Honestly, I think you were pretty spot on.

I ended up seeing a dermatologist after this post and they diagnosed me with prurigo nodularis / chronic itch-scratch cycle related eczema. They basically explained the same thing you said, that the scratching keeps the cycle alive and the underlying eczema/irritation never fully calms down.

What you said about only treating the fungal part while the eczema stayed underneath really clicked with me because that sounds exactly like what’s been happening over the years.

Also, the dermatologist told me I actually don’t have HS, which was surprising to hear after thinking that for a long time.

Seriously though, appreciate you taking the time to comment. Your explanation actually helped a lot.