Imagine waking up every morning with deep, throbbing pain in your armpits, groin, or under your breasts-not from an injury, not from infection you can see, but from something inside your skin that won’t go away. For over 1 in 50 people, this isn’t imagination. It’s hidradenitis suppurativa (HS), a chronic, misunderstood skin disease that turns everyday movement into agony. The bumps aren’t pimples. They’re deep, inflamed nodules that burst, scar, and connect under the skin like tunnels. And until recently, doctors had little more than antibiotics and surgery to offer.

What Exactly Is Hidradenitis Suppurativa?

HS isn’t caused by poor hygiene, shaving, or diet alone. It starts when hair follicles get blocked-thanks to thickened skin cells and excess oil-triggering a chain reaction. Your immune system goes into overdrive, attacking the area like it’s under siege. This isn’t just a skin problem. It’s a full-body inflammatory condition, linked to higher risks of heart disease, arthritis, and depression.

It hits women three times more often than men, usually between ages 20 and 29. You’ll find the worst lesions where skin rubs together: armpits, inner thighs, groin, under the breasts, and sometimes the buttocks. The pain is constant. The smell can be overwhelming. Many people avoid social events, gyms, even intimate relationships because of it.

Doctors use the Hurley staging system to measure severity:

• Stage I: Isolated abscesses, no scarring or tunnels
• Stage II: Recurrent abscesses with tunnels forming under the skin
• Stage III: Widespread, connected tunnels and severe scarring

Biologics are now the go-to for Stage II and III. But they weren’t always an option.

How Biologic Therapy Changed the Game

Before 2015, HS treatment was a cycle of frustration: antibiotics for a few weeks, flare-up again, surgery to cut out the damaged tissue, then repeat. Many patients ended up with large scars, chronic pain, and zero hope.

Then came adalimumab (a fully human monoclonal antibody that blocks TNF-alpha, a key inflammatory protein, Humira). Approved by the FDA in March 2015, it was the first drug ever shown to reliably reduce HS flare-ups. In clinical trials, nearly half of patients saw at least half their lesions clear within 12 weeks-compared to just a quarter on placebo.

Since then, two newer biologics have joined the fight:

• secukinumab (targets IL-17A, a cytokine driving inflammation in HS, Cosentyx)-approved in February 2024
• bimekizumab (blocks both IL-17A and IL-17F, two inflammatory signals, BIMZELX)-approved in June 2024

These aren’t just new names. They’re more powerful. In the BE HEARD I trial, bimekizumab cleared 66.9% of patients’ lesions by week 16-far outpacing adalimumab’s 41.8%. Secukinumab showed even better long-term results: 56.4% of patients still responding after a full year, compared to 48.7% on adalimumab.

How Do These Drugs Actually Work?

Biologics are like precision missiles. Unlike antibiotics or steroids that blanket the immune system, they target one specific inflammatory signal.

Adalimumab shuts down TNF-alpha, the body’s main alarm bell for inflammation. It’s given as a weekly or every-other-week injection. Patients often see improvement in 4-8 weeks.

Secukinumab goes after IL-17A, a protein that recruits other immune cells to attack the follicle. It’s injected at 300 mg weekly for five weeks, then every four weeks. Many patients report dramatic pain reduction within days.

Bimekizumab is the most advanced so far-it blocks both IL-17A and IL-17F. Why does that matter? Because both signals are active in HS. Blocking just one leaves the other running. Bimekizumab cuts both off, which is why it shows the highest response rates.

Each drug is given as a subcutaneous injection-like insulin shots. You learn to give them to yourself, usually in the thigh or abdomen. No hospital visits. No IV drips.

Real Results: What Patients Are Actually Experiencing

Numbers on paper don’t tell the full story. Look at patient reports:

• On MyHSteam, 68% of users on adalimumab said their painful nodules dropped significantly within 8-12 weeks.
• On Reddit’s r/hidradenitis, 56% of secukinumab users called their improvement “dramatic” within four weeks.
• A 2023 survey of 452 HS patients found quality of life scores improved by over 50% after starting biologics.

But it’s not perfect.

42% of adalimumab users reported redness or itching at the injection site. One in three stopped treatment because of cost. One in four got upper respiratory infections. And biologics don’t fix scars-only new inflammation.

That’s why experts say: start early. Once tunnels and deep scars form, biologics can’t undo them. Surgery might still be needed. But if you catch HS before Stage III, biologics can stop it cold.

Cost, Insurance, and the Hidden Barriers

These drugs work-but they’re expensive.

• Adalimumab: $5,800 per month
• Secukinumab: $6,200 per month
• Bimekizumab: $6,900 per month

That’s without insurance. Even with coverage, out-of-pocket costs can hit $1,200 a month. Medicaid patients face approval rates as low as 45%, while those with private insurance get approved 82% of the time.

Most drugmakers offer patient assistance programs. Some reduce costs to $0 for qualifying incomes. But navigating them takes time-and many patients don’t know where to start.

There’s another hidden cost: time. You need regular blood tests for TB, hepatitis, and heart risks before starting. Then you’re monitored every 12 weeks. If you don’t respond by week 12, your doctor may switch you to another biologic. That’s a lot of appointments.

Who Benefits Most-and Who Doesn’t

Not everyone responds the same way.

Best candidates:

• Stage II or III HS with active nodules and abscesses
• Patients who failed antibiotics, hormonal therapy, or lifestyle changes
• Those with high inflammation markers (CRP, ESR) or signs of systemic inflammation

Less likely to respond:

• Stage III patients with heavy scarring and deep sinus tracts
• Smokers (tobacco cuts biologic effectiveness by nearly half)
• People with uncontrolled obesity or untreated diabetes

One key insight: biologics don’t just heal skin. They improve your bloodwork. Early responders show a 15% drop in triglycerides and an 8% rise in HDL (“good”) cholesterol. That’s not a side effect-it’s proof the drug is calming your whole body’s inflammation. And that means lower risk of heart attacks and strokes down the line.

What’s Coming Next?

The pipeline is full. Three new biologics are in late-stage trials:

• Guselkumab (targets IL-23)-58.3% response rate in early trials
• Spesolimab (targets IL-36)-52.7% response rate
• TAK-279 (TYK2 inhibitor)-55.1% response rate

And researchers are getting smarter. A 2024 study identified a 12-gene signature that predicts who will respond to adalimumab-with 84.7% accuracy. Imagine a simple blood test telling you which drug will work before you even start.

Combination therapy is also on the rise. One 2024 study found that combining bimekizumab with surgical removal of scarred tissue boosted response rates to 89.2%-far beyond either treatment alone.

What You Can Do Right Now

If you’re living with HS:

1. See a dermatologist who knows HS. Not all do. Ask if they’ve treated HS with biologics.
2. Get staged. Know if you’re Stage I, II, or III. That determines your options.
3. Stop smoking. It makes biologics less effective and worsens scarring.
4. Manage your weight. Even a 5-10% loss reduces flare-ups.
5. Ask about financial help. Drug companies have programs. Nonprofits like the HS Foundation can guide you.
6. Start early. The longer you wait, the more damage builds. Biologics prevent new lesions-they don’t erase old ones.

HS isn’t curable yet. But it’s no longer untreatable. What used to be a life sentence of pain and isolation is now a manageable condition-with the right tools and timing.

For thousands, biologics have meant returning to work, wearing shorts again, sleeping through the night, and feeling like themselves for the first time in years. That’s not just medicine. That’s life restored.