Comprehensive Guide to HS Skin Disorder: Causes and Therapies

March 28, 2024

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Hidradenitis suppurativa (HS), also known as hs skin conditionhs skin disease, or hs skin disorder, is a chronic, painful skin condition characterized by recurring inflamed nodules under the skin. This article provides a comprehensive overview of hs skin, including its causes, symptoms, diagnosis, treatment options, and prevention strategies.

What is HS Skin Condition?

HS skin condition refers to a disorder where abscesses and inflamed lesions develop in areas of the skin that contain apocrine sweat glands like the armpits, groin, and under the breasts. These painful hs skin lesions tend to recur, tunnel underneath the skin, produce pus, and can cause long-term scarring.

Hidradenitis suppurativa (HS) most often arises after puberty and tends to worsen over time. Exact estimates vary, but around 1-4% of the global population suffers from this chronic skin condition. Women are nearly 3 times more likely to develop hs skin issues than men.

Other names for this condition include acne inversa, acne conglobata, apocrine acne, apocrine gland inflammation, Verneuil’s disease, and pyoderma fistulans significa. Despite its name, hs skin disease is not caused by an infection.

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HS Skin Disease Symptoms and Stages

There are 3 main stages of hs skin disease:

  • Stage 1: Single or multiple abscesses form without scarring. This early phase causes red bumps, sometimes painful pus-filled lumps.
  • Stage 2: Recurring abscesses form with intermittent scarring. Tunnels of inflammation called sinus tracts connect abscesses under the skin.
  • Stage 3 (severe): Multiple abscesses form extensive, interconnected tracts and tunnels. Skin thickens and takes on a woody texture. Scarring is widespread.

Hs skin manifestations depend on the disease stage. Common symptoms include:

  • Painful lumps under the arms, breasts, inner thighs, groin, or buttocks
  • Lesions that repeatedly fill with pus, enlarge, rupture, drain, then partially heal
  • Dark scarring and skin thickening after breakouts
  • Foul-smelling odor and bloody discharge
  • Sensations of burning, stinging

Hs skin disorder negatively impacts one’s quality of life. Advanced stages can cause physical limitations, reduced mobility, depression, and social isolation.

What Triggers HS Skin?

The exact causes of hs skin condition are unknown but likely involve multiple interacting genetic, hormonal and environmental factors such as:

  • Family history: Having close relatives with hidradenitis suppurativa (HS) puts you at higher risk
  • Hormonal factors: HS typically begins after puberty, is more common in women, and outbreaks often worsen before menstrual periods
  • Smoking: Tobacco smoke exacerbates HS inflammation
  • Obesity: Excess weight is linked with more severe and widespread hs skin disease
  • Friction: Skin friction in areas like the inner thighs can initiate hs skin problems
  • Bacteria/biofilms: Bacterial colonies deep in hair follicles may play a secondary role

Additionally, hs skin disorder is associated with higher likelihood of developing metabolic disorders like diabetes and heart disease.

Diagnosing HS Skin

To diagnose hs skin disease, doctors take a full medical history and conduct a physical exam of the characteristic skin lesions. They may order tests to rule out other conditions like pilonidal cysts, swollen lymph nodes, and sexually transmitted infections.

No definitive medical test exists for hs skin disorder, so physicians diagnose it based on clinical manifestations:

  • Location of lesions in characteristic areas
  • Recurrent flare-ups, abscesses, and sinus tract formation
  • Scarring and altered skin texture

Tracking symptoms in a hs skin symptoms journal helps doctors accurately gauge the severity and progression.

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HS Skin Disease Stages and Treatment Approaches

Hs skin treatment strategies depend on the stage and severity:

Stage 1 HS Treatment

Mild hs skin condition may be managed by:

  • Warm compresses to encourage drainage
  • Antibiotics like clindamycin or rifampin
  • Retinoids to unclog hair follicles
  • Anti-inflammatory drugs such as corticosteroids or biologics
  • Lifestyle modification like smoking cessation and weight management

Stage 2 HS Treatment

For moderate affliction, combined approaches work best:

  • Antibiotics to reduce bacteria populations
  • Anti-inflammatories to lower swelling and pain
  • Incision and drainage of large, painful lumps
  • Measures to prevent flare-ups like changes in clothing, diet, hygiene habits
  • Laser or light therapy to reduce lesions and kill bacteria

Stage 3 HS Treatment

Advanced hs skin disease often requires aggressive interventions:

  • Powerful antibiotics for infection prevention
  • Biologic medications like anti-TNF drugs
  • Surgery to cut out affected tissue and close tunnels
  • Laser treatment to obliterate remaining involved areas
  • Experimental therapies like radiotherapy and immunotherapy

Reconstructive surgery like skin grafting or flaps may help treat extensive scarring and improve quality of life.

Lifestyle Changes and Home Remedies for HS

Hs skin problems tend to flare up more with smoking, obesity, heat, and friction. Lifestyle adjustments help prevent outbreaks:

Quit smoking

Tobacco exacerbates inflammation. Smoking cessation typically reduces hidradenitis suppurativa severity.

Lose excess weight

Obesity worsens hs skin condition. Slimming down lessens outbreak severity and distribution.

Avoid skin friction

Prevent chafing between thighs, under breasts and in flexures. Wear loose clothing.

Apply cold, wet compresses

Ice packs help shrink early lesions and provide pain relief.

Keep good hygiene

Gently wash with antibacterial soap and pat dry. Avoid harsh scrubbing.

Take anti-inflammatory supplements

Turmeric, omega-3, green tea, and zinc supplements combat inflammation.

Consider dietary changes

Some find dairy, wheat, yeast, nuts, soy, nightshades aggravate hs skin condition.

Reduce stress

Anxiety and tension can trigger flares. Practice relaxing techniques.

Get immune-boosting rest

Adequate, high-quality sleep enhances healing and resilience.

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Prevention of HS Skin Disorder

Currently, no surefire way exists to prevent hs skin disorder. However, focusing on modifiable risk factors offers the best chance at delaying onset and minimizing outbreaks.

Key prevention tips include:

  • Maintain healthy body weight
  • Quit smoking and tobacco
  • Practice good hygiene
  • Avoid skin friction in flexures
  • Wear moisture-wicking breathable fabrics
  • Manage related conditions like metabolic disease
  • Have relatives screened for early hidradenitis suppurativa

Prompt diagnosis and effective treatment of hs skin issues can help containing progression to advanced disease.

FAQs About HS Skin Condition

What’s the difference between HS and regular acne?

Unlike adolescent acne, hs skin condition arises in early adulthood and primarily affects areas with apocrine glands. Hs skin disease causes deeply inflamed lesions that tend to tunnel inward. Breakouts often leave significant scarring.

Is HS skin condition hereditary?

Yes, hs skin disorder has genetic underpinnings, with over one-third of patients reporting an affected first-degree relative. However, family history alone cannot predict one’s risk. Environmental influences also play an important role.

How is HS skin diagnosed?

There are no confirmatory lab tests for hs skin problems. Doctors clinically diagnose it based on characteristic signs like recurrent boils and abscesses in body flexures that subsequently scar. Tracking symptoms helps classify severity.

What’s the best treatment for HS skin?

Hs skin treatment should be tailored to reflect disease extent and symptoms. Mild cases may improve with lifestyle modification alone or antibiotics. More advanced hidradenitis suppurativa requires drugs to counter inflammation and infection, plus surgical procedures.

What happens if you leave HS untreated?

Without treatment, hs skin disease tends to worsen over time – forming extensive scarring, skin thickening, tunnels, and severely impacting one’s quality of life. Early intervention provides the best chance of containment.

In Summary

Key points about hs skin condition, disease and disorder:

  • Painful, recurrent abscesses in certain body areas
  • Three disease stages from mild to severe
  • Driven by multiple genetic, hormonal and environmental factors
  • Often aggravated by smoking, obesity, heat, friction
  • Leads to extensive scarring without treatment
  • Multimodal treatment from antibiotics to surgery

Understanding the symptoms and evolution of hs skin problems allows for earlier intervention to prevent progression and disruption. A combined approach addressing inflammation, infections, scarring, and lifestyle factors brings the best outcomes.


  • Sinno, H. et al. Diagnosis and Management of Hidradenitis Suppurativa. JAMA. 2020 Oct 13;324(18):1990-2000. doi: 10.1001/jama.2020.17304. PMID: 33107915.
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