Hidradenitis Suppurativa (HS): The Overlooked Chronic Sweat Gland Inflammation

6 days ago

3 min read

Hidradenitis Suppurativa (HS), sometimes called Acne Inversa, is a chronic inflammatory skin disease that occurs in skin folds and in areas with many sweat glands, such as the armpits, groin and under the breasts. It is often misdiagnosed as an ordinary boil, a cyst or severe acne, so many patients receive treatment that does not target the real problem for a long time. Understanding the condition and seeing a dermatologist early can help reduce its severity and prevent permanent scarring.

What Is HS, and How Is It Different from an Ordinary Boil?

HS develops when hair follicles in areas of high friction become blocked and inflamed. This causes inflammation under the skin that forms hard, painful lumps and boils that burst, and eventually creates sinus tracts, which are tunnels connecting beneath the skin and cause permanent damage to the skin in that area. Unlike an ordinary boil, which usually heals after the pus is drained, HS tends to come back in the same spot and progress as a chronic condition.

Common Locations

Armpits: the most common site
Groin: including the inner thighs
Under the breasts: including the chest area
Buttocks: the buttocks and the cleft between them
Other sites: the scalp and the back of the neck in some patients

Risk Factors for HS

Overweight: excess body weight and obesity make skin folds deeper and increase friction
Smoking: smoking has been clearly linked to more severe symptoms
Hormonal factors: female hormones; symptoms often worsen before menstruation
Genetics: about 30–40% of patients have a family history

Severity Classification (Hurley Staging)

Dermatologists use the Hurley Staging System to divide the severity of HS into 3 stages so that treatment can be planned appropriately.

Stage I: inflamed lumps are present but there are no sinus tracts
Stage II: some sinus tracts are present but confined to a limited area
Stage III: sinus tracts are widespread and there is extensive tissue damage

How Is HS Treated?

Treatment of HS depends on its severity and should be supervised by a dermatologist.

Mild: topical clindamycin solution or zinc gluconate
Moderate: oral doxycycline, or clindamycin together with rifampicin
Severe: biologics such as adalimumab (Humira), which is FDA-approved specifically for HS
Surgery: surgery to remove sinus tracts is an option for severe and long-standing cases

Frequently Asked Questions

Is HS just an ordinary boil? No. HS is a chronic inflammatory disease of the hair follicles that comes back in the same spot and forms sinus tracts. Unlike an ordinary boil, which usually heals after the pus is drained, it needs a different treatment.

Do smoking and body weight really affect HS? Yes, clearly. Smoking is linked to more severe symptoms, and excess weight increases friction in the skin folds. Quitting smoking and managing weight are therefore an important part of care.

Can HS be cured completely? HS is a chronic disease, and treatment focuses on controlling symptoms and preventing permanent damage. Treating it early helps reduce progression and scarring.

When should I see a doctor? If you have painful, inflamed lumps that keep coming back in the armpits, groin or under the breasts, especially when boils burst repeatedly or tunnels form under the skin, see a dermatologist for diagnosis and treatment early.

HS is a chronic disease, and diagnosis and treatment in the early stages can help reduce its severity and prevent permanent scarring. If you have chronic, recurring inflamed lumps in your skin folds, consult a dermatologist at Siam Dermatology. Call +66 61 448 7000 or LINE @siamderm

Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed July 16, 2026