Hidradenitis Suppurativa: What It Is, What It Looks Like, and How We Can Help
If you’ve ever noticed painful bumps or recurring sores under your arms, near your groin, or under the breasts, and felt unsure (or even too embarrassed) to bring it up, you’re not alone. Many patients quietly struggle with these symptoms for years before receiving a diagnosis, and often try to self-treat what they think is acne, ingrown hairs, or something they caused. However, if your skin is flaring again and again, it might be a condition called hidradenitis suppurativa (HS).
At Cascade Eye & Skin Centers, we want you to know that while HS can be uncomfortable, painful, and emotionally draining, it is treatable, and we’re here to help.
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa is a chronic inflammatory skin condition that causes painful, boil-like lumps under the skin. These bumps often form in areas where skin rubs together or where sweat glands are more concentrated, such as under the arms, between the thighs, under the breasts, or around the groin and buttocks.
What Does It Look Like? Hidradenitis Suppurativa Symptoms
HS often starts subtly. A single tender bump may appear and disappear. However, over time, these flare-ups may become more frequent, more painful, and more widespread. Here’s what HS typically looks like:
- Painful nodules that feel deep, tender, and inflamed
- Lumps that rupture and drain foul-smelling fluid
- Tunnels (sinus tracts) that form under the skin between bumps
- Thick scars or firm areas of tissue from repeated inflammation
In the early stages, HS may resemble a single pimple or boil, but what sets it apart is its recurring nature and tendency to worsen over time if untreated. For many patients, HS becomes a cycle: a lump appears, it hurts, it ruptures or drains, it heals with scarring, and then it happens again.
What Causes Hidradenitis Suppurativa?
The exact cause of HS isn’t fully understood, but it’s believed to be linked to inflammation around hair follicles. In people with HS, these follicles become blocked and inflamed, leading to painful nodules and abscesses.
What we know:
- It’s not caused by a bacterial infection, although secondary infections can occur.
- It’s not a hygiene issue, despite the areas it affects.
- It’s linked to an overactive immune response, similar to other chronic inflammatory conditions.
In other words, it’s a skin condition that seems to be driven by biology, not your behavior or environment.
Who’s at Risk?
Anyone can develop HS, but there are certain factors that seem to increase your risk:
- Family history: There may be a genetic component; HS often runs in families.
- Sex: Women are affected more often than men.
- Age: Symptoms usually begin after puberty, most commonly between ages 20 and 40.
- Smoking: Strongly associated with a higher risk of HS.
- Obesity: Increased friction and inflammation may play a role in triggering flares.
- Other health conditions: HS is more common in people with metabolic syndrome, inflammatory bowel disease (IBD), polycystic ovarian syndrome (PCOS), and insulin resistance.
That said, we also see patients with no clear risk factors at all. HS doesn’t follow a simple formula, which is why a tailored approach to care is so important.
How Is It Diagnosed?
There’s no specific test for hidradenitis suppurativa. Diagnosis is made through a thorough skin exam and by listening to your health history. We may ask questions like:
- How long have you had the bumps?
- Do they come and go in the same areas?
- Have they ever drained or scarred?
- Are they painful or tender?
In some cases, we may perform a culture if drainage is present, to rule out infection, or recommend additional evaluation if there are signs of other inflammatory diseases.
The earlier HS is diagnosed, the easier it is to manage. Even if you’ve been dealing with symptoms for years, we’re here to help you get a handle on it now.
Treatment Options for Hidradenitis Suppurativa
HS treatment depends on the severity and progression of the condition. At Cascade Eye & Skin Centers, we create treatment plans based on where you are in your HS journey, whether you’re experiencing occasional flares or dealing with widespread, recurring inflammation.
Topical and Oral Medications
- Topical antibiotics may help with mild lesions and prevent bacterial overgrowth.
- Oral antibiotics can reduce inflammation and control flares.
- Hormonal therapies (like birth control or anti-androgens) may be helpful in some women.
- Retinoids (vitamin A derivatives) may be prescribed in select cases.
- Biologic medications (like adalimumab) are FDA-approved for moderate to severe HS and target the underlying immune response.
In-office Procedures
- Incision and drainage can offer immediate relief for painful abscesses, though this doesn’t prevent future flares.
- Laser hair removal may help reduce flare frequency by targeting the hair follicle root.
- Corticosteroid injections may reduce inflammation in localized areas.
Surgical Options
For advanced cases, surgery may be recommended to remove scarred or tunnelled tissue, especially when other treatments haven’t provided relief. This is typically reserved for severe or refractory HS.
Find Treatment for Hidradenitis Suppurativa
Managing HS isn’t just about medication; it’s about long-term care, self-awareness, and compassionate support. With the right treatment, many patients can significantly reduce the frequency and severity of flares and improve their quality of life.
At Cascade Eye & Skin Centers, we create a safe, respectful space for patients to talk about what they’re going through, without judgment. If you think you may have hidradenitis suppurativa or have been struggling with recurring bumps, drainage, or scarring under the arms or near the groin, we’re here to help.
Our dermatology providers are experienced in diagnosing and treating HS at all stages and will work with you to create a plan that fits your life.
Click here to schedule an appointment today and take the first step toward relief and a better relationship with your skin.
