Hidradenitis suppurativa: hard to pronounce, live with, and treat

Dr. Crutchfield, my cousin had a skin problem where she developed pimples in sensitive areas that would get bigger, become painful, turn into boils and break. The areas would smell bad. She saw a dermatologist and was diagnosed with a condition called “hidradenitis suppurativa.” What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that may be caused by an inappropriate response of the body’s immune system.

No one knows for sure what exactly causes HS. One theory is that HS is the result of an abnormality in hair follicles. HS tends to occur when hair follicles become blocked, leading to a clogged hair follicle. When the follicle is blocked, pressure builds up in the follicle, causing a rupture and leakage to the sides of the follicle, deep into the skin. The leakage produces a response by the immune system to the material in the skin. The immune response is in the form of inflammation.

This cycle can repeat itself over and over and in many areas, producing a chronic medical condition. The lesions of HS appear as boils in the skin. The medical term for a boil is an abscess. The abscesses of HS can be mild, moderate, or severe.

  • Mild: This means a single abscess or a few abscesses that don’t connect or drain. They can be very painful.
  • Moderate: Commonly, several abscesses are widely separated. These are painful. They may connect and drain with pus and blood.
  • Severe: Multiple abscesses that are close together and cover large areas. These are painful and drain profusely. The common areas are the scalp, on the neck, around the ears, under the arms, under the breasts, in the groin, and on the backside. These areas coincide closely with hair-bearing areas.

HS starts as pimples in sensitive hair-bearing areas that enlarge and turn into large abscesses that can be extremely painful, connect and rupture, and smell foul. The connection between abscesses is called a sinus tract.

HS is an inflammatory skin disease. It is a chronic medical condition, meaning it lasts for a long time, maybe even a lifetime. Some people mistakenly think that HS is an infection. It is not an infection, but is actually a malfunction of one’s immune system.

There are a lot of misconceptions about HS. Here are some other things you should know:

  • HS is not the fault of the person who has it.
  • HS is not transmitted sexually.
  • HS is not caused by poor personal hygiene.
  • HS is not contagious.

What are the symptoms of HS?

The lesions of HS are boils or abscesses. They form under the skin in areas where hair grows and the skin may rub together. They are painful and fill with pus and blood. When they get big, the lesions can rupture and release a very foul-smelling fluid. The amount of fluid produced can be quite significant, and in severe cases they can drain all day long, causing the person to have to wear absorbent pads in the areas that need to be changed often.

Larger regions can connect by tunnels in the skin known as fistulas or sinus tracts. Over time some areas can form scars, and new areas can form. The constant drainage of bad-smelling drainage can lead to a foul odor that travels with the affected person.

As one could imagine, the condition is terribly embarrassing and can interfere or prevent normal personal social interactions, leading to an inferior quality of life. As a result, many dermatologists believe that HS is one of the very worst skin diseases to have.

In some cases, HS may temporarily subside, but it often comes back. It may start out as mild but rapidly progress to severe. Being overweight and smoking are two factors that can be managed and have an impact on the severity and progression of the disease.


Physicians will recommend smoking cessation and weight reduction. In addition, these treatments are available:

  • Antibiotics (as anti-inflammatories, not to treat infection)
  • Steroids
  • Surgery
  • Hormone therapy
  • Immunosuppressant medications
  • Biologic medications

HS can be devastating for self-esteem and lead to profound depression. If HS is impacting social relationships, self-esteem, and/or depression, it is important to talk to experts in the fields of mental and sexual health. It also may be helpful to join a support group so you can share feelings and information with other people who have HS. 

For stubborn or severe cases, you should visit a dermatologist who specializes in HS. These dermatologists are medical doctors who have experience in diagnosing and treating inflammatory conditions of the skin. They understand what you’re going through and can recommend treatment options that are appropriate for you.

There are good treatments for HS, and no one should have to suffer from this terrible condition. Fortunately, there is an FDA-approved biologic treatment (named ‘adalimumab’) for HS.

To find a dermatologist who specializes in the treatment of HS and for a list of national support groups to join, visit

Dr. Crutchfield, my cousin had a skin problem where she…