Hidradenitis Suppurativa: Symptoms, Causes, and Treatment Options
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026
Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic skin condition that causes small, painful lumps to form under the skin — most often where skin rubs together, such as the armpits, groin, buttocks, and breasts. It develops when hair follicles become blocked, though why this happens is not fully understood. The lumps heal slowly, tend to recur, and can form tunnels under the skin. Early diagnosis by a dermatologist is key: treatment combines medications (antibiotics, biologics, hormonal therapy, and more) with procedures such as unroofing and laser therapy, supported by daily self-care habits.
Quick Answer
What it is: blocked hair follicles form small, painful lumps — also called acne inversa; usually starts after puberty, before age 40
Where it appears: armpits, groin, buttocks, and breasts
4 signs to watch: blackheads in pairs, painful pea-sized lumps, leaking sores, and tunnels under the skin
Who is at risk: women (3x more likely than men), people in their teens and 20s, Black people, those with a family history, people who smoke or carry excess weight
Not contagious and not caused by infection or poor hygiene
Treatment: antibiotics, steroid injections, hormonal therapy, biologics, retinoids, and pain medicine — plus procedures like unroofing, laser therapy, and surgical removal
See a dermatologist early if painful lumps don't improve in a few weeks, keep returning, or appear in several locations
What Is Hidradenitis Suppurativa?
Hidradenitis suppurativa, also known as acne inversa, is a condition that causes small, painful lumps to form under the skin.
The lumps usually develop in areas where your skin rubs together — such as the armpits, groin, buttocks, and breasts. The lumps heal slowly, recur, and can lead to tunnels under the skin and scarring.
HS tends to start after puberty, usually before age 40. It can persist for many years and worsen over time, affecting daily life and emotional well-being. Combined medical and surgical therapy can help manage the disease and prevent complications.
Women are three times more likely to develop hidradenitis suppurativa than men, though this ratio can differ around the world. Black people are also more likely to develop the disease than people of other races, possibly due to genetic factors.
Hidradenitis Suppurativa Symptoms: 4 Signs to Watch For
HS can affect one or several areas of the body. The signs and symptoms include:
Blackheads: appear in small, pitted areas of skin, often in pairs.
Painful pea-sized lumps: usually starts as a single painful lump under the skin that persists for weeks or months; more bumps form later in sweaty or friction-prone areas.
Leaking bumps or sores: some bumps get bigger, break open, and drain pus with an odor.
Tunnels: form under the skin connecting the lumps; heal slowly, if at all; drain blood and pus.
Some people with HS experience only mild symptoms. The course of the disease is highly variable. Excess weight and smoking are associated with worse symptoms — but people who are thin and don't smoke can also experience severe disease.
When to See a Doctor
Early diagnosis is key to effective treatment. See your dermatologist if your condition:
Is painful
Makes it difficult to move
Doesn't improve in a few weeks
Returns within weeks of treatment
Appears in several locations
Flares often
HS is not just a boil. People with this condition benefit from a healthcare team with medical and surgical dermatologists at the core, with other specialists involved as needed.
What Causes Hidradenitis Suppurativa?
HS develops when hair follicles become blocked — but why this blockage occurs is not known. Experts think it could be connected to hormones, genetic predisposition, cigarette smoking, or excess weight.
Importantly, an infection or being unclean does not cause HS, and it can't be spread to other people.
Risk Factors
Factors that increase your chance of developing hidradenitis suppurativa include:
Age: risk is higher in teens and 20s.
Sex: females more likely than males (about 3x).
Race: occurs most in Black people, possibly due to genetic factors.
Family history: the tendency can be inherited.
Certain conditions: more common and severe in people who are overweight; associated with severe acne, arthritis, diabetes, metabolic syndrome, and inflammatory bowel disease.
Smoking: tobacco smoking has been linked to HS.
Complications of Untreated HS
Persistent and severe hidradenitis suppurativa can cause serious complications:
Infection: secondary infection is possible; pus is common in HS and doesn't necessarily mean infection.
Scars and skin changes: wounds may heal but leave ropelike scars or pitted skin.
Restricted movement: sores and scar tissue limit or painfully restrict movement, especially in armpits or thighs.
Skin cancer: squamous cell carcinoma reported with long-term HS, particularly in the perianal area.
Swelling: scar tissue can interfere with lymph drainage, causing arms, legs, or genitals to swell.
Psychological effects: drainage, odor, and location of sores can cause embarrassment, social isolation, anxiety, or depression.
Lifelong pain: pain that is much worse than diseases such as psoriasis.
How Is Hidradenitis Suppurativa Diagnosed?
HS can be mistaken for pimples or acne, and for many people it takes years to receive a correct diagnosis.
Your healthcare provider will base a diagnosis on your signs and symptoms, skin appearance, and medical history. You might be referred to a dermatologist — a provider who specializes in skin conditions.
No laboratory test is available to diagnose HS. But if pus or drainage is present, your provider might take a sample for lab testing.
Hidradenitis Suppurativa Treatment: What Options Exist?
Treatment with medicines, surgery, or both can help control symptoms and prevent complications. Expect regular follow-up visits with your dermatologist. Some people need a care team spanning multiple medical specialties.
Medications
Antibiotics: topical liquid/gel for mild symptoms; pills (doxycycline, clindamycin, rifampin/rifampicin, or combinations) for widespread disease; severe cases may need months.
Steroid injections: triamcinolone acetonide injected into sores to reduce swelling and inflammation.
Hormonal therapy: estrogen-containing oral contraceptives for mild HS; spironolactone to reduce antibiotic need; isotretinoin sometimes used.
Biologics: injections that alter the immune system and improve symptoms within weeks; adalimumab and infliximab (tumor necrosis factor inhibitors) approved for moderate to severe HS.
Retinoids: oral retinoids for acne-like disease; not recommended during pregnancy, breastfeeding, or if pregnancy is intended.
Pain medicine: stronger prescription pain relievers or pain clinic referral if over-the-counter options don't help.
Surgery and Other Procedures
Surgery is an important part of management when a tunnel, bump, or abscess is present. The right approach depends on extent and severity:
Unroofing (uncovering tunnels): tissue is removed to expose tunnels under the skin; for moderate or severe HS; usually doesn't need repeating.
Punch debridement: limited unroofing; removes a single inflamed bump.
Laser therapy: a carbon dioxide laser makes sores go away; sores unlikely to return; laser hair removal helps early-stage HS.
Surgical removal: all affected skin is removed; a skin graft may be needed; sores might still occur in other areas.
Incision and drainage: no longer considered effective long-term; may provide short-term pain relief, but sores usually flare again.
Lifestyle and Home Remedies
Mild HS can sometimes be effectively controlled with self-care — and self-care complements medical treatment:
Daily skin care routine: gently wash with a non-soap cleanser; an antiseptic wash (chlorhexidine 4% or benzoyl peroxide) starting weekly, up to daily if tolerated; pat dry; avoid washcloths and loofahs on affected areas; don't squeeze sores; avoid shaving or depilatory creams.
Manage pain: a gentle warm compress reduces swelling and eases pain; ask your provider about pain relievers and wound care.
Healthy weight and activity: not being at a healthy weight worsens symptoms; find activities that don't irritate skin.
Consider altering your diet: dairy, red meat, and high glycemic index foods might worsen symptoms; talk to a dietitian about eliminating them.
Quit smoking: stopping smoking can ease symptoms.
Coping and Support
HS can be a challenge to your emotional health and well-being. Painful sores might affect sleep, movement, or sex life. Drainage and odor can cause anxiety, embarrassment, anger, self-consciousness, or depression.
Try to find support among family and friends. The understanding of others with HS can be comforting. Ask for help with mental health and coping strategies — your provider can refer you to a mental health professional or provide support group contacts.
Preparing for Your Appointment
You'll likely first see your primary care provider, then be referred to a dermatologist. Depending on severity, your care might also involve specialists in colorectal surgery, plastic surgery, or gastroenterology.
What you can do — make a list of:
The symptoms you're experiencing, including any that seem unrelated
All medicines, vitamins, and supplements you take, with doses
Questions to ask your provider
Questions worth asking:
What's the most likely cause of my symptoms?
Are there other possible causes?
Do I need any tests?
How long will my condition last?
What treatments are available, and which do you recommend?
What side effects can I expect?
Is this condition related to another medical disorder?
What your provider may ask:
When did your symptoms begin?
What did the lumps look like when they started?
Do they come back in the same spots?
Are your symptoms painful?
Have your parents or siblings ever had this problem?
What seems to improve or worsen your symptoms?
Bottom Line
Hidradenitis suppurativa is a chronic, often painful condition — but it is treatable, and it is never caused by poor hygiene or contagious through contact. The combination of early diagnosis, the right mix of medications and procedures, daily self-care habits, and emotional support gives people with HS the best chance to control symptoms and protect their quality of life.
Your next step: If you have painful lumps that don't improve within a few weeks, keep returning, or appear in multiple locations, don't wait. Schedule an appointment with a dermatologist — early treatment is your best protection against scarring, tunnels, and lifelong pain.
Frequently Asked Questions
What is hidradenitis suppurativa?
Hidradenitis suppurativa (also called acne inversa) is a condition that causes small, painful lumps to form under the skin, usually where skin rubs together — the armpits, groin, buttocks, and breasts. It develops when hair follicles become blocked, and the lumps can heal slowly, recur, and form tunnels under the skin.
What does hidradenitis suppurativa look like?
Early signs include blackheads in small pitted areas (often in pairs), a single painful pea-sized lump that persists for weeks or months, leaking sores that drain pus with an odor, and tunnels under the skin that connect lumps and drain blood and pus.
Is hidradenitis suppurativa contagious?
No. HS cannot be spread to other people, and it is not caused by an infection or by being unclean. It develops when hair follicles become blocked, possibly related to hormones, genetics, smoking, or excess weight.
Who is most at risk for hidradenitis suppurativa?
Women are about three times more likely to develop HS than men. Other risk factors include being in your teens or 20s, being Black (possibly due to genetic factors), having a family history, carrying excess weight, having conditions like severe acne or inflammatory bowel disease, and smoking tobacco.
How is hidradenitis suppurativa treated?
Treatment combines medications — topical or oral antibiotics, steroid injections, hormonal therapy, biologics like adalimumab, retinoids, and pain medicine — with procedures such as unroofing, punch debridement, laser therapy, and surgical removal for severe cases. Self-care habits like gentle skin washing, warm compresses, weight management, diet changes, and quitting smoking support treatment.
Can hidradenitis suppurativa be cured?
HS is a chronic condition that persists for many years and can worsen over time. There is no simple cure, but combined medical and surgical therapy can control symptoms and prevent complications such as scarring, tunnels, restricted movement, and skin cancer.
When should I see a doctor about skin lumps?
See a dermatologist if lumps are painful, make movement difficult, don't improve in a few weeks, return within weeks of treatment, appear in several locations, or flare often. HS is frequently mistaken for acne, so early specialist evaluation matters.
Does hidradenitis suppurativa affect mental health?
Yes. The pain, drainage, odor, and location of sores can cause embarrassment, anxiety, depression, and social isolation, and can affect sleep, movement, and sex life. Support from family, friends, support groups, and mental health professionals is an important part of care.
References
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. This article reflects medical guidance current as of March 21, 2025.
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