Hidradenitis Suppurativa: Diagnosis and Treatment Options
Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease presenting with recurrent painful nodules, abscesses and tunnels (sinus tracts) in the axilla, groin, submammary and perianal regions. HS is not caused by poor hygiene and is not contagious. This page is for general information only; diagnosis and any individual treatment plan can only be determined through medical examination.
What is hidradenitis suppurativa?
HS is a chronic inflammatory disease that begins with follicular occlusion and inflammation and leads to abscesses, tunnels and scarring in apocrine-bearing areas. It is also known as acne inversa.
HS is not a hygiene problem and does not spread from person to person. This misconception can cause delay in care and stigma.
Symptoms
Painful red nodules, recurrent abscesses, discharge, odour and progressive scarring may occur. Disease is commonly described as Hurley I–III; staging alone does not determine the treatment decision.
- Recurrent painful nodules and abscesses in axilla and groin
- Perianal tunnels with discharge
- Interconnecting sinus tracts
- Scar tissue and persistent skin induration
Causes and associated factors
Genetic predisposition, smoking, obesity, hormonal factors and mechanical friction are associated with disease burden. Bacterial infection is not the primary cause but may be secondary.
Smoking and excess weight are factors associated with disease burden that are recommended to be optimised where possible; correcting them does not guarantee an individual outcome or prevention of recurrence.
Diagnosis and differential diagnosis
Diagnosis is clinical. MRI or ultrasound may be used to map the extent of disease.
Perianal HS tunnels usually originate in the skin and show no communication with the anal canal or rectum. In cryptoglandular or Crohn-related perianal fistula such a communication or internal opening may be present; however, failure to demonstrate an internal opening does not by itself exclude a fistula. The conditions may coexist; differentiation is important, particularly when anal communication, Crohn disease or complex anatomy is suspected, and is based on examination, proctologic assessment and pelvic MRI when needed.
Treatment options
Treatment is planned according to disease stage, involved sites, flare frequency and patient preference. Medical and surgical options are complementary rather than alternatives, and dermatology–surgery co-management is recommended.
- Medical therapy: topical and systemic antibiotics, hormonal therapy, biologics in suitable cases (managed by dermatology)
- Incision and drainage for relief of an acute, tense and painful abscess; this is not definitive treatment
- Surgical options: deroofing, limited excision, excision and reconstruction in extensive disease
- Laser approaches: CO2 laser excision/deroofing is a surgical technique, while laser hair removal is a different treatment option that targets the hair follicle and does not directly remove an established fibrotic tunnel. These are not ranked as the standard for a particular stage
- Perianal tunnelling HS: planned together with proctologic assessment
Wound approach after surgery and follow-up
Wound management after CO2 laser or excision cannot be reduced to a single rule. Secondary healing, primary closure, graft or flap may be selected according to site, defect size, infection status and patient factors.
Follow-up cannot be given as a fixed schedule; intervals are individualised according to the procedure, wound course and concurrent medical therapy. A fixed healing time cannot be predicted either. Wound care, hygiene and smoking cessation are advised for general health; a recurrence-reducing effect is not proven for every patient.
When to seek urgent care; contact
Rapidly enlarging painful swelling, fever of 38 °C or above, signs of a rapidly spreading skin and soft tissue infection (cellulitis), a sudden or marked increase in discharge or malodour together with deterioration in general condition require prompt medical attention.
Examination is necessary for diagnosis and for any individual treatment plan; the information here does not replace personal medical advice.
Frequently Asked Questions
Is hidradenitis suppurativa contagious?+
No. HS is a chronic inflammatory follicular disease; it does not spread between people and is not caused by poor hygiene.
Are antibiotics alone enough?+
In some patients symptoms can be controlled with medical therapy; in extensive or tunnelling disease surgical options come into consideration. Decisions are made through dermatology–surgery co-management.
How do smoking and weight affect HS?+
Smoking and excess weight are associated with disease burden and are recommended to be optimised where possible. Addressing them does not guarantee an individual outcome or prevention of recurrence.
Can HS recur after surgery?+
Disease may reappear in unexcised tunnels or new areas. HS is chronic; no approach guarantees the absence of recurrence.
Can perianal HS be confused with anal fistula?+
Perianal HS tunnels usually originate in the skin and show no communication with the anal canal or rectum. In cryptoglandular or Crohn-related perianal fistula such a communication or internal opening may be present; however, failure to demonstrate an internal opening does not by itself exclude a fistula. The conditions may coexist; differentiation is important, particularly when anal communication, Crohn disease or complex anatomy is suspected, and is based on examination, proctologic assessment and pelvic MRI when needed.
When are laser approaches considered?+
CO2 laser excision/deroofing is a surgical technique, while laser hair removal is a different treatment option that targets the hair follicle and does not directly remove an established fibrotic tunnel. They are not the standard for a specific stage, and suitability is assessed at examination.
How often are follow-up visits?+
No fixed schedule can be given. Intervals are individualised by the physician according to the procedure, wound course and concurrent medical therapy. Contact and admission information is on the [contact page](/en/contact).
This content is for general information only; diagnosis and treatment require an individual medical evaluation.