Hidradenitis suppurativa, or HS, is a chronic inflammatory skin condition that causes painful, recurrent lumps, abscesses, and tunnel-like tracts beneath the skin — most commonly in the underarms, groin, inner thighs, buttocks, and under the breasts. It is not contagious. It is not caused by poor hygiene. It is not simply ingrown hairs or recurring cysts.

HS is an immune-mediated inflammatory condition driven by abnormal follicular occlusion, chronic inflammation, and in many patients, a significant genetic component. Without appropriate treatment, HS tends to progress — leading to more frequent flares, deeper scarring, and a substantial impact on quality of life.

Who does HS affect?

HS affects approximately 1–4% of the general population, but the burden is not equally distributed. Research consistently shows that Black women are diagnosed with HS at significantly higher rates than other groups — and often with more severe disease presentations. Despite this, HS remains one of the most underdiagnosed and undertreated conditions in dermatology.

The average time from first symptom to accurate diagnosis is seven to ten years. Many patients are told they have folliculitis, boils, or infected cysts before someone finally identifies what’s actually happening. If you’ve been dismissed, misdiagnosed, or simply never gotten a satisfying answer — that experience is common, and it’s not your fault.

Signs and symptoms of HS

Common signs of HS include recurring painful nodules or boils in skin-fold areas, abscesses that rupture and drain, scarring and tunnel formation beneath the skin surface, cord-like bands or thickened skin at previously affected sites, post-inflammatory dark spots where lesions have healed, and flares that worsen around menstrual cycles, with heat, friction, or stress.

HS is staged using the Hurley scale — from Stage I (isolated abscesses without scarring) through Stage III (diffuse involvement with extensive scarring and tunneling). Treatment approach depends significantly on stage, and early intervention produces the best long-term outcomes.