Skip to main content
Mother Nature AI
DermatologicalICD-10: L73.2Affects approximately 1-4% of the global population

Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition characterized by painful lumps, abscesses, and tunnels (sinus tracts) that form under the skin in areas where skin rubs together. It typically affects the armpits, groin, buttocks, and under the breasts, and is often misdiagnosed as boils or simple skin infections. HS is a progressive disease that can significantly impact quality of life, and early diagnosis and treatment are essential to prevent scarring and complications.

Symptoms

Painful, deep-seated nodules or lumps under the skin
Recurrent abscesses that drain foul-smelling pus
Blackheads, often appearing in pairs (double-barreled comedones)
Tunnels (sinus tracts) connecting lumps under the skin
Scarring and skin thickening in affected areas
Flare-ups followed by periods of partial improvement
Pain and difficulty moving when lesions occur in skin folds

Causes

  • Occlusion and inflammation of hair follicles (follicular plugging)
  • Dysregulated immune response leading to chronic inflammation
  • Genetic predisposition (family history present in about one-third of patients)
  • Hormonal factors (HS often begins after puberty)
  • Bacterial colonization of lesions as a secondary phenomenon

Risk Factors

  • Family history of hidradenitis suppurativa
  • Obesity (friction and sweating in skin folds worsen the condition)
  • Female sex (women are affected approximately three times more than men)
  • Smoking (strongly associated with disease severity)
  • Age between 20 and 40 years at onset
  • African American descent (higher prevalence)

Diagnosis

  • Clinical diagnosis based on characteristic lesion appearance, location, and recurrence pattern
  • No specific blood test or imaging is required for diagnosis
  • Skin biopsy in atypical cases to rule out other conditions
  • Assessment of disease severity using the Hurley staging system (Stage I-III)

Treatment

  • Topical or oral antibiotics (clindamycin, doxycycline, rifampin) for inflammatory control
  • Biologic therapy (adalimumab/Humira, secukinumab) for moderate to severe disease
  • Intralesional corticosteroid injections for acute flares
  • Surgical excision or deroofing of chronic sinus tracts and abscesses
  • Hormonal therapy (spironolactone, oral contraceptives) for female patients
  • Laser hair removal in affected areas to reduce follicular plugging
  • Pain management and wound care

Prevention

  • Maintain a healthy weight to reduce friction in skin folds
  • Quit smoking, which is strongly linked to disease activity
  • Wear loose-fitting, breathable clothing
  • Use gentle, fragrance-free cleansers on affected areas
  • Avoid shaving in areas prone to flares

When to See a Doctor

  • You develop recurrent painful lumps or abscesses in the armpits, groin, or other skin folds
  • Previous treatments for 'boils' have not prevented recurrence
  • The condition is worsening with new tunnels, drainage, or spreading lesions

Frequently Asked Questions

Related Conditions

Acne Vulgaris

Dermatological

Obesity

Metabolic

Depression

Mental Health

Have questions about Hidradenitis Suppurativa?

Ask Mother Nature AI for personalized, evidence-based guidance.

Ask about Hidradenitis Suppurativa

Medical Disclaimer: This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider.

Content reviewed against peer-reviewed medical literature and clinical guidelines. Read our editorial standards.