Hidradenitis suppurativa (HS) is a life-long, painful condition of the groin and underarms that leads to abscesses and scars.
The exact cause of HS is unknown, but smoking and excess body weight are major risk factors.
HS can be treated with the help of a medical provider.
Hidradenitis suppurativa (HS) is a chronic (life-long) skin condition due to inflammation of the sweat gland. The name comes from the Greek language where hidros means “sweat,” and aden means “glands.” HS causes painful lumps under the skin and is often incorrectly diagnosed as folliculitis, or boils. It can cause long-term issues such as scarring and pain.
Here we’ll review the basics of HS, including symptoms, cause, diagnosis, and treatment.
The basis of HS is inflammation within the sweat gland and its partnered hair follicle. This is unlike folliculitis, which is an infection of the hair follicle. In HS, the surface opening of the hair follicle and gland get clogged, leading 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. They include skin breakdown, large draining abscesses (pockets of pus), scars, and sinus tracts between the scars. This can be painful, disfiguring, and can greatly affect a person’s quality of life. Open skin is more likely to get infected, so infections can occur in HS. But infection is a secondary process in HS, not the cause.
The cause of HS isn’t fully understood. But a number of factors are known to increase a person’s risk to develop HS. They include:
Genetics: About 40% of 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 of greater than 30 has been associated with a higher risk of developing HS.
Smoking: The majority of 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, although the reason for this is not understood.
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. Multiple scars can form underground tunnels, called “sinus tracts.”
HS most commonly affects skin folds where sweat glands and hair predominate. These areas include the groin, armpits, inner thighs, and the area underneath the breasts.
HS severity is measured in stages. They are named after Dr. Hurley, who first wrote about them:
1) Hurley stage 1: a single or a few nodules or open skin abscesses without scarring
2) Hurley stage 2: many recurrent abscesses, and first signs of scarring
3) Hurley stage 3: widespread involvement, scarring, sinus tracts
HS is often incorrectly diagnosed. So the first step is getting the right diagnosis. Consider getting the help of a dermatologist, a doctor who specializes in skin conditions. They can help figure out what’s going on and recommend treatment.
Treatment for HS includes steps you can take on your own — as well as prescription medication. To improve your HS, consider the following steps:
Losing excess weight can help to improve your HS.
Making dietary changes — such as avoiding dairy and reducing sugars — have been shown to be helpful for some.
Many treatments require prescriptions, so it’s important to see a medical provider to discuss your options. These include:
Humira (adalimumab), an injectable biologic medication, which is also used for other inflammatory conditions like psoriasis and inflammatory bowel disease, can also help.
In-office treatments can also offer symptom relief for people with HS. Injections of a steroid into the painful nodules can help them heal faster. Surgeries to remove scars and nodules are another option. Ongoing clinical trials for HS offer hope for future treatments.
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.
HS is a long-standing condition that rarely goes away on its own. Although it’s seldom fatal, having a life-long condition can cause physical and emotional problems that can be difficult and dangerous. Ongoing self-care can help to prevent related issues. For example, when the skin breaks down, the risk of infection increases. Some infections can be serious if they get into the blood or spread to other areas of the body. Also, chronic wounds can turn into skin cancer called “squamous cell carcinoma.” This is why a close relationship with your medical provider is important to help treat and monitor your HS throughout your life.
Hidradenitis suppurativa is a chronic skin condition caused by inflammation within the sweat gland and hair follicle unit. The exact cause is unknown, but genetic factors, smoking, and obesity play a role in the development of HS. Although there are some treatments available for HS — including antibiotics, injections, and surgery — many new treatments are still in development, leaving hope for future breakthroughs.
Alikhan, A., et al. (2019). North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. Journal of American Academy of Dermatology.
Jfri, A. H., et al. (2019). Hidradenitis suppurativa: Comprehensive review of predisposing genetic mutations and changes. Journal of Cutaneous Medicine and Surgery.
Revuz, J. E., et al. (2008) . Prevalence and factors associated with hidradenitis suppurativa: Results from two case-control studies. Journal of American Academy of Dermatology.
Silfvast-Kaiser, A., et al. (2019). Diet in hidradenitis suppurativa: A review of published and lay literature. International Journal of Dermatology.
Sivanand, A., et al. (2020). Weight loss and dietary interventions for hidradenitis suppurativa: A systematic review. Journal of Cutaneous Medicine and Surgery.
Vazquez, B. G., et al. (2013). Incidence of hidradenitis suppurativa and associated factors: A population-based study of Olmsted County, Minnesota. Journal of Investigative Dermatology.