Biologics for Hidradenitis suppurativa and why they wont save you

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 Future of Treating Hidradenitis Suppurativa: A Deep Dive into the Science That Can Set You Free

If you’re reading this, you’ve probably felt that familiar wave of frustration. You’ve tried the antibiotics, the creams, maybe even faced the surgeon’s knife, all while wondering: is this it? Is this a life of just managing symptoms, of waiting for the next flare? You deserve more than that. You deserve answers, and more importantly, you deserve hope. That’s why I was so excited to dive into a recent scientific review paper that maps out the present and future of biologic drugs for how to treat hidradenitis suppurativa.

Today, we’re going to walk through this incredible research together. I want to give a heartfelt thank you to the first author, Dr. Amit Garg, and his colleagues for their work in beautifully summarizing the complex world of HS treatments. Their dedication to advancing our understanding of this disease is a gift to every single person battling it. We will explore what the paper actually says about these drugs, their successes and, just as importantly, their limitations. Then, we’ll discuss how these scientific facts can help us understand why a root-cause, natural approach is so critical for lasting relief.

Decoding the Battlefield: What Science Says Is Happening Under Your Skin

For years, many of us were told HS was just a skin problem, blocked pores, bad hygiene, or bad luck. Science now tells us that’s completely wrong. As the paper by Garg et al. affirms, Hidradenitis Suppurativa is a chronic inflammatory disease. The problem isn’t just in your skin; it’s a body-wide issue of immune dysregulation.

Think of your immune system as your body’s army. In a healthy person, this army only attacks foreign invaders like bacteria and viruses. In HS, the army gets confused. It starts sending out powerful inflammatory signals (called cytokines) that confuse all your immune cells. This creates a warzone under your skin, leading to the painful nodules, abscesses, and tunnels we know all too well.

The research summarized in the paper provides a fantastic battle map of this process in Figure 1. It shows the key players that these biologic drugs are designed to target:

• Immune Cells: Macrophages, Th1 cells, Th17 cells, and B cells are the soldiers on the front lines, creating chaos.
• Inflammatory Messengers (Cytokines): These are the signals the soldiers use to communicate. Key ones in HS include TNF-α, IL-17, IL-1, and IL-36. Think of them as alarm bells that are stuck in the “on” position, constantly screaming “ATTACK!”

Figure 1. The Immune Warzone in Hidradenitis Suppurativa and Where New biologics drugs Intervene. This diagram illustrates the complex immune activity happening in the skin of someone with HS. In the skin layers (Epidermis, Dermis, Adipose), the hair follicle becomes a battleground. Figure by Dr. Amit Garg and colleagues.

• The schematic depicts how innate immune cells like Macrophages release pro-inflammatory cytokines such as TNF-α and IL-1α/β. This recruits and activates adaptive immune cells, including Th1 and Th17 cells, which in turn produce more TNF-α and IL-17. B cells, activated via Bruton’s tyrosine kinase (BTK), and keratinocytes, which respond to IL-36, also contribute to the inflammatory cascade.
• Think of this as a chain reaction if different immune cells that all together get a signal to start fighting, but they end up fightin your own tissue….
• Adalimumab (Humira) and Infliximab block the TNF-α signal.
• Secukinumab, Bimekizumab, and Sonelokimab block the IL-17 signal. Bimekizumab is unique because it hits two versions of IL-17 (A and F).
• Lutikizumab targets the IL-1α/β signals.
• Newer drugs like JAK inhibitors (Povorcitinib, Upadacitinib, Ruxolitinib) work inside the immune cells to stop them from receiving and sending these inflammatory messages.
• Spesolimab blocks the IL-36 receptor on skin cells, and Remibrutinib calms down B cells by blocking BTK.

The Conventional Approach: Powerful Shields with Real-World Limitations

The incredible news, as detailed in the review, is that we now have several FDA-approved biologic drugs that can provide significant relief. The paper summarizes the pivotal clinical trials for three main types:

1. TNF-α inhibitors (like Adalimumab/Humira): The first breakthrough drug approved for HS.
2. IL-17A inhibitors (like Secukinumab/Cosentyx): Targets a different, but equally important, inflammatory pathway.
3. IL-17A and IL-17F inhibitors (like Bimekizumab/Bimzelx): The newest player, blocking two different forms of the IL-17 signal.

These drugs are powerful shields. They are invaluable tools, especially for gaining control during a severe flare. However, the paper’s own data highlights three critical challenges that are often understated:

1. They Don’t Work for Everyone. This is the most important takeaway from the trial data. Garg and colleagues state it clearly: “…still roughly half of patients with HS receiving these biologic treatments in phase 3 clinical trials achieve HiSCR50”. So what does that actually mean? HiSCR50 is the scientific benchmark for success in these trials. It stands for “Hidradenitis Suppurativa Clinical Response,” and it’s a strict definition: a patient must have at least a 50% reduction in their total number of abscesses and inflammatory nodules, with no increase in new abscesses or draining tunnels. While achieving this is life-changing, the statistic means that for every person who hit this goal, another person in the study did not.

2. They Can Lose Effectiveness Over Time. The paper points to a key issue with adalimumab: immunogenicity. In simple terms, your body can recognize the drug as a foreign invader and create “antidrug antibodies” (ADAs) against it. This can make the treatment stop working. This is the “tolerance” many of us have experienced or feared. The paper does note that newer IL-17 inhibitors appear to have a much lower risk of this happening, which is a positive step forward.

3. They Come with Side Effects. Suppressing parts of your immune system carries risks. The paper lists the most common side effects from the trials, including headaches and nasopharyngitis. More specifically, it notes that the dual-acting IL-17 inhibitor, bimekizumab, came with a higher rate of oral candidiasis (thrush) compared to placebo.

But clinical data can sometimes feel abstract. The real-world impact of these side effects is what truly matters. These are not just statistics; they are new battles for HS warriors to fight. I recently came across a discussion where people shared their experiences, and their stories are a powerful reminder of this reality.

One person on Cosentyx (an IL-17A inhibitor) shared their difficult trade-off:

“While I’m incredibly grateful for the relief Cosentyx brought to my HS, it has introduced new and serious challenges… By December, after my monthly Cosentyx injection, the yeast overgrowth had spread to my mouth. I felt weak, unwell, and frustrated.”

This isn’t an isolated case. Another person responded, “oh my gosh so I’m not the only one who’s having really annoying yeast infections and monthly impetigo/perioral dermatitis??”

And it’s not just about infections. Dampening one part of the immune system can sometimes cause another part to overreact in a new way. As a third person described:

“I was on it for a little under 6 months and Cosentyx caused me to have an extreme flair of eczema all over my body (which i’ve never had prior to taking the med)… it did absolutely nothing for my HS other than make them oddly tender?”

These stories aren’t meant to scare you, but to empower you. They paint a clear picture of the trade-offs that can come with these powerful medications.

This is the reality of the conventional approach. It provides apowerful but imperfect shield. And this is where the HS Armor philosophy comes in. The data in this paper doesn’t just show us what biologics can do; it illuminates what they can’tdo. When we see that targeting a single cytokine network isn’t a silver bullet, it begs a bigger question: Why is the entire network out of balance in the first place? Answering that question is the key to a natural treatment of HS and achieving lasting remission. We focus on putting out the “fire” (the root causes of inflammation) so the alarm bells stop ringing on their own.

The Hope on the Horizon: A New Wave of Innovation

Perhaps the most exciting part of this review is the glimpse it gives us into the future. Researchers are not stopping. They are developing an entire arsenal of new therapies that target the HS warzone from different angles.

Figure 2: The Clinical Trial Pipeline for Future Hidradenitis Suppurativa Treatments. This chart provides an estimated timeline for when we can expect results from the final phase (Phase 3) of clinical trials for several new HS drugs. Figure by Dr. Amit Garg and colleagues.

• The timeline categorizes investigational therapies by their mechanism of action. It lists the drug name, its clinical trial identifier (NCT number), and the primary endpoint being measured, typically the Hidradenitis Suppurativa Clinical Response (HiSCR) at a specific time point (e.g., week 16). For example, Sonelokimab, an IL-17 inhibitor, is being evaluated for HiSCR75, a more stringent measure than the HiSCR50 used for earlier drugs.
• For my fellow HS warriors: This timeline is a message of hope. Each box represents a potential new tool to fight HS. It shows that scientists are working on multiple fronts at once. The HiSCR50 or HiSCR75 you see is the goal of the study, it means researchers are looking for a 50% or 75% reduction in abscesses and nodules without an increase in draining tunnels. The different categories show the variety of approaches being tested:
  • IL-17 Inhibitors (e.g., Sonelokimab): New and improved ways to block the IL-17 signal.
  • JAK Inhibitors (e.g., Povorcitinib, Upadacitinib): These are daily pills that work inside the immune cells to calm them down from within.
  • IL-36, IL-1α/β, and BTK Inhibitors: These are all brand-new targets, aiming at different parts of the inflammatory chain reaction that we saw in Figure 1.

The emergence of JAK inhibitors is particularly interesting. Unlike biologics, which are large molecules that have to be injected, these are small molecules that can be taken as a pill. They work by getting inside the immune cells and interfering with the JAK pathway, an internal communication system that tells the cell to go into attack mode.

Even more exciting is the research into B-cells. For a long time, we thought HS was mainly a T-cell disease. New evidence shows that B-cells, the cells that make antibodies, may play a huge role, especially in more advanced, scarred disease. Drugs like Remibrutinib are being developed to specifically calm these cells down. This is cutting-edge science and opens up a whole new avenue for treatment.

Key Takeaways: Your Blueprint for Healing

This research is dense, so let’s boil it down to the most important points for your journey:

• HS is a Systemic Disease: Your skin is the messenger, not the source of the problem. True healing must address inflammation throughout your entire body.
• Biologics are Powerful But Imperfect Tools: The scientific literature confirms these drugs have limitations. Efficacy rates are around 50%, they can lose effectiveness, and they carry side effects.
• The Future is Bright: An exciting pipeline of new treatments, including daily pills (JAK inhibitors) and drugs targeting newly discovered pathways (like B-cells), means more options are coming.
• You Hold the Power to Address the Root Cause: The limitations of our best drugs highlight why the HS Armor philosophy is so vital. Through evidence-based nutrition, strategic lifestyle changes, and natural therapies, you can work to restore balance to your immune system, addressing the why behind the inflammation.

Conclusion: From Scientific Knowledge to Personal Power

Reading a paper like this fills me with immense hope. It shows that the world’s top scientists are working tirelessly to find solutions for us. It validates what we’ve been through and proves that HS is the serious, systemic disease we always knew it was.

But knowledge is only potential. Power comes from using that knowledge. The authors of the paper conclude with a vision for the future of HS care that I couldn’t agree with more. They state it perfectly:

“The future of HS treatments lies within a combination of enhanced understanding of molecular mechanisms of HS paired with the appropriate application of available therapies… These efforts should be combined with adequate patient education on the environmental and lifestyle risk factors associated with HS along with sufficient social and psychological support that is critical to optimizing a holistic approach to achieving positive patient-centered outcomes.“

This is it. This is the validation of everything we work on. The experts in the field are calling for a holistic approach that includes patient education on the environmental and lifestyle risk factors and social and psychological support. This is the very foundation of HS Armor community.

While the pharmaceutical world designs better shields, the path to true, lasting remission is found in this HS Armor model, in understanding our triggers, changing our lifestyle, and supporting our bodies and minds. Healing is possible. And it starts with empowering yourself with this knowledge and taking the first step on your own path.

References

Garg, A., Hsiao, J., Porter, M. L., & Shi, V. (2025). Current Treatments and Future Directions for Hidradenitis Suppurativa: a Narrative Review of Completed and Ongoing Phase 3 Clinical Trials of Biologic Therapies. Dermatology and Therapy, 15, 2361–2377. https://doi.org/10.1007/s13555-025-01487-y

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.