Hidradenitis Suppurativa: Symptoms, Diagnosis and Care

Hidradenitis suppurativa is a recurring inflammatory skin condition that causes painful deep lumps, drainage and scarring in skin folds.

It is also called acne inversa, although it is not ordinary acne and is not caused by poor hygiene. Inflammation begins around hair follicles, especially where skin rubs together, and may return in the same areas.

Painful armpit lumps are a very common presentation of hidradenitis suppurativa, while painful skin is also common. Similar nodules can form in the groin, beneath the breasts, between the buttocks or around the inner thighs.

A lump may settle, open and release fluid, or connect to another affected area through a tunnel beneath the skin. Repeated inflammation can leave thickened or rope-like scars.

The process involves blockage and rupture around a hair follicle, followed by an excessive inflammatory response. It is not an infection passed between people, although bacteria can sometimes complicate an open or draining lesion.

Hormonal influences, inherited susceptibility and immune activity can all contribute. One person may have several contributing factors rather than a single identifiable cause.

Some people experience isolated flares with quiet periods between them. Others develop persistent inflammation, several connected areas or gradually increasing scar tissue. Early control aims to reduce new lesions and limit structural skin damage.

A family history can increase susceptibility. Smoking, friction, heat, sweating and higher body weight may worsen symptoms for some people, but none of these means that the person caused the condition.

Menstrual changes can coincide with flares. Keeping a simple record of timing, location and possible triggers can reveal an individual pattern without assuming every flare has the same trigger.

Diagnosis is usually based on the appearance, typical skin-fold locations and a history of lesions returning. A clinician may ask about drainage, scarring, previous treatments and whether similar problems occur in relatives.

There is no single routine test that confirms hidradenitis suppurativa. A sample may be taken when infection is suspected, and examination helps distinguish cysts, boils and other inflammatory disorders.

Treatment is matched to the activity, extent and scarring. A steroid injection into an individual inflamed lesion may calm a local flare, while oral antibiotics can be used for their antibacterial and anti-inflammatory effects in selected cases.

Biologic therapy targets specific inflammatory signals when disease is more extensive or has not responded adequately to other care. Laser hair removal may reduce follicle activity in suitable areas. Hidradenitis surgery can remove persistent tunnels or repeatedly affected tissue.

Cover draining areas with a non-stick absorbent dressing and cleanse gently rather than scrubbing. A care plan can also address pain, sleep, movement, intimacy and the emotional effect of odour or visible drainage.

Seek prompt assessment if redness spreads rapidly, fever develops, pain becomes difficult to manage or you feel generally unwell, because these features can accompany a secondary infection or another urgent problem.

Repeated disease can produce tunnels, restricted movement, persistent drainage and scarring. Infection may occur in open lesions, while long-standing pain and unpredictability can affect mood, relationships and work.

Hidradenitis suppurativa cannot always be prevented. Avoid squeezing lesions, use gentle hair-removal methods around vulnerable skin, reduce rubbing and follow maintenance treatment even when symptoms are quiet if that is part of the prescribed plan.

Arrange a dermatology assessment for recurring painful lumps in skin folds, drainage, tunnels or new scars. Bring photographs of intermittent flares and a list of previous medicines or procedures; these details help the clinician judge activity over time.