Health condition · Clinically reviewed
Hidradenitis suppurativa, a commonly missed chronic condition — biologics have transformed care.
Painful, recurring boils and abscesses in flexural areas. Often misdiagnosed as “recurrent infection”. Modern biologics (adalimumab, secukinumab) and surgery transform outcomes.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Checked against BAD, European S1 and peer-reviewed sources you can see at the end.
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Current for 2026
Reflects modern UK guidance including anti-TNF and IL-17 biologics for moderate-severe HS.
Key facts
Hidradenitis suppurativa at a glance.
The essentials, in plain English — what it is, who it affects, how it’s staged and how it’s treated in the UK today.
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What it is
A chronic inflammatory disease of the terminal hair follicle — driven by follicular occlusion, rupture and immune activation.
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Where it strikes
Apocrine-rich areas: axillae, groin, buttocks and under the breasts — anywhere skin meets skin.
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How common
UK prevalence about 1% of adults, with women affected more often than men. Frequently under-recognised.
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How it’s staged
Hurley staging I to III — from isolated nodules to widespread interconnected sinus tracts and scarring.
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Anti-TNF therapy
Adalimumab is licensed in the UK for moderate-severe HS and has transformed medical management.
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IL-17 therapy
Secukinumab (IL-17A) is now approved for moderate-severe HS — a genuine second biologic option.
Why this guide matters
Under-recognised, and now genuinely treatable.
HS is often written off as “recurrent boils” for years before anyone names it. Three points frame the rest of this page.
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It is not an infection
Repeated antibiotic courses without a plan miss the point — HS is inflammatory, and needs inflammatory-directed treatment.
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Biologics have changed the game
Adalimumab and secukinumab are now licensed options that transform quality of life in moderate-severe disease.
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Surgery closes the loop
For Hurley III disease, wide excision with reconstruction gives the best long-term control — biologics buy time and reduce inflammation before surgery.
How the diagnosis is made
From recurrent boils to a named diagnosis and a plan.
The steps a UK GP or dermatologist will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Pattern, examination and staging
Phase 2 · Confirming
Co-morbidity and infection screening
Phase 3 · Managing
Impact scoring and joint clinic
- 01
Recognising
Symptoms and family history
Recurrent painful nodules and boils in flexural sites — often a family history of HS in a first-degree relative.
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Recognising
Skin examination and mapping
A full skin examination with photographic mapping of every affected site — essential for tracking disease and planning surgery.
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Recognising
Hurley staging
Stage I (isolated nodules), Stage II (recurrent abscesses with tracts and scarring) or Stage III (diffuse interconnected disease).
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Confirming
Screen for co-morbidity
Inflammatory bowel disease, PCOS and metabolic syndrome are all associated — worth actively looking for.
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Confirming
Culture only if superinfected
HS is not primarily an infection — routine swabs aren’t useful. Culture only when secondary bacterial infection is suspected.
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Managing
Measure life impact (DLQI)
The Dermatology Life Quality Index quantifies the toll on daily life — often extremely high and used to justify biologic therapy.
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Managing
Joint dermatology + plastics clinic
Complex cases benefit from a combined dermatology and plastic surgery clinic — medical control plus definitive excision when needed.
Typical timeline: first dermatology visit to a settled plan in weeks, not months.
Symptoms
What HS actually looks and feels like.
The classic flexural pattern of painful nodules, sinus tracts and rope-like scarring — and the features that mean it’s time to escalate.
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Axillary nodules
Recurrent painful lumps in the armpit — often the first site to declare itself, frequently mistaken for repeated abscesses.
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Groin nodules
Painful lumps in the inguinal folds and on the inner thigh — chafing and friction make it worse.
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Buttock nodules
Nodules on the buttocks and perineum — often severely painful when sitting and can extend perianally.
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Under-breast nodules
Inframammary disease — heat, sweat and pressure combine to keep flares going.
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Painful subcutaneous nodules
Deep, tender lumps that develop over days — sometimes rupturing to discharge pus and blood.
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Sinus tract formation
Interconnected tunnels under the skin that leak persistently — a hallmark of Hurley II and III disease.
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Rope-like scarring
Thick, cord-like scars that follow the course of chronic tracts — restrict movement and rarely resolve without surgery.
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Red-flag features
Fistula formation into bowel or bladder is a surgical emergency — urgent referral is essential.
Treatment
How HS is treated in the UK.
Lifestyle change and topicals first, escalating through oral combinations to biologics and — for extensive disease — definitive surgery.
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Weight loss and smoking cessation
The two most impactful lifestyle changes — both meaningfully reduce flare frequency and improve response to every other treatment.
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Topical clindamycin
First-line topical for Hurley I disease — anti-inflammatory as well as antibacterial. Used as a lotion twice daily.
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Oral tetracycline (long course)
Doxycycline or lymecycline for three months or longer — mainly anti-inflammatory, useful in mild to moderate disease.
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Clindamycin + rifampicin combination
A well-established 10-week combination for moderate disease — evidence-supported and often effective when tetracyclines fail.
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Anti-androgen (spironolactone)
Useful in women with a hormonal pattern of flares — often combined with combined oral contraception.
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Adalimumab (anti-TNF)
Licensed biologic for moderate-severe HS — a fortnightly injection that reduces inflammatory nodule count and quality-of-life impact.
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Secukinumab (IL-17A)
A newer NICE-approved biologic option for moderate-severe HS when adalimumab is unsuitable or fails.
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Wide excision + reconstruction
Definitive surgery for Hurley III disease — wide local excision of affected tissue with plastic reconstruction gives the best long-term control.
What this guide is based on
The sources behind every claim on this page.
UK national guidance, European specialist consensus and patient-organisation resources, current at the time of last review.
Key references
Guidelines and standards we relied on.
A quiet reminder
This guide is for information, not medical advice.
Your GP or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.
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British Association of Dermatologists (BAD). Guideline for the management of hidradenitis suppurativa.
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European S1 guideline for the treatment of hidradenitis suppurativa / acne inversa.
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HS UK. Patient information and support.
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European Hidradenitis Suppurativa Foundation. Clinical resources and staging tools.
Red flags
When HS needs urgent attention.
Most HS is chronic and manageable. These are the situations where it isn’t — and you should act today.
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Squamous cell carcinoma in chronic HS
Long-standing HS carries a small but real risk of SCC arising in chronic sinus tracts — new hard nodules or ulcers warrant urgent biopsy.
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Fistula to bowel or bladder
Rare but serious — perianal or perineal HS can tunnel into the rectum or urinary tract. Urgent surgical referral.
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Depression or suicidality
HS carries one of the highest mental health burdens of any dermatological condition — active screening and support are essential.
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Post-op wound healing failure
Wide excisions in a smoker, in a moist site or under tension can dehisce — expect prolonged healing and plan follow-up.
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Post-biologic infection
Adalimumab and secukinumab increase infection risk — fever, cellulitis or reactivation of latent TB needs same-day review.
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Anaemia of chronic disease
Long-standing inflammation depletes iron and suppresses erythropoiesis — check FBC, ferritin and CRP if fatigue is prominent.
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Anaesthetic risk in extensive disease
Widespread active disease raises perioperative infection and airway risk — a preoperative anaesthetic review is worthwhile.
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Pregnancy planning
Some HS treatments are unsafe in pregnancy — planning ahead with your dermatologist matters.
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Comorbid Crohn’s disease
HS and Crohn’s overlap frequently — new abdominal pain, blood in stool or weight loss should trigger gastroenterology referral.
Living with it
A long-term condition, but a very treatable one.
Four things that make the biggest difference day to day — lifestyle change, gentle skin care, mental health support and knowing when to step up.
A quiet reminder
Consistency beats intensity, every time.
Small, steady habits — kept up for months — do more than a heroic week that doesn’t last.
- 01 Lifestyle
Weight and smoking come first
The two changes that consistently reduce flare frequency — worth prioritising above almost anything else.
- 02 Skin care
Cool, loose, low-friction
Loose cotton clothing, antiperspirants free from aluminium chlorohydrate and gentle antiseptic washes reduce daily irritation.
- 03 Support
Mental health is part of the plan
The visible and invisible toll is enormous — HS UK and local dermatology psychology services can help.
- 04 Escalate
Don’t put up with it
If topical and oral treatments aren’t enough, biologics and surgery have transformed what’s achievable — ask for referral.
Frequently asked
Everything we get asked about HS.
Quick answers on staging, biologics, surgery and when to worry.
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What is hidradenitis suppurativa?
A chronic inflammatory disease of the terminal hair follicle. Follicles become blocked, rupture and trigger deep, painful inflammation with recurrent nodules, abscesses and sinus tracts in skin-fold areas.
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Is HS an infection?
No. HS is primarily inflammatory, not infectious. Bacteria can secondarily infect ruptured lesions, but antibiotics work in HS mainly through their anti-inflammatory effects rather than by killing bacteria.
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How is HS staged?
By the Hurley system. Stage I is isolated nodules or abscesses without tracts or scarring. Stage II is recurrent abscesses with sinus tract formation and scarring. Stage III is diffuse, interconnected tracts across an entire area.
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What are adalimumab and secukinumab?
Both are biologic injections. Adalimumab blocks TNF-alpha and is licensed for moderate-severe HS. Secukinumab blocks IL-17A and has more recently been approved — a genuine second option when adalimumab isn’t suitable.
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When is surgery the right answer?
For Hurley III disease or persistent Hurley II disease unresponsive to medical treatment. Wide local excision of the whole affected area, often with plastic reconstruction, offers the best long-term control.
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When should I see a GP urgently?
For new fistula formation, systemic illness with fever, suspected SCC in a chronic tract, or significant depression or suicidal thoughts. Otherwise, ask your GP for dermatology referral if flares are frequent.
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