WeConnectPatients.com · Skin & Immune Health

This isn’t just a skin problem. And it’s not your fault. You deserve answers — and treatment that works.

Hidradenitis suppurativa is a chronic inflammatory condition, not an infection and not a hygiene issue. Understanding what’s really happening is the first step toward better care.

Of Adults

Estimated to affect roughly 1% of adults worldwide; some studies report higher rates depending on diagnostic criteria used (population-level estimate; individual outcomes vary)

Diagnostic Delay

Higher in Black Patients

HS disproportionately affects Black communities

Report Depression or Anxiety

Studies show a high rate of depression and anxiety among people living with HS, reflecting the condition’s significant emotional burden (population-level estimate; individual outcomes vary)

Your immune system is attacking your own hair follicles. That’s what’s happening.

Hidradenitis suppurativa isn’t caused by dirt, sweat, or anything you did wrong. It’s an inflammatory condition where your immune system targets hair follicles and the tissue around them. The painful bumps, abscesses, and tunnels under your skin are the visible result of a systemic problem.

What’s harder to talk about is everything else. The way you plan your wardrobe around a flare. The way HS changes how you move through the world. The isolation many people feel — until they find a provider and a community who actually get it.

You’re not alone. HS is estimated to affect roughly 1% of adults, though the real number may be higher because so many people go undiagnosed. It typically starts in the teens or twenties and is more prevalent in people with higher estrogen exposure, including many women and some transgender and nonbinary individuals.

The locations make it personal — armpits, groin, buttocks, skin folds including the chest and breast area. These aren’t areas you can casually explain to coworkers or friends. And the pain isn’t just surface-level: abscesses can be deep, draining, and debilitating.

Here’s the part that matters most: HS is not rare. It’s underdiagnosed. The average person waits 5 to 7 years to get a correct diagnosis. If you’ve been told it’s boils, ingrown hairs, or an STI — and it keeps coming back — ask your doctor about HS.

What drives HS

HS starts with your immune system. But genetics, environment, and biology all play a role.

Your immune system

In HS, hair follicles become blocked — likely due to a combination of genetic and hormonal factors. This blockage triggers an exaggerated immune response: your body sends immune cells to the area, but instead of resolving the problem, the inflammation escalates and spreads. Over time, this creates the painful abscesses and tunnels (sinus tracts) beneath the skin.

Genetics

About 30–40% of people with HS have a family member with the condition. If it runs in your family, your risk is higher. But plenty of people develop HS without any family history at all.

Smoking and weight

Smoking increases HS risk by roughly three times. Higher body weight is also associated with more severe condition. These are modifiable factors — not causes — and changing them can sometimes help, but HS is not a lifestyle condition.

Hormones

Many people notice flares that track with hormonal changes — including menstrual cycles, puberty, pregnancy, and menopause. Hormone therapy in transgender individuals can also influence HS activity. Hormonal shifts are a recognized driver of the condition; talk to your provider if you notice a pattern.

Not your hygiene

This is the most important misconception to correct. HS is not caused by poor hygiene, deodorant use, or shaving. Scrubbing harder won’t help — it can actually make things worse. This is an immune-mediated condition. Period.

How HS is diagnosed

Most dermatologists can recognize HS from its pattern. The bigger problem is getting to a doctor who knows HS.

Pattern recognition

HS has a distinctive presentation: recurring painful lumps (nodules) and pus-filled abscesses in specific body folds — armpits, groin, buttocks, and skin folds including the chest and breast area. If painful bumps keep coming back in the same areas, that pattern is a strong signal.

Ruling out mimics

HS is often mistaken for boils, folliculitis, ingrown hairs, or sexually transmitted infections — especially when it appears in the groin. A dermatologist familiar with HS will know the difference. If other diagnoses haven’t stuck, push for a closer look.

Staging the condition

Doctors use the Hurley staging system to describe HS severity: Stage I (isolated abscesses without scarring), Stage II (recurrent abscesses with sinus tracts — tunnels under the skin), Stage III (widespread, deeply connected tracts). Your stage directly shapes which treatments your doctor will recommend — including whether biologics or surgery may be appropriate.

Checking for comorbidities

HS doesn’t travel alone. Depression, anxiety, inflammatory bowel disease, and cardiovascular risk are all more common. A thorough evaluation looks beyond your skin.

Your experience matters

Where your lesions are, how much pain you’re in, how many workdays you’ve missed, whether you’ve been avoiding intimacy — all of this is diagnostic information. Don’t hold back.

Treatment is advancing

The goal is fewer flares, less pain, and a life where HS does not control your daily routine. Today’s options are better than what existed even five years ago.

Starting Point

Topical and Oral Antibiotics

For milder HS, topical clindamycin can help manage individual lesions. Oral antibiotics are used not to fight infection, but for their anti-inflammatory properties. They’re a common first step.

Targeted Therapy

Biologic Treatments

Biologics target specific immune pathways driving HS inflammation. Several biologic treatments have received FDA approval for moderate-to-severe HS, with others still under investigation in clinical trials. They can significantly reduce flares and improve quality of life. If antibiotics alone are not enough, biologics may be the next conversation to have with your dermatologist.

Surgical Options

Procedures and Surgery

For persistent or severe condition, procedures ranging from drainage to wide excision can remove damaged tissue and sinus tracts. Surgery isn’t a standalone answer — it works best alongside medical treatment.

Emerging Science

What’s Coming Next

Some pathway-targeting therapies have already completed regulatory review; researchers continue to test new agents targeting additional immune pathways — including IL-1, complement, and JAK signaling — alongside oral small-molecule options and combination strategies for people who have not responded to currently available treatments.

All treatments carry potential side effects. Talk to your provider about which risks and benefits apply to you.

“I spent eight years thinking I was dirty. When I finally got the right diagnosis, I cried — not because I was sick, but because it wasn’t my fault.”

Reflects common patient experiences

Biologics require a prescription from a dermatologist and often involve an insurance prior authorization process. If cost or coverage is a barrier, patient assistance programs from the manufacturer or nonprofit organizations may help. Some clinical trials also provide medications at no cost — ask your provider whether you qualify.

Answers to common questions

Living with HS raises real, painful questions — about your body, your relationships, and your future. Here are honest answers.

Does HS affect mental health?

Yes, it can. Studies suggest that 40–60% of people with HS report depression or anxiety (population-level estimate; individual outcomes vary). The shame many people feel about their symptoms is real, valid, and understandable. HS affects private, intimate areas — and the stigma that comes with that is something your care team should know about. This is a medical condition, not a personal failing. Talk to your provider about how you’re feeling.

Is HS caused by poor hygiene?

No. This is one of the most harmful misconceptions. HS is an inflammatory condition driven by your immune system, not by cleanliness. Washing more won’t help, and scrubbing can actually make things worse.

Why did it take so long to get diagnosed?

You’re not alone. The average person with HS waits 5–7 years for a correct diagnosis. It’s often mistaken for boils, ingrown hairs, or sexually transmitted infections. In communities where skin conditions in private areas carry additional stigma, people may delay seeking care — which compounds the diagnostic gap. If you’re still waiting for answers, ask your doctor specifically about HS.

Can HS be cured?

Not yet. But it can be managed — and for many people, managed well. Biologic therapies, including several that are now FDA-approved for moderate-to-severe HS, can significantly reduce flares and improve quality of life. The goal is control, not perfection.

Does HS affect Black patients differently?

HS is 2.6 to 3 times more common in Black populations, and diagnostic delays tend to be longer. If you feel dismissed or undertreated, you are not imagining it — disparities in HS care for Black patients are well-documented. Seeking a dermatologist with experience treating HS in skin of color can make a significant difference. Patient advocacy organizations like the HS Foundation can also help connect you to knowledgeable providers.

What triggers flares?

Stress, hormonal changes, friction from tight clothing, heat, and sweating are common triggers. Smoking and higher body weight are also associated with more severe condition. Identifying your personal triggers can help you prepare.

Should I see a specialist?

Yes, it can. A dermatologist experienced with HS will have access to the full range of treatments — including biologics — that most primary care providers may not prescribe. If you can’t access a specialist locally, telehealth dermatology options are expanding and can be a meaningful bridge — particularly for initial consultation and medication management. Check whether your insurance covers telehealth visits, and ask your primary care provider to coordinate with a remote specialist if needed.

Are there communities I can connect with?

The HS Foundation is a strong starting point. Online communities like MyHSTeam, Reddit HS forums, and social media groups provide peer support that can make a real difference. Connecting with people who understand your experience matters.

Research & Progress

The science is moving fast

As of early 2026, HS research has never been more active. Scientists have identified key immune pathways involved in HS — including TNF-alpha, IL-17, IL-23, and complement — and that knowledge is driving a wave of new treatments.

What’s in the pipeline: next-generation biologics targeting multiple inflammatory pathways simultaneously, small molecules offering oral alternatives to injections, and combination strategies designed for people who haven’t responded to existing options. The field has shifted from managing symptoms to targeting root causes.

Clinical trials are how these therapies get tested and eventually made available. Participating gives you access to specialized care teams and emerging treatments while helping shape the future for everyone with HS. No obligation. Your choice. Your standard care continues either way.

You’ve been dealing with this long enough. It’s time for answers that match what you’re going through.

HS research is accelerating. New therapies are being tested right now. Whether you’ve had it for months or decades, there may be options you haven’t explored yet.

Not sure where to start?

Walking into a dermatology appointment with the right questions changes everything. We put together a quick guide.

This content is for educational purposes only and isn’t a substitute for medical advice. Talk to your healthcare provider before making decisions about your care. Information about clinical trials is for general awareness, not an endorsement of any specific study.

Sources: Alikhan et al., Zouboulis et al., Sabat et al., AAD, Mayo Clinic, Cleveland Clinic, HS Foundation, NIH/NIAMS, JEADV, NEJM, Br J Dermatol, peer-reviewed literature (2009–2025), ClinicalTrials.gov.

WeConnect is a Takeda initiative connecting people to clinical trial opportunities. Visit WeConnectPatients.com.