Understanding Hidradenitis Suppurativa

A Chronic, Often Debilitating Skin Disease

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Imagine having a skin disease that your doctor does not understand, is painful, that is resistant to treatment, and that is getting worse over time. Some days you wouldn't even go out in public because of the painful sores on your skin.

This is what it is like for some people with hidradenitis suppurativa, a non-contagious skin disease that usually appears on the body in skin folds of the underarms, groin, or perianal area.

 Few studies have attempted to discover how prevalent hidradenitis suppurativa is in the world. One figure given is 1 percent of the general population is affected. It seems clear that the disease could be easily misdiagnosed as boils, carbuncles, or just a skin infection, so hidradenitis suppurativa may not be rare at all. More research needs to be to determine what causes the disease, how prevalent it is, and how it can best be treated and cured.


Hidradenitis suppurativa usually develops in otherwise healthy people, but it has been associated with Crohn's disease in some individuals. It has three main stages, beginning with boils or pockets of infection (abscesses). These become hard, painful, inflamed lumps with drainage (suppuration). Tunnels (sinus tracts) then form around and between the lumps, resulting in scar formation. This last stage is the most debilitating because large areas of skin are affected by the abscesses, sinus tracts, lumps, and scars.

Hidradenitis suppurativa usually develops slowly over time, with flare-ups, but in some people, the disease progresses quickly. The course of the disease varies for each person. Some will stay at one stage most of the time; others will develop debilitating disease.


When the disease worsens and becomes chronic, hidradenitis suppurativa can result in numerous complications, including: 

  • Severe scarring, skin pitting or discoloration of the skin. 
  • Movement that is restricted due to open sores and scars, especially the armpits or thighs are affected.
  • Obstruction to lymph drainage, resulting in swelling of the arms, legs or genitals. 
  • Avoidance of social situations due to sores that are unsightly and odorous, leading to depression.


There is as yet no definitive, consistently effective treatment, and no cure. However, early diagnosis and treatment can help change the course of the disease and avoid complications. Medications that may help include antibiotics, steroids and tumor necrosis factor (TNF)-alpha inhibitors. For severe cases, and for particularly deep lesions, surgery may be necessary. Surgical approaches include incision and drainage, de-roofing to uncover the tunnels, and surgical removal of involved skin, sometimes requiring a skin graft. 

In addition, certain home remedies may ease discomfort and help healing. These include applying warm compresses, keeping affected areas clean, wearing loose-fitting cotton clothing and maintaining a healthy weight to avoid moist areas of friction.


HS USA.org. What is Hidradenitis Suppurativa?

Jovanovic, M. (2002). Hidradenitis suppurativa. eMedicine, accessed at http://www.emedicine.com/derm/topic892.htm

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