Understanding Hidradenitis Suppurativa: What You Need to Know

Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin condition that affects millions of people worldwide — yet it remains widely misunderstood and underdiagnosed. If you or someone you love is living with HS, understanding its risk factors, associated conditions, and treatment options can make a meaningful difference in quality of life.

What Is Hidradenitis Suppurativa?

HS is a condition that causes painful lumps, boils, and abscesses to develop under the skin, typically in areas where skin rubs together — such as the armpits, groin, and under the breasts. Over time and without management, it can progress to involve tunnelling under the skin and significant scarring.

HS is classified in three stages:

Stage One involves recurrent boils without tunnelling or scarring.

Stage Two is characterised by boils with minor tunnelling and scarring.

Stage Three is the most severe, involving major tunnelling and widespread scarring. Because treatment approaches differ depending on the stage, early diagnosis is key.

Who Is at Risk?

Several factors are associated with an increased likelihood of developing HS or experiencing more severe symptoms.

Cigarette smoking is one of the most well-established risk factors, and quitting is often one of the first lifestyle recommendations made to patients. African ethnicity is also associated with higher rates of diagnosis, suggesting both genetic and potentially environmental components to the condition.

HS is also closely linked to follicular occlusion syndrome — a group of conditions that includes acne conglobata, dissecting cellulitis of the scalp, and pilonidal sinus. People with these conditions may be at greater risk of developing HS or may experience them concurrently.

The Connection Between HS and Other Health Conditions

One of the most important things to understand about HS is that it rarely exists in isolation. It is associated with a range of comorbidities, meaning other health conditions that frequently occur alongside it. These include hypertension, diabetes mellitus, dyslipidaemia, thyroid disorders, arthropathies, polycystic ovary syndrome (PCOS), and adverse cardiovascular outcomes.

The relationship between HS and inflammatory bowel disease — particularly Crohn's disease — is especially well-documented. This gut-skin connection is an important area of focus both for diagnosis and for holistic management of the condition. Other skin disorders such as psoriasis, acne, and hirsutism also commonly co-occur with HS, which can sometimes complicate diagnosis.

Certain medications have also been identified as potential triggers, including lithium, sirolimus, and some biologics. If you are taking any of these and notice new or worsening skin symptoms, it is worth discussing this with your healthcare provider.

Treatment and Management Options

Treatment for HS is highly individual and depends on which stage the condition has reached. There is no one-size-fits-all approach, but a number of interventions have shown promise.

Zinc supplementation  for three months has been used as part of HS management, alongside topical zinc in soaps and washes. Zinc's anti-inflammatory properties make it a useful adjunct therapy for some patients.

Gut health is another area gaining attention in HS management. Given the established link between HS and inflammatory bowel disease, supporting digestive health through diet, probiotics, and lifestyle changes may be beneficial for some individuals.

IPL (Intense Pulsed Light) therapy, sometimes referred to as laser hair removal, has also been used on affected areas. By targeting hair follicles — which play a central role in HS lesion development — IPL may help reduce the frequency and severity of flare-ups.

For more severe cases, medical and surgical interventions may be required, and ongoing management with a specialist dermatologist is strongly recommended.

Living with HS

HS can have a profound impact on physical comfort, emotional wellbeing, and daily life. If you are struggling with symptoms, know that you are not alone — and that effective management is possible with the right support.

We encourage you to speak openly with your healthcare provider about your symptoms, risk factors, and the full range of treatment options available to you.

In health & happiness,

Kirsty

Reference: Bhukhan A, Lio P. Hidradenitis Suppurativa: Seeking More Pieces to the Puzzle. Practical Dermatology. 2022 February; 54–62.