Topic 4: Progression Is Possible, Not Inevitable

HS does not follow one uniform trajectory. Some patients experience persistent or worsening disease, while others improve or enter remission. A 2026 prospective community-based cohort followed 107 participants for approximately 10 years. Among those with nonsevere disease at baseline, 13.0% progressed to severe disease; across all participants, 63.6% experienced full remission as defined by no active symptoms for at least six months at follow-up.⁴

The cohort was observational, not an untreated natural-history study: HS care and treatment occurred during follow-up, and treatment exposure was not standardized. The reported outcomes therefore reflect baseline severity, management received over time, and the variable course of HS; remission was more common with nonsevere baseline disease and should not be interpreted as spontaneous recovery, cure, or a guaranteed individual outcome.^4,5

Compared with hospital-based populations, the study found substantially less progression and more remission. These findings support balanced counseling: progression is possible but not inevitable, and remission is possible but not promised. Continued assessment and appropriate management remain important.