What Is Hidradenitis Suppurativa (HS)?

Hidradenitis suppurativa (HS) is a chronic (long-term) and inflammatory skin condition that causes painful lumps, boils, or abscesses on or under the skin. HS is also sometimes called acne inversa, but it's worth noting that this condition does not cause typical acne.

HS-related lumps form in the hair follicles in areas of your body where skin touches skin, such as your inner thighs, groin, armpits, and under the breasts. If you notice new bumps or lumps on your skin, it's important to seek treatment. Otherwise, these lumps can turn into abscesses (pus-filled bumps), which can leak, scar your skin, and cause pain.

Researchers don't fully understand what causes HS, and at this time, there is no cure for the condition. Fortunately, many treatment options are available to help you manage symptoms. HS is a fairly common condition—affecting 1 in 100 people—but tends to be less known than other skin conditions. That's why many people live with HS for years before seeking treatment. Clinical trials are underway right now to learn more about HS and find more effective treatment options.

Symptoms

The main symptom of HS is a lump or bump on your skin that looks similar to a pimple. You may feel pain or stinging before seeing lumps break through the skin. In many cases, you might notice that the bumps disappear for a while and then come back in the same spot. Over time, more lumps may appear and cause pain around your skin.

As HS progresses, bumps can sometimes join together to form larger, painful nodules. They may fill with pus and develop into boils or abscesses. In some cases, these abscesses can break open and leak pus or foul-smelling fluid.

In advanced stages of HS, your abscesses might heal and then worsen. Repeated episodes of this can cause tunnels to form underneath the skin. These tunnels are also called sinus tracts, and they can become infected and cause permanent scars. People with HS typically have one or more nodules, abscesses, and scars that come and go over time. With advanced HS, scarring can sometimes lead to excessive pain and trouble with mobility.

The following photo shows how HS can manifest under your armpit.

This photo contains medical imagery.

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The photo below is an example of how HS can form on your breast.

This photo contains medical imagery.

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What Causes Hidradenitis Suppurativa?

Researchers are still investigating the exact cause of HS, but early studies theorize that a combination of biological and environmental factors can trigger symptoms. What scientists do know is that the condition initially begins when hair follicles become clogged and then infected, causing an inflammatory response in the nearby skin. This happens more often in areas of the body that experience friction, such as between the thighs or under the arms and breasts.

It’s important to note that HS is not:

• Caused by poor hygiene
• Sexually transmitted
• Contagious

Additionally, genetics appear to play a role in HS. In fact, nearly half of people who develop HS have a close relative with the same condition.

Risk Factors

While the cause of HS isn’t clear, there are some factors that may increase your risk of developing the condition. These include:

• Having a family history of HS
• Being assigned female at birth and under the age of 40
• Taking androgen therapy (male sex hormones)
• Living with obesity
• Smoking tobacco

Diagnosis

It's important to note that researchers haven't yet developed a specific test that checks for and diagnoses HS. Instead, healthcare providers often diagnose the condition by examining the skin. Your provider may also perform other types of tests (e.g., blood tests) to rule out a diagnosis of another skin condition. During your appointment, your provider will likely also ask you about your personal and family medical history.

Diagnosing HS is often challenging. Dermatologists (or, doctors who specialize in the skin) are most knowledgeable about HS, whereas some primary care providers might be unfamiliar with the condition. As a result, HS can sometimes be misdiagnosed as a boil or furuncle. Some people live with HS for years or even decades before they receive the correct diagnosis. The average person with HS lives with the condition for seven years before getting a proper diagnosis and treatment.

Stages of Hidradenitis Suppurativa 

Depending on the severity of your symptoms, you may be in one of three stages of HS. The longer you have untreated HS, the more advanced stage of HS you could be experiencing. Stages are categorized using the Hurley staging system and include the following:

• Hurley Stage I: Lumps or nodules are forming, but no scarring is present
• Hurley Stage II: Bumps and lumps may progress into abscesses that scar and sinus tracts have started forming under the skin
• Hurley Stage III: Multiple bumps or boils have formed and are becoming larger in size, multiple sinus tracts connect, and abscesses appear grouped together across an entire area of skin

Treatment for HS

Unfortunately, there is no known cure for HS at this time. However, several effective treatments are available. The primary goals of treatment are to improve pain symptoms, reduce the frequency of flare-ups, heal HS wounds, and prevent the condition from worsening. Once you receive a proper diagnosis, your primary healthcare provider will often refer you to a dermatologist specializing in HS to determine a treatment plan that is right for you.

Generally, dermatologists can recommend a combination of therapies including medication, wound care, skincare, and certain medical procedures to relieve symptoms.

Medication

Medications may be topical (creams or ointments) or oral (in pill form to swallow). Humira (adalimumab) is the only FDA-approved medication for HS, but other medicines are sometimes prescribed for off-label use. These include: 

• Acnotex (resorcinol)
• Soriatane (acitretin)
• Lidocaine CV (lidocaine)
• Glucophage (metformin)

Wound Care

Because HS involves having regular, slow-healing wounds, participating in wound care is an important part of your treatment plan. Your dermatologist will recommend wound care practices that work best for your bumps, but their recommendations may include soaking your wounds, using antiseptic washes, or changing your wound dressings often.

Skincare

Some skin care products, like soaps or lotions, may cause skin irritation for people with HS. Some dermatologists recommend washing your body with benzoyl peroxide or other antimicrobial soaps. You may find some relief by switching to skin care products that are also more gentle on your skin.

Medical Procedures

Treating advanced HS with medical procedures can help you better manage your condition and reduce symptoms. Occasionally, severe HS may require surgery, but many procedures can be done in your healthcare provider’s office, including:

• Corticosteroid injections to reduce inflammation
• Botulinum toxin (Botox) to reduce sweating which can clog up your hair follicles
• Laser hair removal
• Cutting open and draining abscesses to relieve pain and pressure
• Deroofing, or removing the top layer of an abscess to let it heal
• Wide excision, which removes the entire lesion or abscess including the sinus tract underneath the skin

How to Prevent HS Flare-Ups

While there is no surefire way to prevent HS, there are some steps you can take to reduce or prevent new bumps from appearing. Dermatologists recommend the following steps to reduce flare-ups of HS:

• Limit heavy or strenuous exercise to avoid over-sweating
• Wear loose clothing that doesn’t rub against your skin
• Refrain from smoking cigarettes

Related Conditions

Studies show that people who live with HS are more likely to develop depression as a result of chronic pain and the stress of living with their symptoms. HS can also take an emotional toll because bumps and abscesses tend to appear in sensitive areas, like the groin, under the breasts, and around the anus. This may cause frustration, irritation, shame, or embarrassment.

If your physical symptoms are affecting your emotional well-being, it's good practice to check in with your healthcare provider or ask for a referral to a mental health professional to learn ways to better maintain your mental health.

Living With Hidradenitis Suppurativa

Living with HS can be challenging. It's important to acknowledge how you feel when you receive your diagnosis and take care of your overall well-being as you learn to manage your condition. Unfortunately, it can take several years before you receive an accurate diagnosis for your condition—which ultimately can make symptoms worse. That's why advocating for your health is essential.

If you notice new or unusual bumps on your skin, it's a good idea to see your healthcare provider for testing. It may also help to talk with a dermatologist and learn about early interventions or medications that can help you manage symptoms sooner. Regardless of when you receive your diagnosis, treatments can help reduce pain and lower the frequency of your bumps at any stage of your condition.