Botulinum toxin prevents vesicle fusion at nerve terminals thereby inhibiting neuropeptide release. The investigators will collect punch biopsies of lesional skin from HS patients before, and 1-2 months after botulinum toxin treatment (50U per axilla in 10 injections of 0.1mL) then perform flow cytometric, transcriptomic, and microscopic analysis of skin to determine if nonselective inhibition of neuropeptide release diminishes IL-17 driven skin inflammation. The investigators will also assess association between skin inflammation and clinical disease activity, HS-associated itch and pain, and HS-associated quality of life.
This mechanistic observational study will build on data from humans implicating TRPV1 nociceptors in the pathogenesis of the Type-17 chronic inflammatory skin disease Hidradenitis Suppurativa (HS). In this study, the investigators will test the hypothesis that inhibiting neuropeptide activity with botulinum toxin reduces pathogenic IL-17 inflammation, relieves pain, and improves quality of life for HS patients.