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Hidradenitis Suppurativa

Chronic, painful, recurrent inflammatory disorder of apocrine-bearing skin (axillae, groin, perianal, infra-mammary) with nodules, abscesses, sinus tracts, and scarring, requiring multimodal medical and surgical management.

Written by: Saygı Hospital Health Guide Editorial Board
Published:

This content is for general information; please consult your physician for diagnosis and treatment.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dermatoloji department. Book Appointment →

What is Hidradenitis Suppurativa?

HS is a follicular occlusive disease (not primarily apocrine gland disease as historically thought). Pathogenesis: hair follicle hyperkeratosis and occlusion → follicular rupture → inflammatory cascade with TNF-α, IL-17, IL-23, IL-1β → abscess formation → sinus tract development → fibrosis. Microbiome dysbiosis and biofilm contribute.

Prevalence 0.05-4% (often underdiagnosed/misdiagnosed as recurrent abscesses). Female predominance 3:1, onset typically 20s-30s, persisting decades. Strong genetic component (γ-secretase mutations in familial cases, ~30% positive family history).

Affected sites (in order of frequency): axillae, groin/inguinal, perianal/perineal, infra-mammary, buttocks; uncommon sites include scalp, beard, retroauricular, chest. Bilateral involvement common, often symmetrical.

Symptoms

Painful subcutaneous nodules (deep, tender)
Abscesses (recurrent, often spontaneously drain)
Sinus tracts with chronic drainage (purulent, malodorous)
Scarring (rope-like cords, bridging scars)
Comedones (single and double-headed) — pathognomonic
Affected sites: axillae, groin, perianal, infra-mammary
Pruritus, foul odor, social stigma
Functional limitation (range of motion in axillae, sitting in perianal disease)

Risk Factors

Female sex (3:1 predominance)
Family history (~30%, autosomal dominant in some families with γ-secretase mutations)
Smoking (strong association, both initiation and severity)
Obesity (BMI >30, mechanical and metabolic factors)
Type 2 diabetes, metabolic syndrome
Inflammatory bowel disease (Crohn's, UC)
Acne, polycystic ovarian syndrome
Hormonal factors (postmenarchal onset, premenstrual flares)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrent painful axillary, groin, or perianal nodules/abscesses
  • Chronic draining sinus tracts
  • New onset double-headed comedones in characteristic locations
  • Family history with similar lesions
  • Failed antibiotic therapy with persistent/recurrent disease
  • Dermatology referral for staging and tailored treatment

Treatment Methods

01
Lifestyle: smoking cessation (essential), weight loss, loose-fitting clothing, antibacterial soap, avoid tight or occlusive garments
02
Hurley Stage I (mild): topical clindamycin BID; topical resorcinol 15%; intralesional triamcinolone for inflamed lesions; doxycycline 100 mg BID 3 months
03
Hurley Stage II (moderate): combination clindamycin 300 mg + rifampicin 600 mg BID for 10-12 weeks (effective but resistance concerns); dapsone, zinc gluconate; finasteride or spironolactone (anti-androgens for hormonal flares); metformin if metabolic syndrome
04
Hurley Stage II-III (severe): adalimumab (FDA-approved 2015) — loading dose 160 mg week 0, 80 mg week 2, then 40 mg weekly; significant response rate (HiSCR) ~50%
05
Secukinumab (anti-IL-17A) FDA-approved 2023 for HS; weekly induction then monthly maintenance; alternative biologic option
06
Other biologic and targeted therapies: infliximab (off-label for severe), ustekinumab, IL-23 inhibitors (emerging), JAK inhibitors (upadacitinib trials)
07
Surgical management Stage II: limited excision of recalcitrant nodules, deroofing (unroofing of sinus tracts with secondary intention healing), CO2 laser excision
08
Surgical Stage III: wide local excision with healing by secondary intention, primary closure, flap, or skin graft; recurrence common at margins; multidisciplinary planning
09
Adjunctive: pain management (NSAIDs, neuropathic agents for chronic pain), psychological support (high depression/anxiety prevalence, body image distress), wound care
10
Emerging therapies: bermekimab (anti-IL-1α), spesolimab (anti-IL-36R), JAK inhibitors, complement inhibitors
11
Comorbidity management: metabolic syndrome screening and treatment, cardiovascular risk management, IBD evaluation if GI symptoms, mental health support
12
Long-term: chronic disease, treatment adjustment based on response and stage progression; surgical procedures may be required across decades; genetic counseling for familial forms

Which Department to Visit?

You can visit our Dermatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.