A Study to Evaluate the Efficacy of Botulinum Toxin in Patients With Hidradenitis Suppurativa

Inclusion Criteria: 1\) age \>13 and \<75, 2) established or suspected diagnosis of Hidradenitis Suppurativa, 2) HS skin lesions of duration at least 1 year, 3) HS lesions in at least two distinct body areas, 4) inadequate response to a trial of an oral antibiotic or exhibited recurrence after discontinuation of antibiotics, 5) abscess and nodule (AN) count ≥ 5 at baseline, 6) draining tunnel count of \<20 at baseline, and 7) ability to provide written informed consent and/or assent. Exclusion Criteria: 1\) Age\<13 or \>75, 2) pregnant or breastfeeding, 3) history of neuromuscular disorder (ex. ALS, myasthenia gravis, Lambert-Eaton syndrome, myopathy), 4) medical co-morbidity ex. end stage congestive heart failure or coagulopathy that is a relative contradiction to skin biopsy procedure, 5) received systemic steroids or started a new systemic (biologic or non-biologic immunomodulator, oral retinoid) therapy with potential therapeutic impact for HS \<12 weeks prior to baseline visit, 6) use of opioid or non-opioid oral analgesics within 14 days of baseline visit (exception: at a stable dose for at least 14 days prior to baseline), 7) receiving anti-IL-17A/F, anti-IL-23, or anti-IL-1 biologic therapy or oral JAK inhibitor, TYK inhibitor, 8) active COVID-19 infection or history of COVID-19 infection within 4 weeks prior tobaseline, 9) oral or IV antibiotic use during the treatment period (exception: stable dose of doxycycline or minocycline upto 100mg PO BID for 28 days prior…