Hidradenitis suppurativa

What is hidradenitis suppurativa?

Hidradenitis suppurativa, often shortened to HS, is a chronic inflammatory condition around the hair follicles. It typically affects the armpits, the groin, the area around the anus and under the breasts, that is, the skin folds. The disease causes tender nodules, abscesses and over time tunnels under the skin and scarring. 1

HS is not contagious and is not caused by poor hygiene. That deserves to be said plainly, because many people carry an entirely unnecessary sense of guilt. 2

Typical symptoms

• Tender, deep-seated nodules that can develop into abscesses.
• Discharge of pus, often mixed with blood.
• Repeated flares in the same areas over years.
• Tunnels under the skin that weep, and scars that tighten.
• Pain, odour and markedly reduced quality of life for many. 1, 2

Why early diagnosis matters

Because the early flares are often taken for ordinary boils. Once the pattern is recognised, repeated nodules and abscesses in skin folds, treatment can address the whole disease instead of each flare separately. Repeated simple incision relieves pain in the moment but is not a long-term solution. 1

Examination

The diagnosis is clinical, based on the course, the location and the typical lesions. There is no blood test that makes the diagnosis. 1

Treatment and referral

Treatment is multifaceted and depends on severity. It includes topical treatment, medical treatment in dermatological care, including biological treatment in severe disease, and surgery selected for specific problems such as opening tunnels and removing persistently inflamed tissue. HS causing abscesses, weeping tunnels and scarring belongs with a dermatologist. 1 The European treatment guidelines collect the evidence for the medical and surgical options. 3

Contact the clinic to clarify whether your referral belongs here.

When it needs to be fast

Seek assessment the same day with severe pain and rapidly growing swelling, fever, spreading redness or feeling generally unwell. Call 1813 in the Capital Region or the out-of-hours doctor, and call 112 if you are severely affected.

What you can do yourself

• Stopping smoking and losing weight support treatment, without this being something you could have done differently to avoid the disease. 1
• Loose clothing and gentle washing reduce friction and irritation.
• Note your flares and what seems to trigger them. It helps in choosing treatment.
• Tell your doctor if the disease affects your mood and daily life. That is part of the treatment.
• See also abscess.

Sources

• Hidradenitis suppurativa, Lægehåndbogen at sundhed.dk
• Hidradenitis suppurativa, Patienthåndbogen at sundhed.dk
• European S2k guidelines for hidradenitis suppurativa, part 2: Treatment (2024)