Hidradenitis Suppurativa: Symptoms, Stages and Treatment
Painful pimples and abscesses that keep opening in the skin folds — armpits, groin, buttocks, under the breasts — and, over time, tunnel-like tracts under the skin: most patients take these for "boils" or "ingrown hairs" for years and get by on antibiotics. In fact this is the classic picture of hidradenitis suppurativa (HS, also called acne inversa), a chronic, inflammatory and progressive skin disease. Diagnosis is delayed by about seven years on average, yet early diagnosis is the only way to prevent permanent scarring and tunnel formation.
Causes
HS begins with blockage and rupture of hair follicles and is driven by an exaggerated inflammatory response of the immune system; it is not a simple infection or a hygiene problem. Genetic predisposition (about a third of patients have a family history), smoking, excess weight, hormonal factors and friction trigger and aggravate the disease. Its association with acne, psoriasis and inflammatory bowel disease is well known.
Symptoms and stages
Recurrent, painful, deep nodules and abscesses in the skin folds
Discharge and odour, stained clothing
Double-headed (two-opening) blackheads
In advanced disease, interconnecting tunnels under the skin (sinus tracts) and thick scars
Hurley staging: stage I, isolated nodules or abscesses without scarring; stage II, recurrent abscesses with limited tunnels; stage III, widespread tunnels and areas merged by scarring
Diagnosis
The diagnosis is clinical: typical sites, a recurrent course and the lesion types are enough; laboratory tests or biopsy are rarely needed. Tests may be requested for metabolic syndrome, diabetes and other associated conditions. Ultrasound helps show the extent of tunnels under the skin.
Treatment options
Lifestyle: stopping smoking and weight control are the two steps that change the course of the disease most; loose, non-chafing clothing is advised.
Topical and oral antibiotics: time-limited courses to reduce inflammation in early disease (clindamycin, tetracyclines, combinations when needed).
Anti-androgen and metabolic treatments: hormonal regulators and metformin in suitable patients.
Retinoids: in selected cases.
Biologics: in moderate to severe HS, biologic therapies targeting the TNF-alpha and IL-17 pathways are evidence-based options that change the course of the disease; they are started and monitored by a dermatologist.
Local procedures: intralesional corticosteroid for acute abscesses; opening of tunnels (deroofing); laser reduction of hair follicles.
Surgery: wide excision of established tunnel and scar areas, planned together with medical treatment.
Why a dermatologist?
When acute abscesses are drained in an emergency room and covered with antibiotics, the disease is merely postponed to the next flare. The aim of treatment is to lengthen the interval between flares, control pain and discharge and prevent tunnels and scars — and that requires long-term follow-up.
Frequently asked questions
Is it contagious? No, and it has nothing to do with poor hygiene.
Does it go away completely? It is a chronic disease, but with the right treatment flares become rare and most patients achieve long remission periods.
How does it differ from a pilonidal sinus? A pilonidal sinus usually occurs in a single area at the tailbone; HS recurs in several skin folds. The two sometimes coexist.
Hidradenitis suppurativa care in Kırklareli
Our practice is in central Kırklareli, in Turkish Thrace — about an hour from Edirne, with the Kapıkule (Bulgaria) and İpsala (Greece) border crossings within easy reach. We are open Monday to Saturday, 10:00–18:15, and see patients from Bulgaria and Greece under our international health tourism authorisation. Hidradenitis suppurativa is one of the diseases I worked on during my residency training; the practice offers long-term follow-up with current options, including biologic therapy. To book, use our contact page.
This article is for general information; diagnosis and treatment are decided after an examination.
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