Hidradenitis suppurativa (HS) is a long-lasting skin disease. It causes painful lumps, boils, and “tunnels” under the skin. These bumps happen where skin rubs together, like the armpits, groin, buttocks, and under the breasts. The disease is not an infection you catch from someone. It is not caused by poor hygiene. It starts in the hair follicle and then triggers inflammation and damage in the skin. Over time, tunnels and scars can form and keep coming back. NIAMSDermNet®
Hidradenitis suppurativa (HS), sometimes called “acne inversa,” is a long-lasting skin disease that causes painful, deep lumps under the skin. These lumps can turn into abscesses (boils), leak fluid, and form tunnels (sinus tracts) under the skin that can scar. HS usually shows up where skin rubs on skin—like the armpits, groin, between the buttocks, under the breasts, and inner thighs. HS is not contagious and not caused by poor hygiene. It’s an immune-driven, inflammatory disease that starts in the hair follicle (the tiny pore that grows a hair). Follicles get blocked, rupture, and trigger inflammation; over time, repeated flares can lead to scarring and tunnels. Genes, hormones, weight, smoking, friction, and other health conditions can influence HS severity. ScienceDirectPMC+1
HS begins when a hair follicle gets blocked. The tiny pore plugs up with keratin and debris. The follicle swells and may rupture. When it breaks, the contents spill into nearby skin. The body treats this as an injury and as a threat. The immune system sends many signaling chemicals (such as TNF-alpha, IL-1, and IL-17). This causes pain, heat, swelling, and pus. Bacteria can grow in the damaged area secondarily, which may worsen odor and drainage, but bacteria are not the root cause. In some people, inherited changes in “gamma-secretase” genes (such as NCSTN, PSENEN, and PSEN1) make follicles more likely to clog and rupture. These genetic changes are uncommon, but they prove that hair-follicle biology and the immune system both matter in HS. Mayo ClinicPMC+1
HS affects women more often than men, and it appears more often in people with a family history. Smoking and higher body weight are linked to HS and to worse symptoms. Friction, heat, and sweat can act as day-to-day triggers for flares. HS often begins around puberty and can continue for years. NIAMSPubMed
Types
By clinical severity (Hurley stages).
Doctors often describe HS by three clinical stages.
Stage I: One or more isolated abscesses. There are no tunnels and no scarring yet.
Stage II: Repeated abscesses with one or more tunnels and some scarring. Lesions can be separated by normal skin.
Stage III: Many interconnected tunnels and abscesses over a broad area, with heavy scarring.
This staging helps match treatment to disease severity. DermNet®+1
By clinical phenotype (patterns HS can take).
Dermatologists also recognize patterns: regular HS; “frictional” HS with many deep nodules in areas of rubbing; “scarring folliculitis” with many comedones and pitted scars; “conglobata” with cysts and severe acne-like lesions; and “syndromic” forms that occur with rare autoinflammatory syndromes like PASH or PAPASH. These patterns help explain why HS looks different from person to person. DermNet®
By dynamic severity scores used in clinic and research.
In addition to Hurley stages, doctors may use scores such as Sartorius, HS-PGA, HiSCR (a response measure), and IHS4 (a practical “count and weight” score) to track change over time. IHS4 adds up 1 point per nodule, 2 per abscess, and 4 per draining tunnel; ≤3 = mild, 4–10 = moderate, ≥11 = severe. These tools guide treatment decisions and research. DermNet®ERN Skineihs4.dermavalue.com
Causes and contributors
HS has no single cause. It is “multifactorial,” which means several things add up. Below are common, evidence-based contributors explained in simple language.
Hair follicle plugging (follicular occlusion). The pore clogs with keratin and debris. Pressure builds, the follicle ruptures, and inflammation begins. This is the first push toward an HS bump. Mayo Clinic
Immune over-reaction. The body reacts strongly to the follicle injury. Immune chemical signals like TNF-alpha and IL-17 drive swelling, pain, and pus. This keeps the cycle going. PMC
Genetic factors. Some families carry changes in gamma-secretase genes (NCSTN, PSENEN, PSEN1). These changes alter hair-follicle biology and predispose to HS. PMC
Smoking. Smoking is strongly associated with HS and worse severity. Chemicals in smoke may change follicles and immune responses. PubMed
Higher body weight. Extra weight increases skin friction, warmth, and inflammatory signals from fat tissue, all of which can worsen HS. NIAMS
Mechanical friction. Tight clothes, skin-to-skin rubbing, and repetitive shear can irritate follicles and trigger flares. DermNet®
Heat and sweat. Warmth and moisture macerate skin and raise friction, which can set off new lesions. DermNet®
Hormonal influences. HS often starts after puberty and can flare with menstrual cycles or with polycystic ovary syndrome (PCOS). Androgen signals may play a role for some. NIAMS
Microbiome shifts. Secondary bacterial overgrowth can amplify odor, drainage, and inflammation, though bacteria are not the root cause. PMC
Insulin resistance and metabolic syndrome. These states keep inflammation “on” and often travel with HS. PMC
Family history. About one-third of patients report a relative with HS, showing a genetic contribution. NIAMS
Earlier puberty / hormonal timing. HS often appears around puberty, when sex hormones first rise. NIAMS
Coexisting follicular occlusion disorders. Some people also have acne conglobata, dissecting cellulitis, or pilonidal disease. These clustered conditions share a follicle-plugging tendency. DermNet®
Psychological stress. Stress does not cause HS, but stress can intensify pain and flares by boosting inflammatory signals and sweat. (Clinically observed and patient-reported.) Mayo Clinic
Occlusive products and friction from shaving or depilation. These can irritate follicles on already sensitive skin. (General dermatology practice.) DermNet®
Anemia and poor wound health. Chronic inflammation and draining can contribute to anemia, which may slow healing and perpetuate lesions. DermNet®
Inflammatory comorbidities (e.g., IBD). Shared inflammatory pathways link HS with diseases like inflammatory bowel disease. This points to common immune drivers. PMC
Clothing and equipment pressure. Straps, waistbands, and sports gear can rub and trap heat in flexural areas. DermNet®
Humidity and climate. Humid environments increase moisture and chafing, worsening daily symptoms. DermNet®
Delayed diagnosis and undertreatment. Longer-lasting, uncontrolled inflammation allows tunnels and scars to grow, which in turn fuels more flares. Early recognition helps “break” this cycle. NIAMS
Common symptoms
Painful lumps under the skin. They feel like deep, tender “peas” or marbles that hurt to touch or to move. Mayo Clinic
Boils and abscesses. The lumps can fill with pus and become very painful. They may last for weeks. Mayo Clinic
Leaking bumps with odor. Some lesions break open and drain thick fluid that can have a strong smell. Mayo Clinic
Tunnels (sinus tracts). Narrow channels can form under the skin and connect lesions. They are a key feature of HS. NIAMS
“Double-headed” blackheads. Two black dots joined under the skin by a tunnel are a helpful visual clue. DermNet®
Redness, warmth, and swelling. Active inflammation makes the skin look inflamed and feel hot. Mayo Clinic
Itching or burning. These sensations may come before a flare or accompany it. Mayo Clinic
Scarring. Over time, rope-like or pitted scars can appear and limit movement. Amerikan Hastanesi
Limited movement. Axillary or groin disease can make lifting the arm, walking, or sitting painful. Amerikan Hastanesi
Skin thickening and “bridging.” Repeated flares thicken the skin and create bands over tunnels. DermNet®
Bleeding or crusting. Fragile draining areas can bleed or crust easily. DermNet®
Lymphedema. Long-standing groin disease can block lymph flow and cause swelling of the genitals or nearby skin. DermNet®
Fever or feeling unwell during severe flares. This can happen if there is significant inflammation or superinfection. Mayo Clinic
Fatigue and poor sleep. Pain, drainage, and itching make sleep hard and drain energy. Mayo Clinic
Emotional distress. HS can affect mood, confidence, social life, work, and intimacy. Anxiety and depression are common and deserve care. Mayo Clinic
Diagnostic tests
Doctors diagnose HS mainly by how it looks, where it appears, and how often it comes back. There is no single blood test that “proves” HS. Tests are used to confirm the pattern, stage the disease, check for infection, look for tunnels, and screen for related problems. Below are practical tools grouped by category and written in plain English.
A) Physical examination
Careful visual exam of typical sites. The doctor looks closely at armpits, groin, perineum, buttocks, and under the breasts for bumps, tunnels, scars, and double-headed blackheads. Finding these in classic locations is central to diagnosis. DermNet®NIAMS
Palpation (gentle pressing) of lesions. The clinician feels for depth, tenderness, warmth, and “fluctuance” (the feel of fluid) to tell cysts from abscesses and to plan drainage if needed. Mayo Clinic
The diagnostic “triad” check. Doctors confirm three things: characteristic lesions, typical distribution, and recurrence over time. When all three are present, HS is very likely. DermNet®
Hurley staging at the bedside. The doctor assigns Stage I, II, or III based on tunnels and scarring. This quick stage helps guide treatment choices. DermNet®
Sartorius mapping and lesion counting. The clinician counts involved regions and lesions to generate a repeatable score. This helps track change visit to visit. DermNet®
Pain and life-impact checks. A pain scale and a short life-quality survey (such as DLQI) capture how HS affects sleep, movement, mood, and work. These measures belong in routine care. DermNet®
B) Manual tests and bedside maneuvers
Gentle probing of a tunnel opening. A sterile, blunt probe is gently passed a short distance into a suspected opening to confirm a tract and its direction. This should be brief and careful and is often done only when it will change treatment or surgery planning. Ultrasound is increasingly used instead. medicina.uchile.cl
Expressed drainage for culture when needed. If a lesion is draining or fluctuant, the clinician may take a swab of fluid to check for secondary infection and to choose an antibiotic if clearly infected. HS itself is not primarily infectious. NIAMS
Range-of-motion and scar assessment. The doctor gently checks arm lift, walking, or hip movement when axilla or groin scars restrict motion, because limited movement affects daily life and surgical planning. Amerikan Hastanesi
C) Laboratory and pathological tests
Complete blood count (CBC). This looks for signs of inflammation or anemia of chronic disease, which can occur with long-lasting draining lesions. DermNet®
C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). These inflammation markers can rise during active flares and fall as disease calms. They are not specific to HS but can help track severe disease. Mayo Clinic
Wound culture (if clear signs of infection). Culture helps pick targeted antibiotics when cellulitis or systemic infection is suspected. Routine culture of every lesion is not needed. NIAMS
Glucose or HbA1c. Screening for diabetes or insulin resistance is wise because metabolic problems often coexist with HS and influence healing. PMC
Lipid profile and blood pressure checks. These look for metabolic syndrome, which is linked with HS and overall health risk. PMC
Skin biopsy (when the picture is unclear). HS is usually a clinical diagnosis. A biopsy is reserved for unusual cases, to rule out other conditions, or to check long-standing lesions for rare squamous cell carcinoma. Typical HS pathology shows follicle disruption, tunnels lined by granulation tissue, and chronic inflammation. DermNet®
D) Electrodiagnostic tests
No standard electrodiagnostic test is used for HS. Tests like nerve conduction studies or EMG do not help diagnose HS because HS is a skin and follicle disease, not a nerve or muscle disorder. If an HS patient ever needs such tests, it is for unrelated problems, not for HS itself. (Clinical consensus.)
E) Imaging tests
High-frequency skin ultrasound. Ultrasound can “see” tunnels, fluid pockets, and hidden disease that the eye and finger miss. It helps stage the disease, plan surgery, and monitor response. New international consensus now supports ultrasound as a key tool in HS care. medicina.uchile.clPubMed
Color Doppler ultrasound. Doppler adds information on blood flow and inflammation around lesions and can highlight active disease needing treatment. It also supports ultrasound-guided procedures. PMC
MRI of the pelvis or perineum (for ano-genital disease). MRI maps deep tracts, fistulas, and abscesses near the anus, vulva, or groin and helps surgeons plan. It is especially helpful when Crohn’s disease is also present. PMC
MRI or ultrasound of the axilla or other sites before surgery. Imaging defines how far tunnels reach and which areas need deroofing, excision, or seton placement. This reduces surprises in the operating room. medicina.uchile
Non-pharmacological treatments
These approaches reduce friction, moisture, and secondary infection risk, support wound care and comfort, and can lower flare frequency. None replaces medical therapy, but together they make a big difference.
Gentle daily cleansing with antiseptic washes
Short showers using benzoyl peroxide, chlorhexidine, or zinc pyrithione cleansers can reduce surface bacteria and odor. Avoid scrubbing; use fingertips. Pat dry. Harvard HealthDermNet®Friction control
Wear loose, breathable cotton or moisture-wicking fabrics. Use anti-chafe balms in skin-folds. Avoid tight waistbands and rough seams. Purpose: limit mechanical micro-trauma that triggers lesions. Mechanism: less shear + less maceration = fewer follicle ruptures. Harvard HealthWeight management support
Even modest weight loss can reduce skin-fold friction, sweating, and inflammation, lowering flares for many (not all) people. Mechanism: reduced pro-inflammatory adipokines + less occlusion. American Academy of Dermatologyhs-foundation.orgSmoking cessation
Quitting reduces inflammatory signaling and may cut flare frequency and severity over time. Ask for nicotine replacement and behavioral programs. American Academy of DermatologyWarm compresses during flares
10–15 minutes a few times daily can ease pressure, encourage natural drainage, and calm pain—do not squeeze or lance at home. SELFAbsorbent, non-stick dressings
Use modern, non-adhesive absorbent dressings to manage drainage and protect clothing/skin; change regularly. Mechanism: moisture control reduces maceration and secondary infection risk. bad.org.ukProfessional wound care education
Learning how to clean, pack, and dress complex tracts improves comfort, odor control, and healing between clinic visits. hs-foundation.orgLaser hair reduction (Nd:YAG 1064 nm)
By reducing terminal hair in problem zones, this can lower follicular blockage and flares in some patients; usually done in a series. WikipediaCO₂ laser “deroofing”/ablation (as a procedure-lite option)
For limited tunnels, laser can remove the “roof” of sinus tracts so they can heal from the base; often faster healing than wide excision. PMCStress reduction & psychological support
HS affects mood and social life; CBT, mindfulness, and support groups reduce stress-related flares and improve coping. CosmodermaExercise that minimizes friction
Swimming, low-impact cardio, and strength work keep fitness up while avoiding bike saddles or repetitive rubbing that can trigger lesions.Heat/sweat management
Use breathable layers, fast showers after workouts, and antiperspirants that your skin tolerates to reduce moisture load in folds.Shaving alternatives
If shaving causes irritation, consider electric trimmers or ask about laser hair reduction; avoid waxing in active HS areas. Medical News TodayMenstrual-linked flare planning
If you notice cyclical flares, track them and discuss hormone-modulating options with your clinician.Odor control without irritation
Fragrance-free, sensitive-skin deodorants and regular dressing changes help; avoid strong fragrances that can sting open skin.Nutrition pattern: Mediterranean-leaning
A pattern rich in vegetables, legumes, fish, nuts, whole grains, and olive oil may help quiet systemic inflammation and support weight goals. PMCWiley Online LibraryEducation on early-flare action plans
Starting treatments (e.g., warm compresses, prescribed topicals) early in a flare shortens duration.Partnering on work/school accommodations
Simple adjustments (uniform changes, restrooms near dressings, flexible clothing) reduce friction and missed days.Sun-safe exposure & vitamin D repletion
If you’re deficient, medical vitamin D can be repleted to normal levels (see supplement section). PubMedCommunity and advocacy
HS foundations and peer groups provide practical tips, clinician finders, and emotional support. hs-foundation.org
Drug treatments
Doses below reflect common, guideline- or label-supported regimens; your clinician personalizes them based on your case, other meds, pregnancy plans, and lab monitoring.
Topical clindamycin 1% (antibiotic, lotion/solution)
Why: Helps mild HS (Hurley I) and as add-on for higher stages.
How: Lowers surface bacteria and local inflammation.
How to use: Apply thin layer once or twice daily to active areas; combine with benzoyl peroxide wash to reduce resistance.
Side effects: Skin dryness, irritation; long use can promote resistance. PMCDoxycycline or minocycline (tetracycline-class antibiotics)
Why: First-line oral option for mild-to-moderate HS.
How: Anti-inflammatory effect in hair follicles; also antibacterial.
Dose/time: Doxycycline 100 mg twice daily (or 50–100 mg once/twice daily), often 8–12 weeks; sometimes maintenance.
Side effects: Sun sensitivity, stomach upset (take with food/water), rare esophagitis. PMCClindamycin + rifampin (combination oral antibiotics)
Why: A reliable second-line regimen; also first-line adjunct in more severe HS.
How: Synergistic anti-inflammatory and antibacterial effects.
Dose/time: Clindamycin 300 mg twice daily + rifampin 300 mg twice daily for 8–12 weeks; courses can be repeated.
Side effects: Rifampin interacts with many meds, colors urine/orange, and needs liver checks; clindamycin can cause diarrhea. PMCMoxifloxacin + metronidazole + rifampin (triple regimen)
Why: Option for refractory moderate–severe HS or as a bridge to surgery.
How: Broad antibacterial and anti-inflammatory coverage.
Dose/time: Moxifloxacin 400 mg daily + metronidazole 500 mg three times daily (stop metro at 6 weeks) + rifampin 300 mg twice daily for 1–12 months depending on response; relapse is common, but repeats can help.
Side effects: Tendon issues (moxifloxacin), neuropathy with prolonged metronidazole; drug interactions with rifampin. PMCDapsone (anti-inflammatory antibiotic)
Why: Maintenance in a subset with Hurley I–II disease.
How: Neutrophil-modulating anti-inflammatory action.
Dose/time: Start 50 mg daily, titrate up to 200 mg daily as tolerated; check G6PD and monitor blood counts.
Side effects: Anemia (esp. if G6PD-deficient), rash. PMCSpironolactone (anti-androgen; for women or people assigned female at birth)
Why: Helps hormonal/cyclical flares and may reduce lesions.
How: Blocks androgen effects on hair follicles and sebaceous glands.
Dose/time: Start 50–100 mg daily, often 100–200 mg daily long-term if helpful; monitor potassium and blood pressure; avoid in pregnancy.
Side effects: Urination, menstrual changes, breast tenderness, high potassium (rare in young healthy patients). PMCactasdermo.orgMetformin (insulin-sensitizer; off-label adjunct)
Why: May help HS in people with insulin resistance or metabolic syndrome; evidence is mixed but supportive in some studies.
How: Lowers insulin levels and systemic inflammation.
Dose/time: Start 500 mg once daily with food, titrate to 1500–2000 mg/day as tolerated; GI upset is common at first.
Side effects: GI symptoms; rare lactic acidosis (avoid in advanced kidney/liver disease). MDEdgeOxford AcademicAdalimumab (Humira®, anti-TNF biologic; FDA-approved for HS)
Why: Proven to reduce inflammatory lesions and flares in moderate-to-severe HS.
How: Blocks TNF-α, a key inflammatory cytokine in HS.
Dose/time (adult HS label): 160 mg week 0, 80 mg week 2, then 40 mg every week ongoing.
Side effects: Injection reactions, infection risk (TB/hepatitis screening needed), rare demyelinating disease/worsening heart failure. PMCSecukinumab (Cosentyx®, IL-17A inhibitor; FDA-approved for HS)
Why: Effective in many with moderate-to-severe HS, including some who failed anti-TNF.
How: Blocks IL-17A, a driver of neutrophilic inflammation.
Dose/time (adult HS label): 300 mg weekly for 5 doses (weeks 0–4), then 300 mg every 4 weeks; some may escalate to every 2 weeks if needed.
Side effects: Upper-respiratory infections, candidiasis, rare IBD flares—report new GI symptoms. FDA Access DataVeterans AffairsBimekizumab (Bimzelx®, dual IL-17A/F inhibitor; FDA-approved for HS)
Why: Improves lesions and pain in moderate-to-severe HS.
How: Blocks both IL-17A and IL-17F to tamp down inflammation.
Dose/time (adult HS label): 320 mg subcutaneously at weeks 0, 2, 4, 6, 8, 10, 12, 14, and 16, then every 4 weeks thereafter.
Side effects: Oral/genital candidiasis, URIs; similar infection risk considerations as other biologics. FDA Access Databimzelxhcp.com
Other options your team may consider in select cases include short bursts of oral corticosteroids for acute flares, acitretin or isotretinoin (more useful if you also have severe acne), or infliximab/ustekinumab/anakinra in specialized care pathways. PMC
Dietary molecular supplements
Always clear supplements with your clinician/pharmacist to avoid interactions (especially with antibiotics, blood thinners, or pregnancy). Evidence in HS is limited; the goal is to support overall anti-inflammatory health.
Zinc gluconate
Dose: commonly 90 mg/day elemental zinc (check product label; long-term use may need copper).
Function/mechanism: anti-inflammatory, modulates neutrophils; small studies suggest lesion improvement. PubMedScienceDirectVitamin D3
Dose: individualized to correct deficiency (often 1000–2000 IU/day, or short-term higher medical dosing if very low).
Function: supports immune balance; deficiency is frequent in HS and may relate to severity. PubMedMedical Journals SwedenOmega-3 fatty acids (fish oil EPA/DHA)
Dose: often 1–3 g/day combined EPA+DHA with meals.
Function: anti-inflammatory lipid mediators; general skin/heart health benefits; HS-specific data are limited. PMCN-acetylcysteine (NAC)
Dose: 600 mg twice daily (common dermatology dosing).
Function: replenishes glutathione; antioxidant/anti-inflammatory effects that may help inflammatory skin states. PMCCurcumin (turmeric extract, standardized)
Dose: 500–1000 mg/day (often with piperine for absorption).
Function: downregulates TNF-α, IL-1, IL-6, COX-2; evidence in HS is preliminary. PMCJ Integrative DermProbiotics (multi-strain)
Dose: per product (often 10–20 billion CFU/day).
Function: gut-skin axis support; may help some with bloating/IBD overlap (HS data limited).Green tea extract (EGCG)
Dose: 300–400 mg/day (avoid on empty stomach; mind liver warnings on high doses).
Function: polyphenol anti-inflammatory/antioxidant support. PMCMyo-inositol
Dose: 2 g/day, sometimes with magnesium.
Function: insulin sensitivity and anti-inflammatory signaling; early HS case series suggest possible benefit. Wiley Online LibraryResveratrol
Dose: 150–500 mg/day.
Function: antioxidant/polyphenol; theoretical anti-inflammatory benefits.Quercetin
Dose: 250–500 mg/day.
Function: mast-cell stabilizing, antioxidant properties; HS-specific data are sparse.
Advanced immune-modulating (biologic) therapies
These target cytokines that drive HS inflammation. They require screening (e.g., TB, hepatitis), vaccines up to date, and regular follow-up.
Adalimumab (anti-TNF-α) — FDA-approved for HS. Weekly maintenance dosing improves lesions and pain in many. PMC
Infliximab (anti-TNF-α, IV) — off-label; helpful in some refractory cases; dosing often 5–10 mg/kg every 4–8 weeks after loading, tailored by response. PMC
Secukinumab (IL-17A inhibitor) — FDA-approved; 300 mg weekly ×5, then every 4 weeks (some escalate to every 2 weeks). FDA Access Data
Bimekizumab (dual IL-17A/F inhibitor) — FDA-approved; 320 mg every 2 weeks to week 16, then every 4 weeks. FDA Access Data
Anakinra (IL-1 receptor antagonist) — off-label daily injections; can help some, but data are limited; used by specialists. PMC
Ustekinumab (IL-12/23 inhibitor) — off-label (e.g., 45–90 mg every 12 weeks); may help some refractory patients. PMC
About “stem cell” or “regenerative” therapies: small experimental studies (e.g., PRP, adipose-derived cell grafts) exist, but no approved stem-cell drugs for HS and no standard dosing. If you see these offered, ask about evidence, ethics approval, and risks; prioritize therapies backed by strong safety data.
Surgeries and procedures
Deroofing
What: The surgeon opens (“deroofs”) the tunnel and removes the chronically inflamed lining so it can heal from the base.
Why: Excellent for localized sinus tracts; less tissue removal than wide excision; good symptom relief with shorter downtime.STEEP (Skin-Tissue-sparing Excision with Electrosurgical Peeling)
What: A staged, tangential removal of all diseased tissue while sparing healthy skin; often faster healing and fewer contractures than classic wide excision.
Why: Good for Hurley II–III with grouped tunnels where tissue preservation matters. PubMedMedical JournalsWide local excision (WLE) with closure, grafts, or flaps
What: Removes the entire diseased area down to healthy tissue; closure varies (primary suturing, skin grafts, perforator flaps).
Why: Best chance of long-term control in severe, extensive disease; lower recurrence than limited I&D. ScienceDirectCO₂ laser excision/ablation
What: Vaporizes affected tissue or deroofs tracts with precise laser energy.
Why: Useful for select areas; may reduce bleeding and allow controlled removal. PMCIncision & drainage (I&D) for a tense abscess
What: Simple slit to release pressure and pus in a single acutely painful abscess.
Why (and caution): Provides quick pain relief but has near-universal recurrence and is not a cure—not a long-term solution. Use only for urgent pain with your clinician’s guidance. PMC
Prevention tips
Keep skin folds clean, dry, and cool; quick shower after sweating. Harvard Health
Wear loose, breathable clothes; avoid tight straps and rough seams. Harvard Health
Work toward a healthy weight (even a small loss helps some people). American Academy of Dermatology
Stop smoking; ask for quit-support tools. American Academy of Dermatology
Use non-stick absorbent dressings to protect skin and reduce maceration. bad.org.uk
Choose gentle cleansers (benzoyl peroxide, chlorhexidine, or zinc pyrithione) and avoid scrubbing. Harvard Health
Plan exercise that minimizes friction (e.g., swimming, elliptical).
Consider a Mediterranean-style diet; note any personal food triggers. PMC
Avoid waxing in HS-prone zones; if shaving irritates, switch to a trimmer or consider laser hair removal. Medical News Today
Treat early flares and keep follow-ups—don’t wait for tunnels to form.
What to eat and what to avoid
Eat more of:
Colorful vegetables & fruit (fiber, antioxidants)
Legumes (lentils, beans for fiber and protein)
Whole grains (oats, brown rice)
Fish (especially oily fish—natural omega-3s)
Nuts & seeds (handful daily)
Olive oil (swap for butter)
Limit/avoid if they seem to flare you:
- High-sugar, high-glycemic foods (sodas, candy, white bread)
- Ultra-processed meats and trans-fats
- Alcohol (can worsen flushing/inflammation)
- Brewer’s yeast/gluten (trial eliminations help some; keep a symptom diary and re-challenge to confirm). Cleveland Clinic
When to see a doctor
Painful lumps last >2–3 weeks, keep coming back, or appear in typical HS areas.
You notice drainage, bad odor, new tunnels, or fever/red streaking (possible infection).
Severe pain limits sleep or daily life.
You’re pregnant, trying to conceive, or breastfeeding and need a medication plan.
You feel down, anxious, or hopeless—HS commonly affects mental health and help is available.
You have bowel symptoms or joint pain along with HS (possible comorbidity). Cleveland Clinic
Frequently asked questions (FAQs)
1) Is HS contagious?
No. HS comes from your own immune and follicular pathways and can’t be caught or spread. American Academy of Dermatology
2) Did hygiene cause my HS?
No. Gentle cleansing helps comfort and odor, but HS is not caused by being “dirty.” American Academy of Dermatology
3) Will HS go away?
There’s no single cure yet, but many people gain strong control with the right mix of lifestyle, medicines, and (when needed) procedures. Some immune diseases quiet with age. hs-foundation.org
4) Should I pop or squeeze HS bumps?
No. That can worsen inflammation and cause infection and scarring. Use warm compresses and see your clinician. SELF
5) What is the best first medicine?
For mild HS: antiseptic washes and topical clindamycin; for moderate: add oral antibiotics; for moderate–severe: biologics like adalimumab, secukinumab, or bimekizumab are evidence-based options. Your clinician personalizes the plan. PMC+1FDA Access Data+1
6) Are antibiotics lifelong?
No. They’re given in defined courses (often 8–12 weeks). Relapses can happen, so courses may be repeated or stepped up to biologics. PMC
7) Do biologics suppress my whole immune system?
They target specific cytokines (TNF-α, IL-17A/F). Infection screening and monitoring reduce risks. Many patients tolerate them well and enjoy fewer flares. PMCFDA Access Data+1
8) Can diet help HS?
A Mediterranean-style pattern supports general and inflammatory health; individual triggers (like brewer’s yeast or alcohol) vary—try short, guided elimination trials with re-challenge. PMCCleveland Clinic
9) Is laser hair removal useful?
It can reduce flares for some by decreasing hairs/follicles in HS zones; it’s usually a series and may not be right for everyone. Wikipedia
10) Why do doctors warn against incision & drainage (I&D)?
It relieves pain but recurs nearly 100% of the time; it’s not a cure. Long-term control needs deroofing, STEEP, or wide excision for tracts, and/or medical therapy. PMC
11) Are supplements worth trying?
Some (zinc, vitamin D, omega-3, NAC) are reasonable adjuncts with clinician guidance, but they’re not stand-alone treatments. Evidence ranges from small trials to theoretical benefits. PubMed+1
12) Can HS increase cancer risk?
Long-standing, scarred perineal/perianal HS can (rarely) develop squamous cell carcinoma—regular follow-up helps catch changes early.
13) What about pregnancy?
Plans change: many antibiotics/retinoids/hormones are restricted; some biologics may be continued under specialist guidance. Always tell your clinician if pregnant or trying. (Do not self-start/stop meds.)
14) How fast should I expect improvement?
Topicals/antibiotics may help within weeks; biologics often take 2–3 months to show strong benefit (earlier for some). Keep follow-up appointments to adjust.
15) What specialist should I see?
A dermatologist experienced in HS is ideal; for severe disease, a combined clinic with surgery, pain, mental health, and nutrition support is best.
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: August 16, 2025.
