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Men's HS HubAnatomy

HS on the Buttocks: Why It's More Common in Men

Gluteal HS is one of the most painful and least discussed presentations of hidradenitis suppurativa. Men are disproportionately affected, and most go years without a correct diagnosis.

Start here: Hidradenitis Suppurativa in Men (Complete Guide) →

Men's HS Series

HS on the ButtocksPerianal HS ExplainedHS and TestosteroneManaging HS EarlyMen's Mental Health

When HS affects the buttocks, it changes how a person sits, moves, works, and sleeps. It is not a minor inconvenience. For many men, it is one of the most disabling aspects of living with HS, and one of the least talked about.

Where HS Shows Up on the Buttocks

HS does not appear randomly. It targets areas with high concentrations of apocrine glands and areas where skin rubs against skin or clothing. On the buttocks, the most common locations are:

  • The gluteal fold (the crease between the buttock and upper thigh)
  • The intergluteal cleft (between the two buttocks)
  • The lower buttocks where skin contacts seating surfaces
  • The perianal area (covered in the next article in this series)

Men with HS have significantly higher rates of gluteal involvement than women. Research suggests this is linked to androgen activity, body composition differences, and the tendency for men to delay seeking care until lesions are advanced.

Medical diagram showing gluteal anatomy with HS lesion locations including apocrine glands, follicular occlusion points, and HS lesion sites
Medical diagram showing the primary HS lesion zones on the gluteal region in men, including the gluteal fold, intergluteal cleft, and lower buttocks.

What It Looks Like: Stages of Gluteal HS

Gluteal HS follows the same Hurley staging system as HS elsewhere, but the presentation can be more severe due to constant pressure and friction.

Early (Hurley I)

Single or multiple painful nodules or boils. No tunneling. Often mistaken for ingrown hairs or folliculitis.

Moderate (Hurley II)

Recurring abscesses that drain. Early sinus tract formation. Significant pain when sitting or moving.

Severe (Hurley III)

Extensive tunneling under the skin. Rope-like scarring. Continuous drainage. May involve the entire gluteal region.

Men are more likely to present at Hurley Stage II or III, partly because the gluteal location makes lesions harder to see and easier to dismiss as something minor.

The Biggest Trigger Most Men Overlook

Prolonged sitting is the single most underestimated trigger for gluteal HS flares. Desk workers, drivers, and anyone who sits for more than four hours a day without breaks is at elevated risk of worsening lesions.

Infographic showing 6 daily management strategies for gluteal HS in men: clothing choices, wound care, sitting modifications, hygiene, flare prevention, and when to seek care
Diagram showing pressure and friction hotspots on the gluteal region during prolonged sitting, highlighting zones most likely to trigger HS flares.

Other commonly overlooked triggers include:

  • Tight underwear or jeans that create constant friction in the gluteal fold
  • Synthetic fabrics that trap heat and moisture
  • Shaving or waxing the gluteal area
  • High-impact exercise without moisture-wicking clothing
  • Obesity or rapid weight changes that alter friction patterns

Reality Check

Gluteal HS is not caused by poor hygiene. Washing more aggressively can actually worsen lesions by disrupting the skin barrier. Gentle cleansing with a fragrance-free, non-comedogenic wash is recommended.

Managing Gluteal HS Day to Day

Seating

  • Use a coccyx cutout or donut cushion
  • Stand or shift position every 30-60 minutes
  • Avoid hard chairs during active flares

Clothing

  • Loose-fitting, moisture-wicking underwear (bamboo or cotton)
  • Avoid tight jeans or synthetic fabrics
  • Seamless underwear reduces friction points

Wound Care

  • Gentle cleansing with Hibiclens or fragrance-free wash
  • Non-stick dressings for draining lesions
  • Change dressings after exercise or sweating

Medical

  • Topical clindamycin for early lesions
  • Biologics for moderate-severe disease
  • Wide local excision for tunneling/scarring

Related Resources

HS Hurley Stages Explained
HS Treatment Guide
HS Surgery Patient Guide
HS in Men: Complete Hub
Perianal HS Explained
HS Wound Care Guide

Frequently Asked Questions

This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment of hidradenitis suppurativa.

References

  1. [1] Jemec GB. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158-164.
  2. [2] Alikhan A, et al. North American clinical management guidelines for hidradenitis suppurativa. J Am Acad Dermatol. 2019;81(1):76-90.
  3. [3] Garg A, et al. Prevalence and co-morbidities of hidradenitis suppurativa in the United States. Dermatology. 2014;228(3):261-265.
  4. [4] Canoui-Poitrine F, et al. Characteristics of a series of 302 French patients with hidradenitis suppurativa. J Am Acad Dermatol. 2009;61(1):51-57.
  5. [5] 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.