Hidradenitis Suppurativa (HS): More Than Recurring Boils
Part of: Skincare
Painful lumps that keep coming back in the armpits, groin or under the breasts and leave tunnels and scars. How to tell HS from ordinary boils, who is most at risk, why early diagnosis matters, and treatments from washes to biologics and surgery.
Medical Dermatology · 2 min read · August 22, 2026
Written and medically reviewed by Dr. Yousef Abo Zarad · German board-certified dermatologist · Last reviewed: September 2026
Key takeaways
- HS is a chronic inflammatory disease that starts in hair follicles; it isn't caused by poor hygiene and isn't contagious.
- It appears where skin rubs together: the armpits, groin, buttocks and under the breasts.
- It is often misdiagnosed as recurring boils, and early diagnosis helps prevent tunnels and scars.
- Smoking and excess weight are among the biggest factors that make it worse.
- Effective biologic treatments are now available for moderate to severe disease.
How does HS start?
The first sign is often a painful spot that looks like a deep pimple, cyst or boil, sometimes preceded by discomfort in the area. Over time, small black bumps that look like blackheads may appear, often in pairs.
How does it progress?
- A single painful lump.
- Several lumps joining together.
- Painful abscesses that open and drain pus.
- Tunnels under the skin and permanent scars.
If “boils” keep coming back in the same places in the armpits or groin, ask to be assessed for HS instead of repeating antibiotics alone.
What causes it?
HS starts when a hair follicle becomes clogged with keratin; bacteria multiply as sweat builds up, then the follicle bursts and causes a painful lump. The material spreads to nearby follicles, and with repeated cycles scars and tunnels form.
Who is most at risk?
- It usually starts between puberty and age 40, and rarely before puberty.
- Women are affected more often than men.
- People with a family member who has HS.
- People who smoke: 70% to 90% of people with HS smoke.
- People with excess weight, which raises both the risk and severity.
- People with psoriasis.
What are the complications if it isn't treated?
- Chronic pain.
- Repeated infections.
- Scars that limit movement.
- Anxiety and depression.
- A higher risk of arthritis, and of squamous cell skin cancer in long-affected areas.
How is it treated?
In studies, abscesses and lumps decreased noticeably with adalimumab, and with secukinumab most patients had no increase in draining tunnels after one year.
| Type | Options | Notes |
|---|---|---|
| Skin care | Antibacterial wash and a gentle antiperspirant | Part of every plan |
| Topical | Clindamycin, or resorcinol cream | Resorcinol takes 3 to 4 months to work |
| Oral | Antibiotics, sometimes two types | To calm inflammation and lumps |
| Hormonal | Birth control pills, spironolactone, metformin and others | For some patients |
| Biologics | Adalimumab, secukinumab, bimekizumab, infliximab | For moderate to severe disease |
| Procedures | Steroid injections for painful lumps, laser hair removal, surgical deroofing or removal of tunnels | Laser every 4 to 6 weeks; results take months |
What can you do?
- Stopping smoking is one of the most important steps.
- Losing excess weight eases the disease.
- Care for wounds and change dressings as your doctor advises.
- Don't hesitate to ask for emotional support; HS is painful and draining, and support is part of treatment.
Common questions
- Is HS contagious? No.
- Is it caused by poor hygiene? No; it's an inflammatory disease that starts in hair follicles.
- Can it be cured? It's a chronic disease, but early treatment controls it and prevents tunnels and scars.