Understanding Hidradenitis Suppurativa: What You Need to Know

Hidradenitis suppurativa (HS) is a chronic skin condition that many people live with for years, but few have heard of. It can be confusing, painful and sometimes emotionally challenging. This FAQ guide answers the most common questions people have about HS in clear, patient-centered language.

What is HS?

HS is a long-term inflammatory skin condition that causes painful bumps, abscesses and scars underneath the skin, especially in areas where skin rubs together. These include the armpits, groin, buttocks, under the breasts and inner thighs. HS is sometimes called acne inversa because the lumps can resemble deep, painful acne or boils.

HS is not contagious and is not caused by poor hygiene. We still don’t know exactly why it happens, but research shows it is related to chronic inflammation around hair follicles.

What are the symptoms of HS?

HS symptoms can vary from mild to severe, but common ones include:

Recurrent painful lumps beneath the skin that may persist for weeks or months.
Abscesses that break open and drain pus.
Tunnels under the skin that connect multiple lesions.
Scarring and thickened skin from repeated inflammation.
Itching, burning and chronic drainage can also occur.

Flare-ups can come and go over time, and severity can differ from person to person.

Who gets HS?

About 1% to 4% of people in the United States are estimated to have HS. HS most often begins after puberty and commonly affects people in their teens through their 40s. Women are more frequently diagnosed than men, but men can also have HS. Certain risk factors include:

Family history
Smoking
Obesity
Hormonal influences
Race and ethnicity

Why is HS often misdiagnosed?

HS is frequently misidentified as acne, folliculitis, boils or simple skin infections. Many providers who are not dermatologists may not see enough cases to recognize it quickly. HS has no specific lab or biopsy test, so diagnosis is based on your symptoms and physical exam. This contributes to delayed diagnosis, sometimes lasting years.

If you notice recurrent painful skin lumps that don’t heal, especially in skin folds, ask a dermatologist about HS.

Can HS be cured?

Currently, there is no cure for HS, but many treatments can effectively manage symptoms and reduce flare-ups. Early diagnosis and coordinated care with a dermatologist can help prevent worsening disease and scarring.

What treatments are available?

Treatment options vary depending on severity.

Medical treatments:

Antibiotics can reduce inflammation and secondary infection.
Biologics (e.g., adalimumab/Humira) are U.S. Food and Drug Administration (FDA)-approved for moderate to severe HS and help dampen the immune response that fuels inflammation.
Other injectable or oral medications may be used based on your symptoms and goals.

Procedures:

Laser hair reduction can help reduce lesion frequency.
Surgical options, including deroofing or more extensive removal, may be recommended in severe cases.

Lifestyle changes:

Weight management and smoking cessation may reduce severity.
Loose-fitting clothing and gentle skin care can help minimize irritation.

What about pain, scarring and emotional impact?

HS can significantly affect quality of life. Painful lesions, chronic drainage and scarring can make movement uncomfortable and everyday life harder. Many people also struggle with embarrassment, anxiety or depression linked to living with HS. Support from a health care team, including mental health professionals, can be an important part of care.

When should I see a doctor?

If you have recurrent painful lumps, abscesses that drain pus or skin changes in typical HS areas that don’t heal, especially if they keep coming back, it’s a good idea to see a dermatologist. Early treatment may prevent disease progression. For more information, you can visit the HS Foundation.