What Is HS?
Hidradenitis suppurativa is a chronic inflammatory skin condition that causes painful bumps, abscesses, and sometimes tunnels under the skin. It is not an infection and is not related to poor hygiene or staph bacteria. HS is not contagious and cannot be spread to others.
What Causes HS?
HS develops due to a combination of factors:
- Apocrine sweat gland occlusion and rupture. Genetic factors affect the strength of the sweat gland coil where it enters the hair follicle, causing blockages.
- Unnecessary inflammatory response. Genetic factors cause your immune system to overreact to these blockages.
- Worsening factors include:
- Nicotine (smoking, vaping, pouches, nicotine gum/patches): nicotine receptors in the skin worsen inflammation.
- Friction from clothing or skin rubbing together (worsened with excess weight).
- Normal skin bacteria overgrowth.
- Metabolic issues like insulin resistance.
- Hormonal conditions like polycystic ovary syndrome (PCOS).
- Altered skin microbiome (the balance of bacteria on your skin).
The condition is influenced by hormones, which is why it typically begins after puberty. While excess weight can worsen symptoms through increased friction, many patients with HS are not overweight at all.
Where Does HS Occur?
HS develops in hormone-dependent areas of the body, including:
- Armpits
- Under the breasts
- Groin
- Buttocks
- Inner thighs
Can HS Be Cured?
Unfortunately, HS is not curable. However, there are many treatments that can help control symptoms and reduce flares.
Treatment Options
- Antimicrobial wash (to alter the skin microbiome), over-the-counter:
- Hibiclens® (chlorhexidine)
- Benzoyl peroxide washes
- CLN® body wash
- Topical treatments:
- Clindamycin: must be used with an antimicrobial wash to prevent antibiotic resistance.
- Resorcinol: a spot-treatment cream that requires compounding by a pharmacy.
- Injectable treatments:
- Intralesional steroids: injected directly into affected areas during flares.
- Oral antibiotics:
- Can be helpful, but must be taken for months.
- Usually combination antibiotics.
- May alter your gut microbiome and have other potential side effects.
- Metformin:
- An oral medication typically used for diabetes and PCOS.
- Has anti-inflammatory effects that can help HS.
- Particularly helpful for patients with metabolic syndrome or insulin resistance.
- Generally well-tolerated with minimal side effects.
- Biologic medications (FDA-approved):
- Adalimumab (Humira®)
- Secukinumab (Cosentyx®)
- Bimekizumab (Bimzelyx®)
Important Things to Remember About Treatment
Be patient and realistic:
- No single treatment works for everyone. HS is complex, and it takes time to find the right treatment plan.
- All treatments take 3–6 months to show improvement. Don’t give up on a treatment unless you have intolerable side effects.
- Treatment rarely achieves complete remission. The goal is to control symptoms and reduce flares.
Help us help you:
- Keep a treatment log. Write down everything you’ve tried and what happened. This makes it much easier to figure out what to try next.
- Tell us how HS impacts your quality of life. Insurance companies deny expensive medications routinely. To get approval, we need specific details:
- Are you missing work?
- How does the pain affect your daily activities?
- How does drainage and odor impact your life?
- Be clear about your comfort level with medications. It’s completely okay to be hesitant about side effects, but please let us know before we spend hours getting a medication approved. We need to work together to find treatments you’re willing to try.
- Have a flare plan. Work with us to establish what helps during flares so we can make sure you have what you need.
Have questions about HS, or want me to take a look? You can book online or call the office at 423-528-8833. This page is for general education, not a substitute for a personal exam.