Hidradenitis Suppurativa - Symptoms, Causes & Treatment
By ScanSkinAI Editorial Team✓ Reviewed for medical safetyLast updated June 2026
A chronic skin condition featuring small, painful lumps under the skin. They typically develop where skin rubs together, such as armpits, groin, between buttocks, and under breasts. The condition can significantly impact quality of life.
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Quick Answer
Hidradenitis suppurativa is a chronic skin condition that causes painful, recurrent lumps under the skin, usually where skin rubs together like the armpits, groin, or under the breasts. These bumps often begin as blocked hair follicles and can develop into abscesses that leak fluid, form connecting tunnels, or leave scars over time. While it can be highly distressing and painful, treatments ranging from lifestyle changes and antibiotics to advanced biologic medications and surgery can help manage flares and significantly improve your quality of life.
Clinical Context
Hidradenitis suppurativa (HS) is a chronic, inflammatory, relapsing disease affecting apocrine gland-bearing skin. It affects 1-4% of the population and is often undiagnosed or misdiagnosed for years. The condition results from follicular occlusion leading to rupture, inflammation, and sinus tract formation. HS significantly impacts quality of life, causing pain, depression, and social isolation. Treatment has improved with biologics (adalimumab, secukinumab) now FDA-approved.
Symptoms
- Painful pea-sized lumps that recur in the same areas
- Blackheads in pairs (double comedones)
- Tunnels connecting lumps under the skin (sinus tracts)
- Bumps that leak foul-smelling fluid
- Scarring from repeated inflammation
- Recurring abscesses in skin fold areas
Severity & Progression
Causes & Risk Factors
- Follicular occlusion (blocked hair follicles)
- Immune dysregulation and inflammation
- Genetic factors (often runs in families)
- Smoking (major modifiable risk factor)
- Obesity (friction and hormonal factors)
- Not caused by poor hygiene or infection
Treatment & Management
HS treatment is multimodal and depends on severity. Lifestyle modifications (weight loss, smoking cessation) are foundational. Topical clindamycin helps mild disease. Oral antibiotics (tetracyclines, rifampicin/clindamycin combinations) manage flares and reduce inflammation. Biologics (adalimumab, secukinumab) are effective for moderate-to-severe HS. Surgery (incision and drainage for acute abscesses; wide excision for chronic areas) is often necessary. Pain management is important throughout.
- Lifestyle changes (smoking cessation, weight loss)
- Topical antibiotics (clindamycin)
- Oral antibiotics (doxycycline, rifampicin + clindamycin)
- Biologics (adalimumab - FDA approved for HS)
- Corticosteroid injections for individual lesions
- Surgical drainage or wide local excision
- Laser hair removal in affected areas
Red Flags & Complications
Seek medical attention if you experience any of the following:
- Extensive sinus tract networks
- Significant scarring and contractures
- Secondary infection
- Squamous cell carcinoma (rare, in chronic lesions)
- Depression and anxiety
- Reduced quality of life
Self-Care Tips
- Stop smoking (most important modifiable factor)
- Lose weight if overweight
- Wear loose, comfortable clothing
- Use antiseptic washes
- Apply warm compresses to painful lumps
- Avoid shaving affected areas
When to See a Doctor
If you develop recurring painful lumps in skin folds that don't respond to typical acne treatments, or if existing HS is affecting your quality of life or not responding to current treatment
Frequently Asked Questions
How do I know if these bumps are hidradenitis suppurativa or just regular boils?
Unlike a standard boil, hidradenitis suppurativa causes pea-sized lumps that keep coming back in the exact same areas, especially in skin folds like the armpits or groin. You might also notice paired blackheads, lumps that leak bad-smelling fluid, or firm tunnels connecting under the skin. If your bumps repeatedly return or leave scars, it is important to see a dermatologist for an accurate evaluation.
What actually causes these painful lumps to form?
The exact trigger is still being studied, but it begins when hair follicles become blocked. This blockage leads to inflammation and ruptured follicles, causing the painful bumps. It is strongly linked to immune system dysregulation and genetics, as it often runs in families. Smoking and being overweight are significant risk factors that can make symptoms worse, but it is not caused by poor hygiene or a contagious infection.
Am I getting this because I am not washing properly?
Not at all. A widespread and harmful myth is that hidradenitis suppurativa is caused by poor personal hygiene or an infection, which simply is not true. It is a chronic, internal inflammatory condition related to your immune system, genetics, and hormones. Over-washing or aggressively scrubbing the affected areas will not cure the condition and can actually irritate your skin further, potentially worsening the painful flare-ups.
What treatments are available to get rid of hidradenitis suppurativa?
While there is no absolute cure, a combination of treatments can effectively manage symptoms. Mild cases often respond to topical or continuous oral antibiotics to reduce inflammation. For moderate to severe cases, targeted biologic medications delivered via injection are now approved and highly effective. Pain management, lifestyle adjustments, and surgical options ranging from simple drainage to removing chronic scar tissue are also key parts of a multidisciplinary treatment plan.
Are there any lifestyle changes I can make to stop the flare-ups?
Yes, modifying specific risk factors can greatly reduce the frequency and severity of your flares. If you smoke, quitting is one of the most effective steps you can take, as smoking is a major trigger. For individuals who are overweight or obese, losing weight reduces friction in skin folds and helps balance inflammation-driving hormones. Wearing loose clothing to prevent rubbing and using gentle skincare can also help prevent irritation.
Will this condition eventually go away on its own, or will it get worse?
Hidradenitis suppurativa is a chronic, relapsing condition, meaning it typically persists for years and does not usually resolve on its own. Without treatment, it often progresses through stages. It starts as single, painful bumps, but can eventually develop into widespread, interconnected tunnels beneath the skin that cause permanent scarring. Early medical intervention is crucial to halt this progression, prevent irreversible tissue damage, and effectively control the pain.
When should I finally go see a doctor about these bumps?
You should see a healthcare provider, ideally a dermatologist, if your lumps are painful, do not improve within a couple of weeks, or keep returning in the same spots. Also seek medical care if you notice fluid draining from the bumps, if connecting tunnels appear under the skin, or if the breakouts are causing scarring. Prompt medical assessment helps prevent the condition from progressing to a more severe and difficult-to-treat stage.
How can ScanSkinAI help me figure out if I have hidradenitis suppurativa?
ScanSkinAI can analyze photos of your skin concerns to help identify visual patterns commonly associated with inflammation and blocked follicles. It acts as an accessible, early screening aid to help you understand your symptoms and decide when to seek professional care. However, ScanSkinAI cannot give a definitive medical diagnosis. Because hidradenitis suppurativa requires professional medical treatment, you should always consult a dermatologist for a formal evaluation and treatment plan.
Medical References
Information on this page is sourced from and verified against reputable medical resources:
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Medical Disclaimer: This information is for educational purposes only and is not intended as medical advice. The content on this page should not be used to diagnose or treat any health problem. Always consult with a qualified healthcare professional for proper medical evaluation, diagnosis, and treatment of your condition.