Can You Cure HS? Unpacking the Science of Neutrophil “Kamikaze Webs” in Hidradenitis Suppurativa

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.

The Hidden War Under Your Skin: How Immune Traps Drive Hidradenitis Suppurativa

Have you ever looked at a painful, swollen hidradenitis suppurativa lesion and just wondered, what is actually going on in there? Why does it hurt so much? Why does it feel like a battle is being waged deep beneath your skin?

Well, that’s because it is.

A fascinating new research review published in Cell Death Discovery has shed more light on one of the key soldiers in this battle: a type of white blood cell called a neutrophil (1). And it turns out, in hidradenitis suppurativa, these cells are deploying a weapon that does more harm than good, creating a cycle of endless inflammation. Understanding this process is a critical step in learning how to treat hidradenitis suppurativa at its root, rather than just chasing symptoms. Let’s break down what these scientists found and, more importantly, what it means for your healing journey.

The Immune System’s “Kamikaze Webs”

First, let’s talk about neutrophils. Think of them as your immune system’s first responders. When they sense danger, like an invading bacteria, their job is to rush to the scene and neutralize the threat. They have several ways of doing this, but one of the most dramatic is a process called NETosis.

Essentially, the neutrophil commits cellular suicide. It explodes, casting out a sticky, web-like structure made of its own DNA. These are called Neutrophil Extracellular Traps, or NETs.

Think of them as kamikaze webs. They are designed to trap and kill pathogens. In a healthy immune response, this is a brilliant and effective strategy.

But what happens when this system goes haywire? What if your neutrophils are over-active, trigger-happy, and start throwing these destructive webs everywhere for the wrong reasons? The result is autoinflammation. The NETs don’t just trap microbes; they damage your own healthy tissue, creating a mess that signals more immune cells to the area, pouring gasoline on the inflammatory fire.

What Scientists Found in Hidradenitis Suppurativa Lesions

This is where the research gets personal for us. Scientists have now confirmed the prominent presence of these NETs right inside hidradenitis suppurativa lesions (1).

Here’s what they discovered:

• NETs are abundant in HS skin: The tunnels and abscesses that are hallmarks of HS are filled with these inflammatory webs.
• More NETs = More Severe Disease: The researchers found that the amount of NETs directly correlated with the severity of a person’s HS. This suggests these webs are a key driver of the disease process.
• HS Blood is Primed for Attack: It’s not just happening in the skin. Neutrophils circulating in the blood of HS patients were found to be in a state of high alert, more likely to spontaneously form NETs compared to neutrophils from healthy individuals. This confirms what so many of us feel, HS is a systemic, whole-body issue, not just a “skin problem.”
• The Link to Tunnels: Most compellingly, the study highlights that the increased formation of NETs was directly associated with the formation of tunnels, or sinus tracts (1). These destructive webs are literally helping to carve out those painful, persistent tunnels under the skin.

This research gives us a powerful validation. That deep, burning inflammation you feel? You’re not imagining it. It’s the very real result of your immune system getting the wrong signals and deploying these destructive NETs against your own body.

A Picture of Inflammation: Decoding the Science

But how do these neutrophils even get to the skin in the first place? Think of your blood vessels as highways. When the body sends out a distress signal (inflammation!), these neutrophils, which are normally just cruising along, get the message. They pull over, squeeze through the walls of the blood vessel, a process called extravasation, and travel into the surrounding tissue to find the source of the trouble. The figure below shows what happens next, once they’ve arrived at the scene.

Figure 1 Legend: Deconstructing the “Kamikaze Web” Attack in Hidradenitis Suppurativa. This image maps out the sequence of events, from the initial alarm to the final destructive act of a neutrophil creating a NET. Let’s walk through the key players and actions:

1. The Journey and the Trigger: First, a neutrophil travels from a blood vessel into the skin tissue, drawn in by inflammatory signals. Once there, a Stimulus (like bacterial debris or chronic inflammatory signals common in HS) activates it.
2. Sounding the Internal Alarm: This trigger sets off a chain reaction inside the cell.
   • NADPH oxidase is an enzyme that gets switched on, acting like the first domino.
   • This generates ROS (Reactive Oxygen Species), which are highly reactive molecules. Think of ROS as sparks that start the fire inside the cell. They are a sign of oxidative stress.
   • These sparks activate another key enzyme, PAD4.
3. Preparing the Web: The PAD4 enzyme enters the neutrophil’s nucleus (its control center) and starts to unravel its DNA. At the same time, the ROS signals cause the cell’s internal weapon caches—called granules—to break down, releasing their contents. These weapons include:
   • MPO (Myeloperoxidase): A powerful enzyme that helps create bleach-like substances to kill pathogens but also causes significant tissue damage.
   • NE (Neutrophil Elastase): An enzyme that acts like molecular scissors, chopping up proteins of both microbes and our own tissues.
   • LL-37: An antimicrobial peptide that kills bacteria but can also act as a danger signal to other immune cells, amplifying inflammation.
4. NETosis – The Final Act: All these components, the unraveled DNA, MPO, NE, and LL-37, mix together into a toxic, sticky mess. The neutrophil’s outer membrane then ruptures, and this entire inflammatory web is violently ejected from the cell. This explosive cell death process is called NETosis.
5. The Aftermath: This kamikaze web is now in your skin tissue, trapping some bacteria but also causing immense collateral damage, fueling the pain and inflammation of an HS lesion and contributing to tunnel formation.

This detailed breakdown shows just how complex and violent this process is. It’s not just a simple immune response; it’s a destructive cascade that, once started, is hard to stop.

The Critical Question: Why is This Happening?

First, I want to sincerely thank the researchers for this work. They have beautifully illustrated what is happening at a cellular level. But this is where we must apply our own critical lens and identify the knowledge gap.

The paper shows the weapon (NETs) and the soldier (neutrophils). But it doesn’t focus on the most important question: Who is giving the order to attack?

This is the fundamental difference between the conventional approach and the philosophy we practice at HS Armor.

• The Conventional Approach: Focuses on disarming the soldier or cleaning up the battlefield. This is what biologic drugs and antibiotics do. They try to block the inflammatory signals or suppress the immune cells. This can provide a powerful, temporary shield and is sometimes necessary, but it doesn’t stop the bad orders from being sent. It’s why symptoms often return when the medication is stopped.
• The HS Armor Philosophy: We focus on stopping the bad orders at their source. We ask, “What is the stimulus that’s making our immune system so panicked and trigger-happy in the first place?” Our mission is to identify and remove those triggers.

We believe that the natural treatment of HS is the foundational treatment. We focus on highly effective evidence-based nutrition and lifestyle change, and natural therapies and practices. This is how you achieve a deep, lasting remission. This is how you teach your immune system to be calm again, so it doesn’t feel the need to launch these kamikaze webs.

Key Takeaways

For those of you skimming, here are the most important things to know:

• HS is a War, Not a Blemish: Scientists have found that a type of immune cell called a neutrophil releases destructive, web-like traps (NETs) inside HS lesions.
• NETs Drive Severity and Tunnels: These inflammatory webs are directly linked to more severe disease and the formation of painful tunnels under the skin.
• It’s a Systemic Issue: The problem isn’t just in your skin. The immune cells in the blood of HS patients are on “high alert,” ready to create NETs.
• Focus on the Why: True healing comes from addressing the root cause, the triggers that are telling your immune system to attack in the first place. This is the key to a successful natural treatment of HS.

You Can Stop the War

Seeing the science behind our suffering can be incredibly empowering. Your pain is real, it’s biologically driven, and it’s not your fault. But it’s also not a life sentence. This research shows us a clear mechanism of damage, and when we understand a mechanism, we can learn how to interrupt it.

The question, “Can you cure HS?” is complex, but what I know for sure is that you can achieve a state of deep, lasting, and complete remission. You can stop the war. You can build your own HS Armor, layer by layer, until your body finds its way back to peace and balance.

References

1. Li, S., Ying, S., Wang, Y., Lv, Y., Qiao, J., & Fang, H. (2024). Neutrophil extracellular traps and neutrophilic dermatosis: an update review. Cell Death Discovery, 10(1), 18. https://doi.org/10.1038/s41420-023-01787-2

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.