Hidradenitis Suppurativa: Symptoms, Causes, and Treatment in the UK

Hidradenitis suppurativa (HS), sometimes referred to as 'acne inversa', is a chronic inflammatory skin condition. It is characterised by recurrent, painful lumps that often develop in areas containing apocrine sweat glands—specifically where skin rubs against skin. While it may initially look like a common boil or an ingrown hair, HS is a systemic condition that requires long-term management.

In the UK, it is estimated that around 1 in 100 people live with HS. It is more common in women than men and typically begins around puberty. Because the condition can be embarrassing or mistaken for poor hygiene (which is not a cause), many patients suffer in silence for years before seeking a diagnosis from a medical professional.

The symptoms of hidradenitis suppurativa can vary depending on the severity, often graded using the 'Hurley Staging' system. Common signs to look out for include:

• Painful, firm lumps: Often beginning as single, pea-sized bumps that last for weeks or months.
• Recurrent abscesses: Lumps that may break open and leak pus, often with a distinct odour.
• Pits or blackheads: Appearing in pairs or 'double-ended' patterns.
• Tunnelling: In more advanced stages, tracts (sinus tracts) may form under the skin, connecting the lumps.
• Scarring: Thick or rope-like scars can develop as the skin attempts to heal from repeated inflammation.

Symptoms most frequently occur in the armpits, groin, buttocks, and under the breasts. In some cases, it can also affect the neck, waistband, or inner thighs.

The exact cause of hidradenitis suppurativa is not fully understood, but NHS and NICE guidance suggest it is linked to the blockage of hair follicles. When a follicle becomes blocked, it traps sweat and bacteria, eventually bursting under the skin and causing significant inflammation. It is important to note that HS is not contagious and is not caused by a lack of cleanliness.

Risk Factors

• Genetics: Around one-third of people with HS have a family history of the condition.
• Smoking: There is a very strong link between smoking and HS flare-ups; toxins in cigarettes may alter the inflammatory response.
• Weight: Being overweight can increase the friction in skin folds, which may worsen symptoms.
• Hormones: Flare-ups are often linked to menstrual cycles, suggesting a hormonal component.

Seeking a diagnosis for HS can feel daunting, but early intervention is the best way to manage the disease. You can speak to a GP online from the comfort and privacy of your home to discuss your symptoms. An online doctor can provide an initial assessment via video consultation or through the review of high-quality photographs.

When you consult an online GP for HS, they can:

• Confirm a diagnosis: Differentiating HS from simple boils or cysts.
• Prescribe medication: Initiating treatment with topical or oral antibiotics to reduce inflammation.
• Provide sick notes: If a flare-up is particularly painful and prevents you from working.
• Referral path: If the condition is severe (Hurley Stage 2 or 3), they can signpost you toward a specialist NHS or private dermatologist for advanced therapies like biologics or laser surgery.

Treatment for hidradenitis suppurativa is tailored to the individual and the severity of their symptoms. While there is currently no permanent cure, effective management can reduce pain and flare frequency.

Medical Treatments

• Topical antibiotics: Such as clindamycin, applied directly to the skin for mild cases.
• Oral antibiotics: Longer courses (often 3 months) of lymecycline or erythromycin to control infection and inflammation.
• Antiseptic washes: Using 4% chlorhexidine (Hibiscrub) can help reduce the bacterial load on the skin.
• Retinoids: Sometimes used to help clear the follicles, though these are usually prescribed by a specialist.

Lifestyle and Self-Care

According to British Association of Dermatologists (BAD) guidance, lifestyle measures are a cornerstone of treatment. Patients are advised to stop smoking and maintain a healthy weight to reduce the severity of the condition. Wearing loose-fitting clothing and avoiding shaving near active flare-ups can also prevent further irritation.

Hidradenitis suppurativa is more than just a skin condition; it can have a profound impact on a person's quality of life and mental health. The chronic pain, odour, and scarring often lead to social isolation, anxiety, and depression. It is important to address the emotional aspect of the condition alongside the physical symptoms.

If you find that your skin is affecting your mood or confidence, don't hesitate to mention this during your consultation. Support groups such as the HS Trust UK can also provide valuable community connection and advice for those navigating life with the condition.