

Reference

[1] Rosa, G. P. da, Magina, S., Lisboa, C., Azevedo, F., Mota, A., & Cruz, M. J. (2025). Use of biologics in pediatric-onset hidradenitis suppurativa: a case series. Anais Brasileiros de Dermatologia, 100(5). Advance online publication. https://doi.org/10.1016/j.abd.2025.501188

Important Medical Disclaimer

1. Not Medical Advice: All content and information on this website is for informational and educational purposes only. It does not constitute medical advice and is not a substitute for professional diagnosis, treatment, or consultation with a qualified healthcare provider.

2. My Role and Qualifications: I am a biomedical scientist and PhD candidate and share information from that perspective, combined with my personal experience as a patient with Hidradenitis Suppurativa. However, I am not a medical doctor, physician, or registered healthcare professional. Do not consider our relationship a doctor-patient relationship.

3. Consult Your Doctor: Always seek the advice of your medical doctor or another qualified health professional with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. If you suspect you are experiencing a medical emergency, or a severe infection, do not rely on this website or the HS Armor community, please call your local emergency services or go to the nearest emergency room immediately.

4. A Critical Warning on Medication: Pharmaceutical drugs are a crucial tool in managing Hidradenitis Suppurativa for many people. Under absolutely no circumstances should you ever alter, reduce, or stop taking your prescribed medication without the explicit direction of the doctor who prescribed it. Doing so can be dangerous. Always consult with your doctor before doing anything related to your treatment plan.

5. No Liability: Your use of this website and reliance on any information provided is solely at your own risk.

6. Individual Results May Vary: Every patient’s biological baseline, genetics, and adherence to the protocol is different. Therefore, I cannot guarantee specific results, cures, or timelines for your Hidradenitis Suppurativa.

7. Scientific and Expressive Freedom: The articles published on this blog are distinct from formal peer-reviewed academic literature. They serve as an independent platform for my personal viewpoints, scientific hypotheses, and philosophical reflections as an independent scientist and HS patient. While grounded in biomedical research, I exercise a degree of expressive freedom to translate rigid academic data into insights from a patient perspective. These writings are my personal meditations on the science of HS and should be read as my individual perspective, not as universally accepted clinical consensus or formal peer-reviewed literature.