Treating Hidradenitis Suppurativa Naturally: Unpacking the Latest Research for a Path to Remission

My name is Jaap and I am a pharma researcher with a PhD in biomedical sciences, and I used to have 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 Hidradenitis Suppurativa patients get their lives back, too.

Introduction

Have you ever wondered what’s really going on under the skin when a Hidradenitis Suppurativa (HS) flare hits? It can feel like a painful, unpredictable, and isolating mystery. For years, the medical community didn’t have many answers, which led to an average diagnosis delay of a staggering 10 years! But what if I told you that the science is finally catching up way? A new, very well written and detailed review paper published in the prestigious journal The Lancet by Prof. Robert Sabat and his team has pulled back the curtain on this complex disease. It’s one of the most up to date comprehensive overviews I’ve seen, and it’s confirming so much of what we explore in the HS Armor community.

In this post, we’re going to take a deep dive into this incredible research. We’ll explore how to treat Hidradenitis Suppurativa by truly understanding its root causes. We’ll break down the complex immune pathways, look at why it affects the whole body, and explain how we can use this knowledge to stop the inflammatory cycle for good. This is the science that empowers your healing journey.

What is Hidradenitis Suppurativa? It’s More Than Skin Deep.

Let’s get one thing straight: hidradenitis suppurativa (sometimes known by the older term acne inversa) is not just a simple skin issue. It is a chronic inflammatory disease. It’s characterized by a range of hidradenitis suppurativa symptoms, including those all-too-familiar painful, deep-seated nodules, abscesses, and draining tunnels that appear in areas like the armpits, groin, and under the breasts.

The images below from the paper show the reality of HS for many. You can see everything from deep tunnels under the skin to inflamed abscesses and the scarring that chronic inflammation leaves behind. This isn’t just a cosmetic issue; it’s a reflection of a deep, internal battle.

Figure 1: This figure shows the different ways HS can appear on the skin. Panels A & B show tunnels in the armpit. Panel C shows active, open erosion and abscesses under the breast. Panels D & E show severe scarring and ulceration. Panel F shows nodules on the lower abdomen. The bottom images (G, H, I) is the axillary region of a female patient with hidradenitis suppurativa scored clinically as a mild disease and the corresponding ultrasound scans, revealing the extensive network of tunnels beneath the skin’s surface that aren’t visible to the naked eye.

For so many people, the journey starts in their late teens or early twenties with a single, stubborn nodule that might be misdiagnosed as an infection. Something that unfortunate still to often happens even since the discovery of hidradenitis in 1833. Over time, these can progress, creating an unpredictable cycle of flares and periods of low-level activity. The paper notes that pain is the most troublesome symptom, followed by the often foul-smelling discharge and scarring that can lead to a huge toll on a person’s quality of life. What’s truly happening is a systemic issue, your body is in a state of widespread, chronic inflammation.

The Comorbidity Connection: Why HS is a Whole-Body Issue

One of the most crucial takeaways from this research is that HS rarely travels alone. It’s frequently accompanied by a host of other conditions, or “comorbidities,” because the underlying inflammation is systemic, it affects your entire body. This is a topic we discuss constantly in HS Armor because understanding this connection is the absolute key to a natural treatment of HS.

The paper lays out the science clearly. The central image in the figure below shows the drivers of this systemic issue: insulin resistance, high blood sugar (hyperglycemia), inflammatory cytokines, and autoantibodies. These are the sparks that light fires all over the body, leading to the conditions listed in the surrounding boxes.

Figure 2: This visual from the paper illustrates how HS is a systemic disease. The central figure shows the core drivers of inflammation. The outer boxes show the common comorbidities that result, including Metabolic Syndrome, Type 2 Diabetes, Inflammatory Bowel Disease, and Depression. This isn’t a coincidence; it’s all interconnected.

The research shows that people with HS have a significantly higher risk for:

• Metabolic Syndrome: Up to 50% of people with HS have this cluster of conditions (central obesity, high blood pressure, high blood sugar), making them 2.7 times more likely to have it than the general population.
• Type 2 Diabetes: The risk is more than double.
• Non-alcoholic Fatty Liver Disease (NAFLD): More than half of HS patients may have NAFLD, a 1.8 times greater risk.
• Inflammatory Arthritis: Conditions like spondyloarthritis are twice as likely.
• Inflammatory Bowel Disease (IBD): Crohn’s disease and ulcerative colitis are much more common.
• Depression and Anxiety: The mental and emotional toll is immense, with depression rates up to 2.5 times higher.

This isn’t meant to scare you, but to empower you. When you start treating HS naturally through diet and lifestyle, you are directly targeting those central drivers of inflammation. You’re not just addressing your skin; you’re working to balance blood sugar, improve insulin sensitivity, and calm your immune system. This is why so many in our HS Armor community see improvements not just in their skin, but in their energy levels, mood, and overall health.

Unpacking the Hidradenitis Suppurativa Causes: A Three-Act Tragedy

So, what kicks off this whole inflammatory cascade? The paper explains that the hidradenitis suppurativa causes are a complex mix of genetics (some people are more predisposed), lifestyle factors (like smoking and obesity), and a maladaptive immune system. The diagram below is complex, but let’s walk through it. It’s like a three-act play of how an HS lesion is born.

Figure 3: This is the scientific heart of the paper. (A) shows a normal hair follicle. (B) shows the early changes: the follicle gets blocked, amount and proportion of bacteria become unbalanced (dysbiosis), and the first immune cells arrive, drawn in by alarm signals. (C) shows the last stage: a full-blown immune attack, leading to pus, tissue destruction (tunnels), and skin thickening. The diagrams below show the specific molecules and cells involved in this cascade.

Act 1: The Inciting Incident – The Blocked Folle It all starts around a single hair follicle. As shown in Figure 3B, the top of the follicle thickens and gets clogged with keratin (skin protein). This creates a perfect, low-oxygen environment for certain bacteria to overgrow, this is called dysbiosis. It’s crucial to understand this isn’t about being “dirty.” It’s an imbalance in your skin’s delicate microbiome (and in your body as a whole as shown in figure 2) that sets the stage for this pathological process. This concept aligns perfectly with our philosophy in the HS Armor community. While restoring balance must begin from within, we also provide extensive resources on how to care for your skin externally. Nourishing your skin so it functions optimally and providing tips for wound and scar care is a critical part of preventing flares but also wound and scar healing. We must work from the inside out and the outside in to help prevent follicles from getting clogged and to stop dysbiosis from taking hold.

Act 2: The Alarm – The First Immune Response This blockage traps cell debris and bacterial components. Your immune system’s first responders (macrophages and dendritic cells) see these as alarm signals (called Pathogen-Associated Molecular Patterns PAMPs and Damage-Associated Molecular Patterns DAMPs). They sound the alarm by releasing inflammatory messengers called cytokines, especially TNF and IL-1β. As the paper explains, this is like pouring gasoline on a fire. These cytokines tell the local tissue to call for backup, bringing in an army of immune cells.

Act 3: All-Out War – The Cycle of Destruction This is where things escalate into the last stage shown in Figure 3C. The blocked follicle ruptures, spilling its contents into the dermis. This triggers a massive influx of neutrophils, which create pus and form an abscess. The immune system goes into overdrive. Specialized T-cells, particularly Th17 and Th1 cells, arrive and produce even more inflammatory cytokines like IL-17 and IFN-γ. The body even starts forming “tertiary lymphoid structures”, think of them as unauthorized mini-immune headquarters setting up shop in your skin, perpetuating the attack. This chronic, unrelenting inflammation leads to the release of enzymes (MMPs) that literally dissolve tissue, creating the tunnels that are a hallmark of HS.

This is why just treating the surface doesn’t work. The problem is a deeply rooted, overactive immune response. From a natural healing perspective, our goal is to intervene in Act 1 and 2. By using diet to rebalance our whole body, the microbiome, and systemic inflammation, we can stop the dysfunction of the hair follicle to happen in the fist place and thereby prevent the whole cascade of bad event from occurring.

A Roadmap to Healing: The Three Phases of HS Treatment

The researchers propose a brilliant way to think about managing HS, offering a roadmap for different hidradenitis suppurativa treatments by understanding which “phase” of the disease you’re in. This helps tailor the approach to what your body needs right now.

Figure 4: This flowchart is a roadmap for HS management. Part (A) shows the typical disease course over years, moving from a purely inflammatory phase to a destructive phase with irreversible damage. Part (B) outlines the recommended approach for each phase, emphasizing that lifestyle modification is a constant, foundational element throughout the entire journey. although this is a nice difference from most papre wher lfiestyle is slmost toatlly ignored. The advice given is still not very practiacl and defnialty not alencomapissing. At autoimmuen armor we haev all the sicentific effidence in lectures for yout o watch so you can infor yourself about everythign that you can do to treat this disease naturally and prevent it from escalating.

1. The Inflammatory Phase:

• What it is: This is the early stage, you have inflammatory nodules and abscesses, but no irreversible skin damage like tunnels or major scarring.
• The Goal: The aim here is early care to prevent tissuedamage. The paper calls this the “window of opportunity,” a concept we champion in HS Armor.
• The Study’s Approach: For mild disease, the focus is on topical treatments like 1% clindamycin, antiseptics, and systemic antibiotics (e.g., doxycycline). For moderate to severe cases, they recommend systemic antibiotics or biologics that target specific inflammatory pathways. Intralesional steroid injections are noted as a rescue strategy for acute pain. Also lifestyle modifaication are mentioned but not detailed or practical advice is offered for this avenue.
• The HS Armor Approach: This phase is the perfect time to fully commit to comprehensive lifestyle modification. We see this as the critical window to halt disease progression. This involves a comprehensive anti-inflammatory diet and lifestyle modification to identify and remove trigger foods, , strategic supplementation to lower inflammation, and robust science based and proven stress management techniques to calm the immune system. The goal is to prevent the fire from spreading, so you never have to reach the destructive phase.

2. The Destructive Phase:

• What it is: At this stage, you have both active inflammation and irreversible damage like tunnels and extensive scarring.
• The Goal: Manage the ongoing inflammation while also dealing with the structural damage.
• The Study’s Approach: The recommendation here is a combination of systemic drug therapy (steroids, biologics, antibiotics) to control the inflammation, alongside surgical interventions.
• The HS Armor Approach: We view the natural approach as an essential co-pilot in this phase. While conventional therapies may be necessary to manage severe inflammation or remove damaged tissue, a dedicated HS-apropriate lifestyle is crucial for lowering the overall inflammatory burden. This can reduce the severity and spreading of flare, makes conventional treatments more effective, and support your body’s ability to heal before and after any surgical procedures.

3. The Burnout Phase:

• What it is: Here, the active, painful inflammation has largely subsided, but you’re left with significant, life-altering scarring, fibrotic bands, or contractures.
• The Goal: Address the physical limitations from past damage and prevent recurrence.
• The Study’s Approach: In this phase, the focus shifts almost entirely to surgical therapies to remove scar tissue and restore function. The paper notes that drug therapy is generally not the primary treatment here as the active inflammation is gone.
• The HS Armor Approach: While surgery is often the a to address the physical damage of the burnout phase, our focus is on ensuring you stay in remission. Maintaining a steadfast anti-inflammatory lifestyle is key to preventing the smoldering embers of inflammation from igniting a new fire elsewhere in the body. It’s about long-term health, vitality, and ensuring HS becomes a thing of the past, not a recurring threat.

A New Era of Hidradenitis Suppurativa Treatment: Acknowledging a New Tool

For so long, treatment was limited to antibiotics and steroids. The development of advanced hidradenitis suppurativa medication called biologics has given doctors an extra tool to help control the disease. As you can see in the figure below, these are very powerful drugs designed to find and block the specific inflammatory cytokines that drive HS.

Figure 5: This figure beautifully illustrates how modern targeted therapies work. It shows the different inflammatory signals (like TNF, IL-17, IL-36) and their receptors on skin and immune cells. The drugs (highlighted in red) act like specific keys to block these signals, shutting down the inflammatory message.

• Adalimumab (Humira) works by blocking the cytokine TNF.
• Secukinumab and Bimekizumab work by blocking the IL-17 family of cytokines.

These medications can be life-changing for some, but just like other pharmaceuticals, they have significant limitations. Biologics are powerful immune suppressants, which comes with serious side effects. More importantly, the body can build up a tolerance, meaning they may stop working over time, making them a temporary fix rather than a long-term solution.

Therefore, while these drugs are a welcome advancement, they do not offer a path to truly cure or heal from Hidradenitis Suppurativa. The most important factor in long-term health is lifestyle, a fact still not fully recognized by the mainstream medical community. Even in this beautiful and comprehensive review, there is a lack of practical, actionable advice on what to change in your diet, natural therapies, and skincare.

This is precisely what we do every day at HS Armor. We specialize in summarizing all the scientific information and translating it into a concrete plan to help you heal from HS naturally and manage it effectively for the rest of your life. A natural approach is not about rejecting medicine; it’s about building such a strong foundation of health that these powerful drugs become less necessary, or ideally, completely unnecessary.

Key Takeaways

• HS is a Systemic Inflammatory Disease: It’s not just a skin condition. The root cause is a dysfunctional immune response that affects your entire body.
• Comorbidities are Common: Because of widespread inflammation, HS is linked to metabolic syndrome, diabetes, IBD, and depression. Managing your HS can help manage these, too.
• It Starts with a Blocked Hair Follicle: The disease process is triggered by a blockage that sets off a powerful, destructive inflammatory cycle in the skin.
• Early Intervention is Key: The best way to prevent irreversible damage is to address the inflammation in the early inflammatory phase through a combination of strategies. While there is not much attention and detail on lifestyle modification by the medical doktors we at HS armor think lifestyle and natural therapies are your best weapon against HS.

Conclusion

So, let’s return to the big question: can you cure HS? While there isn’t an official “cure,” we know from our experiences and from the science that we can absolutely manage it, stop its progression, and achieve long-term, sustainable remission. The science is clear: HS is a systemic issue, and we now have a better framework than ever for understanding how to approach treatment.

Unfortunately, as this review also highlights, there’s often a gap between these scientific findings and what happens in the clinic. We see a strong reliance on medications and surgeries, while practical, detailed lifestyle advice (the very foundation of healing) is often overlooked. This is where the true power lies.

At HS Armor, we bridge that gap. We have done the research and have the data to show how to use natural interventions to manage Hidradenitis Suppurativa effectively. By focusing on a comprehensive anti-inflammatory lifestyle, you are directly targeting the root cause of HS. You’re not just masking symptoms; you are fundamentally changing the environment within your body, making it a place where this disease can no longer thrive. You are taking back control, and that is an incredibly powerful place to be.