Understanding Hidradenitis Suppurativa
HS is a chronic, inflammatory skin condition that affects millions worldwide - yet remains one of the most misunderstood and underdiagnosed diseases.
What is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS), also known as acne inversa, is a chronic, inflammatory skin disease characterized by recurrent, painful nodules, abscesses, and sinus tracts that primarily affect areas where skin rubs together: the armpits, groin, buttocks, and under the breasts.
HS affects approximately 1-4% of the global population and is significantly more common in women than men. Despite its prevalence, the average time from symptom onset to correct diagnosis is 7-10 years.
The condition is not caused by poor hygiene, is not contagious, and is not simply "bad acne." It is a systemic inflammatory disease with profound physical, emotional, and social consequences.
Key Facts
- • Affects 1-4% of the global population
- • 3x more common in women than men
- • Average diagnosis delay: 7-10 years
- • Not caused by poor hygiene
- • Not contagious
- • Linked to immune dysregulation
Commonly Affected Areas
- • Armpits (axillae)
- • Groin and inner thighs
- • Buttocks and perianal area
- • Under the breasts (inframammary)
- • Nape of the neck
- • Waistband area
The Hurley Staging System
The Hurley classification system is the most widely used tool for assessing HS severity. It guides treatment decisions and helps track disease progression.
Hurley Stage I
Single or multiple isolated abscesses without sinus tracts or scarring. Lesions are painful but do not connect beneath the skin.
Common Management
Topical antibiotics, antiseptic washes, lifestyle modifications
Hurley Stage II
Recurrent abscesses with sinus tract formation and scarring. Multiple affected areas with some interconnection of lesions.
Common Management
Oral antibiotics, hormonal therapy, biologics (adalimumab), procedural interventions
Hurley Stage III
Diffuse involvement across entire body regions with multiple interconnected sinus tracts, extensive scarring, and near-constant drainage.
Common Management
Biologics, surgical excision, multidisciplinary care team
Symptoms & Diagnosis
Primary Symptoms
How HS is Diagnosed
There is no single definitive test for HS. Diagnosis is clinical, based on:
Find a Specialist
A board-certified dermatologist with HS experience is the ideal specialist. Ask specifically about their HS patient volume and familiarity with biologic treatments.
Common Misdiagnoses
HS is frequently confused with other conditions, leading to years of ineffective treatment. If you have been diagnosed with any of the following and continue to experience recurring lesions in skin-fold areas, ask your doctor about HS.
Why Does HS Develop?
HS is caused by a complex interplay of genetic, hormonal, immune, and environmental factors. It is not caused by poor hygiene or diet alone.
Genetics
Up to 40% of HS patients have a family history of the condition.
Hormones
HS often worsens around menstruation and improves after menopause.
Obesity
Excess weight increases friction and inflammation, worsening HS.
Smoking
Strongly associated with more severe HS; cessation can improve outcomes.
Immune dysregulation
Overactive immune response drives chronic inflammation in hair follicles.
Metabolic syndrome
Insulin resistance and diabetes are common comorbidities.
The Mental Health Impact of HS
HS has one of the highest impacts on quality of life of any dermatological condition. Studies consistently show that people with HS experience significantly elevated rates of depression, anxiety, and social isolation.
The chronic nature of the disease, combined with pain, drainage, odor, and visible scarring, can profoundly affect self-esteem, relationships, employment, and daily functioning.
Seeking mental health support is not a sign of weakness. It is a critical part of comprehensive HS care.
Crisis Support Resources
If you or someone you know is struggling, please reach out. You are not alone.
Ready to Learn More About Living With HS?
Explore our practical guides for managing daily life, flares, and more.
Medical References
- [1]Jemec GBE. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158-164. PubMed
- [2]Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: epidemiology, clinical presentation, and pathogenesis. J Am Acad Dermatol. 2020;82(5):1045-1058. PubMed
- [3]Alikhan A, et al. North American clinical management guidelines for hidradenitis suppurativa. J Am Acad Dermatol. 2019;81(1):76-90. PubMed
- [4]Zouboulis CC, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619-644. PubMed
- [5]Garg A, et al. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol. 2017;77(1):118-122. PubMed
- [6]Kokolakis G, et al. Delayed diagnosis of hidradenitis suppurativa and its effect on patients and healthcare system. Dermatology. 2020;236(5):421-430. PubMed
- [7]Onderdijk AJ, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2013;27(4):473-478. PubMed
Stay Connected with the HS Community
Get the latest HS resources, research updates, and community support delivered to your inbox.
No spam, ever. Unsubscribe anytime.