Her HS Inflammation Improved, But This Other Lesion Grew. hard non inflamed HS-like lesions.

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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 felt like you were finally making progress, only to be blindsided by a new, baffling symptom? Maybe you started a powerful hidradenitis suppurativa medication, like a biologic, and the painful, draining abscesses started to calm down. You felt that first, fragile flicker of hope. But then you noticed something else. The hard tunnels weren’t going away. Or perhaps a new lump, hard, raised, and different from your usual flares, popped up and refused to leave.

It’s one of the most frustrating parts of this disease. You’re trying to figure out how to treat hidradenitis suppurativa, but it feels like a game of whack-a-mole. You solve one problem, and another appears.

If you’ve ever felt this way, you are not alone. And today, I want to share an incredible story from a recent 2025 medical case report that shines a massive spotlight on why this happens [1]. This isn’t just a scary story; it’s an empowering one. It hands us a crucial clue to understanding the natural treatment of HS and why just “managing symptoms” will never be the full answer.

The Case of the Baffling Lesion: A Patient’s Story

The story begins with a 26-year-old female patient with Hidradenitis Suppurativa (HS) [1]. Her HS was active, with the recurrent, painful nodules, abscesses, and sinus tracts that we know all too well, located in the intermammary fold (the area between the breasts) [1].

Given the severity, her doctors started her on Adalimumab (Humira), a powerful biologic drug [1]. Biologics are a class of hidradenitis suppurativa medication designed to be a smart shield. They work by targeting and blocking one specific, over active inflammatory signal in the body. In this case, Adalimumab targets a signal called TNF-α (Tumor Necrosis Factor-alpha), which is a key driver of the fiery inflammation in HS [1, 4].

And the good news? It worked… partially.

Over the following weeks, her inflammatory lesions, the painful abscesses and nodules, saw significant improvement [1]. This is fantastic! It confirms that her active inflammation was being successfully dampened by the biologic shield.

But here’s the twist. The patient also had a different kind of lesion in the same area: an “erythematous nodule appearing as a keloid” [1]. A keloid is a type of aggressive, raised scar. Thinking this was a standard keloid, her doctors treated it with a standard approach: intralesional corticosteroid injections (specifically, triamcinolone acetonide) [1].

This is where the case gets truly baffling. After two injections, the lesion didn’t get better. It got worse.

The report states it “increased in size, became nodular, and developed a brownish discoloration” [1]. You can just imagine the fear and confusion. The inflammation is cooling down, but this other thing is growing. The doctors became concerned about something more sinister, like skin cancer (specifically dermatofibrosarcoma protuberans or amelanotic melanoma) [1].

The Diagnosis That Unlocks the HS “Two-Battle” Secret

This is where the brilliant detective work from Dr. Fabrizio Martora and his colleagues at the University of Naples Federico II comes in [1]. They did the right thing: they performed a skin biopsy to get a definitive answer [1].

And the perpetrator was revealed.

It wasn’t cancer, thank goodness. The diagnosis was a rare, benign (non-cancerous) entity called fibromatous fibrosis [1].

Let’s break that down with an analogy. Think of fibroblasts as your body’s “construction crew.” When you get a cut, fibroblasts are signaled to come to the site and lay down collagen (the “concrete” and “rebar” of your tissue) to build a scar and heal the wound.

In fibromatous fibrosis, this construction crew has gone rogue. It’s like they received a garbled message to keep building long after the construction permit expired. They pile up dense, disorganized collagen, forming a benign tumor or mass [1].

The most stunning part? The researchers noted this was the first time a case of fibromatous fibrosis had ever been reported in an HS patient, especially one being treated with Adalimumab or corticosteroid injections [1].

Figure 1 Legend: Figure by Dr. Fabrizio Martora and colleagues [1].

• (a) Shows the patient’s initial state, with active inflammatory HS lesions (nodules, sinus tracts) and the separate pinkish papular lesion in the intermammary fold.
• (b) Shows the patient after 4 weeks of Adalimumab therapy. You can see a marked improvement in the inflammatory lesions, the redness and swelling have visibly calmed down.
• (c) This is the critical part. It shows that while the inflammation was improving, the other lesion “begins to increase in size becoming a nodule and turns brownish in color” after the steroid injections.
• Key Takeaway: This visual evidence is powerful. It shows the biologic shiel” was working on the inflammation, but a different process (fibrosis) was progressing on its own, and was possibly aggravated by the local steroid injection.

Figure 2 Legend: Figure by Dr. Fabrizio Martora and colleagues [1].

• This image is a dermoscopic (magnified) view of the lesion in panel (c).
• The researchers saw features like an “atypical vascular pattern with branching vessels [1].
• Key Takeaway: This is why they were worried. These features can be red flags that mimic serious conditions like melanoma or dermatofibrosarcoma protuberans, highlighting why a biopsy was absolutely essential to get the right diagnosis [1].

Why This Case Changes How We Must Treat HS: The Two-Battle Front

This case is, in my opinion, one of the most important I’ve read for understanding the complete hidradenitis suppurativa causes and treatment puzzle.

It proves what many of us in the HS Armor community have discussed for years: HS is not one disease. It’s (at least) two separate battles being fought on the same battlefield (your skin).

Now, this is the critical point, and it’s a brilliant nuance to pick up on: these were two separate clinical problems in this patient. The active HS lesions were distinct from the fibrotic nodule. You might think this weakens the argument, but it actually makes it infinitely stronger.

Think of it like a perfect “natural experiment.” In most of us with HS, the “hot” inflammation and the “cold” fibrosis are tangled together in the same chronic tunnel or scar. It’s impossible to see where one ends and the other begins. But in this rare case, the two processes happened in two separate, visible lesions. By treating the whole patient with a single systemic drug, the researchers could clearly see how one tool affected each battlefront differently. This case allows us to physically see the two distinct battles that, for the rest of us, are happening in the same place.

Battle #1: The “Hot” War (Inflammation) 🔥

This is the part of HS we all know. It’s the painful, swollen, red abscesses that throb, drain, and make life miserable. This battle is driven by an immune system in overdrive, a “shouting match” of inflammatory signals like TNF-α [2, 4].

In this case, the Adalimumab biologic was a powerful “shield” that successfully quieted this specific battle [1].

Battle #2: The “Cold” War (Fibrosis) 🧊

This is the other side of HS. It’s the structural part: the sinus tracts, the tunneling, the hypertrophic (raised) scars, the keloids, and, as we now see, this fibromatous fibrosis [1, 5].

This battle isn’t fought by immune cells as much as it is by those rogue construction crews, the fibroblasts [5]. These cells are laying down excessive, disorganized collagen, creating the tunnels and scars that define the chronic nature of this disease. In fact, fibrosis is increasingly recognized as a core component of HS, not just a late-stage complication [5].

Here is the critical insight from this case:

The biologic shield only stopped Battle #1. It did nothing to stop Battle #2.

The “hot” inflammation cooled down, but the cold fibrotic process just kept on building. The steroid injection, which is a common hidradenitis suppurativa treatment for keloids, may have even acted like a physical trigger, poking the already over-eager “construction crew” and telling them to build even faster [1, 8].

The Knowledge Gap: Why Conventional Treatment Falls Short

This case perfectly exposes the Knowledge Gap in conventional HS care. The approach was entirely downstream, it focused only on the symptoms.

• Symptom 1: Inflammation. Tool: Biologic (Adalimumab).
• Symptom 2: Scarring. Tool: Steroid injection.

When the tool for Symptom 2 failed and made things worse, the only option left was to biopsy to check for cancer [1]. The model provides no answers for why this happened. It doesn’t ask the upstream question:

What is the upstream root cause that is sending the go signal to both the immune system (Battle 1) and the fibroblasts (Battle 2)?

This is why just taking a biologic, for many, isn’t a permanent cure for hidradenitis suppurativa. It’s a shield, not a root-cause solution. It may stop the flares, but it often doesn’t reverse the tunnels or stop the scarring.

The HS Armor Philosophy: How to Treat Hidradenitis Suppurativa at the Root

This is where we must shift our thinking from managing HS to healing it. At HS Armor, we use this kind of science to empower our upstream approach.

Drugs like Adalimumab are powerful, and sometimes necessary, “shields.” They can be life-changing for calming the “hot” war and giving you the breathing room to do the real work.

But let’s be honest: these shields are not a long-term solution, and they aren’t ideal. First, they come with a significant list of side effects, from common injection site reactions and upper respiratory infections to terrifying boxed warnings about an increased risk of serious infections (like tuberculosis) and even certain cancers like lymphoma [3, 6, 7]. This is a heavy price to pay for temporary relief. Second, for many patients, they simply stop working. The scientific term for this is “drug survival,” and the data is sobering. One real-world study on HS patients found that while 56.3% of patients were still on Adalimumab at 12 months, that number plummeted to just 30.5% by 24 months [8]. The main reason for stopping? A “loss of effectiveness” [8, 9].

As a scientist, I find the reason for this failure fascinating. It’s a process called immunogenicity. Your own immune system, the very thing we’re trying to calm, is so smart that it can learn to recognize the biologic shield as a foreign invader. It then creates anti-drug antibodies (ADAs) that attack and neutralize the medication itself [10, 11]. Your body literally learns to fight your shield, making it less and less effective over time. This is the ultimate proof that we are not addressing the root cause. We are just bringing a new weapon to a battle that our body can adapt to.

But the real, foundational work (the natural treatment of HS) is about turning off the upstream alarm bells that start the cascade in the first place.

Our approach focuses on the five layers of healing, which are designed to quiet both the inflammatory war and the fibrotic war at their source:

1. Foundational Nutrition: This is signal management. We remove the specific foods that are inflammatory for you, the ones that are constantly poking your immune system and telling it to attack.
2. Strategic Lifestyle Changes: This isn’t fluff. Changing you metabolism naturally, managing stress and optimizing sleep directly lowers the systemic stress signals (like cortisol) that tell your “construction crews” (fibroblasts) to go into overdrive [7].
3. Natural Therapies & Skincare: Using targeted, natural compounds that help calm inflammation and support skin barrier health without a whack-a-mole approach.
4. Accountability & Support: Healing is hard. Doing it with a community that gets it makes it possible.
5. Targeted Medical Testing: Identifying the specific root causes for you, whether it’s a compromised gut (the command center of your immune system), hormonal imbalances, or hidden infections.

The goal is to rebuild your body’s foundation. When you address the root signals, the immune system calms down and the fibroblasts stop receiving the “panic” message to over-build. You create a body that no longer needs the shield.

Key Takeaways

This single case report is a goldmine of information. Here’s what it means for you:

• HS is not one single problem. It’s a two-front war: “hot” inflammation (abscesses, pain) and “cold” fibrosis (tunnels, scars, keloids) [1, 5].
• Biologic shields (like Adalimumab) can be very effective at stopping the “hot” inflammatory battle by blocking signals like TNF-α [1, 4].
• These shields may not stop the “cold” fibrotic battle [1]. The scarring and tunneling can continue or even worsen, as this case demonstrates.
• Vigilance is key. If you have any lesion (new or old) that changes, grows, or doesn’t respond to treatment, it must be evaluated by a dermatologist.
• A true permanent cure for hidradenitis suppurativa is found upstream. Treating HS naturally by addressing the root-cause signals (through diet, lifestyle, and gut health) is the only way to calm down both the inflammation and the fibrosis for lasting remission.

Can You Cure HS? Here Is Your Blueprint for Hope

So, let’s go back to that big question: Can you cure HS?

While medicine avoids the word cure, I will tell you this: lasting remission is 100% possible. I am living proof.

This case report [1] isn’t a story to make you fear biologics or steroid shots. It’s a story to empower you with knowledge. It gives you the “why” behind your frustration. It shows you that the answer isn’t just in a stronger shield.

The answer is in rebuilding your foundation. The answer is in understanding that you are fighting two battles, and you need a strategy that targets the root cause of both. Understanding the science is your first step to take back control.

References

[1] Martora F, Coronella L, Battista T, Noto M, Potestio L, Megna M. An Unusual Case of Fibromatous Fibrosis in a Young Hidradenitis Suppurativa Patient. Case Rep Dermatol. 2025;17:422-426. DOI: 10.1159/000547493.

[2] Vinkel C, Thomsen SF. Hidradenitis suppurativa: causes, features, and current treatments. J Clin Aesthet Dermatol. 2018;11(10):17-23.

[3] Jastrząb B, Szepietowski JC, Matusiak Ł. Hidradenitis suppurativa and follicular occlusion syndrome: where is the pathogenetic link? Clin Dermatol. 2023;41(5):576-83. https://doi.org/10.1016/j.clindermatol.2023.08.021

[4] Chen R, Guo R, Petty AJ, Jaleel T. Immune dysregulation and current targeted biologics in hidradenitis suppurativa. Immuno. 2024;4(1):57-76. https://doi.org/10.3390/immuno4010004

[5] Garg A, Hamer M, Ormerod AD. The role of fibrosis and the fibroblast in hidradenitis suppurativa. Br J Dermatol. 2020;183(1):16-24. https://doi.org/10.1111/bjd.18843

[6] Velez A, Ardon C, Howard J, Al-Rohil R, Patel V, Woo D. Keloids and hypertrophic scars in hidradenitis suppurativa: a comprehensive review. Dermatol Surg. 2021;47(6):761-766.

[7] Ramos-Remus C, González-Díaz V, Barajas-Ochoa A. TNF-α and its role in fibrosis: a double-edged sword. J Immunol Res. 2021;2021:6654924. https://doi.org/10.1155/2021/6654924

[8] Firooz, A., Tehranchi-Nia, Z., & Ahmed, A. R. (1995). Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases. Clinical and experimental dermatology, 20(5), 363–370. https://doi.org/10.1111/j.1365-2230.1995.tb01351.x

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.