Hidradenitis suppurativa explained

What hidradenitis suppurativa is

Hidradenitis suppurativa, sometimes shortened to HS, is a long-term inflammatory skin condition. It affects areas where skin rubs against skin and where certain glands and hair follicles are found, most often the armpits, groin, buttocks and, in women, under the breasts. In HS, hair follicles become blocked and inflamed, leading to painful lumps deep in the skin that can enlarge, become abscesses, and sometimes burst and leak fluid. Over time, repeated inflammation in the same areas can cause tunnels under the skin and scarring. The exact cause is not fully understood, but it involves inflammation, and factors such as family history, smoking and being overweight can play a part. Importantly, HS is not caused by poor hygiene and it is not contagious — it cannot be passed on to anyone else.

The symptoms it causes

Hidradenitis suppurativa usually begins after puberty, often in early adulthood, and tends to come and go in flare-ups. Early on, people may notice one or more painful, firm lumps under the skin, similar to a boil, in areas like the armpit or groin. These can enlarge, become abscesses, and may open and drain fluid or pus, sometimes with an unpleasant smell. As the condition continues, the same areas can be affected repeatedly, and over time this may lead to blackhead-like spots, tunnels under the skin that leak, and scarring that can restrict movement. The pain, discharge and location of the lumps can be uncomfortable, embarrassing and tiring to live with, and flare-ups may be triggered by things like friction, heat, sweating, stress or hormonal changes. Severity ranges widely, from occasional mild lumps to more extensive, persistent disease.

How it is diagnosed

There is no special test for hidradenitis suppurativa; it is diagnosed by a doctor recognising the typical pattern — recurring painful lumps and abscesses in the characteristic areas such as the armpits and groin, coming back over time. Because the early lumps can look like ordinary boils, HS is often mistaken for repeated infections and diagnosed late, sometimes years after it began, so describing the recurring nature and the areas affected is helpful. A doctor may ask about family history and about factors such as smoking. Swabs or other tests are sometimes done to check for infection or to rule out other conditions, but the diagnosis itself is based on the clinical picture. Referral to a skin specialist (dermatologist) is common, especially for more troublesome disease, both to confirm the diagnosis and to plan treatment. Recognising it correctly is the first step to better care.

How it is managed

There is no simple cure for hidradenitis suppurativa, so care aims to reduce pain and flare-ups, treat lumps and abscesses, and prevent scarring, tailored to how severe it is. General measures can help, including stopping smoking, working towards a healthy weight, wearing loose clothing to reduce friction, and gentle skin care. For milder disease, treatments applied to the skin or short courses of certain medicines may be used, and painful abscesses sometimes need to be drained. For more troublesome or widespread HS, specialists can offer longer courses of medicines, treatments that target the underlying inflammation, and, where areas are badly affected or scarred, surgery to remove the involved skin. Managing pain is an important part of care in its own right. Because HS is long-term and can affect confidence and mood, support for wellbeing and regular review to adjust treatment both matter.

Living with hidradenitis suppurativa

Living with hidradenitis suppurativa can be challenging, both physically and emotionally, but understanding the condition and having a clear management plan helps. Learning your own triggers — such as friction, heat, tight clothing or stress — and reducing them where you can may lessen flare-ups, and simple steps like loose clothing, gentle washing and managing sweat can ease day-to-day symptoms. Stopping smoking and working towards a healthy weight can genuinely help the condition as well as general health. Because HS is often painful and appears in private areas, it can affect confidence, relationships and mood, and it is completely reasonable to seek support for this as well as for the skin. Staying in touch with your GP and dermatology team ensures treatment keeps pace with the condition, and patient organisations offer practical tips and the reassurance of others who understand what living with HS is like.