Hidradenitis suppurativa: a deep dive

Hidradenitis suppurativa is a chronic inflammatory skin condition causing painful, recurrent lumps, abscesses, and sometimes tunnels (sinus tracts) under the skin, typically in areas with skin folds and sweat glands such as the armpits, groin, and under the breasts. It is more than a simple skin infection; it involves chronic inflammation of hair follicles and surrounding tissue. It can significantly affect quality of life and often requires long-term, multi-pronged management.

The exact cause is not fully understood, but it involves blockage and inflammation of hair follicles, with genetic predisposition, hormonal factors, smoking, and obesity all recognised as contributing factors. It is not caused by poor hygiene, a common misconception that can add to the stigma some people feel about the condition. A family history of hidradenitis suppurativa is common, suggesting a significant genetic component.

Symptoms include recurrent, painful lumps or boils, often progressing to abscesses that can drain fluid, typically in the armpits, groin, buttocks, or under the breasts. Over time, with repeated episodes, scarring and tunnels (sinus tracts) can develop under the skin connecting different affected areas. Symptoms often follow a relapsing and remitting pattern, with flares and periods of relative improvement.

It is not life-threatening, but it can cause significant pain, scarring, and psychological impact, including depression and reduced quality of life, if not well managed. Long-standing, severe disease can occasionally be associated with other health issues, including an increased risk of certain other inflammatory conditions. With appropriate, often multidisciplinary, treatment, many people achieve meaningful improvement in symptoms and quality of life.

Treatment is tailored to severity and can include topical or oral antibiotics (used for their anti-inflammatory rather than purely antimicrobial effect), hormonal treatments, and for more severe cases, specific biologic medications that target the underlying inflammatory process. Lifestyle measures such as smoking cessation and weight management can also help reduce flare frequency and severity. Surgery, ranging from draining individual lesions to more extensive removal of severely affected skin, may be needed for more advanced or persistent disease.

There is no cure for the underlying condition, but with appropriate, often combined, treatment approaches, many people achieve substantial and sustained improvement in symptom frequency and severity. Some people experience periods of significant remission, particularly with sustained lifestyle changes and appropriate medical treatment. Ongoing dermatology follow-up helps adjust treatment as the condition, and its response to treatment, evolves over time.

Ordinary boils are usually isolated, resolve without recurring in the same specific pattern, and are caused by simple bacterial infection of a hair follicle. Hidradenitis suppurativa causes recurrent lesions specifically in skin fold areas, tends to progress to more chronic changes like tunnels and scarring, and involves a chronic inflammatory process rather than simple infection alone. Acne affects different areas of skin, typically the face, chest, and back, and has a different underlying mechanism, though hidradenitis suppurativa is sometimes grouped with other "acne-related" conditions due to some overlapping features.

Beyond physical symptoms, hidradenitis suppurativa can significantly affect mental health, self-esteem, relationships, and work or social life, given the pain, visible scarring, and unpredictable nature of flares. Support for the psychological impact, alongside physical treatment, is increasingly recognised as an important part of comprehensive care. Patient support groups and organisations can also provide valuable practical and emotional support for people living with this condition.

See a dermatologist if you have recurrent, painful lumps or boils in skin fold areas, particularly if they are recurring in the same locations, so an accurate diagnosis and tailored treatment plan can be established. A private dermatology assessment can typically be arranged within about one to two weeks. Early diagnosis and treatment can help prevent progression to more severe, scarring disease, so it is worth seeking assessment sooner rather than later if you suspect this condition.