Yes. And you should — do not stop.
That is the whole answer, and it belongs at the top, because this question prevents more people from being evaluated than any other. You have finally reached something that holds the disease down. The idea of trading it for a jar of something you have never heard of is not a risk you are prepared to take, and you are right not to be prepared to take it.
Nobody is asking you to. Starting EPOH does not require you to stop anything.
How medication reduction is actually sequenced
There is a specific order, and it does not begin with a withdrawal.
- You begin EPOH while continuing your current medication, at your current dose. Nothing changes on the prescription side. The internal correction runs underneath it.
- The correction is given time to take effect. This is Phase L (Lowering the Load, 4–8 weeks), then Phase I (Internal Healing, 8–16 weeks) — the primary correction phase — with Phase F running alongside. This is where gut lining integrity, microbiome repair, immune recalibration and hormonal patterns are actually worked on.
- When there is something real to review, the medication is reviewed — with your prescribing physician. Not with us instead of them. With them. What we can contribute is a clinical account of what has changed internally. What they contribute is the authority and the monitoring to alter a prescription safely.
- If reduction is appropriate, it is gradual and structured. Tapered, watched, reversible.
- Discontinuation is a goal, not a precondition. It is what the programme works toward. It is not what you have to do in order to begin.
Read the last one twice. Coming off your biologic is the destination, not the entry fee.
Why stopping abruptly is a bad idea
Two reasons. The second is the one nobody mentions.
Rebound. Adalimumab and secukinumab act by suppressing immune signalling. Withdraw the suppression and the signalling does not stay quiet out of politeness — it returns, and it can return harder than it was before you started. If you stop your biologic on the day you begin EPOH, you have engineered a rebound flare into precisely the window (weeks 1–8) in which the internal correction has not yet had time to do anything at all. You get the difficulty of both approaches and the benefit of neither.
You destroy the signal. Change two things at once and nobody on earth can tell you which one caused what. You stop the biologic, you start the formulations, you flare in week three — was that withdrawal rebound, or evidence that the formulations are not working for you? No one can answer that. Not your dermatologist, not us, not you. You will have thrown away the only clean reading you had, and you will spend the following six months arguing with yourself about it.
Holding the biologic steady while the internal work begins is not a compromise. It is the only design in which the result means anything.
The interaction question, answered honestly
You are entitled to a straight answer, so here it is. Adalimumab and secukinumab act downstream, suppressing specific immune signalling pathways. EPOH formulations act upstream, on the drivers that put those pathways into a misfiring state in the first place — gut, immune, hormonal, metabolic, and stress and cortisol. They are not competing at the same target, which is why continuing one while beginning the other is coherent rather than contradictory.
That is the honest mechanistic picture, and it is also the limit of what we will assert. Anything more specific — whether your dose can come down, when, and how quickly — is a clinical decision belonging to the physician who prescribed it and who is able to monitor you. Not to us. Not to you alone at two in the morning with a search engine.
If a practitioner of any tradition tells you to stop a prescribed immunosuppressant on their say-so, that is the moment to stop listening to them.
The other medications
The same principle holds across the board. The details differ.
| Medication | Continue when starting? | The honest complication |
|---|
| Biologics (adalimumab, secukinumab) | Yes, unchanged | Rebound on abrupt withdrawal. Reduction only with the prescriber |
| Long-term antibiotics (tetracyclines, clindamycin/rifampicin) | Yes — though this is usually the first reduction conversation | They reduce bacterial load, and over time they also disrupt the gut microbiome, which is itself a primary driver |
| Steroids (oral) | Yes — and never stop these abruptly | Abrupt withdrawal carries risks entirely separate from HS. Tapering is strictly a prescriber's decision |
| Hormonal and metabolic medication (combined pill, spironolactone, metformin) | Yes | They address hormonal and metabolic symptoms without correcting the gut–hormonal relationship underneath, so symptoms characteristically return on stopping — which is exactly why you do not stop before the correction is in place |
The antibiotic row deserves an extra sentence, because it is the one genuine tension in the whole picture. If gut is a significant driver in your profile, then long-term antibiotics are simultaneously reducing your flares and acting on the system that produces them. That is uncomfortable, and we would rather say it than smooth it over. It does not, however, translate into stop today. It translates into this: antibiotic reduction is usually the earliest item on the agenda when you next see your prescriber, and Phase L includes digestive and microbiome support partly with exactly this history in mind.
Lesion injections, wound care, and everything else your dermatologist does for you remain entirely their domain. This is not a choice between two camps, and you are not being asked to pick one. You keep your dermatologist.
When the conversation actually happens
Not in month one. There is nothing to review in month one.
Realistically it becomes a meaningful conversation around Recovery Stage 2 — reduced flare frequency, months 2–4 — and more firmly at Recovery Stage 3, reduced flare severity, months 4–8, once Phase I has been running long enough for internal change to be more than an impression. Recovery Stage 4, stable remission, is month 8 and beyond, and that is the horizon on which discontinuation becomes a realistic question rather than a wish.
Even then it is a question you take to your prescriber, with evidence, and they decide.
The honest limit
We cannot tell you that you will come off your biologic. Some patients reduce medication substantially. Some reduce it partially and stay there. Some do not reduce it at all.
Not every patient responds equally. Disease duration, degree of organ involvement, and remaining biological repair capacity all influence outcomes. Patients with very advanced structural changes may not achieve full remission. A personalised evaluation is the only way to assess your specific response potential.
What we can tell you is that nothing about beginning is contingent on you giving anything up first, and that the reduction sequence exists precisely so that you never have to gamble a working medication against an unproven one.
If you want to know what your driver profile looks like, and what a realistic reduction timeline would be in your case, that begins with a personalised evaluation. Consultation is by video or WhatsApp, formulations are couriered to you, and there is no clinic visit at any stage. Bring your current prescriptions to it. You will not be asked to surrender a single one of them in order to start.
