Hidradenitis Suppurativa Guide
Hidradenitis Suppurativa: Causes, Symptoms & Treatment
Hidradenitis suppurativa, or HS, is a chronic inflammatory skin disease that causes recurring painful nodules, abscesses and tunnels, most often in the armpits, groin, buttocks and under the breasts. It is not caused by poor hygiene and it is not contagious.
HS is an inflammatory disease centered around the hair follicle. It can look like boils or ingrown hairs, but recurring lesions in the same skin-fold areas, especially when they scar or form tunnels, should raise suspicion for HS. Early dermatology care can reduce flares, pain and permanent skin damage.
Skin Works does not diagnose or medically manage HS.
This article is educational. Suspected HS should be evaluated by a dermatologist, particularly when lesions are recurrent, draining, painful or leaving scars.
HS is often delayed or misdiagnosed because an early lesion can resemble a pimple, cyst, boil or ingrown hair. The pattern over time is what matters: deep painful bumps that return in the same areas, slow healing, drainage, scarring and eventually tunnels beneath the skin.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa is also called acne inversa, although it is not ordinary acne. It is a chronic inflammatory condition that affects hair-bearing skin, especially areas where skin touches skin.
Common sites include the armpits, groin, inner thighs, buttocks and folds beneath the breasts. Symptoms range from occasional painful nodules to severe disease with interconnected tunnels, ongoing drainage and thick scars.
What Does HS Look and Feel Like?
Early HS may appear as a single tender lump beneath the skin. The lesion can persist for days or weeks, improve and then return in the same area.
| Common feature | What you may notice | Why it matters |
|---|---|---|
| Deep nodules | Painful, firm lumps under the skin | Often one of the earliest signs |
| Abscess-like lesions | Swollen areas that may open and drain | Repeated lesions in the same place are an important clue |
| Tunnels | Channels beneath the skin connecting recurrent lesions | Suggest more established disease |
| Scarring | Thick, rope-like or depressed scars | Can limit movement in severe cases |
| Drainage | Blood or pus-like fluid, sometimes with odor | Does not by itself mean HS is primarily an infection |
What Causes Hidradenitis Suppurativa?
The exact cause is complex. Current understanding places follicular blockage and abnormal immune inflammation at the center of the disease. The older idea that HS begins mainly in the apocrine sweat glands is no longer considered an adequate explanation.
Genetics can play a role, and hormonal influences may help explain why disease often begins after puberty. Smoking and higher body weight are associated with HS and can be linked with more severe disease, but neither is required. Thin people and people who have never smoked can still develop severe HS.
Heat, friction, sweating and tight clothing may aggravate symptoms in some patients. They are not the root cause.
How Is HS Diagnosed?
There is no single blood test for HS. Diagnosis is usually based on the type of lesions, their typical locations and a history of recurrence.
A dermatologist may swab drainage when infection is suspected, but a culture does not define whether someone has HS. Imaging or biopsy is not routinely required for a typical case.
What Are the Hurley Stages?
Clinicians often use Hurley staging as a simple way to describe the extent of HS.
| Stage | General description | Typical approach |
|---|---|---|
| Hurley I | Nodules or abscesses without established tunnels or extensive scarring | Skin care, topical or oral medicines, selected procedures |
| Hurley II | Recurrent lesions with some tunnels and scarring, separated by areas of normal skin | Often needs combination medical and procedural treatment |
| Hurley III | Broad involvement with multiple interconnected tunnels | Specialist medical therapy plus procedural or surgical management is often needed |
How Is Hidradenitis Suppurativa Treated?
There is no one treatment for everyone. Dermatologists build a plan around disease severity, lesion type, location, pain, scarring, other health conditions and how much HS affects daily life.
Topical and oral medicines
Topical clindamycin may be used for selected mild disease. Oral tetracycline-class antibiotics and other antibiotic combinations may be used for wider disease. In HS, antibiotics can be used partly for their anti-inflammatory effect, not only to treat infection.
Hormonal treatment
For selected patients, treatments such as spironolactone, combined oral contraceptives or metformin may be considered. The choice depends on medical history, pregnancy plans and disease pattern.
Biologic medicines
Moderate-to-severe HS may require medicines that target specific immune pathways. FDA-approved biologic options include adalimumab, secukinumab and bimekizumab. These medicines require medical screening and ongoing monitoring.
Procedures and surgery
Persistent tunnels and recurring lesions may need deroofing, excision or other surgical treatment. Simple incision and drainage may relieve pressure for a short time but has a high recurrence rate and is not definitive HS treatment.
CO₂ laser can also be used in selected HS procedures to remove affected tissue. That use is different from routine cosmetic fractional CO₂ resurfacing.
Can Laser Hair Removal Help HS?
It can help selected patients, especially when disease is earlier and centered around hair-bearing areas. The American Academy of Dermatology includes laser hair reduction among office-based options that can reduce HS nodules and pus-filled bumps.
Long-pulsed laser systems, including Nd:YAG, have been studied because reducing hair follicles may reduce one part of the follicular process involved in HS. Laser hair reduction is an adjunct, not a replacement for dermatology care or biologic treatment when those are needed.
Skin Works offers laser hair removal with diode and Nd:YAG technology. If you have confirmed HS, medical management should remain with your dermatologist. Laser candidacy should be considered only as part of that treatment plan, especially when active open wounds or severe inflammation are present.
What Can Help Reduce Irritation at Home?
Gentle care matters. Avoid squeezing lesions, aggressive scrubbing and waxing affected skin. Loose clothing may reduce friction. Your dermatologist may recommend an antibacterial or antiseptic wash if appropriate for your skin.
Smoking cessation can improve overall health and may reduce HS activity. If weight is contributing to friction or disease severity, medically appropriate weight management may also help. These steps can support treatment, but HS should never be framed as a disease that someone caused by their weight or behavior.
Is HS Connected to Other Health Conditions?
HS can occur alongside other inflammatory and metabolic conditions. People with HS have higher rates of inflammatory arthritis, inflammatory bowel disease, metabolic disease and depression or anxiety.
This does not mean every person with HS will develop these problems. It does mean that persistent HS deserves medical care that looks beyond the skin when symptoms suggest another condition.
When Should You See a Dermatologist?
Seek dermatology evaluation when painful lumps keep returning in the same area, occur in more than one skin fold, drain repeatedly, do not improve within a few weeks, or begin leaving scars or tunnels.
Repeated short courses of drainage or antibiotics without a clear diagnosis can delay treatment while permanent scarring and tunnels continue to develop.
What Is Skin Works’ Role?
Skin Works Medical Spa does not diagnose or manage hidradenitis suppurativa as a medical dermatology condition. Patients with suspected HS should see a dermatologist.
Our role is narrower. If a dermatologist has already diagnosed HS and recommends laser hair reduction as part of the plan, Skin Works can assess whether the requested area, skin condition and hair characteristics are appropriate for our laser hair-removal program. Active lesions or wounds may mean treatment needs to be postponed.
Frequently Asked Questions
Is hidradenitis suppurativa contagious?
No. HS is not contagious and cannot be spread by touching, sharing towels or sexual contact.
Is HS caused by poor hygiene?
No. HS is an inflammatory disease involving hair follicles and immune signaling. Scrubbing harder does not cure it and can increase irritation.
Is HS the same as an ingrown hair?
No. One early HS lesion can look like an ingrown hair, but recurring deep nodules, drainage, scars and tunnels in typical skin-fold areas are different from a simple ingrown hair.
Can antibiotics cure HS?
No. Antibiotics can reduce inflammation, bacterial burden and some flares, but HS is a chronic inflammatory disease and often needs a broader treatment plan.
Can laser hair removal cure hidradenitis suppurativa?
No. Laser hair reduction can help selected patients and may reduce lesions in treated hair-bearing areas, but it is an adjunct rather than a cure.
What is the most effective treatment for severe HS?
There is no single best treatment for every severe case. Moderate-to-severe disease often needs a biologic medicine, surgery or both, guided by a dermatologist experienced in HS.
Can HS go away permanently?
HS is considered chronic. Some people achieve long periods of good disease control or remission, but treatment is aimed at reducing flares, preventing progression and improving quality of life rather than promising a permanent cure.
Sources & Medical References
- American Academy of Dermatology: Hidradenitis Suppurativa Diagnosis and Treatment
- American Academy of Dermatology: Hidradenitis Suppurativa Self-Care
- Mayo Clinic: Hidradenitis Suppurativa Symptoms and Causes
- Mayo Clinic: Hidradenitis Suppurativa Diagnosis and Treatment
- U.S. FDA: Adalimumab Approval for Hidradenitis Suppurativa
- U.S. FDA Prescribing Information: Bimekizumab for Hidradenitis Suppurativa
This article is educational and does not replace diagnosis or treatment by a dermatologist. HS can cause permanent scarring and significant pain, so recurring lesions should be evaluated rather than repeatedly treated as simple boils or ingrown hairs.