Hidradenitis Suppurativa (HS): Symptoms, Causes, Diagnosis, and Treatment

Hidradenitis Suppurativa, or HS, is a chronic inflammatory skin condition characterised by painful, recurrent nodules, abscesses, and tunnels (sinus tracts) that develop in the folds of the skin.  These lesions commonly appear in the groin, buttocks, and under the arms, where the skin rubs against the skin.

HS significantly impacts the quality of life with its potential to cause pain, discomfort, and emotional distress. It is essential to understand HS symptoms, causes, diagnosis, and available treatment options to manage this condition effectively.

Symptoms of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) symptoms can vary considerably in intensity and diagnosis, often resulting in severe discomfort and distress for those who experience them. The existence of uncomfortable, sensitive lumps under the skin that can vary in size and resemble boils or zits is one of the defining characteristics of HS.

These lesions usually appear in the underarms, groin, buttocks, and under the breasts or other areas prone to skin-to-skin contact. They might eventually develop into cysts or abscesses, which can fill with pus and cause swelling and inflammation. In more severe instances, sinus tracts or skin tunnels may form, joining several abscesses and adding to the chronic nature of the disease.

The quality of life is significantly impacted by the pain, tenderness, and discomfort that come with having HS. It can make daily tasks difficult and negatively impact the victim’s emotional and physical health. Therefore, getting timely medical attention for a precise diagnosis and suitable treatment is essential for effectively managing HS and enhancing general health outcomes.

Causes of Hidradenitis Suppurativa

Hidradenitis suppurativa is marked by the blockage of hair follicles, yet the exact underlying cause of this blockage remains unknown. However, the experts believe it could be tied up to one or more of the following causes:


The development of hidradenitis suppurativa (HS) is known to be greatly affected by genetic factors; research suggests that those who have a family history of the condition are more likely to develop it themselves. Gene mutations, in some cases, have been linked to HS pathogenesis, even though the precise genetic mechanisms underlying the disorder are still being investigated. The development of HS is precisely thought to be caused by variations in genes related to the immune system and hair follicle structure. 

These genetic changes have the potential to impair immunological responses and damage hair follicle integrity, which encourages the development of infections, nodules, and sinus tracts that are a sign of hidradenitis suppurativa.

Hormonal Factors

Changes in hormone levels are usually associated with the beginning or worsening of symptoms of hidradenitis suppurativa (HS), and it has long been known that these changes may be triggers for the disease. Hormonal fluctuations occur during puberty, menstruation, and pregnancy, which can increase the severity and rates of incidents in individuals with HS.

Changes in hormone levels are thought to have an impact on sebum production, which is the oily substance that sebaceous glands secret on the skin. This can result in the development of HS lesions, which could also change the microbiome’s composition on the skin and cause inflammatory reactions. The precise mechanisms by which hormones cause HS remain incompletely understood.

Immune System

Immune system dysregulation has a major role in the beginning and progression of hidradenitis suppurativa (HS). It is believed that the development of the cysts, nodules, and sinus tracts typical of HS is facilitated by abnormal immune responses, marked by increased inflammation and poor wound healing.

Research has found immune cells and inflammation-causing substances within HS lesions. There also happens to be a correlation between HS and other immune-mediated diseases like rheumatoid arthritis and inflammatory bowel disease. These findings suggest that immune system malfunction may play a role in the development of hidradenitis suppurativa. 

Diagnosis of Hidradenitis Suppurativa

Let’s look at how hidradenitis suppurativa is diagnosed:

Physical Examination

A thorough physical examination of the afflicted skin and surrounding areas is crucial to the diagnosis of HS. Doctors look for indications of inflammation, infection, and scarring on the skin, especially in areas where there is a lot of friction and sweat. Doctors can detect telltale signs of HS, such as tender nodules, draining abscesses, and connected sinus tracts, by visually examining the skin and palpating the affected areas. This comprehensive assessment enables precise diagnosis and helps in distinguishing HS from other skin conditions that exhibit comparable clinical symptoms.

Medical History

To diagnose HS and identify its underlying causes, a thorough medical history must be acquired, in addition to a physical examination. Patients are questioned regarding any prior skin conditions, autoimmune diseases, or hormonal imbalances, as well as their family’s medical history.

Doctors ask about the beginning and duration of symptoms, along with any variables that could make them worse or less severe. Doctors may use this information to determine possible HS risk factors and triggers, which can help with treatment choices and preventative measures.

Diagnostic Tests

While a physical examination and medical history provide valuable insights into the diagnosis of HS, additional tests may be necessary to rule out other conditions. These diagnostic procedures could involve bacterial cultures, skin biopsies, or imaging tests like MRIs and ultrasounds

A small sample of tissue from the affected area is removed for laboratory analysis during skin biopsies, which enables histological examination of the inflammatory changes typical of HS. Bacteria cultures can be carried out to find out if any bacterial pathogens are causing secondary infections in HS lesions.

Treatment Options

Take into consideration the following treatment options for managing hidradenitis suppurativa:

Lifestyle Changes

Making lifestyle changes can be very helpful in controlling the symptoms of HS and lowering your risk of attacks.  Easy steps like practising good hygiene, such as routinely washing afflicted areas with mild antibacterial soap, can help halt the growth of bacteria and lower the risk of infection.

While giving up smoking may help enhance general skin health and reduce inflammation, avoiding tight clothing and fabrics that cause friction can help minimise irritation and discomfort. Furthermore, reducing stress through mindfulness exercises, relaxation techniques, or counselling can lessen the adverse effects of stress on symptoms of HS and improve overall health and disease management.


For those suffering from HS, a range of medications are available to help reduce inflammation, ease pain, and stave off infection. To lessen bacterial colonisation and inflammation within HS lesions, doctors may prescribe oral or topical antibiotics like tetracycline or clindamycin. Corticosteroids can help in reducing inflammation and relieving symptoms when applied topically or taken systemically. It is possible to control cell turnover and stop the development of new lesions by using retinoid medications, such as isotretinoin.

In more severe cases, immunosuppressants such as methotrexate or biologic therapies that target specific inflammatory pathways may be considered to achieve disease recovery and improve long-term outcomes.

Surgical Interventions

Surgical intervention may be required in cases of hidradenitis suppurativa when conservative treatments are insufficient to address persistent lesions and improve quality of life. Surgical options for HS include: 

  • procedures to seal or remove sinus tracts to stop further complications, 
  • excision of diseased tissue to remove diseased areas and lower the chance of recurrence, and
  • drainage of abscesses to relieve pain and encourage healing.

For the best results and the lowest chance of complications, surgical decisions should be discussed with a qualified surgeon who has managed HS cases before.


Hidradenitis suppurativa (HS) is a recurrent skin condition marked by inflammation, which can severely impact the quality of life. Victims of HS can take proactive measures to effectively manage their condition and enhance their general well-being by being aware of the symptoms, causes, diagnosis, and available treatments. 


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