Hidradenitis Suppurativa (HS): Your GoodRx Guide

Definition

Hidradenitis suppurativa (HS) is a chronic (lifelong) skin condition caused by the inflammation of the sweat gland. HS causes painful lumps under the skin and can lead to long-term issues, such as scarring and pain. 

In HS, the surface opening of the hair follicle and sweat gland get clogged. This can lead to a buildup of dead skin, sweat, and other fluids underneath the skin. This causes an immune system response and long-lasting inflammation. 

This inflammation under the skin eventually causes more problems. This can include:

• Skin breakdown

• Large draining abscesses (pockets of pus)

• Scarring

• Sinus tracts (multiple connecting lesions that form tunnels under the skin and drain)

• Infections

This can be painful, disfiguring, and can greatly affect your quality of life.

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Causes

Experts don’t fully understand the cause of HS. But a number of factors are known to increase a person’s risk to develop HS. They include:

• Genetics: About 4 in 10 people with HS have a family member with a similar condition.

• Excess body weight: HS can happen in people of any weight. But having a body mass index (BMI) over 30 has been associated with a higher risk of developing HS.

• Smoking: Most people with HS actively smoke.

• Sex at birth: Women are more than twice as likely to have HS than men, which suggests that certain hormonal pathways play a role in HS.

• Race: Data suggest HS is more common among people of African descent. The reason for this is not understood.

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Symptoms

The most common skin changes include painful, red nodules (large bumps), and abscesses that drain fluid. These tend to come and go. Eventually, scars that deform the skin occur. 

HS most commonly affects skin folds and areas where there are prominent sweat glands. These areas include the:

• Groin

• Armpits

• Inner thighs

• Area underneath the breasts

Diagnosis

HS can be hard to diagnose, since there are no specific tests for the condition. In most cases, your healthcare provider will use information about your symptoms and the physical exam to make the diagnosis. 

The early stages of HS can sometimes be mistaken for folliculitis or boils. And it can take up to 7 years to get the correct diagnosis.

After an HS diagnosis, your provider will measure how severe it is by using Hurley stages: 

• Hurley stage 1: a single or a few nodules or open skin abscesses without scarring

• Hurley stage 2: many recurrent abscesses, and the first signs of scarring

• Hurley stage 3: many nodules and abscesses that cover a large area with connecting sinus tracts and wide-spread scarring

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Treatments

Since HS is often misdiagnosed, the first step in treatment is getting the right diagnosis. You’ll need the help of a dermatologist, a doctor who specializes in skin conditions. 

Treatment for HS can include lifestyle changes. That means there are steps you can take to help lessen your symptoms. Here are some possible options:

• Quit smoking. If you smoke, quitting smoking is one of the most important things you can do. Although this isn’t always easy, there are many resources available to help. 

• Lose excess weight. If you’re living with a heavier body weight, losing excess weight may help to lessen your HS symptoms.

• Consider dietary changes. Research shows that avoiding dairy and reducing sugars is helpful for some people with HS.

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Medications

Many HS treatments require prescriptions, so it’s important to see a medical provider to discuss your options. These medications include:

• Antibiotics like doxycycline (pill form) and clindamycin (topical) can treat secondary infections. 

• Retinoids like acitretin may reduce HS inflammation.

• Metformin, a medication used for diabetes, has been shown to improve HS, too. 

• Birth control pills and spironolactone can help decrease the hormonal trigger for HS in women. 

• Humira (adalimumab) and Cosentyx (secukinumab) are injectable medications that help decrease inflammation and HS symptoms.

In-office treatments can also help relieve HS symptoms. These treatments may include: 

• Injections of a steroid into the painful nodules to speed healing 

• Laser hair removal to decrease nodules

• Botox treatments to reduce sweating

• Incision and drainage of any abscesses

• Surgery (laser or traditional) to remove scars and nodules 

Ongoing clinical trials for HS offer hope for future treatments. 

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Coping with hidradenitis suppurativa

There’s no cure for HS yet. But your healthcare provider can make sure your treatment plan helps to improve your quality of life. An effective treatment plan should reduce HS flares and address:

• Pain control (including medications and alternative treatments)

• Wound care (tips and tools for wound dressing changes)

• General skin care (like non-irritant products to use for skin health)

• Mental health (signs of anxiety and depression to look for, and tips for self-care)

If HS has affected your life, know that support is available. Hope for HS and the HS Foundation offer the latest information on HS, stories of people with HS, and support for those with HS at their time of need. 

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