Overview

Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin condition that causes painful lumps under the skin, typically in areas where skin rubs together — such as the armpits, groin, buttocks, and under the breasts. These lumps can break open, ooze pus, and lead to scarring.

HS is not contagious, not caused by poor hygiene, and is often misunderstood. It tends to develop after puberty and can worsen over time without appropriate management. Although there's no cure yet, treatment options are available to reduce symptoms, manage flare-ups, and improve quality of life.

Main Symptoms

The symptoms of hidradenitis suppurativa can vary in severity and presentation, but common signs include:

  • Painful nodules or lumps: Often tender to the touch and located in high-friction areas.

  • Boil-like abscesses: These can rupture and leak foul-smelling pus.

  • Tunnels (sinus tracts): In chronic stages, tunnels may form under the skin, connecting different lesions.

  • Scarring: After lesions heal, they often leave behind thick scars or skin pitting.

Flare-ups may come and go, and the condition can range from mild with occasional lumps to severe and disfiguring. The Hurley staging system is often used to classify the disease severity:

  • Stage I: Single or multiple abscesses, no scarring or tunneling.

  • Stage II: Recurrent abscesses, with tract formation and scarring.

  • Stage III: Diffuse involvement, multiple interconnected tracts, and widespread scarring.

Common Areas Affected

HS often appears in the following regions:

  • Underarms

  • Groin area

  • Inner thighs

  • Buttocks

  • Under the breasts

  • Around the anus

These areas are more susceptible because they have a high concentration of apocrine glands and are prone to friction and sweat buildup.

Causes and Triggers

The exact cause of HS is not fully understood, but it’s believed to involve:

  • Hair follicle blockage: Inflammation starts when hair follicles become blocked, leading to rupture and immune response.

  • Immune system overactivity: HS is classified as an autoinflammatory condition.

  • Genetics: Around one-third of people with HS have a family history of the disease.

While HS is not caused by lifestyle choices, certain factors may trigger or worsen flare-ups:

  • Obesity

  • Smoking

  • Hormonal changes

  • Heat and sweating

  • Tight clothing

It’s important to note that HS is not an infection, though the lesions can become secondarily infected.

Who Is at Risk

HS can affect anyone but is more commonly seen in:

  • Women (especially in their 20s and 30s)

  • Individuals with a family history of HS

  • People with obesity or metabolic syndrome

  • Smokers

  • Those with autoimmune conditions

HS is also associated with conditions like Crohn’s disease, arthritis, and diabetes.

How It's Diagnosed

There are no lab tests that specifically diagnose HS. Instead, healthcare providers rely on:

  • Medical history: Recurrent boils in typical areas.

  • Physical examination: Appearance and distribution of lesions.

  • Imaging (occasionally): To assess sinus tracts or extent of tissue involvement.

In some cases, your provider may refer you to a dermatologist for a more accurate diagnosis, especially if symptoms are mistaken for infections, cystic acne, or ingrown hairs.

Treatment Options

While HS has no cure, several treatments can help reduce symptoms and improve quality of life:

1. Medications

  • Antibiotics: Oral or topical antibiotics help manage infection and inflammation.

  • Anti-inflammatory drugs: Steroids may be used during flare-ups.

  • Hormonal therapy: Birth control pills or anti-androgen medications for hormone-related HS.

  • Biologics: TNF-alpha inhibitors like adalimumab (Humira) have shown success in moderate-to-severe cases.

2. Lifestyle Management

  • Weight loss: Reducing body weight can help relieve friction and inflammation.

  • Quit smoking: Smoking cessation may improve outcomes.

  • Hygiene: Use gentle, antibacterial cleansers and avoid shaving irritated areas.

3. Surgical Options

  • Incision and drainage: Offers temporary relief but not a long-term solution.

  • Laser therapy: Destroys hair follicles to prevent lesion formation.

  • Wide excision: For advanced cases, surgical removal of the affected area may be necessary.

Living with HS

HS is a physically and emotionally challenging condition. Patients often experience:

  • Chronic pain

  • Embarrassment and social anxiety

  • Depression or low self-esteem

  • Limitations in physical activities or work

Supportive care is essential. Joining support groups or talking to a therapist can provide emotional relief and coping strategies. Being open with healthcare providers about both physical and mental symptoms ensures comprehensive care.

Daily Care Tips

Here are practical ways to manage HS at home:

  • Wear loose-fitting clothes: Prevents friction and sweating.

  • Use zinc supplements: Some evidence supports its role in reducing flare-ups.

  • Apply warm compresses: Helps with pain and drainage.

  • Avoid irritating products: Skip harsh deodorants or exfoliants in sensitive areas.

  • Track your symptoms: Use a journal to identify patterns or triggers.

HS in Different Populations

Children and Teens

HS can occur in adolescents, especially during puberty. Early diagnosis can help slow progression and reduce long-term damage.

Pregnant Individuals

Hormonal shifts during pregnancy may either improve or worsen HS. Treatment plans should be adjusted to ensure safety for both parent and baby.

Men vs. Women

Women tend to develop HS more frequently and in different body areas than men. Men, on the other hand, may experience more severe cases with tunneling.

Long-Term Outlook

While HS is chronic and often progressive, many people find significant relief through proper treatment and lifestyle changes. Early intervention improves outcomes, and newer medications like biologics have made it easier to control the disease than ever before.

Long-term goals include:

  • Reducing flare-up frequency

  • Minimizing scarring and complications

  • Improving quality of life

  • Supporting mental health

Possible Complications

Without proper management, HS can lead to:

  • Scarring and skin thickening

  • Fistulas (abnormal connections between tissues)

  • Restricted movement

  • Chronic infections

  • Squamous cell carcinoma (in rare, severe cases)

Regular checkups and early treatment help prevent or manage complications effectively.

Questions to Ask Your Doctor

If you suspect you have HS or have already been diagnosed, consider asking:

  • What stage is my HS?

  • What treatments are best for me?

  • Are there any lifestyle changes I should make?

  • Could my medications be worsening my symptoms?

  • What can I do to prevent scarring?

Being proactive with your care can lead to better outcomes and faster relief.

Summary

Hidradenitis Suppurativa is more than just a skin condition — it’s a chronic inflammatory disease that can affect physical comfort, self-esteem, and daily life. While challenging, it’s manageable through a combination of medical treatment, self-care, and support. Understanding the condition, recognizing symptoms early, and staying informed about treatment options are the keys to living well with HS.