New insights in how tunnels work 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 World of HS Tunnels: How to Treat Hidradenitis Suppurativa by Healing the Root Cause

If you’re reading this, you probably know the reality of HS tunnels. That deep, relentless pain. The draining, the odor, the feeling that a part of your own body has become a foreign, hostile territory. For years, many of us were told these tunnels were just the end-stage “scars” of the disease, unfortunate, but inactive.

A groundbreaking new review paper by Dr. Nicole Vecin and her colleagues has pulled back the curtain on the secret life of these tunnel structures, and what they’ve found is a game-changer for anyone wondering how to treat hidradenitis suppurativa for good. The research confirms what many of us have felt in our bodies for years: tunnels are active, dynamic, and central to the chronicity of HS.

Today, we’re going to walk through this incredible science together. We’ll explore what it tells us about why conventional treatments often fall short and, most importantly, how this knowledge gives us a powerful roadmap for treating HS naturally by addressing the root cause.

The Old Myth vs. The New Reality: Tunnels as Active Inflammation Factories

First, I want to give a massive thank you to the researchers who compiled this work. By bringing all this data together, they’ve given us a clear picture of what’s happening deep within the skin.

For too long, the prevailing view was that tunnels were inert fibrotic tissue. But this paper confirms a radical new understanding: HS tunnels are powerful, self-sustaining micro-environments of inflammation. Think of them less like scars and more like underground bunkers for the disease, constantly fueling the fire.

The study highlights that the very presence of tunnels makes HS harder to manage and is linked to a lower chance of responding to even powerful biologic therapies. Why? Because the cells lining these tunnels aren’t just passive skin cells. They are “activated” keratinocytes, behaving like cells in a wound that never, ever heals. They pump out a cocktail of inflammatory signals, creating a vicious cycle that pulls in more immune cells, causes more damage, and keeps the disease raging. This is the “story” within the data—the validation that these tunnels are a key battleground in our fight for remission.

Inside the Bunker: A Vicious Cycle of Inflammation (Figure 1)

So, what’s actually happening inside a tunnel? The researchers paint a vivid picture of organized chaos. It’s not just a simple tube; it’s a complex ecosystem of immune cells, inflammatory proteins, and bacteria, all interacting to keep the disease going. Figure by Dr. Nicole Vecin and her colleagues

Figure 1 Legend: The Vicious Cycle Inside a Hidradenitis Suppurativa Tunnel. This illustration reveals the intense inflammatory activity happening within an established HS tunnel. The tunnel is not a passive scar; it’s a dynamic environment.

The lining is made of activated keratinocytes (skin cells) that release alarm signals (like S100 proteins and interleukins IL-1β, IL-36G). These signals, along with other inflammatory messengers like TNF-α, create a “call to arms,” recruiting a massive influx of immune cells like T-cells, neutrophils, macrophages, and dendritic cells into the area.

T-cells, in turn, release IL-17, a key driver of inflammation in HS. This creates a feedback loop, causing keratinocytes to produce even more inflammatory signals. Inside the tunnel lumen, a gelatinous mass and bacterial biofilms provide a perfect breeding ground for this inflammation to fester.

Neutrophils release “neutrophil extracellular traps” (NETs) in an attempt to fight bacteria, but this process also adds to the tissue damage.

Finally, activated fibroblasts in the area contribute to both inflammation and the release of matrix metalloproteinases (MMPs), enzymes that break down tissue and contribute to the uncontrolled fibrosis and remodeling characteristic of chronic HS.

To put it simply, the tunnel becomes its own self-perpetuating engine of disease. Here’s a breakdown of the key players:

• Activated Keratinocytes: The skin cells lining the tunnel are in a constant state of alarm. They express proteins (like Keratins 6, 16, and 17) usually found in migrating, wound-healing skin, and they scream for help by releasing inflammatory messengers like IL-17C, IL-1β, and IL-6.
• A Flood of Immune Cells: In response to these alarms, the body sends in the troops. The paper shows that tunnels are packed with T-cells (especially those producing IL-17), neutrophils, and B-cells. This isn’t a normal immune response; it’s a relentless, over-the-top assault that causes more harm than good.
• Neutrophil Extracellular Traps (NETs): Neutrophils, a type of white blood cell, try to fight off bacteria by spewing out web-like structures called NETs. While meant to be protective, in the chronic environment of an HS tunnel, these NETs contribute to the inflammatory sludge and tissue damage.
• Bacterial Dysbiosis: The warm, moist, low-oxygen environment of a tunnel is a paradise for specific types of bacteria, especially Gram-negative anaerobes. These aren’t the friendly bacteria of healthy skin. They form resilient biofilms and release substances that further provoke the immune system, pouring gasoline on the inflammatory fire.

This is the core tragedy of an HS tunnel: it’s a wound-healing response gone haywire, trapped in a destructive loop that it can’t escape on its own.

The Birth of a Tunnel: Where Does It All Begin? (Figure 2)

If tunnels are the factories, what’s the blueprint? How does one form in the first place? The paper lays out the leading hypothesis, which starts with the hair follicle. Figure by Dr. Nicole Vecin and her colleagues

Figure 2 Legend: The Blueprint for a Hidradenitis Suppurativa Tunnel. This diagram illustrates the complex, multi-step process believed to lead to the formation of HS tunnels, starting at the hair follicle.

(1) Epidermal Stem Cell (ESC) Aberrant Activation: The process may begin with faulty signals in the epidermal stem cells located in the hair follicle. Genetic factors (like variations in SOX9 and KLF5) and inflammatory signals (like IL-1β and IL-17) can cause these stem cells to activate abnormally.

(2) The Role of Fibroblasts and EMT: Nearby fibroblasts, the skin’s “architects,” get drawn into a dysfunctional wound healing response. They can trigger a process called Epithelial-Mesenchymal Transition (EMT), where skin cells (epithelial) lose their structure and start behaving more like migratory cells (mesenchymal). This is driven by signals like TWIST1, ZEB1, and N-cadherin, allowing skin cells to “invade” the dermis where they don’t belong.

(3) Dysregulated Signaling: The normal, balanced communication between different cell types breaks down. For example, chronic WNT signaling, which promotes fibrosis, can become overactive. At the same time, an inflammatory soup of cytokines (IL-1α, IL-6, IL-17) further drives the process.

(4) Tissue Breakdown and Invasion: The result is a cascade of events where activated keratinocytes, originating from the hair follicle, begin to burrow through the dermis. Enzymes like MMPs degrade the surrounding tissue, clearing a path for the tunnel to extend. This leads to the formation of the epithelium-lined tube we know as a tunnel, which then becomes a new source of chronic inflammation as shown in Figure 1.

The journey from a healthy hair follicle to a chronic tunnel is a multi-act tragedy:

1. The Inciting Event: Hair Follicle Disruption. It all starts with inflammation around the hair follicle, leading to its rupture. But unlike a simple pimple, in HS, the body’s repair system is broken.
2. Faulty Instructions from Stem Cells. The paper points to Epidermal Stem Cells (ESCs) within the follicle as key players. Genetic predispositions (researchers have identified genes like SOX9 and KLF5 that regulate these cells) might mean that in people with HS, these stem cells get the wrong instructions when injury occurs. Instead of just repairing the follicle, they start to proliferate and migrate abnormally.
3. The Fibroblast-Driven Invasion. Here’s where it gets fascinating. Fibroblasts are the cells responsible for building our skin’s scaffolding (collagen, etc.). In HS, they get activated into a dysfunctional, frantic wound-healing mode. They can trigger something called Epithelial-Mesenchymal Transition (EMT). This is a scientific term for a process where well-behaved, stationary skin cells are told to transform into migratory, invasive cells. It’s like the body’s construction crew (fibroblasts) suddenly tells the bricks (keratinocytes) to get up and start burrowing through the walls. This is how the “tendrils” of skin begin to invade the dermis, where they absolutely do not belong.

This process explains why tunnels are lined with skin-like cells and why they are so invasive. They are the physical result of a healing signal gone terribly, terribly wrong.

The “Knowledge Gap”: Why Drugs and Surgery Aren’t the Whole Answer

This is where we must connect this incredible science to our real-world experience. The paper reviews the current treatments: antibiotics, biologic drugs that block signals like TNF-α or IL-17, and surgery. And while acknowledging their value, it also highlights their limitations.

• Biologics: These drugs can be life-changing for many, but as the paper notes, response rates are lower in patients with established tunnels. Think of it like this: the drug might turn down the volume on the inflammatory “music” (like IL-17), but it doesn’t dismantle the concert hall (the tunnel) where the music is being played.
• Antibiotics: These often provide temporary relief, likely due to their anti-inflammatory effects more than their antibacterial ones. But they don’t address the underlying immune dysfunction or the resilient biofilms deep within the tunnels.
• Surgery: Procedures like deroofing or excision can remove the tunnel, but as any warrior who has had a recurrence knows, if you don’t stop the systemic inflammation that creates tunnels in the first place, the body can simply build new ones.

This is the knowledge gap I see in so much of the conventional approach. It focuses on managing the downstream consequences (the smoke alarm) without putting out the upstream fire. Pharmaceuticals and surgery are powerful and sometimes necessary tools (like a temporary shield) but they do not solve the underlying problem and in addition come with their own severe side effects. In addition when taking steroids, biologics, and antibiotics for long time, your body build up tolerance and the drugs lose potency.

The HS Armor Philosophy: Putting Out the Fire From Within

So if the problem is a dysfunctional, overactive inflammatory response that causes the body to build these tunnels, then how to treat HS for lasting remission?

The answer is to reverse the paradigm!!!

Conventional medicine often views drugs and surgery as the main pillars, with lifestyle as a small, optional add-on. The HS Armor philosophy reverses this. For us, the foundational work is the main treatment. Our goal is to build such a strong foundation of health that these powerful tools become less necessary, or ideally, completely unnecessary.

This is a core principle we put into practice every day in the HS Armor community. We at HS Armor focus on highly effective evidence-based nutrition and lifestyle change, and natural therapies and practices.

• Foundational Nutrition: The science shows us that signals like IL-1β and IL-17 are driving this. We know from extensive research that certain foods can trigger these exact pathways. By systematically identifying and removing your personal inflammatory triggers and flooding your body with nutrient-dense, healing foods, you begin to quiet the inflammatory signals at their source. You stop providing the raw materials for the inflammation factory.
• Strategic Lifestyle Changes & Natural Therapies: Stress, poor sleep, and environmental toxins all contribute to systemic inflammation. By incorporating science-backed stress management, optimizing sleep, and using targeted natural compounds and supplements that are shown to balance the immune system, you further reduce the body’s tendency to over-react to triggers.
• Building Your Defenses, Layer by Layer: Think of HS Armor not as a single cure, but as a protective shield you build for yourself, piece by piece. Each choice is another layer. It’s about combining these powerful strategies to create a comprehensive defense, making your body a less hospitable place for the inflammation that leads to tunnels.

Seeing how these changes have helped so many in our community truly brings this research to life. When you stop the fire, the smoke alarms go silent, and the body can finally begin to truly heal.

Key Takeaways

If you’re skimming or just need the core message, here it is:

• Tunnels Are Not Scars: HS tunnels are active, dynamic “inflammation factories” that perpetuate the disease, making it more severe and resistant to treatment.
• Tunnel Formation Starts at the Hair Follicle: A dysfunctional wound-healing process, driven by faulty stem cell signals and invasive fibroblasts, causes skin cells to burrow into the dermis, creating the tunnel.
• Conventional Treatments Are Incomplete: While helpful, drugs and surgery often manage the symptoms (the smoke alarm) without addressing the root cause of systemic inflammation (the fire) that creates tunnels.
• True Healing is an “Inside-Out” Job: The most powerful way to treat hidradenitis suppurativa and prevent tunnels is to build a strong foundation of health through nutrition, lifestyle, and targeted natural therapies that calm the underlying inflammation.

A New Chapter of Hope

This research is more than just science; it’s validation. It’s a message that you aren’t imagining things, these tunnels are a serious and active part of the disease. But more than that, it’s a message of hope. By understanding how and why tunnels form, we are empowered. We can see that the path to healing isn’t just about fighting the lesions we see, but about fundamentally changing the internal environment.

Healing is possible. Remission is possible. It starts with understanding the science and using that knowledge to take back control of your health, one foundational choice at a time.

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.