Hidradenitis Suppurativa (HS) is a chronic, recurrent inflammatory disorder affecting the apocrine gland-bearing areas of the body, such as the axillae, groin, buttocks, inner thighs, and perineal region. It is characterised by painful nodules, abscesses, pus discharge, and progressive scarring. Due to its long-standing nature, HS can significantly affect an individual’s physical comfort, mobility, and quality of life.

What is Hidradenitis Suppurativa (HS)?

Hidradenitis Suppurativa, or HS, is a long-term skin condition that causes painful lumps, pus-filled boils, and scars. It usually affects areas where the skin rubs together, like the armpits, groin, buttocks, and inner thighs. Because it keeps coming back and often causes discomfort, HS can seriously affect a person’s daily life. HS often begins after puberty, usually in the 20s or 30s, and is more common in women than men. It may also be linked to severe acne in some people.

What causes HS?

HS happens when small sweat glands, called apocrine glands, get blocked. When these glands are clogged, sweat and bacteria build up under the skin. This leads to swelling, infection, and formation of pus. Over time, the lumps can burst, and the area may heal with scarring or form tunnels under the skin. Hormonal changes may be one reason why HS is more common in women and often starts after puberty.

If you notice painful, recurring boils or discharge from the skin in areas like your armpits or groin, it's important to see a dermatologist early. Starting treatment in the early stages can help reduce pain, prevent scarring, and improve your quality of life.

What Are the Symptoms of Hidradenitis Suppurativa (HS)?

Hidradenitis Suppurativa often starts with small, painless lumps under the skin in areas like the armpits, groin, buttocks, or inner thighs. These lumps may feel slightly itchy at first.

Over time, the lumps can:

Become swollen and painful
Fill with pus and form abscesses
Burst and release foul-smelling discharge
Heal slowly, often leaving behind scars
Develop tunnels under the skin, known as sinus tracts, that may keep leaking fluid

One of the noticeable features of HS is the presence of blackheads or whiteheads near the affected areas. As the condition progresses, repeated flare-ups can lead to thick scarring and changes in the texture of the skin.

How Is Hidradenitis Suppurativa Treated?

Treatment for HS depends on the stage and severity of the condition. Here are the main approaches:

1. Lifestyle Measures

Keeping the area clean and dry
Wearing loose-fitting clothing
Weight loss in overweight individuals
Stopping smoking, which can worsen HS

2. Medications

Antibiotics: Medicines like tetracyclines or erythromycin are commonly used to reduce infection and inflammation. These may be needed for several weeks.
Isotretinoin: In some cases, this medicine (often used for severe acne) is prescribed to reduce blocked hair follicles.
Hormonal therapy: Birth control pills or hormone-regulating medicines may help in women, depending on individual hormone levels.

What About Laser or Cell-Based Therapies?

Laser treatments are newer options that may help in selected cases:

Nd:YAG laser can be used to reduce hair growth in affected areas, which may lower the risk of new lumps forming.
CO₂ laser can be used surgically to remove the damaged skin tissue.

Results from these treatments vary, and they are usually considered when other options don’t work.

When Is Surgery Needed for HS?

Surgery is recommended in cases where other treatments have not worked or when the disease is advanced. Surgical options include:

Curettage: Scraping out the affected tissue
Sinus tract removal: Opening or removing tunnels under the skin
Wide excision: In severe cases, the entire affected area is removed, and the skin may be replaced with a skin graft

Early diagnosis and treatment can help manage symptoms, reduce flare-ups, and prevent long-term damage. Always consult a dermatologist to discuss the best treatment plan for your case.

Hidradenitis Supprativa- Dermatologist Guide