Importance Hidradenitis suppurativa (HS) is a chronic inflammatory dermatological disease with prevalence estimates ranging from 0.1% to 0.5% in clinical settings to 1% to 2% in general populations. While tertiary care data show that 22% of patients progress to severe disease within 2 years, estimates of disease development outside the hospital setting remain unknown. Objective To investigate HS development in a non−hospital-based setting and to identify baseline factors associated with remission and progression to severe disease in the community. Design, Setting, and Participants This prospective cohort study used 10-year follow-up data on HS disease severity among a municipality-based cohort identified via a questionnaire in the Danish General Suburban Population Study conducted from 2010 to 2013. Disease severity (mild, moderate, severe) was determined using a modified Hurley score. Progression (severe disease at follow-up) and remission (no active HS symptoms for 6 months or longer at follow-up) rates were calculated by severity level. Separate Cox proportional hazard regression analyses explored whether baseline demographic variables associated with disease severity at follow-up in 2023 could be used to estimate changes in disease severity. Data analysis was performed from March 2024 to September 2025. Main Outcomes and Measures HS remission and progression rates across baseline severity groups as determined at follow-up in January to February 2023. Measures included baseline HS disease severity, body mass index, smoking history, employment status, and number of anatomical areas with active lesions. Results The analysis included 107 patients with HS (mean [SD] age, 47.1 [8.8] years; 88 female [82.2%] and 19 male [17.8%] individuals). At baseline, 57 patients (53.3%) had mild, 20 (18.7%) had moderate, and 30 (28.0%) had severe disease. During the follow-up period, 16.9% of patients with nonsevere disease progressed (13.0% to severe disease), while 71.0% of all patients experienced regression (63.6% to full remission). Stratified by baseline severity, 73.7%, 60.0%, and 46.7% of patients with mild, moderate, and severe disease, respectively, experienced full remission. Cox regression analyses did not reveal any baseline demographic factors capable of predicting disease development at follow-up. Conclusions and Relevance This cohort study found that estimates from hospital-based cohorts likely overstate HS disease progression and underestimate its remission. In this community-based cohort, HS progression to severe disease was 10.4 times lower and rates of HS remission were 3.8 times higher than reported within hospitals, suggesting a more favorable disease course than previously reported.