Hidradenitis suppurativa (HS).
The pain underneath the skin
Most of us have had boils. The annoying experience is caused by that painful, swollen lump under the skin that eventually bursts and heals.
But imagine those “boils” coming back again and again, in the same areas, under the arms, groin, buttocks, or under the breasts. Painful, draining, and leaving deep scars. That’s Hidradenitis Suppurativa (HS).
Hidradenitis Suppurativa is a chronic inflammatory skin condition that occurs when hair follicles become blocked and inflamed, leading to recurrent, painful nodules and abscesses.
It’s not contagious. It’s not poor hygiene. It’s a long-term immune-related condition that causes the skin to literally turn against itself.
What Happens Beneath the Skin? [Pathophysiology]
Normally, sweat glands and hair follicles release oil and sweat to the skin’s surface.
In HS, these follicles get blocked, trapping bacteria and triggering the immune system.
Instead of calming down, the immune system overreacts, attacking healthy skin tissues and creating painful tunnels (sinus tracts) under the skin.
Over time, these areas heal with thick scars and may reopen, starting the cycle again.
Who’s at Risk?
More common in women, often appearing after puberty.
People with a family history of HS.
Smoking and obesity increase the risk or worsen flare-ups.
It can coexist with other conditions like diabetes, polycystic ovarian syndrome (PCOS), or inflammatory bowel disease (IBD).
The Stages of HS (Hurley Stages)
Stage I: Single or multiple isolated abscesses without tunnelling
Stage II: Recurrent abscesses with tunnelling and scarring
Stage III: Multiple interconnected tunnels and abscesses across entire area
Treatment & Care
There’s no absolute cure yet, but treatment helps manage symptoms and prevent flare-ups:
Lifestyle Management:
Wear loose-fitting clothing
Avoid shaving affected areas
Quit smoking
Maintain healthy weight
Medical Treatments:
Antibiotics and anti-inflammatory medications
Hormone therapies
Surgery for advanced cases.
The Real Impact: Beyond Physical Symptoms
Constant Pain: Ranging from dull aching to sharp, debilitating pain
Drainage and Odor: Wounds may leak fluid with a distinct Odor
Social Isolation: Shame and embarrassment lead to withdrawal
Limited Mobility: Scarring and pain restrict movement
Depression and Anxiety: The chronic nature takes a mental health toll
Final Note
Hidradenitis Suppurativa isn’t “just boils.”
It’s an underestimated chronic illness that needs empathy, early diagnosis, and long-term care. See a dermatologist.
Myths vs. Facts
MYTH: “HS is caused by poor hygiene”
FACT: HS is an inflammatory disease; cleanliness doesn’t cause or prevent it.
Knowledge Is Your Head Start
Understanding that HS is a medical condition not a personal failing, is the first step toward proper management and reclaiming your quality of life.
Stay aware,
[ADENIRAN OLUWASEMILORE]
P.S. If you’ve been hiding painful lumps and tunnels under your skin, know this: you’re not alone, it’s not your fault, and help is available. Share this with someone who might recognize these symptoms, it could be the validation they need to seek proper care.