Hidradenitis suppurativa is a chronic, long-term skin condition that causes painful lumps to develop beneath the surface of the skin, most commonly in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts. These lumps, often described as boils or abscesses, can become inflamed, rupture, and ooze pus, causing significant discomfort and often leaving behind thick scars. While it is not infectious or the result of poor hygiene, hidradenitis suppurativa is widely misunderstood and often misdiagnosed, particularly in its early stages. People affected by the condition typically experience repeated flare-ups, and the emotional toll can be just as severe as the physical discomfort.
Who Gets Hidradenitis Suppurativa?
Hidradenitis suppurativa affects about 1% of people, but the real number could be higher. Many cases go undiagnosed. The condition usually starts after puberty and affects women more often than men. Over time, it worsens. People may have calm periods, followed by sudden flare-ups that can last for days or even weeks.
As flare-ups continue, they can create tunnels under the skin, called sinus tracts. These tunnels connect inflamed lumps and can lead to serious scarring. In severe cases, this scarring may even change how the skin looks and feels.
Stages of Hidradenitis Suppurativa
Doctors use the Hurley staging system to describe how severe hidradenitis suppurativa is:
- Stage I includes small, isolated lumps. There are no tunnels or serious scars yet.
- Stage II includes repeated lumps in different places. At this point, tracts and scarring begin to form.
- Stage III is the most serious stage. It includes many connected lumps, drainage, ongoing swelling, and deep scarring.
These stages help guide the treatment plan and show how far the condition has progressed.
What Causes the Condition?
The exact cause of hidradenitis suppurativa is still unclear. However, experts believe it begins in the hair follicles. In areas where the skin has lots of sweat glands, the follicles get blocked. This blockage causes them to swell and eventually burst. As a result, the immune system reacts strongly, causing swelling, pain, and damage to the skin.
Bacteria may be found in these areas, but they usually come in after the damage starts. This means the condition is not contagious and cannot spread from person to person.
Risk Factors and Triggers
Many things may increase the risk or severity of hidradenitis suppurativa. For example, people with a family history are more likely to get it. Hormones also play a role. Flare-ups often get worse during menstruation, and most people first notice symptoms after puberty.
Lifestyle habits matter, too. Being overweight increases skin rubbing and moisture, which makes symptoms worse. Smoking also affects how the body heals and how the immune system works. Because of this, quitting smoking and losing weight can help control symptoms.
The Impact on Daily Life
Living with hidradenitis suppurativa is often painful and draining. The lumps can make walking, sleeping, or getting dressed hard. When they drain, they may smell or look unpleasant. This can cause embarrassment or make people avoid social situations.
Mental health struggles are common. Many people with HS also deal with depression, anxiety, and low self-esteem. It’s important to support not just the physical symptoms but also the emotional side of living with this disease.
Getting the Right Diagnosis
There is no known cure for hidradenitis suppurativa. Still, many treatments can help manage symptoms and reduce flare-ups. These include changes in daily habits, medicines, and sometimes surgery. The sooner someone gets diagnosed, the better. Early treatment helps stop the condition from getting worse and lowers the chance of lasting scars.
Sadly, many people get treated for acne or other skin problems before they learn they have HS. This delay can lead to years of pain without proper care.
Managing Hidradenitis Suppurativa
A team of healthcare providers often works together to manage hidradenitis suppurativa. This may include dermatologists, surgeons, pain doctors, and mental health professionals. Every patient needs a plan that fits their specific case. Some people improve with creams or lifestyle changes. Others need stronger treatments like long-term antibiotics, hormone therapy, or immune-blocking drugs.
For severe cases, surgery may help. Options include draining painful areas, removing tunnels, or using lasers to clear blocked follicles.
Why Awareness Matters
Better awareness helps everyone—patients and doctors alike. Many people with HS don’t seek help because they feel embarrassed or fear being judged. Some worry others will think they are dirty or have an infection. These wrong beliefs only add to the emotional strain.
By spreading accurate information, we can reduce stigma and help people get the care they need sooner.
Final Thoughts on Hidradenitis Suppurativa
Hidradenitis suppurativa is a complex condition that affects both the body and mind. Early recognition, patient-focused treatment, and long-term care can make a big difference. Even though there is no cure yet, many people manage the disease successfully through a mix of medicine, surgery, and lifestyle changes.
Everyone living with hidradenitis suppurativa deserves compassion, clear answers, and care that respects their full experience—not just the visible symptoms.
