Treating HS Naturally: Why Stacking New Drugs Isn’t the Only Answer

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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 your immune system is playing a cruel game of Whac-A-Mole?

You finally find a medication that starts to calm your Hidradenitis Suppurativa (HS). You feel a glimmer of hope. And then… BAM. A new problem pops up.

Maybe it’s debilitating joint pain from a co-existing condition like lupus that the drug doesn’t touch. Or, in a cruel twist of irony, maybe the drug itself causes a new, painful skin condition like psoriasis.

It’s one of the most frustrating parts of this journey. It can make you feel trapped, hopeless, and completely at the mercy of your body’s chaotic signals. This is a very real, and very difficult, challenge in figuring out how to treat Hidradenitis Suppurativa when it’s complex.

A new case series, published in Dermatology and Therapy, sheds light on this exact problem. A team of researchers led by Dr. Francisco Javier Melgosa Ramos at the Hospital Lluís Alcanyís de Xàtiva in Spain explored a novel strategy for patients caught in this “immune crossfire”.

What they found is fascinating. And for me, as a scientist and former patient, it perfectly illustrates both the incredible power of modern medicine and the critical knowledge gap we must address if we want true, lasting remission.

The “Immune Whac-A-Mole” Problem

First, let’s validate what you might be experiencing. HS is a chronic inflammatory skin disease, but it rarely travels alone. It’s frequently associated with a whole family of other immune-mediated inflammatory diseases (IMIDs), like psoriasis, systemic lupus erythematosus (SLE), and inflammatory bowel disease.

This makes treatment incredibly complicated. A drug that works for one condition might not work for the other.

But the Whac-A-Mole gets even worse. Sometimes, the very biologic drugs used to treat HS (like adalimumab) can trigger something called a paradoxical reaction. Paradoxical is just the scientific term for unfair. It means the drug causes the very type of inflammation (like psoriasis) it’s often used to treat.

This happened to two of the three patients in this new report. They started adalimumab for their HS, and months later, they developed severe, new-onset psoriasis on their scalp and the palms of their hands.

This leaves patients and their hidradenitis suppurativa specialists in a terrible bind. What do you do then?

A New Strategy: Targeting Two Pathways at Once

Dr. Ramos and his colleagues presented the cases of three women with moderate-to-severe HS who were stuck in this exact trap. All had already failed at least two conventional systemic therapies.

• Case 1: A 52-year-old woman with Hurley stage III HS and poorly controlled lupus (SLE). She was on secukinumab, which was helping her HS, but her lupus-related joint pain was persistent and debilitating.
• Case 2 & 3: A 22-year-old and a 25-year-old, both with Hurley stage II HS. Both developed that awful paradoxical palmoplantar psoriasis after taking adalimumab. They were switched to secukinumab. This helped their HS and some of their psoriasis… but the painful plaques on their palms and soles persisted or even got worse.

This is the Whac-A-Mole in action. The doctors suppressed one inflammatory pathway, and the immune system just… found another.

So, the researchers decided to try something new. They decided to hit two different pathways at the same time.

The Shields: How Secukinumab and Upadacitinib Work

To understand their strategy, let’s use an analogy. Think of your immune system as a complex army.

Secukinumab (The Sniper): This is a biologic. It’s designed to be a highly-precise sniper. It targets and neutralizes one very specific inflammatory messenger (a cytokine) called Interleukin-17 (IL-17). IL-17 is like a master signal for inflammation in both HS and psoriasis. Secukinumab takes that signal out.

Upadacitinib (The Switchboard Jammer): This is a different type of drug called a “small molecule” or JAK inhibitor. Think of the JAK-STAT pathway as the master communications switchboard inside the army’s command center (the immune cell). Many different inflammatory messengers (not just IL-17) have to plug into this switchboard to send their ATTACK! order. Upadacitinib goes inside the cell and jams that switchboard, preventing the “attack” signal from getting through.

The doctors’ strategy? The sniper (Secukinumab) wasn’t enough for these complex patients. They needed to also send in a jammer (Upadacitinib) to shut down the internal communications.

What They Found: A “Dual Shield” Approach

In all three cases, the patients were already on Secukinumab 300mg. After 5-6 months, when it was clear the comorbidities weren’t controlled, the doctors added Upadacitinib (15-30 mg) to their treatment.

The results were remarkable:

• Case 1 (HS + Lupus): Adding Upadacitinib led to improvement in both her HS activity and her persistent, painful lupus-related joint symptoms.
• Case 2 & 3 (HS + Psoriasis): Adding Upadacitinib led to the complete clearance of their stubborn palmoplantar psoriasis and further improvement in their HS symptoms.

The combination therapy achieved what neither drug class could do alone. It “whacked” both moles at the same time.

Figure 1 Legend: Figure by Dr. Ramos and colleagues. These images show the hand of Patient 3, who had severe paradoxical palmoplantar psoriasis that was not responding to treatment.

• (A) Before adding Upadacitinib, her palm shows severe, red, thick, and scaly psoriatic plaques.
• (B) This is her hand just 6 weeks after adding Upadacitinib 30mg to her ongoing Secukinumab treatment. The skin is almost completely clear.
• Key Takeaway: This image powerfully demonstrates that for this patient, the “dual shield” approach of targeting both the IL-17 and JAK-STAT pathways was able to resolve the severe comorbidity that other treatments could not touch.

Importantly, the combination was reported as well-tolerated over the 3-6 month follow-up, with no adverse events or discontinuations.

The “Knowledge Gap”: Why Are We Stacking Shields?

First, I want to sincerely thank Dr. Ramos and his colleagues. This is a fantastic piece of clinical problem-solving. They took three patients in a very difficult, refractory situation and used their deep knowledge of immunology to find a solution. They gave these women their quality of life back. This is what great, compassionate hidradenitis suppurativa specialists do.

But now, as a scientist, I want you to take a 30,000-foot view with me.

What we are looking at is the pinnacle of downstream management.

We are (successfully, in this case) stacking two powerful, systemic hidradenitis suppurativa medication types to block two separate inflammatory pathways. The researchers themselves correctly note that this dual immunosuppression is for select, complex cases and must be monitored very closely for amplified risks, including infections, blood count changes (cytopenia), and metabolic or cardiovascular complications.

This is the Knowledge Gap I talk about so often.

This paper shows us how to build a bigger, stronger, more complex dam to stop a raging inflammatory flood.

But it doesn’t (and can’t, given its scope) answer the most important question: Why is the flood raging in the first place?

Why is the immune system so completely dysregulated that it’s using multiple pathways (IL-17 and JAK-STAT) to relentlessly attack the body? Why is it creating this “Whac-A-Mole” scenario?

That is the “upstream” question. And in conventional medicine, it’s the question that is almost never asked.

HS Armor: Fixing the “Upstream” Storm

This is where the HS Armor philosophy is so critical. This paper perfectly illustrates why we need it.

Let’s be crystal clear: those drugs, Secukinumab and Upadacitinib, are powerful shields. For the three women in this report, they were necessary, life-changing shields to stop a relentless assault. At HS Armor, we never shame the use of a shield.

But our mission is to address the upstream storm that’s making the shields necessary.

The goal of the natural treatment of HS is not to replace the shields, but to calm the storm so you don’t need such heavy shielding.

We do this by systematically addressing the 5 Layers of healing:

1. Foundational Nutrition: Identifying your specific, individual food triggers (like dairy, gluten, sugar, or nightshades) that are pouring gasoline on your inflammatory fire.
2. Strategic Lifestyle Changes: Aggressively managing stress (which is a known driver of the JAK-STAT pathway!), optimizing your sleep (when your body repairs), and finding movement.
3. Natural Therapies & Skincare: Using evidence-based natural compounds to calm inflammation from the inside and support your skin barrier from the outside.
4. Targeted Medical Testing: Looking “under the hood” with your doctor to find the root of the storm. Is it a hidden gut infection? Severe hormone imbalance? Micronutrient deficiencies?.
5. Accountability & Support: (This is me and our community) Guiding you through the process so you’re not trying to figure this all out alone.

The goal is to rebuild your body’s foundation. To fix the reason the storm started.

When you do that, one of two things happens:

1. The storm calms down so much that you can, like me, put the shield down completely and live in remission.
2. The storm calms down enough that one shield is more than enough. You’re no longer in the desperate Whac-A-Mole situation of having to stack multiple, heavy shields just to function.

Key Takeaways

Here are the key points to take away from this fascinating report:

• HS is often complex and can co-exist with other immune diseases like lupus or psoriasis.
• Sometimes, treatments for HS can (paradoxically) cause other issues, like psoriasis.
• For these very severe, complex cases, a new report shows that combining two different drug classes (an IL-17 inhibitor like Secukinumab and a JAK inhibitor like Upadacitinib) can be highly effective at controlling both HS and the associated disease.
• This dual shield approach is a powerful downstream solution, but it must be reserved for select cases and monitored closely by specialists due to potential risks.
• This strategy doesn’t address the upstream reason for the immune dysregulation. That’s where foundational, root-cause work is essential.

Can You Cure HS? The Answer Is “Upstream.”

So, can you cure HS?

This paper is a beacon of hope for those in the most complex, difficult situations. It shows that even when HS is tangled up with lupus or paradoxical psoriasis, improvement is possible.

But it also shows the path of downstream management. It can get very complicated, very expensive, and require stacking multiple, powerful shields.

I believe lasting remission is 100% possible.

But the permanent answer to how to treat Hidradenitis Suppurativa isn’t found in a bigger, stronger, or stacked shield. It’s found upstream.

It’s found in the hard, empowering, and transformative work of identifying your root causes and systematically rebuilding your health from the ground up. Use the shields you need to get through the day. But never stop working on the foundation. That is your path to lasting freedom.

Ramos, F.J.M., Ruiz, E.M., Pascual, M.G., Sanz-Motilva, V., & Martorell, A. (2025). Secukinumab Plus Upadacitinib for the Treatment of Severe Hidradenitis Suppurativa and Associated Immune-Mediated Comorbidities: A Case Series. Dermatology and Therapy (Heidelberg). https://doi.org/10.1007/s13555-025-01569-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.