Hidradenitis suppurativa (HS) is a chronic skin condition characterised by painful nodules, abscesses and scarring.
It usually occurs in areas where skin rubs together and creates friction.
Despite being frequently overlooked, recent research shows that HS affects around one in 100 people worldwide, making it far more common than many realise.
The exact cause of HS is not fully understood, but several factors and traits can make someone more prone to developing the condition.
These include:
- Genetics – Approximately one-third of people with HS have a close relative who also has the condition.
- Hormonal factors – HS often begins after puberty.
Some women also report flare-ups in relation to their menstrual cycles.
- Obesity – Being overweight is associated with HS due to increased friction and sweating in skin folds, as well as systemic inflammation.
- Smoking – Tobacco use is strongly linked to HS due to its effects on the immune system and skin inflammation.
- Age and gender – HS typically starts in early adulthood and is more common in women than in men.
- Ethnicity – Some studies suggest that HS may be more common in certain ethnic groups, though more research is needed to confirm these findings.
- Immune system dysregulation – HS is considered an autoinflammatory condition, and dysregulation of the immune system may contribute to its development.
Having one or more of these risk factors does not necessarily mean someone will develop HS, and people without these risk factors can still develop the condition.
Signs and symptoms
Early signs of HS include recurring boils, lumps, nodules or abscesses that develop in oil-producing areas of the body.
These commonly appear in places such as the armpits, under the breasts, the groin or pubic area, and between the buttocks.
You should seek medical attention when you have:
- Persistent symptoms – If the lumps or nodules do not heal, recur frequently or cause significant discomfort.
- Signs of infection – If you notice redness, warmth, swelling, or pus drainage, which could indicate an infection.
- Pain – When you experience severe discomfort that interferes with daily activities.
- Scarring and tunnelling – If you notice scars or sinus tracts (tunnels under the skin) that may connect multiple lesions.
- Emotional or psychological effects – If the condition negatively affects your mental health.
If left untreated, HS can lead to permanent scarring and thickened skin.
Painful sinus tracts may form beneath the skin, sometimes connecting multiple lesions and increasing the risk of infection, which may require antibiotics or surgery.
Ongoing inflammation and scarring can also limit movement and significantly affect emotional well-being.
In rare cases, HS has been linked to serious complications such as fistulas and an increased risk of squamous cell carcinoma in affected areas.
Starting treatment
HS does not go away on its own, so a person should start treatment as soon as they notice boils on their skin that frequently come and go.
This is the best time to prevent scarring.
Practise habits like maintaining a healthy body weight and quit smoking to help manage or reduce flare-ups.
Wearing loose-fitting clothing can minimise skin friction, while gently cleansing the affected areas with an antiseptic two to three times a day may help reduce bacteria infection.
Limiting exposure to hot, humid environments can also keep symptoms under control.
Currently-available treatments to manage HS over the long term are:
- Topical treatments – Antibiotic creams or washes can help reduce mild inflammation and bacterial growth.
- Oral antibiotics – Long-term use can help manage inflammation and prevent infections.
- Hormonal treatments – Women can consume oral contraceptives or anti-androgens (e.g. spironolactone), which may help regulate hormonal influences.
- Biologic inhibitors – Some are approved for moderate to severe HS, and can be effective in reducing symptoms and preventing flare-ups.
- Immunosuppressants – These may be used in severe cases to reduce immune system activity.
- Oral or injected corticosteroids – Short courses of these drugs can reduce inflammation during flare-ups.
- Incision and drainage – This provides temporary relief for painful abscesses, but is not a long-term solution.
- Laser treatments – Laser hair removal or other treatments can reduce lesions and hair growth in affected areas.
- Surgical removal – In severe cases, removing affected skin areas may be necessary.
Wide excision can be effective in preventing recurrence in the treated area.
- Deroofing – This procedure involves removing the top layer of skin over tunnels and abscesses to promote healing.
The effectiveness of these treatments varies and a combination approach is often necessary for optimal management.
Long-term management focuses on reducing the frequency and severity of flare-ups, minimising scarring, and maintaining the patient’s quality of life.
Regular follow-up with a dermatologist is essential to monitor the condition and adjust treatment as needed.
Dr Darshni Chandrasakaranpillay is a consultant dermatologist. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
