Abstract
IMPORTANCE: Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological disease with prevalence estimates ranging from 0.1% to 0.5% in clinical settings to 1% to 2% in general populations. While tertiary care data show that 22% of patients progress to severe disease within 2 years, estimates of disease development outside the hospital setting remain unknown. OBJECTIVE: To investigate HS development in a non-hospital-based setting and to identify baseline factors associated with remission and progression to severe disease in the community. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used 10-year follow-up data on HS disease severity among a municipality-based cohort identified via a questionnaire in the Danish General Suburban Population Study conducted from 2010 to 2013. Disease severity (mild, moderate, severe) was determined using a modified Hurley score. Progression (severe disease at follow-up) and remission (no active HS symptoms for 6 months or longer at follow-up) rates were calculated by severity level. Separate Cox proportional hazard regression analyses explored whether baseline demographic variables associated with disease severity at follow-up in 2023 could be used to estimate changes in disease severity. Data analysis was performed from March 2024 to September 2025. MAIN OUTCOMES AND MEASURES: HS remission and progression rates across baseline severity groups as determined at follow-up in January to February 2023. Measures included baseline HS disease severity, body mass index, smoking history, employment status, and number of anatomical areas with active lesions. RESULTS: The analysis included 107 patients with HS (mean [SD] age, 47.1 [8.8] years; 88 female [82.2%] and 19 male [17.8%] individuals). At baseline, 57 patients (53.3%) had mild, 20 (18.7%) had moderate, and 30 (28.0%) had severe disease. During the follow-up period, 16.9% of patients with nonsevere disease progressed (13.0% to severe disease), while 71.0% of all patients experienced regression (63.6% to full remission). Stratified by baseline severity, 73.7%, 60.0%, and 46.7% of patients with mild, moderate, and severe disease, respectively, experienced full remission. Cox regression analyses did not reveal any baseline demographic factors capable of predicting disease development at follow-up. CONCLUSIONS AND RELEVANCE: This cohort study found that estimates from hospital-based cohorts likely overstate HS disease progression and underestimate its remission. In this community-based cohort, HS progression to severe disease was 10.4 times lower and rates of HS remission were 3.8 times higher than reported within hospitals, suggesting a more favorable disease course than previously reported.