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It was called other things in other era's and its not well understood mainly due to what are call comorbid conditions that we all have different flavors of. Diabetics see these problems too when they tilt way out of control for too long. Other conditions, like IBS and gut related things too can cause similar symptoms and as far as diagnosis goes. Eyeballs and brains really didn't start taking a larger look into this problem until recent years and if you follow the JAAD and other publications it wasn't until very recent years that its gotten some PR and larger awareness. The comorbid stuff, lets take diabetes as an example... did the diabetes cause it and its the real problem? Antibiotics were a bit of mixed result for me. For many decades they were a near daily part of my life. Decades alongside other trials, drugs, misdiagnoses of other conditions I did not have and such. They have their place if there is infection, but months of them do damage to your gut. Not recommended, unless there is a real need and that need is active infection, imho. They can flare without infection too, those heal very well. That gut damage from treatments and antibiotics and the types and quantities of things you stick in there caused me to develop celiac disease and other food allergies I never grew up with during my struggles with HS. That was as bad if not worse than the HS. I dealt with that for nearly 2 decades before kicking that out of my life. You need to be eating extremely healthy and avoid processed, baked and junk foods. They can be a now and then, but shouldn't be a large input. Get the variety of many things from fruits, nuts, veggies, proteins, yogurts and fermented stuff, and mostly eat things close to fresh and not massively processed where they come from cans, packets, and plastic wraps, and box's and fast food and junk food types of things. Take at least a decent gut restore probiotic in-between antibiotic doses to try to maintain health. Personally for me, it also came down to overcoming social norms and denial about things like alcohol (daily drinking is bad for me, a round or two a week is all fine) and smoking if you do. Those two things, for me, had an enormous impact and influence over my control and how often and bad I flared. Those are comorbid problems too. So is -> The mental load and the stress... get control of that. Those stress hormones arre also a body wide systemic feeder and influence on inflammatory pathways. I struggle with that still and how my engineer and scientist mind obsesses and ruminates on things for weeks on end. If you don't have some turmeric supplements, or say eat curries or certain mexican or other foods regularly, get some. Arnica is good too, alongside things like Ibuprofen for taming some of the things in our bodies that infliuence and feed inflammation. Like taking aspirin for a mild headache or to thin your blood some. Some daily input that, I get it in foods and a supplement when I feel I am thickening and inflaming systemically. Some folks can't take ibuprofen, so don't do that if that applies you, but know there are many other options you can get from the grocery store or pharmacy. For the active flares, aside maybe a steroid topical or alongside. Try this. I don't like to recommend this stuff often as skin types can be different, but I love these two things. Two vital products for my skin needs in those HS areas and with the stuff left behind to keep it controlled and tame while I get the damage frozen and lasered out over time. These are anchors for me. https://www.amazon.com/Vichy-Normaderm-Phytosolution-Daily-Care/dp/B07NQ8BVXM?th=1 https://www.amazon.com/Eva-Naturals-Niacinamide-Botanical-Hyaluronic/dp/B0FH2TBT74?s=beauty I find its fine to apply this stuff after bathing and maybe again later after wet wiping the area when it feels like it needs help. If its super deep and thick, adapaline can helps get other things to penetrate, its a 3rd gen retinol, and the first one I never had a bad reaction with like previous and other prescription strength retinols. For a time it was a game changer for me, today where I am notso much needed or impact. I found when they flared, it was best to keep the area covered somehow. Thin gauze rolls and pads taped over the area and like loose but snug biker style underwear, along with sorta briefs sometimes too. Groins and back to the farside crack are easy. Armpits.. ugh. Those are hard and that's where my problem was most prevalent. Ears too, those can be hard, especially if you sleep on that side. The struggle tends to be different for all of us, as our lives are different and we live in different weather conditions, eat different things, etc. It will be many micro changes. If something helps, keep it in rotation, make it a habit. if it doesn't, toss it after a few months and move on. I wish you well.