Emergency Room Detective Work: What Doctors Are Learning from Children with Hidradenitis Suppurativa

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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.

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Have you ever sat in a doctor’s office, holding a new prescription for an antibiotic or a steroid cream, and had this sinking feeling that they were missing the point?

You try to explain that it’s not just the flares. It’s the fatigue. It’s the joint pain. It’s the digestive issues. It’s the feeling that your entire body is somehow… wrong. But so often, the focus snaps right back to the skin. “Let’s try this pharamceutical,” “Let’s increase this dose.”

It’s frustrating, and it leaves you feeling unheard. It makes you ask, “If these treatments work, why do I keep flaring? Why isn’t this getting better?”

What if the answer is that we’ve been looking in the wrong place? What if HS isn’t a skin disease at all, but a systemic disease that just shows up in our skin?

This is the key to understanding how to treat Hidradenitis Suppurativa for good. And excitingly, a new scientific study, while focused on children, just gave us one of the clearest maps to the root cause I’ve ever seen. This science is our blueprint for a natural treatment of HS that actually works.

HS Doesn’t Travel Alone: The “Detective Story” in the Data

First, I want to extend a huge thank you to Dr. Rahwa Hailemichael and her colleagues at Northwestern University’s Feinberg School of Medicine. Their recent paper in Pediatric Dermatology is a brilliant piece of scientific detective work.

Here’s what they did: They looked at a massive nationwide database of emergency department visits over 13 years (2006-2019). They identified all the pediatric patients (under 18) who came in with a diagnosis of Hidradenitis Suppurativa. Then, they looked for “accomplices”—what other conditions were these kids with HS dramatically more likely to have compared to kids without it?

Why does a study on kids matter for us adults? Because it shows us what this disease looks like from its earliest stages. It blows away all the “noise” and shows us the core connections.

And what they found is staggering. It confirms what so many of us in the HS Armor community have felt for years: HS is a whole-body problem.

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Clue #1: The Inflammatory “Family”

The first clue was that kids with HS were far more likely to have other inflammatory skin conditions.

• Psoriasis: 4.68 times more likely
• Acne: 10.44 times more likely
• Pilonidal Cyst: 4.59 times more likely
• Pyoderma Gangrenosum (a rare, ulcerative skin condition): A massive 52.64 times more likely ⁹⁹⁹
• Atopic Dermatitis (Eczema): 2.07 times more likely

This isn’t a coincidence. This tells us the “soil” (our internal environment) is the problem, not just the “plant” (the flare).

Think of your body as a neighborhood where all the house alarms are hyper-sensitive. In one house, the alarm looks like psoriasis. In our house, it’s HS. The study also found that kids with HS were significantly more likely to have other systemic inflammatory diseases, like:

• Crohn’s Disease: 5.04 times more likely
• Rheumatoid Arthritis (RA): 2.38 times more likely
• Systemic Lupus Erythematosus (SLE): 2.95 times more likely

This proves, in black and white, that HS is part of a family of inflammatory diseases. The root isn’t just a follicular occlusion; it’s a body-wide inflammatory shouting match. Understanding this is the first step, but it’s the next clue that changes the entire game.

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Why Your Metabolism Might Be the Master Switch

This is the part of the study that made me stop and read it three times. The strongest connections they found weren’t to other skin diseases. They were to metabolic disorders.

Let this sink in. Compared to kids without HS, pediatric HS patients in the ER were:

• 17.98 times more likely to have Metabolic Syndrome
• 8.90 times more likely to have Obesity
• 8.21 times more likely to have Polycystic Ovary Syndrome (PCOS)
• 9.33 times more likely to have Obstructive Sleep Apnea (OSA)
• 5.24 times more likely to have High Cholesterol
• 1.83 times more likely to have Type 1 Diabetes

This isn’t a small clue. This is the culprit, holding the smoking gun.

The researchers themselves conclude, “These findings suggest metabolic dysregulation may drive HS development“.

This is fantastic news. Why? Because we can’t easily change our genes. But we absolutely can change our metabolism.

This is the why. This is the root. This is the target we’ve been looking for.

So, How Does Metabolism “Drive” HS?

The study shows us the what, but other research helps us understand the how. The common thread linking metabolic syndrome, obesity, PCOS, and high cholesterol is almost always insulin resistance.

Here’s the analogy I use with my clients:

1. Think of insulin as a key. Its job is to unlock your body’s cells to let sugar (energy) inside.
2. In insulin resistance, your cell locks get rusty. They stop hearing the key.
3. Your body, sensing the cells are starving, panics. It shouts by pumping out more and more insulin. You end up with a flood of keys.

This flood of insulin is a disaster for HS. Research shows this high level of insulin acts like a growth signal for your skin cells (keratinocytes), encouraging them to overgrow and helping to plug the hair follicle, the very start of an HS lesion [2].

At the same time, this entire state of metabolic chaos pours gasoline on that inflammatory shouting match we talked about, keeping your whole immune system on high alert [3].

This is the engine of the disease for so many of us. And it’s happening right under the surface.

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The “Knowledge Gap”: Why Weren’t We Told This?

So, let me ask you again: Did your dermatologist sit you down and create a comprehensive plan to reverse your insulin resistance? Did they order a fasting insulin test (not just glucose) or an HOMA-IR to see what your metabolism is actually doing? Did they connect you with a nutritionist to create a detailed blueprint for healing?

I’m guessing not.

And this is the Knowledge Gap that keeps so many HS patients trapped in a cycle of flares and frustration.

Conventional medicine is incredible at managing “downstream” problems. It sees the fire (your flare) and hands you a fire extinguisher (antibiotics, steroids, or biologics like TNF-alpha inhibitors). These tools can be powerful, necessary “temporary shields” to get you out of a crisis.

But they do nothing to stop the upstream problem: the metabolic fire-starter in your body’s basement. They are treating the symptom (the skin), not the system (your metabolism).

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How to Treat Hidradenitis Suppurativa: Building Your Foundation

This new study from Dr. Hailemichael and colleagues isn’t just data; it’s a target. It’s all the validation we need to shift our focus.

This is the entire philosophy at HS Armor. We don’t just hand you a better shield. We teach you how to put out the fire at its source. We use highly effective, evidence-based nutrition and lifestyle changes to address the root cause.

This science directly explains why our 5-Layer approach is so effective for lasting remission:

1. Foundational Nutrition: This isn’t a generic “HS diet.” This is precision nutrition designed to reverse insulin resistance and calm inflammation.
2. Strategic Lifestyle Changes: This means tackling the other metabolic disruptors. It means optimizing your sleep (remember that 9.33x link to sleep apnea?) and managing stress, which spikes your inflammatory and insulin-related hormones.
3. Natural Therapies & Skincare: Using targeted, evidence-based supplements and topicals that support metabolic health and calm the skin from within.
4. Targeted Medical Testing: Finally getting the right tests. We empower you to ask for the right labs, like fasting insulin, HOMA-IR, and a full thyroid panel, so you can see your upstream blueprint clearly.
5. Accountability & Support: Doing this with a community that gets it.

Understanding this science gives you the power to see your body differently. Your flares aren’t random. They are signals. They are messengers telling you to look deeper, to look at your metabolism.

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Key Takeaways

• A new study in Pediatric Dermatology confirms that HS, even in children, is a systemic disease, not just a skin-deep problem.
• HS is strongly linked to a family of other inflammatory conditions like Crohn’s, RA, and psoriasis, showing a common root of body-wide inflammation.
• The strongest link found was to metabolic dysregulation, patients were almost 18 times more likely to have metabolic syndrome.
• This metabolic mayhem, likely driven by insulin resistance, may be a primary driver of HS by clogging follicles and fueling systemic inflammation.
• This discovery empowers us. A natural treatment of HS must focus on the “upstream” root cause: healing your metabolism through foundational nutrition and lifestyle changes.

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Can You Cure HS? Here’s What This Science Tells Me.

Let’s go back to that big, painful question: Can you cure HS?

If we stay in the conventional model of just managing skin-deep symptoms, the answer is often a grim “no, it’s chronic”.

But when you look at this science, when you understand that HS is very often a symptom of a deeper, fixable metabolic fire, the answer changes completely.

You can put out the fire. You can address the root cause. You can achieve lasting, full remission naturally.

I am living proof. The hundreds of individuals in our HS Armor community are living proof.

This research from Dr. Hailemichael’s team isn’t just data; it’s a permission slip. It’s the scientific validation for what many of us have felt all along: this is a whole-body problem. And that means it has a whole-body solution.

Your healing journey starts not with another cream, but with this knowledge. You are the CEO of your health, and you now have the blueprint. You have the power to heal this from within.

References

[1] Hailemichael R, Martin SA, Hwang A, et al. Comorbidities of Pediatric Patients With Hidradenitis Suppurativa in the Emergency Department Setting: A Cross-Sectional Study. Pediatr Dermatol. 2025; 0:1-4. https://doi.org/10.1111/pde.70054

[2] González-López MA, et al. The Role of Insulin Resistance in Hidradenitis Suppurativa. Actas Dermosifiliogr. 2022;113(8):780-787. https://doi.org/10.1016/j.ad.2022.05.004

[3] Phan K, et al. Metabolic syndrome and hidradenitis suppurativa: A systematic review and meta-analysis. J Am Acad Dermatol. 2021;84(2):335-343. https://doi.org/10.1016/j.jaad.2020.07.051

[4] Barrea L, et al. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Patients with Hidradenitis Suppurativa. Nutrients. 2021; 13(1):108. https://doi.org/10.3390/nu13010108

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.