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. Severity was rated using a modified Hurley score. 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 6 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, although none had undergone biologic therapy. The reported outcomes therefore reflect baseline severity, management received over time, and the variable course of HS.4,5
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.
| Balanced message: Do not minimize early disease, but do not predict severe progression for an individual patient. Recognize HS, assess current activity and burden, arrange follow-up, and respond to evidence of persistence or progression. |