Hidradenitis Suppurativa

Hidradenitis Suppurativa – Symptoms, Causes, And Treatment

Hidradenitis suppurativa (HS), also known as acne inversa is a painful skin condition. It leads to the development of small lumps to form under your skin. These painful lumps can break open or cause tunnels to form under your skin. The lumps usually form in the folds of your skin that rubs together. So, it is common in areas like breasts, buttocks, groin, or armpits. People who have reached their puberty develop the skin condition. The condition persists for many years. It usually worsens over time and causes serious hindrance in your normal life. Due to the social stigma associated with the problem, you develop emotional problems. With early intervention, you can prevent complications and manage the symptoms. You can seek the doctor’s assistance for developing a treatment plan to manage the problem.

Hidradenitis suppurativa

Symptoms Associated With Hidradenitis Suppurativa

Symptoms Associated With Hidradenitis Suppurativa

Hidradenitis suppurativa can cause skin issues. You can the problems developing in one area or multiple spots in the body. With acne inversa, you can see the following signs:


You can see a double-barreled pattern on your skin that contains blackheads. The small pitted areas often appear in pairs.

Painful Bumps

You develop small, painful lumps as a result of the condition. In most cases, affected people to develop a single lump under the skin that causes pain. It persists for several weeks or months. After some time, you develop more bumps under the skin. These bumps appear in areas with hair follicles. The bumps are common when you have excess oil as well as sweat glands. So, you can find them in your groin, armpits, and anal region. The bumps also develop in places where your skin rubs together like buttocks, breasts, and inner thighs.


As time progresses, affected people can develop tracts that connect lumps under your skin. Such wounds have slow healing (if at all it heals). It also leaks pus with odor.

While some people experience only mild symptoms associated with the condition, others can see severe issues. From painful lumps to pus draining, the symptoms become troubling. People who are stressed, have excess weight, experience hormonal changes, or heat/humidity suffer from severe symptoms. Women who have reached their menopause can see less severe signs.

Stages Of Hidradenitis Suppurativa

Doctors usually stage the condition using the Hurley clinical staging system. Based on the severity, the stages are determined. It helps develop a treatment plan. The three stages are:

Stage 1

You develop single or multiple abscesses or nodules (lesions) with a little scarring.

Stage 2

During the stage, you develop single or multiple lesions. These lesions have limited tunnels along with scarring.

Stage 3

It is the most severe stage with many lesions covering your entire body. These lesions have extensive tunnels along with scarring.

See A Doctor For Hidradenitis Suppurativa

When you detect HS earlier, the chance of complication reduces. So, early detection and effective treatment are necessary to avoid irreversible issues. You need to see a doctor as early as possible when you see the following signs:

  • You feel pain
  • It never improves in a few weeks
  • It recurs after weeks of treatment
  • Appears in several locations
  • You suffer flare-ups

For people who have received a diagnosis of HS before, the above-mentioned signs are warnings of a flare-up. So, they can experience the symptoms that have occurred earlier. It is also important to pay attention to new symptoms developing in your body. It either indicates a flare or a complication triggered due to the treatment. For long-term care, see a dermatologist or a surgeon.

Causes Of Hidradenitis Suppurativa

While the exact cause of hidradenitis suppurativa remains unclear, it is believed the problem develops due to the blocking of hair follicles in your skin. Scientists believe it is associated with your hormones, inherited genes, and the body’s immune system. Some external factors like excess weight, smoking, and metabolic syndrome also plays a role. It is not an infection or cannot spread from one person to another. You never develop it because of bad hygiene.

Risk Factors Associated With Hidradenitis Suppurativa

Not all people develop hidradenitis suppurativa. The factors increasing your risk of developing HS include:


Hidradenitis suppurativa most commonly occurs in women between the ages of 18 and 29. People who develop the condition at an early age may be at increased risk of developing the more widespread disease.

People’s Sex

It is common among women compared to men. So, more HS is more common among women.

Family History

You can inherit the condition. So, HS is common among people who have a family member with a condition that can develop it in the future.


Several studies have shown a relationship between being overweight and Hidradenitis Suppurativa.


People who smoke or use tobacco products frequently can develop acne inversa.

Complications Due To Hidradenitis Suppurativa

When people suffer from severe and persistent Hidradenitis Suppurativa, it can affect their daily life. The physical and mental problems can make their life hell. Here are some of the complications associated with the condition.


The area affected by acne inversa is more prone to infection.

Skin Changes And Skin Changes

While mild to moderate cases of HS can heal, but the wounds developed due to the condition leaves scars. So, you can see skin changes due to the problem. The pitted skin or rope-like scars may remain after the wounds heal.

Restricted Movement Due To Hidradenitis Suppurativa

Due to development sores as well as scar tissue, your movement feels restricted. Simple movements feel painful when you develop the condition in areas like thighs or armpits.

Obstructed Lymph Drainage

You can also develop HS in many of your lymph nodes. In such cases, you develop scar tissue that interferes with the lymph drainage system. It results in swelling in your arms, genitals, or legs.

 Social Isolation

When you develop such lumps on the exposed skin surface or suffer from drainage along with bad odor from the sore, it causes embarrassment. It makes you self-conscious and you feel reluctant to go out. It results in social isolation, leading to sadness or depression.

Diagnosing Hidradenitis Suppurativa

When you see the signs or symptoms associated with acne inversa, then see a dermatologist. It is important to seek medical help as early as possible. With early intervention, you can prevent irreversible complications. Unfortunately, you have no specific test to detect the condition conclusively. So, in most cases, doctors can misdiagnose the problem. But, an expert dermatologist can identify the problem by close assessment. Here are the diagnostic methods used to assess the condition:

Physical Assessment

The doctors ask and check the signs and symptoms you suffer. With closer inspection, it is possible to identify any skin lesions, especially in the areas of skin folds. You need to answer questions regarding the history of lesions and the history of painful lesion, discharging pus.

Lab Tests

No specific lab tests can diagnose the problem. But, when pus or drainage occurs, your doctor sends the sample of the fluids to the lab for testing. The lab tests can detect other problems like infection. Based on the test results, you can get the necessary treatment.

Treatment For Hidradenitis Suppurativa

You have no permanent cure for hidradenitis suppurativa. But, treatments help manage the symptoms associated with the condition. The treatment can include both invasive and non-invasive options based on the severity of the symptoms. A single option alone does not offer complete relief. The search for a reliable and effective combination of treatment is still under research. So, you need to talk with your doctor regarding the risks and benefits of different treatment options available. With your doctor’s assistance, you can develop a customized approach to deal with your situation better. Since it is a lifelong condition, you need to have regular follow-up visits with your dermatologist. It is important to keep track of your progress for long-lasting management.


The doctor prescribes medications for mild to moderate cases of HS. The following medications are suggested for the condition:

Antibiotic Creams

Your doctor manages mild symptoms with topical creams. The antibiotics creams fight off infection. So, your doctor suggests gentamicin or clindamycin.

Systemic Drugs

When the condition is more widespread, you need to take antibiotics orally. So, medications like doxycycline, clindamycin, and rifampin are prescribed to deal with the infection. In moderate to severe cases of infection, systemic drugs like adalimumab can offer results. But, it takes around two weeks to see any results. Studies indicate the effectiveness of injectables like anakinra and infliximab.

Pain Medication

If over-the-counter pain relievers don’t help, your doctor may prescribe a stronger type.

Laser Therapy

It is the non-invasive option used to make the lesion go away. So, the doctor suggests the option. The technique uses a carbon dioxide laser to ease the symptoms.

Surgery For Hidradenitis Suppurativa

In severe cases, you need to undergo invasive treatments to overcome the symptoms triggered due to the problem. The options include:

Uncovering Tunnels

The surgical option known as un-roofing involves removing the tissues in the affected areas to expose the tunnels under your skin. It is the method suggested for moderate to severe Hidradenitis Suppurativa. It is the option that is not repeated.

Punch Debridement

It is the procedure, also referred to as limited un-roofing. The procedure is used to remove just a single inflamed nodule.

Tissue-sparing Excision With Electrosurgery

For severe cases of HS, you need to undergo this type of invasive surgery. The method combines excision (skin-tissue-sparing removal) of damaged tissue using the method of electrosurgical peeling.

 Surgical Removal

Invasive options like surgical removal are for people who suffer from severe or persistent symptoms associated with HS. You need to undergo a skin graft to close the wound. But, it does not mean all the sores will go away. But, some sores may still develop in other areas. Some men who suffer from the condition develop the problem between their anus and scrotum. So, the doctor suggests surgical removal of the scrotum as it is essential to ease the symptoms.

Incision And Drainage

Incision and drainage. Surgical drainage is no longer considered an effective option for treating hidradenitis suppurativa. The method may be considered to provide short-term pain relief, but sores tend to flare again.

Emerging Therapies For Hidradenitis Suppurativa

Today, scientists are studying the different options available for improving the treatment options available for HS care. Several good quality clinical trials on the way to evaluate the right timing of surgery as well as the type of procedure. Several intervention techniques like topical antiseptics, novel biological therapies, and the adalimumab studies are promising patients with better management of the condition.

Diet For Hidradenitis Suppurativa

Diet For Hidradenitis Suppurativa

Do you know that what you eat or drink can affect acne inversa? It is true as some foods you eat can prevent the condition while others can trigger flare-ups. While your doctor may not suggest a specific diet for the disease, several studies indicate the inclusion and exclusion of certain foods from your diet. So, here are some suggestions you can follow to manage HS.

Foods To Avoid When You Suffer From Hidradenitis Suppurativa

Some food items can affect the function of your body. So, you need to avoid the following food items that can worsen the symptoms of HS.

Dairy Products

All products containing dairy can affect the hormones in the body. This hormonal fluctuation can result in the flaring of HS. Therefore, you need to avoid the following from your diet:

  • Milk (from a cow)
  • Cheese
  • Ice Cream
  • Butter

Sugary Foods

Sugary foods can increase blood sugar levels. Due to the increase in blood glucose levels, it causes inflammation. The rise in sugar levels can also trigger inflammation. So, avoid the following from your diet:

  • Boxed cereals
  • Soda
  • Candy

Brewer’s Yeast

The products containing brewer’s yeast can trigger an immune system reaction. It is specifically found in people who are predisposed to hear intolerance. So, it is better to avoid products containing brewer’s yeast like wine, beer, and soy sauce.

Red Meat

Red Meat

Avoid red meat from your diet when you are suffering from HS. The different cuts of red meat have high levels of saturated fat. So, it can contribute to obesity as well as inflammation. It also contains omega6-fatty acids. They can trigger inflammation in your body when you consume too much red meat

High GI Food

High glycemic index foods elevate your blood glucose levels. It can affect insulin levels and worsens inflammation. Foods with a high GI are quickly digested as well as absorbed by the body. So, it rapidly increases blood sugar levels. Processed food containing high carbohydrates and sugar levels contain high GI value. But, other foods can also have a high GI value. Some examples of high GI foods are:

  • White rice
  • Doughnuts
  • French fries
  • White bread

Foods To Include To Manage Hidradenitis Suppurativa

While you need to avoid some foods, it is essential to include certain others in your diet for managing the symptoms of HS. Here are some of the list of foods you need to include in your diet:

Fiber-Rich Foods

When you include fiber-rich foods in your diet, it helps balance your hormone and blood sugar levels. Since fiber takes more time to digest and absorb, you feel full for a long time. So, it reduces unhealthy cravings that lead to binge eating. This helps maintain a healthy weight by promoting weight loss. You can replace simple carbohydrates with the whole as well as complex carbohydrates. Try to include the following in your diet:

  • Fresh/frozen vegetables
  • Frozen/fresh fruits
  • Lentils
  • Brown rice
  • Whole wheat bread
  • Whole grain pasta

Include Omega-3 Fatty Acids

Foods rich in omega-3 fatty acids reduce inflammation in the body. So, the intake of food rich in omega-3 fatty acids foods will soothe or prevent inflamed sores. While more research is required to understand the additional benefits of taking omega-3 fatty acids, it offers you more benefits. It is good for your heart, brain, and blood vessels. So, try adding some of the following foods:

  • Sardines
  • Salmon
  • Walnuts
  • Avocados
  • Flaxseed and flaxseed oil
  • Olive oil
  • Chia seeds
  • Pumpkin seeds
  • Navy beans

Popular Diets For Hidradenitis Suppurative

Do you know that some popular diet programs are followed by people suffering from HS? Two main diets used by people suffering from acne inversa to manage the symptoms are:

Autoimmune Protocol Diet (AIP Diet)

The autoimmune protocol diet eliminates food causing unwanted inflammation in the body. The relatively new diet focuses on including foods that promote gut healing. It reduces inflammation triggered due to autoimmune conditions. It is a restrictive diet, which mainly includes vegetables and meats. In most cases, people are trying the AIP diet for several weeks. After some time, other foods are added to the diet.

Whole30 Diet For Hidradenitis Suppurativa

Whole30 Diet For Hidradenitis Suppurativa

Whole30 is a diet with nutritious food designed to change the way you eat in a month. So, it transforms the way you feel. The diet removes all the potential inflammatory foods as well as beverages from your diet. The diet involves eating three clean meals. So, you need to avoid the following food from your diet:

  • Processed food
  • Added sugar
  • Alcohol
  • Sweeteners
  • Alcohol
  • Legumes
  • Grains
  • Dairy
  • Baked goods
  • Processed foods and beverages
  • Junk food

You have to eat a meal prepared only with vegetables, seafood, eggs, and meats.

Lifestyle And Home Remedies For Hidradenitis Suppurativa

Mild cases of acne inversa are easily managed at home with self-care methods at home. You need to follow these home remedies and lifestyle changes to complement the medical treatment you undergo. Here are some of the tips you need to follow to relieve the discomfort caused, enhance healing, or prevent any outbreaks:

Follow A Good Skin Care Routine

Follow a daily skincare routine for ensuring such problems do not crop up. Here are some of the steps you can follow:


So, use a non-soap cleanser to wash away dirt and grimes gently from your body. You can use products like Cetaphil or antiseptic wash like chlorhexidine with 4% while showering. When you use such products, it is important to try it first once a week. Then, you can gradually increase the use to once a day after your skin tolerates the product. It will prevent any unnecessary skin problems.

Avoid Abrasive Products

People suffering from acne inversa can have severe complications when they use products like loofahs, washcloths, or other items on the affected areas. It is because it causes irritation of the skin. So, it is wise not to use such products.

Use OTC Cream For Hidradenitis Suppurativa

Then apply an over-the-counter antibiotic cream or a cream containing the antimicrobial benzalkonium chloride. It might also help to apply extra-absorbent powder or zinc oxide.

Hidradenitis Suppurativa Pain Management

HS can trigger pain, which can cause severe distress. So, you need to apply a warm compress on the affected areas to get relief. You can use a warm, wet washcloth, warm bottle, tea bag, or other compresses to reduce swelling. It also reduces pain. Place a warm compress on the affected area for at least ten minutes. You can also consult your doctor to recommend pain relievers. It is because some people suffer from severe pain that is unmanageable with a warm compress. The doctor can suggest OTC or prescription pain medication for easing pain.

Wound Care For Hidradenitis Suppurativa

Some patients suffer from draining nodules that recur. So, you need to talk to your doctor regarding wound care. It is important to know how to properly care and dress the wounds at home. Since improper wound care can affect your lives by limiting the daily activities, always follow a care routine. Here are some of the pointers you need to follow:

  • Keep the lesion you develop as well as abscesses always clean.
  • Moist the wound with clean petroleum jelly to avoid chaffing.
  • Then, cover the affected skin with adhesive bandage.
  • You need to change the bandage every day. It keeps the wound clean and ensures quick wound healing.
  • People can develop scars on the affected area when exposed to sunlight. So, it is better to apply sunscreen after the wound heals to avoid the problem.

Avoid Tight Clothes

Wearing tight clothes with room to breathe increases the chances of friction and causes irritation. So, it is essential to choose loose, lightweight clothes that do not cause friction.

Refrain From Irritating Products

When you use products for personal hygiene, choose with caution. If you suffer from HS, then use tampons instead of sanitary pads as it causes less friction with your skin. Avoid products like detergents or others containing no perfume, enzymes, or dyes.

Safeguard Your Skin

Avoid any action that can injure your skin. So, try not to shave the affected skin. Also, never squeeze or pop out the sores or pimples.

Maintain Healthy Weight

Keep a healthy weight and stay active. Not being at a healthy weight can worsen the symptoms of hidradenitis suppurativa. Try to find activities that don’t irritate your skin.

Make Changes To Your Diet

You have to make changes to your diet when you suffer from acne inversa. Avoid food items triggering inflammation while including foods that can prevent flaring of the condition. The diet ideal for people suffering from HS can follow the diet suggested here.

Avoid Tobacco Products

Using tobacco products is not good for your body. If you smoke, you are compromising the immune system. So, quit smoking as well as other tobacco products as it can worsen the symptoms of HS. Get professional help to quit the bad habits when you find it difficult to avoid such products by yourself.

Coping And Support For Hidradenitis Suppurativa

Do you suffer from acne inversa? Then, apart from the problem, you also have to experience other challenges while living with the problem. You have to brace yourself to deal with pain as well as embarrassment associated with the condition. Due to the painful sores, you cannot sleep properly at night. The condition also affects your mobility and interferes with your sex life. In some people, the sores tend to drain pus, which smells badly even with good care. With such experiences, affected people tend to become self-conscious and become withdrawn. When you feel in such a way for a long time, it affects your mental health, resulting in depression.

How can you deal with it? By getting support from your closed ones and seeking professional assistance. Talk to your friends and family members regarding your condition. It is essential to get the support from your close-knit group to overcome the mental issues triggering due to the condition. You can also connect with online support groups with people experiencing the same problem. It will help you find others understanding of your situation. It offers you comfort. If you are showing signs of depression, then seek assistance from a mental health professional.


While hidradenitis suppurativa is a chronic inflammatory skin disease, you have a better outlook with early diagnosis and effective treatment. The condition occurs due to the inflammation occurring in the hair follicles as well as sweat glands. With proper treatment at the right time, you can manage the pimple-like bumps. Else, these bumps will grow deep into the skin. So, it can result in a painful boil (pockets of pus) or hard lumps. No permanent cure is available for the condition. So, you need constant management for controlling the symptoms. Without treatment, you can suffer from severe pain, discomfort, additional scare, mobility issues, and low self-esteem. It will make your life a living hell. So, take the necessary action to avoid complications.
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