Explore triggers of hidradenitis suppurativa, a painful skin condition in armpits, groin and other friction zones, and learn medical and surgical treatments.

Hidradenitis suppurativa is a chronic inflammatory skin condition that causes painful nodules, deep abscesses, and irreversible scarring. The disease primarily affects body areas where skin rubs together, including the armpits, groin, buttocks, and under the breasts.

Dermatologists report that the condition originates from clogged hair follicles. Hair follicles become blocked by keratin and sweat, triggering localized inflammation. As fluid builds up, the follicle ruptures beneath the skin, creating painful lesions that frequently recur.

Symptoms and disease progression

Initial symptoms often resemble isolated pimples, deep boils, or inflamed cysts. Without effective intervention, these lesions persist and coalesce into larger, painful lumps that rupture to discharge fluid.

Repeated cycles of inflammation lead to sinus tract formation, creating subterranean tunnels beneath affected skin surfaces. Hardened scar tissue forms over time, restricting movement and causing chronic pain. Medical professionals categorize disease severity using the Hurley staging system, which ranks involvement from solitary isolated abscesses in Stage I to interconnected sinus tracts and widespread scarring in Stage III.

Causes and key risk factors

The precise etiology of hidradenitis suppurativa remains under study, but clinical consensus links the disorder to immune system dysregulation. It is not contagious and does not stem from poor hygiene.

Genetic factors contribute to individual risk, with approximately one-third of diagnosed patients reporting a family history of the disorder. Biological females experience higher rates of diagnosis than males. Cigarette smoking and higher body mass index correlate with increased disease severity and higher frequency of painful flare-ups.

Treatment options and medical management

While no definitive cure exists, clinicians employ a combination of medical and surgical approaches to control inflammation and minimize pain. Early intervention remains critical to prevent structural skin damage.

Pharmacological options include topical and systemic antibiotics, hormonal therapies, and oral retinoids. Severe or refractory cases often respond to biologic medications, such as tumor necrosis factor inhibitors and interleukin inhibitors, which suppress specific inflammatory proteins.

Surgical procedures range from unroofing minor sinus tracts to full surgical excision of chronically affected skin tissue. Patients also benefit from supportive measures, including pain management, wound care, weight control, and smoking cessation programs.