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Overview

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a chronic inflammatory skin condition that causes recurring painful lumps, nodules, and abscesses in areas where skin rubs together. Some people develop drainage, open sores, tunnels under the skin, or scars over time. It is not contagious and is not caused by poor hygiene. Hidradenitis suppurativa often begins after puberty and commonly affects the armpits, groin, buttocks, inner thighs, and area under the breasts.

Symptoms

Hidradenitis Suppurativa Symptoms

  • Painful deep lumps or nodules under the skin.
  • Boil-like abscesses that may recur in the same area.
  • Pus or blood draining from a lesion.
  • Open sores that heal slowly.
  • Tunnels beneath the skin called sinus tracts.
  • Thick or rope-like scars after repeated flares.
  • Lesions in the armpits, sometimes called armpit hidradenitis.
  • Lesions in the groin, buttocks, inner thighs, or under the breasts.

Causes

What Causes Hidradenitis Suppurativa?

Hidradenitis suppurativa usually begins when hair follicles become blocked and inflamed. This inflammation can cause painful nodules and may progress to abscesses, drainage, tunnels beneath the skin, and scarring. The exact cause of hidradenitis is not fully understood, but it is not contagious and is not simply the result of poor hygiene.

How inflammation leads to recurring lesions

Immune-system activity may intensify inflammation around blocked follicles, while hormonal influences, friction, and inherited susceptibility may also play a role. These factors can contribute to repeated flares, but no single factor explains every case. H. suppurativa is a complex inflammatory condition rather than a problem caused by personal cleanliness.

Risk Factors

Hidradenitis Suppurativa Risk Factors

  • Nonmodifiable: a family history of hidradenitis suppurativa.
  • Nonmodifiable: being in the years after puberty, when HS often begins.
  • Potentially changeable or medically influenced: hormonal changes or conditions that affect hormone levels.
  • Potentially changeable: overweight or obesity, which may increase friction and inflammation.
  • Potentially changeable: smoking tobacco.
  • Potentially changeable: heat, sweating, or repeated friction in skin folds.
  • Associated health condition: inflammatory bowel disease or another inflammatory condition.

Complications

Hidradenitis Suppurativa Complications

  • Permanent scars or changes in skin texture may remain after repeated flares.
  • Sinus tracts may connect lesions beneath the skin.
  • Pain or scarring may limit movement and daily activities.
  • Damaged skin may develop a secondary bacterial infection.
  • Anemia can occur with severe, persistent drainage or inflammation.
  • Depression or anxiety may develop because of pain, appearance, or unpredictable flares.
  • Social isolation or difficulty with work, school, intimacy, or exercise may reduce quality of life.

Get prompt medical advice

Watch for signs of infection

Seek prompt medical care for rapidly spreading redness, increasing warmth or swelling, fever, chills, severe worsening pain, or feeling very unwell.

Diagnosis

How Hidradenitis Suppurativa Is Diagnosed

A dermatologist or other clinician usually diagnoses hidradenitis suppurativa by asking about recurring lesions and examining the skin. There is no single blood test that confirms HS. Tests may be used when needed to rule out an infection or another condition with similar symptoms.

  • The type and appearance of skin lesions.
  • Whether lesions occur in typical areas such as the armpits or groin.
  • Whether lesions have returned over time.
  • The presence of scars, drainage, or sinus tracts.
  • Pain, flare frequency, and effects on daily activities.
  • Whether testing is needed to rule out infection or another skin condition.
  • An ICD-10 code may be added to medical records and billing documents, but it does not replace clinical assessment.

Hurley stages and disease severity

Hurley stage I generally means isolated lesions without tunnels or extensive scarring. Stage II describes repeated lesions with some tunnels and scars, while stage III involves extensive interconnected tunnels and scarring across an area. Clinicians may also consider pain, flare frequency, affected body areas, and quality of life, because Hurley stage does not fully describe each person’s burden.

Treatment & Management

Hidradenitis Suppurativa Treatment and Management

Hidradenitis suppurativa treatment aims to reduce inflammation, pain, new lesions, drainage, scarring, and flare frequency. The best plan depends on disease severity, affected locations, previous treatments, pregnancy status, other health conditions, and personal goals. Long-term follow-up may be needed to adjust care as symptoms change.

  • Gentle cleansing, breathable clothing, and measures that reduce friction, heat, and sweating may help limit irritation.
  • Clinician-guided wound care can protect draining areas and reduce discomfort.
  • Topical antibiotics or antiseptic washes may be prescribed for selected lesions or areas.
  • Oral antibiotics may be used for their anti-inflammatory effects or when infection is suspected.
  • Hormonal medicines may help some people whose flares are linked to hormonal changes.
  • Biologic medicines may be considered for moderate-to-severe HS that does not respond adequately to other treatments.
  • A clinician may inject a corticosteroid into a selected painful nodule.
  • Deroofing or surgical removal may treat persistent tunnels or severe localized disease.

Outlook and Prognosis

Outlook and Prognosis

Hidradenitis suppurativa is usually chronic and may alternate between flares and quieter periods. It is not contagious, and treatment can reduce flares and complications, but existing scars and tunnels may not disappear without procedures. The condition can often be managed, although its course varies from person to person.

What affects the outlook?

The outlook may be influenced by how early treatment begins, disease severity, flare frequency, scarring, response to medication, smoking status, associated conditions, and access to specialist care. Ongoing follow-up is important, especially when treatment is not controlling pain, drainage, new lesions, or effects on daily life. No single treatment works for everyone, and care may need to be reassessed over time.

When Should You See a Doctor

When Should You See a Doctor?

Make a routine appointment for painful lumps that recur, lesions that drain or scar, symptoms in several skin-fold areas, or symptoms that interfere with sleep, movement, work, relationships, or mood. Early evaluation can help distinguish HS from repeated boils and support a suitable treatment plan.

Know when to act

Seek prompt medical care for severe changes

Contact a clinician promptly for rapidly spreading redness, fever, chills, severe worsening pain, marked swelling, heavy bleeding, or feeling very unwell. These symptoms may signal an infection or another urgent problem.

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