I never imagined that a skin disease could take over my life the way hidradenitis suppurativa has. My journey with HS began 8 years ago, when painful nodules first appeared in my groin and axillary areas. At first, I tried to convince myself that it was ‘just a few boils’, something temporary that would go away with a bit of care. But HS did not go away. It grew with me, around me and inside every part of my routine, every plan, every emotion. I have lost count of the number of antibiotic cycles I have taken over the years. During the first 3 years after diagnosis, I was treated almost continuously with different antibiotics. Each new prescription made me feel hopeful. I imagined that this time the pain would disappear for good, that the swelling would calm down, that I would be able to move without fear of a new flare. But after so many rounds, the hope that antibiotics alone could help slowly faded. The disease always came back, often stronger than before. HS began to interfere with my daily life in concrete ways. I missed several days of work because walking was too painful or because dressings were soaking through my clothes. I stopped going to the gym and avoided social gatherings for fear that someone would notice the smell of drainage or the stains on my clothes. I cancelled dinners with friends and even family events because I could not sit comfortably or because I felt ashamed of my body. Surgery was supposed to be a turning point. Between the fourth and sixth year of disease, I underwent three operations, each one with the promise of a fresh start. I put all my expectations into those procedures, believing they would free me from the constant pain. But none of them solved the problem. The wounds healed, but new lesions kept appearing elsewhere. It felt like trying to put out a fire with my bare hands. Then came the biologics. First adalimumab, which I used for about 1 year. I was told it could change everything. For a while, I dared to imagine a different life. But it did not work for me. Then secukinumab, for another year, with the same expectations and the same disappointment. When treatments fail one after another, it is not only your skin that hurts. Something inside you breaks. ‘NON NE POZZ CCHIÙ’ (Neapolitan dialect sentence; translation: ‘I can't take it anymore’). I started feeling a deep sadness, a heavy depression that made it difficult to get out of bed, go to work or look at myself in the mirror. My relationships also suffered. Intimacy became almost impossible because of pain and embarrassment. I felt defective, powerless, stuck in a body I could not control. Now I am about to start bimekizumab. It is my last thread of hope, the only therapy that I have not tried yet. I want to believe in it. I need to believe in it. But I am also terrified. What if it fails too? What if nothing can stop this disease? Living with HS means living with constant questions and constant fear. I want a future where the pain does not dictate my day, where I can wear clothes without thinking, move freely and make plans without worrying about draining boils or infections. I want a future where I can go to work without fear, attend a dinner with friends without excuses and feel comfortable in my own body again. I hope bimekizumab can give me that chance. But right now, hope and fear walk side by side. As a physician, listening to this patient's story forces me to confront the real weight of hidradenitis suppurativa—a weight that often goes far beyond what clinical scales and scores can measure. We speak about ‘treatment failure’ in clinical terms, but for patients, each failure is a deeply emotional event. Every unsuccessful antibiotic course, every surgical relapse and every biologic that does not work adds another layer of frustration, fear and fatigue.1 This case reflects a familiar but troubling pattern. Delayed diagnoses, repeated antibiotics over several years and isolated surgeries can create a sense of temporary relief but rarely alter the long-term course of HS.2 When biologics such as adalimumab and secukinumab fail after prolonged use, the psychological impact is immense. Patients begin to wonder if their disease is stronger than anything medicine can offer. This constant fear of failure is one of the most overlooked elements of HS management.3 The burden of HS is not only physical. It affects mental health, mobility, relationships, work, intimacy and self-image. The depression described here is not an accessory to the disease—it is part of the disease. HS reshapes the patient's life, often in silence, and too often without adequate psychological support. Starting bimekizumab represents both a therapeutic opportunity and an emotional crossroads. For the patient, it is a new beginning, but also a reminder of past disappointments. For clinicians, it reinforces the need for early, structured and compassionate care. HS should not be treated in a fragmented way. The patient's journey must be understood as a whole, with coordinated interventions, psychological support and clear communication. This narrative reminds us that treating HS means treating the person, not only the skin. And every step—especially the challenging ones—deserves to be acknowledged with empathy and urgency. None. Claudio Marasca is serving as Junior Editor of JEADV; Salvatore Casillo has no conflicts of interest to declare. Not applicable. Not applicable. Data sharing is not applicable to this article as no new data were created or analysed in this study.
Marasca et al. (Tue,) studied this question.