17716 Hidradenitis Suppurativa

Overview

Hidradenitis suppurativa (HS) is a long-term skin condition that causes painful lumps and boils under the skin. It happens when hair follicles become blocked and inflamed. The lumps usually appear where skin rubs together, such as the armpits, groin, and buttocks. HS is not contagious and is not caused by poor hygiene.

Yes, HS affects about 1 in 100 people, though many do not realise they have it. It is more common than often thought.

HS usually starts after puberty, often in a person's late teens or early 20s. It is more common in women. People who smoke or are overweight are at higher risk. It can also run in families.

Symptoms

Common symptoms

• Painful, tender lumps under the skin, often in the armpits, groin, or buttocks
• Boil-like spots that may leak fluid or pus
• Blackheads or small pitted areas in the affected skin
• Tunnels (narrow passages) under the skin that can open and drain
• Scarring and changes in skin colour over time

Causes

Main causes

• Blocked hair follicles – the exact cause is unknown, but HS starts when hair follicles become blocked and inflamed.
• Inflammation – the body's immune system reacts too strongly, causing swelling and pus.
• Sweat glands – HS affects areas with apocrine sweat glands, which are concentrated in the armpits and groin.
• Not caused by poor hygiene – washing more will not make HS go away.

Risk factors

• Smoking – tobacco use is strongly linked to HS and makes symptoms worse.
• Overweight or obesity – extra weight increases skin friction and hormone levels.
• Family history – HS often runs in families.
• Hormones – symptoms may flare around periods in women.
• Age – most cases begin after puberty.

When to see a doctor

See a doctor urgently if:

• If you have a high temperature, spreading redness, or severe pain, seek urgent medical advice.
• If a boil or lump becomes very large, hot, and painful, or if you feel generally unwell.

Book a routine appointment if:

• If you have painful lumps that keep coming back in the same areas.
• If you are embarrassed by the lumps and are not sure what they are.
• If over-the-counter care (such as warm compresses) is not helping.

Diagnosis

A doctor can usually diagnose HS by looking at the skin and asking about your symptoms. No special test is needed in most cases. They may ask about where the lumps appear and how often they return.

Tests that may be done

• Physical examination – the doctor will look at the affected areas for characteristic lumps, tunnels, or scarring.
• Swab – if a lump looks infected, the doctor may take a small swab of fluid to check for bacteria.
• Blood test – sometimes used to check for inflammation or other conditions, but not always.
• Skin biopsy – rarely needed; a tiny sample of skin is taken and sent to a lab to confirm the diagnosis.

What to expect at your appointment

You may be referred to a dermatologist (skin specialist). They will discuss your symptoms and work with you to plan treatment. HS is not serious for most people, but it can affect quality of life, so your doctor will take it seriously.

Treatment

There is no cure for HS, but many treatments can control symptoms, reduce flare-ups, and prevent scarring. The right treatment depends on how severe your symptoms are. In all cases, self-care and lifestyle changes are the foundation of treatment.

Self-care at home

• Warm compresses – apply a clean, warm, damp cloth to painful lumps for 10–15 minutes a few times a day.
• Gentle cleansing – wash affected areas with a mild, unscented cleanser and pat dry. Avoid scrubbing.
• Loose clothing – wear soft, breathable fabrics to reduce friction and sweating.
• Don't pick or squeeze – this can make inflammation worse and increase scarring.
• If you smoke, ask your GP about stop-smoking support. If you are overweight, aim for gradual weight loss.

Medical treatments

Medical treatment is tailored to each person. It may include prescription creams or washes applied to the skin, antibiotics taken by mouth to reduce bacteria and inflammation (not just for infection), steroid injections to calm swollen lumps, medicines that affect the immune system, and in some cases biologic therapies given by injection or infusion. You and your doctor will decide the best plan together. Never start or stop a treatment without advice from your healthcare provider.

When is surgery considered?

Surgery is used when symptoms are severe and other treatments have not worked. Options may include cutting out a single lump (deroofing), laser treatment to remove affected tissue, or wider surgery to remove the whole area of inflamed skin. Recovery times vary. Talk to your specialist about the potential benefits and risks.

Living with this condition

Living with HS can be challenging, especially if you get flare-ups. Try to plan ahead: carry a small kit with wipes and a spare T-shirt, and wear dark, loose clothing when you have drainage. Tell people you trust – explaining your condition can reduce anxiety and embarrassment.

Lifestyle tips

• Stay a healthy weight – extra weight puts pressure on skin folds.
• Quit smoking – smoking makes HS worse and harder to treat.
• Keep skin cool – avoid heavy sweating and tight clothing.
• Stress management – stress can trigger flare-ups; try breathing exercises or gentle walks.

Diet and exercise

No specific diet cures HS, but eating a balanced diet helps you maintain a healthy weight, which can reduce friction and hormone levels. Some people find that a low-glycaemic diet (fewer sugary and refined foods) helps, but this is not proven for everyone. Regular exercise, when comfortable, supports overall health and mood.

Mental health and emotional wellbeing

HS can affect your confidence, body image, and mood. It is common to feel embarrassed or stressed, and some people feel depressed or anxious. These feelings are valid. Talk to your doctor if HS is affecting your mental health – you do not have to cope alone. Support groups and counselling can help.

Prevention

HS cannot always be prevented, but you can reduce the risk of flare-ups by not smoking, maintaining a healthy weight, avoiding skin friction, and treating early signs early. There is no guaranteed way to stop HS from starting.

Vaccines

There is no vaccine that prevents hidradenitis suppurativa. However, keeping your vaccinations up to date is important for your general health.

Screening programmes

There is no routine screening test for HS. If you have symptoms, see a doctor for an assessment.

Complications

If left untreated

• Worsening pain and repeated flare-ups
• Scarring and tunnelling under the skin that can become permanent
• Skin infections that may need antibiotics
• Restricted movement if lumps form over joints
• Rarely, long-standing HS can increase the risk of a type of skin cancer called squamous cell carcinoma

Long-term outlook

HS is a long-term condition, but with the right support most people see significant improvement. Treatments are better than ever, and many people manage their symptoms well. While there is no cure, you can live a full life. Don't lose hope – talking to a specialist and finding a care plan that works for you makes a real difference.

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