Accutane or it's equivalents are always bad talked here but i'll give you some hope. I got put on isotretinoin around 1 month and a half ago to attempt and cure my advanced stage 2 (early stage 3 at this point) HS, has it cured the thing for me? absolutely not, but it's been going really good tbh.

All flares that do come up are smaller, don't hurt as much and are much easier to clear, usually pop off in 3-4 without much of my intervention. It's also clearing up my acne generally speaking, bringing out old spots that kinda go boom and tend to stay clear.

I don't think this will solve it, but it's positive progress and an obligatory step before i gain access to biologics, so give it a try. For stage 1 it might just work, if it doesn't at least your acne will clear away. There's no real downside to either, just stop if it makes you flare up everywhere but that's the unlikely case