Hidradenitis suppurativa (HS), sometimes also known as acne inversa, is a chronic, inflammatory skin disorder. It causes painful, recurring lumps, abscesses, which can result in tunnels (sinus tracts) beneath the skin, usually in areas where skin rubs together, such as the armpits, groin, and buttocks.
HS is commonly classified into three stages, based on Hurley staging:
Mild disease with isolated single or multiple abscesses. Scarring is usually absent at this stage.
Moderate disease involves repeated abscess formation, sometimes with tunnel-like tracts forming under the skin. Scarring may be present but is usually less pronounced than in more severe stage.
Severe disease involving widespread, interconnected abscesses and sinus tracts. Significant scarring is common and can lead to substantial discomfort and complications that affect daily life.
The exact cause of HS is not fully understood, but it is thought to result from a combination of contributing factors:
Common symptoms include:
About 40% of people with HS have a family member with the condition, suggesting a hereditary component.
HS is more common in individuals with certain health conditions such as obesity, diabetes, inflammatory bowel disease, arthritis, and metabolic syndrome.
Some individuals experience flare ups around their menstrual cycle, with symptoms sometimes improving during pregnancy, indicating that hormones may play a role.
Smoking is strongly linked to an increased risk of hidradenitis suppurativa and may contribute to more severe disease.
Some studies suggest that high-glycaemic index foods and certain dairy products may influence disease activity in HS, although responses can vary between individuals.
Early diagnosis of HS is important for effective treatment and long-term control, to mitigate and prevent the risk of sinus tract formation and irreversible scarring. You should consider seeking medical care if the condition is painful, affects your movement or daily activities, does not improve after a few weeks, returns soon after treatment, appears in multiple areas, or flares frequently.
HS most often affects areas of the body where skin rubs against skin and where sweat and oil glands are more concentrated. These areas are prone to repeated friction and inflammation, which can contribute to symptom development.
Some individuals may experience symptoms in more than one area at the same time, and the pattern of involvement can vary over time. Recognising the typical distribution of lesions helps distinguish HS from other conditions such as recurrent boils or infections.
A consultation with our dermatologist, Dr Laura Hui, can help confirm the diagnosis and create a personalised treatment plan tailored to your needs.
HS is not simply a boil, and many individuals with this condition may also have related medical issues. Managing it often requires a coordinated care approach, with medical and surgical dermatologists at the core and other specialists involved when necessary.
Long standing or severe HS can lead to a range of complications, including:
HS is a long term, recurring condition. Early diagnosis and treatment are important to prevent progression. Mild cases may be managed with medication, while more severe disease may require surgery.
Treatment options may include:
Hidradenitis suppurativa often starts after puberty and is more common in women than men. Risk factors include a family history of the condition, obesity, smoking, and hormonal changes. It is also more frequently seen in individuals with other inflammatory conditions, such as Crohn’s disease.
Effective treatment can relieve pain, reduce inflammation, promote healing of lesions, improve quality of life, and help prevent complications such as scarring, infections, and disease progression.
Hidradenitis suppurativa does not resolve on its own and has no cure. However, with proper treatment, symptoms can be effectively managed. A dermatologist can guide you on the best approach to control flare ups and reduce discomfort.
Hidradenitis suppurativa can vary widely in how it presents and progresses. A dermatology consultation at our clinic can help to clarify the stage of disease and explore appropriate management options, taking into account symptoms, flare frequency, and daily impact.
