Understanding Hidradenitis Suppurativa: A Deep Dive into a Chronic Skin Condition

Hidradenitis Suppurativa, also known as acne inversa, HS (for short) is a chronic inflammatory skin condition that affects millions of people worldwide. And yet, many people have never heard of it. For those who live with HS, it can feel frustrating, isolating, and exhausting physically, emotionally, socially, and even financially.

In this post, we’ll explore what HS is, how it shows up in the body, what might trigger it, and how you can begin to manage it. Whether you’re newly diagnosed, searching for answers, or supporting someone with HS, this is a place to start.

What Is Hidradenitis Suppurativa?

Hidradenitis Suppurativa is a chronic inflammatory condition that causes painful, recurring boil like lumps under the skin. These bumps often appear in areas where sweat glands and hair follicles are most active, think armpits, groin, under the breasts, buttocks, and inner thighs.

The lumps can start as small, pimple-like pus filled and develop into abscesses that burst, drain fluid or pus, and leave behind scarring. In more severe cases, tunnels (known as sinus tracts) form under the skin, connecting multiple lesions and causing extensive tissue damage.

Despite how it looks or smells, HS is not caused by poor hygiene and is not contagious. It's an inflammatory condition involving the immune system, hair follicles, and skin barrier.

What Does HS Feel Like?

The experience of HS varies, but here are common symptoms:

• Painful lumps or boils: Tender, deep bumps that may last for weeks.
• Abscesses that leak fluid: Pus-filled lesions that often rupture and drain.
• Tunnels beneath the skin: Known as sinus tracts, which can worsen over time.
• Scarring and thickened skin: Especially in areas of repeated flare-ups.
• Itching or burning: Skin may feel irritated or hot even before a flare appears.

This condition doesn’t just affect the skin. It can impact self-esteem, intimacy, daily movement, clothing choices, and mental health.

The Hurley Stages of HS

HS severity is often categorized using the Hurley staging system:

• Stage 1: Isolated abscesses, no tunnels or major scarring
• Stage 2: Recurrent abscesses with sinus tracts and visible scarring
• Stage 3: Extensive, interconnected abscesses and tunneling with widespread scarring

You can be in different stages on different parts of your body. For example, you might be at Stage 1 in your underarms and Stage 2 or 3 in the groin.

There are also in-between stages, where your symptoms are more intense than Stage 1 but don’t fully meet the criteria for Stage 2.

What Causes HS?

The exact cause of HS is still unknown. But one common explanation is this: in acne, the pore ruptures and debris is pushed out. In HS, the pore stays clogged, and the immune system responds aggressively, triggering a cascade of inflammation under the skin.

That immune response is what leads to redness, swelling, and pain. Genetics, hormones, lifestyle, and immune dysfunction are all thought to play a role.

Factors that may increase your risk include:

• A family history of HS
• Hormonal changes (like during puberty or menstrual cycles)
• Smoking
• Carrying extra weight, especially in areas where skin rubs together—doesn’t cause HS, but it can make managing symptoms more difficult by increasing friction, moisture, and inflammation.
• Immune system issues

Common Triggers (and Why They Vary So Much)

HS triggers are personal and unique. What sets off a flare for one person might not affect someone else at all. Still, some common triggers include:

• Friction (from exercise, sitting, or certain clothing)
• Fabric type and fit (some prefer loose cotton; others find tighter options help reduce rubbing)
• Bras and underwear
• Certain foods and drinks (like dairy, gluten, sugar, nightshades, alcohol)
• Stress (huge for many)
• Hormonal shifts
• Heat and sweat

It can take time (and patience) to identify your triggers. And yes, trying to figure them out can be a trigger in itself, so be gentle with yourself during that process.

Getting a Diagnosis and Exploring Treatment

Because HS can look like boils, infected ingrown hairs, or cystic acne, it often takes years for people to get an accurate diagnosis. A knowledgeable dermatologist will usually recognize HS by examining your skin and asking about your symptoms. In some cases, they might take a skin biopsy to rule out other conditions.

While there’s no cure (yet), remission is possible, and there are treatment options that can reduce symptoms and help prevent flares:

• Topical treatments: Steroid creams or antibiotic gels can reduce inflammation.
• Oral antibiotics: These can help calm bacterial overgrowth and reduce immune flare-ups.
• Biologics: Injections like adalimumab (Humira) target the immune system to reduce inflammation.
• Surgery: May be needed to drain abscesses or remove damaged skin in more severe cases.

Holistic Healing

Many people also turn to holistic healing to support their body from the inside out. Here are a few to consider:

• Anti-inflammatory diets: Eating nutrient-dense, whole foods that support gut health and lower inflammation (think leafy greens, berries, turmeric, omega-3s) can reduce flare frequency for some.
• Herbs and natural topicals: Calendula, turmeric, manuka honey, aloe vera, and zinc-based balms supports wound healing and calm irritated skin.
• Stress reduction: Chronic stress is a known trigger. Practices like meditation, journaling, breathwork, gentle yoga, or walks in nature can bring the nervous system back into balance.
• Movement and lymphatic support: Light movement (like stretching or walking) can support lymphatic drainage, which helps flush inflammation and boost circulation.
• Support systems: Talking with others who truly understand HS, whether in support groups or online communities, can be deeply healing.

Remember, holistic healing is a journey. It often takes experimenting, tracking, and compassion to find what works for your body.

 

Final Thoughts

Living with HS is hard. There’s no sugar-coating that. But you are not alone. The more we talk about it, the more we learn—and the less shame we carry.

You deserve answers. You deserve support. And you deserve to feel better in your skin.

If you suspect you have HS, don’t wait. Reach out to a provider who knows what to look for. The journey might be long, but there is help, and there is hope.

You are not your diagnosis. And you are so much more than your scars.

Want to learn more about managing HS naturally? Stay tuned for more holistic tips, product suggestions, and empowering stories from fellow warriors.