Painful Bumps? Why Hidradenitis Suppurativa Flares & Medically Approved Next Steps

Painful, deep bumps in areas like the armpits, groin, buttocks, or under the breasts can be more than just "bad acne." If these lumps keep coming back, drain, or leave scars, hidradenitis suppurativa (HS) may be the cause.

Hidradenitis suppurativa is a chronic (long-term) inflammatory skin condition. It is not contagious, and it is not caused by poor hygiene. However, it can be painful, frustrating, and emotionally draining. The good news? Early recognition and medical care can significantly reduce flares and long-term skin damage.

Below, we'll break down why hidradenitis suppurativa flares happen and what medically approved steps you can take next.

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What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa is a chronic inflammatory disease that affects hair follicles in areas where skin rubs together. Common locations include:

• Armpits
• Groin
• Inner thighs
• Buttocks
• Under the breasts
• Around the genitals

It typically starts after puberty and is more common in women, though anyone can develop it.

Common Symptoms of Hidradenitis Suppurativa

• Painful, deep lumps under the skin
• Recurrent boils or abscesses
• Drainage of pus with odor
• Tunnels under the skin (called sinus tracts)
• Scarring or thickened skin
• Skin that feels warm and tender

Symptoms often come and go in cycles, known as flares.

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Why Does Hidradenitis Suppurativa Flare?

HS flares happen when hair follicles become blocked and inflamed. The exact cause is not fully understood, but experts believe several factors play a role.

1. Immune System Overactivity

Hidradenitis suppurativa is considered an inflammatory disease. The immune system becomes overactive in affected areas, leading to swelling, pain, and tissue damage.

2. Hormonal Changes

Hormones can influence flares. Many people notice worsening symptoms:

• Before menstrual periods
• During times of hormonal shifts
• In early adulthood

This is one reason HS often begins after puberty.

3. Friction and Skin Irritation

Tight clothing, shaving, sweating, and skin rubbing against skin can trigger flare-ups in sensitive areas.

4. Smoking

Smoking is strongly linked to hidradenitis suppurativa. It may increase inflammation and make symptoms worse.

5. Obesity and Metabolic Factors

Excess weight increases skin friction and systemic inflammation, both of which can worsen HS. However, it's important to understand that HS occurs in people of all body types.

6. Genetics

HS can run in families. About one-third of people with hidradenitis suppurativa report a family history of the condition.

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Is It Just Acne?

Many people mistake hidradenitis suppurativa for acne, ingrown hairs, or simple boils. The key differences:

• HS bumps are deeper and more painful.
• They occur in skin-fold areas rather than the face or upper back.
• They tend to recur in the same spots.
• They may form tunnels and scars over time.

If you're experiencing these symptoms and want clarity before your doctor visit, try this free Hidradenitis Suppurativa symptom checker to help you understand what might be causing your painful bumps.

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Medically Approved Next Steps

Hidradenitis suppurativa is a medical condition that usually requires professional care. Early treatment can reduce pain, prevent complications, and limit scarring.

1. See a Doctor Early

If you have recurring painful bumps in typical HS areas, speak to a primary care physician or dermatologist. Early-stage HS is easier to treat than advanced disease.

Seek urgent care if you experience:

• High fever
• Rapidly spreading redness
• Severe pain
• Signs of widespread infection

These can be serious and require immediate medical attention.

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2. Prescription Medications

Treatment depends on severity. Options may include:

Topical Treatments

• Prescription antibiotic creams (like clindamycin) for mild disease

Oral Antibiotics

• Used to reduce inflammation and control infection
• Often prescribed for weeks to months

Hormonal Therapy

• Birth control pills or anti-androgen medications in some women

Biologic Medications

• For moderate to severe hidradenitis suppurativa
• Target specific parts of the immune system
• Given as injections
• Can significantly reduce flares and new lesion formation

Biologics are often considered when other treatments fail.

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3. In-Office Procedures

For painful or advanced lesions, doctors may recommend:

• Steroid injections into inflamed nodules
• Incision and drainage for painful abscesses (short-term relief)
• Laser treatments to reduce hair follicles
• Surgical removal of affected areas in severe cases

Surgery may offer long-term relief in areas with repeated scarring and tunneling.

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4. Lifestyle Adjustments That May Reduce Flares

While lifestyle changes alone won't cure hidradenitis suppurativa, they can support medical treatment.

Consider:

• Wearing loose, breathable clothing
• Avoiding shaving over affected areas
• Using gentle, fragrance-free cleansers
• Quitting smoking (if applicable)
• Working toward gradual, sustainable weight management if advised by a doctor

Even small changes can help reduce friction and inflammation.

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What Happens If HS Is Not Treated?

Hidradenitis suppurativa is not life-threatening in most cases, but untreated disease can lead to:

• Chronic pain
• Extensive scarring
• Skin thickening
• Sinus tract formation
• Limited movement in severe cases
• Emotional distress, depression, or anxiety

Rarely, long-standing severe HS can increase the risk of certain skin cancers in affected areas.

This is why early diagnosis and consistent care matter.

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Emotional Impact Is Real

Living with hidradenitis suppurativa can affect more than your skin. Pain, drainage, odor, and visible scarring can lead to embarrassment or isolation.

If HS is affecting your mental health, tell your doctor. Support groups, counseling, and medical treatment adjustments can help. You are not alone—and the condition is more common than many people realize.

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When to Speak to a Doctor Immediately

While most HS flares are not emergencies, seek urgent medical care if you experience:

• Fever with worsening skin pain
• Rapid swelling
• Spreading redness
• Severe drainage with systemic symptoms
• Signs of sepsis (confusion, fast heart rate, weakness)

If anything feels severe or life-threatening, do not wait. Speak to a doctor immediately or go to emergency care.

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The Bottom Line

Hidradenitis suppurativa is a chronic inflammatory skin condition that causes painful, recurring bumps in areas where skin rubs together. It is not caused by poor hygiene, and it is not contagious. Flares happen due to immune system activity, hormones, friction, smoking, genetics, and other inflammatory triggers.

The most important next steps are:

• Recognize recurring symptoms
• Avoid dismissing them as simple acne
• Seek early medical care
• Follow a consistent treatment plan
• Address lifestyle factors where possible

If your symptoms match what you've read here and you want to better understand your condition, use this free Hidradenitis Suppurativa symptom checker to get personalized insights before seeing your healthcare provider.

Most importantly, speak to a doctor about persistent, painful, or worsening skin problems—especially if symptoms are severe or could be serious. Early treatment can reduce pain, prevent long-term damage, and help you regain control over your health.

You deserve answers, relief, and proper care.