Hidradenitis Suppurativa (HS): Causes, Treatment Options and How to Prevent Flare-Ups
By Dr Lim Tzyy Huei (林子辉医生) Consultant Dermatologist | Pantai Hospital Batu Pahat, Johor, Malaysia
Do you frequently develop painful lumps, boils or abscesses around your armpits, groin, buttocks or inner thighs?
If these painful swellings repeatedly return to the same areas, you may have a chronic inflammatory skin condition called Hidradenitis Suppurativa (HS).
HS is often mistaken for ordinary boils or bacterial infections. However, it is a long-term inflammatory condition involving hair follicles and surrounding skin.
Early diagnosis and appropriate treatment can help reduce flare-ups, pain and permanent scarring.
Living with Hidradenitis Suppurativa
Living with HS can be physically and emotionally challenging. Recurrent painful lumps, discomfort and scarring may affect daily activities, sleep, confidence and social interactions.
For some patients, even after the skin has improved, the worry of another painful flare-up can remain.
If you are living with HS, remember that you are not alone. With appropriate treatment and ongoing care, many patients can achieve better disease control and regain confidence in their daily lives.
1. What Causes Hidradenitis Suppurativa?
HS develops when hair follicles become blocked and inflamed, leading to painful lumps, abscesses and sometimes tunnels beneath the skin.
Common contributing factors include:
Genetic predisposition: HS may run in families.
Smoking: Associated with HS and may worsen disease activity.
Excess body weight: Skin friction and sweating may aggravate symptoms.
Hormonal influences: Some patients experience flare-ups around menstruation.
Heat, sweating and friction: These may worsen irritation in affected areas.
Importantly, HS is not caused by poor hygiene and is not contagious.
2. What Are the Symptoms of HS?
Common symptoms include:
Recurrent painful lumps or boils.
Swellings that discharge pus or blood.
Repeated inflammation in the armpits, groin, buttocks or inner thighs.
Persistent wounds or tunnels beneath the skin.
Scarring after repeated episodes.
Without appropriate treatment, some patients may develop extensive scarring and chronic draining wounds.
3. What Are the Treatment Options?
Treatment depends on the severity, frequency of flare-ups and extent of skin involvement.
Mild HS
Topical antibiotics such as clindamycin.
Antiseptic washes when appropriate.
Treatment for individual painful inflamed lumps.
Measures to minimise friction and irritation.
Moderate HS
Oral antibiotics such as doxycycline.
Combination antibiotic treatments when indicated.
Hormonal treatment for selected patients.
Procedures for persistent or recurrent lesions.
Moderate-to-Severe HS
Patients with frequent painful abscesses, draining tunnels or significant scarring may require more advanced treatment.
Options include:
Biologic injections: Such as adalimumab, secukinumab or bimekizumab, which target specific inflammatory pathways.
Surgical procedures: Deroofing or excision of persistent tunnels and recurrent lesions.
Combination treatment: Medication and procedures may be used together for better disease control.
Treatment is individualised, and not every patient requires biologic injections or surgery.
4. How to Reduce HS Flare-Ups
Although HS cannot always be permanently cured, good daily care can help reduce irritation and support treatment.
Recommended measures include:
Wear loose, breathable clothing to reduce friction.
Avoid squeezing or picking painful lumps.
Keep affected areas clean and gently dry.
Stop smoking if applicable.
Maintain a healthy weight where appropriate.
Avoid close shaving or hair-removal methods that irritate affected skin.
Seek early treatment when new painful lumps develop.
For painful flare-ups, a warm compress may provide temporary relief.
Lifestyle measures are helpful, but medical treatment is often necessary to control the underlying inflammation.
5. Can Hidradenitis Suppurativa Come Back?
Yes. HS is a chronic inflammatory condition that may recur even after successful treatment.
Some patients experience occasional mild flare-ups, while others develop frequent painful lumps, persistent wounds or scarring.
Although existing treatments can help control inflammation and reduce flare-ups, managing HS can sometimes be challenging, particularly in patients with moderate-to-severe disease.
Fortunately, advances in dermatology research have led to the development of newer treatments, including biologic therapies that target specific inflammatory pathways.
Ongoing Research and New Treatment Developments
As our understanding of HS continues to improve, international clinical studies are exploring additional treatment options to achieve better and longer-lasting disease control.
As part of my involvement in dermatology research, I attended an international Hidradenitis Suppurativa Investigator Meeting in Tokyo, Japan, serving as a Principal Investigator in a multicentre clinical study.
The meeting brought together dermatology investigators from different countries to discuss ongoing clinical research, patient safety and potential new treatment approaches for HS.
These research efforts are important because HS can significantly affect patients' physical comfort, emotional well-being and quality of life.
For patients living with recurrent HS, continued medical advances offer hope for more effective long-term treatment options.
You can read more about my involvement in HS research here:
6. When Should You See a Dermatologist?
Consider consulting a dermatologist if:
Painful boils repeatedly appear in the same areas.
Swellings frequently discharge pus.
Scars or persistent wounds develop.
Repeated antibiotic treatments provide only temporary relief.
Symptoms affect walking, sitting, sleep or daily activities.
Early diagnosis and appropriate treatment may help prevent disease progression and permanent scarring.
Conclusion: Living Better with HS
Hidradenitis suppurativa is more than just recurrent boils. It is a chronic inflammatory skin condition that can affect both physical comfort and emotional well-being.
Although HS may recur, advances in treatment and ongoing clinical research continue to improve the options available to patients.
With appropriate medication, lifestyle measures and regular follow-up, many patients can achieve better disease control, fewer flare-ups and improved quality of life.
Early diagnosis, individualised treatment and long-term care are key to managing HS effectively.
About the Author
Dr Lim Tzyy Huei (林子辉医生) is a Consultant Dermatologist at Pantai Hospital Batu Pahat, Johor, Malaysia.
His clinical practice includes the management of eczema, psoriasis, hidradenitis suppurativa, acne and other inflammatory skin conditions.
He is also involved in international dermatology clinical research, including studies exploring potential treatment options for hidradenitis suppurativa.
This article is intended for general patient education and does not replace individual medical consultation.
