HS is a chronic inflammatory skin condition causing tender lumps, boils, and tunnels in areas with friction and apocrine glands—most often armpits, groin, under breasts, buttocks, and inner thighs. It’s not contagious and not due to poor hygiene.
How it looks/feels
- Painful, deep lumps that may drain blood/pus and recur in the same spots.
- Blackheads in pairs (“double comedones”).
- Sinus tracts (tunnels) and scarring over time.
- Flares often before periods; heat, sweat, and friction worsen it.
Why it happens
- Hair follicle blockage and immune inflammation; smoking, excess weight, friction, hormones, and genetics can contribute.
What you can do now
- Wear loose, breathable clothing; minimize friction.
- Gentle cleansing; avoid scrubbing. Consider benzoyl peroxide or chlorhexidine wash a few times weekly.
- Warm compresses for 10–15 minutes to help drainage.
- Pain: NSAIDs if appropriate; consider topical lidocaine for short-term relief.
- Stop smoking if you smoke; gradual weight loss can reduce flares.
When to see a clinician
- Recurrent painful lumps/boils in typical sites, scarring, or drainage.
- If home care hasn’t helped after a few weeks, or impact on daily life is significant.
Medical treatments (tailored to severity)
- Topicals: clindamycin 1% solution/gel; resorcinol 15% cream in some regions.
- Oral antibiotics (e.g., doxycycline) for anti-inflammatory effect; sometimes combinations (clindamycin + rifampin) short-term.
- Hormonal options for women: combined oral contraceptives, spironolactone.
- Biologics: adalimumab is FDA-approved; others (infliximab, secukinumab, etc.) in select cases.
- Procedures: intralesional steroid shots for flares, deroofing of tunnels, limited excisions; advanced disease may need surgical excision.
- Wound care: nonstick dressings; consider absorbent pads for drainage.
Daily tips
- Antiperspirants are usually okay; avoid harsh deodorant fragrances if stinging.
- Shaving may trigger flares—consider trimming or laser hair reduction (often helpful).
- Manage stress and sleep; HS is tied to mood symptoms—seek support.