Hidradenitis suppurativa (HS) does not go away permanently. It is a chronic, relapsing inflammatory skin condition with no known cure. However, many people experience long stretches of reduced or inactive disease, and certain life changes, treatments, and surgical approaches can dramatically lower how often and how severely flares occur. Some people reach a point where the disease is effectively quiet for years at a time.
Why HS Doesn’t Fully Resolve
HS is driven by a cycle of inflammation and structural changes beneath the skin, primarily in areas with a high concentration of sweat glands: the armpits, groin, buttocks, and under the breasts. The process starts with blocked hair follicles that rupture below the skin surface, triggering an immune response. Over time, this can create tunnels (sinus tracts) and scarring that make the affected tissue more prone to future flares, even after successful treatment.
The chronicity of HS is one of its defining features. A diagnosis technically requires recurrent lesions in these characteristic locations over at least six months. That said, “chronic” doesn’t mean “constantly active.” Many people cycle between flares and quieter periods, and the goal of treatment is to extend those quiet periods as long as possible.
What Remission Looks Like
In a long-term follow-up study of 121 patients tracked over an average of 22 years, 39% reported reaching remission, 32% reported improvement, 21% had unchanged severity, and only 9% experienced worsening. So roughly seven in ten people saw their disease get better or go quiet over time.
Remission in HS typically means no new painful nodules or abscesses forming, though scarring from previous flares may remain. It is not the same as being cured. Flares can return after months or years of quiet, sometimes triggered by stress, hormonal shifts, friction, or dietary factors. Still, for the roughly 46% of patients who have mild (Hurley stage I) disease, the severity tends to stay stable for a median of nine years, suggesting that many people with early-stage HS will not progress to more severe forms.
Hormonal Changes and Menopause
HS has a strong hormonal component, which is one reason it disproportionately affects women and typically begins after puberty. Many women notice flares worsening in the days before menstruation, when estrogen and progesterone levels shift. Pregnancy often brings temporary improvement.
Menopause frequently leads to significant improvement or near-resolution of symptoms. After menopause, the apocrine sweat glands shrink and produce less secretion, which reduces the likelihood of the duct blockages that initiate flares. This is one of the most common natural pathways to long-term quiet disease, though it is not guaranteed for every woman, and HS can occasionally persist or even develop after menopause.
Treatments That Reduce Flares
The most studied biologic medication for HS produced meaningful clinical improvement in about 42% to 59% of patients in major clinical trials at 12 weeks, compared to roughly 26% to 28% on placebo. In a smaller real-world study, 63% of patients achieved a clinical response by 24 weeks. These numbers reflect significant improvement, not necessarily complete clearance, but for many people the reduction in painful nodules is substantial enough to change daily life.
Metformin, a medication more commonly associated with blood sugar management, has shown promise as well. In a study of 25 patients who hadn’t responded to standard treatments, 72% showed clinical improvement over 24 weeks. A separate analysis of 53 patients found that 68% responded to treatment, and about 19% of those responders achieved complete clearance of active lesions. These results are encouraging, particularly for patients who also have insulin resistance or polycystic ovary syndrome, conditions that frequently overlap with HS.
Surgery and Recurrence Rates
For people with persistent tunnels or scarred tissue that keeps flaring, surgery offers the most direct path toward long-term control in those specific areas. Wide excision, which removes the entire affected zone of skin, has an average recurrence rate of about 10%. A large study of 206 surgical procedures found an overall recurrence rate of 18.5%, with some of those recurrences being new inflammatory nodules in nearby tissue rather than true failure of the original surgery.
Healing after wide excision can take weeks to months, especially when the wound is left open to heal gradually from the bottom up. This approach is slower but associated with lower recurrence rates than closing the wound immediately. Less extensive procedures like deroofing, where the roof of a tunnel or abscess is removed, are quicker to heal but may carry higher recurrence rates depending on the extent of the disease.
Surgery doesn’t cure HS systemically. It removes damaged tissue in a specific area, but new flares can develop elsewhere. Many people find that combining surgery with ongoing medical treatment gives the best long-term results.
Lifestyle Factors That Make a Difference
Smoking is one of the strongest modifiable risk factors for HS. A large Korean study of over six million people found that quitting smoking lowered the risk of developing HS, and that after about three to four years of sustained cessation, the risk dropped to levels similar to people who had never smoked. For people who already have HS, quitting won’t reverse existing damage, but it reduces the inflammatory burden that drives new flares. Notably, people who quit and then resumed smoking showed no benefit compared to continuous smokers.
Weight loss has a more complicated relationship with HS. While obesity is a known risk factor and mechanical friction worsens flares, bariatric surgery results have been mixed. In online patient reports, only 29% described improvement or remission after weight loss surgery, and 69% actually reported worsening symptoms due to increased skin folds. Among those who had excess skin surgically removed afterward, 26% then saw improvement. Weight loss may help, but the physical changes it creates in skin folds can temporarily make things worse.
Dietary Changes
Certain foods appear to trigger flares in a subset of patients. In one study, 83% of 47 patients on a dairy-free diet experienced clinical improvement. Patients most commonly identified sweets (68%), bread and pasta (51%), and dairy products (51%) as foods that worsened their symptoms. A separate line of research found that among 37 patients who eliminated brewer’s yeast from their diet (found in beer, some breads, and fermented products), 70% reported improvement, with 87% experiencing a flare within a week of reintroducing yeast.
These dietary studies are small and mostly observational, so they don’t prove cause and effect for every patient. But the pattern is consistent enough that an elimination approach, removing one suspected trigger at a time for several weeks, is a low-risk strategy worth trying. Many dermatologists now consider dietary modification a reasonable addition to a broader treatment plan.
The Realistic Outlook
HS is a condition you manage rather than one you eliminate. But “managing” it can range from constant, painful flares to years of quiet skin, depending on the severity, your response to treatment, and the lifestyle factors you’re able to address. Most people with mild disease stay mild. Hormonal shifts like menopause can bring lasting relief. Biologics, metformin, targeted surgery, smoking cessation, and dietary changes each offer a meaningful chance at reducing flare frequency and severity. For many people, the combination of these tools brings the disease close enough to silent that it no longer dominates daily life.