Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by large bumps and tunnels under the skin. HS affects up to 4 percent of the global population, so it’s not especially rare.
The condition tends to occur in zones of high friction. Yup, like those fun spots under your boobs, on your butt and between your sweet cheeks, in your groin, and along your inner thighs. Depending on the severity, HS can range from inconvenient and uncomfortable to debilitating and painful.
Medical experts aren’t sure what causes this condition, and there’s no cure. But there are several treatments available. It’s totally possible to manage the symptoms.
HS may rear its head in a single, isolated spot or show up in multiple areas.
The symptoms and severity of HS can vary from person to person and can change over time. Here are the main symptoms of this condition:
- Blackheads. You may see skin pits with blackheads in them. They often show up in pairs.
- Large, cyst-like bumps. HS can look like little, reddish blemishes.
- Small, firm bumps. These caper-size lumps can form under your skin and are often tender or painful.
- Tunnels. Channels may develop under your skin, connecting the lumps.
- Pain. You may experience discomfort or pain in the affected area.
- Oozing sores. The lesions may leak fluid such as pus or blood, which might have a not-so-pleasant odor.
Where to look on your bod
HS can happen anywhere on your body, but there are definitely places it’s more common. Notably, HS symptoms typically appear where you have a lot of skin-on-skin action or hair follicles with oil and sweat glands.
Here are the big six HS hot zones:
HS may also show up under your chin, on your neck, and on your belly.
Progression of the condition
The onset of HS is usually marked by the formation of a lone, painful nodule under the skin. This lump can last for several weeks or months. New bumps follow suit.
As HS progresses, tunnels may develop under your skin. These connect the lumps in a sort of network of subdermal sores. Sometimes smelly fluids (such as pus or blood) drain from the wounds — especially if they get infected. If these sores heal (they might not), you can expect it to happen at a snail’s pace.
Just a heads-up: Some of these pics are difficult to see. Some show things like blood, open sores, and genital areas. These images may not be appropriate for the kiddos or the stranger sitting next to you on the bus.
It’s maddening, but the root cause of HS is unknown. Some likely theories include:
What do we know for sure about hidradenitis suppurativa?
There’s a smorgasbord of risk factors for HS. Your chances of developing hidradenitis suppurativa go up if you’re:
- post-pubescent, especially between ages 20 and 39
- of African descent
- related to someone with HS
- taking certain medications
- considered clinically overweight
- a current or past tobacco user
Developing HS at a younger age could mean you’re at greater risk of the condition becoming more widespread. On a positive note, HS may become less severe in females after menopause.
Complications often arise with ongoing or severe hidradenitis suppurativa. These could include:
- Skin damage. The skin can thicken, darken, or develop pits or scars.
- Infections. Open sores and irritated skin are more vulnerable.
- Blocked lymph nodes. Scars and sores could obstruct this critical drainage system.
- Mobility issues. Movement may become restricted due to wounds, damaged tissue, or pain.
- Emotional distress. HS symptoms can lead to social isolation and other mental health concerns.
- Cancer. HS is associated with elevated cancer risk.
Diagnosing and treating HS ASAP is your best bet for effective management of the condition. So book a visit with a medical professional if your skin issues:
- cause you pain
- occur in multiple areas
- don’t disappear within a few weeks
- return soon after treatment
- get worse
- flare up frequently
- show signs of infection
- are unresponsive to your home-grown care efforts
- cause you emotional distress
- interfere with your regular daily activities
This is also solid advice if you’ve already gotten a hidradenitis suppurativa diagnosis. Changes in your condition could be a signal that your treatment isn’t working or that other risk factors are coming into play.
Prepping for your Dr. appointment
Make the most of your appointment by being prepared and knowing what to expect.
Your to-do list
Continue reading up on HS. The more informed you are heading into your appointment, the more comfortable you may be and the better you’ll be able to advocate for yourself.
In addition to your HS research, here’s a smart pre-appt task list. Jot down:
- All the symptoms you’re experiencing. Include notes about where, when, how severe, etc. You want to give your doctor as much detail as possible.
- Your medications and supplements. Document all the prescription and over-the-counter (OTC) meds, vitamins, and supplements you take. Include details on when and how much of each you consume. Don’t forget to include topical remedies and things like CBD!
- All your questions about HS. Leverage your doc’s knowledge — get the answers you need!
Writing this stuff down is a great idea, especially if medical visits make you nervous or you’re squeezing the appointment into a super-busy day. (Or are we the only ones whose memories go kaput the moment our butts hit that crinkly exam-table paper?)
Questions *for* your doctor
If you’re wondering what to ask your doc, these are a good start:
- Why am I having these symptoms?
- What are the possible root causes of my symptoms?
- Is my condition related to another health issue, family history, lifestyle, etc.?
- Do I need any lab work, other tests, or additional exams?
- Should I see a specialist?
- Will this condition go away? When?
- What are my treatment options?
- What treatments do you recommend for me?
- Are there side effects or downsides to treatment?
- Where/how can I learn more about this condition?
Questions to expect *from* your doctor
In addition to a thorough skin exam, expect your doc to have their own Qs for you to A. They may want to know:
- when your symptoms first started
- how your skin lumps have looked over time
- whether you’re in pain
- whether anything makes your symptoms better or worse
- whether the lumps ever go away
- whether the lumps return to the same area
- whether you have any relatives who have experienced similar issues
- your broader medical history
- whether you’re a tobacco user
There’s no definitive test to diagnose hidradenitis suppurativa. Your doc has to rule out other conditions and determine your diagnosis based on the info you provide and the examination.
While you’ll likely start with your primary care doctor, they may refer you to a specialist — like a dermatologist or surgeon. Specialists have deeper or more focused credentials to deal with severe cases or to address other/underlying medical issues. This is a good thing for you!
Treatment depends on your specific situation. Options will vary based on the severity of your HS, the nature of your symptoms, the rest of your medical profile, and other factors.
The goals of treatment include:
- managing the pain and other symptoms
- preventing complications
- reducing the severity and frequency of flare-ups
- promoting wound healing
- tending to psychosocial needs
- improving quality of life
Your doc may recommend:
- lifestyle changes
- laser hair removal
- complementary remedies
- some combo of the above
None of these therapies is 100 percent effective. Each comes with risks and benefits. Together, you and your doctor can determine the best care plan for you.
You’ll probably have periodic visits with your doctor to keep your HS (and associated health issues) in check. Treatment may shift over time to keep pace with your symptoms.
Medications for HS
Several types of meds are used to treat hidradenitis suppurativa. Topicals are more of a spot treatment, whereas oral and injectable medications work systemically against more widespread symptoms. Your care team may prescribe:
- Pain medications. Acetaminophen or lidocaine (a topical anesthetic) might relieve discomfort. If needed, your doctor can offer something with more oomph.
- Antibiotics. Mild cases might respond to drugs like clindamycin, gentamicin, or rifampin. These combat inflammation, infections, and new breakouts.
- Steroids. These guys work to reduce inflammation and improve symptoms. Corticosteroids and prednisone are common options.
- Biologics. These drugs modulate your immune system so it stops attacking you. Adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel) are in this category. Maybe you’ve seen a commercial (or 50) for one of these?
- Hormone blockers. These can counter the effects of testosterone or metabolic syndrome. For the ladies, hormone therapy might be as effective as antibiotics.
- Retinoids. Often used to treat acne, retinoids may also help with HS symptoms.
Hidradenitis suppurativa surgery
Surgical procedures might be necessary for severe HS or for longer-term treatment. Surgery may involve:
- exposing the tunnels under the skin by removing the skin over them
- laser therapy on the lesions
- removal of all affected skin, possibly paired with a skin graft
New HS therapies and clinical trials
More research is needed to advance the treatment of hidradenitis suppurativa. But medical science is ever-evolving, and new care options are always becoming available.
Some studies focus on improving HS testing and diagnosis. Others are seeking ways to better assess treatments so medical pros can determine which ones will work best for a given case of HS. Researchers are also looking into innovative topical and biologic therapies.
Research requires human participants, so clinical trials may open up. These could be ideal for folks with more complicated HS or those whose HS isn’t responding to current treatments. It could be worth asking your doctor about clinical trials.
Hidradenitis suppurativa natural treatments
Here’s a ray of sunshine: It may be possible to treat mild HS without meds or scalpels. And more profound cases of HS will still benefit from good self-care practices.
To help alleviate or prevent flare-ups, you might try:
- Washing gently. Use a nonsoap body wash. An antiseptic cleanser may help too. Ditch the washcloths, loofahs, brushes, razors, etc. — they can further anger your inflamed skin. Dry your skin thoroughly.
- Healing and protecting. An OTC antibiotic salve may soothe or aid in the healing of your skin. Blotting your skin with a noncomedogenic powder could make you more comfortable.
- Addressing pain. Applying a warm compress for 10 minutes can help reduce pain. A healthcare pro can suggest a suitable pain reliever. Be sure to practice proper wound care.
- Being clothes-minded. Opt for clothing that’s on the looser, more lightweight end of the spectrum — it may not irritate or rub on your skin as much as tighter or heavier options. Use laundry products made for sensitive skin.
- Going with the flow. Tampons or menstrual cups may provide a more comfortable menstrual experience than pads.
- Loving the skin you’re in. Avoid inflicting further trauma or injury to your largest organ — don’t pop zits, pick at sores, or shave affected areas.
- Removing hair. Ask your doc about options, particularly for your underarms and pubic area. Hair removal could help prevent breakouts.
- Nourishing for flourishing. Topical treatments made from earthly ingredients like turmeric, honey, tea tree or neem oil, aloe vera, and/or apple cider vinegar have been used in HS treatment. These items are known for anti-inflammatory, antimicrobial, antibacterial, and other healing effects. Zinc or vitamin B12 supplements might also help.
Hidradenitis suppurativa diet and lifestyle
Diet and lifestyle choices can also affect hidradenitis suppurativa. The general guideline of “maintain a healthy weight and move your body” applies here too — even more so.
Here are some tips to get you going:
- Avoid dairy, red meat, anything sugary or high in refined carbs, and brewer’s yeast. Eliminating nightshades and grains may also be beneficial.
- Eat foods that are high in fiber and contain omega-3 fatty acids (e.g., fish, nuts and seeds, avocado, olive oil). Try to eat plenty of fresh fruits and veggies. Cinnamon, ginger, dark chocolate, and green tea are also anti-inflammatory.
- Consider trying an HS-friendly diet, like the autoimmune protocol, Mediterranean diet, or Whole30.
- Avoid activities that aggravate your skin.
- Don’t smoke or use tobacco.
On top of the physical symptoms of HS, many people face social and psychological challenges. People with HS have reported feeling all the feels: embarrassment, anxiety, depression, isolation… Fortunately, there are resources and strategies for coping:
- Family and friends can be a fantastic support system. Because they love you (You are awesome!), they’re likely open to learning about your condition and how they can help you.
- Support groups are readily available. There are probably IRL ones near you. But if not, there are plenty of them online.
- Doctors and counselors are trained to help. Professional therapy is a terrific way to address your mental and emotional wellness concerns.
HS is a chronic skin condition that may flare up throughout your life. It’s characterized by boil-like lumps under the skin, sometimes with tunnels connecting the bumps and/or leakage of blood or pus.
There’s no known cause for HS, but factors such as hormones, genetics, age, weight, and tobacco use may be linked to the condition.
There’s also no known cure for HS. A wide variety of treatment options are available to manage the symptoms. Therapies range from topical and systemic meds to surgery.
Counseling, support groups, and a caring network of family and friends can help you cope with the emotional and mental health aspects of living with HS.