If you’re experiencing painful bumps or lesions forming under the skin, but it feels or looks different from a typical breakout, it could be a sign of hidradenitis suppurativa. This chronic inflammatory skin condition impacts up to two percent of the US population, according to the HS Foundation, although it affects some people more than others. According to a study published in the International Journal of Women’s Dermatology in 2021, women are twice as likely to have hidradenitis suppurativa than men, and Black people are three times more likely to have the condition than white people.
Still, hidradenitis suppurativa isn’t as well known or talked about as other skin conditions like eczema or psoriasis. Ahead, dermatologists explain hidradenitis suppurativa, the major signs to look out for, and how to get relief.
Experts Featured in This Article
Ife J. Rodney, MD, is a dermatologist and the founding director of Eternal Dermatology + Aesthetics.
Michael Rosenblum, MD, PhD, is a dermatologist, skin immunology researcher, and professor of dermatology at the University of California, San Francisco.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa, also known as acne inversa, is a chronic skin disease. “You may get cysts or boils, usually in folded areas of the skin, like the armpits, groin area, or under the breasts,” says dermatologist Ife J. Rodney, MD. (Just a heads up: acne inversa is different from the more common acne vulgaris. A good way to think of it is that the former typically affects the deeper layers of the skin, whereas the latter is seen more outwardly through blemishes like pimples.)
How hidradenitis suppurativa manifests depends on a number of factors, but it can often look like bumps or acne cysts, and it can get worse without treatment, according to the American Academy of Dermatology (AAD). When an abscess breaks open, blood and pus leak out. As it heals, a scar will often develop. Patients may develop more abscesses in the same area, and pus-filled tunnels called sinus tracts can form under the skin, Dr. Rodney says.
“Some forms are quite mild and easily treatable, while others require surgery and adequate pain control,” says dermatologist Michael Rosenblum, MD, PhD. “It tends to be a relapsing and remitting disease that is all on a spectrum.” That means symptoms may flare up and go away for a period of time before resurfacing again.
What Causes Hidradenitis Suppurativa?
While the exact cause of hidradenitis suppurativa is unknown, many experts believe it is linked to blocked hair follicles under the skin, Dr. Rosenblum says. “The blocked hair follicles trap bacteria, which leads to inflammation and rupture.” It’s unclear why the blockages occur in the first place, although genetics, environment factors, and hormonal changes may play a role.
“For patients with hidradenitis suppurativa, the inflammation doesn’t go away and starts to feed on itself – it gets worse and worse,” Dr. Rosenblum says, adding that the condition is ultimately “an inability to control the inflammation.”
Although the spread of bacteria is a factor with the condition, hidradenitis suppurativa is not contagious. “Many cases can be pretty striking in appearance, but you cannot get hidradenitis suppurativa from another person,” Dr. Rodney says. The AAD also notes that hidradenitis suppurativa isn’t a sexually transmitted disease or caused by having unclean skin.
Hidradenitis Suppurativa Symptoms
Symptoms of hidradenitis suppurativa can vary, depending on how severe the condition is in a patient, but Dr. Rodney says there are a few common signs to look out for.
- Small, pitted areas of skin that contain blackheads
- Painful lumps that grow and break open
- Abscesses that drain fluid and pus
- Itchy abscesses that may have an odor
- Abscesses that heal very slowly and happen again over time
With mild hidradenitis suppurativa, you may only have one or a few lumps in one area of the skin, Dr. Rodney says. Moderate cases of hidradenitis suppurativa usually include lumps that form in different areas of the skin, recur, and break open, while severe cases can include widespread lumps, scars, and chronic pain.
How Is Hidradenitis Suppurativa Diagnosed?
Hidradenitis suppurativa is usually a clinical diagnosis, meaning doctors can determine if you have it after a physical exam. “When patients come in, we can usually tell right away whether they have it or not,” Dr. Rosenblum says. However, your doctor may do a skin biopsy if they think there’s a chance your symptoms could be due to something else, he says.
“Sometimes, the condition can be very mild, where it may just include one or two cysts that come and go – those can be more difficult to diagnose,” Dr. Rodney says. “The more severe cases with larger cysts are easier to spot.”
Hidradenitis Suppurativa Treatments
While treatment recommendations vary by patient, there are effective therapy options worth considering. Those can include antibiotics to help reduce the amount of bacteria that can contribute to the inflammation, Dr. Rodney says, along with steroids. “We frequently do steroid injections into the cysts to shut down the inflammatory process,” she adds. “That’s very helpful, especially if you get it injected as soon as the cyst appears versus when it’s larger and really painful.”
In more severe cases, a biologic (or a medication made from living organisms, like plasma or growth factors, for example) can be used to try to help control the inflammation, Dr. Rosenblum says. Surgery may be needed to remove the lumps and scars.
There are also a few lifestyle tweaks you can make to help with the pain during flare-ups, including wearing loose-fitting clothes, doing your best to avoid heat and humidity, and trying to avoid injuring your skin.
Does Hidradenitis Suppurativa Ever Go Away?
While the treatments above can help manage the condition, “if you have hidradenitis suppurativa, you have it for life,” Dr. Rodney says.
Dr. Rosenblum is hopeful that there will be more options for patients in the future, including more effective treatments. However, the FDA just approved a new medication to treat moderate to severe hidradenitis suppurativa last year, and research is also exploring new targeted therapies. “There’s been a real explosion in the science of trying to understand this disease,” he says. “Over the next five to 10 years, there should be new therapies.”
