Hidradenitis Suppurativa

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What is hidradenitis suppurativa?

Hidradenitis suppurativa is a skin disease that’s also called acne inversa. At first, you may not realize that you have the condition because it may resemble other skin problems, such as pimples, cysts or boils. However, if you notice symptoms of hidradenitis suppurativa, be sure to get it checked out. Early treatment can prevent the condition from getting much worse.

At first, hidradenitis suppurativa appears as acne-like bumps. Except the bumps appear in places you wouldn’t expect to find acne. These are areas where your skin touches skin, such as your underarms, groin, buttocks, upper thighs, or underneath the breasts. As with acne, you may experience breakouts. The breakouts may clear up, but return to the same area or a different spot nearby. Without treatment, these bumps can cause serious complications and scarring.

What are the symptoms of hidradenitis suppurativa?

In addition to acne-like bumps, hidradenitis suppurativa causes symptoms that include:

  • Bumps that burst and leak a bloody, smelly fluid

  • Infections

  • Painful breakouts that clear up and return

  • Scars that become thick and spongy and form tunnel-like tracts beneath your skin

  • Scars that form where you had a breakout

In rare cases, hidradenitis suppurativa can contribute to skin cancer risk. Some people may develop squamous cell carcinoma where they previously had hidradenitis suppurativa breakouts and scarring. This is most commonly reported in men with hidradenitis suppurativa on their anus or genitals.

What causes hidradenitis suppurativa?

The exact cause of hidradenitis suppurativa is not known. The condition occurs after puberty, so hormones may play a role. It’s also three times more common in women than men.

As in regular acne, hidradenitis suppurativa begins when hair follicles become clogged with bacteria. A person who develops hidradenitis suppurativa may have an immune system that overreacts to the clogged hair follicle.

What are the risk factors for hidradenitis suppurativa?

There are also certain factors that appear to increase your risk of developing hidradenitis suppurativa, including:

  • Being overweight or obese

  • Genetics—about one-third of people with hidradenitis suppurativa have a close relative with the condition

  • Smoking

  • Taking lithium

How is hidradenitis suppurativa treated?


Several medications that are used to treat other diseases can be helpful for treating hidradenitis suppurativa. These include:

  • Acne washes and medications

  • Antibiotics

  • Birth-control pills

  • Corticosteroids

  • Medications that target the immune system response, called biologics

  • Metformin, a drug used to treat diabetes

  • Methotrexate, a medication used to treat cancer and severe psoriasis

  • Radiation therapy

Surgical procedures

For severe hidradenitis suppurativa that affects deeper layers of your skin, surgery may be necessary. Some surgical options include:

  • Draining or incision, in which your dermatologist drains or cuts out the lesions

  • Excision, in which a doctor surgically removes the affected area and uses your own skin to cover the wound

  • Laser surgery, which destroys hair follicles and may help clear existing breakouts and prevent future breakouts

Lifestyle changes

Finally, some lifestyle changes can make a big difference. Taking any of these steps can help you feel better:

  • Lose weight—dropping just 10% of your body weight can improve your condition.

  • Quit smoking.

  • Wear loose-fitting clothes to reduce friction that can lead to breakouts.

Key Takeaways

  • Hidradenitis suppurativa, also called acne inversa, is a skin disease that appears as acne-like bumps in places you wouldn’t expect to find acne—most likely areas where your skin touches skin.

  • Symptoms of hidradenitis suppurativa include bumps that burst and leak a bloody, smelly fluid; painful breakouts that clear up and return; and scars that become thick and spongy and form tunnel-like tracts beneath your skin.

  • Talk with your doctor about treatment options. Hidradenitis suppurativa treatments include medication, surgical procedures, and lifestyle changes.
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Sep 14
  1. Hidradenitis suppurativa. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hidradenitis-suppurativa
  2. Hidradenitis suppurativa: diagnosis, treatment, and outcome. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hidradenitis-suppurativa/diagno...
  3. Hidradenitis suppurativa: Signs and symptoms. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hidradenitis-suppurativa/signs-...
  4. Hidradenitis suppurativa: Tips for managing. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hidradenitis-suppurativa/tips-f...
  5. Who gets Hidradenitis suppurativa? American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/e---h/hidradenitis-suppurativa/who-ge...
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