A 28‐year‐old woman presented with SLE since the age of 13, with renal involvement (class III nephritis), myocarditis, and antiphospholipid antibody syndrome that was previously treated with hydroxychloroquine and salicylic acid. Medical history also included autoimmune thyroiditis, fibromyalgia, and osteoporosis. First manifestations of HS were reported at the age of 20 years. Frequent flares (>2 episodes/months) occurred, and minimal clinical and ultrasonographic improvements were obtained with previous HS‐specific treatments. At our observation (Fig. 1a), the patient reported a worsening of disease associated with a relevant disease burden (Hurley II; IHS4: 12; pain‐Numeric Rating Scale [NRS]: 7/10; itch‐NRS: 3/10; HidraDisk: 62; Dermatology Life Quality Index [DLQI]: 15). Concomitant SLE showed low‐disease activity with current maintenance therapy consisting of hydroxychloroquine (400 mg/day), oral steroids, acetylsalicylic acid, and pregabalin. Because adalimumab was considered contraindicated, off‐label subcutaneous secukinumab injections at the dosage of 300 mg at weeks 0, 1, 2, 3, and 4, followed by monthly maintenance dosing, were prescribed.