Hidradenitis suppurativa

Overview

Hidradenitis suppurativa (HS) is a long-term skin condition that causes painful, swollen lumps under the skin, often in areas where skin rubs together, like the armpits, groin, and buttocks. These lumps can become infected and turn into abscesses (pockets of pus) that may drain fluid. Over time, tunnels (sinus tracts) can form under the skin, leading to scarring.

HS is more common than many people realize. It affects about 1 in 100 people, but many cases are mild and not diagnosed.

HS usually starts after puberty, most often in people in their 20s and 30s. It is more common in women and in people who are overweight or smoke.

Symptoms

Common symptoms

• Painful, red bumps under the skin that look like boils or pimples
• Lumps that can grow, burst, and leak pus or blood
• Tunnels (sinus tracts) that connect lumps under the skin
• Scarring as lumps heal and come back in the same area
• Itching, burning, or discomfort in affected areas

Symptoms in children

• HS is rare before puberty. If it does appear, it usually looks like small, painful bumps in the groin or underarms.
• Children may be embarrassed or anxious about the sores.
• Early diagnosis is important to help manage the condition and reduce impact on school and social life.

Symptoms in older adults

• HS may become less active after menopause in women, but it can still cause flares.
• Older adults may have more trouble managing pain or dressing wounds because of other health problems.
• Scarring and tunnels may be more advanced if HS has been present for many years.

Causes

Main causes

• The exact cause is not fully understood. It happens when hair follicles become blocked and inflamed, leading to infection deep in the skin.
• Genes play a role — HS often runs in families.
• It is linked to problems with the immune system, where the body’s defenses overreact and cause inflammation.

Risk factors

• Being overweight or obese
• Smoking tobacco
• Having a family history of HS
• Hormonal changes (such as around periods or pregnancy)
• Other health conditions like acne, diabetes, or inflammatory bowel disease

When to see a doctor

See a doctor urgently if:

• A very painful lump that is growing quickly or making you feel ill (fever, chills)
• Pus that is dark, foul-smelling, or mixed with blood
• Difficulty moving a joint because of the lump

Book a routine appointment if:

• Painful bumps that keep coming back in the same spots (armpits, groin, buttocks)
• Lumps that burst and drain fluid
• Scarring or tunnels under the skin

Diagnosis

A doctor will usually diagnose HS by asking about your symptoms and examining the affected areas. They will look for typical signs like painful bumps, tunnels, and scarring in typical body areas.

Tests that may be done

• No specific lab test can confirm HS. Diagnosis is based on your history and physical exam.
• Sometimes a doctor may take a swab of pus to check for bacteria if an infection is suspected.
• In rare cases, a small skin biopsy (taking a tiny sample of skin) may be done to rule out other conditions.

What to expect at your appointment

Your doctor may ask about how long you have had the bumps, where they appear, how often they flare, and if anyone in your family has similar issues. Be honest about your symptoms — it helps them give you the best care.

Treatment

Treatment for HS aims to reduce pain, control flare-ups, prevent new lumps, and improve quality of life. It often involves a combination of self-care, medications, and sometimes procedures or surgery. There is no one-size-fits-all approach, and treatment plans are tailored to each person.

Self-care at home

• Keep affected areas clean and dry using gentle, fragrance-free soap
• Apply warm compresses to painful bumps to help them drain
• Wear loose, breathable clothing to reduce friction
• Use over-the-counter pain relievers (like paracetamol or ibuprofen) for pain, following the label instructions
• Avoid shaving or waxing affected areas during a flare

Medical treatments

A doctor may prescribe antibiotic creams or pills to treat or prevent infection. Anti-inflammatory medicines (like those used for acne or arthritis) can reduce swelling. Biologic drugs that target specific parts of the immune system are also an option for moderate to severe HS. Your healthcare provider will discuss the risks and benefits of each option.

When is surgery considered?

If lumps or tunnels do not heal with medicine, a doctor may recommend minor surgery to drain large abscesses. For severe HS, surgery to remove the affected skin and tunnels can provide long-term relief. This is called ‘excision’ and is done by a specialist.

Living with this condition

HS can be frustrating and painful, but many people manage it well with treatment and lifestyle changes. Keep a diary of your flares to see if any triggers (like stress, tight clothes, or certain foods) make things worse. Having a routine for wound care can help you feel in control.

Lifestyle tips

• Quit smoking — smoking makes HS worse and harder to treat
• Lose weight if you are overweight — even a small amount of weight loss can help
• Avoid skin irritation — use gentle soaps and avoid harsh deodorants or antiperspirants

Diet and exercise

Some people find that certain foods trigger flares, such as dairy or high-sugar foods. You could try keeping a food diary. Gentle exercise (like walking or swimming) is good for overall health and may help with weight, but avoid activities that rub the affected areas.

Mental health and emotional wellbeing

Living with a visible, painful skin condition can affect your mood and self-esteem. You may feel embarrassed, anxious, or depressed. It is important to talk to a healthcare provider if you feel this way. They can connect you with counselling or support groups.

Prevention

HS cannot be completely prevented, but you can lower your risk of flares by maintaining a healthy weight, not smoking, and taking good care of your skin. Early treatment of mild symptoms may also prevent the condition from getting worse.

Complications

If left untreated

• Chronic pain and scarring that can limit movement
• Deep infections (cellulitis) that may require hospital care
• Formation of extensive tunnels under the skin that are hard to treat
• Skin cancer (squamous cell carcinoma) in very rare, long-standing cases

Long-term outlook

HS is a lifelong condition for most people, but with the right care, many people experience fewer and milder flares. Treatments have improved a lot in recent years. Working closely with a healthcare team can help you manage symptoms and maintain a good quality of life.

Find support

International organisations

• HS Foundation (International)

Local organisations

• NHS website – Hidradenitis suppurativa · UK

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