What is Hidradenitis Suppurativa? Diagnosis & Treatment
What is Hidradenitis Suppurativa? Diagnosis and Treatment Process
💡 Quick Answer
Hidradenitis suppurativa, also known as acne inversa, is a chronic inflammatory skin disease that usually affects areas where skin rubs together, such as the armpits, groin, buttocks, under the breasts, and around the anus. It may cause painful lumps, recurrent abscesses, foul-smelling drainage, tunnels under the skin, and scarring. HS is not contagious and is not caused by poor hygiene. Diagnosis is usually clinical and is based on typical lesion type, typical body areas, and recurrence. Treatment depends on severity and may include lifestyle changes, topical or oral medications, antibiotics, biologic treatments, laser-based approaches, drainage of abscesses, or surgery.
Table of Contents
- What is hidradenitis suppurativa?
- What are the symptoms?
- What causes hidradenitis suppurativa?
- How is HS diagnosed?
- What are the stages of hidradenitis suppurativa?
- What are the treatment options?
- When are laser or surgical treatments considered?
- What should not be done?
- When should you see a doctor?
- Frequently asked questions
What is Hidradenitis Suppurativa?
Hidradenitis suppurativa, often shortened as HS, is a chronic inflammatory disease of the hair follicle. It is also called acne inversa. The condition usually appears in areas with friction, sweating, and hair follicles, including the armpits, groin, inner thighs, buttocks, under the breasts, and around the anus.
HS is not a simple pimple, ordinary boil, or hygiene problem. It can begin as a painful lump under the skin and may later develop into abscesses, draining tunnels, recurrent inflammation, and scars. Because the early lesions can resemble boils or ingrown hairs, diagnosis may be delayed.
The ICD-10-CM code for hidradenitis suppurativa is L73.2. This classification reflects HS as a recognized chronic skin condition rather than a temporary superficial infection.
If you are looking for a treatment-focused overview, see our main service page: Hidradenitis Suppurativa: Laser Treatment and New Methods.
What are the Symptoms?
The symptoms of hidradenitis suppurativa vary according to disease severity. Early HS may cause small painful nodules. More advanced disease may include abscesses, drainage, sinus tracts, and thick scars.
Common Symptoms of HS
- Painful lumps under the skin
- Recurrent abscesses
- Foul-smelling discharge
- Blood-stained or pus-like drainage
- Tunnels or openings under the skin
- Scarring and thickened skin
- Pain that worsens with movement, sweating, or friction
- Repeated flare-ups in the same body area
Commonly Affected Areas
| Area | Typical Complaint | Why It Matters |
|---|---|---|
| Armpits | Painful lumps, movement-related pain | Friction, shaving, and sweating can worsen irritation. |
| Groin | Drainage, odor, pain | Tight clothing and moisture may increase flare-ups. |
| Buttocks / perianal area | Abscess, drainage, pain when sitting | May be confused with pilonidal disease or anal fistula. |
| Under breasts | Tender swelling, moisture, friction | Can be confused with irritation or fungal rash. |
What Causes Hidradenitis Suppurativa?
HS is not caused by poor hygiene and it is not contagious. Current understanding suggests that HS begins around the hair follicle, where blockage and inflammation may lead to rupture, abscess formation, tunnels, and scarring. The disease usually develops through a combination of genetic, immune, hormonal, metabolic, and environmental factors.
Risk Factors and Triggers
- Family history or genetic predisposition
- Smoking
- Excess weight
- Skin friction
- Sweating and moisture
- Hormonal changes
- Metabolic factors such as insulin resistance
- Stress and poor sleep
- Dietary triggers in some patients
For a deeper look at causes and risk factors, see: Is Hidradenitis Suppurativa Genetic? Causes and Risk Factors.
How is HS Diagnosed?
Hidradenitis suppurativa is usually diagnosed clinically. This means that diagnosis is made by a physician based on the appearance, location, recurrence pattern, and history of the lesions. There is no single blood test that confirms HS in every patient.
Three Key Diagnostic Clues
- Typical lesions: painful nodules, abscesses, drainage, tunnels, or scarring.
- Typical locations: armpits, groin, buttocks, under-breast area, inner thighs, or perianal region.
- Recurrence: repeated episodes in the same or similar areas.
In some cases, the doctor may request imaging, culture tests, or additional evaluation to distinguish HS from pilonidal disease, anal fistula, infected cysts, Crohn-related perianal disease, or other skin conditions.
What are the Stages of Hidradenitis Suppurativa?
HS severity is commonly described using the Hurley staging system. Staging helps physicians plan treatment and estimate the need for medications, laser-based approaches, biologic therapy, or surgery.
| Stage | Clinical Picture | General Treatment Direction |
|---|---|---|
| Hurley Stage I | Nodules or abscesses without obvious tunnels or widespread scars. | Lifestyle care, topical treatment, early medical follow-up. |
| Hurley Stage II | Recurrent abscesses, tunnels, and scarring in separated areas. | Oral medications, antibiotics, laser, local procedures, combined treatment. |
| Hurley Stage III | Widespread interconnected tunnels, chronic drainage, extensive scars. | Biologic therapy, surgery, wound care, multidisciplinary management. |
What are the Treatment Options?
HS treatment should be individualized. The best plan depends on disease stage, affected areas, pain level, drainage, previous treatments, medical history, and patient expectations. Modern guidelines describe HS management as multimodal, meaning that different treatments may be combined over time.
Main Treatment Options
- Lifestyle measures: smoking cessation, weight management, friction reduction, gentle skin care.
- Topical treatments: may be used in limited early disease under medical supervision.
- Oral antibiotics: may reduce inflammation and drainage in selected patients.
- Hormonal or metabolic approaches: may be considered for suitable patients.
- Biologic therapies: may be used for moderate to severe or resistant disease.
- Abscess drainage: may be needed for tense, painful abscesses.
- Laser-based treatments: may help in selected patients, especially when hair follicles contribute to flares.
- Surgery: may be required for chronic tunnels, scarring, and persistent diseased tissue.
For antibiotic-focused information, see The Best Antibiotics for Hidradenitis Suppurativa. For lifestyle and diet, see Could Diet Affect Hidradenitis Suppurativa?.
When are Laser or Surgical Treatments Considered?
Laser and surgical treatments are considered according to HS stage and lesion type. Laser hair removal may reduce follicular triggers in selected patients, while CO2 laser or surgical excision may be considered for chronic tunnels and scarred areas. Surgery is usually individualized and should not be seen as a one-size-fits-all solution. Surgical literature emphasizes that HS surgery is often part of a broader treatment plan rather than a stand-alone cure.
Laser May Be Considered When:
- Hair follicle density contributes to repeated flares
- Disease is mild to moderate and active abscess is controlled
- Flares occur repeatedly in friction-prone areas
- Long-term reduction of triggers is part of the plan
Surgery May Be Considered When:
- Chronic sinus tracts are present
- Drainage and odor persist despite medical treatment
- Scarred diseased tissue causes repeated flares
- Abscesses recur in the same area
- Quality of life is significantly affected
For surgery-specific guidance, see: Surgical Treatment for Hidradenitis Suppurativa: When and How Is It Performed?.
What Should Not Be Done?
Incorrect self-treatment may worsen HS, increase irritation, or delay proper care. This is especially important when lesions are draining, painful, or recurrent.
- Do not squeeze, pop, or puncture abscesses at home.
- Do not apply vinegar, garlic, lemon, alcohol, or harsh essential oils to open wounds.
- Do not start or repeat antibiotics without a doctor’s recommendation.
- Do not assume that every recurring lump is a simple boil.
- Do not delay care if there is fever, spreading redness, or foul-smelling drainage.
- Do not blame HS on poor hygiene or personal failure.
When Should You See a Doctor?
You should see a doctor if painful lumps or abscesses recur in typical HS areas, especially if they drain, smell unpleasant, leave scars, or affect sitting, walking, working, or daily life.
Medical Evaluation is Recommended If You Have:
- Repeated painful lumps in the same area
- Foul-smelling or pus-like drainage
- Skin tunnels or openings
- Scarring or thickened skin
- Fever or spreading redness
- Pain that limits movement
- Symptoms around the anus or buttocks
- Repeated “boils” that do not behave like ordinary infections
Early diagnosis can reduce delays, prevent unnecessary home experiments, and help build a long-term treatment plan.
Frequently Asked Questions About Hidradenitis Suppurativa
Is hidradenitis suppurativa contagious?
No. Hidradenitis suppurativa is not contagious. It does not spread through touching, sharing a room, using the same toilet, or social contact. HS is related to inflammation around hair follicles, immune response, genetics, friction, smoking, weight, and hormonal or metabolic factors. Active draining wounds should still be kept clean and covered when appropriate, not because HS spreads to others, but because wound hygiene helps reduce irritation and secondary infection risk.
Is HS caused by poor hygiene?
No. HS is not caused by poor hygiene. Many patients with excellent hygiene develop HS. The condition is a chronic inflammatory disease involving the hair follicle and is influenced by genetic, immune, hormonal, metabolic, and environmental factors. Gentle cleansing may help reduce irritation, but excessive scrubbing, harsh soaps, alcohol, lemon, vinegar, or aggressive peeling can worsen the skin barrier and increase pain.
Can hidradenitis suppurativa be cured completely?
HS is usually a chronic and recurrent disease. Some patients achieve long periods with few or no symptoms, while others need ongoing treatment. The goal is to reduce pain, drainage, odor, abscess formation, scarring, and recurrence. Early diagnosis, proper staging, lifestyle support, medical treatment, laser-based approaches, biologics, or surgery may improve disease control and quality of life.
How is HS different from a boil?
A common boil is often a short-term skin infection. HS tends to be deeper, recurrent, and located in typical friction areas such as the armpits, groin, buttocks, under-breast area, and perianal region. HS can create tunnels under the skin and leave scars. If “boils” repeatedly appear in the same area, drain, smell unpleasant, or leave marks, HS should be considered and evaluated by a physician.
Does diet affect hidradenitis suppurativa?
Diet may affect symptoms in some patients, but there is no universal HS diet that works for everyone. Some patients report worsening with high-glycemic foods, dairy, brewer’s yeast, or highly processed foods. Current evidence suggests dietary approaches may support conventional treatment, but should not replace medical care. A personalized food and flare diary may help identify individual triggers.
Are antibiotics enough for HS?
Antibiotics can help selected patients by reducing inflammation, pain, drainage, or flare severity. However, they are not always enough, especially if sinus tracts, chronic drainage, deep abscesses, or extensive scars are present. Antibiotics should not be started, stopped, or repeated without medical advice because of resistance, side effects, and drug interactions. Moderate or severe HS may require biologics, laser, procedures, or surgery.
When is surgery needed for HS?
Surgery may be considered when there are chronic tunnels, repeated abscesses in the same area, persistent drainage, scarred diseased tissue, or major quality-of-life impairment. Surgery may include drainage, deroofing, limited excision, wide excision, or reconstruction depending on disease severity and location. It is usually part of a broader treatment plan, not a stand-alone magic switch.
Can laser treatment help hidradenitis suppurativa?
Laser treatment may help selected patients. Laser hair reduction can decrease follicular triggers in some mild to moderate cases. CO2 laser or other tissue-directed approaches may be considered for chronic diseased areas. Laser is not suitable for every patient and should not be used as a substitute for treating active infection, large abscesses, or advanced tunnel networks.
When should HS be evaluated urgently?
Urgent evaluation is recommended if there is fever, chills, rapidly spreading redness, severe pain, a fast-growing abscess, foul-smelling heavy discharge, uncontrolled bleeding, or general weakness. These findings may indicate infection or a complication that needs prompt medical care. Recurrent abscesses should also be assessed even if they temporarily improve.
5 Key Takeaways
- Hidradenitis suppurativa is a chronic inflammatory disease of the hair follicle.
- It is not contagious and is not caused by poor hygiene.
- Typical symptoms include painful lumps, abscesses, drainage, tunnels, and scarring.
- Diagnosis is usually clinical and depends on lesion type, location, and recurrence.
- Treatment may include lifestyle measures, medications, antibiotics, biologics, laser, drainage, or surgery depending on disease severity.
Appointment and Evaluation
If you have recurrent painful lumps, abscesses, drainage, odor, scarring, or suspected hidradenitis suppurativa, a medical evaluation can help determine disease severity and the most suitable treatment options.
Contact: Book an appointment / Contact us
Related Articles
Diagnosis and Risk Factors
- Is Hidradenitis Suppurativa Genetic? Causes and Risk Factors
- Could Diet Affect Hidradenitis Suppurativa?
- How to Treat Hidradenitis Suppurativa Naturally?
Treatment Options
- Hidradenitis Suppurativa: Laser Treatment and New Methods
- The Best Antibiotics for Hidradenitis Suppurativa
- Surgical Treatment for Hidradenitis Suppurativa: When and How Is It Performed?
Sources and References
- North American Clinical Practice Guidelines for the Medical Management of Hidradenitis Suppurativa
- S2k Guideline for the Treatment of Hidradenitis Suppurativa / Acne Inversa
- Comprehensive and Updated Algorithm of Hidradenitis Suppurativa Management
- Dietary Factors and Hidradenitis Suppurativa
- ICD-10-CM L73.2 | Hidradenitis Suppurativa
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