Hidradenitis suppurativa
Created: 09.01.2025
Updated 13.10.2026
Approved by: Consultant Dermatologist, Dr James Denny
What is Hidradenitis suppurativa?
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects the hair follicles, leading to painful lumps beneath the skin. It most commonly develops in areas where skin rubs together, including the armpits, groin, buttocks, under the breasts, and inner thighs.
HS is not caused by infection and is not related to poor hygiene. Instead, it results from inflammation and blockage of hair follicles, which can eventually rupture and trigger an exaggerated immune response.
The condition usually begins after puberty and is most commonly diagnosed in early adulthood. It affects approximately 1% of the population and is more common in women.
Although the exact cause remains unclear, genetics, smoking, obesity, and hormonal factors all appear to increase the risk of developing HS.
What are the symptoms?
The symptoms of hidradenitis suppurativa vary in severity and tend to occur in recurring flare-ups.
Common symptoms include:
- Painful nodules beneath the skin
- Tender boils or abscesses
- Pus drainage from affected areas
- Unpleasant odour due to chronic drainage
- Scarring and thickening of the affected skin
Repeated inflammation can result in the formation of interconnected tunnels beneath the skin known as sinus tracts. These tunnels may repeatedly fill with fluid and become infected, making the condition more difficult to treat.
The condition often affects both sides of the body and may significantly impact quality of life because of pain, discomfort, and recurrent drainage.
How severe can hidradenitis suppurativa become?
HS ranges from mild hidradenitis suppurativa, with isolated recurring nodules, to severe hidradenitis suppurativa, where extensive inflammation, multiple abscesses, sinus tracts, and widespread scarring develop.
Dermatologists often classify HS into stages to help guide treatment. Early diagnosis and treatment reduce the risk of disease progression and permanent skin damage.
Associated conditions
People with hidradenitis suppurativa are more likely to have other inflammatory conditions, including:
These associated conditions may influence long-term management and are considered during specialist assessment.
How is hidradenitis suppurativa diagnosed?
HS is usually diagnosed clinically by a dermatologist based on:
- The appearance of the affected skin
- The typical body sites involved
- The pattern of recurrent flare-ups
No single blood test confirms the diagnosis, although investigations may occasionally be performed to exclude infection or other skin conditions.
Early diagnosis is important because treatment is generally more effective before extensive scarring develops.
Hidradenitis suppurativa treatment
There is currently no cure for HS, but hidradenitis suppurativa treatment aims to reduce inflammation, prevent flare-ups, minimise scarring, and improve quality of life.
Lifestyle measures
Lifestyle modifications play an important role alongside medical treatment.
Patients are encouraged to:
- Stop smoking where possible
- Achieve and maintain a healthy weight
- Wear loose-fitting clothing to minimise friction
- Avoid squeezing or picking lesions
- Clean affected areas gently using appropriate antiseptic washes if recommended
It is important to remember that HS is not caused by poor hygiene, and excessive washing or scrubbing does not improve the condition.
Medical treatment
Treatment depends on disease severity and may include:
- Topical antibiotics for localised disease
- Oral antibiotics to reduce inflammation
- Corticosteroid injections into inflamed nodules
- Biologic medications such as adalimumab for moderate to severe disease
- Other immunomodulatory medications in selected patients
Surgical treatment
Persistent abscesses, extensive sinus tracts, or severe scarring may require surgical management.
Procedures range from limited drainage to removal of chronically affected tissue. Surgery is often combined with medical therapy for the best long-term outcomes.
What is the prognosis?
HS is a chronic relapsing condition that often requires long-term management.
While there is no cure, many patients achieve good symptom control with early diagnosis, appropriate treatment, and lifestyle modification.
Without treatment, repeated inflammation can lead to permanent scarring, chronic drainage, and extensive sinus tract formation. Early specialist dermatology care helps reduce disease progression and improves long-term quality of life.
Frequently Asked Questions
Is hidradenitis suppurativa caused by poor hygiene?
No. Hidradenitis suppurativa is not caused by poor hygiene or infection. It is a chronic inflammatory condition affecting the hair follicles. Gentle skin care is important, but excessive washing will not prevent or cure the condition.
What are the early signs of hidradenitis suppurativa?
The earliest signs are usually painful nodules or boil-like lumps that repeatedly develop in areas such as the armpits, groin, or under the breasts. Early diagnosis can help prevent progression to scarring and sinus tract formation.
Can hidradenitis suppurativa be cured?
There is currently no cure, but hidradenitis suppurativa treatment can effectively reduce flare-ups, control inflammation, relieve pain, and minimise scarring. Treatment is tailored to the severity of the condition.
When is surgery needed for hidradenitis suppurativa?
Surgery may be recommended for persistent abscesses, extensive sinus tracts, or severe hidradenitis suppurativa that has not responded to medical treatment. A dermatologist can determine the most appropriate approach.
When should I see a dermatologist for hidradenitis suppurativa?
You should seek specialist assessment if you have recurrent painful lumps, draining abscesses, or scarring in skin folds. Early treatment offers the best chance of controlling symptoms and preventing long-term skin damage.
