Adalimumab & Infection Risk: Why Hidradenitis Suppurativa Patients Face a Higher risk (and How to Fight Back Naturally)

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 Double-Edged Sword of HS Treatment

Living with Hidradenitis Suppurativa (HS) often feels like navigating a minefield. The pain, the unpredictable flares, the search for relief… it’s exhausting. And when powerful medications like biologics enter the picture, a new layer of concern often arises: the risk of infection. If you’re taking a drug like adalimumab (Humira) or considering it as part of your hidradenitis suppurativa treatment plan, you’ve likely wondered about this potential side effect. It’s a valid concern, often adding a layer of anxiety to an already challenging journey.

For years, much of the guidance on infection risk with biologics has been borrowed from research on other conditions, primarily psoriasis. But as we know deep in our bones, what is hidradenitis suppurativa? It’s not just psoriasis in different locations. It feels different, behaves differently, and, as emerging science confirms, it impacts our bodies differently.

A recent study tackles this head-on, directly comparing the risk of serious infection in HS patients taking adalimumab versus psoriasis patients on the same drug¹. First, a sincere thank you to the lead author, Dr. Bruna Galvao de Oliveira Wafae, and her colleagues for this important work published in JAMA Dermatology. Their research gives us valuable data, but more importantly, it offers clues that reinforce a crucial truth: addressing the root cause of HS is paramount, not just for managing flares, but potentially for managing overall health risks as well. Let’s unpack what they found and what it means for our path to healing.

The Study

The researchers used a large US claims database (MarketScan) to look back at the experiences of thousands of adults who started adalimumab between 2017 and 2020. They identified over 10,000 patients: about 1,650 with HS and nearly 8,700 with psoriasis. Their primary goal was clear: to compare the risk of being hospitalized for a serious, non-cutaneous infection (meaning infections not involving the skin, like pneumonia, sepsis, or urinary tract infections) between these two groups, while trying to account for other differences like age, sex, and comorbidities. They specifically excluded skin infections to avoid confusing an HS flare with a true infection, a smart move that acknowledges the complexities we live with.

The Findings: A Higher Burden for Hidradenitis Suppurativa Patients

The results were statistically significant and confirmed what many of us might have suspected based on our lived experience:

• Increased Risk of Serious Infection: Even after using statistical methods (inverse probability weighting) to balance out differences between the groups, individuals with HS had a 53% higher risk (Hazard Ratio of 1.53) of being hospitalized for a serious non-cutaneous infection compared to those with psoriasis, while using the same medication, adalimumab.
• Different Infection Profiles: The types of serious infections also differed. While lower respiratory tract infections were common in both groups, HS patients were twice as likely to develop sepsis (a life-threatening reaction to infection) and more than twice as likely to experience serious genitourinary infections (like kidney or severe bladder infections) compared to the psoriasis group.
• Potentially Longer Hospital Stays: Although the average number of days spent in the hospital was similar between the groups initially, a more detailed statistical model suggested that HS patients had 28% greater odds of experiencing a longer hospital stay once admitted for an infection, even after adjusting for age, sex, and overall health status.

What Does This Mean? Beyond the Drug, It’s About the Disease

Adalimumab is a TNF-alpha inhibitor; it works by suppressing a key inflammatory signal. Suppressing parts of the immune system inherently carries an increased risk of infection, that’s the trade-off for reducing the inflammatory symptoms of diseases like HS and psoriasis. This is why we, at HS Armor, often refer to these drugs as powerful, sometimes necessary, temporary shields. They block the smoke alarm (TNF-alpha), providing relief, but they don’t extinguish the underlying fire (the root cause inflammation).

However, this study tells a more nuanced story. It shows that even when using the same shield, individuals with HS seem to be more vulnerable to serious infections than those with psoriasis¹¹. This strongly suggests that the hidradenitis suppurativa causes and its underlying nature play a significant role. HS isn’t just skin deep; it’s a profound state of systemic immune dysregulation and chronic inflammation. This internal “fire” might simply be more intense or widespread in HS compared to psoriasis.

Emerging research supports this idea. Studies suggest that HS patients may have a higher baseline risk of infections even before starting immunomodulatory therapies, possibly due to factors like chronic skin barrier disruption, altered immune cell function, and the systemic inflammatory burden itself. Think about it: our skin, particularly in affected areas like the hidradenitis suppurativa groin or hidradenitis suppurativa armpit, is often compromised with tunnels and inflammation even between flares. This chronic state might create vulnerabilities that aren’t present to the same degree in plaque psoriasis. The higher rates of sepsis found in this study are particularly concerning, although correctly diagnosing sepsis in HS can be tricky, as severe flares sometimes mimic its symptoms. Nonetheless, it points towards a deeper immune vulnerability.

So, while adalimumab (the shield) certainly contributes to infection risk, the intensity and nature of the underlying HS fire likely explains the difference in risk observed between the two groups. Silencing one alarm (TNF-alpha) might not be enough when the whole house is smoldering more intensely.

The “Knowledge Gap”: Focusing Downstream, Missing Upstream

This research is incredibly valuable, providing data that can help doctors and patients make more informed decisions about hidradenitis suppurativa medication. But it also perfectly illustrates the “knowledge gap” inherent in the conventional medical approach.

The paper concludes by highlighting the need for future research into disease severity, treatment regimens, and prevention strategies. This is absolutely correct. However, the conventional interpretation often stops there: acknowledging the risk and perhaps adjusting medication or monitoring more closely. This is a downstream focus, dealing with the consequences after the fire has already started and the shield has been deployed.

Where is the deep, actionable guidance on the upstream factors? How do we reduce the intensity of the underlying inflammatory fire itself? The study notes differences in comorbidities like obesity between the HS and psoriasis groups, adjusting for them statistically. But it doesn’t delve into how addressing these root-cause factors before or alongside medication could potentially change the entire risk equation. Could improving metabolic health, optimizing diet (specific hidradenitis suppurativa diet), managing stress, sleep, etc., not only reduce HS symptoms but also lower the baseline infection risk, making biologics treatments safer?

This is the crucial question often missing from the conversation. The focus remains on managing the smoke alarm and optimizing the shield, rather than fundamentally trying to put out the fire.

The HS Armor Philosophy: Putting Out the Fire First

This research, while focused on pharmaceutical risks, provides powerful indirect support for the HS Armor philosophy. If HS inherently carries a higher risk profile due to deeper systemic inflammation, then the most logical and effective long-term strategy is to address that inflammation at its source.

Our approach flips the conventional model:

• Foundation First: We focus on highly effective evidence-based nutrition and lifestyle changes, and natural therapies and practices to address the root causes of inflammation. This is about putting out the fire.
• Shields as Tools: We view powerful medications like adalimumab as temporary shields, incredibly valuable for controlling severe symptoms and preventing damage while the foundational work is being done.
• The Goal: Lasting Remission: The ultimate aim is to build such a strong foundation of health that the fire dies down, the smoke alarms fall silent, and the need for powerful shields diminishes or disappears entirely.

By systematically reducing your body’s inflammatory burden through our 5 layers

(Foundational Nutrition, Strategic Lifestyle Changes, Natural Therapies & Skincare, Accountability & Support, Targeted Medical Testing).

You are not just working towards clearer skin. You are potentially making your entire system more resilient, possibly reducing your baseline infection risk, and creating a healthier internal environment overall. This holistic approach recognizes that you cannot separate the skin from the rest of the body, nor the treatment from the underlying disease state.

Key Takeaways

• HS Increases Infection Risk on Adalimumab: This study confirms that HS patients taking adalimumab face a significantly higher risk of serious non-skin infections (especially sepsis and GU infections) compared to psoriasis patients on the same drug.
• It’s Not Just the Drug: The difference in risk strongly suggests that the underlying systemic inflammation and immune dysregulation of HS itself contribute significantly to this vulnerability. HS likely represents a more intense internal fire.
• Conventional Approach is Downstream: Focusing solely on managing drug risks misses the opportunity to address the upstream, root causes of inflammation that drive both HS and potentially increase infection susceptibility.
• Put Out the Fire: A foundational, natural approach aimed at reducing systemic inflammation through diet, lifestyle, and natural therapies offers a path not just to HS remission, but potentially to a more resilient immune system overall.

Conclusion: Hope Through Understanding and Action

This research might initially sound alarming, confirming a risk many of us feared. But I see it differently. I see it as empowering knowledge. It validates our experience that HS is a unique and challenging condition. It underscores the importance of vigilance regarding infections if you are on biologic therapy. But most importantly, it highlights the critical need to look beyond symptom management.

The question “Can hidradenitis suppurativa kill you?” is complex, but studies linking HS to increased mortality often point towards complications arising from chronic inflammation, including potentially infections and cardiovascular issues. This makes addressing the root cause even more vital.

While there might not be a single permanent cure for hidradenitis suppurativa in the conventional sense, achieving deep, lasting remission is possible. This research reinforces that the most effective path involves tackling the underlying systemic inflammation (the fire) not just managing the smoke alarms. By building your HS Armor, you are not just aiming for clearer skin; you are investing in your overall health and resilience. You are taking back control. And that is where true healing begins.

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References:

1. Wafae, B. G. O., Charrow, A. P., Stein, D., Barbieri, J. S., & Noe, M. H. (2025). Risk of Serious Infection With Adalimumab in Hidradenitis Suppurativa Compared With Psoriasis. JAMA Dermatology. Published online August 20, 2025. https://jamanetwork.com/journals/jamadermatology/fullarticle/2837975

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.