More people living with hidradenitis suppurativa (HS) are using biologic medications to help manage their symptoms and flares. But what if you need surgery for HS or another health condition? Do you have to stop using your biologic first?

It’s a common question, but the answer isn’t always straightforward. Whether you need to pause your biologic depends on factors such as what type of surgery you’re having and how severe your HS is.

In this article, we’ll look at what the research says about stopping biologics before surgery for HS — and what you should talk about with your doctor.

What Are Biologics?

Biologics are injectable medicines made from living cells or proteins. These drugs target specific parts of the immune system involved in inflammation, such as tumor necrosis factor (TNF) and interleukin-17 (IL-17). By blocking these proteins, biologics help reduce swelling, pain, and skin damage caused by HS. They’re mostly used for moderate to severe cases, especially when other HS treatments — like topical antibiotics, corticosteroids, or hormone therapy — haven’t worked well.

Biologics for Hidradenitis Suppurativa

As of August 2025, three biologic drugs have been approved by the U.S. Food and Drug Administration (FDA) to treat moderate to severe HS:

• Adalimumab (Humira) — Approved for HS in 2015, this drug blocks TNF, a protein involved in inflammation. Adalimumab is also used to treat conditions like rheumatoid arthritis and Crohn’s disease.
• Secukinumab (Cosentyx) — Approved in 2023, secukinumab targets IL-17A, a protein linked to skin inflammation.
• Bimekizumab-bkzx (Bimzelx) — Approved in 2024, this biologic blocks both IL-17A and IL-17F, offering a two-pronged approach to reducing inflammation.

Some doctors may prescribe other biologics off-label for HS. This means the medicine is FDA-approved for a different condition but may also help people with HS. Examples include infliximab (a TNF blocker) and ustekinumab (which blocks IL-12 and IL-23). Doctors may consider these options when the approved biologics haven’t helped or aren’t available.

How Might Biologics Cause Problems After Surgery?

Biologics calm the immune system, which helps reduce HS symptoms and boosts quality of life. However, because the immune system is also responsible for healing wounds and fighting infections, some researchers have questioned whether biologics could slow recovery after surgery. Possible risks include:

• Infection — A weaker immune system may make it harder for your body to fight off bacteria during the healing process. Some studies suggest a higher chance of infection, especially after major surgeries, when people are taking biologics.
• Slower wound healing — Blocking proteins like TNF, which help repair tissue, may slow down how quickly surgical wounds close.
• Increased bleeding — A 2020 study found that people taking biologics experienced more bleeding during wound healing and took longer to recover. However, the overall rate of complications was similar between those on and off biologics.

Some Research Shows No Additional Risks

One clinical trial looked at people with moderate to severe HS who had surgery in areas like the armpit and groin. About half stayed on adalimumab before and after surgery, and these participants had no higher risk of infection, excessive bleeding, or other complications than the others.

A study of 4,500 people with inflammatory bowel disease also found no added risk of infection. People who took biologics before surgery healed just as well as those who didn’t.

Which Types of Procedures Pose a Concern?

Not all surgeries carry the same risks and worries when you’re taking a biologic. Doctors mostly focus on how large the wound will be and how deep they need to cut.

HS surgeries with smaller wounds — called outpatient or minor procedures — include draining small abscesses or deroofing tunnels (removing the skin over a tract or injury). These surgeries generally heal quickly and rarely get infected. Studies show that people can usually stay on biologics during minor procedures without problems.

Larger surgeries might cause more concern. For example, wide local excision may be used for severe HS, especially around the armpits or groin. Because wide excisions leave larger wounds that heal slowly, there’s a higher risk of infection or slow healing if you’re taking a biologic. The same might apply to surgeries such as breast reduction.

Doctors sometimes recommend pausing biologics a few weeks before a major surgery to boost the immune system during healing.

What Are the Risks of Stopping Biologics?

It might seem safer to stop your biologic before surgery, but doing so can bring its own set of risks — especially if your HS is active. These risks include:

• Flare-ups during recovery — Stopping your biologic could cause your HS symptoms to come back or get worse. This may lead to new abscesses, nodules, or tunnels — potentially in the same area that’s healing from surgery.
• Slower healing — Flare-ups after surgery can mean more pain, leaking wounds, and new scarring. These issues can make it harder for your surgery site to heal properly.
• Loss of treatment response — Stopping treatment for too long may also cause the medicine to stop working as well when you restart. In some cases, the immune system may build resistance to the drug, making it less effective in the future.

Because of these risks, your doctor may recommend staying on your biologic or taking a short pause, depending on your surgery and HS symptoms.

Talk With Your Doctor About Stopping Biologics Before Surgery

Every person with HS is different. That’s why the question “Can I have surgery while on immunosuppressants?” should be discussed with your healthcare team. The answer depends on your unique situation. You and your doctors, including your dermatologist and surgeon, will work together to develop your treatment plan.

Here are some topics to discuss:

• Type of surgery — Minor skin surgeries may not require stopping biologics, whereas major surgeries might need a pause for a few weeks.
• HS severity — If you have severe HS with frequent flare-ups, your doctor may lean toward staying on the biologic to keep your disease calm during recovery.
• Timing — Different biologics work in different ways. Ask, “How long does it take biologics to leave your system?” and “When should I restart?”
• Other treatments — Ask if you’ll be given antibiotics, pain management, or other topical treatments to help manage HS if you’ll be off your biologic therapy.

Also, speak up about any concerns you have. If you’re feeling anxious about infection risks or side effects, tell your dermatology team. Your doctors should help you feel informed and confident going into surgery. Sometimes, just having a clear understanding of your treatment plan can help ease your mind.

Join the Conversation

On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.

Are you considering surgery for HS while taking a biologic? What questions or concerns do you have? Let others know in a comment below.