The Basics
What is Hidradenitis Suppurativa?
Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful lumps, abscesses, tunnels under the skin, and scarring. These symptoms most often appear in areas where skin rubs together, such as the armpits, groin, buttocks, inner thighs, and under the breasts. HS can significantly reduce quality of life for those with the condition.
How Common Is HS?
HS is more common than many people realize.
Globally, millions of people are affected.
In Canada, estimates suggest hundreds of thousands to over one million people may live with HS.
Some studies estimate that up to about 3.8% of Canadians may have HS.
Because HS is frequently misdiagnosed, the true number may be higher.
Common Symptoms of HS
HS symptoms can vary from person to person, but commonly include:
Painful lumps under the skin
Abscesses that fill with pus
Drainage or leaking from lesions
Tunnels under the skin (called sinus tracts)
Scarring over time
Recurring flare-ups in the same areas
HS often begins with small tender bumps that can grow larger, break open, and recur repeatedly.
Where HS Usually Appears
HS most commonly occurs in skin-fold areas, including:
Armpits
Groin
Inner thighs
Buttocks
Under the breasts
These are areas where hair follicles and sweat glands are concentrated and where skin friction is common.
HS can appear in other areas, too. The only real exception are the palms of the hands and the soles of the feet.
How HS Is Diagnosed
HS is usually diagnosed by a healthcare provider based on:
The appearance of lesions
Where the lesions occur on the body
Recurring symptoms over time
There is currently no single lab test that confirms HS, which is one reason diagnosis can be delayed.
Many patients are initially told they have boils, infections, ingrown hairs or acne.
Seeing a dermatologist familiar with HS can help ensure proper diagnosis and treatment.
Understanding HS Severity (Hurley Stages)
Doctors often use the Hurley staging system to describe HS severity.
Stage 1 – Mild
Individual lumps or abscesses
No tunnels
- No extensive scarring
Stage 2 – Moderate
Recurrent lesions
Development of tunnels under the skin
Scarring in affected areas
Stage 3 – Severe
Widespread inflammation
Multiple interconnected tunnels
Extensive scarring
Treatment Options for HS
There is currently no cure for HS, but many treatments can help control symptoms and reduce flare-ups. Doctors may combine medical treatments with surgery depending on disease severity.
Check out our resource on accessing treatments.
Topical Treatments
Antibiotic creams or washes
Antiseptic cleansers
Steroid injections into inflamed lesions
Oral Medications
Anti-inflammatory antibiotics
Hormonal treatments in some patients
Pain management medications
Biologic Medications
For moderate to severe HS, doctors may prescribe biologic medications that target the immune system.
These are available in Canada:
- Humira (adalimumab) and biosimilars
- Cosentyx (secukinumab)
- Bimzelx (bimekizumab)
Surgical Treatments
Procedures may include:
Drainage of abscesses
Deroofing (opening tunnels)
Removal of affected tissue
Living with HS
HS can affect more than just the skin. Many people experience:
Chronic pain
Fatigue
Emotional stress
Social isolation
Research shows HS can significantly impact quality of life, making emotional and community support important parts of care.
When to See a Doctor
If you experience recurrent painful lumps in skin-fold areas, especially if they return repeatedly or drain fluid, consider speaking with a healthcare provider or dermatologist.
Early diagnosis and treatment may help reduce complications and improve long-term outcomes.
You Are Not Alone
Living with HS can be challenging, but support and treatment options are available.
Connecting with others who understand HS can make a meaningful difference.
