Biohacking & Emerging Therapies for HS

Three biologics are now FDA-approved for moderate-to-severe HS: adalimumab (Humira, TNF-α inhibitor), secukinumab (Cosentyx, IL-17A inhibitor), and bimekizumab (Bimzelx, IL-17A/F inhibitor). Additional biologics targeting IL-23, IL-36, and other pathways are in clinical trials. These represent the most significant therapeutic advances in HS treatment in recent years.

Janus kinase (JAK) inhibitors block intracellular signaling pathways (JAK1, JAK2, JAK3, TYK2) that transmit inflammatory signals from cytokines. Several JAK inhibitors approved for other inflammatory conditions (including upadacitinib and tofacitinib) are being studied for HS. Early trial data is promising, particularly for patients who have not responded to biologics.

Since HS originates in hair follicles, laser hair removal (particularly Nd:YAG laser) has been studied as a way to reduce the number of follicles that can become occluded and inflamed. Multiple studies have shown significant reductions in HS lesion counts with laser hair removal in affected areas. This is a well-established adjunctive treatment, particularly for axillary and groin HS.

Photodynamic therapy (PDT) uses a photosensitizing agent applied to the skin followed by light activation to destroy bacteria and reduce inflammation. Blue light therapy (405–420nm) has antibacterial properties against Cutibacterium acnes and other bacteria implicated in HS. Clinical studies have shown variable results. It appears most effective for mild-to-moderate HS.

PRP is derived from the patient's own blood by centrifugation to concentrate platelets and growth factors. When injected into tissue, these growth factors (PDGF, TGF-β, VEGF) stimulate tissue repair and regeneration. Early case reports and small studies suggest potential benefit for HS wound healing and scar tissue, but large randomized controlled trials are lacking.

Research increasingly shows that the skin and gut microbiome influence HS disease activity. Studies have found altered microbiome compositions in HS lesions and in the gut of HS patients. Potential future therapies include targeted probiotics, fecal microbiota transplantation (FMT), and topical microbiome modulators. This is an active and exciting area of HS research.

Artificial intelligence tools are being developed to help patients and clinicians track HS progression, predict flares, and optimize treatment decisions. Applications include image analysis for lesion assessment, wearable sensors for inflammation markers, and machine learning models trained on patient data to identify personalized triggers and treatment responses.

Regenerative medicine approaches using mesenchymal stem cells (MSCs) are being investigated for chronic inflammatory conditions including HS. MSCs have immunomodulatory properties that may help reset dysregulated immune responses. Early preclinical and small clinical studies are underway, but this remains experimental and is not available as a standard treatment.

HBOT involves breathing 100% oxygen inside a pressurized chamber at 2 to 3 times normal atmospheric pressure, increasing oxygen delivery to damaged tissue. Researchers are exploring it for HS because the condition involves chronic inflammation, impaired wound healing, and bacterial biofilms in low-oxygen tissue. Current evidence is limited to small case reports and observational studies, with no large randomized controlled trials confirming HBOT as an effective HS treatment.

LLLT (photobiomodulation) uses precise red and near-infrared laser wavelengths to stimulate cellular repair, reduce inflammation, and support wound healing. Multiple small controlled studies have shown measurable reductions in HS lesion counts with Nd:YAG and diode lasers. It has a stronger evidence base than most biohacking modalities, though it is not yet a standard guideline treatment. Best considered as an adjunct to medical therapy.

Red light therapy uses specific wavelengths of light (630-660nm red, 810-880nm near-infrared) to stimulate healing processes in the body. Researchers believe it may help HS by reducing inflammation, improving blood circulation, accelerating wound healing, and decreasing bacterial growth in affected tissue. Evidence is still developing and it should be considered a supportive therapy rather than a primary HS treatment.