Is there a cure for hidradenitis suppurativa?

There is no definitive cure, but modern treatment - biologics, laser hair removal and targeted surgery - can bring most patients into long remission with far fewer flares. The goal is disease control, comfort and prevention of scarring.

Will private insurance fund biologics like adalimumab or secukinumab?

Both adalimumab (NICE TA392) and secukinumab (NICE TA935) are approved for moderate-to-severe HS on the NHS. Private medical insurers vary: some cover biologics for HS, others exclude them or route you back to the NHS pathway. We check funding before you commit.

Does smoking really make HS worse?

Yes. Smoking is one of the strongest modifiable drivers of HS flares and severity. Stopping does not always clear the disease, but it consistently improves response to every other treatment. It is the single most useful thing most patients can do.

How much does weight loss help?

Weight loss reduces mechanical friction and hormonal drivers, and often lowers flare frequency. It rarely resolves established disease on its own but improves biologic response and surgical outcomes. We treat it as part of the plan, not a prerequisite.

Will surgery leave a large scar?

Deroofing leaves a shallow open wound that heals by secondary intention with a soft, flat scar - often better cosmetically than the sinus tracts it replaces. Wide excision for Hurley III leaves larger scars but usually ends recurrent abscesses in that area. Your surgeon will show you photographs of realistic outcomes before you consent.

Can laser hair removal really reduce HS flares?

Yes. Nd:YAG or diode laser hair removal in affected areas reduces recurrence by roughly 30–50% in published series, because HS starts in the terminal hair follicle. It is most useful in Hurley I–II disease and as maintenance after surgery or during biologic therapy.

Consultant dermatology · London

Hidradenitis suppurativa (HS) clinic - London.

HS is painful, under-recognised and often misdiagnosed for years. Our private London clinic brings together consultant dermatology, biologics, laser hair removal and reconstructive surgery so you get control, not another course of antibiotics.

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What HS is

A chronic inflammatory disease of the hair follicle.

Hidradenitis suppurativa (also called acne inversa) is a chronic inflammatory disease of the terminal hair follicles in apocrine-rich skin - the armpits, groin, buttocks, and under the breasts. It causes recurrent painful nodules, abscesses, tunnelling sinus tracts, fistulas and, over time, thick rope-like scarring.

Severity is described using the Hurley stages: Hurley I is mild disease with isolated nodules and abscesses and no scarring; Hurley II is moderate disease with recurrent lesions and limited sinus tracts; Hurley III is severe, with diffuse involvement, multiple interconnected tracts and extensive scarring. Most patients we see have lived with HS for eight to ten years before getting a firm diagnosis.

Causes

Multifactorial, and not caused by poor hygiene.

HS is driven by a combination of genetic susceptibility, smoking, obesity, hormonal factors, mechanical friction and follicular occlusion. Roughly one in three patients has a first-degree relative with the disease. Despite a stubborn public myth, HS is not caused by being unclean. Aggressive washing usually makes things worse, not better.

Assessment

A proper dermatology work-up.

Your first appointment is a specialist dermatology examination. We confirm the diagnosis, stage the disease using the Hurley system and the International Hidradenitis Suppurativa Severity Score (IHS4), and measure quality-of-life impact with the DLQI. We also screen for common comorbidities that quietly go with HS: inflammatory bowel disease, metabolic syndrome, spondyloarthropathy and depression. Treating those alongside the skin often makes as much difference as the biologic.

Treatment ladder

From first-line to biologics to surgery.

First-line

Topical clindamycin lotion, an antiseptic wash such as chlorhexidine or benzoyl peroxide, weight loss where relevant, smoking cessation, and avoiding tight friction-heavy clothing. We also treat the day-to-day pain properly, which is often overlooked.

Second-line - oral antibiotics

Long-term oral doxycycline or lymecycline for their anti-inflammatory effect, or a clindamycin plus rifampicin combination for ten to twelve weeks in moderate disease. Antibiotics here work by damping inflammation, not by treating an infection.

Third-line - biologics

For moderate-to-severe disease that has not responded to antibiotics, biologics are now the standard of care. Adalimumab (Humira) at 40 mg weekly is NICE-approved (TA392). Secukinumab (Cosentyx) received NICE approval (TA935) in 2024. Guselkumab (Tremfya), risankizumab, upadacitinib and bimekizumab are in active trials and available on a case-by-case basis. We manage biologic initiation, screening bloods, TB testing and follow-up in-house.

Surgery and laser

For established sinus tracts, deroofing is a minimally invasive procedure that lays open the tract and lets it heal flat. Wide local excision with healing by secondary intention or split-skin grafting is used for Hurley III. The STEEP procedure (skin-tissue-sparing excision with electrosurgical peeling) preserves more healthy tissue than traditional excision. Nd:YAG or diode laser hair removal to affected sites reduces recurrence by around 30 to 50% and is often used alongside biologics.

Indicative cost

What private HS care costs in London.

Item	Indicative range
Initial dermatology consultation	£280–£450
Long-term oral antibiotics (per month)	£25–£60
Adalimumab (biosimilar, per month)	£680–£950
Secukinumab (per month)	£1,200–£1,600
Surgical deroofing (per lesion)	£2,400–£4,500
Laser hair removal (6–8 sessions)	£1,200–£2,400

Ranges are indicative and vary by clinic and consultant. We confirm firm quotes before you commit.

Where we refer

Specialist London HS services.

Chelsea and Westminster Private HS Clinic - one of the longest-running dedicated services in the UK.
HCA Wellington Dermatology - multidisciplinary biologic and surgical pathway.
King's Private Dermatology - academic HS interest, trials access.
Cadogan Clinic HS Service - dermatology plus reconstructive surgery in one site.
HS UK - the national patient support charity, useful for peer support alongside clinical care.

Frequently asked

What patients ask us about HS.

Is there a cure for hidradenitis suppurativa?

There is no definitive cure, but modern treatment - biologics, laser hair removal and targeted surgery - can bring most patients into long remission with far fewer flares. The goal is disease control, comfort and prevention of scarring.
Will private insurance fund biologics like adalimumab or secukinumab?

Both adalimumab (NICE TA392) and secukinumab (NICE TA935) are approved for moderate-to-severe HS on the NHS. Private medical insurers vary: some cover biologics for HS, others exclude them or route you back to the NHS pathway. We check funding before you commit.
Does smoking really make HS worse?

Yes. Smoking is one of the strongest modifiable drivers of HS flares and severity. Stopping does not always clear the disease, but it consistently improves response to every other treatment. It is the single most useful thing most patients can do.
How much does weight loss help?

Weight loss reduces mechanical friction and hormonal drivers, and often lowers flare frequency. It rarely resolves established disease on its own but improves biologic response and surgical outcomes. We treat it as part of the plan, not a prerequisite.
Will surgery leave a large scar?

Deroofing leaves a shallow open wound that heals by secondary intention with a soft, flat scar - often better cosmetically than the sinus tracts it replaces. Wide excision for Hurley III leaves larger scars but usually ends recurrent abscesses in that area. Your surgeon will show you photographs of realistic outcomes before you consent.
Can laser hair removal really reduce HS flares?

Yes. Nd:YAG or diode laser hair removal in affected areas reduces recurrence by roughly 30–50% in published series, because HS starts in the terminal hair follicle. It is most useful in Hurley I–II disease and as maintenance after surgery or during biologic therapy.

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