Without treatment, the natural progression of HS is typically chronic and progressive (Micheletti, 2014).
Without treatment, more painful nodules, abscesses and tunnels may develop under the skin, draining malodourous material.
Deep abscesses may join together and form chronic, draining sinus tracts that may lead to scarring and extension into deeper tissue (Micheletti, 2014).
Anyone can choose to not receive treatment for their HS.
Those who rapidly progressed from Hurley stage I to II, as they may likely progress to Hurley stage III (Vanlaerhoven, Ardon, van Straalen, Vossen, Prens, & van der Zee, 2018). Those who are in pain and discomfort, unable to perform usual daily activities or feeling down and depressed due to their HS.
Level of evidence: Not available.
Strength of recommendation: Not available.
Among 156 HS patients who completed a survey investigating the natural history of HS, the average disease duration was nearly 19 years, with 90% of patients having experienced symptoms within the past year. In particular, painful boils occurred for an average of about 1 week, with 62% of patients having reported persistence (von der Werth & Williams, 2000).
In another study involving 129 HS patients, the following follow-up survey results were reported:
Serious: Psychological distress, sinus tract formation, scarring (Micheletti, 2014) (Micheletti, 2014; Smith, Nicholson, Parks-Miller, & Hamzavi, 2017).
Other: Pain, drainage (Micheletti, 2014).
Pregnancy risk according to the U.S. Food and Drug Administration (FDA):
Untreated HS may interfere with daily life and overall life quality, as it is currently one of the most distressing of all dermatological diseases (von der Werth & Williams, 2000).