Hidradenitis Suppurativa – How to Treat and Manage This Often Painful Skin Disease

January 2025

We’re back with another Derm Deep Dive, a series where we provide expert advice from one of our board-certified dermatologists about common skin conditions or treatments. We’re speaking with board-certified dermatologist at our Mentor, OH location, Dr. Rachel Delost, about a condition many people have never heard of: hidradenitis suppurativa.  

Understanding Hidradenitis Suppurativa 

If you have not heard of Hidradenitis Suppurativa, or HS, you’re not alone – in fact, patients who are diagnosed with this skin disease rarely know anything about it.  

HS can run in families, and is most common in women, especially African American women and women in their 30s and 40s. HS causes lumps to form deep in the skin that are often painful and typically manifest in the armpits, inner thighs, underneath the breasts, or around the buttocks and groin where the skin rubs together.  

This skin disease has been referred to as “acne inversa” because it causes sores, pimples, and cysts that can mimic acne. Unfortunately, the similarities can result in misdiagnosis, leading patients to suffer with painful symptoms for many years.  

Symptoms will worsen over time if left untreated, and for some sufferers, the pain can become so bad that they visit an emergency room. Raising greater awareness about this skin disease will help patients obtain treatment sooner and avoid living in pain for longer than they need to. 

Symptoms of Hidradenitis Suppurativa 

In its early manifestations, HS appears as one or several lumps, bumps, or sores in pitted areas of the skin that experience more sweat, have oil glands, or where the skin rubs together.  

These lumps can resemble blackhead pimples, and if broken open, can leak a discharge.  

Over time, these lumps or bumps worsen, developing sinus tracts, which are channels or lesions that form between the abscess and the skin’s surface and can drain fluid. These lesions can cause debilitating pain, restricting movement such as raising the arms or sitting down.  

There are three stages of the disease – patients at Stage 3 have likely been living with Hidradenitis Suppurativa for a long time without treatment.  

Stage 1: A single abscess or formation of multiple abscesses without sinus tracts or scarring.  

Stage 2: Abscesses with sinus tracts and scarring that come and go.  

Stage 3: Multiple, interconnected sinus tracts and abscesses that cover the entire affected area.  

HS often comes and goes, making it difficult for patients to understand what they are dealing with. An individual may believe they are completely better, only to have the symptoms reappear.  

What Causes Hidradenitis Suppurativa, and Why Does It Come and Go? 

The exact cause of HS is unknown, but it appears to be the result of an overactive immune system, which creates inflammation beneath the skin, irritating the most sensitive areas first.  

There are several factors that have been shown to cause HS to flare up, and while these can vary by individual, they include: 

• Hormones. Because HS does manifest during puberty in some individuals, it is thought that hormones may play a role.  

• Blocked Hair Follicles. HS is common in the folds of the skin and where skin rubs together, suggesting that blocked hair follicles may be a precursor to its development. 

• Genetics. HS has been found to run in families, so if someone in your family has HS, it is likely others in the family will develop it also. 

• Lifestyle. Certain lifestyle and environmental triggers have been associated with HS, such as smoking and obesity.  

Hidradenitis Suppurativa is NOT caused by poor hygiene, a sexually-transmitted disease, or acne, and it is not contagious.  

How to Treat Hidradenitis Suppurativa 

A holistic approach to treatment is recommended. Hidradenitis Suppurativa is worsened by smoking and obesity, so certain lifestyle changes are necessary for optimal treatment results.  

Topical treatments like skin washes can be effective, and in some cases, antibiotics are prescribed to treat infection caused by the disease or to help reduce inflammation.  

In rare cases, surgical treatment can help by removing the affected tissue and reconstructing the area. There are several surgical options depending on the severity of a patient’s HS.  

A newer treatment option for patients with HS are injectable medications, and I predict there will be numerous treatment options in the next 5 to 10 years that will drastically improve the outlook for patients with HS.  

I advise patients that at-home treatments with ointments or wrappings can make Hidradenitis Suppurativa worse, so it’s important to get a proper diagnosis and discuss the most appropriate treatment plan with your board-certified dermatologist.  

Don’t Suffer in Silence – Seek Treatment 

Whether you’re aware of your Hidradenitis Suppurativa and having a flare-up or are experiencing any of the symptoms discussed and want to get a diagnosis, schedule an appointment to establish a treatment plan that will work best for you.