What Is Hidradenitis Suppurativa? Causes and Care for Recurring Underarm and Groin Inflammation
If you keep getting painful, acne-like bumps in your underarms, groin, or the folds of your buttocks — and they return to the same spot even after being drained — this may not be ordinary acne but rather hidradenitis suppurativa (HS). HS is a chronic inflammatory condition centered around hair follicles and the glands surrounding them, and it tends to occur in areas where skin rubs together. Because it often follows a long-term, recurring course, recognizing it early and setting a sensible care plan matters.
Why does hidradenitis suppurativa happen?
The exact cause is not yet fully understood, but the inflammatory process is believed to begin when a hair follicle opening becomes blocked. Genetic predisposition, smoking, obesity, and friction from tight clothing are reported to act together and contribute to recurring flare-ups. Because the underlying inflammatory response — rather than bacterial infection itself — appears to drive the condition, its mechanism is considered different from typical acne. Individual differences are significant, so severity and frequency can vary widely from person to person even under similar conditions.
How is it different from regular acne?
Ordinary facial or back acne is often mainly driven by excess sebum and clogged pores, whereas hidradenitis suppurativa tends to appear specifically in areas where skin folds and rubs together, such as the underarms, groin, buttocks, or under the breasts. Rather than a simple pimple that rises and fades, the same area can develop repeated nodules or abscesses, and over time tunnel-like tracts can form beneath the skin. Paying attention to which areas recur and how the lesions behave can help in distinguishing HS from ordinary acne.
What happens if it's left untreated?
Early on, it may appear as isolated nodules or abscesses, but without management, the inflammation can become chronic, leading to scarring, underlying tunnels, and firm fibrous tissue. Once it reaches this stage, pain and disruption to daily life can increase, and recovery may take considerably longer. For this reason, if inflammation recurs more than once in the same area, it's advisable to see a dermatologist early rather than attempting to drain it yourself or leaving it untreated.
How can it be managed day to day?
Reducing friction and irritation is a core part of managing hidradenitis suppurativa. Choosing breathable, loose-fitting clothing over tight garments and keeping the affected area clean and dry can help. Smoking has been associated with worsening symptoms, so quitting may be worth considering, and weight management can also help reduce friction in affected areas. That said, lifestyle changes alone don't control symptoms for everyone, so depending on severity, it's important to discuss a treatment plan with a physician that may include medication or procedural approaches.
What kind of evaluation and treatment can I expect at a clinic?
Dermatologists assess the location, recurrence pattern, and severity of lesions visually and, when needed, take a history to gauge disease severity. In early stages, topical or oral antibiotics and anti-inflammatory treatment may be considered; for cases that recur frequently or become chronic, other medical or surgical approaches may be discussed. Because treatment direction differs by lesion location, severity, and recurrence frequency, an individualized approach through proper medical evaluation is important rather than self-diagnosis or self-treatment.
This information is provided for general reference only. Accurate diagnosis and treatment require consultation with a board-certified dermatologist.
Find more information on the skin health blog.