Hidradenitis Suppurativa: Symptoms, Causes, Treatment, and Living With This Painful Skin Condition

Hidradenitis suppurativa is a chronic inflammatory skin condition that can cause painful lumps, recurring abscesses, drainage, and permanent scarring. Often mistaken for ordinary boils, acne, or ingrown hairs, the condition can affect much more than a person’s skin. For some, it can interfere with sleep, movement, work, relationships, and confidence.

Despite its impact, hidradenitis suppurativa, commonly known as HS, is not always recognized quickly. People may spend years trying different skin products or treatments before discovering that their recurring symptoms have a name and that specialized care is available.

HS most often develops in areas where skin rubs together, including the armpits, groin, buttocks, and beneath the breasts. The condition can range from occasional painful bumps to more extensive inflammation that creates tunnels beneath the skin and wounds that repeatedly open and drain.

Although there is currently no universal cure, several treatments can help reduce inflammation, control flare-ups, relieve pain, and prevent the condition from progressing. Understanding the symptoms and seeking appropriate medical care can make an important difference.

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a long-term inflammatory disease that develops around hair follicles. It is sometimes called acne inversa because some of its lesions resemble acne, although it is a distinct condition with its own causes and treatment needs.

HS is not simply a skin infection. The disease involves inflammation within the skin, and affected follicles can become blocked and rupture, triggering a reaction in the surrounding tissue. This can lead to painful lumps, pockets of pus, and recurring inflammation.

As the condition progresses, some people develop channels beneath the skin called tunnels or sinus tracts. These may connect inflamed areas and allow fluid or pus to drain repeatedly. Healing can leave thickened, raised, or indented scars.

The severity varies widely. One person may experience occasional flare-ups in a small area, while another may develop multiple affected areas, persistent wounds, and significant pain.

HS is not contagious. It cannot be passed from one person to another through touching, sharing clothing, or ordinary personal contact. It is also not caused by poor hygiene, a misconception that can contribute to embarrassment and delay in seeking care.

What Are the Symptoms of Hidradenitis Suppurativa?

The symptoms of HS often begin after puberty and may recur in the same locations over many months or years. Some people notice a tender lump before any visible changes appear on the skin.

Common signs and symptoms include:

• Painful lumps beneath the skin that may resemble deep pimples or boils.
• Swollen areas that enlarge, become tender, or fill with pus.
• Recurrent sores that break open and drain fluid, blood, or pus.
• Unpleasant odor from draining wounds.
• Blackheads, sometimes appearing in pairs or clusters.
• Scars, including thickened bands of tissue or pitted areas.
• Tunnels beneath the skin that repeatedly drain or fail to heal completely.
• Itching, burning, or discomfort around affected areas.

Not everyone experiences all these symptoms. The disease can also change over time, with periods of relative improvement followed by painful flare-ups.

Where Does HS Usually Appear?

Hidradenitis suppurativa tends to develop in areas where skin folds or rubs together. Common locations include the armpits, groin, inner thighs, buttocks, skin beneath the breasts, and areas around the anus.

These locations can make the condition particularly difficult to manage. Walking, exercising, sitting for long periods, wearing fitted clothing, or participating in intimate relationships may become uncomfortable when lesions are inflamed.

People may also feel anxious about visible scars or drainage, particularly when wounds occur in private areas. These challenges are part of the disease’s impact and deserve attention alongside physical treatment.

What Causes Hidradenitis Suppurativa?

The exact cause of HS is not fully understood. Researchers believe that the condition begins when hair follicles become blocked and inflamed. When a follicle ruptures, the surrounding tissue can develop an intense inflammatory response.

Several factors may contribute to a person’s likelihood of developing the condition, but no single factor explains every case.

Genetics and Family History

HS can run in families. Some people have relatives with the same condition, suggesting that inherited factors may influence susceptibility.

However, having a family history does not mean someone will necessarily develop HS, and many people diagnosed with the condition have no known affected relatives.

Hormonal Influences

HS commonly begins after puberty, and some people notice that their symptoms become more pronounced around menstruation or during other hormonal changes.

These patterns suggest that hormones may influence the disease in some individuals. They do not mean that HS is simply a hormone imbalance, and hormone testing is not automatically necessary for everyone with the condition.

Smoking and Body Weight

Smoking and excess body weight are associated with HS and, in some people, more severe symptoms. Friction, heat, and sweating may also aggravate already inflamed areas.

However, HS can affect people of every body size, including those who do not smoke. These factors should not be treated as proof that someone caused their own condition.

If weight management or smoking cessation is relevant to a person’s health, supportive guidance may be helpful. Neither should replace medical treatment or be presented as a guaranteed way to eliminate HS.

Immune System and Inflammation

HS involves an abnormal inflammatory response in the skin. This is one reason treatments that target inflammation or specific immune-system pathways can help some patients.

The condition is also associated with certain other health problems, including inflammatory bowel disease, arthritis, metabolic syndrome, and depression. These associations do not mean that everyone with HS will develop another illness, but they make comprehensive healthcare important.

Who Is Most Likely to Develop HS?

Hidradenitis suppurativa can affect adults of different ages, backgrounds, and body types. It often begins in adolescence or early adulthood, although symptoms may start later.

Women are diagnosed more frequently than men in many populations, and research has found a higher reported burden among Black people. The reasons for these differences are not fully understood and may involve a combination of biological, genetic, environmental, and healthcare-access factors.

Family history can also increase the likelihood of developing HS.

Because the condition may be mistaken for recurring boils or other skin problems, some people experience a long delay before receiving a diagnosis. Recognizing recurring lesions in characteristic body areas is an important step toward getting appropriate care.

How Is Hidradenitis Suppurativa Diagnosed?

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There is no single blood test or routine laboratory test that confirms HS. Diagnosis is generally based on the appearance of the skin, the locations of the lesions, and the history of recurring symptoms.

A dermatologist will usually ask when the symptoms began, how frequently they return, whether the same areas are affected repeatedly, and whether there is a family history of the condition.

The doctor may examine the affected areas for nodules, abscesses, tunnels, and scars. If a wound is draining, a sample may sometimes be collected to investigate a possible secondary infection, but a culture alone cannot establish whether someone has HS.

Why HS Can Be Misdiagnosed

Early HS can look like acne, an ingrown hair, a boil, or an ordinary skin infection. A person may receive repeated treatments for these problems without anyone recognizing the recurring pattern.

If painful lumps keep appearing in the same areas, return soon after treatment, or leave scars and draining openings, it is worth asking a healthcare professional whether HS could be responsible.

Early diagnosis can help patients access appropriate treatment before repeated inflammation leads to more extensive scarring or tunnels beneath the skin.

What Treatments Are Available for Hidradenitis Suppurativa?

Treatment depends on the severity of the condition, the areas affected, how frequently flare-ups occur, and whether tunnels or persistent wounds have developed.

A dermatologist may recommend medication, wound care, in-office procedures, surgery, or a combination of approaches. The goal is to reduce inflammation, relieve symptoms, prevent new lesions, and preserve quality of life.

Medications and Anti-Inflammatory Treatments

For milder disease, a clinician may prescribe a topical medication, such as clindamycin, to help manage certain lesions. Oral antibiotics may also be used for their anti-inflammatory effects or when a bacterial infection is suspected.

Antibiotics are not appropriate for every flare, and repeated or prolonged courses require medical supervision because of possible side effects and antibiotic resistance.

For selected patients, hormonal treatments may help, particularly when symptoms appear to follow a menstrual pattern or when other hormonal factors are relevant. These treatments are not suitable for everyone and should be chosen according to a person’s medical history and treatment goals.

Biologic Medications

People with moderate to severe HS may benefit from biologic medications that target parts of the immune system involved in inflammation.

Adalimumab is an established treatment option, and other biologic therapies are available for eligible patients. The choice depends on factors such as disease severity, other medical conditions, previous treatments, and the potential benefits and risks.

Because these medications affect immune pathways, patients may need screening and monitoring for certain infections and other adverse effects. A dermatologist can explain whether a biologic is appropriate and what follow-up is required.

Procedures and Surgery

When HS causes persistent abscesses, tunnels, or scarred tissue, procedures may be necessary in addition to medication.

Options can include removing the tissue covering a tunnel, treating selected lesions with a procedure, laser-based treatments in appropriate cases, or surgically removing more extensive affected tissue.

Simply cutting open and draining an abscess may provide temporary relief from pressure, but the lesion can return because the underlying inflammatory disease remains. A treatment plan should therefore address the recurring condition, not just an individual painful lump.

For some patients, a combination of medical therapy and surgery offers better long-term control than either approach alone.

Everyday Care: Managing HS at Home

Medical treatment is often the foundation of HS care, but everyday habits can help reduce irritation and make flare-ups easier to manage.

Gentle skin care is important. Use a mild cleanser, avoid aggressive scrubbing, and pat affected areas dry rather than rubbing them. Some patients may benefit from an antiseptic wash, but the right product depends on individual skin sensitivity and should be discussed with a healthcare professional.

Warm compresses may help ease discomfort during a flare. Loose-fitting clothing and breathable fabrics can reduce friction in sensitive areas. If shaving or hair-removal products trigger irritation, avoid using them on affected skin and ask a dermatologist about alternatives.

For draining wounds, follow professional wound-care instructions and use suitable dressings to protect the skin and absorb fluid. Avoid squeezing or attempting to drain lumps yourself, as this can worsen tissue injury.

If smoking is a factor, getting help to stop may support overall health and could improve HS outcomes. For people whose weight is affecting symptoms, a compassionate, individualized plan may be useful. There is no single lifestyle change that works for everyone, and patients should not be made to feel that their disease is their fault.

Does Diet Affect Hidradenitis Suppurativa?

Some people report that certain foods appear to trigger flare-ups, and researchers are investigating how diet may influence inflammation and HS symptoms. However, evidence for specific dietary restrictions remains limited, and no single diet has been proven to cure the condition.

A balanced eating pattern that supports overall health is a reasonable starting point. If you suspect a particular food affects your symptoms, keeping a diary of meals and flare-ups may help you identify patterns to discuss with a healthcare professional or registered dietitian.

Avoid eliminating entire food groups or taking high-dose supplements without appropriate guidance, especially if doing so could lead to nutritional deficiencies.

The Emotional Impact of Living With HS

Hidradenitis suppurativa can affect much more than physical comfort. Repeated pain, drainage, scarring, and uncertainty about when the next flare will occur can influence how a person feels about their body and interacts with others.

Some people avoid social activities, exercise, dating, or intimacy because they fear pain, odor, visible lesions, or questions about their skin. Others experience frustration after years of unsuccessful treatment or feel embarrassed about symptoms they do not fully understand.

These reactions are understandable. HS is a medical condition, not a personal failing, and people living with it deserve care that addresses both physical symptoms and emotional well-being.

Talking openly with a healthcare professional about pain, sleep, relationships, or mental health can help identify additional support. Counseling, peer-support groups, and connecting with others who understand the condition may also reduce feelings of isolation.

Family members and partners can help by listening without judgment, learning about the disease, and respecting the person’s preferences around wound care, privacy, and treatment.

When Should You Seek Medical Care?

Recurring painful lumps, wounds that do not heal, or repeated drainage in the armpits, groin, buttocks, or beneath the breasts warrant medical evaluation, particularly when the symptoms keep returning.

Arrange an appointment with a healthcare professional if lesions are becoming more frequent, scars or tunnels are forming, pain is interfering with everyday activities, or previous treatment has not helped. A dermatologist with experience treating HS may be especially helpful.

Seek prompt medical care if an affected area develops rapidly spreading redness, worsening swelling, fever, or other signs that could indicate a significant infection. Severe or rapidly worsening symptoms should not be managed solely at home.

Early assessment can help distinguish HS from other conditions and identify the most appropriate treatment.

Can Hidradenitis Suppurativa Be Cured?

HS is a chronic condition that can recur over time. There is no single treatment that guarantees a permanent cure for everyone, but that does not mean symptoms cannot improve.

Many patients can achieve better control with a treatment plan tailored to their disease. Medication may reduce inflammation and flare frequency, while procedures or surgery can help manage persistent tunnels and damaged tissue.

The condition may require adjustments to treatment as symptoms change. Regular follow-up allows clinicians to evaluate progress, manage side effects, and address new or recurring lesions.

The most important message is that people do not have to accept repeated pain and draining wounds without help. A timely diagnosis, informed treatment choices, and ongoing support can make a meaningful difference in daily life.

The Bottom Line

Hidradenitis suppurativa is a chronic inflammatory skin disease that can cause painful lumps, recurring abscesses, drainage, tunnels, and scarring. Because it can resemble boils or acne, it is sometimes overlooked or misdiagnosed.

Although the precise cause is not fully understood, HS is not contagious and is not caused by poor hygiene. Treatment may include medications, biologic therapies, wound care, lifestyle adjustments, and procedures or surgery, depending on the person’s needs.

If you experience recurring painful lesions, especially in areas where skin rubs together, speak with a healthcare professional rather than repeatedly treating them as ordinary boils. Getting the right diagnosis can open the door to better symptom control and support for both physical and emotional health.

Health Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Consult a qualified healthcare professional about symptoms, diagnosis, and treatment options.