The disease centres on the hair follicles in areas rich in certain glands, the armpits, groin, buttocks and under the breasts. Follicles become blocked and inflamed, leading to deep, painful nodules that can rupture, drain and, over time, form sinus tracts and scarring. Understanding that this is an inflammatory disease, not a hygiene problem or a simple infection, is the first and most important step.

What causes hidradenitis suppurativa?

HS arises from inflammation around blocked hair follicles, influenced by genetic, hormonal and immune factors. It is not caused by poor hygiene and it is not contagious, two myths that cause needless shame. Smoking and excess weight are recognised contributors, and the full set of factors is explained on the causes page.

Symptoms and where they appear

The hallmark is recurring, painful lumps in skin folds that may drain and recur in the same spots. Over time, ropelike scars and tunnels can develop. The full description is on the symptoms page. When the disease affects the buttocks and groin, it overlaps with the surgical territory covered on the perianal and groin HS page.

How HS is staged

Severity is described using the Hurley staging system, from Stage 1 through Stage 3, and the stage guides treatment as much as the symptoms do. The detail is on the Hurley stages page.

How HS is treated

Treatment is almost always multimodal, combining medical therapy to control inflammation with procedures for established disease. Medical options range across general drug categories and are discussed on the treatment page, while surgery has a defined and valuable role for tracts and recurrent areas, covered under HS surgery and laser treatment. Day-to-day measures matter too, as set out on the self-care page.

Why early care matters

HS is frequently diagnosed late, often years after the first symptoms, because it is mistaken for ordinary boils. Treating moderate disease promptly, before extensive scarring forms, gives the best long-term outcome. If you have recurring painful lumps in skin folds, it is worth being assessed rather than managing each flare alone. A localised lump in the buttock cleft can sometimes be a pilonidal sinus instead, which a clinician will distinguish.

How hidradenitis suppurativa is diagnosed

HS is diagnosed clinically, from the pattern rather than from a single test, yet it is one of the most under-diagnosed conditions in this field, often recognised only years after the first symptoms. The defining clue is recurrence: painful lumps returning to the same skin folds, sometimes forming tunnels and scars. A clinician confirms the diagnosis by the location, the recurring nature and the appearance, and notes the extent of tracts and scarring to assign a Hurley stage. Disease in the buttocks and groin in particular must be distinguished from other conditions before any operation, which is why assessment by someone experienced in anorectal disease matters, the focus of the perianal and groin HS page.

Clearing up the myths

Few conditions carry as much misplaced blame as HS, and correcting that is part of treating it. It is not caused by poor hygiene, and over-washing actually irritates already inflamed skin. It is not contagious. It is not simply bad acne or a run of ordinary boils. HS is a chronic inflammatory disease driven by genetic, hormonal and immune factors, set out on the causes page. Stating these facts plainly matters, because the shame attached to the myths is a leading reason people delay seeking care for years.

Why early treatment changes the outcome

The single most useful message about HS is that timing matters. Treated early, while disease is at Hurley Stage 1 with abscesses but no tracts or scarring, it can often be controlled with medical therapy and good daily care. Left to progress, it forms the sinus tracts and scarring that medication cannot reverse and that then require surgery, the stages described on the Hurley staging page. Catching the disease before extensive scarring forms is the closest thing HS has to a turning point, which is why recurring lumps in skin folds are worth assessing rather than enduring.

The multimodal treatment approach

HS is rarely controlled by one treatment alone, and that is by design rather than failure. The modern approach combines medical therapy to calm inflammation, across general drug categories including antibiotics used for their anti-inflammatory effect, hormonal treatments and biologic agents in moderate to severe disease, with surgery for the tracts and scarred areas that medication cannot remove. Surgical options range from tissue-sparing deroofing to wider removal, with laser playing a defined role, all set out on the treatment page. This page does not name specific drugs or dosages; medication is chosen by your doctor.

Living well with a chronic condition

Because HS is long-term, day-to-day management is as important as any single procedure. Gentle skin care rather than aggressive scrubbing, reducing friction in skin folds, not smoking and managing weight all reduce flares and support every other treatment, the practical measures on the self-care page. The emotional burden of HS is real and legitimate, and caring for wellbeing is part of managing the disease rather than an afterthought. With the right combination of medical care, surgery where needed, and daily measures, HS can be brought firmly under control.