Hidradenitis Suppurativa – Symptoms and Causes

ByJanis Updated

Overview

Hidradenitis suppurativa is a skin condition characterized by painful lumps forming beneath the skin’s surface. These lumps typically develop in areas where skin friction occurs, such as the armpits, groin, buttocks, and breasts.

The condition follows a pattern of slow healing, recurrence, and potential complications, including tunneling beneath the skin and scarring.

The condition usually begins after puberty and before age 40, often continuing for many years with progressively worsening.

Women have approximately three times the risk of men, though this ratio varies geographically. Black individuals show higher susceptibility compared to other racial groups, possibly due to genetic factors.

Hidradenitis suppurativa can significantly impact both physical comfort and emotional health. The condition needs ongoing management, but a combination of medical and surgical treatments can effectively control symptoms and prevent complications.

The condition is sometimes referred to as acne inversa, though the two terms describe the same disorder.

Signs and Common Problems

Hidradenitis suppurativa can show up in one or many body areas. People with this skin condition may notice:

  • Double blackheads – Small, pitted areas of skin often appearing in pairs.
  • Painful lumps – Usually begins with a single, painful bump under the skin that stays for weeks or months.
  • Leaking sores – Some bumps grow larger, break open, and leak pus with an unpleasant smell.
  • Skin tunnels – Over time, channels may form under the skin connecting the lumps, which heal slowly and leak blood and pus.

The condition often affects areas with more sweat and oil glands, or where skin rubs together, such as:

  • Armpits
  • Groin
  • Buttocks
  • Breasts

Symptoms range widely from person to person. Being overweight and smoking can make symptoms worse, but even thin non-smokers can develop severe cases.

When to Contact a Healthcare Provider

Getting an early diagnosis helps treatment work better. Talk to a skin doctor if your condition:

  • Causes pain
  • Limits your movement
  • Doesn’t get better within a few weeks
  • Comes back shortly after treatment
  • Appears in multiple places
  • Flares up often

This condition is more than just a simple boil. Many patients also have related health problems. Treatment works best with a team approach, led by skin specialists who can create a personalized care plan.

Causes

Scientists don’t fully understand why hidradenitis suppurativa occurs. The condition begins when hair follicles become blocked, but the exact reason for this blockage remains unknown.

Several factors may contribute to its development:

  • Hormonal factors: Changes or imbalances in hormones.
  • Genetic factors: Family history of the condition.
  • Lifestyle factors:
    • Smoking cigarettes
    • Having excess body weight

It’s important to know that hidradenitis suppurativa is not caused by poor hygiene or an infection. The condition cannot be transmitted from person to person, so it is not contagious.

Risk Factors

Several factors may raise your chances of getting hidradenitis suppurativa:

  • Age: Teens and young adults in their 20s face a higher risk.
  • Gender: Women develop this condition more often than men.
  • Ethnicity: Black individuals have higher rates, possibly due to genetic factors.
  • Genetics: The condition can run in families.
  • Health conditions: Being overweight increases risk and severity; connections exist with:
    • Severe acne
    • Arthritis
    • Diabetes
    • Metabolic syndrome
    • Inflammatory bowel disease
  • Tobacco use: Smoking links to higher rates of this skin condition.

Complications

Ongoing and acute hidradenitis suppurativa can lead to several serious complications:

Physical Complications

  • Secondary infection – Pus is normal with this condition, but actual infections can also develop in affected areas.
  • Scarring – Healing often results in rope-like scars or pitted skin texture.
  • Mobility issues – Sores and scar tissue can make movement painful or limited, especially when located in armpits or thighs.
  • Cancer risk – Long-term cases, especially in the perianal region, have been linked to squamous cell carcinoma.

Systemic Complications

  • Lymphatic problems – Scar tissue can block lymph drainage, causing swelling in arms, legs, or genital areas.
  • Chronic pain – The pain from this condition is typically more severe than other skin diseases.

Psychological Impact

  • Embarrassment from visible sores, drainage, and odor
  • Social withdrawal and isolation
  • Higher rates of anxiety and depression
  • Reduced quality of life

The combined physical and emotional toll of hidradenitis suppurativa can be significant. The visible nature of symptoms, along with pain and discomfort, often affects daily activities and social interactions.

Health Writer

Janis's areas of expertise include nutrition, exercise, stress management, and mental health. She is passionate about educating and empowering people to take control of their health and make positive changes that can last a lifetime. Janis believes that small, sustainable changes are the key to long-term success, and she works with her clients to develop personalized plans that fit their individual needs and lifestyles.