Hidradenitis Suppurativa (HS)
Painful lumps and boil-like swellings that keep coming back in the armpits, groin, under the breasts and between the buttocks. It’s a long-term inflammatory condition of the hair follicles. Not an infection, not contagious and not caused by poor hygiene.
Quick answer: Hidradenitis suppurativa (HS) is a long-term inflammatory skin condition that causes painful lumps, boil-like abscesses and tunnels under the skin in the armpits, groin and other skin folds. It isn’t contagious or caused by poor hygiene. Treatment depends on severity: antiseptic washes, months of antibiotics, biologic injections, and surgery for tunnels.
How common. About 1 in 100 people in the UK have HS. It usually starts after puberty, often in the late teens or 20s, and is more common in women and in people with darker skin. Many people go years before it’s recognised, often after being told they just get boils.
Causes. Hair follicles in skin folds block, swell and burst under the skin, setting off inflammation. Genes play a part (about 1 in 3 people have a relative with it), as do hormones and an overactive immune response. Smoking and carrying extra weight are strongly linked and make flares worse. It is not caused by being unclean.
Symptoms. Tender, deep lumps that last days to weeks, may burst and leak pus or blood, then heal with scarring. Over time, tunnels can form under the skin, along with rope-like scars and blackheads that come in pairs. It often smells when lumps leak, which many people find the hardest part.
Look-alikes. Ordinary boils (usually one-off, from infection), infected cysts, a pilonidal sinus (only at the top of the buttock crease), folliculitis, and Crohn’s disease affecting the skin around the bottom.
How it’s diagnosed. From the look and pattern: typical lumps, in typical places, that keep coming back (a common rule of thumb is twice in 6 months). No blood test or swab proves it. Swabs are only useful if a lump looks infected. HS is linked with diabetes, high blood pressure, high cholesterol and low mood, so your GP may suggest a general health check.
The HS ladder
Treatment aims to calm flares, stop new lumps and prevent tunnels and scarring. Start early: tunnels don’t reverse on their own.
- Step 1 · Self-careStop smoking, lose weight if you carry extra, and go gentle on the skinLoose clothing, an antiseptic wash (such as chlorhexidine) on affected areas, and warm compresses on sore lumps.
- Works
- No trials, but people who lose weight or quit smoking tend to have fewer flares
- Cost
- Free to a few dollars a week
- How long
- Ongoing
- Watch for
- Scrubbing doesn’t help and irritates. This is inflammation, not dirt.
HS isn’t a hygiene problem, so harsh soaps aren’t the fix.
- Step 2 · PrescriptionClindamycin lotion or gelFor mild HS with a few lumps, applied twice a day.
- Works
- One small trial and guideline consensus: helps mild disease
- Cost
- About $20–40 a bottle on a private script
- How long
- Up to 3 months, then review
- Watch for
- Dryness and irritation. Not a long-term solo treatment because of antibiotic resistance.
A thin layer on the spots that flare, not the whole postcode.
- Step 3 · PrescriptionAntibiotic tablets for 3 months (doxycycline or lymecycline)Used for their anti-inflammatory effect as much as against bacteria.
- Works
- Mainly observational studies: many people with mild to moderate HS have fewer and smaller flares
- Cost
- About $15–30 a month; often PBS
- How long
- 12 weeks, sometimes repeated
- Watch for
- Sun sensitivity and heartburn (take upright with water). Not in pregnancy.
Three months is the course. Day 10 isn’t judgement day.
- Step 4 · Specialist or GPClindamycin plus rifampicin tabletsA stronger combination for moderate HS or when step 3 doesn’t work.
- Works
- Observational studies: a good response in many, though flares often return after stopping
- Cost
- PBS-subsidised
- How long
- 10–12 weeks
- Watch for
- Diarrhoea, orange body fluids, and rifampicin stops the contraceptive pill working. Use condoms or another method.
Orange tears are a known side effect, not a plot twist.
- Step 5 · SpecialistBiologic injections (adalimumab, secukinumab or bimekizumab)For moderate to severe HS that hasn’t settled with antibiotics.
- Works
- In the PIONEER trials of adalimumab, a meaningful improvement at 12 weeks in 42% and 59% of people vs 26% and 28% on placebo
- Cost
- PBS-subsidised for eligible people through a dermatologist
- How long
- Long term, while it helps
- Watch for
- Higher infection risk, so you’ll be screened for TB and hepatitis first.
Big guns, big paperwork, and for many people a big difference.
- Step 6 · SurgeryDeroofing or wide excisionDeroofing opens and cleans out tunnels under local anaesthetic. Wide excision removes the affected skin for deep or widespread disease.
- Works
- Wide excision has the lowest chance of HS coming back in that spot; works best combined with medicines
- Cost
- Medicare rebates; public waiting lists, private fees vary
- How long
- Healing takes weeks, longer after wide excision
- Watch for
- Repeated simple draining gives short relief, but lumps tend to come back.
Draining a lump releases the pressure; it doesn’t remove the problem.
Other options a dermatologist may use include hormonal treatment for flares around periods (certain contraceptive pills or spironolactone), metformin, acitretin, and a steroid injection straight into a very painful lump to settle it within days.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Harsh scrubs and frequent washingHS isn’t caused by dirt. Over-washing irritates the skin and doesn’t prevent lumps.
- ‘Cure’ diets and supplementsNo good trials show a diet or supplement controls HS. Weight loss and stopping smoking are the lifestyle changes with the best support.
- Squeezing lumpsPushes inflammation deeper and can spread tunnels. Warm compresses are kinder.
What you can do
- Quit smoking. It’s the single change most linked with fewer flares. Our quit smoking guide has options.
- If you carry extra weight, even a modest loss can ease symptoms.
- Wear loose, breathable clothing and avoid tight waistbands and bra wires on sore areas.
- Use an antiseptic wash on affected areas and a warm compress on painful lumps.
- Use absorbent dressings or pads for leaking lumps so you can get on with your day.
- Keep a simple flare diary (photos help) to show your GP or dermatologist.
- Look after your mood: HS is hard to live with, and support groups and counselling help.
See your GP if
- Painful lumps keep coming back in your armpits, groin, under the breasts or buttocks
- You have tunnels, leaking areas or scarring
- Treatment isn’t controlling flares after 3 months
- HS is affecting your sleep, work, relationships or mood
See a doctor the same day for a large, very painful swelling, spreading redness, fever or feeling unwell, which may mean a serious skin infection. If you feel hopeless or unsafe, call 000 in an emergency, or Lifeline on 13 11 14 (Australia).
Outlook. HS is long-term, with flares and quieter spells, and it can become inactive in later life. There’s no cure yet, but treatment has improved a lot, and treating early helps prevent tunnels and scars. Most people find it’s unchanged or better during pregnancy, though flares can follow the birth.
In Australia. Adalimumab and secukinumab are PBS-subsidised for moderate to severe HS when treatment is managed by a dermatologist and set criteria are met.
Common questions
Is hidradenitis suppurativa contagious?
No. HS can’t be passed on by touch, sex or sharing towels. It isn’t an infection or a sexually transmitted condition, and it isn’t caused by poor hygiene.
What causes hidradenitis suppurativa?
Hair follicles in skin folds block and burst under the skin, setting off inflammation. Genes, hormones and the immune system all play a part. Smoking and extra weight are strongly linked and make it worse.
Is HS the same as boils?
No. Boils are infections that usually come and go. HS lumps keep coming back in the same areas, often on both sides of the body, and can form tunnels and scars. Many people are told they have recurrent boils for years before HS is recognised.
Does shaving cause hidradenitis suppurativa?
Shaving doesn’t cause HS, but it can irritate the skin and trigger lumps in some people. If shaving makes things worse, try clipping instead.
Can hidradenitis suppurativa be cured?
Not yet, but it can be controlled. Antibiotics, biologic injections and surgery for tunnels can greatly reduce flares, and HS can become inactive later in life.
What is the best treatment for hidradenitis suppurativa?
It depends on severity. Mild HS: clindamycin lotion and antiseptic washes. Moderate: 3 months of antibiotic tablets. Moderate to severe: biologic injections such as adalimumab. Surgery for tunnels. Stopping smoking and weight loss help at every stage.
Does losing weight help HS?
Often, yes. Extra weight is strongly linked with HS, and people who lose weight tend to have fewer, milder flares. It works best alongside medical treatment, not instead of it.
Evidence and more information
- British Association of Dermatologists: Hidradenitis suppurativa patient leaflet (2025)
- Ingram et al, Br J Dermatol 2019: BAD guidelines for the management of hidradenitis suppurativa
- Kimball et al, N Engl J Med 2016: Two phase 3 trials of adalimumab for hidradenitis suppurativa (PIONEER I and II)
- Services Australia: PBS biologics for hidradenitis suppurativa
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