Long-Term Course of HS Disease More Favorable Than Previous Estimates

In new follow-up data from a large community cohort, findings suggest hidradenitis suppurativa (HS) may have a far more favorable long-term course than hospital-based studies have often suggested.1

Rune Kjærsgaard Andersen, MD, PhD, and a team of other investigators had set out to explore whether progression and remission rates of HS are the same in community settings and hospital settings. The investigators also wrote this prospective cohort study to identify any baseline factors linked with HS remission and progression to severe disease.

Andersen et al pointed to most HS prevalence and severity estimates originating from tertiary care; therefore accurate representation of the broader HS population was seen as essential. Prior data suggest 22% of those with HS develop severe disease within only 2 years, though this statistic’s reflection on the entire HS community had been unclear prior to the current analysis.2

“To compare discrepancies between hospital and community cohorts, we performed a 10-year follow-up study of a municipality-based HS cohort focusing on HS progression and remission rates,” Andersen and coauthors wrote.1

Study Design and Findings

In this study, Andersen and coauthors presented a follow-up assessment of HS severity within an unselected, municipality-based cohort originally drawn from GESUS in the period between January 2010 - October 2013. GESUS invited every individual within Denmark's Næstved municipality in Denmark who was at least 20 years old. There were 21,205 who participated as participated.

During each participant's initial visit, the investigative team asked them to full out a paper questionnaire inquiring about well-being, health status, depressive symptoms, and dermatologic screening information. Each of the subjects also underwent a physical evaluation. In early 2023, those who had screened positive for HS during the baseline period were informed and asked to complete a follow-up survey.

Andersen and colleagues' aim in conducting this follow-up was to determine rates of HS progression and remission, as well as to evaluate any baseline demographic qualities found to be associated with changes in HS activity. They categorized HS severity at both time points as mild, moderate, or severe via a modified Hurley staging system. Additionally, Andersen et al determined the proportion of subjects whose HS progressed to severe, as well as the proportion attaining remission.

Cox proportional hazards models were also implemented by the investigative team with the aim of evaluating any baseline demographic factors showed a link with shifts in severity by 2023. The team's data analysis took place from March 2024 - September 2025.

There were 107 individuals with HS who the investigators included in the analysis.1 These subjects were 82.2% female and 17.8% male, with a mean (SD) age of 47.1 (8.8) years. During the time of enrollment, 53.3% were found by the team to have mild disease, 18.7% with moderate disease, and 28.0% with severe disease. Over the follow-up interval, 16.9% of patients showing non-severe HS reported disease progression. They also found 13.0% advanced to severe disease.

Overall, Andersen and coauthors' findings suggested 71.0% of all individuals showed some degree of HS regression and 63.6% attained a complete level of HS remission.1 When broken down by original severity, the investigators found full remission had been achieved by 73.7% of participants with mild HS, 60.0% of participants with moderate disease, and 46.7% of those with severe disease. In their Cox regression analysis, the investigative team did not identify any baseline demographic predictors of shifts in severity at follow-up.

The findings suggest that hospital-based estimates may have exaggerated the likelihood of HS worsening and underestimated the frequency of the skin disease's remission.1 In this community sample, the team found risk of progression to severe HS was 10.4 times lower, and remission took place 3.8 times more often, compared with rates typically observed in hospital settings.

“Limitations were HS case definition and severity staging that relies on self-reported information; remission defined as a symptom-free period of 6 months; a single follow-up time (which may not account for the fluctuating nature of HS); and a relatively low participation rate,” the team concluded.1

References

1. Kjærsgaard Andersen R, Pedersen OBV, et al. Hidradenitis Suppurativa Remission and Progression in a Community Setting. JAMA Dermatol. Published online November 26, 2025. doi:10.1001/jamadermatol.2025.4700.

2. Kokolakis G, Wolk K, Schneider-Burrus S, et al. Delayed diagnosis of hidradenitis suppurativa and its effect on patients and healthcare system. Dermatology. 2020;236(5):421-430. doi:10.1159/000508787.