Quick answer: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful lumps, recurring abscesses and draining tunnels in areas such as the armpits, groin and buttocks. While there is no permanent cure, modern laser and minimally invasive treatments can clear active lesions, dramatically reduce flare-ups and restore quality of life. At Avrupa Cerrahi in Istanbul, most patients are examined, treated and discharged the same day — without general anesthesia.
Medically reviewed by Op. Dr. Yasir Gözü · General Surgery and Proctology · Last updated: July 20, 2026
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa is a long-term skin condition that develops in areas of the body rich in sweat glands and skin folds. It begins as deep, tender nodules under the skin. Over time, these nodules can turn into recurring abscesses that rupture, drain and heal poorly, eventually forming interconnected tunnels (sinus tracts) beneath the skin and leaving visible scars.
It is important to understand what HS is not. It is not an infection caught from someone else, it is not caused by poor hygiene, and it is absolutely not contagious. HS is a chronic inflammatory process rooted in the immune system and the structure of the skin itself — which is why simple abscess drainage or antibiotics alone rarely stop it from coming back.
Because HS lesions so often appear near the buttocks, groin and perianal region, many patients are first seen in a proctology setting. Our clinic specializes in exactly these areas and treats HS with the same minimally invasive philosophy we apply to all perianal conditions.
Symptoms: How to Recognize HS
HS typically announces itself with a pattern that patients describe as "boils that keep coming back in the same place." The hallmark signs include:
- Painful, deep-seated lumps or nodules under the skin
- Recurring abscesses that swell, rupture and drain
- Foul-smelling discharge from affected areas
- Tunnels (sinus tracts) that form under the skin over time
- Progressive scarring and thickened skin in affected regions
- Flare-ups that return repeatedly to the same locations
The areas most commonly affected are the armpits, groin, buttocks, genital region, under the breasts, abdominal skin folds and the neck — anywhere skin rubs against skin and sweat glands are concentrated.
If painful swellings keep recurring in these regions, especially with drainage or tunnel formation, HS is a strong possibility and deserves specialist evaluation.
HS or Something Else? Distinguishing It from Acne, Boils and Pilonidal Disease
HS is frequently mistaken for severe acne, simple boils or pilonidal disease (an ingrown-hair condition near the tailbone). The key differences: HS lesions sit deeper, return again and again to the same sites, and gradually create tunnels and scars. Persistent flare-ups with foul-smelling drainage are typical of HS and unusual for acne or a one-off boil; an experienced physician can distinguish them on examination.
The Hurley Stages of HS
Physicians grade the severity of hidradenitis suppurativa using the Hurley staging system, and the stage guides which treatments make sense:
- Stage 1: Occasional single or scattered nodules and abscesses, without tunnels or scarring.
- Stage 2: Recurrent abscesses with early tunnel (sinus tract) formation and beginning scarring, in one or more separate areas.
- Stage 3: Widespread involvement — multiple interconnected tunnels, large abscesses and significant chronic inflammation across an entire region.
Most patients in Stages 1 and 2 can be managed with medication and minimally invasive procedures, including laser treatment. Stage 3 disease, or severe repeatedly recurring abscesses, may require surgical clearance, sinus tract excision or wider surgery. Identifying the stage early is one of the strongest arguments for not delaying evaluation.
Causes and Risk Factors
The exact cause of HS is not fully understood. Current evidence points to an overactive immune response combined with blockage and inflammation of hair follicles in sweat-gland-rich skin. Several factors are known to increase risk or trigger the disease:
- Genetics: roughly one in three patients has a family member with HS, making inherited predisposition a significant risk factor.
- Smoking: tobacco use is one of the strongest known triggers. It worsens disease severity and reduces the response to treatment; quitting has a clearly positive effect on healing.
- Excess weight: obesity increases friction and sweating in skin folds and intensifies inflammation.
- Hormonal fluctuations: many patients notice flares linked to hormonal changes.
- Friction and heat: tight clothing, sweating and repetitive skin-on-skin rubbing can set off new lesions.
- Stress and certain foods: both are commonly reported flare triggers.
HS is somewhat more common in women, although when men develop the condition, the abscesses tend to be larger and behave more aggressively.
How HS Is Diagnosed
Diagnosis is clinical: a physician recognizes HS from the characteristic appearance, location and recurring pattern of the lesions during examination. When needed, ultrasound imaging can map abscesses and sinus tracts hidden beneath the skin — particularly useful for planning laser or surgical treatment of deeper disease.
Because HS is chronic and progressive, an accurate diagnosis early in the course of the disease — before extensive tunneling and scarring develop — makes treatment simpler and outcomes better.
Treatment Options: From Medication to Laser
There is no single "one-and-done" cure for HS, but with the right combination of therapies, flare-ups can be brought largely under control and quality of life restored. Treatment is always staged and personalized.
Non-Surgical and Medical Treatments
Depending on the stage and severity, the treatment plan may include:
- Antibiotics to settle acute inflammation
- Anti-inflammatory medications
- Immunomodulating therapies for stubborn disease
- Biologic agents in appropriate chronic cases
- Laser hair reduction in affected areas to remove a key trigger
- Lifestyle measures: smoking cessation, weight management, friction reduction and dietary changes
Laser Treatment of HS at Avrupa Cerrahi
For chronic lesions and established sinus tracts, laser treatment is the centerpiece of our approach. Under local anesthesia, the laser is used to clear inflamed HS foci and treat tunnel structures precisely, sealing diseased tissue while sparing the healthy skin around it. This helps clean out chronically inflamed areas and accelerates the healing process — without the large wounds, hospital stay and prolonged recovery associated with conventional excisional surgery.
What this looks like in practice at our clinic:
- No general anesthesia, no fasting, no pre-operative work-up. Treatment is performed under local anesthesia in an outpatient setting.
- Same-day care. Examination, treatment and discharge typically happen in a single visit; the procedure itself often takes only minutes.
- Safe for higher-risk patients. Because general anesthesia is avoided, the approach is suitable for patients with heart disease, high blood pressure or diabetes.
- Minimal downtime. Most patients return to daily activities quickly, with far less pain than after open surgery.
Our team describes it to patients simply: as easy as a dental filling, as effective as surgery. Before any procedure, your physician explains the plan in detail, and all patient information is kept strictly confidential.
When Is Surgery Necessary?
Laser and medical therapy control the great majority of Stage 1 and Stage 2 disease. In Stage 3 HS — widespread tunnels, large abscesses and severe inflammation — or when serious abscesses keep returning despite treatment, surgical cleaning, sinus tract excision or wider surgery may be required. Even then, early referral means smaller, more conservative procedures.
Recovery After Laser Treatment
Recovery after minimally invasive HS treatment is usually straightforward. Because the laser works through small access points rather than large excisions, wounds are limited, pain is modest, and patients go home the same day with simple wound-care instructions. Healing proceeds over the following weeks, and follow-up visits let your physician confirm that lesions are resolving and catch any new activity early — regular follow-up is one of the most important predictors of long-term success in HS.
Living with HS: Reducing Flare-Ups
Alongside medical and laser treatment, daily habits have a real impact on how often HS flares:
- Stop smoking. This is the single most powerful lifestyle change; tobacco drives disease severity and blunts treatment response.
- Adjust your diet. Reducing dairy, sugar and processed foods while favoring a Mediterranean-style, anti-inflammatory diet rich in omega-3s and fiber helps control flares.
- Manage weight and friction. Losing excess weight and choosing loose, breathable clothing reduces the rubbing and sweating that trigger lesions.
- Watch your triggers. Heat, heavy sweating, stress and hormonal shifts commonly precede flares; anticipating them helps you act early.
Mild nodules can occasionally settle on their own, but recurring abscesses do not resolve by themselves — left untreated, they progress to tunnels and scarring. Early, proactive treatment is always the better path.
Why Choose Avrupa Cerrahi for HS Treatment?
- A specialist center with more than 20 years of experience, focused exclusively on proctological and perianal conditions
- Non-surgical, laser-based treatment philosophy: no general anesthesia, no fasting, no hospital stay
- Same-day examination, treatment and discharge
- Safe protocols for patients with cardiac disease, hypertension and diabetes
- A multilingual patient-coordination team experienced in caring for international patients traveling to Istanbul
- Thousands of patients treated with high satisfaction using minimally invasive methods
We do not simply treat the disease — we aim to make the entire experience, from first consultation to full recovery, as comfortable as possible.
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Disclaimer: This content is for general information only and is not a substitute for professional medical advice, diagnosis, or treatment. Please consult a physician for guidance specific to your condition.
