Hidradenitis Suppurativa: Why It's Not Just Boils and What Dermatologists Do for Recurring Flares

Hidradenitis suppurativa (HS) is a chronic skin condition that affects about 1–4% of people worldwide. Unlike an occasional boil, HS causes painful, recurring nodules and tunnels in areas where skin rubs together, such as underarms, groin, buttocks and under the breasts. Left untreated, it can lead to scarring, chronic pain and significant impact on daily life. Here's what you need to know—and what dermatologists can do to help.

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What Is Hidradenitis Suppurativa?

• Chronic inflammatory disorder of the hair follicles and apocrine (sweat) glands
• Develops as painful, deep-seated nodules that can break open, leak pus and form connecting tunnels (sinus tracts)
• Often misdiagnosed as simple boils or infections—HS is progressive and may worsen without proper care

Key points:

• Onset typically in late teens to early 30s
• More common in women than men
• Can run in families, suggesting a genetic component

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Risk Factors and Triggers

While the exact cause is unclear, several factors increase HS risk:

• Genetics: About one-third of people with HS have a family history
• Smoking: Strongly linked to more severe disease
• Obesity: Extra skin friction and inflammation worsen symptoms
• Hormones: Flares often begin around puberty and may worsen before menstruation
• Mechanical irritation: Tight clothing and skin rubbing can trigger new lesions

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Symptoms You Might Notice

HS often presents in stages, but common signs include:

• Deep, painful nodules under the skin
• Recurrent abscesses that ooze blood-stained or foul-smelling fluid
• "Tunnels" or sinus tracts connecting lesions beneath the skin
• Scars, thickened skin and darkened areas after healing
• Itching or burning before nodules form

Because HS can look like acne or infected hair follicles, people often delay seeking help. If you've had recurring boils in the same area for months, it's time to take action—use this free Hidradenitis Suppurativa symptom checker to understand what you're experiencing and whether you should see a specialist.

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Why It's Not Just Boils

• Chronicity: Boils (furuncles) often heal completely; HS nodules tend to recur in the same zones.
• Tunneling: Unlike single boils, HS can form interconnected sinus tracts under your skin, leading to persistent drainage and scarring.
• Progression: Without intervention, lesions can worsen, merge into large "horseshoe" patterns and cause extensive tissue damage.
• Quality of life: HS pain, odor and drainage can interfere with work, social life and mental health—far beyond a simple skin infection.

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How Dermatologists Manage Recurring Flares

A dermatologist tailors HS treatment based on disease severity (Hurley stage), patient preferences and overall health. Common approaches include:

1. Topical and Intralesional Therapies

• Topical clindamycin: Applied twice daily to early, mild lesions to reduce surface bacteria and inflammation
• Intralesional corticosteroids (e.g., triamcinolone): Injected directly into nodules to decrease size and pain

2. Oral Antibiotics

• Tetracycline antibiotics (doxycycline, minocycline) for anti-inflammatory effects
• Combination therapy: Clindamycin plus rifampin for moderate to severe HS; helps reduce bacterial load and inflammation

3. Hormonal Treatments

• Oral contraceptives: May help in women whose flares link to menstrual cycles
• Spironolactone: Anti-androgen therapy can reduce oil gland activity and improve lesions

4. Biologic Medications

• Adalimumab (Humira): The first FDA-approved biologic for HS; blocks TNF-alpha, a key inflammatory molecule
• Other TNF inhibitors (infliximab) or IL-17 blockers under study or used off-label

5. Surgical and Procedural Options

• Incision and drainage: Offers short-term relief for painful abscesses but has high recurrence if used alone
• Deroofing: Surgeon removes the top of the tunnel, leaving healthy skin to heal; good for limited areas
• Wide excision: Removing all affected skin down to healthy tissue; best for extensive, recurrent disease but requires more recovery time
• Laser therapy (Nd:YAG): Destroys hair follicles and reduces new lesion formation; may decrease inflammation

6. Pain and Symptom Management

• Analgesics: NSAIDs or short-term opioids for severe pain
• Antiseptic washes: Chlorhexidine or benzoyl peroxide to reduce bacteria on the skin surface
• Dressings: Non-adhesive, moisture-wicking dressings to manage drainage and prevent friction

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Lifestyle Tips and Support

While medical treatments are key, these steps can help reduce flares and improve comfort:

• Weight management: Even a modest weight loss can decrease inflammation and friction
• Smoking cessation: Quitting can significantly improve treatment outcomes
• Loose, breathable clothing: Minimizes skin rubbing and moisture buildup
• Warm compresses: Eases pain and fluid drainage from early lesions
• Nutrition: Anti-inflammatory diet rich in fruits, vegetables and whole grains; consider working with a dietitian
• Support networks: HS support groups (online or local) can reduce isolation and stress

Mental health matters: HS can contribute to anxiety, depression and social withdrawal. Talking to a counselor or joining peer support can be as important as medical care.

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When to Seek Medical Help

HS can, at times, lead to serious complications. Contact a healthcare professional or go to the emergency department if you experience:

• High fever, chills or rapid heartbeat (signs of systemic infection)
• Severe pain not controlled by prescribed medication
• Rapid swelling or redness spreading beyond the lesion site
• Any symptoms that feel life-threatening

For non-urgent concerns—like recurrent nodules that don't improve with over-the-counter care—schedule an appointment with a dermatologist. If you're unsure whether your symptoms could be Hidradenitis Suppurativa, this free AI-powered assessment can help you identify key patterns and guide your next steps toward getting proper care.

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Take-Home Message
Hidradenitis suppurativa is much more than occasional boils. It's a chronic, often painful condition that requires a comprehensive approach: medical treatment, lifestyle adjustments and emotional support. Early diagnosis and a customized treatment plan from a dermatologist can control flares, minimize scarring and improve quality of life. Always speak to your doctor about any concerning or life-threatening symptoms. Together, you can develop a management plan that addresses both the physical and emotional impact of HS.