Hidradenitis Suppurativa: Symptoms, Causes & Treatment

Hidradenitis suppurativa (acne inversa) is a chronic, painful inflammatory skin disease affecting areas where skin rubs against skin and where hair follicles and glands are abundant, such as the armpits, under the breasts, the lower abdomen, and the groin, thighs, and buttocks. It is marked by recurrent painful inflamed lumps and nodules under the skin that may turn into abscesses which burst and discharge pus and may form tunnels (sinus tracts) and scars over time.

It is very important to correct two common misconceptions: first, that the disease is not an infection and does not spread between people; and second, that it is not caused by poor hygiene, although many wrongly think so and feel embarrassed. In truth, it is an inflammatory disease linked to hair-follicle blockage and an immune response, worsened by factors such as smoking, obesity, heredity, and hormonal changes. It affects women more and often begins after puberty.

One of the biggest problems with this disease is that its diagnosis is often delayed for years, as the lumps are wrongly treated as just recurrent abscesses or boils. The longer diagnosis is delayed, the higher the risk of permanent scars and tunnels and the impact on quality of life and mental state due to pain, discharge, and appearance. There is no definitive cure, but early treatment effectively controls the disease: it includes lifestyle changes (quitting smoking, weight loss, avoiding friction), topical treatments, antibiotics and anti-inflammatories, modern biologic therapies for moderate to severe cases, and sometimes surgical procedures for recurrent tunnels and abscesses. Early detection by a dermatologist is the key to avoiding complications.

• Recurrent painful lumps and nodules under the skin in folds (armpit, groin, under the breast).
• Abscesses that burst and discharge foul-smelling pus.
• Tunnels under the skin and scars over time.
• Pain and restricted movement in the affected areas.

• Inflammation linked to hair-follicle blockage and an immune response.
• Aggravating factors: smoking, obesity, heredity, hormonal changes.
• It is not an infection or due to poor hygiene.

• Clinical diagnosis from the location, recurrence, and characteristic appearance of the lesions.
• Assessing the disease severity and stage to determine treatment.
• There is no confirmatory test; history and examination are the basis of diagnosis.

Lifestyle

• Quitting smoking, weight loss, wearing loose clothing, and avoiding friction.

Medications

• Topical treatments, antibiotics, anti-inflammatories, and hormonal treatments in some cases.
• Modern biologic therapies effective in moderate to severe cases.

Procedures

• Draining abscesses and surgery to remove tunnels and recurrent areas in advanced cases.

This content is educational and does not replace consulting a dermatologist.

• Permanent scars and tunnels under the skin.
• Recurrent infection and restricted movement.
• A severe psychological impact (embarrassment, anxiety, depression) due to pain and appearance.

• Quitting smoking and maintaining a healthy weight.
• Avoiding friction and tight clothing in vulnerable areas.
• Early detection and treatment to avoid scars and disease progression.