Treatment of severe hidradenitis suppurativa with a combination of 5-aminolevulinic acid photodynamic therapy, surgery, and secukinumab

•Severe hidradenitis suppurativa is recalcitrant to treatment.•ALA-PDT sometimes cannot penetrate lesions very well.•Surgical pretreatment before ALA-PDT is crucial.•The use of secukinumab in HS remains controversial while worth trying.•The combination of ALA-PDT, surgery, and secukinumab is an effective and safe strategy for treating patients with severe HS.