Hidradenitis suppurativa

Created: 09.01.2025

Updated 09.01.2025

Approved by: Consultant Dermatologist, Dr James Denny

What is Hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a chronic skin condition characterized by the formation of painful lumps, abscesses, and tunnels under the skin. It primarily affects areas with sweat glands, such as the armpits, groin, buttocks, and under the breasts.

HS often starts in teens and early adulthood but can appear as early as childhood in patients who are genetically predisposed. It's more common in women, affecting about 1% of people.

What are the symptoms?

The symptoms of HS include painful, deep-seated lumps that may rupture and drain pus. These lumps can form abscesses and create tunnels under the skin known as fistulas. Over time, repeated flare-ups can lead to scarring and skin changes, such as thickened or dimpled skin. The condition is often accompanied by pain, tenderness, and odour.

What are the treatments?

Treatment for HS focuses on reducing inflammation, preventing infection, and managing pain. Topical or oral antibiotics can help control bacterial infections, while corticosteroids are used to reduce inflammation. In more severe cases, immunosuppressive drugs or biologics like adalimumab may be prescribed.

Surgical options, including draining abscesses or removing affected tissue, may be necessary for chronic or severe cases. Good skincare and lifestyle modifications, such as weight management and avoiding triggers, can also help manage symptoms.

Wearing loose clothing can help minimise friction on affected areas. Avoid squeezing or putting pressure on any new nodules. For hygiene, gently clean the areas daily to manage odour and prevent infection, for example with an antiseptic such as 4% chlorhexidine wash.

What is the prognosis?

HS is a chronic condition, and while it cannot be cured, its symptoms can be managed with appropriate treatment. The severity of the condition can vary, with some people experiencing periodic flare-ups and others dealing with more frequent and severe outbreaks. With proper care, many people can control the condition, although scarring and long-term skin changes may occur. Early intervention and ongoing treatment are important for improving the quality of life and reducing complications.

Quitting smoking can improve blood circulation in the skin and enhance the body's healing ability, while weight reduction can reduce symptoms in overweight people. Both are recommended lifestyle changes for HS.