What Dermatologists Want You to Know About Treating HS Today

For years, HS was treated like an infection. Experts explain what’s changed—and how today’s treatments target the disease at its source.

For years, people living with hidradenitis suppurativa (HS) were often met with confusion—sometimes even in clinical settings. Painful nodules, abscesses and draining tunnels were frequently treated as isolated infections or hygiene-related issues, leading to cycles of antibiotics, incision and drainage—and frustration when symptoms inevitably returned.

Today, that understanding has changed in a meaningful way. And with it, so has the way experts approach treatment. Ahead, dermatologists share what they want you to know about HS today—from how the condition is understood to how treatment strategies have evolved and what that means for long-term care.

A Shift in Understanding—And
Why It Matters

“Hidradenitis suppurativa (HS) was historically viewed primarily as an infectious or apocrine gland disorder, often misattributed to poor hygiene, bacterial overgrowth or simple follicular blockage,” says dermatologist Dr. Nicole Hayre. “This led to treatments focused on antibiotics and repeated surgical drainage of lesions. Now, we have a better understanding of the disease and recognize it as a chronic inflammatory disease.”

That shift—from infection to inflammation—is more than semantic. It fundamentally changes how HS is treated.

Dr. Sharleen St. Surin-Lord, board-certified dermatologist, echoes this evolution and that the understanding of HS has undergone a fundamental paradigm shift.

“HS was misunderstood and treated as a skin infection, a hygiene problem or a condition that patients somehow brought upon themselves,” she says. “We now understand that HS is a chronic, systemic, immune-mediated inflammatory disease of the hair follicle.”
This means HS is not just about what’s happening on the skin’s surface. It’s a complex condition involving the immune system, inflammatory pathways and even broader health factors like metabolic disease and hormonal influences.

Moving Beyond Symptom Management

Traditionally, treatment focused on reacting to flares, and while these approaches can still provide relief, they don’t address the root cause.

“The traditional, reactive approach… only addresses surface-level symptoms while the underlying inflammatory disease continues largely unchecked,” says St. Surin-Lord.

Today, treatment goals are more ambitious—and more patient-centered. Instead of simply managing flares, dermatologists aim to:

  • Reduce overall inflammation
  • Prevent new lesions from forming
  • Slow or stop disease progression
  • Minimize scarring and tissue damage
  • Improve quality of life

Understanding the Treatment Landscape

While older treatments still have a role—especially in milder cases—the HS treatment landscape has expanded significantly.

“For milder cases, I begin with topical antibiotics… oral antibiotics… and an anti-bacterial cleanser,” says St. Surin-Lord, noting that these are often used for their anti-inflammatory effects rather than to treat infection.

  • Hormonal therapies may also be helpful for some patients, particularly when disease activity is influenced by hormonal fluctuations.
  • But for moderate to severe HS, newer approaches are increasingly central.
  • “Most moderate to severe cases are now treated with biologics,” says Hayre. “The biologics work by targeting inflammatory cytokines (cell-to-cell messengers).”
  • These therapies are designed to interrupt the inflammatory signaling pathways that drive HS, rather than simply treating its visible symptoms.
  • St. Surin-Lord adds that the beauty is that we have far more and better treatment and management options than we did just five years ago.
  • And more importantly, treatment is rarely one-size-fits-all. Many patients benefit from a multimodal approach that may include medication, lifestyle changes and, in some cases, procedural interventions like laser therapy or surgery.

Why Inflammation Is the Focus Now

  • One of the most important advancements in HS care is understanding what’s happening beneath the surface.
  • “Visible lesions (nodules, abscesses, tunnels) are the result of a self-perpetuating inflammatory cycle,” says Hayre. “Simply treating lesions… addresses symptoms temporarily, but doesn’t halt recurrence or progression to irreversible scarring.”
  • St. Surin-Lord puts it more plainly: “If we only treat the lesion we can see, we are perpetually chasing the disease from behind.”
  • By the time a flare becomes visible, the inflammatory process has already been underway. That’s why targeting inflammation early—and consistently—is key to preventing long-term damage.

Addressing Scarring and Skin Changes

Even with improved disease control, many patients are left managing the lasting effects of HS—particularly scarring and post-inflammatory pigmentation. And while a growing number of dermatologic treatments can help address these changes, experts emphasize that these approaches should always be considered in consultation with a qualified provider.

“It’s important to talk with a doctor or dermatologist before treating HS, because it can be misdiagnosed and varies widely in severity and even type,” says Golbari. “Some people respond better to hormonal therapy, others may benefit more from a biologic. These nuances can better be worked through with the help of a dermatologist. A professional can help confirm the diagnosis and recommend the right treatment plan for your specific case. Also, many of the most effective treatments require prescriptions and monitoring, so self-prescribing isn’t safe. Early, guided care can also prevent complications like scarring and chronic pain. Overall, medical guidance helps ensure treatment is both safe and effective long-term.”

For patients whose disease is under control, that guidance may also extend to addressing visible skin changes—something that can have a meaningful impact on confidence and overall quality of life.

“Because of the inflammation cascade caused by HS, there is most often some post-inflammatory hyperpigmentation and also scarring present,” says Lisa Goodman, founder and CEO of GoodSkin Clinics. “We do not specialize in treating HS as a primary condition, but we do specialize with advanced biostimulators and laser treatments to address scarring.”

These approaches can include a range of technologies and regenerative treatments aimed at improving skin texture and tone after inflammation has been brought under control.

“We combine modalities often to give the most superior result,” Goodman adds, noting that treatments may include options like biostimulators, fat-derived injectables and targeted laser therapies.

While these interventions don’t treat the underlying disease, they can play an important role in helping patients address the visible—and often emotionally complex—after-effects of HS, particularly when pursued as part of a broader, dermatologist-guided treatment plan.

How Treatment Plans Are Personalized

No two HS cases are exactly alike, which is why treatment decisions are highly individualized. “Dermatologists will assess the patient’s disease severity, duration and impact of the disease on the patient’s lifestyle,” says Hayre. But clinical severity is only part of the picture. St. Surin-Lord emphasizes a broader, more holistic approach: “We must move from simply prescribing with our pads, to taking the entire patient’s life into consideration.” That can include:
  • Lifestyle factors like smoking and stress
  • Diet and its role in inflammation
  • Coexisting conditions, such as PCOS or inflammatory bowel disease
  • Pain levels and daily functioning
  • Emotional and psychological impact
Timing also matters. Waiting too long to escalate treatment can allow the disease to progress.
“Early intervention with effective therapy in high-burden or rapidly progressive disease can mean the difference between a patient who maintains function… and one who develops extensive scarring that no future therapy can fully reverse,” she says.

Living With HS Today

Despite advances, HS remains a chronic condition without a cure. But the outlook for patients is far more hopeful than it once was.

“Fortunately, our understanding of the disease has led to new treatments which have been a game-changer, especially for those with severe forms of HS,” says Hayre.

For some, lifestyle changes that reduce systemic inflammation can also play a meaningful role in managing symptoms. Equally important is addressing the stigma that has long surrounded the condition.

“I want patients to hear this clearly: HS is not your fault. It is not caused by poor hygiene. It is not simply infected skin,” says St. Surin-Lord. “It is a complex, genetically influenced, immune-mediated disease.”

That misunderstanding has real consequences—from delayed diagnosis to emotional distress.

“The psychological burden of HS—the anxiety, the depression, the social withdrawal, the impact on intimacy and relationships—is real, documented and deserving of direct clinical attention,” she adds.

 

A More Hopeful Future

What dermatologists want patients to understand today is that HS care has entered a new era—one defined by deeper understanding, more targeted treatments and a more holistic view of health.

While there is still no cure, remission is increasingly seen as a realistic goal for many patients.

And perhaps most importantly, the focus has shifted from simply reacting to symptoms to proactively managing the disease—improving not just skin outcomes, but overall quality of life.

“A good HS treatment plan addresses the whole person, not just the skin,” St. Surin-Lord says.

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